Risk Factors for Nosocomial Infections in a Critically Ill Pediatric Population: A 25-Month Prospective Cohort Study

2000 ◽  
Vol 21 (5) ◽  
pp. 340-342 ◽  
Author(s):  
Alfredo E. Gilio ◽  
Adalberto Stape ◽  
Crésio R. Pereira ◽  
Maria Fátima S. Cardoso ◽  
Claudia V. Silva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Critically Ill ◽  
Nosocomial Infections ◽  
Pediatric Population ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Utilization Ratio

We studied risk factors for nosocomial infections among 500 critically ill children who were admitted to a pediatric intensive care unit from August 1994 through August 1996 and who were prospectively followed until death, transfer, or discharge. Age, gender, postoperative state, length of stay, device-utilization ratio, pediatric risk of mortality score, and total parenteral nutrition were the risk factors studied. Through multivariate analysis, we identified three independent risk factors for nosocomial infection: device-utilization ratio (odds ratio [OR], 1.6; 95% confidence interval [CI95], 1.10-2.34), total parenteral nutrition (OR, 2.5; CI95, 1.05-5.81) and length of stay (OR, 1.7; CI95, 1.31-2.21).

scholarly journals Early Supplemental Parenteral Nutrition in Critically Ill Children: An Update

2019 ◽  
Vol 8 (6) ◽  
pp. 830 ◽  
Author(s):  
An Jacobs ◽  
Ines Verlinden ◽  
Ilse Vanhorebeek ◽  
Greet Van den Berghe
Keyword(s):  
Parenteral Nutrition ◽  
Critically Ill ◽  
Controlled Trial ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Optimal Dose ◽  
Adverse Outcomes ◽  
Critically Ill Children ◽  
Clinical Practices ◽  
Supplemental Parenteral Nutrition

In critically ill children admitted to pediatric intensive care units (PICUs), enteral nutrition (EN) is often delayed due to gastrointestinal dysfunction or interrupted. Since a macronutrient deficit in these patients has been associated with adverse outcomes in observational studies, supplemental parenteral nutrition (PN) in PICUs has long been widely advised to meeting nutritional requirements. However, uncertainty of timing of initiation, optimal dose and composition of PN has led to a wide variation in previous guidelines and current clinical practices. The PEPaNIC (Early versus Late Parenteral Nutrition in the Pediatric ICU) randomized controlled trial recently showed that withholding PN in the first week in PICUs reduced incidence of new infections and accelerated recovery as compared with providing supplemental PN early (within 24 hours after PICU admission), irrespective of diagnosis, severity of illness, risk of malnutrition or age. The early withholding of amino acids in particular, which are powerful suppressors of intracellular quality control by autophagy, statistically explained this outcome benefit. Importantly, two years after PICU admission, not providing supplemental PN early in PICUs did not negatively affect mortality, growth or health status, and significantly improved neurocognitive development. These findings have an important impact on the recently issued guidelines for PN administration to critically ill children. In this review, we summarize the most recent literature that provides evidence on the implications for clinical practice with regard to the use of early supplemental PN in critically ill children.

Risk factors and outcomes for hyperbilirubinaemia after heart surgery in children

2020 ◽  
Vol 30 (6) ◽  
pp. 761-768
Author(s):  
Daniel M. Pasternack ◽  
Manal AlQahtani ◽  
Rafael Zonana Amkie ◽  
Lisa J. Sosa ◽  
Marcelle Reyes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Length Of Stay ◽  
Parenteral Nutrition ◽  
Extracorporeal Membrane Oxygenation ◽  
Total Parenteral Nutrition ◽  
Morbidity And Mortality ◽  
Prolonged Length ◽  
Conjugated Hyperbilirubinaemia ◽  
Neonates And Infants

AbstractIntroduction:Liver dysfunction, associated with morbidity and mortality, is common in patients with CHD. We investigate risk factors for and outcomes of hyperbilirubinaemia in neonates and infants after cardiac surgery.Materials and methods:In a retrospective analysis of neonates and infants undergoing cardiac surgery at our institution between January 2013 and December 2017, we identified those with post-operative conjugated hyperbilirubinaemia. We tested various demographic and surgical risk factors, and use of post-operative interventions, for an association with conjugated hyperbilirubinaemia. We also tested hyperbilirubinaemia for association with post-operative mortality and prolonged length of stay.Results:We identified 242 post-operative admissions, of which 45 (19%) had conjugated hyperbilirubinaemia. The average conjugated bilirubin level in this group was 2.0 mg/dl versus 0.3 mg/dl for peers without hyperbilirubinaemia. The post-operative use of both extracorporeal membrane oxygenation (OR 4.97, 95% CI 1.89–13.5, p = 0.001) and total parenteral nutrition (OR 2.98, 95% CI 1.34–7.17, p = 0.010) was associated with conjugated hyperbilirubinaemia. No demographic variable analysed was found to be a risk factor. Hyperbilirubinaemia was associated with higher odds of mortality (OR 3.74, 95% CI 2.69–13.8, p = 0.005) and prolonged length of stay (OR 2.87, 95% CI 2.02–7.97, p = 0.005), which were independent of other risk factors.Discussion:We identified the post-operative use of total parenteral nutrition and extracorporeal membrane oxygenation as risk factors for hyperbilirubinaemia. These patients were more likely to experience morbidity and mortality than control peers. As such, bilirubin may be marker for elevated risk of poor post-operative outcomes and should be more frequently measured after cardiac surgery.

Bowel Frequency in Critically III Children

2004 ◽  
Vol 9 (3) ◽  
pp. 187-191
Author(s):  
Karen D. Dominguez ◽  
Matthew E. Borrego
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Prospective Observational Study ◽  
Pediatric Intensive Care ◽  
Male Gender ◽  
Stool Frequency ◽  
Critically Ill Children ◽  
Healthy Children ◽  
Stepwise Linear Regression ◽  
Bowel Movements

BACKGROUND Bowel frequency in healthy children has been determined, but it is not well documented in critically ill children. The objectives of this prospective observational study were to determine if critical illness alters stool frequency in children and to identify risk factors that may increase or decrease stool frequency. METHODS Stool frequency was assessed in children admitted to the pediatric intensive care unit (PICU) over a five month period. The median daily number of bowel movements during admission to the PICU was compared to the patient's estimated number of bowel movements prior to illness. Stepwise linear regression was performed to determine which factors best predicted stool frequency in critically ill children. RESULTS Daily stool frequency was significantly reduced (P < 0.001) during PICU stay (median = 0.5; interquartile: 0, 0.8) compared to preadmission stool frequency estimates (median = 2; interquartile: 1, 2.5). Covariates associated with an increase in stool frequency included male gender and length of stay in the PICU. Conversely, the administration of opioids decreased stool frequency. CONCLUSIONS Bowel frequency was reduced by 75% in children admitted to the PICU. The use of opioids was associated with decreased bowel frequency. Male gender and increased PICU stay was associated with increased bowel frequency.

scholarly journals A prospective observational study on critically ill children with diaphragmatic dysfunction: clinical outcomes and risk factors

2020 ◽  
Author(s):  
Yang Xue ◽  
Chun-Feng Yang ◽  
Yu Ao ◽  
Ji Qi ◽  
Fei-Yong Jia
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Treatment Time ◽  
Negative Impact ◽  
Extubation Failure ◽  
Critically Ill Children ◽  
Diaphragmatic Dysfunction ◽  
Factors Associated

Abstract Background Diaphragmatic dysfunction (DD) has a great negative impact on clinical outcomes, and it is a well-recognized complication in adult patients with critical illness. However, DD is largely unexplored in the critically ill pediatric population. The aim of this study was to identify risk factors associated with DD, and to investigate the effects of DD on clinical outcomes among critically ill children. Methods Diaphragmatic function was assessed by diaphragm ultrasound. According to the result of diaphragmatic ultrasound, all enrolled subjects were categorized into the DD group (n=24) and the non-DD group (n=46). Collection of sample characteristics in both groups include age, sex, height, weight, primary diagnosis, complications, laboratory findings, medications, ventilatory time and clinical outcomes. Results The incidence of DD in this PICU was 34.3%. The level of CRP at discharge (P=0.003) in the DD group was higher than the non-DD group, and duration of elevated C-reactive protein (CRP) (P<0.001), sedative days (P=0.008) and ventilatory treatment time (P<0.001) in the DD group was significantly longer than the non-DD group. Ventilatory treatment time and duration of elevated CRP were independently risk factors associated with DD. Patients in the DD group had longer PICU length of stay, higher rate of weaning or extubation failure and higher mortality. Conclusion DD is associated with poorer clinical outcomes in critically ill childern, which include a longer PICU length of stay, higher rate of weaning or extubation failure and a higher mortality. The ventilatory treatment time and duration of elevated CRP are main risk factors of DD in critically ill children.

scholarly journals Hypophosphatemia in critically ill children

2004 ◽  
Vol 59 (5) ◽  
pp. 306-311 ◽  
Author(s):  
Fernanda Souza de Menezes ◽  
Heitor Pons Leite ◽  
Juliana Fernandez ◽  
Silvana Gomes Benzecry ◽  
Werther Brunow de Carvalho
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Critically Ill ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Pediatric Intensive Care ◽  
Cochrane Library ◽  
Critically Ill Children ◽  
Renal Diseases ◽  
Bibliographic Databases

The purpose of this paper is to review clinical studies on hypophosphatemia in pediatric intensive care unit patients with a view to verifying prevalence and risk factors associated with this disorder. We searched the computerized bibliographic databases Medline, Embase, Cochrane Library, and LILACS to identify eligible studies. Search terms included critically ill, pediatric intensive care, trauma, sepsis, infectious diseases, malnutrition, inflammatory response, surgery, starvation, respiratory failure, diuretic, steroid, antiacid therapy, mechanical ventilation. The search period covered those clinical trials published from January 1990 to January 2004. Studies concerning endocrinological disorders, genetic syndromes, rickets, renal diseases, anorexia nervosa, alcohol abuse, and prematurity were not included in this review. Out of 27 studies retrieved, only 8 involved pediatric patients, and most of these were case reports. One clinical trial and one retrospective study were identified. The prevalence of hypophosphatemia exceeded 50%. The commonly associated factors in most patients with hypophosphatemia were refeeding syndrome, malnutrition, sepsis, trauma, and diuretic and steroid therapy. Given the high prevalence, clinical manifestations, and multiple risk factors, the early identification of this disorder in critically ill children is crucial for adequate replacement therapy and also to avoid complications.

scholarly journals Clinical outcomes and risk factors in critically ill children with diaphragmatic dysfunction: an prospective observational study

2020 ◽  
Author(s):  
Yang Xue ◽  
Chun-Feng Yang ◽  
Yu Ao ◽  
Ji Qi ◽  
Fei-Yong Jia
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Treatment Time ◽  
Negative Impact ◽  
Extubation Failure ◽  
Critically Ill Children ◽  
Diaphragmatic Dysfunction ◽  
Factors Associated

Abstract Background: Diaphragmatic dysfunction (DD) has a great negative impact on clinical outcomes, and it is a well-recognized complication in adult patients with critical illness. However, DD is largely unexplored in the critically ill pediatric population. The aim of this study was to identify risk factors associated with DD, and to investigate the effects of DD on clinical outcomes among critically ill children.Methods: Diaphragmatic function was assessed by diaphragm ultrasound. According to the result of diaphragmatic ultrasound, all enrolled subjects were categorized into the DD group ( n=24 ) and the non-DD group ( n=46 ). Collection of sample characteristics in both groups include age, sex, height, weight, primary diagnosis, complications, laboratory findings, medications, ventilatory time and clinical outcomes.Results: The incidence of DD in this PICU was 34.3%. The level of CRP at discharge (P=0.003) in the DD group was higher than the non-DD group, and duration of elevated C-reactive protein (CRP) (P<0.001), sedative days (P=0.008) and ventilatory treatment time (P<0.001) in the DD group was significantly longer than the non-DD group. Ventilatory treatment time and duration of elevated CRP were independently risk factors associated with DD. Patients in the DD group had longer PICU length of stay, higher rate of weaning or extubation failure and higher mortality. Conclusion: DD is associated with poorer clinical outcomes in critically ill childern, which include a longer PICU length of stay, higher rate of weaning or extubation failure and a higher mortality. The ventilatory treatment time and duration of elevated CRP are main risk factors of DD in critically ill children.

scholarly journals The effect of thiaminepyrophosphate levels on mortality and morbidity ın patients with stress hyperglycemia

2020 ◽  
pp. 25-29
Author(s):  
Zehra VATANSEVER ◽  
Serkan ÖZSOYLU ◽  
Mustafa KENDİRCİ ◽  
Basak AKYILDIZ
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Blood Glucose ◽  
Length Of Stay ◽  
Critically Ill ◽  
Pediatric Intensive Care ◽  
Thiamine Pyrophosphate ◽  
Critically Ill Children ◽  
Stress Hyperglycemia ◽  
C Peptide

Background: The aim of this study is to evaluate the thiamine pyrophosphate deficiency and effects on critical illness hyperglycemia in pediatric intensive care. Materials-Methods: 126 critically ill children included to the study which applied to Erciyes University Faculty of Medicine, Department of Pediatric Intensive Care Unit (ICU). Age, sex, diagnosis and presence of malnutrition in admission to ICU; Pediatric risk of Mortality III (PRISM III) and Pediatric Logistic Organ Dysfunction (PELOD) scores; mechanical ventilation and length of stay in ICU was evaluated. Blood glucose, thiamine pyrophosphate, cortisol, insulin, C-peptide, HbA1c level, serum lactate in blood gas were analyzed at the time of application. Results: The patients grouped based on blood glucose levels, the group whose glucose level in blood is more than 150 mg/dl (n:75); PRISM and PELOD scores were high, mechanical ventilation and length of stay in intensive care were longer, thiamine pyrophosphate levels were lower (p<0.001, p=0.005, p=0.008, p<0.001, p<0.01). In case of blood glucose >150 mg/dl (n:51) and thiamine pyrophosphate <180 nmol/l is together; mortality increases 3.342-fold and the case was statistically significant (p=0.014). The group whose glucose level in blood is more than 150 mg/dl respectively, insulin, c-peptide and cortisol levels found high and the findings were statistically significant (p<0.001, p=0.005, p=0.040). Conclusion: Stress hyperglycemia is a common situation seen in critically ill patients as a cause of worse clinical outcomes. Identification of stress hyperglycemia due to thiamine deficiency is difficult but it will shed light on the treatment of critically ill children.

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