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Addressing the low survival rates of paediatric patients

Younger paediatric dogs and cats presenting to emergency clinics are less likely to survive than their older counterparts, according to a new study

24 October 2018, at 10:25am

By comparing survival rates of patients under three months of age with those between three and six months old, “Survival and presenting complaint of canine and feline paediatric emergencies presenting to UK emergency clinics” discovered that younger kittens had a survival rate less than half that of older ones, while the youngest dogs were almost 20 percent less likely to survive than older puppies.

These findings, based on a large study population of over 3,000 patients, could have major implications for how we treat very young animals.

The paediatric knowledge gap

It is unclear whether the correlation between survival rates and age is due to physiological immaturity or our lack of understanding of this younger subset of the population.

In their discussion at the end of the paper, the authors state, “the conclusions of this study are clear: survival of paediatric patients presented to emergency clinics within the UK is low but increases with patient age.

“The impoverished veterinary literature regarding small animal paediatric medicine may translate into reduced clinician knowledge and familiarity with this population; hence, the low survival rate may therefore also highlight a gap in our understanding of such patients, making their treatment less effective.”

The authors consider the range of difficulties veterinary professionals in emergency and non-emergency settings may encounter when faced with a younger patient, including but not limited to:

  • The small size of young animals makes gaining intravenous access, placement of feeding tubes and general management more challenging
  • The difficulty, or perception of difficulty, of gaining intravenous access may deter repeated attempts to gain vascular access
  • Peripheral blood pressure is lower in healthy paediatric patients compared to the adult dog and cat
  • Determining the success of resuscitation is more challenging as the end-points of resuscitation are not as easily identified – differences between paediatric and adult patients may lead to errors in ascertaining the response to a resuscitation effort
  • Microperfusion can be difficult to determine as both puppies and kittens are reported to have higher lactate values than their adult counterparts
  • Diagnosing hypoglycaemia can be more difficult as their response to a hypoglycaemic episode differs from adults
  • Determining the level of dehydration is difficult as paediatric patients will continue to have moist mucous membranes while being severely dehydrated

By far the leading cause of death among all the study’s groups was euthanasia. Although beyond the scope of this research, the authors suggest this may be due to the lack of a firm bond between the owner and the animal, making euthanasia a more viable option on financial grounds.

Whatever the reasons, the propensity to euthanise younger patients potentially poses a longer-term problem: “Euthanasia itself prohibits the development of paediatric veterinary medicine; it limits clinician experience with this age group but also precludes clinical research. As a consequence, anecdotal experience often replaces evidence- based medicine,” say the authors.

The authors stress the need for further research and an evidence-based approach to the treatment of young animals: “Further prospective studies are required to fully elucidate the causes of mortality in neonatal and paediatric patients, as well as to investigate whether clinician experience or the application of an algorithmic approach to these patients might alter survival.

“Such bundles of care have been introduced in both human medicine (the Surviving Sepsis campaign) and in veterinary medicine (the RECOVER guidelines). [This evidence-base] should drive improvements in clinical care.”

Full Knowledge Summary
Authors: Bruce Smith and Shailen Jasani

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