Prevalence of, and risk factors for, upper gastrointestinal tract bleeding in critically ill pediatric patients

Cochran, Emily B.; Phelps, Stephanie J.; Tolley, Elizabeth A.; Stidham, Gregory L.

doi:10.1097/00003246-199211000-00007

Cited by 50 publications

(24 citation statements)

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“…8 A prospective comparative study conducted in a PICU in a tertiary care, university-based facility in the United States found a 25% prevalence of UGIB. 5 The overall mortality of patients in this study was 4.8%, with a significantly higher mortality seen in patients with UGIB than in those without (16% vs 1.3%; P ϭ .0001). 5 A prospective Canadian study conducted in a PICU within a university hospital, detected UGIB in 63 of 984 children (6.4%), but only 0.4% had a clinically significant outcome, for example, hypotension, death, or transfusion occurring within 24 hours after the bleeding episode.…”

Section: Epidemiologymentioning

confidence: 57%

“…5 The overall mortality of patients in this study was 4.8%, with a significantly higher mortality seen in patients with UGIB than in those without (16% vs 1.3%; P ϭ .0001). 5 A prospective Canadian study conducted in a PICU within a university hospital, detected UGIB in 63 of 984 children (6.4%), but only 0.4% had a clinically significant outcome, for example, hypotension, death, or transfusion occurring within 24 hours after the bleeding episode. 9 In this study 43% were female and their mean age was 5.3 years.…”

Section: Epidemiologymentioning

confidence: 57%

“…4,5 In the United States mortality is on the lower end of the spectrum as a result of improved pediatric intensive care, advances in diagnosis and treatment, as well as in the stabilization and management of critically ill patients. Mortality can be decreased by early identification of UGIB, and improved morbidity and mortality are most often the result of a multidisciplinary approach to care.…”

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confidence: 99%

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Diagnosis and Management of Upper Gastrointestinal Bleeding in Children

Owensby

Taylor

Wilkins

2015

The Journal of the American Board of Family Medicine

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Upper gastrointestinal bleeding is an uncommon but potentially serious, life-threatening condition in children. Rapid assessment, stabilization, and resuscitation should precede all diagnostic modalities in unstable children. The diagnostic approach includes history, examination, laboratory evaluation, endoscopic procedures, and imaging studies. The clinician needs to determine carefully whether any blood or possible blood reported by a child or adult represents true upper gastrointestinal bleeding because most children with true upper gastrointestinal bleeding require admission to a pediatric intensive care unit. After the diagnosis is established, the physician should start a proton pump inhibitor or histamine 2 receptor antagonist in children with upper gastrointestinal bleeding. Consideration should also be given to the initiation of vasoactive drugs in all children in whom variceal bleeding is suspected. An endoscopy should be performed once the child is hemodynamically stable. (J Am Board Fam Med 2015; 28:134 -145.)

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Section: Epidemiologymentioning

confidence: 57%

Section: Epidemiologymentioning

confidence: 57%

mentioning

confidence: 99%

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Diagnosis and Management of Upper Gastrointestinal Bleeding in Children

Owensby

Taylor

Wilkins

2015

The Journal of the American Board of Family Medicine

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“…2,5,6,17 The incidence of clinically important (major) upper gastrointestinal bleeding is so low in patients with one or no risk factors (0.1%) that SU prophylaxis would be entirely unwarranted in this group; it has been suggested that prophylaxis be indicated only in patients with two out of these three risk factors. 6 Mechanical ventilation was clearly regarded as a major indication for prophylaxis by the physicians in our sample;…”

Section: Discussionmentioning

confidence: 99%

Profilaxia para úlcera de estresse em pacientes internados em UTI pediátrica

Araújo¹,

Vieira²,

Carvalho³

2010

J. Pediatr. (Rio J.)

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Objective: To assess use of stress ulcer prophylaxis in patients admitted to five pediatric intensive care units (PICUs) in Porto Alegre, Brazil.Methods: This was a multicenter, prospective, cross-sectional observational study. PICUs were visited on randomly defined days between April 2006 and February 2007, and the medical records of admitted patients were reviewed. Patients whose records had been previously assessed were excluded, as were those with upper gastrointestinal bleeding on admission. Data were collected on age, gender, admission diagnosis, severity of illness, administration of stress ulcer prophylaxis, rationale for prophylaxis, and first-line prophylactic agent of choice. Variables were described as absolute and relative frequencies, mean and standard deviation, or median and interquartile range as appropriate. Pearson's chi-square test for linear trend or Fisher's exact test were used to assess possible associations. The level of significance was set at 5% (p ≤ 0.05).Results: 398 patients (57% male) were assessed [median age, 16 months (IQR 4-65); median length of PICU stay, 4 days (IQR 1-9)]. Respiratory illness was the main reason for admission (32.7%). Most patients received stress ulcer prophylaxis (77.5%; range, 66-91%). Mechanical ventilation (22.3%) was the most common rationale provided, followed by informal routine use of prophylaxis (21.4%). Only one of the participating PICUs had a specific care protocol for use of stress ulcer prophylaxis. Ranitidine was the most commonly used drug (84.5% of cases). Evidence of minor gastrointestinal bleeding was found in 3% of patients; none had clinically significant bleeds. Conclusions:Administration of stress ulcer prophylaxis is a common practice in the participating PICUs, with ranitidine the most commonly used drug. Among the various rationales provided, mechanical ventilation and informal routine use were the most prevalent.J Pediatr (Rio J). 2010;86(6):525-530: Gastroduodenal ulcer, prophylaxis, children, intensive care, gastrointestinal bleeding.

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“…It constitutes 10%-15% of all admissions to pediatric gastroenterologists (1). Additionally, 6% to 25% of children in the intensive care units have some form of UGB during hospitalization (2,3). The clinical presentation ranges from asymptomatic microcytic anemia to hypovolemic shock.…”

Section: Introductionmentioning

confidence: 99%

Application of endoscopic hemoclips for nonvariceal upper gastrointestinal bleeding in children

Ünal¹,

Çakır²,

Baran³

et al. 2014

Turk J Gastroenterol

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Background/Aims: Data about the efficiency and outcome of therapeutic endoscopic techniques in children with nonvariceal upper gastrointestinal bleeding (UGB) are scarce. We aimed to analyze our experience with endoscopic hemoclip application in children with non-variceal UGB. Materials and Methods: During a 3-year period, a total of 1715 endoscopies were performed in our pediatric endoscopy unit; 182 (10.6%) of them were performed for UGB to 158 patients. Fifty-six of them had emergent endoscopy. Among them, 15 cases with nonvariceal UGB were only given endoscopic hemoclips. Demographic, clinical, and laboratory findings at initial admission; endoscopic appearance of bleeding lesions; and outcome of hemoclip application were recorded from the hospital files and endoscopy records. Results: Ten patients (66.6%) had gastric ulcer, 3 (20%) had duodenal ulcer, 1 (6.7%) had Dieulafoy lesion, and 1 (6.7%) had bleeding at the post-polypectomy site. Initial homeostasis after hemoclip application was achieved in all patients (100%). Rebleeding was seen in only one patient (6.5%) with a Dieulafoy lesion, who needed hemoclip application for a second time, and the bleeding was controlled successfully. Permanent hemostasis was 100%. The median number of hemoclips used per case and per application was 3.4 and 3.2, respectively. None of the patients experienced any complication related to hemoclip application. Median duration of hospitalization was 6 days. On follow-up, none of the patients received surgical therapy, and 30-d mortality related to bleeding was 0%. Conclusion: The use of hemoclips for nonvariceal UGB in children is an effective modality to control bleeding without any complications in children.

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Prevalence of, and risk factors for, upper gastrointestinal tract bleeding in critically ill pediatric patients

Cited by 50 publications

References 0 publications

Diagnosis and Management of Upper Gastrointestinal Bleeding in Children

Diagnosis and Management of Upper Gastrointestinal Bleeding in Children

Profilaxia para úlcera de estresse em pacientes internados em UTI pediátrica

Application of endoscopic hemoclips for nonvariceal upper gastrointestinal bleeding in children

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