CAUSES AND OUTCOMES OF PEDIATRIC SHOCK

Background: Pediatric shock is a life-threatening condition caused by insufficient tissue perfusion, which can lead to organ malfunction and death if not treated immediately. It is still a major cause of childhood mortality, especially in low-resource settings where avoidable diseases like sepsis and severe gastroenteritis are prevalent. Early recognition is challenging, as children maintain blood pressure until late stages, making clinical assessment crucial. Local statistics on pediatric shock in Iraq are limited. Objectives: To evaluate the etiology, clinical characteristics, management, and outcomes of pediatric shock in a tertiary care hospital in Mosul, Iraq. Methods: A hospital-based observational study was conducted at Al-Khansaa Teaching Hospital from February 2025 to January 2026. A total of 200 children aged 1 month to 14 years diagnosed with shock based on clinical criteria were included. Data on demographics, clinical presentation, type and etiology of shock, laboratory findings, management strategies, and outcomes were collected and analyzed using SPSS version 30. Results: The mean age was 28.9 ± 24.3 months, with a male predominance (56.5%). Most patients were aged 12–59 months (43.5%), and 55.5% were from rural areas. Hypovolemic shock (44%) and septic shock (36%) were the most common types. Acute gastroenteritis (38.5%) and sepsis (32%) were the leading etiologies. Clinically, tachycardia (93%) and prolonged capillary refill time (84%) were the most frequent findings, while hypotension was present in only 29% of cases. Leukocytosis was observed in 54.5% of patients. All patients received intravenous fluids; antibiotics were administered to 74.5%, inotropes to 41.5%, and mechanical ventilation was required in 18.5%. The overall mortality rate was 14.5%, with the highest mortality observed in septic (25%) and cardiogenic shock (22.2%). Conclusion: Pediatric shock is primarily caused by avoidable conditions, particularly severe gastroenteritis and sepsis. Early clinical recognition and management are crucial for better outcomes. To reduce mortality, primary healthcare services must be strengthened, access to early treatment improved, and critical care resources enhanced.