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Prevalence and outcome of lymphopenia in the Paediatric Intensive Care Unit: A prospective observational study
Karthi Nallasamy1, Aidan Magee2, K Johnny Millar3
1Pediatric Intensive Care Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
In critically ill children, lymphopenia is common and often temporary. This condition, however, can be linked to worse outcomes, necessitating further research into its full impact.
Area of Science:
- Pediatric Critical Care Medicine
- Immunology
- Hematology
Background:
- Leukopenia, encompassing lymphopenia and neutropenia, may indicate altered immunity and increased risk in critically ill children.
- Understanding the prevalence, trajectory, and outcomes of leukopenia is crucial for managing pediatric intensive care unit (PICU) patients.
Purpose of the Study:
- To evaluate the prevalence of leukopenia in children admitted to the PICU.
- To assess the clinical course and outcomes associated with leukopenia in this patient population.
Main Methods:
- A prospective study enrolled 200 consecutive children admitted to the PICU (excluding those with malignancy or primary immune deficiency) between June and August 2018.
- Demographic, clinical, and laboratory data were collected, including white blood cell counts and follow-up blood counts for a subset of patients.
Main Results:
- Leukopenia was identified in 67.5% of children within the first week of PICU admission, with lymphopenia being the most common type (58.5%).
- Among children with follow-up, lymphopenia often resolved within days (48% within 48 hours, an additional 29% by 4 days).
- Children with lymphopenia showed associations with higher rates of cardiac surgery, prolonged mechanical ventilation, vasopressor use, organ failure, and longer hospital stays.
Conclusions:
- Lymphopenia is a frequent finding in critically ill children, frequently transient but associated with adverse outcomes.
- Further investigation with larger sample sizes and detailed blood count monitoring is warranted to fully elucidate the course and impact of lymphopenia.
Aim:
Leukopenia (lymphopenia or neutropenia) may be an important marker of altered immunity and risk in children with critical illness. We aimed to evaluate the prevalence, course, and outcome of leukopenia in children admitted to Paediatric Intensive Care Unit (PICU).
Methods:
All consecutive children (n = 200) admitted to PICU for any reason except malignancy or pre-existing immune deficiency were enrolled during June-August 2018.
Results:
Median (interquartile range) age was 2.2 (0.6-8.5) years. About 52% (n = 103) had undergone a surgical procedure; 34% (n = 68) being cardiac surgery. Among medical illnesses, respiratory disorders were the most common (n = 39, 20%). Laboratory confirmed infections were present in 63 (31.5%) children. Leukopenia was identified in 135 (67.5%) children in the first week; 117 (58.5%) had only lymphopenia, 16 (8%) had both lymphopenia and neutropenia, and 2 (1%) had only neutropenia. In 69 children who had follow-up blood counts, lymphopenia resolved in 33 (48%) within 48 h and in another 20 (29%) by 4 days, and in a further 10 (14%) by 7 days. Children with lymphopenia had higher frequency of cardiac surgery, longer cardiopulmonary bypass time, greater need for invasive ventilation and vasopressor/inotrope therapy, and a higher probability of organ failure on day 4 and longer hospital stay.
Conclusion:
In critically ill children, lymphopenia is very common, often transient, but may be associated with unfavourable outcomes. Further studies with follow-up of blood counts in a larger sample are required to determine the course and outcomes of lymphopenia.
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