O018 / #588: WHY, HOW AND WHEN DO CHILDREN DIE IN A PAEDIATRIC INTENSIVE CARE UNIT (PICU) IN SOUTH AFRICA?\

Abstract

Aims & Objectives: To describe the modes of death and characteristics of children who died in a South African Paediatric Intensive Care Unit (PICU) Methods: Retrospective review of data extracted from the Child Healthcare Problem Identification Programme (Child PIP) and the PICU summary system on children of any age who died in the PICU between 01 January 2013 and 31 December 2017. Setting and Participants: Single-centre tertiary institution. All children who died during PICU admission were included. Results: Four-hundred and fifty one (54% male; median (IQR) age 7 (1-30) months) patients died in PICU on median (IQR) 3 (1-7) days after PICU admission; 103 (22.8%) had a cardiac arrest prior to PICU admission. Mode of death in 23.7% (n=107) was withdrawal of life sustaining therapies; 36.1% (n=163) died after limitation of life sustaining therapies; 22.0% (n=99) died after failed resuscitation and 17.3% (n=78) were diagnosed brain dead. Ultimately, 270 (60%) children died after the decision to limit or withdraw life sustaining therapies. Severe sepsis (21.9%) was the most common condition associated with death, followed by cardiac disease (18.6%). Ninety-four (20.8%) patients were readmitted; 278 (61.6%) had complex chronic disorders. During the last phase of life, 75.0% (n=342) were on inotropes, 95.9% (n=428) ventilated, and 10.8% (n=46) received renal replacement therapy. Only 1.5% (n=7) of children became organ donors. Conclusions: Most PICU deaths occurred after a decision to limit or withdraw life-sustaining therapy. Severe sepsis was the most common condition associated with death. Referral for organ donation was extremely rare.