In the eye of the storm: impact of COVID-19 pandemic on admission patterns to paediatric intensive care units in the UK and Eire

Background The coronavirus disease-19 (COVID-19) pandemic had a relatively minimal direct impact on critical illness in children compared to adults. However, children and paediatric intensive care units (PICUs) were affected indirectly. We analysed the impact of the pandemic on PICU admission patterns and patient characteristics in the UK and Ireland. Methods We performed a retrospective cohort study of all admissions to PICUs in children < 18 years during Jan–Dec 2020, using data collected from 32 PICUs via a central database (PICANet). Admission patterns, case-mix, resource use, and outcomes were compared with the four preceding years (2016–2019) based on the date of admission. Results There were 16,941 admissions in 2020 compared to an annual average of 20,643 (range 20,340–20,868) from 2016 to 2019. During 2020, there was a reduction in all PICU admissions (18%), unplanned admissions (20%), planned admissions (15%), and bed days (25%). There was a 41% reduction in respiratory admissions, and a 60% reduction in children admitted with bronchiolitis but an 84% increase in admissions for diabetic ketoacidosis during 2020 compared to the previous years. There were 420 admissions (2.4%) with either PIMS-TS or COVID-19 during 2020. Age and sex adjusted prevalence of unplanned PICU admission reduced from 79.7 (2016–2019) to 63.1 per 100,000 in 2020. Median probability of death [1.2 (0.5–3.4) vs. 1.2 (0.5–3.4) %], length of stay [2.3 (1.0–5.5) vs. 2.4 (1.0–5.7) days] and mortality rates [3.4 vs. 3.6%, (risk-adjusted OR 1.00 [0.91–1.11, p = 0.93])] were similar between 2016–2019 and 2020. There were 106 fewer in-PICU deaths in 2020 (n = 605) compared with 2016–2019 (n = 711). Conclusions The use of a high-quality international database allowed robust comparisons between admission data prior to and during the COVID-19 pandemic. A significant reduction in prevalence of unplanned admissions, respiratory diseases, and fewer child deaths in PICU observed may be related to the targeted COVID-19 public health interventions during the pandemic. However, analysis of wider and longer-term societal impact of the pandemic and public health interventions on physical and mental health of children is required.

Nursing-Sensitive Outcomes among Patients Cared for in Paediatric Intensive Care Units: A Scoping Review

Measuring the effectiveness of nursing interventions in intensive care units has been established as a priority. However, little is reported about the paediatric population. The aims of this study were (a) to map the state of the art of the science in the field of nursing-sensitive outcomes (NSOs) in paediatric intensive care units (PICUs) and (b) to identify all reported NSOs documented to date in PICUs by also describing their metrics. A scoping review was conducted by following the framework proposed by Arksey and O’Malley. Fifty-eight articles were included. Publications were mainly authored in the United States and Canada (n = 28, 48.3%), and the majority (n = 30, 51.7%) had an observational design. A total of 46 NSOs were documented. The most reported were related to the clinical (n = 83), followed by safety (n = 41) and functional (n = 18) domains. Regarding their metrics, the majority of NSOs were measured in their occurrence using quantitative single measures, and a few validated tools were used to a lesser extent. No NSOs were reported in the perceptual domain. Nursing care of critically ill children encompasses three levels: improvement in clinical performance, as measured by clinical outcomes; assurance of patient care safety, as measured by safety outcomes; and promotion of fundamental care needs, as measured by functional outcomes. Perceptual outcomes deserve to be explored.

Asthma in Paediatric Intensive Care in England Residents: Observational Study

Purpose Despite high prevalence of asthma in children in the UK, there are no prior report on asthma admissions in paediatric intensive care units (PICU). Methods PICANet, a UK national PICU database, was queried for asthma as the primary reason for admission, of children resident in England from April 2006 till March 2013. Results There were 2,195 admissions to PICU for a median stay of 1.4 days. 59% were males and 51% aged 0-4 years. The fourth and fifth deprivation quintiles represented 61% (1,329) admissions and 73% (11) of the 15 deaths. Deaths were most frequent in 10-14 years age (n=11, 73%), with no deaths in less than 5 years age. 38% of admissions (828/2193) received invasive ventilation, which was more frequent with increasing deprivation (13% (108/828) in least deprived to 31% (260/828) in most deprived) and decreasing age (0-4-year-olds: 49%, 409/828). Conclusions This first multi-centre PICU study in England found that children from more deprived neighbourhoods represented the majority of asthma admissions, invasive ventilation and deaths in PICU. Children experiencing socioeconomic deprivation could benefit from enhanced asthma support in the community.

Parental perceptions of the impact of COVID-19 restrictions on family-centred care at a paediatric intensive care unit

Background/Aims Restrictions to clinical practice necessitated by the COVID-19 global pandemic exerted pressures on staff, families and patients within the paediatric intensive care unit of the Royal Hospital for Children in Glasgow. The authors sought to explore parents' experiences during this pandemic. Methods A single centre study was performed using a questionnaire distributed to parents of patients in the 22-bed paediatric intensive care unit. The key areas targeted were visiting restrictions, ward round changes, facilities closures and the need to wear personal protective equipment. Free text responses were reviewed by two authors independently and common themes identified. Results The findings offer insight into family perceptions that illustrate the negative repercussions of the restrictions to parents. Understanding on the part of the parents was demonstrated throughout; however, restrictions and pandemic interventions also resulted in isolation, distress, exclusion and anxiety. Conclusions There are no current studies exploring parental perceptions of COVID-19 interventions within paediatric intensive care units. These findings offer insights that illustrate the unique challenges faced by those who strive to deliver family-centred care, and the additional stress that this can put upon parents. The authors propose adaptive strategies to enhance family-centred care at paediatric intensive care units.

The I-KID Study Protocol: Evaluation of Efficacy, Outcomes and Safety of a New Infant Haemodialysis and Ultrafiltration Machine in Clinical Use: a Randomised Clinical Investigation using a Cluster Stepped-wedge Design.

Introduction: The I-KID study aims to determine the clinical efficacy, outcomes and safety of a novel non-CE-marked infant haemodialysis machine, the Newcastle Infant Dialysis Ultrafiltration System (NIDUS), compared to currently available therapy in the UK. NIDUS is specifically designed for renal replacement therapy in small babies between 0.8 and 8 kilograms. Methods and analysis: The clinical investigation is taking place in six UK centres. This is a randomised clinical investigation using a cluster stepped-wedge design. The study aims to recruit 95 babies requiring renal replacement therapy in paediatric intensive care units over 20 months.

A COMPREHENSIVE UPDATE ON INCIDENCE, PREVALENCE AND COMPLEX ETIOLOGY OF CENTRAL LINE–ASSOCIATED BLOODSTREAM INFECTION IN PEDIATRIC INTENSIVE CARE UNITS IN KING SAUD MEDICAL CITY

Central Line Associated Bloodstream Infection (CLABSI) is a type of bloodstream infection that is caused by microorganisms after the insertion of central lines. Paediatric Intensive Care Units have been studied to conduct this research on CLABSI in children from 2 to 15 years old. Children have been divided in two age groups that are 2-5 and 5-15 years. The Royal Children’s Hospital, Melbourne has been chosen as a sample of this besides other five hospitals of Australia. A total of 350 patients are studied in the course of this research and 216 among them were inserted with central lines. Bloodstream infection has been identified in 49 patients from these 216 patients and CLABSI occurred in 75.51% of them that is 37 patients. Associated microorganisms and other underlying diseases are listed in this study to develop an idea about factors responsible for CLABSI.