|Year : 2018 | Volume
| Issue : 4 | Page : 57
Outcomes and prediction
Department of Pediatric, Faculty of Medicine, Public Health and Nursing, Dr. Sardjito Hospital, Universitas Gadjah Mada, Yogyakarta, Indonesia
|Date of Web Publication||28-Dec-2018|
Department of Pediatric, Faculty of Medicine, Public Health and Nursing, Dr. Sardjito Hospital, Universitas Gadjah Mada, Jl. Kesehatan 1, Yogyakarta
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Triasih R. Outcomes and prediction. Pediatr Respirol Crit Care Med 2018;2:57
Understanding the short-term and long-term outcomes of diseases is of importance for clinicians. Moreover, recognizing factors that predict the outcomes may assist the clinicians to make a clinical decision in choosing investigations, providing treatment, and considering ethical issues and economic strategies. In this issue, three articles discussing outcomes of diseases and conditions related to respiratory problems and intensive care for children with different point of views are presented.
One of the significant adverse outcomes of obstructive sleep-disordered breathing (SDB) in children is neurocognitive dysfunction and behavioral problems., This is thought as a result of recurrent nocturnal hypoxia and sleep fragmentation that occur during SDB. In the first article of this issue, Walter and Horne present a comprehensive review, compiling recent studies evaluating the effect of SDB in the child brain, which used near-infrared spectroscopy or functional magnetic resonance imaging of the brain. From a limited number of studies, it was shown that children with SDB are better in maintaining cerebral oxygenation than adults, but SDB leads to adverse outcomes on the autonomic control, respiration, behavior, and neurocognition.
Lung is one of the major organs affected in sickle cell anemia (SCA). Children with SCA are prone to have recurrent and chronic pulmonary diseases, which cause lung damage and may result in long-term outcomes of abnormalities of the lung function. In this issue, Kuti and Adegoke reported that restrictive lung function abnormalities were more common among Nigerian children with SCA compared to healthy children. They also documented that children who were at adolescent age and had previous acute chest syndrome are more likely to have the lung function abnormalities. For clinicians, information of at which age is the lung function impairments is started is also important; hence, we can start aggressive treatment at that age to prevent chronic lung damage.
The short-term outcomes of children admitted to pediatric intensive care unit (PICU) are varied, but they are at high risk for mortality. A simple and objective tool to characterize the disease severity at admission and to predict mortality among these children is needed. The ideal tool should be simple, easy to use, low cost, easy to reproduce, minimally invasive, and accurate and does not require sophisticated tool. The Pediatric Risk of Mortality (PRISM) III is one of the scoring systems that has been used widely and had a good prediction for mortality. Nevertheless, this scoring system needs arterial blood gas analysis as one of the variables, which is invasive and sometimes is not feasible to be performed in critically ill patients. Ruangnapa et al. developed and validated a modified PRISM III score, by removing blood gas analysis and added a number of clinical features. This modified scoring system showed as good as the PRISM III performance in predicting mortality in PICU, not only in the first 2 days of hospitalization but also in 7-day mortality and overall mortality. The more simple and less invasive of the modified PRISM III will be more feasible for resource-limited settings such as in many countries in Asia.
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