Epidemiology and peculiarities of pediatric multiple organ dysfunction syndrome in New Delhi, India.
OBJECTIVE
Most pediatric studies on multiple organ dysfunction syndrome derive from developed countries. There is little information regarding the etiologies and outcomes of multiple organ dysfunction syndrome in critically ill children from developing countries. The objective of this study was to examine the differences in epidemiology of multiple organ dysfunction syndrome and the relationship of the Organ Failure Index (OFI) to outcomes from multiple organ dysfunction syndrome in critically ill children from a developing country.


METHODS
Prospective observational study.


METHODS
A 10-bed tertiary pediatric intensive care unit.


METHODS
A total of 1722 children (1 month to 16 years of age) admitted to a pediatric intensive care unit during the study period from January 1998 to June 2003.


METHODS
None.


RESULTS
Of all the patients admitted to the pediatric intensive care unit, 184 patients (10.6%) had persistent multiple organ dysfunction syndrome. During the study period 136 deaths (7.9%) occurred in the ICU. Multiple organ dysfunction syndrome was associated with nearly half of these deaths, 67/136 (49.2%). Overall survival of all patients with persistent multiple organ dysfunction syndrome was 64% (117/184). In addition to sepsis, falciparum malaria, fulminant hepatic failure, dengue shock syndrome, severe poisonings, post cardiopulmonary bypass, and post cardiac arrest were significant antecedents of multiple organ dysfunction syndrome . Patients with OFI scores of 2, 3, 4-5, and >5 exhibited mortalities of 9%, 29%, 58%, and 100% respectively.


CONCLUSIONS
In addition to "traditional" sepsis, common etiologies of multiple organ dysfunction syndrome included falciparum malaria, fulminant hepatic failure, and dengue shock syndrome. In developing countries like India, multiple organ dysfunction syndrome carries a significant risk of mortality which is directly related to the OFI.
Khilnani
Praveen
P
Pediatric Critical Care Services, Institute of Pediatrics, Max Health Care Hospitals Saket, New Delhi, India. pkhilnani@vsnl.com
Sarma
Devajit
D
Zimmerman
Jerry
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D015278:Intensive Care Units, Pediatric; D016778:Malaria, Falciparum / Q000150:complications; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D019595:Severe Dengue / Q000150:complications; D012720:Severity of Illness Index; D016896:Treatment Outcome