1.Risk Factors for Mortality in Asian Children Admitted to the Paediatric Intensive Care Unit after Haematopoietic Stem Cell Transplantation.
Haripriya SANTHANAM ; Jacqueline Sm ONG ; Liang SHEN ; Poh Lin TAN ; Pei Lin KOH
Annals of the Academy of Medicine, Singapore 2017;46(2):44-49
INTRODUCTIONThis study aimed to investigate the risk factors associated with mortality in haematopoietic stem cell transplant (HSCT) patients admitted to our paediatric intensive care unit (PICU) over an 8-year period.
MATERIALS AND METHODSA retrospective chart review was conducted of all HSCT patients requiring PICU admission at our centre (a tertiary care university hospital in Singapore) from January 2002 to December 2010. Chief outcome measures were survival at the time of PICU discharge and survival at 6 months after initial PICU admission.
RESULTSNinety-eight patients underwent HSCT during this period; 18 patients (18%) required 24 PICU admissions post-HSCT. The overall survival to PICU discharge was 62.5%. Of those who survived discharge from the PICU, 33% died within 6 months of discharge. Non-survivors to PICU discharge had a higher incidence of sepsis (89% vs 33%,= 0.013) and organ failure as compared to survivors (cardiovascular failure 100% vs 20%,= 0.0003; respiratory failure 89% vs 20%,= 0.002; and renal failure 44% vs 7%,= 0.047). Mortality rates were higher in patients requiring mechanical ventilation (70% vs 14%,= 0.010) and inotropic support (70% vs 14%,= 0.010). Mortality in all patients with renal failure requiring haemodialysis (n = 4) was 100%. Presence of 3 or more organ failures was associated with 80% mortality (= 0.003).
CONCLUSIONSepsis, multiple organ failure and the need for mechanical ventilation, inotropes and especially haemodialysis were associated with increased risk of mortality in our cohort of HSCT patients.
Adolescent ; Cardiotonic Agents ; therapeutic use ; Child ; Child, Preschool ; Female ; Heart Failure ; drug therapy ; epidemiology ; mortality ; Hematopoietic Stem Cell Transplantation ; Hospital Mortality ; Humans ; Infant ; Intensive Care Units, Pediatric ; Male ; Multiple Organ Failure ; epidemiology ; mortality ; Prognosis ; Renal Dialysis ; statistics & numerical data ; Renal Insufficiency ; epidemiology ; mortality ; therapy ; Respiration, Artificial ; statistics & numerical data ; Respiratory Insufficiency ; epidemiology ; mortality ; therapy ; Retrospective Studies ; Risk Factors ; Sepsis ; epidemiology ; mortality ; Singapore ; epidemiology
2.Non-Invasive Ventilation in Children with Paediatric Acute Respiratory Distress Syndrome.
Jian Sheng ZENG ; Su Yun QIAN ; Judith Jm WONG ; Jacqueline Sm ONG ; Chin Seng GAN ; Nattachai ANANTASIT ; Yek Kee CHOR ; Rujipat SAMRANSAMRUAJKIT ; Phan Huu PHUC ; Suwannee PHUMEETHAM ; Xu FENG ; Rehena SULTANA ; Tsee Foong LOH ; Jan Hau LEE
Annals of the Academy of Medicine, Singapore 2019;48(7):224-232
INTRODUCTION:
Evidence supporting non-invasive ventilation (NIV) in paediatric acute respiratory distress syndrome (PARDS) remains sparse. We aimed to describe characteristics of patients with PARDS supported with NIV and risk factors for NIV failure.
MATERIALS AND METHODS:
This is a multicentre retrospective study. Only patients supported on NIV with PARDS were included. Data on epidemiology and clinical outcomes were collected. Primary outcome was NIV failure which was defined as escalation to invasive mechanical ventilation within the first 7 days of PARDS. Patients in the NIV success and failure groups were compared.
RESULTS:
There were 303 patients with PARDS; 53/303 (17.5%) patients were supported with NIV. The median age was 50.7 (interquartile range: 15.7-111.9) months. The Paediatric Logistic Organ Dysfunction score and oxygen saturation/fraction of inspired oxygen (SF) ratio were 2.0 (1.0-10.0) and 155.0 (119.4- 187.3), respectively. Indications for NIV use were increased work of breathing (26/53 [49.1%]) and hypoxia (22/53 [41.5%]). Overall NIV failure rate was 77.4% (41/53). All patients with sepsis who developed PARDS experienced NIV failure. NIV failure was associated with an increased median paediatric intensive care unit stay (15.0 [9.5-26.5] vs 4.5 [3.0-6.8] days; <0.001) and hospital length of stay (26.0 [17.0-39.0] days vs 10.5 [5.5-22.3] days; = 0.004). Overall mortality rate was 32.1% (17/53).
CONCLUSION
The use of NIV in children with PARDS was associated with high failure rate. As such, future studies should examine the optimal selection criteria for NIV use in these children.
3.Interim Singapore guidelines for basic and advanced life support for paediatric patients with suspected or confirmed COVID-19.
Gene Yong-Kwang ONG ; Beatrice Hui ZHI NG ; Yee Hui MOK ; Jacqueline Sm ONG ; Nicola NGIAM ; Josephine TAN ; Swee Han LIM ; Kee Chong NG
Singapore medical journal 2022;63(8):419-425
The COVID-19 pandemic has resulted in significant challenges for the resuscitation of paediatric patients, especially for infants and children who are suspected or confirmed to be infected. Thus, the paediatric subcommittee of the Singapore Resuscitation and First Aid Council developed interim modifications to the current Singapore paediatric guidelines using extrapolated data from the available literature, local multidisciplinary expert consensus and institutional best practices. It is hoped that this it will provide a framework during the pandemic for improved outcomes in paediatric cardiac arrest patients in the local context, while taking into consideration the safety of all community first responders, medical frontline providers and healthcare workers.
Infant
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Child
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Humans
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Cardiopulmonary Resuscitation/methods*
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COVID-19/therapy*
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Pandemics
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Singapore
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Heart Arrest