Citas bibligráficas
Atarama, N., (2018). Factores de riesgo asociados al ingreso a uci en pacientes pediátricos con malaria grave en hospitales públicos de Iquitos, 2013 – 2017 [Tesis, Universidad de la Amazonía Peruana]. http://repositorio.unapiquitos.edu.pe/handle/20.500.12737/5544
Atarama, N., Factores de riesgo asociados al ingreso a uci en pacientes pediátricos con malaria grave en hospitales públicos de Iquitos, 2013 – 2017 [Tesis]. : Universidad de la Amazonía Peruana; 2018. http://repositorio.unapiquitos.edu.pe/handle/20.500.12737/5544
@misc{sunedu/3117686,
title = "Factores de riesgo asociados al ingreso a uci en pacientes pediátricos con malaria grave en hospitales públicos de Iquitos, 2013 – 2017",
author = "Atarama Cardama, Nátaly Del Carmen Sybila",
publisher = "Universidad de la Amazonía Peruana",
year = "2018"
}
In Peru, malaria remains a major public health problem, which continually threatens the well-being of children in our region. OBJECTIVE: To recognize risk factors associated with admission to the Critical Care Unit in children with severe malaria hospitalized from 2013 to 2017 in the public hospitals of Iquitos. METHODOLOGY: An observational, retrospective, cross-sectional and analytical study was carried out, in which 144 patients with a diagnosis of malaria entered, and who additionally presented at least one of the severe malaria severity criteria. We worked with the total population, in addition the group that entered the ICU was used to perform the analytical study. RESULTS: The following characteristics were found: male predominance (58%), greater number of children between 2 and 5 years old (30.6%) with an average of 5.58 years, 73.6% came from rural or peri-urban areas, the district with the highest prevalence was San Juan (28.5%), as well as the presence of the antecedent of travel or residence to risk areas (91%), the previous infection by malaria was reported in 91%. It was also found that the prevalent type of Plasmodium was P. vivax (75.7%), the mean pre-hospital time was 6.22 days, 27.1% had chronic comorbidities, 59% had parasitemia less than 3 crosses, it was reported that the 6.3% presented complications at admission, 34.7% had some acute comorbidity, only 43.3% received intravenous antimalarial treatment, 33.3% received an additional antibiotic, 13.9% had blood transfusions. The main signs and symptoms were: fever (92.4%), vomiting (54.9%), headache (41.7%), chills (40.3%) and abdominal pain (38.9%). It was also found that the most reported severity criteria were: coagulation disorders (44.4%), hyperparasitemia (36.8%), severe acute anemia (34%), hyperpyrexia (20.1%) and consciousness compromise (15.3%). Of the total of patients with severe malaria, 14.6% (21) entered the Intensive Care Unit (ICU). In the bivariate analysis, the presence of the severity criteria was found as risk factors for admission to the ICU: respiratory distress (OR = 16.00, p <0.05), jaundice (OR = 7.37, p <0.05), hemoglobinuria (OR = 7.47, p <0.05) and severe anemia (OR = 3.09, p <0.05). Among the clinical characteristics, P. falciparum infection (OR = 3.59, p <0.05), parasitaemia less than 3 crosses (OR = 3.43, p <0.05), the presence of complications at admission (OR = 75.07, p <0.05), acute comorbidities (OR = 4.83, p <0.05) and treatment with antibiotics (OR = 3.22, p <0.05) also resulted as risk factors. However, after the multivariate analysis only the presence of complications at admission and parasitemia less than 3 crosses were significantly associated with admission to the ICU.CONCLUSIONS: There are risk factors for admission to the ICU in children with severe malaria: the presence of severity criteria (respiratory distress, jaundice, haemoglobinuria and severe anemia), P. falciparum infection, parasitemia less than 3 crosses in malaria severe for P. falciparum, severe anemia in severe P. vivax malaria and regardless of the infective Plamodium the presence of complications at admission, acute comorbidities and additional treatment with antibiotics.
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