SAQ 426 – Paediatrics – cerebral palsy with severe pneumonia

Paediatrics – cerebral palsy with severe pneumonia.

a. Admission-influencing history

• Poor oral intake, reduced urine output, dehydration, or inability to take usual medications.
• Vomiting, aspiration, apnoea/cyanosis, increased work of breathing, or rigors.
• Previous similar admissions, resistant organisms, failed oral antibiotics, or significant comorbidities.
• Existing advance care plan or previously expressed wishes.
• Parents request admission or are not coping with home care.
• Features suggesting an alternative serious diagnosis such as meningitis or sepsis.

b. Access or treatment options

c. Discussion with parents

• Explain the diagnosis, current severity, and potentially reversible factors.
• Clarify the parents' understanding of his baseline quality of life, likely recovery, and previously expressed wishes.
• Describe treatment options including ward care, non-invasive support, intubation, ICU referral, and comfort-focused limits if appropriate.
• Explain that ICU can be consulted but admission is not guaranteed and treatment may be considered non-beneficial or harmful.
• Discuss possible burdens: prolonged ventilation, tracheostomy, ICU complications, failure to return to baseline, or death despite treatment.
• Set clear treatment goals, ceilings of care, review points, and escalation plans while continuing compassionate active care.