Paediatric and neonatal admissions to an intensive care unit at a regional hospital in the Western Cape

[摘要] ENGLISH ABSTRACT: Objective:The aim of the study was to determine the outcome of critically ill neonates and childrenadmitted to a general intensive care unit in a large regional hospital (Worcester) in theWestern Cape. A secondary aim of the study was to determine the risk factors for death inthese neonates and children.Methodology:This was a retrospective descriptive survey of all paediatric admissions (under 13 years ofage; July 2008 till June 2009) to an intensive care unit at a large regional hospital inWorcester, South Africa. Data collected included: demography, admission time, length ofstay, diagnoses, interventions and outcome. Outcome was defined as successful discharge,death or transfer to a central hospital.Results:There were 194 admissions including children and neonates. The files of 185 children andneonates were analysed, while 8 children were excluded due to incomplete data set and onepatient was a surgical admission. The male: female ratio was 1.3: 1 and the majority ofpatients (83%) admitted, were younger than 12 months of age at admission with a mean ageof 8.5 months (median age 3.7 months; range 0 to 151 months). The majority (70%) ofadmissions were successfully discharged, nearly a quarter (24%) transferred to centralhospitals in Cape Town and only 6% died (all younger than 5 years of age). Causes of deathincluded acute lower respiratory tract infections (33%), acute gastroenteritis (25%), birthasphyxia complicated by pulmonary hypertension (16%) and prematurity (16%). Patientsrequiring airway assistance, were more likely to experience an adverse event (p=0.0001) andinvasive ventilation was associated with an increased risk for a poor outcome (p=0.00).Conclusion:The majority of children requiring access to a paediatric ICU are younger than one year ofage. The common causes of death are acute lower respiratory tract infections, acutegastroenteritis, prematurity and neonatal asphyxia. A regional hospital in South Africa shouldoffer intensive care to children as the majority of their admissions can be successfully caredfor without transfer to tertiary hospitals. To our knowledge, this is the first study reportingadmissions and outcome of neonates and children cared for in a mixed intensive care unit in alarge regional hospital in South Africa. This study suggests that large regional hospitals inSouth Africa should have mixed intensive care units to improve child survival.

[发布机构] Stellenbosch University