Department of Pediatric Intensive Care, Emma Children's Hospital of the Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Mercy James Center for Pediatric Surgery and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi.
Pediatr Crit Care Med. 2023 Jun 1;24(6):473-483. doi: 10.1097/PCC.0000000000003210. Epub 2023 Mar 1.
Dedicated PICUs are slowly starting to emerge in sub-Saharan Africa. Establishing these units can be challenging as there is little data from this region to inform which populations and approaches should be prioritized. This study describes the characteristics and outcome of patients admitted to the first PICU in Malawi, with the aim to identify factors associated with increased mortality.
Review of a prospectively constructed PICU database. Univariate analysis was used to assess associations between demographic, clinical and laboratory factors, and mortality. Univariate associations ( p < 0.1) for mortality were entered in two multivariable models.
A recently opened PICU in a public tertiary government hospital in Blantyre, Malawi.
Children admitted to PICU between August 1, 2017, and July 31, 2019.
None.
Of 531 included PICU admissions, 149 children died (28.1%). Mortality was higher in neonates (88/167; 52.7%) than older children (61/364; 16.8%; p ≤ 0.001). On univariate analysis, gastroschisis, trachea-esophageal fistula, and sepsis had higher PICU mortality, while Wilms tumor, other neoplasms, vocal cord papilloma, and foreign body aspiration had higher survival rates compared with other conditions. On multivariable analysis, neonatal age (adjusted odds ratio [AOR], 4.0; 95% CI, 2.0-8.3), decreased mental state (AOR, 5.8; 95 CI, 2.4-13.8), post-cardiac arrest (AOR, 2.0; 95% CI, 1.0-8.0), severe hypotension (AOR, 6.3; 95% CI, 2.0-19.1), lactate greater than 5 mmol/L (AOR, 4.2; 95% CI, 1.5-11.2), pH less than 7.2 (AOR, 3.1; 95% CI, 1.2-8.0), and platelets less than 150 × 10 9 /L (AOR, 2.4; 95% CI, 1.1-5.2) were associated with increased mortality.
In the first PICU in Malawi, mortality was relatively high, especially in neonates. Surgical neonates and septic patients were identified as highly vulnerable, which stresses the importance of improvement of PICU care bundles for these groups. Several clinical and laboratory variables were associated with mortality in older children. In neonates, severe hypotension was the only clinical variable associated with increased mortality besides blood gas parameters. This stresses the importance of basic laboratory tests, especially in neonates. These data contribute to evidence-based approaches establishing and improving future PICUs in sub-Saharan Africa.
专门的儿科重症监护病房（PICU）在撒哈拉以南非洲地区逐渐兴起。由于该地区几乎没有数据可以用来确定应优先考虑哪些人群和方法，因此建立这些单位具有一定挑战性。本研究描述了马拉维第一家 PICU 收治的患者的特征和结局，旨在确定与死亡率增加相关的因素。
对前瞻性构建的 PICU 数据库进行回顾性分析。采用单因素分析评估人口统计学、临床和实验室因素与死亡率之间的关联。将死亡率的单因素关联（p < 0.1）纳入两个多变量模型。
马拉维布兰太尔一家公立三级政府医院内新开设的 PICU。
2017 年 8 月 1 日至 2019 年 7 月 31 日期间收治于 PICU 的患儿。
无。
纳入的 531 例 PICU 住院患儿中，有 149 例死亡（28.1%）。新生儿（88/167；52.7%）的死亡率高于大龄儿童（61/364；16.8%；p ≤ 0.001）。单因素分析显示，腹裂、气管食管瘘和脓毒症的 PICU 死亡率较高，而威尔姆斯瘤、其他肿瘤、声带乳头状瘤和异物吸入的存活率较高。多因素分析显示，新生儿年龄（调整后比值比[OR]，4.0；95%置信区间[CI]，2.0-8.3）、精神状态下降（OR，5.8；95%CI，2.4-13.8）、心脏骤停后（OR，2.0；95%CI，1.0-8.0）、严重低血压（OR，6.3；95%CI，2.0-19.1）、乳酸大于 5 mmol/L（OR，4.2；95%CI，1.5-11.2）、pH 值小于 7.2（OR，3.1；95%CI，1.2-8.0）和血小板小于 150×109/L（OR，2.4；95%CI，1.1-5.2）与死亡率增加相关。
在马拉维的第一家 PICU 中，死亡率相对较高，尤其是在新生儿中。手术新生儿和脓毒症患者被认为是高危人群，这强调了为这些人群改进 PICU 护理方案的重要性。在大龄儿童中，一些临床和实验室变量与死亡率相关。在新生儿中，严重低血压是除血气参数外唯一与死亡率增加相关的临床变量。这强调了基本实验室检查的重要性，尤其是在新生儿中。这些数据有助于建立和改进撒哈拉以南非洲地区未来 PICU 的循证方法。
