Childhood Obesity and Survival After In-Hospital Pediatric Cardiopulmonary Resuscitation

Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
PEDIATRICS (Impact Factor: 5.47). 02/2010; 125(3):e481-8. DOI: 10.1542/peds.2009-1324
Source: PubMed


We hypothesized that childhood obesity would be associated with decreased likelihood of survival to hospital discharge after in-hospital, pediatric cardiopulmonary resuscitation (CPR).
We reviewed 1477 consecutive, pediatric, CPR index events (defined as the first CPR event during a hospitalization in that facility for a patient <18 years of age) reported to the American Heart Association National Registry of Cardiopulmonary Resuscitation between January 2000 and July 2004. The primary outcome was survival to hospital discharge. A total of 1268 index subjects (86%) with complete registry data were included for analysis. Children were classified as obese (> or =95th weight-for-length percentile if <2 years of age or > or =95th BMI-for-age percentile if > or =2 years of age) or underweight (<5th weight-for-length percentile if <2 years of age or <5th BMI-for-age percentile if > or =2 years of age), with adjustment for gender.
Obesity was noted for 213 (17%) of 1268 subjects and underweight for 571 (45%) of 1268 subjects. Obesity was more likely to be associated with male gender, noncardiac medical illness, and cancer and inversely associated with heart failure. Underweight was more likely to be associated with male gender, cardiac surgery, and prematurity and inversely associated with age and cancer. Self-reported, process-of-care, CPR quality was generally worse for obese children. With adjustment for important potential confounding factors, obesity was independently associated with worse odds of event survival (adjusted odds ratio: 0.58 [95% confidence interval: 0.35-0.76]) and survival to hospital discharge (adjusted odds ratio: 0.62 [95% confidence interval: 0.38-0.93]) after in-hospital, pediatric CPR. Underweight was not associated with worse outcomes.
Childhood obesity is associated with a lower rate of survival to hospital discharge after in-hospital, pediatric CPR.

Download full-text


Available from: Vijay Srinivasan, Nov 17, 2015
  • Source
    • "Being significantly underweight is associated with prolonged ICU stay and increased mortality [1, 9, 10]. However, published data on outcome in overweight children and adults is conflicting [11–14]. Broadly, adult intensive care unit (AICU) data suggest increased duration of mechanical ventilation and ICU stay but no clear association with mortality [15–17]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Aims: To determine whether the paediatric intensive care (PIC) population weight distribution differs from the UK reference population and whether weight-for-age at admission is an independent risk factor for mortality. Methods: Admission weight-for-age standard deviation scores (SDS) were calculated for all PIC admissions (March 2003-December 2011) to Great Ormond Street Hospital: this is the number of standard deviations (SD) between a child's weight and the UK mean weight-for-age. Categorised into nine SDS groups, standardised mortality ratios (SMR) and logistic regression were used to assess the relationship between weight-for-age at admission and risk-adjusted mortality. Results: Out of 12,458 admissions, mean weight-for-age was 1.04 SD below the UK reference population mean (p < 0.0001). Based on 942 deaths, risk-adjusted mortality was lowest in those with mild-to-moderately raised weight-for-age (SDS 0.5-2.5) and highest in children with extreme under- or overweight (SDS < -3.5 and SDS > +3.5). Logistic regression indicated that age, gender, ethnicity and weight-for-age are independent risk factors for mortality. South Asian and 'other' ethnicities had significantly increased risk of death compared to children of white and black ethnic origin. Conclusion: The PIC population mean weight-for-age is significantly lower than the UK reference mean. The extremes of weight-for-age are over-represented, especially underweight. Weight-for-age at admission is an independent risk factor for mortality. A U-shaped association between weight and risk-adjusted mortality exists, with the lowest risk of death in children who are mild-to-moderately overweight. Future studies should determine the impact of malnutrition on risk-adjusted mortality and investigate the aetiology of risk disparities with ethnicity.
    Intensive Care Medicine 07/2014; 40(8). DOI:10.1007/s00134-014-3381-x · 7.21 Impact Factor
  • Source
    • "These findings were confirmed in a large meta-analysis involving over 62,000 critically ill subjects comparing outcomes in obese and non-obese patients (8). Obesity lowers the odds of survival in pediatric patients after in-hospital cardio-pulmonary arrest (9). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to examine the effect of short-term high fat feeding on the inflammatory response in polymicrobial sepsis. Male C57BL/6 mice at 6 weeks of age were randomized to a high-fat diet (HFD) (60% kcal fat) or control diet (CD) (16% kcal fat) for 3 weeks. After 3 weeks of feeding, sepsis was induced by cecal ligation and puncture (CLP) and animals were monitored for survival. In a separate experiment, after 3 weeks of feeding mice underwent CLP and were sacrificed at various time points thereafter. Tissue was collected for biochemical studies. Mice fed a HFD gained more weight and had a greater fat mass compared to CD-fed mice. Mice on a HFD had a lower probability of survival and more severe lung injury compared with CD-fed mice following sepsis. Myeloperoxidase (MPO) activity, an indicator of neutrophil infiltration, was increased in the lung and liver after CLP in HFD-fed mice compared with CD (P < 0.05). The plasma cytokines tumor necrosis factor-α (TNF-α) and interleukin (IL)-6 were increased in both groups after CLP, however, TNF-α and IL-6 levels were lower in HFD mice at 3 h after CLP compared with CD and consistent with lung, but not liver, messenger RNA (mRNA) expression. Leptin levels were higher in HFD-fed mice at 18 h after sepsis compared to baseline levels (P < 0.05). Polymicrobial sepsis increased hepatic nuclear factor-κB (NF-κB) activation in HFD-fed mice after CLP vs. CD-fed mice. Short duration high fat feeding increases mortality and organ injury following polymicrobial sepsis. These effects correspond to changes in NF-κB.
    Obesity 02/2012; 20(10):1995-2002. DOI:10.1038/oby.2012.40 · 3.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We report pulsed and continuous-wave operation of an optically-pumped III-V VCSEL emitting at λ&ap;2.9 μm. The laser consists of a 12-1/2 period GaSb/AlAsSb distributed Bragg reflector (DBR) bottom mirror, a 79-period type-II “W” quantum well active region [InAs/GaSb/InAs/AlSb] and a dielectric DBR top mirror. The reflection plateaus of the top and bottom mirror are centered at λ=3.0 μm, and the top mirror is also optimized for >80% transmission at 1.064 μm. The cavity containing the active region is nominally one wavelength long. The first results demonstrate the feasibility of diode-pumped mid-IR VCSELs with low thresholds at high temperatures
Show more