RESUMO
BACKGROUND AND OBJECTIVES: Although child mortality is declining in Saudi Arabia, new trends and causes are emerging. The objective of the study is to determine the causes of child death in a tertiary care hospital in Saudi Arabia and to identify its preventable causes and associated risk factors. METHODS: A modified UNICEF Multiple Indicator Cluster Survey (MICS) was used to analyze all deaths among children under the age of 18 which occurred at the King Abdullah Specialized Children's Hospital (KASCH) between 2010 and 2016. RESULTS: After reviewing all the death charts of 1138 children, the team determined that 15% (172) of all deaths could have been prevented and the preventability increased with age. Only 2% of the neonates died of preventable causes, while 53% of the children of 6 years of age or older died of preventable causes. The highest percentage of preventable deaths occurred in children aged 13-18 years (39.3%), followed by the age group of 6-12 years (32.4%) and the age group of 29 days to 5 years (13.9%). All 966 (85%) deaths from biological causes were considered to be unpreventable. Among the preventable causes, 142 (82.5%) had injuries and 30 (17.4%) were sudden unexpected infant death (SUID) with no documented autopsy or death scene investigation, and thus it was considered preventable by the researchers. The 5 major causes of deaths secondary to injuries were motor vehicle accidents (MVA) accounting for 86 deaths (60.6%), followed by drowning accounting for 19 deaths (13.4%), child maltreatment accounting for 13 deaths (9.2%), fire and weapon accounting for 12 deaths (8.5%), and finally home accident (fall, poisoning, suffocation) accounting for 12 deaths (8.5%). CONCLUSION: The State Child Death Reviews Board should thoroughly investigate deaths due to SUID and injuries by identifying the factors that contribute to the implementation of preventive strategies.
RESUMO
OBJECTIVE: To evaluate the safety and efficacy of moderate sedation in the Pediatric Intensive Care Unit (PICU) settings according to moderate sedation protocol using ketamine and midazolam and to determine areas for the improvement in our clinical practice. SETTINGS AND DESIGN: A retrospective study was conducted in the PICU. MATERIALS AND METHODS: Retrospective chart review was performed for patients who had received moderate sedation between January and the end of December 2011 and who are eligible to inclusion criteria. RESULTS: In this study, 246 moderate sedation sessions were included. 5.3% were in infant age, while 94.7% were children (1-14 years). Their gender distributed as 59.8% males and 40.2% females. The majority of them had hematology-oncology disease nature, i.e., 80.89% (n = 199). Lumbar puncture accounted for 65.3% (n = 160) of the producers; the rests were bone marrow aspiration 32.7%, endoscopy 8.2%, and colonoscopy 2.9%. Two doses of ketamine (1-1.5 mg/kg) to achieve moderate sedation during the procedure were given to 44.1% (n = 108) of the patients. One dose of midazolam was given to 77.2% (n = 190), while 1.22% (n = 3) of sessions of moderate sedation was done without any dose of midazolam. Adverse events including apnea, laryngeal spasm, hypotension, and recovery agitation were observed during moderate sedation sessions, and it has been noticed in four sessions, i.e., 1.6%, which were mild to moderate and managed conservatively. CONCLUSION: Moderate sedation in the PICU using ketamine and midazolam is generally safe with minimal side effects as moderate sedation sessions were conducted by pediatric intensivist in highly monitored and equipped environment.
RESUMO
Objective. Pain control is an essential goal in the management of critical children. Narcotics are the mainstay for pain control. Patients frequently need escalating doses of narcotics. In such cases an adjunctive therapy may be beneficial. Dextromethorphan (DM) is NMDA receptor antagonist and may prevent tolerance to narcotics; however, its definitive role is still unclear. We sought whether dextromethorphan addition could decrease the requirements of fentanyl to control pain in critical children. Design. Double-blind, randomized control trial (RCT). Setting. Pediatric multidisciplinary ICU in tertiary care center. Patients. Thirty-six pediatric patients 2-14 years of age in a multidisciplinary PICU requiring analgesia were randomized into dextromethorphan and placebo. The subjects in both groups showed similarity in most of the characteristics. Interventions. Subjects while receiving fentanyl for pain control received dextromethorphan or placebo through nasogastric/orogastric tubes for 96 hours. Pain was assessed using FLACC and faces scales. Measurements and Main Results. This study found no statistical significant difference in fentanyl requirements between subjects receiving dextromethorphan and those receiving placebo (p = 0.127). Conclusions. Dextromethorphan has no effect on opioid requirement for control of acute pain in children admitted with acute critical care illness in PICU. The registration number for this trial is NCT01553435.
Assuntos
Analgésicos Opioides/uso terapêutico , Dextrometorfano/uso terapêutico , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Fentanila/uso terapêutico , Dor/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Escala de Coma de Glasgow , Humanos , Unidades de Terapia Intensiva Pediátrica , Masculino , Medição da Dor , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: To evaluate the clinical and biochemical characteristics of children with diabetic ketoacidosis (DKA). METHODS: In this retrospective study conducted between June 2012 and November 2013 at the King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, we evaluated pediatric DKA admissions from 1995-2008 (Phase 1). From the case files, we obtained information related to patients' age, gender, weight, presenting complaints, serum biochemical profile, and management. RESULTS: This study included 373 DKA admissions with a median age of 11 years (interquartile range [IQR]: 8-13). The patients in the subgroup of age more than 10 years old had the highest proportion of admissions (n=250, 67%, p<0.000). The median duration of diagnosis of diabetes mellitus (DM) was 3 years (IQR: 2-6). New-onset DM was 47%. Predominant precipitating cause was acute illness, mostly viral syndrome in 22% of all cases, and non-compliance to insulin regimen was in 79% of the diagnosed diabetic cases. Blood glucose, pH, anion gap, serum osmolality, serum potassium, and serum phosphate showed the highest change during the initial 6 hours of management, while trends of serum bicarbonate and blood urea nitrogen demonstrated a predominant change in the initial 12 hours. CONCLUSION: The notable findings in this study, such as, higher mean age of presentation, high rate of non-compliance to insulin as the cause of precipitation, and a high prevalence of abdominal pain at presentation should be followed up with further comparative studies.
Assuntos
Diabetes Mellitus/diagnóstico , Diabetes Mellitus/tratamento farmacológico , Cetoacidose Diabética/sangue , Cetoacidose Diabética/etiologia , Dor Abdominal/etiologia , Adolescente , Idade de Início , Criança , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Adesão à Medicação , Estudos RetrospectivosRESUMO
OBJECTIVE: To estimate the incidence of temporary central venous line (CVL) related thrombosis among the pediatric population of critical care units, and to determine the possible predictors for developing CVL thrombosis. METHODS: A retrospective cohort study of patients =14 years of age who were admitted to the pediatric intensive care unit (PICU) at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 2009 to 2011 was performed. The patients were recruited using the PICU admission database, and the infection control unit database. RESULTS: In 2 years, there were 1,361 admissions to the PICU. Only 248 patients required a central line for acute management. Twenty-one (8.5%) patients developed a thrombosis. The risk of thrombosis increased with multiple insertions of the central line compared with a single central line insertion (95% confidence interval: 2.339-16.667; p=0.0003). CONCLUSION: Among all predictors, the number of CVLs was the only significant predictor of CVL thrombosis. Patients with multiple CVLs are at 6.2 times higher risk of developing thrombosis compared with those with a single CVL.