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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.

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Ballot DE, Davies VA, Cooper PA, Chirwa T, Argent A, Mer M,


Ballot DE, Davies VA, Cooper PA, Chirwa T, Argent A, Mer M, (click to view)

Ballot DE, Davies VA, Cooper PA, Chirwa T, Argent A, Mer M,

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BMJ open 2016 6 36(6) e010850 doi 10.1136/bmjopen-2015-010850

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.

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