Survival, short-term morbidity of extremely low gestational age infants and their predictors
Infant; sepsis; cohort analysis; controlled study; female; human; male; retrospective study; perception; palliative therapy; Pregnancy; stillbirth; gender; necrotizing enterocolitis; clinical article; gestational age; neonatal intensive care unit; prevalence; infant; conference abstract; birth weight; corticosteroid; length of stay; mortality risk; Gestational Age; brain hemorrhage; regression analysis; univariate analysis; survival prediction; encephalomalacia; morbidity; lung dysplasia; probability; retrolental fibroplasia
BACKGROUND: Despite advances in neonatal care for extremely low gestational age (ELGA) infants, they experience high rates of mortality and morbidity. Local data on survival, predictors, and outcomes of ELGA infants is crucial in order to provide accurate antenatal counseling. <br/>OBJECTIVE(S): To determine the survival and morbidities of ELGA infants in our region stratified by gestational age. DESIGN/METHODS: We performed a retrospective cohort study of infants born at <26 weeks gestational age who received intensive care at two level III Neonatal Intensive Care Units between January 1st 2014 and December 31st 2017. We excluded stillbirths and infants who received only palliative care from birth. Outcomes included survival to discharge home (or transfer to another center), length of admission, and the following short-term morbidities: intraventricular hemorrhage (IVH) grade III - IV, periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC) Bell's Stage >=2, late-onset sepsis, and retinopathy of prematurity (ROP) requiring treatment. A multivariable regression analysis was performed to analyze three factors identified as significant (p<.05) on univariate analysis. <br/>RESULT(S): 117 infants were included: 8 infants at 22 weeks, 20 at 23 weeks, 38 at 24 weeks, and 51 at 25 weeks. The rates of survival were 37.5%, 50.0%, 68.4%, and 76.5% at 22, 23, 24, and 25 weeks, respectively. The probability of survival was similar for infants born at 22 and 23 weeks GA and significantly lower than for infants born at 24 and 25 weeks (fig.1). The mean (+/-SD) length of stay in the NICU was 114.6 +/- 33.7 days. The overall prevalence of short-term morbidities was 25.9% for IVH grade III - IV, 5.4% for PVL, 89.9% for BPD, 16.1% for NEC, 40.0% for late-onset sepsis, and 19.3% for ROP requiring treatment. Only 2.7% of infants who survived >=36 weeks (post-menstrual age) had no short-term morbidities. The multivariable regression analysis demonstrated: an increased risk of mortality for every 100g decrease in birth weight (OR=1.97; 95% CI: 1.40 - 1.98; p =.02), an increased risk of mortality for an incomplete course of antenatal corticosteroids (OR=1.58; 95% CI: 1.2 - 1.78; p =.008), and no effect of gender on mortality over time (OR=1.38; 95% CI: 0.8 - 1.68; p=.15). <br/>CONCLUSION(S): ELGA infants from our region faced similarly high rates of mortality and major short-term morbidity compared to other Canadian centers. Infants born at 22 and 23 weeks experienced similar survival trajectories, which should be further explored as it may influence clinical perceptions of viability at 22 weeks. (Figure Presented).
Kis H; Lemyre B; Radonjic A; Feberova J
Paediatrics and Child Health
2019
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/pch/pxz066.129" target="_blank" rel="noreferrer noopener">10.1093/pch/pxz066.129</a>
Pediatric oncology nursing research in low- and middle-income countries
fatigue; stress; human; palliative therapy; priority journal; cancer survival; health care personnel; pain; quality of life; posttraumatic stress disorder; risk factor; low income country; middle income country; cancer incidence; nutrition; caregiver; sepsis; treatment response; infant mortality; geographic distribution; malnutrition; high income country; methodology; nursing care; pediatric oncology nursing; caregiver burden; gross national income; Burkitt lymphoma; lifestyle; alternative medicine; caregiver burnout; cytotoxicity; economic status; immune status; Impact of Events Scale; Kaposi sarcoma; nurse training; nursing practice; nursing science; Southeast Asian; Southern Europe; traditional medicine
Cancer and other non-communicable diseases are a growing public health issue now that infectious disease control (e.g., HIV/AIDS, malaria, and tuberculosis) has made great strides across low- and middle-income countries (L&MIC). The large majority (85%) of children and adolescents with cancer reside in L&MIC where children represent up to 50% of a country's population, and resources are severely limited for the comprehensive cancer care these patients require. Nursing care of these patients and families must be based on research performed in country to account for challenges in access to care and limited resources and opportunities for nursing specialization. Examples of these challenges include cancer stigma, poverty, traditional medicine practices, cultural norms and decision-making hierarchies, limited education opportunities, lack of universal healthcare, and poor transportation infrastructure to access tertiary care. This chapter summarizes the 137 articles in five languages from 2008 to 2018 that communicate nursing research findings pertaining to pediatric oncology issues from L&MIC across all six World Health Organization (WHO) regions. Despite little or no funding, nurses in academic and clinical settings are actively exploring care priorities in their settings, most often (but not limited to) addressing parent coping, nurse and nursing care issues including symptom management (pain and fatigue, especially), and children's quality of life. The nursing research evidence presented here will begin to inform personalized and precision health in L&MIC to ensure that care is culturally acceptable and considers the environment, nursing practice, nursing science, family, lifestyle behaviors, and response to disease and treatment of this large patient population.
Challinor J M; Day S W; Afungchwi G M; Alqudimat M R
Pediatric Oncology
2020
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/978-3-030-25804-7_15" target="_blank" rel="noreferrer noopener">10.1007/978-3-030-25804-7_15</a>
Procedural burden experienced by children with cancer during their terminal hospital admission
acute respiratory failure; adolescent; amputation; article; artificial ventilation; bone marrow biopsy; bone marrow transplantation; brain ventricle peritoneum shunt; cancer palliative therapy; central nervous system tumor; central venous catheter; child; childhood cancer; cohort analysis; craniotomy; debridement; disease burden; excision; fasciotomy; female; heart arrest; heart surgery; hospital admission; human; intestine resection; invasive procedure; laparoscopy; length of stay; leukemia; lobectomy; major clinical study; male; myringotomy; ostomy; pain; priority journal; public health insurance; retrospective study; segmentectomy; sepsis; spine fusion; stem cell transplantation; terminal care; thoracoscopy; thoracotomy; vascular access; ventriculostomy
Background: Children with chronic conditions, including cancer, have been shown to have high-intensity end-of-life care. We assessed the frequency and timing of invasive procedures that children with cancer undergo during their terminal hospital admission (THA).
Corkum K S; Lautz T B; Hebal F N; Rowell E E
Journal of Pediatric Surgery
2019
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jpedsurg.2018.10.007" target="_blank" rel="noreferrer noopener">10.1016/j.jpedsurg.2018.10.007</a>
Clinical and laboratory factors that predict death in very low birth weight infants presenting with late-onset sepsis
Female; Humans; infant; Male; retrospective studies; Intensive Care Units; Comorbidity; Risk Factors; Multivariate Analysis; Sepsis; Neonatal; Newborn; Connecticut; Very Low Birth Weight
BACKGROUND: Late-onset sepsis (LOS) in very low birth weight (VLBW) infants is associated with significant morbidity and mortality. The ability to predict mortality in infants with LOS based on clinical and laboratory factors at presentation of illness remains limited. OBJECTIVES: To identify predictors of sepsis-associated mortality from a composite risk profile that includes demographic data, category of infecting organism, clinical and laboratory data at onset of illness. STUDY DESIGN: Data were collected from VLBW infants with at least 1 episode of LOS admitted to Yale Neonatal Intensive Care Unit from 1989 through 2007. Episodes were categorized as Gram-positive, Gram-negative or fungal. Multivariate logistic regression analysis was used to compare and contrast different types of infections and to assess independent risk factors for death. RESULTS: Four hundred twenty-four cases of LOS were identified in 424 VLBW infants. Of these, 262 (62%) were categorized as Gram-positive, 126 (30%) as Gram-negative and 36 (8%) as fungal. Multivariate analyses revealed that infants with Gram-positive infections had significantly lower odds of death compared to those with Gram-negative (adjusted odds ratio: 0.17; 95% confidence interval: 0.08-0.36) or fungal LOS (adjusted odds ratio: 0.22; 95% confidence interval: 0.07-0.64). Need for intubation, initiation of pressors, hypoglycemia and thrombocytopenia as presenting laboratory signs of infection and necrotizing enterocolitis were independent risk factors for sepsis-related death. CONCLUSIONS: We identified presenting clinical and laboratory factors, including category of infecting organism, which predict the increased risk of LOS-related death. This information can be useful in estimating prognosis shortly after the onset of disease.
2014-02
Levit O; Bhandari V; Li Fang-Yong; Shabanova V; Gallagher PG; Bizzarro MJ
The Pediatric Infectious Disease Journal
2014
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/INF.0000000000000024" target="_blank" rel="noreferrer">10.1097/INF.0000000000000024</a>
Improving cancer care for children in the developing world: Challenges and strategies
Child Care;childhood Cancer; Accreditation; Antineoplastic Agent; Awareness; Cancer Diagnosis; Cancer Recurrence; Cancer Registry; Cancer Research; Cancer Survival; Cancer Therapy; Clinical Effectiveness; Clinical Trial (topic); Cost Effectiveness Analysis; Country Economic Status; Cultural Factor; Delayed Diagnosis; Diagnostic Error; Family Therapy; Health Care Availability; Health Care Cost; Health Care Personnel; Human; Job Change; Medical Education; Medical Technology; Palliative Therapy; Patient Abandonment; Patient Referral; Poverty; Priority Journal; Program Sustainability; Review; Sepsis; Stratification; Toxicity
Cancer is a global health problem particularly in developing countries where the burden of cancer is ever increasing and claiming the lives of about 100,000 children under the age of 15 years every year. Majority of these occur in the Low and Middle Income Countries (LMICs) where 90% of world children live. Contributing factors to this trend is the reduction of communicable diseases and emergence of new infections, improvement of nutrition and socio-economic conditions, industrialization and urbanization. However, due to its complexity, childhood cancer is given the least priority by the governments' funding. The weak health systems, poor and late access to diagnosis and care, fewer numbers of trained health care professionals and lack of cancer drugs are amongst the many challenges faced. A major challenge for the future is extending the work to reach the many children who die without access to cancer treatment and palliation. Given the inequalities in the survival rates of children with cancer there is therefore an urgent need to close the gap between developed and developing countries. Strategies at individual, institutional, country, regional and global levels must be implemented to improve cancer survival and its effects on human suffering. These strategies are able to strengthen the health systems, improve care and research, increase awareness and coordinate training of professionals thus meeting the challenges. Financial support should be an integral part of the strategy as the cost of drugs is often a substantial barrier to treatment of cancer in poor countries. However, in resource-limited settings without specialized services, much can still be done to support and offer curative and palliative treatment. As have been shown for several cancers, life can be extended with low-tech treatment protocols, which are effective at the same time, decrease sepsis and toxicity. The concept of twinning with privileged nations is paramount to the success of any national cancer program. International partnership offers the opportunity to provide expertise, advice, support and transfer technology from established pediatric oncology unit. Their mission is to build capacity for cancer treatment and research with a vision of developing network of dedicated advocates. The LMIC teams must locally drive projects and volunteers and funding organizations can help to make progress possible. This will require a tremendous effort on the part of both high and low-middle-income countries, if we are all to work together to achieve this goal.
Al Lamki Z
Current Pediatric Reviews
2017
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2174/1573396312666161230145417" target="_blank" rel="noreferrer">10.2174/1573396312666161230145417</a>