http://www.angirx.com/blog/congenital-heart-disease-support-group/
congenital heart disease support group
Reasons for admission and results in children under five years in the pediatric unit of Intensive Care Hospital Bugando After one year (July 2006-June 2007)
SUMMARY
An intensive care unit or intensive care unit, is a section of a hospital providing comprehensive and continuous care for people who are seriously ill and may benefit from treatment. The purpose of this investigation was to determine the reasons for admission and outcome between underfives in Pediatric Intensive Care Unit Bugando Medical Center July 2006-June 2007. The intensive care BMC are presented in two units, the NICU and AICU. Design of the study, Retrospective of the Red Cross study.
Methodology, data regarding age, refferal origin, time of admission, diagnosis and length of stay and outcomes were collected from July 2006-June 2007 and analyzed using Epi Info program developed by the CDC, the 2005 version. RESULTS: 471 patients were admitted to care neonatal intensive and 249 patients in AICU July 2006 June 2007. NICU patients: 56.6% were male and 43.4% were women. Mortality was higher among women (59.3%). The overall mortality among newborns admitted to neonatal intensive care for a year is 58.1%. birth premature and asphyxia are the most common causes in NICU admission, 36.7% and 25.1% respectively. Others involved in disease heart defect, aspiration pneumonia, hypothermia, anemia etc70.2% and 72.4% of patients admitted because of prematurity and sepsis, respectively, were killed in the average length of stay was 4.73 hours of NICU.The. AICU patients: 52.6% were male, while 47.4% were women. Most patients have developed require intensive care while admitted to hospital and the two sources of reference for most patients have survived. AICU overall mortality was 45.4% and mortality was higher among patients male (46.6%) compared to female patients (44.1%). Most patients were admitted during the afternoon (32.5%) while mortality was higher among patients admitted during the night hours (60.3%). malaria and pneumonia were the leading cause of admission AICU to the 27.7% and 24.1% respectively. Other causes are head trauma, congenital heart disease, post surgical care, septicemia, meningitis, malnutrition, diarrhea, Burn, poisoning, tuberculosis pleural effusion etc94.1% of all patients admitted for malnutrition d. APCU.The average length of stay of all patients was 60 hours.
CONCLUSION: Although the ICU has been created with the objective of reducing mortality among children, especially underfives, the mortality rate among admitted to the NICU remains underfives BMC high (58.1%) underfives however AICU mortality is low (45.4%) compared with the NICU.
INTRODUCTION AND REVIEW OF THE LITERATURE
An intensive care unit or ICU, is a specialized hospital that offers comprehensive care and continuous for people who are seriously ill and may benefit from treatment. It is a hospital for patient care in critical condition a level more intense than that required for other patients. Experts in the intensive care unit contains a complex array of monitors and teams Support that can support life instead of threatening situations, including respiratory distress syndrome in adults, renal failure, organ failure Multiple and sepsis. The purpose of the intensive care unit (ICU) is simple, although the practice is complex. Health professionals working in intensive care or rotate through them in providing training around the clock intensive monitoring and treatment of patients, seven days a week. Patients are generally admitted to intensive care, if they can get the level of care. ICU has demonstrated benefit for patients who are acutely ill and clinically unstable, ie they have a potentially fatal disease or disorder.Although criteria for admission to the ICU is somewhat controversial, excluding patients who are either too well or too ill to receive intensive care, there are four priorities recommended that intensivists (specialists medical intensive care) use to decide this question.
In general, critical care requires a multidisciplinary team, but not limited to intensivists (physicians who specialize in care for serious illnesses), pharmacists and nurses, therapists care respiratory and other medical consultants from a wide range of specialties, including surgery, pediatrics and anesthesiology. The ideal of the ICU have a team that represents over 31 different health professionals and practitioners working in patient assessment and treatment. The intensive management will provide the treatment, diagnosis, interventions, and personal attention to each patient recovers serious illness.
When patients are transferred to the ICU of another hospital, prescription treatment and planning must be reviewed and new treatment plans written for the current state of the patient. For example, a patient hospitalized in chronic illness in May grow much worse in a few hours and can be transferred to the intensive care unit, where staff orders must reassess your care.
A thorough and comprehensive study conducted in 1992 by the Society of Critical Care Medicine, in collaboration with the American Hospital Association revealed that about 8% of all licensed hospital beds in the United States have been designated for intensive care. Small hospitals less than 100 beds was generally intensive care unit, while large hospitals with over 300 beds, more commonly referred patients ICU Medical, surgical and coronary. Small hospitals often do not have full board certified specialist in time medicine critical care, while major centers generally employ intensive medical certificates.
Arias G, Taylor and Marcin J conducted a study to determine whether an association between the time of admission (Monday through Friday and the weekend in the face day to face the night) and the risk of deaths among pediatric patients included in a cohort of children in a national sample of Picus in USA.They found that pediatric patients admitted to the PICU during evening hours had a greater chance of death than those admitted during the day. There was no association between mortality and the day of admission (income over weekend admissions from Monday to Friday). Here, we see that there is a high risk Death is for certain pediatric patients admitted to the PICU during evening hours.
A retrospective study by Cooper S, Lyall H, Walters S, et al evaluate the results of children with HIV admitted and treated in the ICU Pediatric UK revealed than sixteen (38%) children died in the ICU, and 26 (62%) survived their last PICU. 5 of them died at a later date (between 1 and 32 months after discharge from PICU) and 21 survived to write the report. The most common reason for ICU admission was insufficient breathing, either because of Pneumocystis carinii pneumonia (45% of revenues) or pathogens respiratory (32%). Over 80% of current survivors had good results in terms of growth and development and 6 children had signs of diplegia. There Spastic is significant mortality among children of HIV infection admitted to PICU, although many of them survive their admission, and over 80% of survivors had good results with high active antiretroviral therapy available.
Another study by Jeena PM, Wesley AG, Coovadia HM describe forms of income and outcome of diseases managed in a unit of pediatric ICU (PICU) in a country developing countries. The overall mortality rate was 35.44%, over 90% of children admitted were intubated and 80% required intermittent ventilation positive pressure. The average length of stay in intensive care for survivors during the study period was 13,891 days. Disease tetanus, sepsis, and HIV take longer ICU stay for survivors, while unintentional injuries apnea of the newborn and asthma requires more time shorter ICU stay for survivors, 23.9% of all deaths occurred within 24 h.
A prospective cohort study on the results children with different accessibility to tertiary pediatric intensive care in a developing country was conducted by Goh AY, Abdel-Latif Mel-A, Lum LC and Abu Bakar MN. In this study, we can say that the prognosis of critically ill children transferred to hospitals in the Community differ not those who develop ICU needs the services of a tertiary center, despite being carried out by non-dedicated equipment. Outcome was not affected by the lack of Initial access to intensive care if the children finally received care in a tertiary center.
PROBLEM STATEMENT AND JUSTIFICATION
Patients who are admitted to the intensive care unit for children are seriously sick, they are not taken seriously, death can occur at any time, however, ICU medical staff should use their skills to reduce mortality in ICU Underfive, but the role of pediatric intensive care on the outcome of pediatrics at BMC still not well documented compared to other countries and that this study was necessary to study the current situation in our environment ..
Studies have revealed among children admitted to the PICU during evening hours had higher odds of death than those admitted during the day. Here we see a risk death are increased for certain pediatric patients admitted to the PICU during evening hours (Arias G, et al.) You must determine if the results the search for differences in the structure of care, care processes, or both. This study attempted to link the relationship between the time of admission and result in the configuration of the BMC.
Young children admitted to PICU can be admitted directly to the community and / or may be those who develop needs, while in the rooms. However, the results between the two groups has not been established. Studies are needed to generate Data on the results of these two groups.
OBJECTIVES
Broad objective
The objective of this study was to determine the reasons for admission and outcome of Underfives in Pediatric Intensive Care Unit Bugando Medical Center in July 2006, June 2007.
The specific objectives were:
- To determine trends in admission ICU, including age, sex, diagnosis, time of admission and referral source.
- To describe patterns of outcome diseases managed APCU
- To determine the number and causes of mortality and morbidity in ICU underfives
- To determine length of stay of hospital admission or death.
METHODOLOGY
Study Design
A cross-sectional retrospective study
Study area
The study was conducted in the NICU and AICU BMC.BMC is located in the city of Mwanza and serves as a referral hospital for Mara, Kagera and Shinyanga and Mwanza region. Mwanza is located south of Lake Victoria, along Shinyanga in its southern part, Mara Region in the east and Kagera in the north-west. Most residents are Sukuma Mwanza Kerewan, Zinzan and other tribes are the result of economic activities are fishing companies (main), extraction mining, small businesses, etc.
Care Unit Neonatal Intensive construction is in H2 and receives patients from the room premature delivery unit and the peripheral hospitals. The staff pediatrician (1) residents (1), Intern Doctor (1) Nurses (10) and auxiliary (3). It has 5 beds and 2 extra beds (bedÿÿ kangaroo, 3 pumps, 6 boxes drop by drop, 1 machine phototherapy, 5 Heat 1 Air Conditioning, 2 tables, 5 closets, 1 weighing machine, 1 Fan, 6 monitors, ECG 1 and 2 cars.
Adult ICU: H2 is also the construction and delivery of adults and children, except infants treated in neonatal intensive care. Staff of AICU are doctors (3), nurses (2), nurses (16) and assists (3). There will be a large office and laboratory facilities, 12 beds, 9-drops, 2 ECG machines, 1 stabilizer, 1 starilizer, 1 autoclave, 1 microscope, 1 centrifuge, 1 defibrillator, 3 pumps, 15 instructors, 5 fans, 1 echo machine, 1 suction machine, oxygen concentrator 1 and other survival equipment.
Size Sample
The sample size has allowed all underfives AICU both NICU and as documented in the records of July 2007.471 June 2006 newborns were admitted to neonatal intensive care and patients were admitted AICU.
Data collection
Chart records of all patients under 5 years of age from July 2006-June 2007 were collected and analyzed retrospectively. Information on sex, age, length of stay, admission diagnosis, and the rejection or the result of death were recorded.
Ethical issues
A permit to carry This study sought to muchso, BMC Authority and leaders of the respective sections.
Study Limitations
- The result of the patient was transferred to headquarters could be evaluated. Most patients may die shortly after leaving the pediatric intensive care and because of the configuration of these studies were not included in my cabinet who may have an effect on the sample size.
- Because of the age limit for a significant number of patients over five years of age who were admitted to have been omitted AICU in my study, this may affect the sample size.
- Errors and / or entry in the records incomplete especially in the care Neonatal Intensive affected my study, some targets are not met because of incomplete data as documented in the records.
Detail Analysis
The data were analyzed by Epi Info version of the CDC and presented in tabular form in associations which have proved mathematically.
RESULTS
1: NICU DEPARTMENT
NB: The total number of patients hospitalized in the NICU for the last year it was 471, however, when analyzing data in column "Total" and / or lines may change due to lack of enrollment in one or other of the exposure variables and outcome found in the files in the NICU.
TABLE Results of May is displayed not
Most newborns in the NICU were men. Significant of NICU deaths in women and overall mortality in the neonatal intensive care was 58.8%.
Most babies who have developed the need, while in the halls and admitted to the house and the hospital device, APCU death. The progress of patients transferred to the room paeditric general was not known.
Prematurity, birth asphyxia, hypothermia, sepsis and abnormal defects were the main causes of admission in the NICU. Other initiatives include malaria, resuscitation, observation, hypoglycemia, HIV = 4, low score, etc., etc.
Most patients stayed in the NICU in 10 hours.
The total time of all patients during one year was 1816.32 hours. The average length of stay of each patient, regardless of the outcome (death, discharge or transfer to the service Pediatric General was 4.73 hours.
2: AICU DEPARTMENT
Table 1 Children under five years admitted AICU July 2006-June 2007, taking into account the age and sex
Most patients were younger than 12 months. Males were 52.6%, while the women was 47.4%
Most patients were admitted during the afternoon. In the majority of patients admitted overnight APCU died (60.3%).
Malaria and pneumonia were the most frequent causes of admission to AICU.
Other initiatives include epilepsy, tumors, bleeding disorders, Council on Foreign Relations, etc.
Most patients admitted for malnutrition AICU death.
Most patients remained in AICU within 24 hours.
The total time of all patients during one year was 14,941 hours.
The average length of stay of each patient, regardless of the outcome (death, discharge or transfer pediatric general Ward was 60 hours.
Discussion
In this study, that data were collected retrospectively underfives records for admission to the NICU and ICU for adults, 471 newborns and 249 underfives were admitted to neonatal intensive care and AICU, respectively, in the past year. We find that admission to the NICU was double that of AICU however, the registration system in the NICU is low because there are many incomplete AICU any system registration is sufficient. In the NICU, about 56.6% newborns were male and 43.4% were women. In most (89%) were below the age of 7 days. The overall mortality among newborns admitted to neonatal intensive care for a year is 58.1%, mortality was higher among women (59.3%), this not compatible with a study by ten Berge and Jetske circumstances surrounding illness and mortality in the pediatric unit of intensive care, where only 87 (4.4%) patients admitted died in 1995. The mortality remains high compared to the same study Isangula K MNH, where 54.1% of patients admitted died in APCU. The high mortality rates observed in the NICU in May cause delays in support services to life and / or save the life inadequate and / or the shortage of doctors and nurses in intensive care newborn.
In AICU, 52.6% were male, while 47.4% were women. AICU overall mortality was 45.4%, although this result is consistent with a study by ten Berge and Jetske the circumstances surrounding the morbidity and mortality in the pediatric unit intensive care where only 87 (4.4%) hospitalized patients died in 1995. Mortality is low compared to the same study Isangula K MNH since 54.1% of patients admitted died in APCU.The could be allocated to working groups and organize the delivery of BMC compared AICU MNH.
In the NICU, most patients were developed in need of intensive care, while in the halls of any work area, This finding is similar for patients admitted to AICU and two units of the majority of patients have survived regardless of the referral source.
In AICU overall and mortality was higher among male patients (46.6%) compared to female patients (44.1%). Most patients were admitted during the afternoon (32.5%), while mortality was higher among patients admitted during the evening (60.3%). This finding is consistent with the same study Isangula MNH K, in which most patients were admitted during the afternoon and most patients admitted during the hours of midnight when he died in APCU. These results are also consistent with another study by Arias G, Taylor and Marchin G to determine if an association between the date of intake and the risk of death among pediatric patients included in a cohort of children admitted in a national sample of Picus in USA.They found that pediatric patients admitted to the PICU during evening hours had a greater chance of death than those admitted during the day. However, their study found no association between mortality and admission day. Here, we see that there was an increased risk of death for some pediatric patients admitted to the PICU during evening hours. Although my study does not cause no association between income and weekend and weekday pediatric admissions results, but I have discovered that most patients were AICU admitted during the afternoon and most patients were admitted during the night (60.3%) died, which can be attributed to the fact during that time, the doctor on duty can not be readily available. This study shows that the time of admission have an effect on patient outcomes. However further studies are needed to establish the true relationship between time of admission and outcome.
Prematurity and birth asphyxia were the commonest causes of admission to neonatal intensive care, 36.7% and 25.1% respectively. Other people involved in congenital heart disease, pneumonia from aspiration, hypothermia, anemia, etc., but 70.2% and 72.4% of patients admitted because of prematurity and sepsis, respectively, died in the NICU. The average length of stay in NICU was 4.73 hours. In AICU, malaria and pneumonia are the dominant causes of admission AICU, 27.7% and 24.1% respectively. Other causes include head injuries, heart disease congenital, post surgical care, sepsis, meningitis, malnutrition, diarrhea, Burn, poisoning, TB effusion / pleural etc. About 94.1% of all patients admitted because of malnutrition APCU death. The average length of stay was 60 hours AICU equivalent to 2.5 days. The study by Jeena PM, Wesley AG, Coovadia HM describe forms of income and outcome of diseases managed in a pediatric unit ICU (PICU) in a developing country. The overall mortality rate was 35.44% of the average length of stay in ICU survivors during the study period was 13.891 days. Disease tetanus, septicemia, and HIV requires longer stay in intensive care for survivors, while accidental injury, apnea of the newborn and asthma, should stay shorter ICU for survivors. In the same study of general mortality APCU MNH is 54.1%. The average length of stay of each patient, regardless of the outcome (death, liberation or transfer to the pediatric general to 114.5 hours, the equivalent of 4.8 days. severe pneumonia, sepsis and meningitis are main causes of admission MNH.Other causes APCU involved in PCP, oral candidiasis, poisoning, liver failure, multiple congenital anomalies, malaria etc. The short length of stay in BMC may be due to a pathological development and services organization and the BMC receives patients from parts of the lake, while zone SNS receives patients from all regions of Tanzania and in most cases, patients 'complicated'.
Conclusions and Recommendations
This study shows some differences with studies in other contexts. This may be due to geographical, social, cultural and economic differences in the parameters were the studies were conducted. However, ICU was created with the objective of reducing mortality among children, especially underfives, the mortality rate among underfives admitted to NICU and BMC AICU remains high (58.1%) and 45.1% respectively. There is a need to improve the overall life care saving of health in the NICU and AICU in terms of equipment and regular updating of doctors and nurses on management skills of children who need emergency care. However, patient care and registration systems in the NICU should be revised to reduce mortality and improve record keeping in this department. Further studies are needed to produce knowledge about how to treat patients, especially underfives BMC may still be full.
References.
- Althabe M Cardigni G, Vassallo JC, Allende D, Berrueta M Codermatz M, Cordoba J, Castilian S Jabornisky R, Marrone, and Orsi MC, Rodriguez G, Varon J, Schnitzler E, Tamusch M, Torres JM, Vega L. die in the intensive care unit: collaborative multicenter study on the resignation of a life-sustaining treatment in Argentina, units pediatric intensive care. Pediatr Crit Care Med 2003; 4:164-9.
- Arias, Taylor DS, Marcin JP: Association between overnight admissions and mortality rates higher among children unit.Pediatrics ICU 2004, 113: E530-4.
- Van der Wal ME, Renfurm LN, van Vught AJ, RJ Gemka: Circumstances of death in hospital children.Eur J Pediatr 1999, 158:560-5.
- Cooper S, Lyall H, Walters S, Tudor-Williams G, Habibi P, De Munter C, Britto J, Nadel S: Children with the syndrome virus immunodeficiency admitted to a pediatric unit of intensive care in the United Kingdom during a 10-year period.Eur J Pediatr 1999,168:504-9.
- Jeena PM, Wesley AG, Coovadia HM: Admission patterns and outcomes in the pediatric unit of intensive care in South Africa over 25 years (1971-1995): PMID: 10051O84.
- Isangula K: reasons for admission and results between Underfives in APCU Muhimbili National Hospital, April-June 2007. (Unreleased)
- Goh AY, Abdel-Latifmel-A, Lum LC, Abu Bakar MN: Results of children with access to tertiary different unit pediatric intensive care in a developing country, a prospective cohort study: Pediatrics 2004:235-8
About the Author
Dr.Kahabi Isangula
Zonal HIV/AIDS and Malaria Coordinator
WORLD VISION TANZANIA
Any teenager with a heart condition, near Houston, TX?
I (with other groups inside support) from a support group adolescents affected by congenital heart disease in Houston, Texas. It is both healthy and heart disease, so If you are interested, please respond! 
caileywailey – I think it's a fantastic idea! If you are not already member, I suggest you also try to be part of the Adult Congenital Heart Association (achaheart.org). Their website includes a bulletin board where I am sure he would be able to find some more teenagers in the Houston area would be interested to join your group! Good luck to you!