CLINICALLY SIGNIFICANT UPPER GASTROINTESTINAL-BLEEDING ACQUIRED IN A PEDIATRIC INTENSIVE-CARE UNIT - A PROSPECTIVE-STUDY

Objectives. To determine the incidence, risk factors, and complication s associated with or attributable to clinically significant upper gast rointestinal (GI) bleeding acquired in a pediatric intensive care unit (ICU). Methods. Prospective, descriptive epidemiologic study in a mul tidisciplinary pediatric ICU of a tertiary-care university hospital. U pper GI bleeding was considered to be present if hematemesis occurred or blood was present in the gastric tube. An upper GI bleed was qualif ied as clinically significant if two or three reviewers independently assessed that at least one of the six complications considered for ana lysis was attributable to the upper GI bleed. Results. A cohort of 111 4 consecutive admissions was enrolled; 108 (9.7%) were excluded mostly (37.0%) because they already had an upper GI bleed at entry to the pe diatric ICU. The final sample included 1006 admissions (881 patients); 103 upper GI bleeds (10.2%) were diagnosed, including 16 clinically s ignificant upper GI bleeds (1.6%). Complications attributed to an uppe r GI bleed included: decreased hemoglobin concentration (10 cases), tr ansfusion (10), hypotension (3), and surgery (1). Three independent ri sk factors for clinically significant upper GI bleeding were retained by multivariate analysis: respiratory failure, coagulopathy, and pedia tric risk of mortality score greater than or equal to 10. Nine of the 16 cases (56.3%) with clinically significant upper GI bleeding had thr ee risk factors, 14 (87.5%) had two, and 1 (6.3%) had none. Conclusion s. Clinically significant upper GI bleeds are rare in critically ill c hildren. Prophylaxis to prevent them may be limited to patients who pr esent with at least two risk factors.