title: Fluid balance of pediatric hematopoietic stem cell transplant recipients and intensive care unit admission.
abstract: Fluid administration is essential in patients undergoing hematopoietic stem cell transplant (HSCT). Admission to pediatric intensive care unit (PICU) is required for 11-29% of pediatric HSCT recipients and is associated with high mortality. The objective of this study was to determine if a positive fluid balance acquired during the HSCT procedure is a risk factor for PICU admission. The medical records of 87 consecutive children who underwent a first HSCT were reviewed retrospectively for the following periods: from admission for HSCT to PICU admission for the first group (PICU group), and from admission for HSCT to hospital discharge for the second group (non-PICU group). Fluid balance was determined on the basis of weight gain (WG) and fluid overload (FO). PICU group consisted of 19 patients (21.8%). Among these, 13 (68.4%) developed>or=10% WG prior to PICU admission compared with 15 (22.1%) in the non-PICU group (p<0.001). Thirteen patients (68.4%) developed>or=10% FO prior to PICU admission compared with 31 (45.6%) in the non-PICU group (p=0.075). Following multivariate analysis, >or=10% WG (p=0.018) and cardiac dysfunction on admission for HSCT (p=0.036) remained independent risk factors for PICU admission. Smaller children (p=0.033) and patients with a twofold increase in serum creatinine (p=0.026) were at risk of developing>or=10% WG. This study shows that WG is a risk factor for PICU admission in pediatric HSCT recipients. Further research is needed to better understand the pathophysiology of WG in these patients and to determine the impact of WG prevention on PICU admission.
authors.affiliation: Division of Nephrology, Department of Pediatrics, Hôpital Sainte-Justine, Université de Montréal, 3175 Chemin de la Côte Sainte-Catherine, H3T 1C5, Montréal, QC, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Benoit
authors.forename: Véronique
authors.initials: V
authors.lastname: Phan
authors.forename: Michel
authors.initials: M
authors.lastname: Duval
authors.forename: Martin
authors.initials: M
authors.lastname: Champagne
authors.forename: Catherine
authors.initials: C
authors.lastname: Litalien
authors.forename: Aicha
authors.initials: A
authors.lastname: Merouani
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007668:Kidney / Q000503:physiopathology; D008297:Male; D010343:Patient Admission; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects; D014883:Water-Electrolyte Imbalance / Q000209:etiology* / Q000503:physiopathology; D015430:Weight Gain