A description of premature and ex-premature infants admitted to the paediatric intensive care unit in the first six months of life

Abstract

Background. Prematurity is a major risk factor for paediatric morbidity and mortality. Rehospitalisation with paediatric intensive care unit (PICU) admission constitutes significant morbidity; however, the extent of this problem in South Africa (SA) is not known. Objective. To describe the outcomes, clinical course and characteristics of premature and ex-premature infants admitted to a SA PICU, and to determine predictors of mortality. Methods. This prospective observational study analysed unplanned PICU admissions of infants in the first six months of life, over a six-month period. The primary outcome was mortality. Data were analysed using standard descriptive and inferential statistics. Results. Included in the study were 29 infants (65% male; median (interquartile range) birthweight and gestational age 1 715 (1 130 - 2 340) g and 32 (29 - 34) weeks, respectively) in 33 admissions. Five (17.2%) infants died in the PICU. Apnoea (39.4%), respiratory failure (24.2%) and shock (24.2%) were the most common reasons for PICU admission, secondary to pneumonia (33.3%), sepsis (27.3%) and meningitis (12.1%); 72.4% of infants were mechanically ventilated; and 48.3% received blood transfusions. Higher revised paediatric index of mortality score ( p =0.03), inotrope use ( p <0.0001), longer duration of mechanical ventilation ( p =0.03), and cardiac arrest in the PICU ( p <0.0001) were associated with mortality on univariate analysis with no independent predictors of mortality. Conclusion. Infections leading to apnoea, respiratory failure and shock are common indications for PICU readmission in premature infants. Mechanical ventilation and blood transfusion were frequently required.