Children In Intensive Care Unit Research Articles

Analysis of the changes of bacterial spectrum and drug resistance in sputum culture of ICU children in a hospital of pediatric in Jiangsu Province from 2017 to 2022

Objective: To investigate the changes of the distribution and drug resistance profile of bacteria from ICU children with lower respiratory tract infection (LRTI) in Suzhou City, Jiangsu Province from 2017 to 2022. Methods: From January 2017 to December 2022, a cross-sectional observational study on the bacterial spectrum analysis among intensive care unit (ICU) children with LRTI was conducted in Children's Hospital of Soochow University. The bacteria was cultivated by culture methods from sputum samples, and identified by MALDI-TOF mass spectrometry. Drug sensitivity tests were performed by the VITEK2 Compact fully automated analysis system and the paper slide method. The χ2 test or Fisher's exact probability was used to analyze the changes of the distribution of sputum culture-positive bacteria and drug resistance in ICU children. Results: The overall detection rate of sputum culture was 42.06% (1 182/2 810). Staphylococcus aureus (25.63%,303/1 182), Acinetobacter baumannii (13.62%,161/1 182) and Haemaphilus influenzae (13.28%,157/1 182) were the top three. Proportions of Acinetobacter baumannii (17.90% vs. 11.02%,χ²=11.17, P=0.001), especially carbapenem-resistant Acinetobacter baumannii (43.70% vs. 23.50%, χ²=15.21, P<0.001) increased significantly from 2020 to 2022. However, the proportions of Haemophilus influenzae (8.50% vs. 16.19%, χ²=14.27, P<0.001), Streptococcus pneumoniae (8.50% vs. 15.92%, χ²=13.42, P<0.001) and extended-spectrum-lactamase producing Escherichia coli (8.89% vs. 18.00%, χ²=5.45, P=0.025) decreased. Drug resistant results showed that Acinetobacter baumannii was obviously more resistant to imipenem (χ²=4.43, P=0.035) and levofloxacin (χ²=12.53, P<0.001), while more sensitive to minocycline (χ²=8.34, P=0.004). Escherichia coli showed a significant increase in resistance to piperacillin tazobactam (χ²=8.29, P=0.008) and cefoperazone sulbactam (χ²=5.07, P=0.024) from 2020 to 2022; Klebsiella pneumoniae consistently maintained a resistance rate of more than 60% to first and second-generation cephalosporins, and remain susceptible to quinolones and carbapenems. Staphylococcus aureus remained highly susceptible to levofloxacin (drug resistance rate: 2.31%,7/303) and sulfamethoxazole/trimethoprim (drug resistance rate: 4.95%,15/303) from 2020 to 2022. Conclusion: Higher detection and resistance rates of Acinetobacter baumannii from sputum culture in ICU children from 2020 to 2022 were explored. Resistance of Escherichia coli to β-lactamase inhibitor combinations was more serious. Regular monitoring the changes of the etiology of respiratory tract infections in ICU Children is particularly important for the prevention and treatment of multidrug-resistant bacterial infections.

Management of protective lung ventilation in children with a critical course of acute respiratory distress syndrome caused by SARS-CoV-2 coronavirus infection

the pandemic of coronavirus disease COVID-19 has created a serious threat to the public health system worldwide. With the beginning of the pandemic, it became clear that children infected by SARS-CoV-2, for unknown reasons, have a milder course compared to adults. In some cases, children are asymptomatic carriers of the infection. In light of today's scientific discoveries, contrary to initial reports, recent studies have shown that children are just as likely to contract the virus as adults, while vague symptoms and a milder course more often characterize the disease itself. However, it is worth noting that the true prevalence of asymptomatic SARS-CoV-2 infection is most likely underestimated since children are not tested for COVID-19 without obvious clinical symptoms. This fact has been confirmed by multiple blood tests indicating high titers of IgG to SARS-CoV-2. Compared to adults, the typical clinical manifestations of COVID-19 in children are fever, runny nose, cough, and general weakness. The laboratory test results indicate a normal level of leukocytes, lymphopenia, and an increased level of aspartate aminotransferase, alanine aminotransferase, D-dimer, and MB creatine kinase. Currently, there is no sufficient evidence that the etiotropic therapy is 100% successful. Yet a course of action such as respiratory system protection, control of fluids and electrolyte homeostasis, anti-cytokine therapy, preventative measures for thrombosis, and treatment for bacterial superinfection proved to be efficient at preventing the development of possible complications caused by SARS-CoV-2. Therefore, it is important to collect and accumulate new experiences\cases of respiratory system protection management of an acute respiratory syndrome with a critical course of acute respiratory distress syndrome caused by COVID-19 and implement practical treatment plans for healthcare facilities. The results were analyzed using clinical epidemiology methods. Children were admitted to the intensive care unit on an average of 6,6±0,62 days of illness and were more associated with systemic disorders and water-electrolyte imbalance, which required prosthetic respiratory function, correction of hemodynamics and water-electrolyte disorders, which was carried out in the infectious diseases department of anesthesiology and intensive care for an average of 5,2±0,7 days. In children in the clinical group, SARS-CoV-2 was verified by reverse transcription polymerase chain reaction of a nasopharyngeal swab and/or exhaled air condensate based on its positive results. Comprehensive treatment of patients with severe and extremely severe respiratory distress syndrome in coronavirus disease included respiratory and hemodynamic support, antiviral and antibacterial therapy, parenteral glucocorticosteroids and anticoagulants, which was in line with current national regulatory guidelines and local protocols. According to the criteria for choosing a method of respiratory function prosthetics, in more than half of the patients (62,2%) with hemoglobin oxygen saturation of less than 92%, while maintaining active respiratory capacity, respiratory support was provided by supplementing humidified oxygen through a face mask or nasal cannulas. In another 29,7% of patients, non-invasive ventilation was performed by constant positive airway pressure, with an oxygenation index of 0,4-0,5 and a positive end-expiratory pressure of 4-5 cm of water column. Children who had a critical course of acute respiratory syndrome caused by coronavirus infection COVID-19 (8,1%) and in whom non-invasive methods of respiratory support did not bring the desired therapeutic result were on invasive ventilation in the mode of auxiliary controlled ventilation or in the mode of synchronized intermittent forced ventilation. It should be noted that children who received respiratory support in the form of non-invasive ventilation by means of constant positive airway pressure required a lower concentration of oxygen in the inhalation mixture compared to patients on free-flow oxygen supplementation. The need for admission to the intensive care unit of children with COVID-19 is primarily associated with respiratory disorders caused by interstitial pneumonia. Oxygen supplementation was of paramount importance in patient management, primarily through noninvasive ventilation with constant positive airway pressure or free flow. The use of a pulmonary protective strategy in the treatment of acute respiratory distress syndrome caused by coronavirus disease COVID-19 in children requiring invasive ventilation was accompanied by a pronounced positive result, as it was not accompanied by side effects and resulted in a rapid recovery of patients.

Predicting delayed extubation and transfer to the intensive care unit in children undergoing posterior fusion surgery for scoliosis : Aretrospective observational study.

Delayed extubation and transfer to the intensive care unit (ICU) in children undergoing major scoliosis surgery may increase postoperative complications, prolong hospital stay, and increase medical expenses; however, whether achild will require delayed extubation or transfer to the ICU after scoliosis orthopedic surgery is not fully understood. In this study, we reviewed the risk factors for delayed extubation and transfer to the ICU after scoliosis orthopedic surgery in children. The electronic medical records of pediatric patients (≤ 18years) who underwent posterior spinal fusion surgery between January 2018 and November 2021 were reviewed and analyzed. Patient characteristics (age, sex, body mass index, American Society of Anesthesiologists, ASA, grade, preoperative lung function, and congenital heart disease), preoperative Cobb angle, scoliosis type, correction rate, vertebral fusion segments, pedicle screws, surgical osteotomy, intraoperative bleeding, intraoperative allogeneic transfusion, intraoperative hemoglobin changes, intraoperative mean arterial pressure changes, intraoperative tidal volume (ml/kg predicted body weight), surgical time, postoperative extubation, and transfer to the ICU were collected. The primary outcomes were delayed extubation and transfer to the ICU. Multivariate logistic regression models were used to determine the risk factors for delayed extubation and ICU transfer. Atotal of 246 children who satisfied the inclusion criteria were enrolled in this study, of whom 23(9.3%) had delayed extubation and 81(32.9%) were transferred to the ICU after surgery. High ASA grade (odds ratio [OR] 5.42; 95% confidence interval [CI] 1.49-19.78; p = 0.010), high Cobb angle (OR 1.04; 95% CI 1.02-1.07; p < 0.001), moderate to severe pulmonary dysfunction (OR 10.9; 95% CI 2.00-59.08; p = 0.006) and prolonged surgical time (OR 1.01; 95% CI 1.00-1.03; p = 0.040) were risk factors for delayed extubation. A high Cobb angle (OR 1.02; 95% CI 1.01-1.04; p = 0.004), high intraoperative bleeding volume (OR 1.06; 95% CI 1.03-1.10; p = 0.001), allogeneic transfusion (OR 3.30; 95% CI 1.24-8.83; p = 0.017) and neuromuscular scoliosis (OR 5.38; 95% CI 1.59-18.25; p = 0.007) were risk factors for transfer to the ICU. A high Cobb angle was arisk factor for both delayed extubation and ICU transfer. Age, sex, body mass index, number of vertebral fusion segments, correction rate, and intraoperative tidal volume were not associated with delayed postoperative extubation and ICU transfer. The most common risk factor for delayed extubation and ICU transfer in pediatric patients who underwent posterior spinal fusion was ahigh Cobb angle. Determining risk factors for apoor prognosis may help optimize perioperative respiratory management strategies and planning of postoperative care for children undergoing complicated spinal surgery.

Rapid genomic sequencing for genetic disease diagnosis and therapy in intensive care units: a review.

Single locus (Mendelian) diseases are a leading cause of childhood hospitalization, intensive care unit (ICU) admission, mortality, and healthcare cost. Rapid genome sequencing (RGS), ultra-rapid genome sequencing (URGS), and rapid exome sequencing (RES) are diagnostic tests for genetic diseases for ICU patients. In 44 studies of children in ICUs with diseases of unknown etiology, 37% received a genetic diagnosis, 26% had consequent changes in management, and net healthcare costs were reduced by $14,265 per child tested by URGS, RGS, or RES. URGS outperformed RGS and RES with faster time to diagnosis, and higher rate of diagnosis and clinical utility. Diagnostic and clinical outcomes will improve as methods evolve, costs decrease, and testing is implemented within precision medicine delivery systems attuned to ICU needs. URGS, RGS, and RES are currently performed in <5% of the ~200,000 children likely to benefit annually due to lack of payor coverage, inadequate reimbursement, hospital policies, hospitalist unfamiliarity, under-recognition of possible genetic diseases, and current formatting as tests rather than as a rapid precision medicine delivery system. The gap between actual and optimal outcomes in children in ICUs is currently increasing since expanded use of URGS, RGS, and RES lags growth in those likely to benefit through new therapies. There is sufficient evidence to conclude that URGS, RGS, or RES should be considered in all children with diseases of uncertain etiology at ICU admission. Minimally, diagnostic URGS, RGS, or RES should be ordered early during admissions of critically ill infants and children with suspected genetic diseases.

Nurses' attitudes towards factors determining the safety of patients treated in intensive care units: A cross-sectional study.

The goal of health care systems is to ensure high quality of medical services provided, including patient safety. The intensive care unit (ICU) is an environment conducive to the occurrence of adverse events and medical errors because of the complexity of the care provided, the severity of the conditions of patients treated in these units and work often performed under stressful conditions. Assessment of attitudes of nurses working in ICUs towards patient safety. A cross-sectional, descriptive study was conducted in a group of 214 nurses employed in ICUs in hospitals located in the southern part of Poland. The study used the Polish version of the Attitudes towards safety: (SAQ-SF PL) questionnaire and an original questionnaire consisting of questions on socio-demographic and professional data. The overall SAQ score for the whole group was 61.89, 57.29 for adult ICU nurses and 68.20 for children's ICU. The surveyed nurses in general obtained the highest average results in terms of teamwork climate (TC)-66.92, while the lowest scores were given to the management-hospital management (PM)-45.08 and working conditions (WC)-57.56. job satisfaction (JS) positively correlated with the assessment of the TC, the assessment of the safety climate (SC), the assessment of the management staff (Head of Department) (PM), the assessment of the management staff (hospital management) (PM) and the assessment of work conditions (WC). A statistically significant, negative correlation was found between the assessment of JS and the assessment of stress recognition (SR) (r = -.20; p < .01). In the surveyed ICU branches, there is a low SC, and it is related, among others, to the perception of WC and the role of the management staff. The level of JS among nursing staff mainly depends on the SC, the TC, WC and the support of the management staff. The results of the research presented here provide valuable assistance in identifying areas related to patient safety in ICUs. Managers' awareness of the importance of coping with occupational stress, WC or effective teamwork can help to improve staff attitudes and attitudes towards patient safety. When shaping a safe culture in a health care organization, it is important to remember that ensuring safe patient care is not only about programmes, standards or procedures, but safety is primarily about human resources-the staff involved in the treatment process-doctors, nurses, paramedics and physiotherapists. High awareness of safety at work, cooperation in an interdisciplinary team, assessment of safety culture at work and analysis and drawing conclusions may result in a real increase in quality and safety, and the patient will feel safer in 'XX' hospitals.

Epidemiology and drug resistance analysis of bloodstream infections in an intensive care unit from a children’s medical center in Eastern China for six consecutive years

BackgroundChildren in the intensive care unit (ICU) who suffer from severe basic diseases and low immunity are usually in critical condition. It is crucial to assist clinicians in selecting the appropriate empirical antibiotic therapies for clinical infection control.MethodsWe retrospectively analyzed data from 281 children with bloodstream infection (BSI). Comparisons of basic data, pathogenic information, and drug resistance of the main bacteria were conducted.ResultsWe detected 328 strains, including Gram-positive bacteria (223, 68%), mainly coagulase-negative Staphylococci (CoNS); Gram-negative bacteria (91, 27.7%); and fungi (14, 4.3%). The results of the binary logistic regression analysis showed that the main basic disease was an independent risk factor for death. Compared with Escherichia coli, Klebsiella pneumoniae exhibited a higher proportion of extended-spectrum β-lactamases (ESBLs), and its resistance to some β-lactamides and quinolones antibiotics were lower. Twenty-seven isolates of multidrug-resistant (MDR) bacteria were detected, of which carbapenem-resistant Acinetobacter baumannii (CRAB) accounted for the highest proportion (13, 48.2%).ConclusionsCoNS was the principal pathogen causing BSI in children in the ICU of children, and Escherichia coli was the most common Gram-negative pathogen. The main basic disease was an independent risk factor for death. It is necessary to continuously monitor patients with positive blood cultures, pay special attention to detected MDR bacteria, and strengthen the management of antibiotics and prevention and control of nosocomial infections.

Analysis of factors associated with admission to the intensive care unit of children and adolescents with COVID-19: application of a multilevel model.

To identify factors associated with hospitalization in the intensive care unit in children and adolescents with COVID-19. This was a retrospective cohort study using secondary data of hospitalized children and adolescents (zero to 18 years old) with COVID-19 reported in Paraíba from April 2020 to July 2021, totaling 486 records. Descriptive analysis, logistic regression and multilevel regression were performed, utilizing a significance level of 5%. According to logistic regression without hierarchical levels, there was an increased chance of admission to the intensive care unit for male patients (OR = 1.98; 95%CI 1.18 - 3.32), patients with respiratory distress (OR = 2.43; 95%CI 1.29 - 4.56), patients with dyspnea (OR = 3.57; 95%CI 1.77 - 7.18) and patients living in large cities (OR = 2.70; 95%CI 1.07 - 6.77). The likelihood of requiring intensive care was observed to decrease with increasing age (OR = 0.94; 95%CI = 0.90 - 0.97), the presence of cough (OR = 0.32; 95%CI 0.18 - 0.59) or fever (OR = 0.42; 95%CI 0.23 - 0.74) and increasing Gini index (OR = 0.003; 95%CI 0.000 - 0.243). According to the multilevel analysis, the odds of admission to the intensive care unit increased in male patients (OR = 1.70; 95%CI = 1.68-1.71) and with increasing population size of the municipality per 100,000 inhabitants (OR = 1.01; 95%CI 1.01-1.03); additionally, the odds of admission to the intensive care unit decreased for mixed-race versus non-brown-skinned patients (OR = 0.981; 95%CI 0.97 - 0.99) and increasing Gini index (OR = 0.02; 95%CI 0.02 - 0.02). The effects of patient characteristics and social context on the need for intensive care in children and adolescents with SARS-CoV-2 infection were better estimated with the inclusion of a multilevel regression model.

Acute Kidney Injury in Children after Cardiac Surgery and Associated Risk Factors

Introduction: Acute kidney injury (AKI) is a common complication after cardiac surgery, and its occurrence is associated with a worse prognosis and increased mortality. The term cardiac surgery-associated AKI (CSA-AKI) is used to describe the entity. CSA-AKI is independently associated with an increase in short-term morbidity, costs of treatment, and long-term mortality. In this study, we evaluated the frequency of CSA-AKI in an intensive care unit for children undergoing cardiac surgery to examine the prevalence of CSA-AKI and the risk factors contributing to it. Methods: This retrospective descriptive cross-sectional study evaluated 73 patients admitted to a single center for cardiac surgery in 2022. Inpatient files were reviewed for patients who underwent surgical procedures for congenital heart disease (CHD) during 2022. Results: AKI occurred in 35.6% of children undergoing cardiac surgery. The majority of cases were infants or had cyanotic heart disease (42.5% and 25.8%, respectively). Conclusions: Almost one-third of postcardiac surgery patients develop AKI. Monitoring for AKI postoperatively is especially necessary in infants and patients with cyanotic CHD.

Effects of on-table extubation on resource utilization and maternal anxiety in children undergoing congenital heart surgery in a low-resource environment.

To study the applicability of on-table extubation (OTE) protocol following congenital cardiac surgery in a low-resource setting and its impact on the length of intensive care unit (ICU) stay, hospital stay, hospitalization cost, parental anxiety, and nurse anxiety. In this prospective, nonrandomized, observational single-center study, we included all children above 1 year of age undergoing congenital cardiac surgery. We evaluated them for the feasibility of OTE using a prespecified protocol following separation from cardiopulmonary bypass. The data were prospectively collected on 60 children more than 1 year of age, belonging to the Risk Adjustment for Congenital Heart Surgery 1, 2, 3, and 4 groups and divided into two groups: those who underwent successful OTE and those who were ventilated for any duration postoperatively (30 children in each group). Duration of hospital stay, ICU stay, and total hospital cost were collected. Anxiety levels of the primary caregiver (nurse) in the ICU and the mother were assessed immediately after the arrival of the child in the ICU using the State Trait Anxiety Inventory (STAI). Children who were extubated immediately following congenital cardiac surgery had significantly shorter ICU stay (median 20 [19, 22] h vs. 22 [20, 43] h [P < 0.05]). Patients extubated on table had a significant reduction in hospital cost {median Rs. 161,000 (138,330; 211,900), approximately USD 1970 (P < 0.05)} when compared to children who were ventilated postoperatively {median Rs. 201,422 (151,211; 211,900) , approximately USD 2464}. The anxiety level in mothers was significantly less when their child was extubated in the operating room (STAI 36.5 ± 5.4 vs. 47.4 ± 7.4, P < 0.001). However, for the same subset of patients, anxiety level was significantly higher in the ICU nurse (STAI 46.0 ± 5.6 vs. 37.8 ± 4.1, P < 0.05). OTE following congenital cardiac surgery is associated with a shorter duration of ICU stay and hospital stay. It also reduces the total hospital cost and the anxiety level in mothers of children undergoing congenital heart surgery. However, the primary bedside caregiver during the child's ICU stay had increased anxiety managing patients with OTE.

Role of Capillary Blood Ketone Assay in Management of Diabetic Ketoacidosis in Paediatric Intensive Care Unit

Objective: To assess the role of capillary blood ketone assay in managing Diabetic Ketoacidosis in the Paediatric Intensive Care Unit. Study Design: Prospective longitudinal study. Place and Duration of Study: Paediatric Intensive Care Unit of Children’s Hospital, University of Child Health Sciences, Lahore Pakistan, from Jul to Dec 2021. Methodology: Patients with Diabetic ketoacidosis fulfilling the inclusion criteria and admitted during the study period were enrolled, and treatment was given according to standard protocol. On admission, capillary blood ketones were measured after 4-6 hours, and serial blood glucose, serum electrolytes, serum creatinine and venous blood gas were done. Results: Out of 554 admissions, 55(9.9%) patients with diabetic ketoacidosis were enrolled. The mean age was 8.2±3.5 years, with 28(50.9%) females. Among 33(60%) newly diagnosed cases, 13(23.6%) were moderate and 41(74.5%) with severe diabetic ketoacidosis. 12(21.8%) cases developed AKI, 5(9.1%) required continuous renal replacement therapy, 10(18.2%) needed mechanical ventilation, and 2(3.6%) expired. A positive statistical correlation was observed between capillary blood ketones and standard acidosis markers on admission. Conclusion: Capillary blood ketone assay has a significant role in managing Diabetic Ketoacidosis by prompt diagnosis, early initiation of treatment and early stoppage of insulin infusion at resolution of ketosis without waiting for blood gas parameters to normalise. Its use should be encouraged in PICUs, especially in low-resource settings, because of its cost-effectiveness.

A Revolving Door to the Intensive Care Unit for Children Surviving Acute Respiratory Distress Syndrome

A Revolving Door to the Intensive Care Unit for Children Surviving Acute Respiratory Distress Syndrome

Association between early parenteral nutrition and the development of bronchopulmonary dysplasia in preterm infants

To study the relationship between early parenteral nutrient intake and the development of bronchopulmonary dysplasia (BPD) in preterm infants with gestational age less than 32 weeks who could not receive enteral nutrition within one week after birth. A retrospective study was conducted on preterm infants born between October 2017 and August 2022 with gestational age less than 32 weeks who were admitted to the Neonatal Intensive Care Unit in Children's Hospital of Soochow University within 24 hours after birth and relied solely on parenteral nutrition within the first week of life. The study population included 79 infants with BPD and 73 infants without BPD. Clinical data during hospitalization were compared between the two groups. The proportions of infants with weight loss of more than 10% after birth, extrauterine growth retardation, and parenteral nutrition-associated cholestasis in the BPD group were higher than in the non-BPD group (P<0.05). The time to regain birth weight, time to achieve full enteral feeding, and corrected gestational age at discharge were longer in the BPD group than in the non-BPD group. The Z-scores of physical growth at corrected gestational age of 36 weeks were lower in the BPD group than in the non-BPD group (P<0.05). The BPD group had a higher fluid intake and a lower calories intake in the first week than the non-BPD group (P<0.05). The starting dose and total amount of amino acids, glucose, and lipids in the first week were lower in the BPD group than in the non-BPD group (P<0.05). The BPD group had a higher glucose-to-lipid ratio on the third day and higher energy-to-nitrogen and glucose-to-lipid ratios on the seventh day after birth than the non-BPD group (P<0.05). Preterm infants with BPD had lower intake of amino acids and lipids and a lower proportion of calories provided by amino acids and lipids in the first week of life, which suggests an association between early parenteral nutrition intake and the development of BPD.

Clinical practice of whole-genome sequencing in the rapid diagnosis of critically ill neonates

To explore the application of whole-genome sequencing (WGS) in the rapid clinical diagnosis of critically ill neonates. The critically ill neonates who admitted to the neonatal intensive care unit of Children's Hospital of Fudan University and underwent WGS from August to September, 2019 were enrolled in this prospective study. The genetic testing results and clinical outcome were analyzed with reference to the sequencing data and clinical features of the neonates. A total of 15 neonates were tested, among whom there were 9 boys and 6 girls. The main reason for hospitalization included abnormal breathing in 7 neonates, poor response in 2 neonates, feeding difficulty in 2 neonates, fever in 1 neonate, hypothermia in 1 neonate, preterm birth in 1 neonate, and convulsion in 1 neonate. The mean turn-around time was 4.5 days for WGS. Finally a genetic diagnosis was obtained for 3 neonates, with a positive diagnostic rate of 20% (3/15). Among the 3 neonates, 2 neonates were withdrawn from the treatment due to severe conditions and 1 neonate died on the day when the sample was sent for genetic testing, whose etiology could be explained by the results of genetic testing. WGS technique can provide a timely and effective diagnosis for critically ill neonates suspected of genetic diseases and provide genetic evidence for clinical treatment of critically ill cases.

Lactate acid level and prognosis of neonatal necrotizing enterocolitis: a retrospective cohort study based on pediatric-specific critical care database

ObjectiveTo investigate the relationship between lactate acid level and hospitalization mortality in neonatal necrotizing enterocolitis (NEC). MethodPaediatric-specific critical care database collected clinical data from the intensive care unit of Children's Hospital Affiliated to Zhejiang University Medical College from 2010 to 2018. Clinical and laboratory examination information of NEC patients was collected and divided into the death group and discharge group to find out the risk factors affecting the prognosis through univariate and multivariate analysis. ResultsAmong 104 NEC neonates, the admission age was 7.5 days and the weight was 2.03 kg. Comparing the death group with the discharge group, there were significant differences in therapeutic regimen, pH, serum albumin, total protein, creatinine and lactate acid. Multivariate and threshold effect analysis showed that lactate acid had a linear correlation with hospital mortality, and newborns who died in the hospital had much higher lactate levels than those who were discharged. The mortality of NEC newborns increased by 40–45% for every 1 mmol/L increase in lactate acid level. ConclusionsThere was a correlation between lactate acid level and hospital mortality in newborns with NEC, and lactate acid level was an important index to evaluate the prognosis of NEC.

Unplanned Return to Cardiac Intensive Care Unit of Children After Congenital Heart Surgery: Incidence, Outcomes, and Risk Factors.

Factors leading to an unplanned return to the cardiac intensive care unit (CICU) in children after congenital heart disease and their impact on mortality have not been well characterized. We sought to determine the incidence and outcomes of unplanned return to the CICU. A secondary objective was to identify risk factors. Retrospective analysis of the registration data collected by our unit. The study subjects included postoperative patients with congenital heart disease who survived to initial transfer out of the CICU. Patients who unexpectedly returned to the CICU due to an acute change in clinical status were defined as unplanned returns. Demographic, preoperative, intraoperative, and postoperative variables were assessed. Univariate comparisons were performed between the return group and non-return group, and multivariate regression analysis was performed to identify potential risk factors for unplanned return to the CICU. Of the 531 children who met the inclusion criteria, 29 were unplanned returns to the CICU. Respiratory symptoms (41.4%) and cardiac symptoms (44.8%) were the most common reasons for returning to the CICU. Patients with unplanned returns had a higher mortality rate (13.8% vs. 0.56%, P < 0.01). In multivariate analysis, unplanned CICU admission was associated with chromosomal abnormalities (P < 0.01), longer ventilator duration (P < 0.01), and more prolonged cardiopulmonary bypass (P < 0.01) was associated with a return to independence. Unplanned return to the CICU during the same hospital stay was uncommon but associated with higher mortality. Chromosomal abnormalities, longer ventilator use duration, and prolonged CPB were significant risk factors for the entire cohort. We hope to minimize the impact of unplanned return after congenital heart disease surgery by changing the process of transferring these high-risk postoperative patients out of the CICU and early postoperative care.

Etiology and Risk Factors for Admission to the Pediatric Intensive Care Unit in Children With Encephalitis in a Developing Country.

To describe a cohort of pediatric patients with encephalitis and their risk factors for admission to the pediatric intensive care unit (PICU). Children (<18 years old), with encephalitis evaluated by conventional microbiology and syndromic, multiplex test in cerebrospinal fluid (CSF) between July 2017 and July 2020, were recruited from 14 hospitals that comprise the Colombian Network of Encephalitis in Pediatrics. Multivariate analyses were used to evaluate risk factors associated with the need for PICU admission. Two hundred two children were included, of which 134 (66.3%) were male. The median age was 23 months (IQR 5.7-73.2). The main etiologies were bacteria (n = 55, 27%), unspecified viral encephalitis (n = 44, 22%) and enteroviruses (n = 27, 13%), with variations according to age group. Seventy-eight patients (38.6%) required management in the PICU. In multivariate analysis, factors associated with admission to the PICU were the presence of generalized seizures (OR 2.73; 95% CI: 1.82-4.11), status epilepticus (OR 3.28; 95% CI: 2.32-4.62) and low leukocyte counts in the CSF (OR 2.86; 95% CI: 1.47-5.57). Compared with enterovirus, bacterial etiology (OR 7.50; 95% CI: 1.0-56.72), herpes simplex encephalitis (OR 11.81; 95% CI: 1.44-96.64), autoimmune encephalitis (OR 22.55; 95% CI: 3.68-138.16) and other viral infections (OR 5.83; 95% CI: 1.09-31.20) increased the risk of PICU admission. Data from this national collaborative network of pediatric patients with encephalitis allow early identification of children at risk of needing advanced care and can guide the risk stratification of admission to the PICU.

Is the Oral Cavity of Intensive Care Unit Pediatric Patients More Susceptible to Methicillin-Resistant Staphylococcus aureus Infection?

Objective: The aim of this study was to assess the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the oral cavity of pediatric patients hospitalized at an intensive care unit (ICU). Methodology: Thirty ICU patients (group 1) and 30 healthy patients (group 2), between 1 and 12 years of age, matched by sex and age, were selected from a public hospital in Brazil. After oral examinations, biological specimens (nostril swab, oral mucosa, and supragingival biofilm) were collected from both groups to verify the presence of Staphylococcus aureus. Identification occurred after growth in Tryptic Soy Broth with 7.5% of NaCl for 48 hours, growth in Mannitol Salt Agar, gram staining, catalase, and coagulase tests. S. aureus isolates were submitted to antibiotic sensitivity test. Results: Only 36.7% of patients in the ICU perform oral hygiene during the hospitalization period and 41.7% presented high level of dental biofilm accumulation. The presence of S. aureus was similar in patients from group 1 (43.3%, 13) and group 2 (50.0%, 15) (p = 0.60). Both groups presented 18 samples each that tested positive for S. aureus. However, when considering patients infected by MRSA, the prevalence was higher in group 1 (eight; 26.7%) than in group 2 (five; 16.7%) but no statistical difference was observed (p = 0.53). In group 1, nine MRSA samples were resistant to erythromycin and seven to clindamycin. In group 2, two MRSA samples were resistant to erythromycin and two to clindamycin. Conclusions: Although ICU children did not show a significant higher carriage of MRSA when compared with the healthy group in the population studied, the number of highly resistant strains in the oral cavity isolated from ICU patients adds an important risk factor to be considered by the medical team as possible source of systemic infections, extended hospital stay, and poor outcomes.

0793 Postoperative Monitoring in Children less than 2 years of Age undergoing Adenotonsillectomy for Obstructive Sleep Apnea

Abstract Introduction To analyze variables associated with postoperative monitoring in children &amp;lt;2 years of age undergoing adenotonsillectomy (T&amp;A) for the management of obstructive sleep apnea (OSA). Methods Retrospective case series of children &amp;lt;2 years of age who underwent T&amp;A for the management of OSA between 1/1/08-6/1/18. Postoperative respiratory complications and hospital course were analyzed to determine higher acuity of monitoring in Intensive Care Unit (ICU) versus observation unit was indicated. Results A total of 69 children were analyzed. Fifty-two (75.4%) patients were male, and their mean age was 18.8 months. Fifty-six (81.2%) children had severe OSA, 6 (8.7%) had moderate OSA, and 7 (10.1%) children had mild OSA. Thirty-seven (53.6%) children were monitored in the ICU; one (2.7%) child was admitted to the ICU directly from the sleep lab, and3 (8.1%) children were intubated. The average Apnea Hypopnea Index (AHI) for those who were intubated was 64.6 events/hour and low SpO2 average was 66.3%, when compared to an average of 36.2 events/hour and 75.5% respectively for the entire group. Three (8.1%) patients needed &amp;gt;2 liters/minute of O2, and 5 (13.5%) had minor O2 requirements. Only 7/32 (21.9%) patients monitored in the observation unit required supplemental O2. Conclusion A greater severity of AHI and low SpO2 nadir were associated with respiratory issues requiring monitoring of children in ICU after T&amp;A for OSA. No specific PSG cut-off values for ICU versus observation unit were noted. Low incidences of respiratory issues were observed, and most children could have been monitored safely outside of the ICU setting. Support (If Any) None

Prevalence of KPC-producing bacteria in negative gram of clinical samples obtained from patients

ObjectiveCarbapenems are beta-lactam antibiotics that can play an important role in infections with multiple and severe resistance. The aim of this study was to investigate the frequency of carbapenem-producing bacteria in gram-negative isolates of clinical samples obtained from patients. Methods291 g-negative bacilli were isolated from the samples of hospitalized patients using gram staining method, conventional methods and biochemical tests. The antibiotic susceptibility of the isolates was determined using the agar disk diffusion method for 5 different antibiotics. Strains that were resistant to Meropenem antibiotic, KPC enzyme production was examined by the Modified Hodge test method. ResultsOut of 291 g-negative bacilli, 14 isolates showed resistance to Meropenem by a disk agar diffusion method where 12 (85.8%) strains were producing KPC enzyme. The highest frequency of Gram-negative KPC-producing bacilli was related to Klebsiella pneumoniae and the most positive samples were urine. The prevalence of this type of bacteria was highest in NICU and the male internal ward, respectively. ConclusionIt was shown that carbapenem-resistant strains are considered as a growing problem in hospitals, especially in the intensive care unit for children and men.

Effect of Benson relaxation therapy on sleep quality among children in pediatric intensive care unit

Background: Children in intensive care units must get enough sleep to maintain their physical and mental health. Benson’s Muscle Relaxation Technique is an effective complementary and non-pharmacological technique used to improve sleep patterns. Aim: To evaluate the effect of Benson relaxation therapy on sleep quality among children in the pediatric intensive care unit. Subjects and Methods: Design: A quasi-experimental design was used to achieve this study. Setting: The study was conducted in Pediatric Intensive Care Unit affiliated to Sohag University Hospital. Subject: Non-probability purposive sampling technique was used to select a sample of 60 children who were randomly assigned into two groups, 30 for each (the study and control groups). Two tools were used: (I) a structured interview questionnaire and (II) the Pittsburgh Sleep Quality Index scale. Results: The present study findings demonstrated that There were significant differences and improvements regarding sleep quality mean scores between the two groups post-implementation of Benson relaxation therapy at (P&lt;0.05). Conclusion: Benson's relaxation therapy implementation was an effective and safe intervention used to improve sleep quality among children in the pediatric intensive care unit. Recommendations:Benson relaxation therapy is recommended alongside treatment for children in the pediatric intensive care unit to improve their sleep quality.