Clinically Significant Upper Gastrointestinal Bleeding Acquired in a Pediatric Intensive Care Unit: A Prospective Study

OBJECTIVES: To determine the incidence, risk factors, and complications associated with or attributable to clinically significant upper gastrointestinal (GI) bleeding acquired in a pediatric intensive care unit (ICU). METHODS: Prospective, descriptive epidemiologic study in a multidisciplinary pediatric ICU of a tertiary-care university hospital. Upper GI bleeding was considered to be present if hematemesis occurred or blood was present in the gastric tube. An upper GI bleed was qualified as clinically significant if two or three reviewers independently assessed that at least one of the six complications considered for analysis was attributable to the upper GI bleed. RESULTS: A cohort of 1114 consecutive admissions was enrolled; 108 (9.7%) were excluded mostly (37.0%) because they already had an upper GI bleed at entry to the pediatric ICU. The final sample included 1006 admissions (881 patients); 103 upper GI bleeds (10.2%) were diagnosed, including 16 clinically significant upper GI bleeds (1. 6%). Complications attributed to an upper GI bleed included: decreased hemoglobin concentration (10 cases), transfusion (10), hypotension (3), and surgery (1). Three independent risk factors for clinically significant upper GI bleeding were retained by multivariate analysis: respiratory failure, coagulopathy, and pediatric risk of mortality score >/=10. Nine of the 16 cases (56. 3%) with clinically significant upper GI bleeding had three risk factors, 14 (87.5%) had two, and 1 (6.3%) had none. CONCLUSIONS: Clinically significant upper GI bleeds are rare in critically ill children. Prophylaxis to prevent them may be limited to patients who present with at least two risk factors.