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[Development of pediatric and neonatal intensive care units: results of a national survey (2000 - 2009)].

OBJECTIVE
To understand the current situation and development of intensive care units for neonates and children (ICUs) in China.


METHODS
A form of survey was e-mailed to chief of each ICU who is one of the thirty five board members of Subspecialty group of Emergency Medicine Chinese Society of Pediatrics or Chinese Society of Emergency Medicine Pediatric Branch. The data from Jan. 1 to Nov. 30, 2009 were collected and compared with the first survey which was conducted during the year 2000(Group B).


RESULTS
Thirty three of 35 (94.3%) hospitals responded. Among them, 25 were children's hospitals (Group A1), 8 were pediatric department of general hospitals (Group B). The total number of ICU beds accounted for 6.9% and 5.8% of total numbers of hospital beds in Group A1 and B respectively, increased 1.1 percent. The doctor to bed ratio in Group A1 and B were 0.5:1 and 0.75:1, nurse to bed ratio in Group A1 and B was 1.17:1 and 1.38:1. The monitor to bed ratio in Group A1 were 1.44:1, Group B were 0.74:1 and the ventilator to bed ratio in Group A1 were 0.64:1, Group B were 0.46:1. The percentage of blood gas analyzers, portable X-ray, bedside ultrasound which ICUs owned in Group A1 and B were 100% (25/25) vs. 60% (16/27), 96% (24/25) vs. 70% (19/27) and 88% (22/25) vs. 30% (8/27) separately. The percentage of surfactant therapy use, blood purification therapy, high frequency ventilation and ECMO in Group A1 and B were 96% (24/25) vs. 48% (13/27), 80% (20/25) vs. 22% (6/27), 84% (21/25) vs. 37% (10/27) and 20% (5/25) vs. 0%. The survival rate of ventilated patients in group A1 and B were 77.5% (6393/8245) vs. 63.4% (809/1276) separately, Group B was lower than Group A1 (P < 0.001). The survival rate of premature infants weighted 1 - 1.5 kg in Group A1 and B were 88% (2183/2482) vs.75.1% (531/707), weighted > 1.5 - 2.5 kg were 93.7% (6836/7296) vs.84.1% (1890/2247), Group B were lower than group A1(P < 0.01). There were 12 659 and 1392 patients in Group A1 and A2 respectively for whom the Pediatric Critical Illness Scoring system (PCIS) was used to assess the severities of illness in PICU patients. Among them, the percentage of non critically ill (> 90) patients in group A1 and A2 were 3616 (28.6%) and 639 (45.9%) respectively, Group A1 was lower than A2 (P = 0.000). The mean bed occupation rate of PICU in Group A1 and A2 were 127.1% (103.3% - 186.0%) vs. 90.91% (71.0% - 126.0%), NICU in the above Groups were 138.0 (83.8 - 290.5) vs.108.9 (90.7 - 128.0).


CONCLUSION
The present study may roughly reflect the development of ICUs in the past ten years and current situation of neonatal and pediatric ICUs in tertiary hospitals in the mainland of China, especially development of PICUs. The percentage of ICU bed to hospital bed was increased. The equipments, new techniques and survival rates of patients treated in ICUs had been improved remarkably, but the occupation rate of bed was too high. A number of PICU beds were occupied by low risk patients and lack of human resource need to be urgently addressed.