Ill Children Research Articles

Elevated Interleukin-6 Levels within 72 Hours Post Admission Are Associated with Disease Progression in Nonseptic Critically Ill Children.

It has been established that the innate and adaptive immune suppression was heterogeneous in septic and nonseptic critically ill patients, while the value of immune function in pediatric patients with nonseptic critical illness is limited. We conducted a single-center retrospective study to explore this issue. A total of 65 children with nonseptic illnesses were studied for lymphocyte subpopulations, immunoglobulin concentrations, complement concentrations, and cytokines in peripheral blood in the next 72 hours after admission to our Pediatric Intensive Care Unit (PICU). When compared to clinically recovered patients, patients with disease progression had a numerically lower but not significantly different median pediatric critical illness score and longer PICU median stays. The analysis of serum immunoglobulin (IgG, IgM, and IgA), serum complement (C3, C4) concentrations, and lymphocyte subpopulations showed no significantly difference between patients with and without relieved clinical symptoms by day 4. For the cytokine analysis, the level of IL-6 was significantly higher in patients with disease progression than that in patients who clinically recovered (p = 0.046). In the univariate Cox regression analysis, plasma IL-6 levels were associated with outcome. Multivariate analysis evidenced that the level of plasma IL-6 was one of the factors determining the length of hospital stays. In conclusions, our results demonstrate that increased IL-6 levels in the initial 72 hours post admission are associated with prolonged stays and disease progression in nonseptic critically ill children in the PICU.

Evaluation of the Validity of the Pediatric Sequential Organ Failure Assessment Score in Critically Ill Children

IMPORTANCE: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis- 3) utilizes the Sequential Organ Failure Assessment (SOFA) score to predict life-threatening organ dysfunction and increased mortality in the adult population. The SOFA criteria is not applicable to the pediatric population as the SOFA variables do not adjusted for pediatric value norms. A Pediatric Sequential Organ Failure Assessment Score (pSOFA) was created and verified in one study at the Ann & Robert H. Lurie Children’s Hospital of Chicago which showed to be superior to other pediatric sepsis assessment tools, but the pSOFA score has …

Ill children should be seen in hospital

Ill children should be seen in hospital

Role of PSOFA-E Score in Predicting the Clinical Outcome of Critically Ill Children

Background: Recently pediatric sequential organ failure assessment (pSOFA) score was adapted and validated in critically ill children. This study was aimed to evaluate the feasibility of addition of echocardiographic parameters to paediatric version of SOFA score (pSOFA-E score) and to adapt and validate with reference to pSOFA score in predicting the mortality of critically ill children.Subjects and Methods:This hospital based prospective, observational, analytical study was conducted in the Department of Paediatrics, A. J Hospital, Mangalore, Karnataka, from November 2017 to November 2019. A total of 74 cases were studied. Result:Most of the children were aged <1 year (41.89%). Majority of the patients (62.16%) improved and 37.84% of the patients expired. The mean and median pSOFA-E scores were 10.53±4.06 and 10 respectively and pSOFA-E score of 5-8 was noted in most of the children (32.43%). Mortality was significantly high in children with pSOFA-E score between 9-12 (39.13%), 13-16 (77.78%), 17-20 (83.33%) (p<0.001). Receiver operating characteristic curve (ROC) yielded area under curve (AUC) of 0.920 and 0.791 with a cut-off value of 11.5 in predicting mortality. Significantly higher number of children with pSOFA-E score of ≥ 11.5 had positive blood culture (30%). Conclusion:The findings of the present study validate and emphasize that, addition of score devised by requirement of ionotropes to maintain adequate ejection fraction defy simple bedside echocardiography to pSOFA score is highly useful and accurate in discrimination of PICU mortality, morbidity and cardiovascular status/ compromise of body.

Beyond ventilatory support: challenges in general practice and in the treatment of critically Ill children and adolescents with SARS-CoV-2 infection.

Severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2 infection) is a new challenge for all countries, and children are predisposed to acquire this disease. Some studies have demonstrated more severe diseases in adults, but critically ill pediatric patients have been described in all ages. Pulmonary involvement is the major feature, and ventilatory support is common in critical cases. Nevertheless, other very important therapeutic approaches must be considered. In this article, we reviewed extensively all recent medical literature to point out the main clinical attitudes to support these pediatric patients during their period in respiratory support. Radiologic findings, fluid therapy, hemodynamic support, use of inotropic/vasopressors, nutritional therapy, antiviral therapy, corticosteroids, antithrombotic therapy, and immunoglobulins are analyzed to guide all professionals during hospitalization. We emphasize the importance of a multi-professional approach for adequate recovery.

Bioethics in the Pediatric ICU: Ethical Dilemmas Encountered in the Care of Critically Ill Children

Bioethics in the Pediatric ICU: Ethical Dilemmas Encountered in the Care of Critically Ill Children

Current Literature in Pediatric Psychosomatics (CLiPPs)

CLiPPs (Current Literature in Pediatric Psychosomatics) are pertinent article reviews from the AACAP Physically Ill Child Committee for psychosomatic clinicians on a range of medical science journals and literature. CLiPPs are edited by Chase Samsel, MD, of Boston Children’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA. All critical summaries are written by the designated reviewers.

Calcium, Magnesium and phosphate deficiency and their Effect on Clinical outcome in Critically Ill child

Critical illness may trigger an acute phase response which is associated with several metabolic derangements. These include hypocalcaemia, hypophosphatemia and hypomagnesaemia. To determine the incidence and associated risk factors of hypocalcaemia, hypomagnesaemia and hypophosphatemia that develop in critically ill children and their effect on their clinical outcome. 50 child enrolled in our study aged from 1month to 6 years admitted in pediatric intensive care unit in Benha University Hospital. Levels of serum calcium, magnesium and phosphate were measured during admission. The following variables were analyzed: age, gender, diagnosis on admission, clinical severity score on admission OFI (Organ Failure Index) and daily scores PELOD (Pediatric Logistic Organ Dysfunction), length of hospital stay and outcome were analyzed. Out of 50 patients, the frequency of Calcium deficiency was (64%), magnesium deficiency (46%), and phosphate deficiency (57%) on admission. There was negative correlation between calcium level and PELOD (P=0.048), OFI (P=0.001) and period of hospitalization (P=0.002). Patients with hypomagnesaemia on admission had higher PELOD score (P=0.008), higher OFI (P=0.008),prolonged period of hospitalization(P=0.038) and was associated with hypokalemia (P<0.05). Hypophosphatemia was associated with higher PELOD score (P=0.019) and increased period of hospitalization (P=0.012). Mortality rate increased in patients with hypocalcaemia (P=0.022) and also in patients with hypomagnesaemia (P=0.006). Deficiency of calcium, magnesium and phosphate were common among critically ill children and affected clinical outcome of patient.

Serum Cortisol Level in Combination with High Adrenocortico-trophic Hormone Concentrations are Associated with Poor Outcome in Critically Ill Children

Background: Cortisol is one of the major hormones in stress condition to maintain the heamostasis in the body. The severity of disease is associated with cortisol level in the blood, there is dissociation between adrenocorticotropin (ACTH) and cortisol level in blood. This study aimed to evaluate serum cortisol level and adrenocorticotropin (ACTH) level in critically ill children. Methods: The present study was a single blinded randomized controlled interventional trail that was conducted in neonatal intensive care unit (NICU), pediatric department, Zagazig University children hospital in period between July 2017 to July 2018. 64 infants and children in the study. There were randomly divided into 2 groups. Group 1 included (24 males & 20 females) Group 2 included 20 healthy control subjects matched in age and sex. All patients were subjected to: measurement of blood pressure, heart rate, respiratory rate and temperature. Lab investigation included CBC, albumin, CRP and blood culture, basal cortisol and ACTH. Results: Mean ACTH at patients group was 21.7 ± 6.47 pg/ml and 11.3 ± 8.64 pg/ml in control group. Mean basal cortisol was 25.8 ± 4.62 ug/dl and 9.26 ± 1.95 ug/dl in group (1) and (2), respectively. Mean serum albumin was 3.16 ± 0.96 g/dl and 4.10 ± 0.45 g/dl in groups (1) and (2), respectively. There were a statistically significant difference between the patients’ group and controls regarding serum cortisol and ACTH (p

Response to Suffering of the Seriously Ill Child: A History of Palliative Care for Children.

Most pediatric clinicians aspire to promote the physical, emotional, and developmental well-being of children, hoping to bestow a long and healthy life. Yet, some infants, children, and adolescents confront life-threatening illnesses and life-shortening conditions. Over the past 70 years, the clinician's response to the suffering of these children has evolved from veritable neglect to the development of pediatric palliative care as a subspecialty devoted to their care. In this article, we review the history of how clinicians have understood and responded to the suffering of children with serious illnesses, highlighting how an initially narrow focus on anxiety eventually transformed into a holistic, multidimensional awareness of suffering. Through this transition, and influenced by the adult hospice movement, pediatric palliative care emerged as a new discipline. Becoming a discipline, however, has not been a panacea. We conclude by highlighting challenges remaining for the next generation of pediatric palliative care professionals to address.

Critically Ill Children Admitted into the Paediatric Emergency Unit of a Tertiary Hospital in a Developing Country and the Causes of Delayed Presentation

Decades of advancement in health care delivery and clinical practice may have massively impacted the efficiency of health delivery and patient outcome in high-income countries, but its effect is still minimal in the low-income countries who are still dealing with poorly equipped and inadequate health facilities low insurance coverage and poor education. This study set out to evaluate the clinical profiles of critically ill admitted into the paediatric emergency unit and causes delay presentation. A prospective review of children admitted into the children emergency room between January 2018 to December 2019. A total of 8087 emergency room visits were attended to over the two years out of which 4039 were admitted. The majority of participants (63.5%) are less than 5 years, there was a male to female ratio of 1.6:1 and 1458 (36.1%) had emergency signs necessitating resuscitation at presentation. 74% of participants have been self-medicated by parent/caregiver before presenting in the hospital (50% antibiotics, 44% antimalaria). The most frequent symptoms include fever, vomiting, breathlessness and seizures, majority (73%) of those with emergency sign presented 48 hours after onset of symptoms and the major reason for the delay was the fear of the cost of treatment. Children that had significant odd of dying include those that: were self-medicated, had emergency signs and under- 5 children. The high dependence of out-of-pocket financing in Nigeria health care system remains a major cause of delayed presentation among critically ill children. There is an urgent need for the government to improve on the universal health coverage by improving the number of the population with health insurance coverage.

Pediatric Palliative Transport in Critically Ill Children: A Single Center's Experience and Parents' Perspectives.

The transfer of critically ill children from intensive care units (ICUs) to their homes for palliation is seldom described. We report our 10-year pediatric palliative transport experience and conducted a survey to gain parents' perspectives of their child's transport experience. Over the study period, eight patients were transported from our pediatric ICU to their homes or hospice facilities. There were no intratransport adverse events. Parents who participated in the survey responded positively to the transport experience. The availability of a dedicated critical care transport service allowed for palliative transfers to be performed safely. Facilitating transport to allow withdrawal of life support at home is an acceptable option to families as part of holistic end-of-life care.

Route of Oseltamivir Administration Affects Metabolite Concentrations in Critically Ill Children.

We performed a prospective cohort study to investigate oseltamivir administration in critically ill children. We found that enteric tube administration of oseltamivir resulted in lower concentrations of its active metabolite compared with oral delivery. These findings could have significant clinical implications, and more studies are required to better understand the effects of administration route on potential lower systemic metabolite exposure.

Bleeding in Critically Ill Children With Underlying Oncologic Diagnoses

Bleeding in Critically Ill Children With Underlying Oncologic Diagnoses

Lived Experiences and Impact of Delirium in Critically Ill Children: a Qualitative Study

Lived Experiences and Impact of Delirium in Critically Ill Children: a Qualitative Study

Abstract 348: Laryngoscopy With Vallecula Blade Position is Associated With Higher Success in Tracheal Intubation for Critically Ill Children

Introduction: Classical teaching in pediatric laryngoscopy advocates the use of straight blades to be placed underneath the epiglottis, whereas curved blades are placed in the vallecula. Anesthesia studies suggest that straight blade positioning in the vallecula may be a satisfactory technique for small children. We sought to assess laryngoscope blade tip position during pediatric tracheal intubation (TI) and its association with intubation success. Methods: Observational single center study. Children undergoing TI from November 2017 until December 2018 in a pediatric emergency department (ED) and pediatric intensive care unit (PICU) using a CMAC video laryngoscope with recorded images available for review were eligible for inclusion. Patient and provider characteristics were obtained from quality improvement database. Each video was independently reviewed, and the blade tip position was determined by study personnel as ‘in vallecula’ or ‘under epiglottis’. TI success was defined as observation of the tube entering the trachea on video. Univariate analysis between blade tip position and success, as well as potential confounders, was performed by chi 2 testing. Multivariable logistic regression to determine the independent association between blade tip position and success while controlling for relevant confounders. Results: 95 TI attempts were analysed. 58% of attempts were successful (14/35 in infants, 8/15 in 1-7 yr old, 33/45 in 8+ yr, p=0.01). Blade tip position was in the vallecula for 20/31 (65%) attempts with curved blades and 23/64 (36%) with straight blades. In univariate analysis, TI attempts with blade tip position ‘in vallecula’ were significantly more successful than attempts with ‘under epiglottis’ (37% vs. 84%, p&lt;0.001). Median duration of laryngoscopy was 41 sec (IQR 27-59), not significantly different between two blade tip positions (p=0.06). After controlling for patient age and blade type (potential confounders), TI attempts with blade tip ‘in vallecula’ was independently associated with success (aOR 7.2, 95% CI 2.6 - 20.1). Conclusion: During pediatric TI, laryngoscope blade tip position in the vallecula was independently associated with success when compared with placement under the epiglottis.

Current Literature in Pediatric Psychosomatics (CLiPPs)

CLiPPs (Current Literature in Pediatric Psychosomatics) are pertinent article reviews from the AACAP Physically Ill Child Committee for psychosomatic clinicians on a range of medical science journals and literature. CLiPPs are edited by Chase Samsel, MD, of Boston Children’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA. All critical summaries are written by the designated reviewers.

Multi-Compartment Profiling of Bacterial and Host Metabolites Identifies Intestinal Dysbiosis and Its Functional Consequences in the Critically Ill Child.

Adverse physiology and antibiotic exposure devastate the intestinal microbiome in critical illness. Time and cost implications limit the immediate clinical potential of microbial sequencing to identify or treat intestinal dysbiosis. Here, we examined whether metabolic profiling is a feasible method of monitoring intestinal dysbiosis in critically ill children. Prospective multicenter cohort study. Three U.K.-based PICUs. Mechanically ventilated critically ill (n = 60) and age-matched healthy children (n = 55). Collection of urine and fecal samples in children admitted to the PICU. A single fecal and urine sample was collected in healthy controls. Untargeted and targeted metabolic profiling using 1H-nuclear magnetic resonance spectroscopy and liquid chromatography-mass spectrometry or urine and fecal samples. This was integrated with analysis of fecal bacterial 16S ribosomal RNA profiles and clinical disease severity indicators. We observed separation of global urinary and fecal metabolic profiles in critically ill compared with healthy children. Urinary excretion of mammalian-microbial co-metabolites hippurate, 4-cresol sulphate, and formate were reduced in critical illness compared with healthy children. Reduced fecal excretion of short-chain fatty acids (including butyrate, propionate, and acetate) were observed in the patient cohort, demonstrating that these metabolites also distinguished between critical illness and health. Dysregulation of intestinal bile metabolism was evidenced by increased primary and reduced secondary fecal bile acid excretion. Fecal butyrate correlated with days free of intensive care at 30 days (r = 0.38; p = 0.03), while urinary formate correlated inversely with vasopressor requirement (r = -0.2; p = 0.037). Disruption to the functional activity of the intestinal microbiome may result in worsening organ failure in the critically ill child. Profiling of bacterial metabolites in fecal and urine samples may support identification and treatment of intestinal dysbiosis in critical illness.

The Influence of Parents' Religiosity or Spirituality on Decision Making for Their Critically Ill Child: An Integrative Review.

Background: Religion and/or spirituality are important values for many parents of critically ill children; however, how religion and/or spirituality may influence which treatments parents accept or decline for their child, or how they respond to significant events during their child's illness treatment, remains unclear. Objective: To summarize the literature related to the influence of parents' religiosity or spirituality on decision making for their critically ill child. Design: Integrative review, using the Whittemore and Knafl approach. Setting/Subjects: Data were collected from studies identified through PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL plus), Embase, Scopus, and PsychInfo. Databases were searched to identify literature published between 1996 and 2016. Results: Twenty-four articles of variable methodological quality met inclusion criteria. Analysis generated three themes: parents' religiosity or spirituality as (1) guidance during decision making, (2) comfort and support during the decision-making process, and (3) a source of meaning, purpose, and connectedness in the experience of decision making. Conclusion: This review suggests that parents' religiosity and/or spirituality is an important and primarily positive influence on their decision making for a critically ill child.

Evaluation of Enteral Nutrition in Critically Ill Children

Evaluation of Enteral Nutrition in Critically Ill Children