title: The oral health of critically ill children: an observational cohort study.
abstract: OBJECTIVE
  This study will describe the oral health status of critically ill children over time spent in the paediatric intensive care unit, examine influences on the development of poor oral health and explore the relationship between dysfunctional oral health and healthcare-associated infections.
  
  
  BACKGROUND
  The treatment modalities used to support children experiencing critical illness and the progression of critical illness may result in dysfunction in the oral cavity. In adults, oral health has been shown to worsen during critical illness as well as influence systemic health.
  
  
  METHODS
  A prospective observational cohort design was used.
  
  
  METHODS
  The study was undertaken at a single tertiary-referral Paediatric Intensive Care Unit. Oral health status was measured using the Oral Assessment Scale and culturing oropharyngeal flora. Information was also collected surrounding the use of supportive therapies, clinical characteristics of the children and the occurrence of healthcare-associated infections.
  
  
  RESULTS
  Of the 46 participants, 63% (n = 32) had oral dysfunction and 41% (n = 19) demonstrated pathogenic oropharyngeal colonisation during their critical illness. The potential systemic pathogens isolated from the oropharynx and included Candida sp., Staphylococcus aureus, Haemophilus influenzae, Enterococcus sp. and Pseudomonas aeruginosa. The severity of critical illness had a significant positive relationship (p < 0·05) with pathogenic and absent colonisation of the oropharynx. Sixty-three percent of healthcare-associated infections involved the preceding or simultaneous colonisation of the oropharynx by the causative pathogen.
  
  
  CONCLUSIONS
  This study suggests paediatric oral health to be frequently dysfunctional and the oropharynx to repeatedly harbour potential systemic pathogens during childhood critical illness.
  
  
  CONCLUSIONS
  Given the frequency of poor oral health during childhood critical illness in this study and the subsequent potential systemic consequences, evidence based oral hygiene practices should be developed and validated to guide clinicians when nursing critically ill children.
authors.affiliation: School of Nursing, Queensland University of Technology, Paediatric Intensive Care Unit, Royal Children's Hospital, Herston, Qld, Australia. amanda_ullman@health.qld.gov.au
authors.forename: Amanda
authors.initials: A
authors.lastname: Ullman
authors.forename: Debbie
authors.initials: D
authors.lastname: Long
authors.forename: Peter
authors.initials: P
authors.lastname: Lewis
mesh_terms: D002648:Child; D015331:Cohort Studies; D016638:Critical Illness; D006801:Humans; D015278:Intensive Care Units, Pediatric; D009909:Oral Health