Suchergebnisse

ABSTRACT
ObjectiveTo identify children with a Life-Limiting Condition (LLC) who have had an admission to a Paediatric Intensive Care Unit (PICU) in England and their outcomes.
ApproachData for all children who had had a PICU admission in the UK between 1st Jan 2004 and 31st March 2015 were identified from the PICANet dataset.
Linkage to inpatient Hospital Episode Statistics (HES) data was undertaken by the NHS Health and Social Care Information Centre for all children who had been resident in England. Their standard algorithm using NHS number, date of birth, sex and postcode was used. All inpatient HES episodes from the financial years 1997/98-2014/15 were received.
Although the data quality is high in the PICANet dataset, comorbidities are variably coded therefore identifying whether a child has a LLC or not is not possible. A previously developed ICD10 coding framework was used to identify individuals with one or more of these LLC codes in the inpatient HES dataset.
ResultsA total of 199,548 PICU admissions in the UK for 135,759 individuals occurred during the time period of the study. Data for 43,565 admissions (32,025 individuals) were excluded due to not having been resident in England or poor quality demographic data.
Data on 103,734 individuals (155,983 admissions) were sent for linkage. Successful linkage occurred in 102,722 individuals (99.4%). Individuals who could not be linked were excluded from the analysis.51.0% of these children had a LLC and these children accounted for 62.7% of the PICU admissions.
The crude PICU death rate in the children with a LLC was 5.0% (n=4826) compared to 3.1% (n=1786) in those without a LLC. The OR of death in a model adjusted for diagnostic group, sex, age, and expected risk of mortality for children with a LLC was 2.11 (95%CI 1.97-2.27).
ConclusionsChildren with a LLC account for a large proportion of all PICU admissions in England. Although only one in twenty of these children die in PICU, as death may be expected in this population of children more integration of specialist palliative care with PICU services may allow more choice for children and families.

ABSTRACT
AimTo identify characteristics of children who died in the community rather than hospital.
MethodsAll children admitted to a PICU in England or Wales (1st Jan 2004 and 31st Dec 2014) were identified in the PICANet dataset. Linkage to death certificate data was available up to the end of 2014.Place of death was categorised as hospital (hospital or PICU) or community (hospice, home or other) for multivariable logistic modelling.
ResultsThe cohort consisted of 110,328 individuals. 4760 deaths occurred on first admission in PICU (excluded from analyses) and 7709 deaths occurred after first discharge from PICU. Overall 41.2% of these deaths occurred in hospital, 32.5% in PICU, 16.6% at home, 8.7% in hospice and 0.7% elsewhere. Deaths in hospital (incl PICU) decreased from more 83.8% in 2004 to 68.1% in 2014. 852 (0.8%) of children were discharged to palliative care.Children discharged to palliative care were 8.4 times more likely to die in the community (OR 8.36 95%CI (6.76-10.34)). Children in all older age groups were significantly more likely to die outside hospital than the under 1s.Children from a South Asian background (OR 0.48 95%CI (0.36-0.58)) and those living in the most deprived categories were significantly less likely to die outside the hospital.
ConclusionsA large proportion of children dying after discharge from PICU continue to die in hospital. More involvement of palliative care at the point of discharge has the potential to offer choice around place of care and death for these children and families.

Background: Acrylamide is a common dietary exposure that crosses the human placenta. It is classified as a probable human carcinogen, and developmental toxicity has been observed in rodents. Objectives: We examined the associations between prenatal exposure to acrylamide and birth outcomes in a prospective European mother–child study. Methods: Hemoglobin (Hb) adducts of acrylamide and its metabolite glycidamide were measured in cord blood (reflecting cumulated exposure in the last months of pregnancy) from 1,101 singleton pregnant women recruited in Denmark, England, Greece, Norway, and Spain during 2006–2010. Maternal diet was estimated through food-frequency questionnaires. Results: Both acrylamide and glycidamide Hb adducts were associated with a statistically significant reduction in birth weight and head circumference. The estimated difference in birth weight for infants in the highest versus lowest quartile of acrylamide Hb adduct levels after adjusting for gestational age and country was –132 g (95% CI: –207, –56); the corresponding difference for head circumference was –0.33 cm (95% CI: –0.61, –0.06). Findings were similar in infants of nonsmokers, were consistent across countries, and remained after adjustment for factors associated with reduced birth weight. Maternal consumption of foods rich in acrylamide, such as fried potatoes, was associated with cord blood acrylamide adduct levels and with reduced birth weight. Conclusions: Dietary exposure to acrylamide was associated with reduced birth weight and head circumference. Consumption of specific foods during pregnancy was associated with higher acrylamide exposure in utero. If confirmed, these findings suggest that dietary intake of acrylamide should be reduced among pregnant women. ; The NewGeneris (Newborns and Genotoxic exposure risks) study was funded by the European Union (EU Contract FOOD-CT-2005-016320). The study was also supported by grants obtained locally, including the Swedish Cancer and Allergy Foundation and the Swedish Research Council Formas, the National Institute for Health Research, UK (programme grant RP-PG-0407-10044), the Norwegian Ministry of Health, the Norwegian Ministry of Education and Research, the Norwegian Research Council/FUGE (grant 151918/S10), the EU funded HiWATE (contract Food-CT-2006-036224), the U.S. National Institutes of Health (NIH)/National Institute of Environmental Health Sciences (contract NO-ES-75558), and the U.S. NIH/National Institute of Neurological Disorders and Stroke (grant 1 UO1 NS 047537-01). M.P. holds a Juan de la Cierva postdoctoral fellowship awarded from the Spanish Ministry of Science and Innovation (JCI-2011-09479)