Data on effective outcomes of child sepsis survival are scarce in low- and middle-income countries

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In children, sepsis is a leading cause of death and illness in low- and middle-income countries (Low and middle income countries – LMIC), Where there is a huge burden of infectious diseases. Despite the lack of resources, adapting to protocol-based care has reduced sepsis-related deaths, but surviving pediatric patients are still at risk for poorly functioning outcomes. Functional conditions include the ability to perform daily life activities to meet basic needs and maintain health, including mainly physical, cognitive, psychological and social activities.

In a recent article published in the journal Frontiers in Pediatrics, Researchers in India have concluded that research on these results is still very limited in LMIC. The aim of the study was to review the literature on the effective outcomes of pediatric sepsis after discharge from the Pediatric Intensive Care Unit (PICU) and to discuss the effects for patients in this region.

Learn more: Studies show that sepsis and septic shock are more prevalent among children in Brazil

Sepsis

Method

From January 2005 to November 2021, major electronic medical databases were analyzed for relevant literature, including Medline (via PubMed), Embass, CINAHL, and Google Scholar Databases. The main focus of the study was sepsis survivors at LMIC.

Observational studies that reported functional or quality of life (QOL) results in children during discharge and subsequent follow-up (1, 3, 6, and 12 months). Studies should only include children (age group> 1 month to <18 years) or reported separately for children (if adults and children are the study population). Only mortality, unpublished data, and studies not published in English were excluded. In summary, the results included reduced functional or quality of life (QOL) results during follow-up or recovery, and the prevalence of survival with changes over time, and these results were compared with other patient groups.

Researchers have followed the PRISMA guidelines for scoping review (PRISM-ScR).

The result

Eight articles published since 2013 and reporting data on the functional outcomes of 2,915 children were included (53% were male and 56.6% had congenital diseases). The children ranged in age from 1 month to 18 years. The studies were conducted in the following countries: United States (n = 6), Canada (n = 1) and India (n = 1). All studies were integrated, classified as both probabilistic (n = 5) and previous (n = 3) and second level of evidence.

Obstacles that affect the physical, cognitive, psychological and social functions of children after discharge have been reported. The overall disability reported by the researchers ranged from 23 to 50% during hospital discharge or within 28 days. Residual disabilities were reported in follow-up with an overall trend towards improvement at 1, 3, 6, and 12 months. Failure to restore primary health-related quality of life (HRQL) in follow-up has been observed in one-third of survivors. Organ dysfunction scores such as pSOFA, PeLOD, vasoactive inotropes scores, neurological events, need for immunocompromised status, cardiopulmonary resuscitation, and extracorporeal membrane oxygenation were associated with poorly functional outcomes.

Conclusion

According to researchers, there is limited data on long-term outcomes in children after serious illness. In LMIC, post-discharge mortality rates may exceed hospital-deaths and are not often reported. Losing a follow-up case exacerbates this problem. Thus, it is crucial to select an appropriate outcome measure to evaluate the suitability of an intervention in a given setting. Original results sets specifically designed for LMIC may be needed to eliminate inconsistencies in reported results and improve quality and relevance for these sites.

In the article, researchers suggest that after hospital discharge for sepsis, the focus should be on management:

  • Identify new physical, mental and cognitive problems and make appropriate referrals;
  • Review and manage illness and long-term treatment;
  • Identify treatable conditions that require hospitalization.

The authors recommend ongoing outpatient assessment and treatment of all pediatric sepsis survivors for at least the first three months after discharge from the hospital, with particular focus on adolescents, hospitalized over one week, immunocompromised, and septic shock patients. . Furthermore, they suggest that in a small subgroup with chronic disease before sepsis and those who experience further deterioration, relief and symptomatic management may be considered.

Also read: The risk of early neonatal sepsis in low-risk infants

Comments

Sepsis is one of the major risk factors Delirium In critically ill patients including children. In the 2018 PADIS Guide (2018 Clinical Practice Guidelines for Prevention and Management of Adult Patient Pain, Excitement / Relaxation, Delirium, Stuttering and Sleep Disruption in ICU) Gives Society of Critical Care Medicine (SCCM)), Devlin and colleagues describe that delirium can lead to long-term cognitive outcomes, even three months to a year after discharge from the hospital. In the case of children, the latest PANDEM guidelines (2022 SCCM Clinical Practice Guidelines on the Prevention and Management of Pain, Movement, Neuromuscular Blockage and Delirium in Critically Ill Pediatric Patients Considering ICU Environment and Early Mobility), The relationship between that quoted by Smith and Al Delirium And the long-term outcomes of pediatric patients, such as cognitive or executive dysfunction, psychological recovery, and post-traumatic symptom pediatric intensive care are a highly relevant topic for future research.

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#Rabikumar N, Shankar J, Das RR. Effective Outcomes of Pediatric Sepsis Survivors: A Scoping Review and Discussion of Impact for Lower- and Middle-Income Countries. Pediatric front. 2022; 10: 762179. Published March 20, 2022 8. doi: 10.3389 / fped.2022.762179 # Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation / sedation, delirium, restlessness, and sleep disturbances in adult patients in ICU. Crete Care Med. 2018; 46 (9): e825-e873. doi: 10.1097 / CCM.0000000000003299 # Smith HAB, Besunder JB, Betters KA, et al. 2022 Society of Critical Care Medicine Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium Considering the ICU environment and early mobility of critically ill pediatric patients. Pediatric Crit Care Med. 2022; 23 (2): e74-e110. doi: 10.1097 / PCC.000000000000002873

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