Related Experiment Video
Updated: Apr 15, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Mortality patterns among critically ill children in a Pediatric Intensive Care Unit of a developing country
Naveed-Ur-Rehman Siddiqui1, Zohaib Ashraf2, Humaira Jurair1
1Department of Pediatric and Child Health, Aga Khan University Medical College, Karachi, Pakistan.
Insights
Limitation of life-sustaining treatment was the leading cause of death in a Pakistan Pediatric Intensive Care Unit (PICU). Parents were consistently involved in end-of-life decisions for critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Bioethics
- Health Outcomes Research
Background:
- Biomedical advances prolong life but can increase patient suffering.
- Limitation of life-sustaining treatment is a critical ethical consideration.
- Understanding mortality patterns in developing countries is essential.
Purpose of the Study:
- To analyze mortality patterns in a Pakistani Pediatric Intensive Care Unit (PICU) over six years.
- To identify the primary causes of death in critically ill children.
- To compare findings with international data on end-of-life care.
Main Methods:
- Retrospective cohort study design.
- Analysis of medical records from a tertiary care hospital PICU in Pakistan.
- Inclusion of children aged 1 month to 16 years who died between 2007 and 2012.
Main Results:
- Overall mortality rate was 12.9% (248 deaths out of 1919 admissions).
- Limitation of life-sustaining treatment (63.7%) was the most frequent cause of death, followed by failed cardiopulmonary resuscitation (28.2%).
- An increasing trend in do-not-resuscitate (DNR) orders was observed over the study period.
Conclusions:
- Limitation of life support treatment, encompassing DNR and withdrawal of care, is the predominant cause of death in this PICU.
- Parental involvement in end-of-life decision-making was a consistent aspect of care.
- Findings highlight the importance of ethical considerations in pediatric critical care in developing nations.
Background And Aim:
Advances in biomedical technology have made medical treatment to be continued beyond a point, at which it does not confer an advantage but may increase the suffering of patients. In such cases, continuation of care may not always be useful, and this has given rise to the concept of limitation of life-sustaining treatment. Our aim was to study mortality patterns over a 6-year period in a Pediatric Intensive Care Unit (PICU) in a developing country and to compare the results with published data from other countries.
Materials And Methods:
Retrospective cohort study was conducted in a PICU of a tertiary care hospital in Pakistan. Data were drawn from the medical records of children aged 1-month - 16 years of age who died in PICU, from January 2007 to December 2012.
Results:
A total of 248 (from an admitted number of 1919) patients died over a period of 6 years with a mortality rate 12.9%. The median age of children who died was 2.8 years, of which 60.5% (n = 150) were males. The most common source of admission was from the emergency room (57.5%, n = 143). The most common cause of death was limitation of life-sustaining treatment (63.7%, n = 158) followed by failed cardiopulmonary resuscitation (28.2%, n = 70) and brain death (8.1%, n = 20). We also found an increasing trend of limitation of life-sustaining treatment do-not-resuscitate (DNR) over the 6-year reporting period.
Conclusion:
We found limitation of life support treatment (DNR + Withdrawal of Life support Treatment) to be the most common cause of death, and parents were always involved in the end-of-life care decision-making.
Related Concept Videos
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:29Drug Dosing: Infants and Children