The Devastating Effect of Secondhand Smoking Exposure in Pediatric Intensive Care Admissions

Abstract

Background: The aim of this study was to evaluate the effect of secondhand parental smoking in pediatric intensive care unit patients.

Methods: This cross sectional prospective survey study was conducted as a questionnaire regarding the smoking habits of all parents of hospitalized patients in our pediatric intensive care unit between September 2014 and January 2015. We studied the prevalence and potential effects of secondhand parental smoking on the diagnosis, severity of disease, duration of hospitalization and length of stay on mechanical ventilation.

Results: A total of 125 female and 178 male were included in the study. The median age was 53 (min:1 - max: 216) months. Indications of hospitalizations were intoxication (16.5%), neurological disorders (14.9%), malignancy (12.9%), congenital heart diseases (11.2%), genetic syndromes (9.9%), trauma (9.6%), shock (%7.3), arrhythmia (6.3%), renal failure (5%), diabetes (2.6%), burns (2.6%) and metabolic diseases (%1.3). A total of 42.2% of patients were on invasive, 5.3% were on non-invasive mechanical ventilation. Mothers, fathers and guests smoking rates were 40.6%; 75.2% and 58.4% respectively. The rate of illiterate fathers and mothers were higher in secondhand parental smoking group compared with non-exposure group (6% vs 4%, p=0.004, 10.7% vs 5.7%, p=0.21, respectively). The secondhand parental smoking rate was 76.9% whereas the smoking prevalence in Turkey was determined to be 30.5% for the whole population reflecting an increased velocity of PICU admissions. The secondhand parental smoking rate of children diagnosed as malignancy was 16.4% compared with non-exposed group (1.4%) which was statistically significant (p<0.05). There was no significant difference in secondhand parental smoking rate was of children diagnosed as intoxication, trauma, burns and others. The mean length of stay in MV and Pediatric Risk of Mortality (PRISM)  score were 5.8 days ± 6.3 and 11.6 ± 8 respectively.. The PRISM score was statistically significant in secondhand parental smoking exposed children compared with non-exposed ones ( 12.2 ± 7.9 vs 9.6 ± 7.8 ; p= 0.007). The length of stay in pediatric intensive care unit (PICU) and duration of mechanical ventilation were longer in children secondhand smoking exposure (p<0.05).

Conclusion: Secondhand smoking is related with increased velocity of PICU admissions, severity of disease, increased diagnosis of malignancies, prolonged duration of mechanical ventilation and PICU stay. Besides, secondhand exposed patients are more likely to have low parental education level.

Keywords

• Smoking exposure,pediatric intensive care unit,parents

References

1. References1. Oberg M, Jaakkola MS, Woodward A, Peruga A, Prüss-Ustün A. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. 2011;377:139-46.
2. 2. Vineis P, Hoek G, Krzyzanowski M, Vigna-Taglianti F, Veglia F, Airoldi L, et al. Lung cancers attributable to environmental tobacco smoke and air pollution in non-smokers in different European countries: a prospective study. Environ Health. 2007;6:7.
3. 3. Lee W, Lee S, Kim J, Kim J, Kim YK, Kim K, et al. Relationship Between Exposure to Second-Hand Smoke in the Workplace and Occupational Injury in the Republic of Korea. Ann Work Expo Health. 2017;62:41-52. 4. González Barcala FJ, Takkouche B, Valdés L, Temes E, Leis R, Cabanas R, et al. Parental smoking and lung function in healthy children and adolescents. Arch Bronconeumol. 2007;43:81-5.
4. 5. Soesanti F, Uiterwaal CSPM, Grobbee DE, Hendarto A, Dalmeijer GW, Idris NS. Antenatal exposure to second hand smoke of non-smoking mothers and growth rate of their infants. PLoS One. 2019;14:e0218577.
5. 6. Hawamdeh A, Kasasbeh FA, Ahmad MA. Effects of passive smoking on children's health: a review. East Mediterr Health J. 2003;9:441-7.
6. 7. Shiue I. Correlations of indoor second-hand smoking, household smoking rules, regional deprivation and children mental health: Scottish Health Survey, 2013. Environ Sci Pollut Res Int. 2015;22:9858-63.
7. 8. Northrup TF, Green C, Evans PW, Stotts AL. Characteristics associated with intervention and follow-up attendance in a secondhand smoke exposure study for families of NICU infants. J Matern Fetal Neonatal Med. 2015;28:1208-13.
8. 9. Vitória PD, Machado JC, Araújo AC, Ravara SB, Samorinha C, Antunes H, et al. Children's exposure to second hand smoke at home: a cross-sectional study in Portugal. Rev Port Pneumol 2015;21:178-84.

9. 10. Renwick C, Wu Q, Breton MO, Thorley R, Britton J, Lewis S,et al. Cost-effectiveness of a complex intervention to reduce children's exposure to second-handsmoke in the home. BMC Public Health. 2018;18:1252.
10. 11. Ozer N, Kilickap M, Tokgozoglu L, Goksuluk H, Karaaslan D, Kayıkcioglu M, et al. Data on smoking in Turkey: Systematic review, meta-analysis and meta-regression of epidemiological studies on cardiovascular risk factors. Turk Kardiyol Dern Ars. 2018; 46: 602-612. 12. Pollack MM, Patel KM, Ruttimann UE. Prism III: an updated Pediatric Risk of Mortality Score. Crit Care Med 1996; 24:743-52.
11. 13. Zhang R, Cao Q, Lu Y. The analysis of cigarette smoking behaviors and its influencing factors among chinese urban and rural residents. Acta Univ Med Nanjing (Nat Sci). 2014;34:84–9.
12. 14. Xi B, Liang Y, Liu Y, Yan Y, Zhao M, Ma C, et al. Tobacco use and second-hand smoke exposure in young adolescents aged 12-15 years: data from 68 low-income and middle-income countries. Lancet Glob Health. 2016;4:e795-e805.
13. .