Retrospective cross-sectional review of survival rates in critically ill children admitted to a combined paediatric/neonatal intensive care unit in Johannesburg, South Africa, 2013-2015.
Report on survival to discharge of children in a combined paediatric/neonatal intensive care unit (PNICU).



Retrospective cross-sectional record review.



All children (medical and surgical patients) admitted to PNICU between 1 January 2013 and 30 June 2015.



Primary outcome-survival to discharge. Secondary outcomes-disease profiles and predictors of mortality in different age categories.



There were 1454 admissions, 182 missing records, leaving 1272 admissions for review. Overall mortality rate was 25.7% (327/1272). Mortality rate was 41.4% (121/292) (95% CI 35.8% to 47.1%) for very low birthweight (VLBW) babies, 26.6% (120/451) (95% CI 22.5% to 30.5%) for bigger babies and 16.2% (86/529) (95% CI 13.1% to 19.3%) for paediatric patients. Risk factors for a reduced chance of survival to discharge in paediatric patients included postcardiac arrest (OR 0.21, 95% CI 0.09 to 0.49), inotropic support (OR 0.085, 95% CI 0.04 to 0.17), hypernatraemia (OR 0.16, 95% CI 0.04 to 0.6), bacterial sepsis (OR 0.32, 95% CI 0.16 to 0.65) and lower respiratory tract infection (OR 0.54, 95% CI 0.30 to 0.97). Major birth defects (OR 0.44, 95% CI 0.26 to 0.74), persistent pulmonary hypertension of the new born (OR 0.44, 95% CI 0.21 to 0.91), metabolic acidosis (OR 0.23, 95% CI 0.12 to 0.74), inotropic support (OR 0.23, 95% CI 0.12 to 0.45) and congenital heart defects (OR 0.29, 95% CI 0.13 to 0.62) predicted decreased survival in bigger babies. Birth weight (OR 0.997, 95% CI 0.995 to 0.999), birth outside the hospital (OR 0.21, 95% CI 0.05 to 0.84), HIV exposure (OR 0.54, 95% CI 0.30 to 0.99), resuscitation at birth (OR 0.49, 95% CI 0.25 to 0.94), metabolic acidosis (OR 0.25, 95% CI 0.10 to 0.60) and necrotising enterocolitis (OR 0.23, 95% CI 0.12 to 0.46) predicted poor survival in VLBW babies.



Ongoing mortality review is essential to improve provision of paediatric critical care.
Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Wits- UQ Critical Care Infection Collaboration, Johannesburg, South Africa.
Daynia E
DE
Ballot
Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Victor A
VA
Davies
Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Peter A
PA
Cooper
Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Tobias
T
Chirwa
Faculty of Health Sciences, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
Andrew
A
Argent
Wits- UQ Critical Care Infection Collaboration, Johannesburg, South Africa Department of Internal Medicine, Division of Critical Care and Pulmonology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Mervyn
M
Mer
D001724:Birth Weight; D002423:Cause of Death; D002648:Child; D016638:Critical Illness / Q000401:mortality*; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends*
HEALTH SERVICES ADMINISTRATION & MANAGEMENT; NEONATOLOGY