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Published on: December 31, 2017
The oral health of critically ill children: an observational cohort study
Amanda Ullman1, Debbie Long, Peter Lewis
1School of Nursing, Queensland University of Technology, Paediatric Intensive Care Unit, Royal Children's Hospital, Herston, Qld, Australia. amanda_ullman@health.qld.gov.au
Insights
Critically ill children frequently experience poor oral health, increasing their risk of infections. This highlights the need for evidence-based oral hygiene practices in pediatric intensive care units.
Area of Science:
- Pediatric Intensive Care
- Oral Health
- Infectious Diseases
Background:
- Critical illness and its treatments can impair oral cavity function in children.
- Worsening oral health in critical illness is linked to systemic health, similar to adult findings.
Purpose of the Study:
- To describe oral health status in critically ill children over time.
- To identify factors influencing poor oral health development.
- To explore the link between oral dysfunction and healthcare-associated infections.
Main Methods:
- Prospective observational cohort study in a tertiary-referral Pediatric Intensive Care Unit.
- Oral health assessed using the Oral Assessment Scale and oropharyngeal flora cultures.
- Data collected on supportive therapies, clinical characteristics, and healthcare-associated infections.
Main Results:
- 63% of children had oral dysfunction; 41% showed pathogenic oropharyngeal colonization.
- Commonly isolated pathogens included Candida sp., Staphylococcus aureus, and Pseudomonas aeruginosa.
- Illness severity correlated positively with pathogenic/absent oropharyngeal colonization; 63% of infections involved prior oropharyngeal colonization.
Conclusions:
- Paediatric oral health is often dysfunctional during critical illness, with frequent colonization by potential systemic pathogens.
- Evidence-based oral hygiene practices are needed to guide care for critically ill children.
- Poor oral health in this population has potential systemic consequences requiring clinical attention.
Aims And Objectives:
This study will describe the oral health status of critically ill children over time spent in the paediatric intensive care unit, examine influences on the development of poor oral health and explore the relationship between dysfunctional oral health and healthcare-associated infections.
Background:
The treatment modalities used to support children experiencing critical illness and the progression of critical illness may result in dysfunction in the oral cavity. In adults, oral health has been shown to worsen during critical illness as well as influence systemic health.
Design:
A prospective observational cohort design was used.
Method:
The study was undertaken at a single tertiary-referral Paediatric Intensive Care Unit. Oral health status was measured using the Oral Assessment Scale and culturing oropharyngeal flora. Information was also collected surrounding the use of supportive therapies, clinical characteristics of the children and the occurrence of healthcare-associated infections.
Results:
Of the 46 participants, 63% (n = 32) had oral dysfunction and 41% (n = 19) demonstrated pathogenic oropharyngeal colonisation during their critical illness. The potential systemic pathogens isolated from the oropharynx and included Candida sp., Staphylococcus aureus, Haemophilus influenzae, Enterococcus sp. and Pseudomonas aeruginosa. The severity of critical illness had a significant positive relationship (p < 0·05) with pathogenic and absent colonisation of the oropharynx. Sixty-three percent of healthcare-associated infections involved the preceding or simultaneous colonisation of the oropharynx by the causative pathogen.
Conclusions:
This study suggests paediatric oral health to be frequently dysfunctional and the oropharynx to repeatedly harbour potential systemic pathogens during childhood critical illness.
Relevance To Clinical Practice:
Given the frequency of poor oral health during childhood critical illness in this study and the subsequent potential systemic consequences, evidence based oral hygiene practices should be developed and validated to guide clinicians when nursing critically ill children.
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