Pediatric nonmalignant hematology ICU admissions: A 10-year study

Nonmalignant hematological disorders in children may lead to severe complications requiring Pediatric Intensive Care Unit (PICU) admission. Data regarding critically ill patients with these conditions remain limited. This study assesses disease burden, clinical course, and critical care requirements in this population. We conducted a retrospective observational study of pediatric patients with nonmalignant hematological disorders in a level III PICU between 2016 and 2025. Demographics, diagnoses, admission characteristics, supportive therapies, organ dysfunction, infectious complications, and outcomes were analyzed. During the study period, 146 admissions involving 91 patients accounted for 3.9% of all PICU admissions. Median age at admission was 10 years (IQR 6.2-13.4), and 56% of patients were male. SCD was the most frequent underlying diagnosis (47 patients, 51.6%; 70 admissions, 47.9%), followed by BMF syndromes (20 patients, 22%; 47 admissions; 32,2%), predominantly aplastic anemia (AA). Most admissions were planned (n = 92, 63%). Surgical indications accounted for 45.2% of admissions (n = 66), medical causes for 39.7% (n = 58), and procedure-related for 15.1% (n = 22). Among unplanned medical admissions, septic shock was the leading cause of PICU admission (40.8%), followed by pulmonary complications. Infectious episodes occurred in 40 admissions, with microorganisms isolated in 47.5% of cases. Healthcare-associated infections (HAI) occurred in 16.4% of admissions. Unplanned admissions were associated with longer PICU stays. Overall PICU mortality was 6.2%, exceeding predicted mortality (3.4%), with septic shock the leading cause of death. Nonmalignant hematological disorders represent a substantial PICU burden, particularly among SCD and BMF patients. Unplanned admissions carried higher morbidity and mortality, underscoring the need for vigilant monitoring and timely escalation of care.