Forging an easier path through graduation: Improving the patient transition from paediatric to adult critical care

Table 1 Disease phenotypes, specific conditions and potential clinical manifestations relevant to intensive care

Chronic disease phenotypes	Specific diseases	Key manifestations relevant to intensive care
Primary single organ chronic disease	Cystic fibrosis	Respiratory failure, pneumonia, pancreatitis (acute/chronic), liver failure, and distal intestinal obstruction syndrome
	Haemophilia	Life or limb threatening haemorrhage
	Congenital heart disease	Heart failure, post operative care (e.g., shunt upgrade), endocarditis, and single ventricle physiology
	Insulin dependent diabetes mellitus	Diabetic ketoacidosis and cardiovascular complications
	Organ transplantation	Organ failure and opportunistic infection
Complex disability	Cerebral palsy with neurocognitive disability: Perinatal hypoxia, traumatic brain injury, severe infections of the CNS, and neuronal migration disorders (e.g., lissencephaly)	Seizures, pneumonia, post operative monitoring respiratory support, chest wall deformity (scoliosis), abnormal bulbar tone, nutritional deficiency, intellectual disability, and polypharmacy
Rare conditions	Metabolic or mitochondrial conditions (e.g., urea cycle disorders and amino acidopathies)	Hyperammonaemia, neurological problems, metabolic acidosis, organ dysfunction, seizures, intellectual disability, and need for blood purification therapies (e.g., renal replacement therapy)
	Genetic abnormalities (e.g., Duchenne syndrome and Marfan syndrome)	Neuromuscular weakness, progressive heart or respiratory failure, and airway difficulty
	Chromosomal disorders (e.g., Down syndrome)	Pneumonia, immunodeficiency, congenital heart disease, cervical spine instability, and intellectual disability
Technology dependence	Tracheostomy with long term ventilation (e.g., cervical spine injury)	Pneumonia, respiratory failure, and home ventilation
	Long term gastric feeding tube, TPN dependence (e.g., short gut syndrome, bulbar palsy, and neurocognitive disability)	Nutritional deficiency, line related sepsis, and device malfunction

CNS: Central nervous system; TPN: Total parenteral nutrition.