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Hemoglobin Levels Across the Pediatric Critical Care Spectrum: A Point Prevalence Study
Nabil E Hassan1, Diann E Reischman2, Robert K Fitzgerald3
1Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Illinois, The University of Illinois College of Medicine, Peoria, IL.
Insights
Pediatric intensive care unit (PICU) patients
Area of Science:
- Pediatric critical care medicine
- Hematology
- Epidemiology
Background:
- Hemoglobin levels are critical indicators of oxygen-carrying capacity and patient status in pediatric intensive care units (PICUs).
- Understanding variations in hemoglobin levels and their correlates is essential for optimizing patient management and transfusion strategies.
- Previous research has not comprehensively analyzed hemoglobin levels across diverse PICU populations and geographical regions.
Purpose of the Study:
- To determine the prevailing hemoglobin levels in pediatric intensive care unit (PICU) patients.
- To identify potential demographic, clinical, and institutional correlates of hemoglobin levels in this population.
Main Methods:
- Post hoc analysis of prospective, multicenter, observational data collected from 59 PICUs in seven countries.
- Data included hemoglobin levels and clinical information for 2,389 PICU patients across four specific days in 2012.
- Statistical analyses, including multivariable regression, were used to identify associations between hemoglobin levels and various factors.
Main Results:
- The median hemoglobin level across all patients was 11.0 g/dL, with significant variations observed.
- Hemoglobin levels were associated with age (neonates highest), race (Blacks lower than whites), geographic location (Spain/Portugal highest), and PICU type (cardiac PICUs highest).
- Patients with cyanotic heart disease had the highest median hemoglobin; no correlates were found in cancer patients.
Conclusions:
- Patient hemoglobin levels in PICUs are influenced by demographic factors such as age, race, and geographic location, as well as the presence of complex cardiac disease.
- These findings highlight the need to consider these variables when interpreting hemoglobin levels and making transfusion decisions in critically ill children.
- Further research is warranted to explore the underlying mechanisms and clinical implications of these observed associations, particularly the lack of identified correlates in pediatric cancer patients.
Objectives:
To determine the prevailing hemoglobin levels in PICU patients, and any potential correlates.
Design:
Post hoc analysis of prospective multicenter observational data.
Settings:
Fifty-nine PICUs in seven countries.
Patients:
PICU patients on four specific days in 2012.
Interventions:
None.
Measurements And Main Results:
Patients' hemoglobin and other clinical and institutional data. Two thousand three hundred eighty-nine patients with median age of 1.9 years (interquartile range, 0.3-9.8 yr), weight 11.5 kg (interquartile range, 5.4-29.6 kg), and preceding PICU stay of 4.0 days (interquartile range, 1.0-13.0 d). Their median hemoglobin was 11.0 g/dL (interquartile range, 9.6-12.5 g/dL). The prevalence of transfusion in the 24 hours preceding data collection was 14.2%. Neonates had the highest hemoglobin at 13.1 g/dL (interquartile range, 11.2-15.0 g/dL) compared with other age groups (p < 0.001). The percentage of 31.3 of the patients had hemoglobin of greater than or equal to 12 g/dL, and 1.1% had hemoglobin of less than 7 g/dL. Blacks had lower median hemoglobin (10.5; interquartile range, 9.3-12.1 g/dL) compared with whites (median, 11.1; interquartile range, 9.0-12.6; p < 0.001). Patients in Spain and Portugal had the highest median hemoglobin (11.4; interquartile range, 10.0-12.6) compared with other regions outside of the United States (p < 0.001), and the highest proportion (31.3%) of transfused patients compared with all regions (p < 0.001). Patients in cardiac PICUs had higher median hemoglobin than those in mixed PICUs or noncardiac PICUs (12.3, 11.0, and 10.6 g/dL, respectively; p < 0.001). Cyanotic heart disease patients had the highest median hemoglobin (12.6 g/dL; interquartile range, 11.1-14.5). Multivariable regression analysis within diagnosis groups revealed that hemoglobin levels were significantly associated with the geographic location and history of complex cardiac disease in most of the models. In children with cancer, none of the variables tested correlated with patients' hemoglobin levels.
Conclusions:
Patients' hemoglobin levels correlated with demographics like age, race, geographic location, and cardiac disease, but none found in cancer patients. Future investigations should account for the effects of these variables.
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