title: Development of a PICU in Nepal: the experience of the first year.
abstract: OBJECTIVE
  Analysis of hospitalization data can help elucidate the pattern of morbidity and mortality in any given area. Little data exist on critically ill children admitted to hospitals in the resource-limited nation of Nepal. We sought to characterize the profile, management, and mortality of children admitted to one PICU.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  A newly established PICU in Nepal.
  
  
  METHODS
  All patients between the ages of 0 to 16 years admitted to the PICU from July 2009 to July 2010.
  
  
  METHODS
  None.
  
  
  RESULTS
  In 12 months, 126 children were admitted to the PICU including 43% female patients. Sixty-three percent were under 5 years. Twenty-nine percent came from tertiary care hospitals and 38% from rural areas outside Kathmandu. Only 18% were transported by ambulance. Median distance travelled to be admitted was 30 km (interquartile range, 10-193). Highest number of admissions were in spring (40%) followed by summer (25%). Almost half were admitted for shock (45%), particularly septic shock (30%). The second commonest reason for admission was neurologic etiologies (15%). Neonatal admissions were also significant (19%). Mortality was 26% and was significantly associated with septic shock (p < 0.01), mechanical ventilation (p < 0.01), and multiple organ dysfunction (< 0.05). Almost one third of patients required mechanical ventilation; median duration was 4 days (interquartile range, 2-8). Mean length of stay in the hospital was 6.2 days (± 5.3) and median 4 (interquartile range, 2.5-9.0). Median Pediatric Risk of Mortality II score for nonsurvivors was 12 (interquartile range, 7-21), and median Pediatric Index of Mortality II for nonsurvivors was 10 (interquartile range, 3-32).
  
  
  CONCLUSIONS
  Within a short time of opening, the PICU has been seeing significant numbers of critically ill children. Despite adverse conditions and limited resources, survival of 75% is similar to many units in developing nations. Sepsis was the most common reason for PICU admission and mortality.
authors: 1Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL. 2Department of Pediatrics, Patan Academy Health Sciences, Kathmandu, Nepal. 3Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL.
authors: Sangita
authors: S
authors: Basnet
authors: Shrijana
authors: S
authors: Shrestha
authors: Amrit
authors: A
authors: Ghimire
authors: Dipsal
authors: D
authors: Timila
authors: Jeena
authors: J
authors: Gurung
authors: Utkarsha
authors: U
authors: Karki
authors: Neelam
authors: N
authors: Adhikari
authors: Jennifer
authors: J
authors: Andoh
authors: Janak
authors: J
authors: Koirala
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D008297:Male; D009390:Nepal; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome