Lactate clearance as a predictor of mortality among children admitted in pediatric intensive care unit with shock

Abstract

Background : We conducted this prospective observational study to identify the various causes and contributory factors for children to be brought in dead (BID) state to tertiary care centre by carrying out a root cause analysis. These causes were forked out into biological and non-biological social/ system related determinants. By doing so it was intended to look beyond ‘disease and diagnosis’ into various hiatus in health care delivery system so as to identify and address potentially correctable variables. Methods : In this study, disease related causes of mortality were analysed retrospectively and socially modifiable factors were identified prospectively in all enrolled cases. The information required for study was collected by a) direct interview and b) field observation. Results : Of the enrolled cases, more than half (55%) were neonates among which 78% were LBW. Major symptoms with which child was referred were breathing difficulty (80%), fever (21%), refusal of feed (17%). The most common referral diagnosis among neonates were LBW (78%), RDS (38%), Birth asphyxia (34.5%) and among non neonates were pneumonia (24.4%), CHD (13%), AGE (13%). Moderate to severe malnutrition was an accompanying feature in more than two-third of cases. Of referred cases, 71% of referral notes were found to be insufficient. In over three-fourth cases ambulance was used as a means of transport but umpteen lacked accessories needed for pediatric usage. Paramedic who had accompanied the cases were found to be undertrained/ untrained in handling pediatric cases. Main reason for delay in transit was found to be heavy traffic (23%), poor road condition(15%) and unfamiliarity of route(7%). Rate of ROSC(2%) was poor in the study. Conclusion: A substantial number of deaths among the referred children/neonates are preventable. A proper adoption and implementation of integrated management of childhood and neonatal illness at first level of health care contact will help in curbing preventable deaths. Better outcome can be anticipated by ameliorating care at periphery by regular training of doctors and health workers/paramedics, making medicines and equipments available and strengthening support mechanism like effective pediatric transport system