Browsing by Author "Kruger, Irma"

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    The impact of cerebrospinal fluid viral analysis on empiric antibiotic use in children admitted to Tygerberg Children’s hospital with suspected meningitis
    (Medpharm Publications, 2018-10) Kruger, Irma; Maritz, Jean; Finlayson, Heather
    Background: Viral meningitis is the most common form of aseptic meningitis and requires minimal investigation and treatment. Polymerase chain reaction (PCR) has become the ‘gold standard’ for identifying viruses in cerebrospinal fluid and can provide rapid results. The objective of the study was to describe the aetiology and epidemiology of viral meningitis at Tygerberg Children’s Hospital, as well as the impact of a positive cerebral spinal fluid (CSF) viral panel on the duration of empiric antibiotic treatment. Methods: This was a retrospective folder review of all children aged between 29 days and 13 years who had a CSF specimen on which a viral analysis was performed from January 1, 2010 to December 31, 2014. Results: A total of 288 specimens were identified from the laboratory database. Seventy-nine specimens were presented for data analysis. Thirty-seven specimens had a positive viral analysis. The median age was 11.3 months (IQR 3.7–49.16 months). The microscopy and chemistry results were similar for the two groups except for the CSF lymphocyte count, which was significantly higher in the group with a positive CSF viral analysis compared to those with a negative CSF viral analysis (median 52 vs. 12 × 106/l, p = 0.005). The most common identified virus was Epstein–Barr virus (EBV) (23%), followed by enterovirus (17%). Children with a positive viral analysis tended to receive antibiotics for longer than those who had negative results (p = 0.223). Conclusion: The addition of CSF viral analysis could be helpful in the management of children with meningitis, but at present appears to have little impact on the length of antibiotic use.
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    Outcome of children admitted to a general highcare unit in a regional hospital in the Western Cape, South Africa
    (Health & Medical Publishing Group, 2016-10-03) Kruger, Irma; Gie, Robert Peter; Harvey, Justin; Kruger, Mariana
    Background. Critically ill children are often managed in non-tertiary general intensive care units admitting both adults and children, but few data are currently available regarding paediatric outcomes in these general units. Objective. To determine the outcome of critically ill neonates and children admitted to a general high-care unit in a large regional hospital in the Western Cape, South Africa. Methods. This was a retrospective descriptive analysis of outcome of all neonatal and paediatric (<13 years of age) patients admitted with non-surgical disease, during a 1-year period, to a general high-care unit at a large regional hospital in Worcester, South Africa. Data included demography, admission time, length of stay, diagnoses, HIV status, therapeutic interventions and outcome. The primary outcome was defined as successful discharge, transfer to a central hospital or death. Results. There were 185 admissions, with the majority (83%) <12 months of age (median age 3.7 months; range 0 - 151 months) and a male:female ratio of 1.3:1. The majority (70%) were successfully discharged, while 24% were transferred to a tertiary paediatric intensive care unit (PICU) and only 6% died. Causes of death included acute lower respiratory tract infections (33%), acute gastroenteritis (33%), birth asphyxia (16%) and complications of prematurity (16%). Nasal continuous positive airway pressure (p<0.001), ventilation (p<0.001) and HIV infection (p=0.010) were associated with transfer to a PICU in a central hospital or death. Conclusion. The majority of children (70%) requiring admission to a general high-care unit in a regional hospital were successfully treated and discharged. These good outcomes were only achievable with a good transfer system and supportive tertiary healthcare system.
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    Paediatric and neonatal admissions to an intensive care unit at a regional hospital in the Western Cape
    (Stellenbosch : Stellenbosch University, 2014-04) Kruger, Irma; Kruger, Mariana; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Objective: The aim of the study was to determine the outcome of critically ill neonates and children admitted to a general intensive care unit in a large regional hospital (Worcester) in the Western Cape. A secondary aim of the study was to determine the risk factors for death in these neonates and children. Methodology: This was a retrospective descriptive survey of all paediatric admissions (under 13 years of age; July 2008 till June 2009) to an intensive care unit at a large regional hospital in Worcester, South Africa. Data collected included: demography, admission time, length of stay, diagnoses, interventions and outcome. Outcome was defined as successful discharge, death or transfer to a central hospital. Results: There were 194 admissions including children and neonates. The files of 185 children and neonates were analysed, while 8 children were excluded due to incomplete data set and one patient was a surgical admission. The male: female ratio was 1.3: 1 and the majority of patients (83%) admitted, were younger than 12 months of age at admission with a mean age of 8.5 months (median age 3.7 months; range 0 to 151 months). The majority (70%) of admissions were successfully discharged, nearly a quarter (24%) transferred to central hospitals in Cape Town and only 6% died (all younger than 5 years of age). Causes of death included acute lower respiratory tract infections (33%), acute gastroenteritis (25%), birth asphyxia complicated by pulmonary hypertension (16%) and prematurity (16%). Patients requiring airway assistance, were more likely to experience an adverse event (p=0.0001) and invasive ventilation was associated with an increased risk for a poor outcome (p=0.00). Conclusion: The majority of children requiring access to a paediatric ICU are younger than one year of age. The common causes of death are acute lower respiratory tract infections, acute gastroenteritis, prematurity and neonatal asphyxia. A regional hospital in South Africa should offer intensive care to children as the majority of their admissions can be successfully cared for without transfer to tertiary hospitals. To our knowledge, this is the first study reporting admissions and outcome of neonates and children cared for in a mixed intensive care unit in a large regional hospital in South Africa. This study suggests that large regional hospitals in South Africa should have mixed intensive care units to improve child survival.