An audit of primary medical conditions in children admitted to the paediatric intensive care unit of Charlotte Maxeke Johannesburg Academic Hospital

Abstract

Background. There is approximately one paediatric intensive care unit (PICU) bed per 22 800 children in SA, making PICU beds a very limited resource.

Objectives. To determine the spectrum of medical conditions in children admitted to a PICU, their outcomes, and to compare the number and outcomes of HIV-exposed/infected children v. HIV-unexposed children.

Methods. This was a retrospective chart review of children older than 28 days, admitted to Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) PICU for medical conditions from 1 January 2013 to 31 July 2014.

Results. There were 883 admissions; 518 (59%) were neonates and 234 (26.5%) were surgical patients, leaving a final sample of 131 (14.8%) children with medical conditions. The median age of children admitted was 3.8 months. Out of 131 children, 44 (34%) were HIV-exposed and 16 (12.2%) had a positive HIV polymerase chain reaction (PCR) result. Lower respiratory tract infections (LRTIs) accounted for two-thirds of all admissions at 84 (64.1%) and were significantly more common in HIV-exposed children (p=0.0005); 32 (24.4%) patients died. HIV-exposed children stayed 3 days longer (p=0.015), were ventilated for 4 more days (p=0.012) and were three times more likely to require high-frequency oscillatory ventilation (p=0.0005) than HIV-unexposed children. Mortality was similar between these two groups. Children confirmed HIV PCR-positive had a significantly longer duration of ICU stay (p=0.03) and ventilation (p=0.006) than those who were exposed but uninfected.

Conclusion. There were 883 children admitted in 19 months to CMJAH PICU. A total of 15% of admissions were for medical conditions, two-thirds of which were for LRTIs. One-third of the children were HIV-exposed and had similar outcomes to their unaffected counterparts, although their duration of ventilation and length of stay were longer.