Deprivation, ethnicity and prematurity in infant respiratory failure in PICU in the UK

O’Donnell,; Parslow, Roger C; Draper, Elizabeth S

doi:10.1111/j.1651-2227.2010.01803.x

Cited by 28 publications

(26 citation statements)

References 14 publications

(20 reference statements)

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“…The increased odds of mortality remained, even after adjusting for the presence of high-risk conditions. Previous studies have also identified an increased risk of death in children from an Asian ethnic group following PICU admission [39,40]. The type and severity of comorbidities could be different in children from non-majority ethnic groups.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and mortality risk of children with life-threatening influenza infection admitted to paediatric intensive care in England 2003–2015

Hardelid

Kapetanstrataki

Norman

et al. 2018

Respiratory Medicine

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Section: Discussionmentioning

confidence: 99%

Characteristics and mortality risk of children with life-threatening influenza infection admitted to paediatric intensive care in England 2003–2015

Hardelid

Kapetanstrataki

Norman

et al. 2018

Respiratory Medicine

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“…As the live birth rate increased by approximately 15% in 10 years in England and Wales, greater numbers of infants were at increased risk of respiratory compromise with viral or bacterial infections 19. Much of the growth in birth rates over this period was to mothers born outside the UK, who as a percentage of all births increased from 20% to 25% 20.…”

Section: Discussionmentioning

confidence: 99%

Increasing admissions to paediatric intensive care units in England and Wales: more than just rising a birth rate

et al. 2017

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An additional increase in the number of children from England and Wales admitted to PICU from 2009 onwards is not explained by a rising child population or an increased risk of admission among South Asian children. There was no evidence of a reduction in the admission criteria to PICUs. Given healthcare funding in England and Wales, continued increases would present a challenging prospect for both providers and commissioners of these services.

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“…Social risk represents a main reason for hospitalization and occasionally for more frequent therapeutic interventions, as reported for many diseases, including bronchiolitis [8,9]. Spencer et al [10] reported that children living in more socially deprived areas appeared to be more than 1.5 times as likely to be admitted and to require a medical intervention (i.e.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs?

et al. 2010

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BackgroundBronchiolitis guidelines suggest that neither bronchodilators nor corticosteroids, antiviral and antibacterial agents should be routinely used. Although recommendations, many clinicians persistently prescribe drugs for bronchiolitis.Aim of the studyTo unravel main reasons of pediatricians in prescribing drugs to infants with bronchiolitis, and to possibly correlate therapeutic choices to the severity of clinical presentation. Also possible influence of socially deprived condition on therapeutic choices is analyzed.MethodsPatients admitted to Pediatric Division of 2 main Hospitals of Naples because of bronchiolitis in winter season 2008-2009 were prospectively analyzed. An RDAI (Respiratory Distress Assessment Instrument) score was assessed at different times from admission. Enrolment criteria were: age 1-12 months; 1st lower respiratory infection with cough and rhinitis with/without fever, wheezing, crackles, tachypnea, use of accessory muscles, and/or nasal flaring, low oxygen saturation, cyanosis. Social deprivation status was assessed by evaluating school graduation level of the origin area of the patients. A specific questionnaire was submitted to clinicians to unravel reasons of their therapeutic behavior.ResultsEighty-four children were enrolled in the study. Mean age was 3.5 months. Forty-four per cent of patients presented with increased respiratory rate, 70.2% with chest retractions, and 7.1% with low SaO2. Mean starting RDAI score was 8. Lung consolidation was found in 3.5% on chest roentgenogram. Data analysis also unraveled that 64.2% matched clinical admission criteria. Social deprivation status analysis revealed that 72.6% of patients were from areas "at social risk". Evaluation of length of stay vs. social deprivation status evidenced no difference between "at social risk" and "not at social risk" patients. Following therapeutic interventions were prescribed: nasal suction (64.2%), oxygen administration (7.1%), antibiotics (50%), corticosteroids (85.7%), bronchodilators (91.6%). Statistically significant association was not found for any used drug with neither RDAI score nor social deprivation status. The reasons of hospital pediatricians to prescribe drugs were mainly the perception of clinical severity of the disease, the clinical findings at chest examination, and the detection of some improvement after drug administration.ConclusionsWe strongly confirm the large use of drugs in bronchiolitis management by hospital pediatricians. Main reason of this wrong practice appears to be the fact that pediatricians recognize bronchiolitis as a severe condition, with consequent anxiety in curing so acutely ill children without drugs, and that sometimes they feel forced to prescribe drugs because of personal reassurance or parental pressure. We also found that social "at risk" condition represents a main reason for hospitalization, not correlated to clinical severity of the disease neither to drug prescription. Eventually, we suggest a "step-by-step" strategy to rich a more evidence based approach...

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Deprivation, ethnicity and prematurity in infant respiratory failure in PICU in the UK

Cited by 28 publications

References 14 publications

Characteristics and mortality risk of children with life-threatening influenza infection admitted to paediatric intensive care in England 2003–2015

Characteristics and mortality risk of children with life-threatening influenza infection admitted to paediatric intensive care in England 2003–2015

Increasing admissions to paediatric intensive care units in England and Wales: more than just rising a birth rate

Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs?

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