New morbidity following critical illness in Latin American children under 18 years old with lower respiratory tract infection

Abstract

Acquisition of new morbidity (NM) has become a key clinical outcome measure after pediatric critical illness. Data on Latin American children are still scarce. 

Objective: to analyze the development of new morbidities acquired after hospitalization due to lower respiratory tract infection (LRTI) in pediatric intensive care units (PICU). 

Patients and Method: we included patients from 35 PICUs from 8 countries, aged 0 to 18 years with a diagnosis of LRTI, discharged alive, registered between April 2018 and September 2019, and who required some type of ventilatory support (high-flow system, noninvasive ventilation or invasive ventilation), included in the LARed Network registry, which includes the Functional Status Scale (FSS) validated in the pediatric population, which assesses functional status in six domains: mental status, sensory, communication, motor skills, feeding, and respiratory status. NM considered LRTI after hospitalization and was defined as an increase of ≥ 3 points in the FSS. 

Results: Of 3280 children with LRTI, 85 (2.6%) developed NM, associated with diagnoses of sepsis and acute respiratory distress syndrome (ARDS), pneumococcal or adenovirus infection, healthcare-associated infections (HAIs), and invasive mechanical ventilation. Adenovirus infection, ARDS, and HAIs were independently associated with NM. 

Conclusions: We observed that the development of NM at PICU discharge is infrequent but is associated with modifiable risk factors. These data define certain risk groups for future interventions and initiatives to improve the quality of care.