Depth In Children Research Articles

Diagnostic accuracy of airway ultrasound in confirming the endotracheal tube depth in critically ill children

BackgroundChest X-ray, the established standard of confirming endotracheal tube (ETT) position, has important drawbacks including radiation exposure. Point-of-care airway ultrasound, which has been insufficiently studied in children, can overcome these problems. Materials and methodsThis was a prospective cross-sectional study done on children aged 2 months to 17 years undergoing intubation with cuffed ETT in the PICU. The ETT cuff was filled with saline and three ultrasonographic techniques were used– 1) Suprasternal (SS) method 2) Cricoid (CC) metho and 3) Tracheal ring (TR) method. Position of the ETT as determined by ultrasound and X-ray were compared. The main outcomes were sensitivity, specificity, and area under curve (AUC) for ultrasound-based methods vs. X-ray. For the TR method, concordance between the X-ray and ultrasound categories were taken. ResultsTotal 62 patients were enrolled. The sensitivity and specificity of SS method were 71% (95% CI: 57–83%) and 100% (40–100%). The CC distance method had an AUC of 0.94 (95% CI: 0.86, 1.0). In the TR method, 98% of correct position on X-ray were correctly classified by USG. The agreement between X-ray and ultrasound categories with the cuff between the first and third tracheal rings, was very good [kappa (95% CI): 0.87 (0.70, 1.00), p ≤0.001)]. ConclusionBedside ultrasound is a good method to confirm ETT depth in children. The tracheal ring method had the best diagnostic accuracy and is easy to perform. The new method using cricoid cuff distance needs further validation in different ICU settings.

Correlation of Comfort Score and Narcotrend Index during Procedural Sedation with Midazolam and Propofol in Children.

Background/Objectives: Precise assessment of hypnotic depth in children during procedural sedation with preserved spontaneous breathing is challenging. The Narcotrendindex (NI) offers uninterrupted information by continuous electrocortical monitoring without the need to apply a stimulus with the risk of assessment-induced arousal. This study aimed to explore the correlation between NI and the Comfort Scale (CS) during procedural sedation with midazolam and propofol and to identify an NI target range for deep sedation. Methods: A prospective observational study was conducted on 176 children (6 months to 17.9 years) undergoing procedural sedation with midazolam premedication and continuous propofol infusion. Statistical analyses included Pearson correlation of NI and CS values, logistic regression, and receiver operating curves. Results: Median NI values varied with CS and age. The correlation coefficient between CS and NI was 0.50 and slightly higher in procedure-specific subgroup analyses. The optimal NI cut-off for deep sedation was between 50 and 60 depending on the analyzed subgroup and displayed high positive predictive values for sufficient sedation throughout. Conclusion: Our study found a moderate correlation between NI and CS, demonstrating reliable identification of adequately sedated patients.

Abstract 382: The Effect of Stepstool Use on Chest Compression Quality During CPR in Young Children: Findings From the Videography in Pediatric Emergency Research (VIPER) Collaborative

Background: Delivering chest compressions (CC) of adequate depth and rate during pediatric cardiopulmonary resuscitation (CPR) has known beneficial hemodynamic consequences; however, chest compression quality in this population is often suboptimal. While common, the benefit of stepstool use during pediatric CPR has not been studied. Objective: To analyze the effect of step stool use on chest compression quality (depth, rate) in a pediatric emergency department (ED). Methods: We conducted a prospective observational cohort study involving patients <8 years of age receiving chest compressions in an ED for >2 minutes. Data was collecting via structured video review and from a CC monitoring device. Analysis was by compressor segment. We compared CC rate and depth by step stool use in each of 3 age groups: < 1 year, 1-8 years, 9-18 years. We also examined step stool and CC quality by compressor hand position: 1) two thumbs, hands encircling chest (2T), 2) two fingers, 2 nd and 3 rd digits, pressing on anterior sternum (2F), 3) one hand (1H), and4) two hands (2H). Results: 46 patients received 390 CC segments (565 total minutes of CC). In patient <1 year and 1-8years of age, the majority of compressors utilized a step stool (73% <1 year; 83.3% 1-8 years). For <1year, there was no difference in mean CC rate or depth with or without step stool use. In children >1year of age, a step stool was associated with deeper chest compressions [3.63cm (IQR 3.07 - 4.17)versus 2.74 cm (IQR 2.39 - 3.24) without, p=0.000] and a mean CC rate more consistent with AHA guidelines [115 compressions per minute (IQR 115 - 128) versus 125 (IQR 110 - 121) without p=0.0037]. Stratified by hand placement technique, 1H compressions with a step stool achieved greater depth in children >1 years (p<0.01); 2H compressions with a step stool achieved a more compliant CC rate in children >1 years (p<0.05). Conclusions: CPR depth failed to reliably meet AHA guidelines regardless of stepstool use across all age categories. However, in children between 1 - 8 years of age, step stool use was significantly associated with higher quality chest compressions. Our findings of better CC depth and rate with one and two hand compressions should prompt further investigation and evaluation of CC technique in the pediatric population.

Recommendations for endotracheal tube insertion depths in children

BackgroundEndotracheal tube (ETT) malposition is frequent in paediatric intubation. The current recommendations for ETT insertion depths are based on formulae that hold various limitations. This study aimed to develop age-based,...

Cognitive-linguistic skills and vocabulary knowledge breadth and depth in children’s L1 Chinese and L2 English

AbstractThis study examined the correlates of different aspects of vocabulary knowledge in L1 Chinese and L2 English in Hong Kong bilingual children (N = 481, age = 6–12 years old). Their nonverbal IQ, cognitive-linguistic skills, receptive and expressive vocabulary knowledge breadth, and vocabulary knowledge depth in Chinese and English were measured. Results demonstrated that morphological awareness was uniquely correlated with different aspects of vocabulary knowledge across Chinese and English. Phonological processing skills played different roles in vocabulary knowledge in L1 and L2. In addition, receptive vocabulary breadth uniquely contributed to expressive vocabulary breadth across languages. Moreover, both receptive and expressive vocabulary breadth contributed to vocabulary knowledge depth in L1 Chinese and L2 English. The findings highlight some shared and unique aspects of different vocabulary constructs across languages.

Clinical and functional characteristics of pseudophakic myopia in children after congenital cataract extraction in infancy

One of the serious challenges facing surgeons after congenital cataract extraction with IOL implantation in infancy is unplanned refractive results revealed in the long-term period, including the cases of myopia higher than 3.0 D in approximately 50 %. Purpose. The study aimed to evaluate the clinical and functional condition of the eyes in children with moderate to high myopia. Material and methods. Our study included a total of 33 patients (61 eyes) with pseudophakia, of which 16 (26 eyes) developed moderate (12 eyes) or high (14 eyes) myopia at the age of 5 to 15 years. Parameters of the anterior and posterior eye segments were evaluated using Galilei Dual Scheimpflug Analyzer and Optical Coherence Tomography RS-3000 Advance 2, and the axial length using Optical Biometer Al-Scan. Results. The central corneal thickness (CCT) was found considerably above the norm (up to 580 ± 35 pm) in most cases of pseudophakic myopia (72.2 %). Anterior chamber depth in children (4.07 ± 0.39 mm) was equal to that in adults with pseudophakia. Astigmatism and axial length in children with highmyopia significantly exceeded those in children with moderate myopia (3.5 and 1.88 D; 23.57 ± 1.31 and 25.04 ± 1.90 mm, respectively), while choroidal thickness and best corrected visual acuity (BCVA) were much lower (268 and 181 pm; 0.1 and 0.3, respectively). There were no variations in spherical equivalent between different axial length in high and moderate myopia. Conclusion. Taken together these results suggest that with the increase of astigmatism axial length elongated and high myopia developed in children with pseudophakia. Choroidal thickness declined due this process and may be a cause of poor functional outcome. Sufficient CCT opens possibilities for refractive surgery in those patients to improve visual outcomes.

Investigation of the Relationship between Semantic Information and Verbal Working Memory in Children with Typical Developing, Down Syndrome and Autism Spectrum Disorder

The aim of this study is to investigate the relationship between semantic knowledge and verbal working memory (VWM) in children with typical development (TD), Down syndrome (DS) and autism spectrum disorder (ASD).Descriptive research and relational research methods were used in the design of the research.Children in the study group were matched with the Raven Colored Progressive Matrices Test according to their non-verbal intelligence score.The study group of the study consisted of 17 TD children aged 4-5 years and 14 DS and 15 ASD children whose nonverbal intelligence ages are between 4-5 years.Semantic knowledge was evaluated in the dimensions of vocabulary breath and vocabulary depth.The language sample collected in narrative context was used to evaluate of vocabulary breath. Vocabulary Depth Test (VDT) was used to assess vocabulary depth.VWM was assessed with the Nonsense Word Repetition Test (NWR).The results of the research revealed that all groups showed significant differences in vocabulary breadth, vocabulary depth and VWM performances.It was found that there was a significant and positive relationship between vocabulary breadth, vocabulary depth and VWM in all groups.VMW predicted vocabulary breadth and vocabulary depth in children with TD and DS.Vocabulary breadth was found to predict vocabulary depth in children with TD and ASD.However, VMW did not predict vocabulary breadth and depth in ASD.The results obtained from the study show that the results differ in the two different diagnostic groups.While the results were discussed regarding the contribution of verbal working memory in the acquisition of semantic knowledge in DS, the importance of word width in the acquisition of word depth in ASD was discussed. In addition, it has been suggested to examine different variables that may be effective in the development of semantic knowledge in both diagnostic groups.

Evaluation of the association between nasopharyngeal depth and respiratory complications after cleft palate surgery in children between 9 and 18 months old

Background: Considering the incidence of respiratory complications after cleft lip and palate surgery and its significance in the survival of children undergoing the mentioned surgery, the present study was performed to evaluate the association between the nasopharyngeal depth and the incidence of respiratory complications after cleft palate surgery.Materials and Methods: The present cross-sectional study was performed on 222 children who aged 9–18 months and were the candidates for cleft palate surgery. After performing general anesthesia and implanting mouth gag and before surgery, the nasopharyngeal depth and the cleft palate width were measured with a calibrated ruler and an ophthalmic caliper, respectively. At the end of the surgery and after extubation, the incidence of respiratory complications such as respiratory distress, laryngospasm, bronchospasm, and need for intubation was recorded.Results: The nasopharyngeal depth in children with respiratory complications with a mean of 7.57 ± 3.12 mm was significantly less than that of children without respiratory complications with a mean of 10.82 ± 2.14 mm (P < 0.001). The nasopharyngeal depth of ≤8 mm with a sensitivity of 80% and a specificity of 89.60% had a significant predictive value in the incidence of respiratory complications (P < 0.001).Conclusion: According to the results of the present study, it seems that the nasopharyngeal depth of ≤8 mm can make the incidence of respiratory complications more likely. Therefore, considering the simplicity and convenience of measuring the nasopharyngeal depth and the cleft palate width, it is suggested to perform further studies to evaluate the anatomy of palate before this surgery using the employed method and address its association with respiratory complications.

Accuracy of predictive equations in guiding tracheal intubation depth in children: A prospective study.

Accurate insertion depth of endotracheal tube (ETT) in children has been predicted using the demographic variables, such as age, weight, and height. Middle finger length showed good correlation with ETT depth measurement in children aged 4-14years. The primary objective was to correlate the actual ETT insertion depth with the depth derived from middle finger length, age, weight, and height formulae in children aged 1-4years. The secondary objective was to find the most accurate formula for prediction of ETT insertion depth. This prospective parallel group study was done in 50 american society of anesthesiologists 1 or 2 children aged 1-4years undergoing elective surgery under general anesthesia. Children with difficult airway, finger anomalies, or syndromic associations were excluded. Age, weight, height, and middle finger length of all children were measured. Depth of orally inserted uncuffed ETT and tracheal length was measured by fiberoptic bronchoscopy. The actual ETT depth was correlated with the depth calculated from different formulae. The mean middle finger length was 4.42±0.50cm, age was 2.64±1.07years, weight was 12.28±2.84kg, and height was 82.89±16.23cm. The mean tracheal length was 6.42±0.96cm. The mean depth of ETT was actual depth (12.89±1.09cm), middle finger depth (13.23±1.53cm; p=.001; 95%CI 0.12-0.50), age-based depth 1(3.31±0.53cm; 95%CI 0.37-1.44; p=.001), weight-based depth (14.14±1.42cm; 95% CI 0.10-0.51; p=.004), and height-based depth (13.73±0.94cm; 95% CI 0.15-0.77; p=.004). Middle finger length and age-based formulae showed higher number of accurate placements (58% each). Weight- (74%) and height (64%)-derived formulae gave a higher number of distal ETT placements. Formulas based on the demographic variables and middle finger length showed good correlation with the actual ETT depth in children aged 1-4years. The percentage of accurate ETT depth placements was higher with middle finger length and age-based formulae.

Sing it or speak it?: the effects of sung and rhythmically spoken songs on preschool children's word learning

Vocabulary knowledge in the primary grades predicts later reading comprehension and academic success. For young children, low initial knowledge about academically-valued words at school entry can serve as a barrier to accessing text and sustaining reading achievement in school. Many studies focus on direct vocabulary instruction and shared book reading as the primary context for fostering preschool children's word learning, but few explore songs as a context for building minoritized preschool children's knowledge about words. Using a within-subject design, we investigated children's word learning from songs. Words were taught with picture cards-only, a song that was sung with a melody, and a song that was rhythmically spoken with no melody. Vocabulary knowledge was measured using a receptive task and a productive definitional task that assessed children's depth of word knowledge. We found that on the receptive measure, children's word learning did not vary across picture card-only instruction and instruction with sung and rhythmically spoken songs. However, both types of songs led to significantly greater gains in children's depth of word knowledge compared to words taught with picture cards-only. The findings of this study contribute to an understanding of whether songs, and specific features of songs, affect preschool children's word learning.

Anterior chamber depth measurement using Pentacam and Biograph in children

ABSTRACT Clinical relevance Accurate measurement of the anterior chamber depth is very important. There is no report regarding the agreement between rotating Scheimpflug imaging (Pentacam HR) and biograph (Lenstar LS 900) in children. This study therefore explores the agreement between Pentacam and Biograph in measuring anterior chamber depth in children. Background This study aims to determine the agreement between Pentacam and Biograph in measuring anterior chamber depth in children. Methods The participants were students living in urban and rural areas of Shahroud, Iran, selected through cluster sampling. The students were transported to the examination site to undergo imaging and optometric tests. Pentacam imaging was then conducted, and biograph was used to measure biometric components. In this report, the anterior chamber depth was calculated from the corneal endothelium. Results Of 6624 students selected randomly, 5620 participated in the study. After applying the exclusion criteria, 4882 eyes were included in the final analysis. The mean anterior chamber depth measured by the Pentacam (3.09 ± 0.26 mm) was higher than that of biograph (3.04 ± 0.24 mm) (p < 0.001). The 95% limit of agreement (LOA) between the two devices was −0.19 to 0.09 mm. The variation of the difference between the two devices decreased, LOA became narrower, and the correlation coefficient of the devices increased with ageing. The highest intraclass correlation coefficient was seen among myopic (0.974) participants. The 95% LOA was −0.20 to 0.12 mm in hyperopic, −0.17 to 0.07 mm in myopic and −0.19 to 0.09 mm in emmetropic participants. Conclusion The Pentacam and Biograph can be used interchangeably for measuring the anterior chamber depth in children.

IgA-dominant infection-associated glomerulonephritis in the pediatric population.

IgA-dominant infection-associated glomerulonephritis is well-documented in adults but has not been studied in depth in children. We assessed the incidence of pediatric IgA-dominant infection-associated glomerulonephritis and clinical and kidney biopsy findings. Pediatric native kidney biopsies over a 10-year period with IgA dominance, strong C3, and findings indicative of infection-associated etiology were identified. We identified 9 cases of IgA-dominant infection-associated glomerulonephritis, 0.8% of pediatric native kidney biopsies. Seven patients presented with elevated creatinine. All had hematuria and proteinuria. Eight patients had clinical evidence of infection: one each with central port infection by methicillin-sensitive Staphylococcus aureus, recurrent streptococcalpharyngitis and recent otitis media, streptococcalpharyngitis demonstrated 8months after biopsy, suspected streptococcalscalded skin syndrome, and viral gastroenteritis, and three with serologic evidence of Streptococcal infection but no identified site of infection. All but one patient experienced short-term normalization of creatinine and resolution of proteinuria, though two eventually progressed to kidney failure: one 3years later due to progressive disease and one 11years later due to focal segmental glomerulosclerosis without concurrent immune deposits. Pediatric IgA-dominant infection-associated glomerulonephritis is rare, and generally has a favorable prognosis, contrasting that seen in adults with severe comorbidities. A higher resolution version of the Graphical abstract is available as Supplementary.

Experimental study of the older preschool children’s vocabulary development while acquainting with professions

The paper mainly highlights the features of older preschool children’s acquaintance with the professional activities of adults. The theoretical and methodical bases of the researched issue are generalized. The structural components of the formation of preschoolers’ ideas about professions are highlighted. The results of a pilot study to determine the level of older preschool children’s acquaintance with the occupations of adults are presented. The influence of the place of residence on the depth of children’s knowledge about the professional activity is found out. It is revealed that older preschool children understand the meaning of words that characterize the adults’ professional activities but rarely use them in their active speech. Based on the results obtained, it is stated that children in urban areas are more familiar with the professions that have emerged in recent years (beautician, blogger, baker, manager, cameraman, photographer, cashier, president and taxi driver), but ignore the agricultural and factory professions. Preschoolers in rural areas are more inclined to occupations related to technology and agriculture. The influence of gender on children's preferences for choosing a particular profession is analyzed. It is observed that girls prefer professions related to care, service (doctor, cook, hairdresser and veterinarian), for boys the most desirable professions are heroic, courageous and professional (policeman, firefighter and driver). It is concluded that the professions well known to children in the 20th century are hardly known to modern children (astronaut and postman).

Depth of Gingival Sulcus in Healthy Children with Erupting Permanent Teeth.

Measuring the gingival sulcus depth in children while their permanent teeth erupt is rather difficult especially if using reference norms for adults for a base. Assessment of the depth of the gingival sulcus during the period of tooth eruption in healthy children. Thirty children were included in the study (age range 6 - 14 yrs). The children had good oral hygiene and no history of systemic disease. They were clinically examined - their dental statuses were taken, stages of permanent teeth eruption (up to 1/3 of the clinical crown, between 1/3 and 2/3, over 2/3, in occlusion contact), and their gingival sulcus depth was measured at 6 distovestibular, vestibular, mesiovestibular, mesiolingual, lingual, and distolingual sites using an electronic probe Parometer (Orange). It was concluded that the one with the highest value would be considered the maximum depth of the sulcus. The gingival sulcus depth in fully erupted teeth is very similar to that in healthy adults (2.20 - 0.49 mm). The change of sulcus depth in incisors and canines has a variation of 1.5 mm, which at the end of eruption is close to those in adults. Maximum sulcus depth for molars, premolars and incisors was measured distovestibularly, and for canines - mesiovestibularly. At the various stages of eruption, the depth of the gingival sulcus plausibly decreases in all tooth types, and by the end of eruption it reaches a depth similar to that of the adult standard. Most indicative in regard to depth are the vestibular probing point.

Contribution of thermal imaging in determining the depth of pediatric acute burns.

Early burn wound assessment is a major problem in pediatrics. It involves regular clinical evaluations, and may be helped by objective tools, such as thermal imagers. Because of the skin temperature difference between partial and full thickness burns, due to injured vascular perfusion of the dermis in the latter, it could precisely identify areas with superficial burns which could heal from controlled wound healing, and those with deep burns which would need skin graft, at an early stage. The objective of this study was to assess the validity of the Flir one thermal imager® for this purpose. Thermal images were obtained by a single observer three times after burn: day 1-3 (T1); day 4-7 (T2); day 8-10 (T3). ΔT (temperature difference between burned area and healthy skin) was calculated on a tablet with Flir One application. Validity was assessed by comparing ΔT obtained at each time between two groups at day 15 depending on the healing time of the burn wounds : before or after day 15. Primary outcome was the AUC (area under curve) of the ROC (Receiver operating characteristic) curve for ΔT at T1, T2 and T3, representing the ability of the Flir One Thermal Imager® to discriminate between a healing time <15 days and >15 days. 40 patients were included (13 months to 13 years old). AUC at T1 and T2 are 0.700 (95% CI: 0.649; 0.925) and 0.787 (95% CI: 0.523; 0.877), respectively. AUC at T3 is 0.968 (95% CI: 0.918; 1.00). A ΔT threshold of -1.2°C at T3 is associated with a specificity of 100% allowing to diagnose as of day 8 all the patients having deep burns which heal after 15 days. The Flir One Thermal Imager® is an inexpensive, non-invasive, and easy-to-use device. It measures indirectly but with an excellent specificity the dermis perfusion reflecting the burns depth in children. However its low sensitivity calls for additional research to allow skin grafts earlier in common practice and decrease the length of stay.

Using sternal angle as anatomic landmark for right internal jugular vein catheterization in pediatrics.

Many formulas based on the patient's height, weight and/or age exist to determine central venous catheter (CVC) depth in children. However, this information is unavailable in some emergency conditions. Therefore, direct methods should be developed to guide catheter position in children. Eighty patients aged 1-10y were enrolled from July 2015 to August 2016 and seventy-five were completed; fifty were male, and twenty-five were female. The exclusion criteria were inability to identify the sternal angle or failure to use the right internal jugular vein approach. The catheter was inserted using the right internal jugular vein approach, the distance from the skin puncture point to the midpoint of the sternal angle plane was measured, and the catheter tip was positioned to this distance minus 1cm. Chest radiography were performed for those children after catheter insertion. The relative position between the catheter tip and carina was confirmed and the longitudinal distance from the catheter tip to the carina was calculated on radiographic images, and related complications were recorded. All catheter tips were above the carina, and the average distance from the catheter tip to the carina was 9.8mm. No patients experienced serious complications. The sternal angle is a useful and reliable anatomic landmark for guiding CVC position in children. Using this landmark, the catheter can be quickly and conveniently placed at a safety position in right internal jugular vein, especially in some emergency conditions.

Partnering With Parents

Contributing to a decade of national research on device ownership and app usage, this study provides evidence of how children from 120 homes across 46 classrooms use apps and portable technology to support their reading development. Parent survey data reveals 99% of children use technology to support reading in the home, primarily on iPad and laptop devices. Apps used most frequently include Istation, YouTube, and PBS Kids Video. To gather parent perceptions and depth of children's technology use, 13 individual interviews were conducted with parents from the same sample. Parents preferred their child read with print books, yet parents allowed their child to use portable technology, in response to their child's interest in technology and general pressure to keep pace with technology skill demands. The finding that nearly all children in this study supported reading skills with portable technology in the home demonstrates the need to foster partnerships between parents and teachers that builds on children's technological knowledge and use to deepen learning between home and school.

The functional impact of strabismus

Despite strabismus being common, little is known about its effect on functional vision and associated systemic morbidity in children. Common pediatric eye diseases often have a negative effect on children's depth perception, visual field, and binocular summation but it is unclear how this affects a child's ability to function.

Estimating the Lumbar Puncture Needle Depth in Children

Background: Lumbar puncture’s (LP) success is dependent on the skill of the physician, anatomy, size, and posture of the patient. Aims: The purpose of this study was to describe a method that could be used to help estimate the correct depth of needle (Y) insertion in children based on age, weight (W), and height (H). Methods: The study consisted of 200 children American Society of Anesthesiologist class I–II aged 0–12 years who underwent spinal block for orthopedic, pediatric, and genitourinary surgery. The distance from the skin entry point to the tip of the spinal needle was measured after the LP was performed. The relationship between the Y and W, H and body mass index (BMI) was calculated. Predictive statistical models were used to determine the LP needle depth. A paired sample t-test was conducted to compare the findings of the developed model with those of earlier models. Results: The patients were aged 2–144 months, with H and W of 43–154 cm and 2.5–48 kg, respectively. The BMI was 10.75–37.72 kg/m2. Before the Y was estimated, the relationship between the independent variables and the depth variable, which was the dependent variable, was examined. According to the obtained results, the model consists of strong relationships with H, W, and H + W. The formula for predicting Y based on W plus H was as follows: for all patients: Y (cm) = 0.861 + 0.012 × H (cm) + 0.035 × W (kg). Based on H, the formula for predicting the required Y was as follows: For all patients: Y (cm) = 0.393 + 0.023 × H (cm). Based on W, the formula for predicting the required Y was as follows: For all patients: Y (cm) = 1.460 + [0.067 × W (kg)]. Conclusion: The formula may provide a more reliable estimate of the required LP depth in children than that obtained using current models. However, larger studies are needed to standardize the formula.

Sedative depth on neurological outcomes in a juvenile rat model of cardiopulmonary resuscitation

The guidelines for cardiopulmonary resuscitation (CPR) in pediatric advanced life support suggest that midazolam is the preferred agent for sedation in patients with mild hypothermia, whereas children with cardiac arrest (CA) are at a crucial stage regarding their immature nervous system. Studies have shown that midazolam may have a detrimental effect on the developmental of the pediatric nervous system. Our previous study found that midazolam induced neuronal damage after CPR in young rats. It is speculated that: midazolam causes the potential injury of neurons by inhibiting mitochondrial autophagy expression and is an important factor for the poor prognosis in children after successful CPR. This project intends to adopt the modified asphyxiant CPR model in juvenile rats. Survival rate, neurological function and histopathological changes were evaluated to determine the protective effects of appropriate sedation depth on cerebral ischemia-reperfusion injury in juvenile rats after CPR. Combined with cell biology and molecular biology related technologies, the mechanism by which the mitochondrial pinkl-parkin signaling pathway induces autophagy to inhibit neuronal apoptosis may be key factor in the protective effects of sedation depth on the brain. The aim of this study is to provide experimental evidence and elucidate the mechanisms of improvement of cerebral ischemia-reperfusion injury by sedation depth in children after successful CPR and to lay a theoretical and experimental basis for clinical treatment.