Differences in organ dysfunctions between neonates and older children: a prospective, observational, multicenter...

Area of Science:

• Pediatric critical care medicine
• Neonatology
• Pediatric intensive care

Background:

• Multiple organ dysfunction syndrome (MODS) is a leading cause of death in pediatric intensive care units (PICUs).
• The Pediatric Logistic Organ Dysfunction (PELOD) score quantifies organ dysfunction (OD) severity.
• Physiological differences exist between neonates and older children.

Purpose of the Study:

• To compare the incidence of ODs and mortality rates between full-term neonates (age <28 days) and older children.
• To identify differences in OD predictors of mortality between neonates and older children.

Main Methods:

• A prospective, observational study included 1806 patients across seven PICUs.
• The PELOD score was calculated daily using 12 variables across six organ systems.
• Statistical analyses, including logistic and multiple regression, compared outcomes between neonates and older children.

Main Results:

• Neonates (9.5% of patients) had higher MODS incidence (14.6% vs. 5.5%) and mortality rates (75.4% vs. 50.9%) than older children.
• Daily PELOD scores and cardiovascular, respiratory, and renal dysfunction scores were significantly higher in neonates during the first four days.
• Neurological, cardiovascular, and hepatic dysfunctions predicted death in neonates, while all ODs predicted mortality in older children.

Conclusions:

• Neonates experience higher rates of MODS and mortality in PICUs compared to older children.
• Neurological, cardiovascular, and hepatic dysfunctions are key predictors of mortality in neonates.
• Stratifying patients by age (neonates vs. older children) may be beneficial for clinical trials assessing MODS outcomes.