Browsing by Subject "Paediatric Critical Care"

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    Disease profile and outcomes of neonates admitted to the paediatric intensive care unit at Red Cross War Memorial Children's hospital in Cape Town, South Africa
    (2023) Riemer, Linda; Argent, Andrew; Morrow Brenda
    Aim Neonatal healthcare is an area of focus in reducing global child mortality. Unwell neonates are usually managed in neonatal intensive care (NICU) but sometimes are admitted into paediatric units (PICU). This study aimed to describe the profile of neonates admitted to a South African PICU and to identify risk factors associated with mortality. Methods Patients with a post-menstrual age of <44 weeks, admitted to the PICU between November 2018 and October 2019, were included in a prospective observational study. Associations with mortality were evaluated with univariate and multivariable logistic regression analyses. Results 266 neonates (median birthweight 2210g (IQR 1397 – 2995g); chronological and post-menstrual age at admission 11 days (IQR 2 – 28) and 38 weeks (35 – 40) respectively were included, accounting for 18.4% of PICU admissions. The largest referral source were tertiary NICUs. Surgical admissions accounted for most patients. Congenital abnormalities occurred in 50.4% of the cohort. Neonatal mortality at ICU discharge was 10.9% compared to 3.8% in older patients (OR 3.08. CI 1.89 – 5.02; p = <0.001). Congenital abnormalities were the most common group of conditions associated with mortality, followed by NEC and infections. After logistic regression analysis the only variables independently associated with death/palliation were oscillatory ventilation, TPN and feeds received. Conclusion We describe a cohort of predominantly term and normal birth weight neonates but also includes expremature babies. Closer analysis of neonatal referral pathways can build on this study. All of this data can help policymakers and unit managers improve neonatal care.
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    A retrospective review of patients admitted to the Paediatric ICU at Red Cross War Memorial Children's Hospital during 2010 with the clinical diagnosis of measles or measles-related complications
    (2013) Coetzee, Saskia; Argent, Andrew; Morrow, Brenda M
    Includes abstract. Includes bibliographical references.
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    The impact of barbiturate therapy in children with severe traumatic brain injury (TBI)
    (2025) Appiah-Baiden, Andrew; Figaji, Anthony; Thango, Nqobile
    INTRODUCTION: There are no clear guidelines on how to use sedation and second-tier therapies for the treatment of raised intracranial pressure (ICP) in children with severe traumatic brain injury (TBI). Specifically, evidence is limited on the use of barbiturate therapy as a second-tier treatment option for uncontrolled ICP in children, in part because cohort sizes are small and there are little data on physiological effects. To address this, we evaluated the impact of thiopentone on physiological variables and outcome in children with severe TBI. METHODOLOGY: In this retrospective study we collected data on children (<13 years) with severe TBI who had undergone multimodality monitoring and received thiopentone to control ICP. We examined 1) the effect of thiopentone on physiological variables, 2) clinical characteristics of the cohort, and 3) outcome. RESULTS: Data were analyzed from 74 children: most were male (67.6%), and most were road traffic accident victims (71.6%). The average time from admission to initiation of thiopentone therapy was 48 hours; the average treatment duration was 4.8 days. On average, patients were extubated 5.3 days after cessation of thiopentone infusion; 20.3% received tracheostomies, and the average duration of ICU stay was 13 days. Decompressive craniectomy (DC) was used in 23% of patients. The mortality rate was 20.3%. Thiopentone use was associated with a reduction in median ICP and median mean arterial pressure (MAP), and no change in cerebral perfusion pressure (CPP). Brain tissue oxygenation was slightly higher on thiopentone, but not significantly. CONCLUSION: This is the largest study to analyze barbiturate therapy in children with TBI. Thiopentone was useful in decreasing ICP. Although there was an associated decrease in MAP, CPP remained similar. Despite this being a selected group of patients on second-tier therapies, the mortality rate was acceptable. Thiopentone use may avoid the surgical morbidity of DC, but at the expense of longer stays in ICU.
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    Transfusion practices among children undergoing cardiac surgery admitted to the Red Cross War Memorial Children's Hospital Paediatrics Intensive Care Unit
    (2018) Fitzwanga, Kaiser; Salie, S; Argent, A; Morrow, B
    Objective- We aimed to describe the use of blood products following cardiac surgery, as well as the outcomes and factors associated with post-operative blood product use Design- Prospective, single centre observational study Setting- Paediatric intensive care unit (PICU) in Cape Town, South Africa Patients- One hundred and twenty-six children <18 years old admitted to the PICU following cardiac surgery between July 2017 and January 2018 Interventions- None Measurements and Main Results- The data was prospectively obtained from blood bank charts, intraoperative and PICU observation charts. Demographic data, intraoperative details and post-operative blood product use were extracted from patient records and entered in a standardised case record form. Fifty three percent of children received blood products following cardiac surgery. The blood products transfused included cryoprecipitate (30.9%), packed red cells (22.2%), albumin (18.3%), fresh frozen plasma FFP (15.9%) and platelet concentrate (15.1%). Low haemoglobin level was commonest indication (86%) for red cell use. Bleeding was the commonest indication for FFP (70%) and cryoprecipitate (67%) use. Thrombocytopenia was the commonest indication (84%) for platelet use while hypotension episodes were predominant (95%) in those who received albumin. The standardized mortality ratio was 3.1 vs 0, respectively, among transfused versus non-transfused patients (p<0.0001). The median (IQR) duration of PICU stay was 5 (3-11) vs 2 (2-5) days, respectively in those transfused versus non-transfused (p<0.0001). The median (IQR) ventilation duration was 47(22-132) hours vs 20 (6-27) hours, respectively among the transfused versus non-transfused (p=<0.0001). The factors associated with blood-product use post cardiac surgery include previous cardiac surgery, younger age, lower weights, and prolonged coagulation parameters (p=<0.05). Conclusion- There is high usage of blood products among children post cardiac surgery. The children transfused had a longer ICU stay, ventilation duration, and higher standardized mortality ratio compared to the non-transfused.
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    Why, 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, Andrew
    Objectives: 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.