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Outcome in Children Admitted to the First PICU in Malawi
Mirjam A de Visser1,2, Diana Kululanga2, Singatiya S Chikumbanje2,3
1Department of Pediatric Intensive Care, Emma Children's Hospital of the Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
High mortality was observed in Malawi's first Pediatric Intensive Care Unit (PICU), particularly among neonates. Factors like neonatal age, decreased mental state, and severe hypotension were linked to increased mortality, highlighting the need for improved PICU care bundles in sub-Saharan Africa.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Sub-Saharan African Healthcare
Background:
- Dedicated Pediatric Intensive Care Units (PICUs) are emerging in sub-Saharan Africa, but regional data is scarce, hindering prioritization of populations and approaches.
- Establishing PICUs in resource-limited settings presents unique challenges.
- Understanding patient characteristics and outcomes is crucial for developing effective PICU strategies.
Purpose of the Study:
- To describe the characteristics and outcomes of patients admitted to the first PICU in Malawi.
- To identify factors associated with increased mortality in this pediatric intensive care setting.
- To inform the establishment and improvement of PICUs in sub-Saharan Africa.
Main Methods:
- Prospective review of a Pediatric Intensive Care Unit (PICU) database.
- Univariate analysis to assess associations between demographic, clinical, and laboratory factors and mortality.
- Multivariable analysis to identify independent predictors of mortality.
Main Results:
- Of 531 admissions, 149 children (28.1%) died, with significantly higher mortality in neonates (52.7%) versus older children (16.8%).
- Factors associated with increased mortality included neonatal age, decreased mental state, post-cardiac arrest, severe hypotension, elevated lactate, low pH, and low platelet count.
- Sepsis and certain congenital anomalies (gastroschisis, trachea-esophageal fistula) were associated with higher mortality, while some cancers and foreign body aspiration had better survival rates.
Conclusions:
- Malawi's first PICU experienced high mortality, especially in neonates, underscoring the need for enhanced care bundles for vulnerable groups like surgical neonates and septic patients.
- Clinical and laboratory variables, including severe hypotension and blood gas parameters, are critical indicators of mortality, particularly in neonates.
- These findings provide essential evidence for establishing and optimizing Pediatric Intensive Care Units (PICUs) across sub-Saharan Africa.
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