title: Paediatric oncology and intensive care treatments: changing trends.
abstract: OBJECTIVE
  To review the outcome of patients with childhood malignancy requiring intensive care treatment and to assess whether there is any secular trend for improved outcome.
  
  
  METHODS
  Retrospective chart reviews of 74 consecutive admissions to a paediatric intensive care unit from a regional paediatric oncology centre between 1990 and 1997. During the same period there were 6419 admissions to the oncology unit, 814 of whom were new cases.
  
  
  RESULTS
  The overall survival at discharge from the intensive care unit was 49 of 74. Patients with either systemic or respiratory infection requiring ventilation had the poorest survival (13 of 31) whereas postoperative patients had the best survival (15 of 15). However, patients with respiratory or systemic infection who required inotropic support with more than three agents all died compared with about one quarter of those needing no inotrope. All patients with systemic or respiratory infective illness were neutropenic and positive microbiological identification was possible in 13 of 21 and five of 18, respectively. Non-survivors had a higher mean acute physiology and chronic health evaluation system (APACHE-II) score than survivors (24.2 v 15.94, respectively) but no patient with a score of > 27 survived.
  
  
  CONCLUSIONS
  Compared with previous series, there has been a great improvement in survival of oncology patients admitted to the intensive care unit especially those with either systemic or respiratory infection needing ventilation. Full intensive care treatment should be provided for these patients.
authors.affiliation: Department of Intensive Care, Manchester Children's Hospital, Pendlebury, Manchester M27 4HA, UK.
authors.forename: I N
authors.initials: IN
authors.lastname: Keengwe
authors.forename: F
authors.initials: F
authors.lastname: Stansfield
authors.forename: O B
authors.initials: OB
authors.lastname: Eden
authors.forename: N D
authors.initials: ND
authors.lastname: Nelhans
authors.forename: O R
authors.initials: OR
authors.lastname: Dearlove
authors.forename: A
authors.initials: A
authors.lastname: Sharples
mesh_terms: D000293:Adolescent; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data* / Q000639:trends; D004198:Disease Susceptibility; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy*; D009894:Opportunistic Infections / Q000401:mortality; D012041:Regional Medical Programs; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
chemical_list: D002316:Cardiotonic Agents