Browsing by Author "Rossouw, Beyra"
Now showing 1 - 3 of 3
Results Per Page
Sort Options
- ItemOpen AccessA description of premature and ex-premature infants admitted to a Paediatric Intensive Care Unit in the first six months of life(2018) Mathew, Grace; Rossouw, BeyraBackground: Prematurity is a major risk factor for morbidity and mortality in children. Rehospitalisation with paediatric intensive care unit (PICU) admission constitutes significant morbidity. There is a paucity of literature regarding rehospitalisations of premature infants in South Africa. Objective: To describe the outcomes, clinical course and characteristics of premature infants admitted to a South African PICU, and to identify any predictors of mortality. Methods: This prospective observational study analysed unplanned PICU admissions of premature and ex-premature infants in the first six months of life, over a six-month period. The primary and secondary outcomes were mortality and length of PICU stay, respectively. Data were analysed using standard descriptive and inferential statistics. Results: 29 infants (65% male; median (IQR) birth weight (BW) and gestational age (GA) 1715 (1130 - 2340) g and 32 (29 - 34) weeks respectively) in 33 admissions were included. Five (17.2%) infants died in PICU. Apnoea (39.4%), respiratory failure (24.2%) and shock (24.2%) were the commonest reasons for PICU admission, secondary to pneumonia (33.3%), sepsis (27.3%) and meningitis (12.1%). 72.4% of infants were mechanically ventilated and 48.3% received blood transfusions. Higher revised Paediatric Risk of Mortality (PIM2) score (p = 0.03), inotrope use (p < 0.0001), longer duration of mechanical ventilation (p = 0.03), and cardiac arrest in PICU (p < 0.0001) were associated with mortality on univariate analysis with no independent predictors of mortality. Conclusion: Infections leading to apnoea, respiratory failure and shock are common indications for PICU readmission in premature infants. Mechanical ventilation and blood transfusion were frequently required.
- ItemOpen AccessNon-invasive ventilation during paediatric retrieval: a systematised review(2018) Cheema, Baljit Kaur; Welzel, Tyson; Rossouw, BeyraBackground: In hospital critical-care and emergency settings, non-Invasive ventilation (NIV) is increasingly used in neonatal and paediatric patients as an alternative to invasive positive pressure ventilation (IPPV). Critically ill children and babies may need transfer to higher levels of care, but the emergency transport setting is lagging behind the hospital sector in terms of availability of NIV. Aim and objectives: The goal of this study was to assess the evidence on the safety and effectiveness of NIV in children during transportation. Safety outcome measures were intubation or escalation of ventilation mode (during and soon after transport) and adverse event (AE) occurrence during transport. Effectiveness outcome measures related to improvement in clinical parameters during transfer. Methods: A systematised review of the literature was conducted, based on searches of MEDLINE via PubMed, EMBASE (via Scopus), Cochrane Central Register of Controlled Trials (CENTRAL), African Index Medicus, Web of Science Citation Index and the World Health Organisation Trials Registry (ICTRP). Two reviewers independently reviewed all identified studies for eligibility, with an initial screening round followed by a full-text review of potentially relevant articles. The quality of studies meeting inclusion criteria was evaluated using an adapted quality assessment tool developed for this study. Results: A total of 1287 records were identified; of these, 12 studies met inclusion criteria. Following quality assessment, eight studies were included and four studies were excluded. There were no randomised controlled trials, quasi-randomised controlled trials or non-randomised studies of intervention, to answer the research question. The included studies were all observational in design: seven studies (n= 708) evaluated in-transport use of continuous positive airway pressure (CPAP) and one study (n=150) reported on use of high-flow nasal cannula (HFNC) in children during transport. During transport on NIV, 3/858 (0.4%) patients required either intubation (1/708; 0.1%; CPAP studies) or escalation of mode of ventilation (2/150; 1%; HFNC study). In the 24 hours following transfer, 63/650 (13%) of children transferred on NIV, were intubated. The odds of intubation within 24 hours were significantly higher for CPAP transfer 60/500 (12%) compared with HFNC 3/150(2%): OR (95% CI) 6.68 (2.40 - 18.63), p=0.00003. Adverse events, where reported, were found to occur in 2-4% of NIV transports, with use of BVM in 8/334 (2%), desaturation episodes in 9/290 (3%), apnoea in 11/290(4%) and administration of CPR in 0/290 (0%) cases being described. There was insufficient reporting of change in vital signs or clinical condition during transport for meaningful analysis. Conclusion: This study is the first systematised review indicating that NIV use in children during transport is likely to be safe. From the low-reliability evidence available, it was calculated that NIV use in children during transport would result in a 0.4% rate of intubation or escalation during transport and an in-transport adverse event rate of 2-4%. There was insufficient evidence to comment on clinical effectiveness of NIV during transfer. Following NIV transfer, 13% of patients were intubated within 24 hours, with significantly higher odds of intubation in children transported on CPAP compared with HFNC. Recommendations: Further research is needed in order to make firm recommendations regarding the safety and effectiveness of NIV during transport of children. A recommended minimum data set, for the standardised reporting of observational studies of paediatric NIV use during transport, is suggested. It is recommended that transport databases and registries are expanded to include NIV details as well as information regarding the presence or absence of pre-specified adverse events during transport.
- ItemOpen AccessWhy, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa?(2020) Wege, Martha Helena; Morrow, Brenda; Rossouw, Beyra; Argent, AndrewObjectives: To describe the characteristics of children who died and their modes of dying in a South African Paediatric Intensive Care Unit (PICU). Design: Retrospective review of data extracted from the Child Healthcare Problem Identification Programme (Child PIP)and the PICU summary system (admission and death records) on children of any age who died in the PICU between 01 January 2013 and 31 December 2017. Setting: Single-centre tertiary institution. Patients: All children who died during PICU admission were included. Measurements and Main Results: Four-hundred and fifty-one (54% male; median (IQR) age 7 (1-30) months) patients died in PICU on median (IQR) 3 (1-7) days after PICU admission; 103 (22.8%) had a cardiac arrest prior to PICU admission. Mode of death in 23.7% (n=107) was withdrawal of life sustaining therapies; 36.1% (n=163) died after limitation of life sustaining therapies; 22.0% (n=99) died after failed resuscitation and 17.3% (n=78) were diagnosed brain dead. Ultimately, 270 (60%) children died after the decision to limit or withdraw life sustaining therapies. There was no difference in the number of deaths during office and after-hours periods (45.5% vs. 54%; p = 0.07). Severe sepsis (21.9%) was the most common condition associated with death, followed by cardiac disease (18.6%).Ninety-four (20.8%) patients were readmitted to the PICU within the same year; 278 (61.6%) had complex chronic disorders. During the last phase of life, 75.0% (n=342) were on inotropes, 95.9% (n=428) were ventilated, 12.0% (n=45) received inhaled nitric oxide and 10.8% (n=46) renal replacement therapy. Only 1.5% (n=7) of children became organ donors and postmortems were done in 47.2% (n=213) of the patients. Conclusions: Most PICU deaths occurred after a decision to limit or withdraw life-sustaining therapy. Severe sepsis was the most common condition associated with death. Referral for organ donation was extremely rare.