Rare condition affected 41 Covid-related intensive care admissions of children over two-year period

There were 82 Covid -related admissions of children to intensive care from March 2020 to the end of July last year and 41 diagnosed with a rare condition associated with the virus

The 41 admissions of children were for a diagnosis of Paediatric Inflammatory Multisystem Syndrome (PIMS-Ts), a condition that happens weeks after someone has had Covid.

It causes swelling throughout the body and makes children very sick, but there is effective treatment.

Signs and symptoms include fever, tummy pain, vomiting, diarrhoea, rash, red eyes and swollen lips or tongue.

There were no Covid-related deaths among children during that same period, said the report on paediatric critical care by the National Office of Clinical Audit (NOCA).

The median age of Covid-related admissions was four years, length of stay was three days and mechanical ventilation was required by 33 children.

The total number of children admitted to paediatric critical care units generally during 2020 was 1,399 – a 9pc reduction in overall admissions when compared with 2019.

Meanwhile, one in ten children in intensive care from 2018-2020 were discharged out-of-hours, which is substandard and should be avoided where possible, said the audit.

The audit of paediatric critical care said that during the evening and night-time there is reduced medical and nursing staff availability on wards, and senior staff are less likely to be there to review the patient.

There were 68 children admitted to adult intensive care units in 2020, down 111 from 2019.

Of these, 40pc were admitted to Galway intensive care unit and 16pc to Cork intensive care unit.

The mortality rate in paediatric critical care units in the Republic is low at 4pc.

Deaths in these units accounted for 21pc of all deaths in the paediatric population in the country in 2020.

The number of patients admitted to paediatric critical care units in 2020 was affected by the onset of Covid.

“While not a disease primarily of children requiring critical care, the reduced incidence of other respiratory infections and diseases, such as viral bronchiolitis and pneumonia, was reflected in reduced numbers of patients requiring emergency admission,” said the audit.

In 2020, 1.7pc of patients were readmitted within 48 hours of discharge. Emergency readmissions to the same unit within 48 hours of discharge may mean that a child was discharged too early or into the wrong care environment, or that the need for future critical care was not predicted.

There is no standard acceptable rate of emergency readmissions within 48 hours to critical care, but they are considered a rare event. Low readmission rates are generally accepted as an indicator of good-quality care.

The audit said that a national respiratory paediatric extracorporeal life support (ECLS) programme should be progressed in Children’s Health Ireland.

A number of children had to be transferred abroad for this treatment, as there is no formally funded and resourced paediatric respiratory ECLS programme in this country. 

Respiratory ECLS provides life-saving treatment for infants and children with very severe lung failure.