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Paediatrics
Research
Retrospective cross-sectional review of survival rates in critically ill children admitted to a combined paediatric/neonatal intensive care unit in Johannesburg, South Africa, 2013–2015
  1. Daynia E Ballot1,2,
  2. Victor A Davies1,
  3. Peter A Cooper1,
  4. Tobias Chirwa3,
  5. Andrew Argent4,
  6. Mervyn Mer2,5
  1. 1Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  2. 2Wits- UQ Critical Care Infection Collaboration, Johannesburg, South Africa
  3. 3Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  4. 4Faculty of Health Sciences, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
  5. 5Department of Internal Medicine, Division of Critical Care and Pulmonology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  1. Correspondence to Dr Daynia E Ballot; Daynia.ballot{at}wits.ac.za

Abstract

Objective Report on survival to discharge of children in a combined paediatric/neonatal intensive care unit (PNICU).

Design and setting Retrospective cross-sectional record review.

Participants All children (medical and surgical patients) admitted to PNICU between 1 January 2013 and 30 June 2015.

Outcome measures Primary outcome—survival to discharge. Secondary outcomes—disease profiles and predictors of mortality in different age categories.

Results There were 1454 admissions, 182 missing records, leaving 1272 admissions for review. Overall mortality rate was 25.7% (327/1272). Mortality rate was 41.4% (121/292) (95% CI 35.8% to 47.1%) for very low birthweight (VLBW) babies, 26.6% (120/451) (95% CI 22.5% to 30.5%) for bigger babies and 16.2% (86/529) (95% CI 13.1% to 19.3%) for paediatric patients. Risk factors for a reduced chance of survival to discharge in paediatric patients included postcardiac arrest (OR 0.21, 95% CI 0.09 to 0.49), inotropic support (OR 0.085, 95% CI 0.04 to 0.17), hypernatraemia (OR 0.16, 95% CI 0.04 to 0.6), bacterial sepsis (OR 0.32, 95% CI 0.16 to 0.65) and lower respiratory tract infection (OR 0.54, 95% CI 0.30 to 0.97). Major birth defects (OR 0.44, 95% CI 0.26 to 0.74), persistent pulmonary hypertension of the new born (OR 0.44, 95% CI 0.21 to 0.91), metabolic acidosis (OR 0.23, 95% CI 0.12 to 0.74), inotropic support (OR 0.23, 95% CI 0.12 to 0.45) and congenital heart defects (OR 0.29, 95% CI 0.13 to 0.62) predicted decreased survival in bigger babies. Birth weight (OR 0.997, 95% CI 0.995 to 0.999), birth outside the hospital (OR 0.21, 95% CI 0.05 to 0.84), HIV exposure (OR 0.54, 95% CI 0.30 to 0.99), resuscitation at birth (OR 0.49, 95% CI 0.25 to 0.94), metabolic acidosis (OR 0.25, 95% CI 0.10 to 0.60) and necrotising enterocolitis (OR 0.23, 95% CI 0.12 to 0.46) predicted poor survival in VLBW babies.

Conclusions Ongoing mortality review is essential to improve provision of paediatric critical care.

  • NEONATOLOGY
  • HEALTH SERVICES ADMINISTRATION & MANAGEMENT

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2015-010850

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