title: Stress induced gastrointestinal bleeding in a pediatric intensive care unit: which risk factors should necessitate prophilaxis?
abstract: BACKGROUND
  The aim of this study was to determine the frequency and the risk factors of stress induced gastrointestinal bleeding (GIB) in critically ill children, and to investigate the effect of prophilaxis. The setting was a 14-beded, tertiary care PICU.
  
  
  METHODS
  Records of 182 children admitted consecutively from December 2012 to May 2013 were retrospectively reviewed. 136 patients were eligible. The age ranged from 40 days to 18 years. Diagnosis, demographic data, risk factors, administration of prophilaxis, drugs used in medication, prescence and degree of GIB and complications were recorded.
  
  
  RESULTS
  The male-female ratio was 1.3. Mean age was 5.9. Mean PRISM III score was 12.2 and 49.3% had PRISM Score ≥10. Most frequent diagnosis was infectious diseases. Sixtyone (44.9%) children received prophylaxis in which antacids was used in 28 (45.9%), sucralfate in 18 (29.5%), proton pomp inhibitors (PPIs) in 51 (83.6%) and 5 (8.2%) received H2 reseptor antagonist. The incidence of GIB was 15.4% (N.=21), in which 66.7% (N.=14) were mild, 23.8% (N.=5) were moderate, 4.8% (N.=1) was significant and 4.8% (N.=1) was massive. In children who received prophylaxis 17 (27.9%) cases developed GIB. Mechanical ventilation was found to be the only risk factor significantly associated with stress induced GIB. Also; mechanical ventilation and trauma was strongly significant (P<0.001) and coagulopathy/thrombocytopenia, PRISM III ≥10, renal and hepatic failure, hypotension, and heart failure/arrhythmia was found to be associated with the development of GIB in critically ill children (P<0.05).
  
  
  CONCLUSIONS
  GIB is a serious concern for PICU clinicians and intensivists are confused about the conflicting evidence supporting prophilaxis. We believe that prophylaxis could be beneficial for mechanically ventilated children. Also trauma, coagulopathy/thrombocytopenia, PRISM III≥10, renal and hepatic failure, hypotension, and heart failure/arrhythmia must be kept in mind as risk factors requiring attention in PICU setting.
authors.affiliation: Pediatric Intensive Care Unit Ankara Children's Hematology Oncology Education and Research Hospital, Ankara, Turkey - sanliay@yahoo.com.
authors.forename: Sanliay
authors.initials: S
authors.lastname: Sahin
authors.forename: Ganime
authors.initials: G
authors.lastname: Ayar
authors.forename: Mutlu U
authors.initials: MU
authors.lastname: Yazici
authors.forename: Tulin
authors.initials: T
authors.lastname: Koksal
authors.forename: Alkin O
authors.initials: AO
authors.lastname: Akman
authors.forename: Razin C
authors.initials: RC
authors.lastname: Gunduz
authors.forename: Ceyda T
authors.initials: CT
authors.lastname: Kirsacoglu
authors.forename: Fulya
authors.initials: F
authors.lastname: Gulerman
mesh_terms: D000293:Adolescent; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000897:Anti-Ulcer Agents