Relevance: Oncological diseases remain the main cause of death in children, increasing the need for intensive care. Hospitalized children suffering from oncological diseases are at high risk for sudden deterioration of their condition, both for the underlying disease and due to infectious complications and the toxic effects of medications. This review highlights information on the Pediatric Early Warning Signs (PEWS) system in oncological patients to detect clinical deterioration promptly. The study aimed to analyze international literature on the use of pediatric early warning signs (PEWS) for clinical deterioration in pediatric oncology. Methods: Current literature on using the PEWS of clinical deterioration in pediatric oncology was studied. Results: The published data show the important role of using the PEWS system in cancer patients for early detection of deterioration of the condition with subsequent provision of emergency medical care. Conclusion: The analysis of international experience has shown that using the PEWS system in children with oncological diseases is an effective method of early recognition of signs of clinical deterioration, which, in turn, allows the timely initiation of complex intensive therapy.

Background and Objectives: Childhood acute lymphoblastic leukemia (ALL) carries substantial morbidity, mortality, and economic burden, particularly in middle-income countries. The Pediatric Early Warning System (PEWS) is designed to trigger timely escalation of care, yet its independent impact on survival among critically ill leukemic children has not been well defined in Kazakhstan and Central Asia. Materials and Methods: We conducted a retrospective review all ICU admissions for patients aged 0–18 years with ALL at the National Center of Pediatrics, Almaty, across two periods: pre-implementation (January 2020–December 2022) and post-implementation of 24 h PEWS monitoring (September 2023–December 2024). The primary outcome was ICU mortality. Seven domains of covariates—demographic, clinical history, transfusion, vital signs, symptoms, laboratory, and instrumental data—were extracted. Univariable and multivariable logistic regression models were used to assess associations with mortality. Results: Among 255 admissions (105 during PEWS implementation; 150 prior to PEWS implementation), overall ICU mortality was 21.7%. After adjustment, PEWS implementation was not associated with reduced ICU mortality (AOR 0.89), despite a lower unadjusted mortality (15.9% vs. 26.6%). The most clinically relevant secondary findings included strong associations between mortality and bilateral pneumonia (AOR 7.45), ≥4 episodes of hyperthermia within 24 h of ICU admission (AOR 5.42), and systemic inflammatory response syndrome (AOR 4.61). Conclusions: These findings suggest that, within this high-acuity cohort, inflammatory and cardiorespiratory derangements outweigh any potential survival benefit from ward-based PEWS surveillance. Optimizing outcomes will require integrating early warning systems with timely deterioration management, focused cardiopulmonary support, and resource allocation tailored to the clinical context—rather than relying solely on surveillance scores.

Relevance: Oncological diseases remain the main cause of death in children, increasing the need for intensive care. Hospitalized children suffering from oncological diseases are at high risk for sudden deterioration of their condition, both for the underlying disease and due to infectious complications and the toxic effects of medications. This review highlights information on the Pediatric Early Warning Signs (PEWS) system in oncological patients to detect clinical deterioration promptly. The study aimed to analyze international literature on the use of pediatric early warning signs (PEWS) for clinical deterioration in pediatric oncology. Methods: Current literature on using the PEWS of clinical deterioration in pediatric oncology was studied. Results: The published data show the important role of using the PEWS system in cancer patients for early detection of deterioration of the condition with subsequent provision of emergency medical care. Conclusion: The analysis of international experience has shown that using the PEWS system in children with oncological diseases is an effective method of early recognition of signs of clinical deterioration, which, in turn, allows the timely initiation of complex intensive therapy.

Aim: The aim is to highlight the importance of early detection, the efficacy of pediatric early warning signs (PEWS), and their implications for clinical practice, focusing on the specific signs that affect the detection and management of clinical deterioration in children with oncological diseases.Methods: The review included English-language studies retrieved from common databases using the keywords “pediatric,” “Early Warning Signs,” “clinical deterioration,” combined with terms related to “onchohematological” and “pediatric cancers.”Results: Sixteen articles were analyzed. The analysis revealed that the PEWS cohort was associated with a lower incidence of unplanned codes (p = 0.0001), cardiopulmonary arrest (P = 0.0001), and mortality (P = 0.01). The incidence of critical deterioration between the cohorts showed no significant variation (P = 0.07).Conclusion: PEWS significantly contributes to reducing mortality rates, unplanned codes, and cardiopulmonary arrest. However, further research is required to address the limitations and challenges associated with its application in this population

Relevance: The most common pediatric malignancy is acute lymphoblastic leukemia (ALL), with a prevalence of 4.2 per 100,000 children. Some patients diagnosed with ALL will require hospitalization in intensive care units (ICU) at some point in their treatment. The study aimed to identify significant clinical and laboratory parameters in prognosis to identify indicators of clinical deterioration in children with ALL and develop a scale for early detection of precursors of critical illness in children with ALL. Methods: This retrospective study included inpatient medical records of all patients (0-18 years old) diagnosed with ALL and hospitalized in the intensive care unit (ICU) for oncohematological patients at the Scientific Center for Pediatrics and Pediatric Surgery (Almaty, Kazakhstan). The study period was three years – 2020 to 2022. Results: The clinical and laboratory parameters of children with ALL were analyzed a day before admission to the ICU since those patients demonstrated worsening clinical status. This window of time was chosen to allow us to understand what were the precursors of early deterioration in children with ALL before hospitalization in the ICU. Study data were collected before hospitalization in the ICU during admission to the ICU, and there is data at transfer from the ICU depending on the outcome of the disease. During the study period, 188 patients with ALL were admitted to the ICU. Leukopenia and neutropenia were present in 60-80% of the patients, and elevated leukocyte count was observed in 30-40%, while normal leukocyte count was only 10%-20%. CRP and procalcitonin levels were elevated, showing the presence of inflammation. Conclusions: Based on the retrospective analysis of the data, it can be said that the presented data are harbingers of critical conditions in children with ALL. Neurological, respiratory, cardiac, renal, and other parameters are important for patient treatment and management.

Relevance: Acute lymphoblastic leukemia (ALL) is the most common cancer among children, accounting for nearly a quarter of all childhood cancers. The study aimed to determine the risk factors and signs of critical conditions in children with acute lymphoblastic leukemia admitted to an intensive care unit (ICU). Methods: The approach used was a systematic review. Data was collected from sources published in 2019-2023. Four cohort studies, four retrospective analyses, two literature reviews, one case-control study, and one case study were included in this systematic review. Results: The prognosis in pediatric ALL depends on the initial number of blast cells in the peripheral blood. Patients with B-cell precursor acute lymphoblastic leukemia (BCP ALL) and low blast cell numbers survived better than patients with T-cell acute lymphoblastic leukemia (T-ALL) and low cell count. IL1B and NLRP1 genetic polymorphisms enhanced ALL risk and reduced infectious comorbidity. However, these gene polymorphisms must be confirmed in juvenile leukemia. KRAS, FLT3, NRAS, PTPN11, KMT2D, PTEN, and NOTCH1 gene mutations affected pediatric ALL patient features and treatment results. These mutations demonstrate the relevance of genetic profiling in risk classification and tailored management. Gene variations and availability of effective medication contributed. Pediatric BCP-ALL patients with the PAX5P80R mutation had worse 5-year overall survival, higher white blood cell counts, male preponderance, and more genetic abnormalities. Pediatric BCP-ALL focused on genetic analysis and risk stratification. Children of African American and European American ancestry showed varied incidence, recurrence, and outcome rates for ALL. African American children exhibited lower incidence but greater recurrence rates and poorer prognosis than European American children. Conclusion: Risk factors for these patients’ admission to ICU include comorbidities, infectious diseases, hypoxia, and hemodynamic instability, as well as age and baseline white blood cell count at diagnosis.