Environmental factors
ETS – Samir et al. looked at the impact of ETS on outcomes in
children at a PICU with severe acute asthma38. In this
retrospective study, they found that children who were ETS-exposed had a
significantly longer overall LOS at the PICU of 15% compared to
children who were not exposed to ETS; moreover, these children
deteriorated faster between the emergency department and the PICU. No
differences were found in number of patients who received mechanical
ventilation38.
Diet – In an attempt to evaluate the effect of zip code (coming
from an area with lower median income) and diet on the PICU outcomes in
infants with bronchiolitis, Leimanis Laurens et al. performed a
retrospective chart review of infants (0-5 months of age) admitted to
the PICU with a primary or secondary respiratory diagnosis, in which
they divided the patients in formula fed, breastmilk fed or a mixed
diet39. They found that significantly more infants
from a lower household income were formula fed and had a public
insurance. However, in the clinical outcomes, no differences were found
in PICU LOS, overall LOS, mortality or the need for extra corporeal
membrane oxygenation (ECMO)39. Swathi et al, described
infants admitted with an acute respiratory infection and the association
between infants who were exclusive breast fed until the age of six
months old, and infants who were not, and found a significantly higher
mortality rate of the infants in the latter group29.