490 - Persistent Anemia after a Pediatric Intensive Care Unit Admission

Publication Number: 490.6505

Bryan McKee, Akron Children's Hospital, Akron, OH, United States; Harold F. Eshun, University of Akron, Akron, OH, United States; Pelletier Jonathan, Akron Children's Hospital, Akron, OH, United States; Ryan A. Nofziger, Akron Children's Hospital, Akron, OH, United States; Christopher Page-Goertz, Northeast Ohio Medical University, Akron, OH, United States; Stephanie L. Savelli, Akron Children's Hospital, Akron, OH, United States

Background: In adults and children anemia has a significant clinical impact as it causes symptoms of fatigue, tachycardia, shortness of breath. In children anemia can cause neurodevelopmental delay. Approximately 50-60% of children admitted to the Pediatric Intensive Care Unit (PICU) have anemia at discharge. Adult studies have shown that anemia persists up to 6 months after intensive care unit discharge. Evaluation of the PICU pediatric population is needed to define the epidemiology of persistent anemia.

Objective: To retrospectively define the level of persistent anemia for children discharged from the PICU with anemia.

Design/Methods: We performed a retrospective study at Akron Children's Hospital of patients admitted to our PICU with a single episode of anemia. With IRB approval, patients eligible for enrollment were identified through a query of Akron Children’s Hospital’s electronic health record. In addition, the Virtual Pediatric Systems Database and Children’s Hospital Association Pediatric Health Information System Database were queried, for demographics and application of inclusion and exclusion criteria. Patients were excluded if they had a hematologic disorder (except for Iron Deficiency Anemia). Demographics and patient characteristics evaluated included age, sex, race, comorbidities, administration of blood products while inpatient, among others. Patients identified in our study were reviewed for a follow up hemoglobin value within 12 months from hospital discharge. The cohort was described with summary statistics. The incidence of anemia on PICU discharge, hospital discharge, and follow up intervals were described.

Results: 2,909 encounters of patients admitted to the PICU between 2018-01-01 and 2022-12-30 were identified. Of those, 2,154/2,909 (74.0%) had anemia in the PICU. Of those who were anemic, 644/2,154 (29.9%) had their hemoglobin re-checked before hospital discharge with 578/644 (89.8%) patients having persistent anemia. 1,014/2,154 (47.1%) patients had their hemoglobin re-checked within 12 months of hospital discharge with 696/1,014 (68.6%%) having persistent anemia.

Conclusion(s): Our study suggests patients with PICU identified anemia have persistent anemia up to 12 months after hospital discharge. Further studies are required to characterize the etiology of persistent anemia, evaluate effects of anemia in this patient population.

Selected Patient Demographics
Table showing selected demographics of the patient cohort. p values are determined by Wilcoxon rank sum test or Pearson’s Chi-squared test where appropriate.

Hemoglobin Trends Over Time
Ridgeline plot showing changes in hemoglobin over time.

Persistent Anemia Described in Follow Up Intervals
The graph shows the percentage of patients in any given follow up window who were still classified as anemic.