2011 and January 2013. Results: 258 children were recruited.
Median age 249
at presentation was 24 months (IQR 7, 81) with gender distribution ratio
1.1:1.The mean Hemoglobin level at admission was 9. 92.49mg/dl and it
decreased by 1.3 gm/dl (IQR 0.1, 2.5) throughout the PICU stay.About half
of our children were found to be anemic (51.2%) at admission. Anemia was
highly prevalent in children < 1yr (51.3%). No significant differences were
found in the length of PICU stay [6(IQR 3,8)Vs 6 (IQR 4,10)] days and hos-
pital stay [10 (IQR 5,15) Vs 10.5 (IQR 6.5,15)] days between the 2 groups
with p>0.05.The duration of ventilation [4 (3,6.4) vs 5(2.9,8.75)] days was
shorter in anemic group as compared to non anemic but not statistically
significant (p>0.05). 39.7% children died in anemic group as compared to
36.7% in non anemic group. 22.2 % were severely anemic (6.0761.24mg/
dl) needing RBC transfusion. Mortality rates were similar between transfused
and non-transfused patients. Conclusions: More than half of our critically ill
children are anemic at presentation. Anemia is not associated with increase
mortality or morbidity.
247
IMPACT OF EARLY FLUID OVERLOAD IN CRITICALLY ILL
CHILDREN A PROSPECTIVE OBSERVATIONAL STUDY
A. Lalitha1, A. Vasudevan2, R. Shilpa2, K. Phadke2; 1pediatrics, St. Johns Medi-
cal College Hospital, Bangalore, India 2pediatrics nephrology, St. Johns Medical
College Hospital, Bangalore, India
Background and aims: Fluid management has a major impact on duration,
severity and outcome of critical illness. Aims: To determine the impact of
early fluid overload on mortality in critically ill children. Methods: Critically
ill children (1 month and 18 years of age) admitted in PICU for at least 24
hours were eligible for recruitment. Fluid overload (FO) was estimated by
subtracting the sum of all fluid inputs from the sum of all fluid outputs on
everyday for 72 hours after admission. Results: 211 children were included.
The difference in the mean daily fluid balance (ml/kg) between survivors and
non-survivors was maximum at 48 hours (32.32.9 vs 46.75.0, p =0.01).
85 patients (40.2%) developed < 10% FO, 81 patients (38.4 %) developed
10%-20% FO, and 45 patients (21.4%) developed > 20% FO at 48 hours of
ICU admission. Patients who developed > 20% FO at 48 hours had signifi-
cantly higher mortality (25/45; 55.6%) than those who had 10%-20% FO
(27/81; 33.1%) and with < 10% FO (25/85; 29.4%). The adjusted odds of
death in presence of early FO > 20% was 3.16 as compared to children with
< 10% (p=0.02). The cumulative fluid balance (%) was significant more posi-
tive in AKI children versus non AKI (9.07.11 versus 11.99.2, p = 0.009).
Conclusions: Children who died in PICU accumulated more fluid in first 48
hours. Fluid overload > 20% at 48 hours was associated with 3 times increase
mortality as compared to FO < 10%.
248
THE IMPACT OF A NURSE-LED FEEDING PROTOCOL ON
NUTRITION ADEQUACY IN CRITICALLY ILL CHILDREN: A
PRELIMINARY ANALYSIS
J.H. Lee1, W.M. Han2, A.N. Lee1, Y.H. Chan1, B.X. Ang2; 1Childrens Intensive
Care Unit, KK Womens and Childrens Hospital, Singapore, Singapore 2Nutri-
tion and Dietetics, KK Womens and Childrens Hospital, Singapore, Singapore
Background and aims: Feeding protocols has been shown to deliver enteral
nutrition (EN) in a more timely and consistent manner. Aims: To determine
effectiveness of a nurse-led feeding protocol, we evaluated nutrition adequacy
of children in the pediatric intensive care unit (PICU) before and after the
protocol. Methods: We conducted an observational study across two periods:
pre- (October 2012 to January 2013) and post- (April to October 2014) pro-
tocol. We excluded patients in whom the protocol was contraindicated: septic
shock with > two inotropes, post-cardiac and post-gastrointestinal surgeries.
Actual energy and protein intakes were compared with calculated require-
ments, expressed as percentages. Clinical outcomes measured were 28-day
ventilation-free and PICU-free days. We summarized continuous and cate-
gorical variables as medians with ranges and proportions respectively. Results:
We identified a total of 32 patients 20 pre- and 12 post-protocol. Median
age was 9.4 (0 160) months. 16 (50%) were admitted for respiratory indica-
tions. There was no difference in proportion of patients having EN initiated
within first two days of admission between both periods. There was also no
difference in energy (31.5 vs. 27.3%, p = 0.88) and protein intake (25.6 vs.
20.7%, p = 0.78) by day 2 of admission between both periods. There was no
change in ventilator-free days (17.5 vs. 23.5, p = 0.42) and PICU-free days
(18.5 vs. 20, p = 0.20) across both periods. Conclusions: The feeding protocol
did not improve nutrition adequacy and clinical outcomes. Quality improve-
ment initiatives to examine the existing protocol are required to enhance the
effectiveness of the protocol.
PROTEIN C (PC) AND ACTIVATED PROTEIN C (APC) LEVELS
IN NECROTISING ENTEROCOLITIS (NEC) COMPARED TO
HEALTHY PRETERM NEONATES.
P. Lister1, N. Klein2, M.J. Peters3; 1PICU, Great Ormond Street Hospital, Lon-
don, United Kingdom 2Immunobiology, Institute of Child Health UCL, Lon-
don, United Kingdom 3Portex, Institute of Child Health UCL, London, United
Kingdom
Background and aims: PC is low in healthy preterm neonates. APC levels have
not been described. Aims: We aimed to characterise the levels of these proteins
in neonates with NEC as compared to healthy preterm controls. Methods: We
had Institutional Review Board approval in 2 UK neonatal intensive care units.
Following parental consent, we obtained plasma samples from 2 groups: healthy
neonates and confirmed NEC. Results: Controls (n=7) and NEC groups (n=13)
did not differ in corrected gestational age at the time of sampling (30.3 vs.33.9
weeks p=0.21). 9 NEC neonates required surgery and 2 died.
Figure: Mean PC antigen levels were lower in NEC group (0.18U/mL 0.015
SEM vs. 0.3U/mL 0.03 SEM; p=0.0007). Grey areas depict reference ranges.
Open squares represent individuals transfused with FFP. Median APC levels in
both cohorts were below adult reference range (1-3ng/mL), but were not dif-
ferent to each other (0.67ng/mL (0.450.68 IQR) vs. 0.48ng/mL (0.370.65
IQR); p=0.22). There were 2 outliers above the reference range (10.2 and 8.1ng/
mL). APC levels did not correlate with PC levels (Spearmans r= 0.28; p=0.24).
Conclusions: Levels of PC and APC in healthy preterm neonates are low. PC
falls in NEC, levels of APC were varied and did not correlate with PC levels. The
findings suggest that the PC pathway is active in attempting to modulate the
inflammatory response in NEC
250
VITAMIN D LEVELS IN CRITICALLY ILL CHILDREN
R. Lodha1, R. Shah1, N. Gupta2, M. Irshad3, S.K. Kabra1; 1Pediatrics, All India
Institute of Medical Sciences, New Delhi, India 2Endocrinology, All India Insti-
tute of Medical Sciences, New Delhi, India 3Laboratory Medicine, All India Insti-
tute of Medical Sciences, New Delhi, India
Background and aims: In addition to the role in bone health, Vitamin D influ-
ences the immune system as well. There are inadequate data on prevalence of
vitamin D deficiency in critically ill children. Aims: We determined the Vitamin
D levels at admission in critically ill children and studied its association with
severity of illness and outcomes. Methods: Critically ill children older than 1
month were enrolled in the study. PIM2 score was calculated at admission. Blood
samples were drawn for 25-hydroxy vitamin D, PTH, calcium, phosphate and
alkaline phosphatise estimation. Vitamin D deficiency was defined as 25OH Vit
D 15ng/mL and insufficiency as 25OH Vit D 1520ng/mL. In a subset of chil-
dren, 25OH Vit D levels were repeated on D3, 7 and 10. The study was approved
by Ethics Committee. Results: Serum 25(OH) Vit D measurements were esti-
mated at admission in 154 children. The median (IQR) serum 25(OH) Vit D
level was 11.7 (7.1, 16.0) ng/mL. Vitamin D deficiency was seen in 110 patients
[71.43% (95% CI: 64.2, 78.6%)]. Hypocalcemia was observed in 47.29% of
Vitamin D deficient and insufficient children; raised ALP was seen in 61.24%,
hypophosphatemia in 47.29% and hyperparathyroidism in 33.33%. There was
Pediatr Crit Care Med 2014 Volume 15 Number 4 (Suppl.)