| Abstract |
BACKGROUND: Children with malignant neoplasms are admitted to the Pediatric Intensive Care Unit (PICU) at least once during the course of their illness, either on an urgent or a scheduled basis. Life-threatening emergencies are due either to the disease itself or to treatment, and have an increased risk of mortality. The scheduled admissions of these children mainly concern post-operative monitoring and procedural sedation for medical operations necessary for the diagnosis or treatment.
OBJECTIVES: To identify the characteristics of children, adolescents and young people with malignant haematological or oncological diseases hospitalized at PAGNI hospital on an urgent or scheduled basis. Have been studied causes of admission, life-threatening manifestations of the disease, their main complications, their modern methods of treatment in the PICU, and the outcome prognostic factors between the groups of patients admitted to the PICU scheduled versus those who were urgently admitted, patients with recurrent admissions versus those admitted only once.
These data were compared to the new recommendations of international scientific organizations who are calling today for a review of strategies for the support and treatment of patients with hematologic-oncological diseases.
METHODS: We performed a retrospective observational study. Demographics, type of malignancy and stage of disease, previous hospitalizations, causes of admission to PICU, disease severity (PRSIM, PELOD), organ failure, treatment and mechanical support systems, possible infections, complications, psychological support and outcome to the PICU and after leaving the PICU were registered. Statistical analyses of data was used as the minimum level of statistical significance at α = 0.05 (Statistical Package for Social Sciences software (SPSS v. 24.0).
RESULTS: During the period 2009 – 2019, 103 children (boys N = 59, 57.3%) with hematological-oncological diseases (solid tumors N = 57, 55.3%) were admitted to PICU. In total, 151 admissions were made, of which 53 (35.1%) were emergency and 98 (64.9%) were scheduled. Overall mortality was 9.7%.
Urgent admissions to the PICU (N = 53, 35.1%) were required more frequently at the time of diagnosis of oncologic disease and less frequently in end-stage disease (p <0.001). Mechanical ventilation was required in 34 patients (22.5%) and renal replacement therapy in 5 patients (9.4%).
Nosocomial infections were reported in 35.8% of patients, of which 50% were the cause of admission.
The deceased children had: 11.5 times (95% DO 2.281 - 57.972) greater probability of urgent 1st admission to PICU (p = 0.003), greater probability of multiorgan failure (22.4% p <0.001), higher severity score PRISM (9.2% p = 0.012) or PELOD (9.5% p = 0.007) and higher frequency of use of inotropic support (70% vs 25.6%, p = 0.008) than surviving children. 9.4% of patients and 5.7% of the patient family received psychological support.
CONCLUSIONS: Overall, children with haematological-oncological diseases accounted for 7.12% of all PICU admissions. The main causes of urgent admission were acute respiratory failure and sepsis. Emergency admissions were primarily at diagnosis of the disease, requiring more supportive treatments, and had a lower survival rate than the median survival of PICU patients.
Scheduled admissions were more frequent, with fewer complications and a good outcome.
The deceased children were mostly urgent admitted, had a high incidence of disease severity, and were more likely to have multiorgan failure.
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