Clinical Outcomes In Children Research Articles

Medium-chain triglycerides and the impact on fat absorption, growth, nutritional status and clinical outcomes in children with cholestatic liver disease: A scoping review

Medium-chain triglyceride (MCT) supplementation is recommended in cholestatic liver disease, despite unclear evidence and no consensus on the ideal percentage of fat that should be MCT. The aim was to undertake a scoping review to identify the extent and type of evidence regarding how MCT supplementation, and percentage of MCT, affects fat absorption, growth, nutritional status and clinical outcomes (morbidity, mortality, transplant) in children with cholestatic liver disease. Nine databases (MEDLINE, Embase, CINAHL, PubMed, AMED, Cochrane Library, Global Health, Scopus, Proquest) were searched from inception, with hand-searching conference abstracts and forward/backward citation searching. Eligible studies investigated oral/enteral MCT supplementation in children under 18y with cholestatic liver disease. There were no language limits. Two reviewers performed screening and data extraction independently. Data were synthesised narratively. Following title/abstract screening (1202 studies) and full-text review (40 studies), 24 studies were included comprising three small RCTs (n=19 patients), one non-randomised controlled trial (n=2), seven uncontrolled trials (n=83) and thirteen case series/reports (n=211). Seventeen studies were published before 1994. Outcomes included absorption, growth and nutritional status. MCT supplementation was associated with greater fat absorption (9/9 studies) and improved growth in some children (2/4). Higher percentage MCT was associated with greater magnesium and calcium absorption (1/1), essential fatty acid (EFA) deficiency (4/4), but not growth (3/3). The limited, mostly observational evidence from >30 years ago points to greater fat absorption on MCT and EFA deficiency on very high percentage MCT. High quality RCTs are required, particularly examining the impact of MCT at different percentages on growth, nutritional status and clinical outcomes.

46 Association of Empiric Antibiotic Selection on Clinical Outcomes in Hospitalized Children with Severe Orbital Infections: A Multicenter Cohort Study

Abstract Background Antibiotic selection in children with periorbital and orbital infections is often empiric and regimens vary widely among institutions in their spectrum and inclusion of anti-anaerobic and anti-staphylococcal agents. Objectives Currently, there are no national clinical guidelines for antibiotic selection and no studies comparing commonly used antibiotic regimens in orbital infections. We aimed to determine the association of initial empiric antibiotic regimens with clinical outcomes in children hospitalized with severe orbital infections. Design/Methods We conducted a multicentre cohort study of children with severe orbital infections admitted to ten hospitals between January 1, 2009, and December 31, 2018. The association between empiric antibiotic regimen in the first 24 hours of hospitalization with length of stay and surgical intervention were assessed with multivariable median regression and multivariate logistic regression, respectively. Results Of 1421 patients, 60.0% were male, and mean age was 6.4 years (SD 4.5). Median length of stay was 86.4 hours (IQR 56.9-137.5) and 180 (12.7%) received surgical intervention. The most frequently (23.6%) administered empiric regimen consisted of a third-generation cephalosporin, anaerobic agent, and staphylococcal agent. After adjustment, broad-spectrum empiric antibiotic regimens with dedicated anti-anaerobic and/or staphylococcal coverage were associated with increased length of stay, ranging from an additional 18.4 hours (95% CI, 6.82, 30.0) to 21.5 hours (95% CI, 11.0, 32.0). Only patients with staphylococcal coverage alone had a statistically significant increased odds of surgical intervention (4.45, 95% CI 1.03, 19.2). Conclusion In children hospitalized with severe orbital infections, broad-spectrum therapy with or without coverage for staphylococci and anaerobes were associated with similar clinical outcomes in a clinical setting with low methicillin-resistant Staphylococcus aureus prevalence. Clinical practice guidelines are needed to standardize antibiotic recommendations.

Predictive value of chemokines (CCL 2) in bronchoalveolar lavage fluid for refractory mycoplasma pneumonia in children

BackgroundThere are relatively few studies investigating C-C motif chemokine ligand 2 (CCL2) level in bronchoalveolar lavage fluid (BALF) in children with Mycoplasma pneumoniae pneumonia (MPP), and the relationship between CCL2 level in BALF and refractory mycoplasma pneumoniae pneumonia (RMPP) is unclear. This study aims to explore the relationship between chemokine CCL2 level in BALF and clinical characteristics and clinical outcome in children with MPP.MethodsA total of 51 children with confirmed acute MPP and requiring bronchoalveolar lavage in Department of Pediatrics, Huanghe Sanmenxia Hospital and The First Clinical College of Xinxiang Medical University from October 2021 to February 2023 were selected as the study group. And 11 children with bronchial foreign body were selected as the control group. The study group was divided into the non-refractory mycoplasma pneumoniae pneumonia (NRMPP) group and the RMPP group based on the response to treatment. BALF and clinical data of the patients were collected. And CCL2 levels were tested in the patients. Differences in CCL2 level in BALF and clinical characteristics were tested and compared.ResultsThe CCL2 level in BALF of the study group was higher than that of the control group, with significant difference (P < 0.05). With ROC curve, the area under the curve (AUC) of CCL2 in BALF predicting RMPP was 0.94, the cut-off value was 0.645 ng/ml, the sensitivity was 85%, and the specificity was 94%, and the diagnostic value was better than that of serum CRP and LDH. Logistic regression analysis was used to build the RMPP prediction model, and CCL2 showed good predictive value.ConclusionThe level of CCL2 in BALF was high in children with MPP and had a high predictive value for RMPP. CCL2 can be used as one of the biomarkers for predicting RMPP.

Clinical outcomes of children with acute asthma managed with intravenous magnesium sulphate outside intensive care setting.

Asthma in children constitutes a well-known respiratory condition with significant mortality. In poorly controlled asthma, multiple adjunct therapies including magnesium sulphate (MgSO4), are recommended to decrease the likelihood of intubation; however, limited evidence exists to support their routine usage in day-to-day situations. Aim of this study is to determine the outcomes of pediatric patients treated with magnesium sulphate during exacerbations of asthma admitted at a tertiary care unit. A retrospective study was conducted at The Aga Khan University Hospital, Karachi, Pakistan from January 2019 to December 2021. Patients aged 6 years to 15 years presented with acute asthma through Emergency Room (ER) having clinical respiratory score (CRS) more than five, admitted in high-dependency unit (HDU) were included in the study. Patients who were started on magnesium sulfate within 24 hours of admission were categorized in magnesium sulfate (MS) group. Patients receiving all standard acute asthma treatment but were not started on magnesium therapy within 24 hours of admission were categorized in the non-magnesium sulfate (non-MS) group. Different outcome variables were compared between the groups. A total of 110 patients with asthma were enrolled. Fifty-four patients were categorized into MS group while 56 were included in non-MS group. Fewer patients were transferred from HDU to pediatric intensive care unit (PICU) (24.07%) in MS group compared to non-MS group (42.85%), (p=0.02). In MS group, the mean number of days spent on oxygen in HDU were 2.38±0.81, while non-MS group spent more days (3.10±0.84 (p<0.01). This study demonstrates that for pediatric patients with severe asthma exacerbations, administration of IV MgSO4 (within 24 hours) is beneficial and results in fewer admissions to PICU and reduces the mean number of days spent on oxygen therapy.

Characterisation and clinical outcomes in children and adolescents with diabetes according to newly defined subgroups: a cohort study from the DPV registry

Personalised therapy has emerged as a possibly more efficient approach taking disease heterogeneity into account. The aim of this study was to determine whether recently described subgroups of childhood diabetes have prognostic association with diabetes-specific complications and, therefore, might be a basis for personalised therapies. We applied a previously developed subgroup classification to pediatric patients (diabetes onset <18 years) from the prospective Diabetes Patient Follow-up (DPV) registry with documented data between January 1, 2000 and March 31, 2022, from diabetes centers in Germany, Austria, Switzerland, and Luxembourg. The classification required information on islet autoantibody status, age, haemoglobin A1c (HbA1c), and body-mass index (BMI-SDS) at disease manifestation, as well as follow up data after 2 and after 4 years, which was available in 22,719 patients. Patients without documented data on these parameters were excluded from the analysis. The cumulative risk of severe hypoglycemia, diabetic ketoacidosis (DKA), retinopathy, and nephropathy were analysed by Kaplan-Meier analyses over a median follow-up of 6.8 years (IQR 4.8-9.6). Patients were classified into 10 subgroups (P1-P7 islet autoantibody-positive, n=19,811; N1-N3 islet autoantibody-negative, n=2908). The groups varied markedly with respect to specific acute and chronic complications. Severe hypoglycemia was a characteristic feature in young islet autoantibody-positive subgroups P1, P3, P4 (10-year risk 46, 46 and 47%) and the islet autoantibody-negative groups N1, N2 (43 and 46%). Nephropathy was identified in patient groups P2 and P5 (10-year risk 16%), which had features of moderate disease such as preserved C-peptide, low HbA1c, and very low frequency of DKA at diabetes onset. Group P7, which was defined by a high BMI, was associated with poor metabolic control, DKA, and retinopathy. In contrast, islet autoantibody-negative patients with high BMI (N3) had a low risk for all four complications. Subgrouping of childhood diabetes at diabetes onset provided prognostic value for the development of acute and chronic diabetes-specific complications. The DPV initiative is supported by The German Ministry of Education and Research (BMBF) within the German Center for Diabetes Research, the diabetes surveillance of the Robert Koch Institute, the German Diabetes Association (DDG) and INNODIA.

Clinical Outcomes of Children With COVID-19 by SARS-CoV-2 Strain: A Cohort Study.

We sought to investigate the disease outcomes and predictors of severe outcomes among children infected with the Delta variant of SARS-CoV-2 compared with pre-Delta strains. Single-center retrospective cohort study in an emergency department located within an urban academic children's hospital. Patients included children (0-18 years) who tested positive for SARS-CoV-2. Main outcomes measured include need for hospital admission or COVID-directed therapies. There was a trend toward decreased hospital admission and no significant difference in the severity of outcomes in the Delta cohort relative to the pre-Delta cohort. The Delta cohort had lower odds of hospital admission (odds ratio [OR], 0.79; 95% confidence interval [CI], 0.51-1.23), but the result was not statistically significant. Logistic regression analyses showed that overall, age 1 to 4 years (OR, 2.35; 95% CI, 1.23-4.57) and public insurance (OR, 1.80, 95% CI, 1.08-3.01) were predictors of hospital admission. Within the Delta cohort, the presence of any comorbidity increased the odds of admission (OR, 2.52; 95% CI, 1.09-6.04). Black children had lower odds of admission than white children (overall OR, 0.53; 95% CI, 0.31-0.90; pre-Delta OR, 0.50; 95% CI, 0.26-0.95). The severity of measured disease outcomes was similar in pediatric patients when comparing children infected with the pre-Delta and Delta variants of SARS-CoV-2, even among children with comorbidities once adjusting for acuity.Ongoing research is essential to determine disease severity and risk for children with comorbidities because SARS-CoV-2 continues to mutate, including with Omicron subvariants.

Study on the role of vis (vasoactive - inotropic score) as a predictor of a poor clinical outcome in children after congenital heart surgery with cardiopulmonary bypass

Objectives: Many authors showed that the VIS (vasoactive-inotropic score) has a strong correlation with morbidity and mortality after cardiac surgery in children, but the conclusions are not completely unified. We therefore performed this study to determine the relationship between the VIS score and clinical outcomes in children undergoing cardiac surgery with extracorporeal circulation.&#x0D; Method: Prospective cohort study. A total of 100 pediatric patients from birth to 2 years of age with indications for cardiac surgery with extracorporeal circulation at the Anesthesiology Department of the Heart Institute of Ho Chi Minh City from January 1, 2021, to December 31, 2021, were included in the study. Hourly doses of all vasoactive medications were recorded for the first 48 hours after admission to cardiothoracic intensive care unit and a vaso-active inotropic score was calculated. The VIS scale is calculated by the formula: VIS = dopamine dose (µg/kg/min) + dobutamine dose (µg/kg/min) + 100 × adrenaline dose (µg/kg/min) + 10 × milrinone dose (µg/min) kg/min) + 10000 × vasopressin dose (U/kg/min) + 100 × noradrenaline dose (µg/kg/min). The max and mean values of VIS in the first 24 hours and the max and mean values of VIS in the subsequent 24 hours after admission (from 25th to 48th hour) were calculated.&#x0D; Results: The rate of patients with low cardiac output syndrome was 38.0%. There were 20/100 cases (20.0%) with a poor outcome, of which 19 cases required peritoneal dialysis, 4/100 cases (4.0%) had cardiac arrest, 2/100 cases (2.0%) had seizures, 1/100 (1.0%) had to run ECMO and 4/100 (4.0%) died after surgery. Patients in the high VIS group (mean 48- hour VIS ≥ 11.06) compared with the low VIS group (mean 48- hour VIS &lt; 11.06) were associated with prolonged duration of mechanical ventilation, prolonged CICU length of stay in the ICU, prolonged time to negative fluid balance.&#x0D; Conclusions: The high VIS after surgery was a good predictor of a poor clinical outcome, prolonged duration of mechanical ventilation, prolonged CICU length of stay outcomes in children undergoing cardiac surgery with extracorporeal circulation

Exploiting frequent and specific expression of PRL3 in pediatric solid tumors for first-in-child use of PRL3-zumab humanized antibody

Phosphatase of regenerating liver 3 (PRL3) is a specific tumor antigen overexpressed in a broad range of adult cancer types. However, its physiological expression in pediatric embryonal and mesenchymal tumors and its association with clinical outcomes in children is unknown. We sought to profile the expression of PRL3 in pediatric tumors in relation to survival outcomes, expression of angiogenesis markers, and G-protein-coupled receptor (GPCR)-mitogen-activated protein kinase (MAPK) signaling targets. PRL3-zumab, a first-in-class humanized antibody, was administered in a dose escalation schedule in a first-in-child clinical trial to study toxicity, pharmacokinetics, and clinical outcomes. Among 64 pediatric tumors, PRL3 was most frequently expressed in neuroblastoma (100%), rhabdomyosarcoma and non-rhabdomyosarcoma soft tissue sarcomas (71%), and renal sarcomas (60%) but absent in paired normal tissues. PRL3 was expressed in 75% of relapsed tumors and associated with shorter median event-free survival. Microarray profiling of PRL3-positive tumors showed elevation of angiogenin, TIMP1 and TIMP2, and GPCR-MAPK signaling proteins that commonly interacted with PRL3. The first use of PRL3-zumab in a pediatric patient saw no adverse events. A 28.6% reduction in maximum target lesion diameter was achieved when PRL3-zumab was administered concurrently with hypofractionated radiation. These findings support wider exploration of PRL3 expression in embryonal and mesenchymal tumors and further clinical application of PRL3-zumab in pediatric patients.

T helper subsets during the acute post-traumatic period in children

Severe mechanical injury is among the main reasons of disability and mortality in pediatric patients. The imbalance between the states of inflammation and immune suppression during the critical period of post-traumatic injury bears an elevated risk for infectious complications and/or multiple organ failure. The present study aimed to determine the informative immunological criteria in order to evaluate severity and prognosis for clinical outcomes in children from the severe injury group (SInj, ISS 16, n = 87); mild/moderate injury group (MInj, ISS 16, n = 34), as based on assessment of helper T cells (Th) ratios, i.e., Th17/Treg, T127hi/ Treg, and Th17/T127hi. The patients with severe injuries were classified by their outcomes (favorable, n = 47; unfavorable, n = 40), presence of infectious complications (IC, n = 16) and the development of multiple organ failure (MOF, n = 11). Th ratios were studied on the 1st, 3rd, 5th, 7th, 14th day after injury. For the Sinj group, a pronounced increase of Th17/Treg ratio in the acute post-traumatic period with a decrease by 14 days was revealed. The indices of T127hi/Treg ratio on the first day for the patients from Minj group corresponded to the values of control group and significantly differed from patients with SInj in the 3rd to 5th day. There are different kinetics of Th subset ratio in peripheral blood of children with severe injuries over time in different groups, as well as with/without MOF, in presence, or absence of infectious complications and different clinical outcomes. Significant differences in T127hi/Treg ratio level were found in group with IC from 1st to 3rd day and from 7th to 14th day. Significant differences in Th17/Treg ratio level were found in IC group (7th day), in MOF group on 14th day post-injury. The patients with MOF had lower median concentrations of Th17/Treg and T127hi/Treg than patients without MOF. The results of the study indicate that the levels of Th17/Treg and T127hi/Treg ratio in children may be used to predict outcome of the traumatic disease and assess the risk of infectious complications and multiple organ dysfunction syndrome.

Impact of the COVID-19 pandemic on the incidence and clinical outcomes of diabetic ketoacidosis among male and female children with type 1 diabetes: systematic review and meta-analysis.

Background: Some studies suggest that the SARS-CoV-2 pandemic increased the incidence of type 1 diabetes mellitus (T1DM) and diabetic ketoacidosis (DKA). However, the impact of this pandemic on pediatric T1DM is still mostly unknown. Therefore, we aimed to assess the effect of the COVID-19 pandemic on clinical outcomes in children with T1DM. Methods: We systematically searched for six databases up to 31 August 2022. We included 46 observational studies, 159,505 children of both sexes with T1DM, and 17,547 DKA events. Results: The COVID-19 pandemic significantly increased, in both sexes, the incidence of 1) DKA (OR 1.68; 95% CI 1.44-1.96), 2) severe DKA (OR 1.84; 95% CI 1.59-2.12), 3) DKA in newly diagnosed T1DM (OR 1.75; 95% CI 1.51-2.03), and 4) ICU admissions (OR 1.90; 95% CI 1.60-2.26). However, we did not find a significant association between this pandemic and 1) the incidence of T1DM, 2) the incidence of DKA in established T1DM, 3) the incidence of KDA complications, 4) the length of hospitalization stay, and 5) mortality. Subgroup analysis showed that the study design and the continent of origin accounted for the heterogeneity. Conclusions: The pandemic SARS-CoV-2 raised, in both sexes, the risk of DKA, severe DKA, DKA de novo, and ICU admissions.

The Effect of Tracheostomy Timing on Clinical Outcomes in Children

The Effect of Tracheostomy Timing on Clinical Outcomes in Children

Clinical outcomes of children using a metered dose inhaler with a sleeve attachment device to improve ease of use.

Activating pressurized metered dose inhalers (pMDIs) is often challenging for children. The Easy Squeezy (ES) is a novel sleeve attachment device that reduces activation force by 3 times. Although users have favored using the ES over using a pMDI alone, the clinical impact of the ES remains unknown. The aim of this study was to compare lung function and quality of life between ES users and users of a pMDI alone. Our aim was to measure and compare lung function of asthmatic children after they used the ES and pMDI alone. In this crossover study we recruited 65 asthmatic children between the ages of 5 and 12 years. The participants were randomized into 2 groups. One of the groups used the ES for 6 weeks whereas the other group used a pMDI. After 6 weeks the participants crossed over to the other group. Lung function test parameters were measured after randomization and after each 6 weeks of device use. Quality of life (measured by the Patient Asthma Quality of Life Questionnaire [PAQLQ]) and Childhood Asthma Control Test were measured after each period of device use. There was no significant difference in the baseline lung function between the groups. The ES group had a significantly lower percentage difference between prebronchodilator and postbronchodilator FEV1 values. Although no significant differences were observed in PAQLQ scores between the groups, more patients in the ES group had improvement of their PAQLQ score than did patients in the group using a pMDI alone. Total Childhood Asthma Control Test scores were significantly higher for the ES group. The ES device may allow users' asthma to be better controlled than by using a pMDI alone.

Emerging Resistance Trends in Viridans Group Streptococci Bloodstream Infections Among Immunocompromised Children Receiving Levofloxacin Prophylaxis.

Levofloxacin prophylaxis (LVXp) is often used for patients with underlying leukemia and severe neutropenia to reduce the risk of fever and bacteremia. This study evaluated trends in viridans group streptococci (VGS) antibiotic susceptibilities over time and clinical outcomes of children with VGS bloodstream infections (BSIs) during institutional adoption of LVXp. VGS blood culture isolates between 1/1/2010 and 12/31/2021 with susceptibility testing reported were included. Available isolates were re-identified to the species level and additional susceptibility testing was performed. Demographic and clinical data were abstracted from medical records. A total of 264 VGS BSI isolates were identified in immunocompromised (IC, n = 125) and non-immunocompromised subjects, (non-IC, n = 139). IC subjects had lower rates of VGS isolates susceptible (S) to LVX and higher minimum inhibitory concentration (MICs) to LVX (p = 0.004) and ciprofloxacin (p = 0.0005) compared with non-IC subjects. No other evaluated antibiotic had increased MICs in either group. Fifteen of 19 (74%) LVX not susceptible (NS) isolates occurred in IC subjects, 13 represented breakthrough infections. IC subjects had higher rates of VGS-related shock (p = 0.012), need for pressor support (p = 0.039), and longer duration of hospitalization than non-IC subjects (p < 0.001). Clinical outcomes were comparable between subjects with LVX S and NS VGS BSI isolates. VGS with reduced susceptibility to LVX emerged during institutional adoption of LVXp in high-risk children with immunocompromising conditions, but did not result in significant differences in clinical outcomes. Ongoing surveillance and susceptibility testing are critical in weighing the utility of LVXp against emerging antimicrobial resistance in this high-risk population.

Transcriptomic profiles of multiple organ dysfunction syndrome phenotypes in pediatric critical influenza.

Influenza virus is responsible for a large global burden of disease, especially in children. Multiple Organ Dysfunction Syndrome (MODS) is a life-threatening and fatal complication of severe influenza infection. We measured RNA expression of 469 biologically plausible candidate genes in children admitted to North American pediatric intensive care units with severe influenza virus infection with and without MODS. Whole blood samples from 191 influenza-infected children (median age 6.4 years, IQR: 2.2, 11) were collected a median of 27 hours following admission; for 45 children a second blood sample was collected approximately seven days later. Extracted RNA was hybridized to NanoString mRNA probes, counts normalized, and analyzed using linear models controlling for age and bacterial co-infections (FDR q<0.05). Comparing pediatric samples collected near admission, children with Prolonged MODS for ≥7 days (n=38; 9 deaths) had significant upregulation of nine mRNA transcripts associated with neutrophil degranulation (RETN, TCN1, OLFM4, MMP8, LCN2, BPI, LTF, S100A12, GUSB) compared to those who recovered more rapidly from MODS (n=27). These neutrophil transcripts present in early samples predicted Prolonged MODS or death when compared to patients who recovered, however in paired longitudinal samples, they were not differentially expressed over time. Instead, five genes involved in protein metabolism and/or adaptive immunity signaling pathways (RPL3, MRPL3, HLA-DMB, EEF1G, CD8A) were associated with MODS recovery within a week. Thus, early increased expression of neutrophil degranulation genes indicated worse clinical outcomes in children with influenza infection, consistent with reports in adult cohorts with influenza, sepsis, and acute respiratory distress syndrome.

Intracerebral Aneurysms in the Young: Institutional Series and Review of Literature

ABSTRACT Introduction: Intracranial (IC) aneurysms in the paediatric population are uncommon. The natural history, clinical presentation and clinical outcome of children with IC aneurysms are different from their adult counterparts. We analyse our hospital database for IC aneurysms in children &lt;20 years and present our findings. Materials and Methods: A retrospective review of case records of patients less than 20 years admitted with IC aneurysm was conducted at our institute. Details of clinical presentation, treatment provided and outcome were obtained from the case records. Results: Ten children were admitted with IC aneurysms. The mean age of presentation was 16.5 ± 3.43 years (9–20 years). While 90% were spontaneous in presentation, one case was post-traumatic. Nine patients underwent treatment for their aneurysm in the form of microsurgical clipping. Subarachnoid haemorrhage with intracerebral haemorrhage was the most common mode of presentation. Outcome was good in 80% and poor in 20% of patients. One patient succumbed to the illness before treatment. Conclusion: IC aneurysms in the young are represent a small subset of patients with aneurysms. IC aneurysms in the young represent a small subset of patients with aneurysms predominantly located in the anterior circulation. Micro-surgical treatment provides excellent outcomes in these patients.

Pressure support versus continuous positive airway pressure for predicting successful liberation from invasive ventilation in children: an open label, randomized non-inferiority trial.

Pressure support (PS) as a spontaneous breathing trial (SBT) was considered inferior to continuous positive airway pressure (CPAP) and T-piece because PS underestimated post-extubation work of breathing in physiologic studies. We aimed to compare PS and CPAP as SBT methods for assessing clinical outcomes in children. This was an open label randomized non-inferiority trial conducted between December 2019 and August 2021 among children aged 1 month to 12 years deemed ready for weaning after at least 48h of invasive ventilation in PICU. Children were randomized to undergo a 2-h SBT with PS of 8cmH2O in addition to PEEP 5-6cm H2O or CPAP (5-6cm H2O). The primary outcome was successful liberation from invasive ventilation for 72h after first SBT. Secondary outcomes included first SBT pass rate, need for post-extubation respiratory support (high flow oxygen and/or non-invasive ventilation), and length of PICU stay. Of the 247 enrolled children, 244 completed the trial (121 in PS and 123 in CPAP group). Median (IQR) age was 24 (9, 84) months. Median (IQR) duration of invasive ventilation before randomization was 4.5 (3, 6.5) days. Successful liberation from invasive ventilation after first SBT occurred in 97 (80.2%) children in PS and 93 (75.6%) children in CPAP group [difference 4.6; 95% CI (-5.8, 15); p=0.39]. First SBT pass rate between PS and CPAP [111 (91.7%) versus 105 (85.4%); difference 6.3; 95% CI (-1.6, 14.3); p=0.12] was similar. Need for post-extubation respiratory support [52 (43%) versus 49 (40%)], rate of reintubation within 72h [14 (11.6%) versus 12 (9.8%)] and median (IQR) length of PICU stay [9 (6, 15) versus 8 (5.5, 13) days] were comparable. Four (1.6%) children, all in CPAP group had unfavourable outcome (1 died, 3 discontinued care). In invasively ventilated children, 2-h SBT with pressure support was non-inferior to CPAP in predicting successful liberation from invasive ventilation. None.

Sickle cell disease: time to act on the most neglected global health problem

Despite being the first monogenic disease described in scientific literature over a century ago, sickle cell disease remains an illness with high morbidity and early mortality, particularly in sub-Saharan Africa and other low-income and middle-income countries (LMICs) in historically malaria-endemic regions of the world. 1 Piel FB Steinberg MH Rees DC Sickle cell disease. N Engl J Med. 2017; 376: 1561-1573 Crossref PubMed Scopus (635) Google Scholar Sickle cell disease is a chronic and progressive condition associated with frequent painful, vaso-occlusive episodes, multiple end-organ complications, and detrimental effects on the psychosocial wellbeing of those affected, their families, and communities. Significant advances in the care of individuals with sickle cell disease over the past several decades, including newborn screening (NBS), penicillin prophylaxis, expanded immunisation programmes, and hydroxyurea therapy, have substantially reduced mortality among children and adolescents living in higher income countries. 2 Quinn CT Rogers ZR McCavit TL Buchanan GR Improved survival of children and adolescents with sickle cell disease. Blood. 2010; 115: 3447-3452 Crossref PubMed Scopus (619) Google Scholar , 3 Telfer P Coen P Chakravorty S et al. Clinical outcomes in children with sickle cell disease living in England: a neonatal cohort in East London. Haematologica. 2007; 92: 905-912 Crossref PubMed Scopus (237) Google Scholar Unfortunately, premature mortality from sickle cell disease during early childhood persists in LMICs, 4 Makani J Cox SE Soka D et al. Mortality in sickle cell anemia in Africa: a prospective cohort study in Tanzania. PLoS One. 2011; 6e14699 Crossref PubMed Scopus (191) Google Scholar where a majority of the global sickle cell disease burden is found. The clinical framework in LMICs is decades behind that of higher income countries, with most affected infants dying in the first years of life due to scarce access to an early diagnosis and available prophylactic or disease-modifying interventions. Despite multiple statements and calls to action from WHO to recognise and address the global burden of sickle cell disease, 5 WHO Regional Committee for AfricaSickle-cell disease: a strategy for the WHO African Region. World Health Organization, Geneva2010 Google Scholar there remains a crucial paucity of data in individual countries or across the highest burdened regions of the world to accurately quantify this problem and drive resource allocation to improve the diagnosis, management, and awareness of sickle cell disease. Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000–2021: a systematic analysis from the Global Burden of Disease Study 2021Our findings show a strikingly high contribution of sickle cell disease to all-cause mortality that is not apparent when each death is assigned to only a single cause. Sickle cell disease mortality burden is highest in children, especially in countries with the greatest under-5 mortality rates. Without comprehensive strategies to address morbidity and mortality associated with sickle cell disease, attainment of SDG 3.1, 3.2, and 3.4 is uncertain. Widespread data gaps and correspondingly high uncertainty in the estimates highlight the urgent need for routine and sustained surveillance efforts, further research to assess the contribution of conditions associated with sickle cell disease, and widespread deployment of evidence-based prevention and treatment for those with sickle cell disease. Full-Text PDF Open Access

Impact of Vitamin D Supplementation on Clinical Outcomes in Children with Asthma

Impact of Vitamin D Supplementation on Clinical Outcomes in Children with Asthma

Which Trauma Severity Scores Are Useful in Predicting Pediatric Mortality?

Trauma is the leading cause of death in children. Several trauma severity scores exist: the shock index (SI), age-adjusted SI (SIPA), reverse SI (rSI), and rSI multiplied by Glasgow Coma Score (rSIG). However, it is unknown which is the best predictor of clinical outcomes in children. Our goal was to determine the association between trauma severity scores and mortality in pediatric trauma. A multicenter retrospective study was performed using the 2015 US National Trauma Data Bank, including patients 1 to 18 years old and excluding patients with unknown emergency department dispositions. The scores were calculated using initial emergency department parameters. Descriptive analysis was carried out. Variables were stratified by outcome (hospital mortality). Then, for each trauma score, a multivariate logistic regression was conducted to determine its association with mortality. A total of 67,098 patients with a mean age of 11 ±5 years were included. Majority of the patients were male (66%) and had an injury severity score <15 (87%). Eighty-four percent of patients were admitted: 15% to the intensive care unit and 17% directly to the operating room. The mortality at hospital discharge was 3%.There was a statistically significant association between SI, rSI, rSIG, and mortality (P < 0.05). The highest adjusted odds ratio for mortality corresponded to rSIG, followed by rSI then SI (8.51, 1.9, and 1.3, respectively). Several trauma scores may help predict mortality in children with trauma, the best being rSIG. Introduction of these scores in algorithms for pediatric trauma evaluations can impact clinical decision-making.

Calciferol Status and Clinical Outcomes in Children with Congenital Heart Disease after Heart Surgery

Highlights: Calciferol has cardioprotective properties, and a severe deficiency of calciferol is associated with septic shock, a longer duration of mechanical ventilation and treatment in the intensive care unit, and mortality. The role of calciferol in critical conditions has been described in several research reports, but relatively little is known about its function in pediatric cardiac surgery. Abstract Calciferol is a micronutrient and a secosteroid hormone that plays a role in maintaining the health of bones and soft tissues in the body, such as the myocardium, as well as the immune system. Hypovitaminosis D has been reported to be associated with poor clinical outcomes and child mortality in pediatric intensive care units. Children with congenital heart disease (CHD) are vulnerable to critical conditions and require early intervention due to heart failure. This study aimed to investigate the influence of calciferol status on the clinical outcomes of pediatric CHD patients who underwent heart surgery. A systematic literature review was conducted using the electronic databases from PubMed, Elsevier, and Cochrane. This study included observational and randomized control studies that assessed the calciferol status of pediatric CHD patients undergoing cardiac surgery. From a total of 168 studies, 8 studies were selected for review. The preoperative and postoperative calciferol status as well as clinical outcomes following pediatric cardiac surgery were reviewed. According to the findings, most pediatric CHD patients suffered from calciferol deficiency prior to corrective heart surgery, which further decreased postoperatively and was associated with clinical outcomes in the intensive care unit (ICU). Preoperative calciferol supplementation has been reported to enhance serum calciferol levels and is associated with good clinical outcomes in pediatric patients undergoing cardiac surgery.