Intensive Care Unit Research Articles

Fibromatosis colli (FC) is an uncommon pseudotumor of the sternocleidomastoid muscle, occurring with an incidence of 0.4%. It is often identified via ultrasonography between 2 and 4 weeks of age, with a higher prevalence in boys. It is categorized as a benign myofibroblastic tumour. A child about two weeks old with a unilateral sternocleidomastoid muscle hypertrophy is the typical presentation. The pathology seems to have a higher incidence in males. A 13-day-old boy was born via lower segment cesarean section (LSCS) breech presentation to a primi mother who was 31 weeks along in her pregnancy. After birth, the infant cried when stimulated and experienced mild respiratory distress and retractions; as a result, the baby was moved to the neonatal intensive care unit (NICU). Following ultrasound sonography (USG) results, fibromatosis colli is diagnosed.

N-terminal pro-B-type natriuretic peptide (NT-proBNP), a marker of cardiac stress, has been proposed as a potential prognostic biomarker for maternal adverse outcome in pre-eclampsia (PE). This study aimed to evaluate the predictive value of NT-proBNP for severe maternal adverse outcome in pregnancies with an established diagnosis of PE. This was a retrospective cohort study of singleton pregnancies diagnosed with PE ≤ 36 weeks of gestation that were assessed at the Medical University of Vienna between January 2018 and December 2023. Maternal serum levels of NT-proBNP, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) were measured at the time of PE diagnosis. The primary outcome was the occurrence of a severe maternal adverse event, including intensive care unit admission, maternal death, pulmonary edema and severe neurological complications. Associations between severe maternal adverse outcome and Z-scores for NT-proBNP and the sFlt-1/PlGF ratio were analyzed using logistic and Cox regression models adjusted for gestational age at sampling and the Z-score of the other biomarker. The area under the receiver-operating-characteristics (ROC) curve (AUC) was used to assess the discriminative ability of the biomarkers. Of 130 women included in our cohort, 13 (10%) experienced severe maternal adverse outcome. NT-proBNP levels were significantly higher in this group (median, 688.0 (interquartile range (IQR), 249.6-1038.0) pg/mL vs 106.1 (IQR, 50.6-280.6) pg/mL; P < 0.001). Higher NT-proBNP Z-score was associated significantly with severe maternal adverse outcome (adjusted odds ratio, 3.24 (95% CI, 1.50-7.84); P = 0.005) and predicted shorter time-to-delivery with severe maternal adverse outcome(adjusted hazard ratio, 3.08 (95% CI, 1.47-6.44); P = 0.003) after adjusting for gestational age at sampling and sFlt-1/PlGF ratio Z-score. The sFlt-1/PlGF ratio was not associated significantly with these outcomes. ROC-curve analysis showed that NT-proBNP had superior discriminative performance compared with the sFlt-1/PlGF ratio (AUC, 0.75 (95% CI, 0.61-0.90) vs 0.67 (95% CI, 0.56-0.79)). The performance of both biomarkers improved when combined with gestational age at sampling (AUC, 0.82 (95% CI, 0.71-0.94) vs 0.76 (95% CI, 0.65-0.88)). NT-proBNP was a strong predictor of severe maternal adverse outcome and time-to-delivery in women diagnosed with PE, especially in early-onset cases. NT-proBNP may serve as a clinically accessible biomarker for risk stratification and surveillance in women with established PE. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Thrombocytopenia (TP) has been associated with poor clinical outcomes in geriatric patients in the intensive care unit (ICU). However, the factors leading to TP in critically ill older patients are not clear. In this study, we aimed to investigate the primary factors influencing TP in geriatric patients in the ICU, as well as to evaluate the relationship between TP and adverse clinical outcomes. Between 2010 and 2020, 5,848 geriatric patients were initially admitted to the ICU at Dongyang People's Hospital, with 3,147 ultimately included in the study. Lasso regression was used to screen for relevant variables, followed by multivariate logistic regression analysis. Propensity score matching (PSM) was used to further assess the impact of TP on in-hospital mortality. Validation of findings was conducted using the Medical Information Mart for Intensive Care database. 32.6% of geriatric ICU patients developed TP during their stay. Compared with the non-TP group, the TP group showed significant increases in disease severity, hormone use, vasoactive drug use, and sepsis rates, as well as in-hospital mortality, mechanical ventilation use, duration of ICU stay, and hospitalization costs (p < 0.001). Lasso regression screening identified 24 relevant variables, and 32.6% of patients developed TP during their ICU stay. Sensitivity analyses and PSM confirmed a strong association between TP and increased in-hospital mortality. TP is common among geriatric patients in ICU and is associated with poor prognosis. This study identified several important factors influencing TP, highlighting valuable implications for the early identification of high-risk patients and the development of individualized treatment strategies.

The relationship between serum sodium levels and stroke prognosis has been investigated, but the effect of serum sodium fluctuations on severe stroke patients remains uncertain. We aimed to evaluate the association between serum sodium trajectories within 72h of admission and all-cause mortality in intensive care unit (ICU) patients with ischemic stroke. This retrospective study utilized data from the Medical Information Mart for Intensive Care (MIMIC) database, including patients diagnosed with ischemic stroke from 2008 to 2022. Serum sodium trajectories within 72h of admission were classified using a latent class trajectory model. Kaplan-Meier survival curves and Cox proportional hazards models were employed to assess the relationship between trajectories and all-cause mortality. Subgroup analyses were conducted to assess the consistency of this association across various populations. Among 881 enrolled patients, two distinct serum sodium trajectory groups were identified: class 1 (n = 778, 88.3%) exhibited stable sodium levels within the normal range, while class 2 (n = 103, 11.7%) showed rapid fluctuations. Kaplan-Meier analyses revealed that patients in class 2 had higher all-cause mortality at 30-day, 90-day, 180-day, and 1-year follow-ups (all P < 0.001). Multivariate COX regression analyses consistently showed elevated mortality risk in class 2 versus class 1 across all timepoints: ICU (HR: 2.17; 95% CI 1.27-3.68; P = 0.004), in-hospital (HR: 2.51; 95% CI 1.64-3.85; P < 0.001), 30-day (HR: 2.41; 95% CI 1.67-3.49; P < 0.001), 90-day (HR: 2.17; 95% CI 1.56-3.03; P < 0.001), 180-day (HR: 2.13; 95% CI 1.55-2.92; P < 0.001) and 1year (HR: 1.99; 95% CI 1.46-2.71; P < 0.001). Subgroup analyses confirmed the robustness of these findings. In critically ill patients with ischemic stroke, rapidly fluctuating serum sodium levels are independently associated with increased short-term and long-term all-cause mortality. Further investigations are needed to elucidate the role of sodium dynamics in stroke outcomes.

In intensive care units (ICU), malnutrition is very common and closely related to severe inflam­matory states. The aim of this study was to develop and validate a nutritional inflammatory prognostic score (NIPS) predictive of short-term mortality, and to verify the validity of existing scores. A total of 606 ICU patients were included in a longitudinal study. The population was randomly divided into two groups: development (383) and validation (223). The NIPS score was developed from nutritional and inflammatory parameters using multi-adjusted Cox proportional regression. Validation of NIPS as a prognostic score was tested using the area under the ROC curve (AUC), Cox proportional regression, and the Kaplan-Meier curve. The validity of five selected scores was also assessed. The NIPS score was developed from C-reactive protein to prealbumin ratio, total cholesterol, procalcitonin and neutrophil to lymphocyte ratio. With an AUC of 0.89 and a cutoff of 5.0, NIPS predicted short-term mortality with a sensitivity of 80.5% and a specificity of 93.8%. The risk of mortality was fivefold higher in the high nutritional risk group (RR= 5.0, [3.1–7.9], p < 0.0001). The crude cumulative incidence of mortality was significantly higher in the high-risk group (pLog-Rank < 0.0001). The five selected scores had a significant, but, lower prognostic value, compared with the developed score (AUC between 0.59 and 0.70). This study provides a new nutritional risk score, based on widely available biological parameters, with proven efficiency in predicting ICU mortality risk. Nutritional risk screening should be routinely performed at the earliest admission stages.

This study aimed to validate the Emergency Surgery Acuity Score (ESAS) in Korean patients who underwent emergency general surgery (EGS) and evaluate its effectiveness in predicting various outcomes. Retrospective cohort study. Two tertiary hospitals in South Korea. This study included 1629 adults who underwent EGS between July 2014 and December 2019. The ESAS and its abbreviated version, the Physiological Emergency Surgery Acuity Score (P-ESAS), were calculated for each patient. Predictive performance was assessed for 28-day mortality, post-operative complications, intensive care unit (ICU) admission, and hospital length of stay (LOS). C-statistics were used to compare ESAS with P-ESAS and other scoring systems, including the Charlson Comorbidity Index (CCI). Logistic regression models were employed to identify independent predictors of 28-day mortality, incorporating clinically relevant covariates such as demographic characteristics, comorbidities, physiological parameters, and surgical factors. The ESAS and P-ESAS demonstrated superior predictive abilities compared to the Charlson Comorbidity Index (CCI) across clinical outcomes. For 28-day mortality, the c-statistics were 0.917 for ESAS, 0.897 for P-ESAS, and 0.691 for CCI. Both ESAS and P-ESAS outperformed CCI in predicting post-operative complications (c-statistics: 0.701, 0.677, and 0.637, respectively) and ICU admission (c-statistics: 0.777, 0.737, and 0.645, respectively). Linear regression analysis revealed a significant relationship between ESAS and hospital length of stay (LOS = 2.96 × ESAS; p < 0.001, adjR2 = 0.430). Both ESAS and P-ESAS were identified as significant independent predictors of 28-day mortality in multivariable analyses. The ESAS is validated as an effective tool for predicting 28-day mortality, post-operative complications, ICU admission, and hospital LOS in Korean patients undergoing emergency general surgery. Its predictive performance compared to other scoring systems highlights its potential to improve risk stratification and resource management in emergency surgery settings.

Weaning from mechanical ventilation is a critical process in the intensive care unit (ICU), and extubation failure remains associated with poor outcomes. ICU-acquired weakness has been identified as a risk factor for delayed weaning. Maximal handgrip strength (HGS) is a simple bedside measure proposed as a surrogate marker of global muscle strength. This systematic review and meta-analysis aimed to assess the association between HGS and weaning outcomes in ICU patients. A systematic search of MEDLINE, EMBASE, CINAHL, and Cochrane Library was conducted up to December 2024. We included prospective cohort studies assessing maximal HGS prior to extubation in mechanically ventilated adults, and its association with extubation failure, spontaneous breathing trial (SBT) failure, or weaning classification (simple, difficult, or prolonged). Meta-analyses pooled mean differences in HGS between outcome groups, and diagnostic accuracy was evaluated using a hierarchical summary ROC model. Risk of bias was assessed using the QUIPS tool. Seven studies were included in the review (n = 707 patients), and six in the meta-analysis. No significant difference in HGS was found between extubation failure and success (mean difference: - 3.62kg; 95% CI: - 7.92 to 0.62). However, significantly lower HGS was associated with SBT failure (-3.00kg; 95% CI: - 4.64 to - 1.36) and non-simple weaning (-3.94kg; 95% CI: - 5.31 to - 2.58). Pooled sensitivity and specificity of HGS were 72% and 60% respectively, in predicting either extubation failure or non-simple weaning. Negative predictive values ranged from 90% to 95%, for 10% and 20% pre-test probability. Maximal HGS does not appear to significantly differentiate extubation success from failure Given the limited number of studies and their heterogeneity, further high-quality research is needed to clarify its prognostic value across different patient subgroups and timeframes.

Multidrug-resistant Gram-negative bacteria (MDR-GNB), especially carbapenem-resistant strains, pose a major therapeutic challenge in intensive care units and are associated with high morbidity and mortality. Polymyxin B (PMB) and colistin sulfate (CS) are the last-line agents for MDR-GNB infections; however, their clinical use is limited by nephrotoxicity. Although the steady-state 24-h area under the curve (AUCss,24h) has been suggested as a predictor of nephrotoxicity, prior studies have mainly applied semiparametric approaches that cannot fully describe the risk across exposure levels. Parametric time-to-event (TTE) analysis offers a more robust framework but has not been applied to polymyxin-induced nephrotoxicity. This study aimed to identify clinical and pharmacological factors influencing PMB- and CS-associated nephrotoxicity in critically ill patients with MDR-GNB infections and to establish AUCss,24h thresholds predictive of acute kidney injury (AKI) using parametric TTE modeling. We retrospectively analyzed real-world data from 562 patients with MDR-GNB infections treated with PMB (n = 354) or CS (n = 208) at Xiangya Third Hospital, Central South University, between July 2018 and July 2023. Pharmacokinetic profiles were simulated using published models, and drug exposure parameters (AUCss,24h, Css,max, and Css,min) were estimated. Propensity score matching was used to balance the baseline covariates. Kaplan-Meier curves and log-rank tests were used to compare the AKI incidence between the groups. Parametric TTE models were developed using NONMEM (version 7.5), incorporating exposure parameters and covariates. The model performance was validated using bootstrap and visual predictive checks. Classification and regression tree (CART) analyses were used to determine the exposure thresholds. Overall, 39.4% of patients developed AKI, with a significantly higher incidence in the PMB group than in the CS group (51.7% vs. 18.4%). The final PMB model identified AUCss,24h, sepsis, transplant history, and vancomycin co-administration as independent risk factors, with an EC50 of 80.4μg·h/mL for PMB. For CS, AUCss,24h and multisite infections predicted AKI with an EC50 of 57.5μg·h/mL. CART analysis revealed nephrotoxicity thresholds of 101μg·h/mL for PMB and 44μg·h/mL for CS administration. Simulation showed that increasing PMB AUCss,24h from 50 to 125μg·h/mL raised 14-day AKI risk from 25 to 75%, while for CS, increasing AUCss,24h from 25 to 50μg·h/mL elevated risk from 20 to 60%. In critically ill patients with MDR-GNB infections, higher plasma exposure to PMB and CS was strongly associated with increased nephrotoxicity. Exposure thresholds of AUCss,24h ≥ 101μg·h/mL for PMB and ≥ 44μg·h/mL for CS significantly elevated the AKI risk. Therapeutic drug monitoring should be integrated into clinical practice to optimize polymyxin dosing, reduce toxicity, and improve patient outcomes.

Although nicotine use is a significant and potentially modifiable risk factor for delirium in ICU patients, evidence on the association between nicotine dependence (ND) and ICU delirium remains limited. This retrospective cohort study used the MIMIC-IV v3.1 database and included adult patients admitted to the ICU for ≥ 24h with documented delirium assessments. Patients with schizophrenia, dementia, depression, alcohol abuse, or cerebrovascular disease were excluded. Patients were classified into ND and non-ND groups. The primary outcome was ICU delirium incidence; secondary outcomes included in-hospital mortality, ICU mortality, hospital length of stay, and ICU length of stay. Confounders were balanced using 1:1 propensity score matching (PSM). Cox regression and competing risk models were used to assess the association between ND and delirium. Subgroup and sensitivity analyses were performed, and the effects of ICD coding versions and NRT treatment were also evaluated. A total of 24,043 patients were included, with 2,662 (11.07%) in the ND group. After PSM, baseline characteristics were balanced. The ND group had a significantly higher incidence of delirium than the non-ND group (30.8% vs. 27.2%, P = 0.004), with no significant differences in mortality or length of stay. Multivariate Cox and competing risk models confirmed that ND was independently associated with increased ICU delirium risk. Findings remained consistent in PSM and sensitivity analyses. Nicotine dependence significantly increases the risk of ICU delirium. These results highlight the need for targeted risk assessment and intervention strategies in ND patients admitted to the ICU.

Cyanide poisoning is a life-threatening condition that impairs cellular oxygen utilization, leading to lactic acidosis. However, serum cyanide levels are not readily available in clinical settings, making diagnosis and treatment monitoring difficult. In this report, we describe the treatment of a patient with severe cyanide poisoning using serum lactate levels as an indicator of the effectiveness of the treatment. A 70-year-old man with suspected cyanide poisoning was transported to the emergency department in an unconscious state approximately 45 minutes after poisoning. Laboratory findings revealed severe lactic acidosis (pH 7.07) with a high lactate level (19.0 mmol/L) and hypertension. Based on his history and clinical presentation, cyanide poisoning was strongly suspected. The patient received antidotes and supportive care, including high-concentration oxygen therapy and antihypertensive medication. Serum lactate levels and blood cyanide concentrations were periodically measured to monitor treatment response. The patient's consciousness improved with decreasing lactate levels, achieving full consciousness approximately 9 hours after poisoning. Finally, he was discharged from the intensive care unit without apparent sequelae and transferred to a psychiatric ward. This case highlights the utility of serum lactate as an accessible biomarker for diagnosing cyanide poisoning and evaluating treatment efficacy. Given the unavailability of rapid cyanide assays in most clinical settings, serial lactate monitoring may aid in guiding therapeutic decisions.

Imipenem-relebactam demonstrates in vitro activity against multidrug-resistant (MDR) Pseudomonas aeruginosa, but real-world effectiveness data are limited. MIRAGE was a multicenter, retrospective, observational study of imipenem-relebactam for MDR P. aeruginosa pneumonia and bacteremia. Patients were included if they received imipenem-relebactam for >48 h within 7 days of index P. aeruginosa culture. The primary outcome was clinical success at day 30, defined as survival, resolution of signs and symptoms of infection, completion of intended treatment course, and absence of recurrent infection. Secondary outcomes included 30- and 90-day mortality, infection recurrence, and development of non-susceptibility. Sixty-three patients were included. Median (IQR) age was 61 (51-70) years, and the median Charlson Comorbidity Index was 5 (3-6). Forty-six percent of patients had an immunocompromising condition, 79% were in the intensive care unit, 76% were receiving mechanical ventilation, and 48% required vasopressors. Median SOFA score was 7 (5-12). Forty percent of index isolates that were tested displayed non-susceptibility to both ceftolozane-tazobactam and ceftazidime-avibactam. Fifty-six percent of patients achieved clinical success at day 30. All-cause 30- and 90-day mortality rates were 18% and 29%, respectively. Recurrent infections were documented in 37% of patients within 90 days, and resistance developed in 39% (16/41) of evaluable patients. Clinical outcomes following imipenem-relebactam for treatment of MDR P. aeruginosa were comparable to those reported in real-world studies for other novel β-lactam agents. Our data suggests that imipenem-relebactam has a role in the treatment of patients infected with MDR P. aeruginosa.

Albumin-corrected anion gap (ACAG) is a prognostic biomarker for various diseases. As a derived metric, the relationship between ACAG and potential related biomarkers, along with their combined effect on death, has yet to be fully elucidated. This study aims to investigate the association between ACAG and mortality of congestive heart failure (CHF), and to identify the specific biomarkers related to increased ACAG and the risk of mortality in CHF. This study selected patients with CHF in intensive care units (ICU) from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were stratified based on their ACAG levels into four groups. The outcomes were 28-day and 1-year mortality of CHF. Cox proportional hazard analysis and subgroup analysis were performed to explore the predictive value of ACAG. The mediation analysis and Pearson correlation analysis were used to explore potential associated biomarkers. A total of 2,689 patients with CHF were included in this study. Of these, 697 and 1,207 patients died within 28 days and 1 year, respectively. Cox proportional hazard analysis showed that increased ACAG level was significantly associated with both 28-day and 1-year mortality (hazard ratio [HR]: 2.18, 95%CI: [1.67, 2.84] and HR: 1.44, 95%CI: [1.18, 1.74], respectively) after adjusting for confounding factors. The subgroup analysis demonstrated that ACAG exhibited a pronounced predictive value among patients admitted to the coronary care unit (CCU), or with myocardial infarction in both 28-day and 1-year mortality. The mediating effect of ACAG was found to be significant between lactate, phosphate and blood urea nitrogen (BUN) concerning 28-day mortality (mediated proportion: 44.0%, 37.4% and 16.5%, respectively), but not 1-year mortality. All three biomarkers showed significant correlations with ACAG. Elevated ACAG was a significant risk factor for 28-day and 1-year mortality in critically ill patients with CHF. ACAG plays an important role in mediating the association between lactate, phosphate and BUN and 28-day death in CHF patients.

Prolonged mechanical ventilation (MV) frequently results in inspiratory and peripheral muscle weakness, impairing recovery. These conditions can be identified at the bedside using respectively Maximal Inspiratory Pressure (MIP) measurement and Medical Research Council (MRC) score. This study investigated the evolution over the acute-care hospital stay of MIP and MRC score in patients with documented post-extubation inspiratory muscle weakness (IMW), defined as MIP ≤ 30 cmH2O, and looked for the factors associated with persistent IMW at the end of the acute care hospital stay. This exploratory prospective observational study was conducted across five Swiss hospitals. Patients in the Intensive Care Unit (ICU) who were extubated after ≥ 7 days of MV, with IMW diagnosed within 48h post planned extubation, were included. Patients' characteristics and ICU-related factors were recorded throughout the acute care stay as were MIP and MRC score. ICU-acquired weakness (ICU-AW) recorded in the medical file, ICU readmission, reintubation, and hospital mortality were also documented. Descriptive statistics and linear interpolation for missing MIP data were applied, and associations with persistent IMW (MIP ≤ 30 cmH2O) at study completion were explored using univariable logistic regression. The optimal timepoint for predicting persistent IMW using MIP was identified using a random forest model. Sixty-nine patients (48 men, 21 women) completed the study. At study completion, persistent IMW was observed in 30 patients (43%), with a median MIP of 22 [13-24] cmH2O. MIP was of 44 [36-64] in patients without persistent IMW. Persistent IMW was positively associated in univariable logistic regression with female sex, duration of catecholamine use until inclusion, MIP at day 12, MRC score at day 12 and changes in MIP from inclusion to day 12. The presence of respiratory comorbidities was negatively associated with persistent IMW. Persistent IMW following prolonged MV is frequent throughout the acute care stay and until acute care hospital discharge. The MIP measured at day 12 after inclusion, as well as its change from inclusion to day 12, were strongly associated with persistent IMW.

Extracorporeal carbon dioxide removal (ECCO₂R) prevents intubation and facilitates extubation in patients with hypercapnic respiratory failure. However, low-flow systems increase shear stress and need full anticoagulation, increasing the risk of circuit-related complications. We assessed the safety and efficacy of a high-caliber dual-lumen cannula, designed for jugular veno-venous extracorporeal membrane oxygenation (VV ECMO), repurposed for femoral vein insertion, with the aim of achieving higher blood-flow rates and more efficient CO₂ clearance. We retrospectively analyzed 16 intensive care unit (ICU) patients (62 years; 81% chronic obstructive pulmonary disease [COPD]) treated with ECCO₂R using a large-caliber dual-lumen cannula (20-23 Fr) inserted via the femoral vein. Key outcomes included changes in gas exchange, ventilatory support status, and complications. Extracorporeal carbon dioxide removal enabled rapid CO₂ clearance, with arterial carbon dioxide pressure (PaCO₂) decreasing from 68 [62-95] to 49 [45-56] mm Hg at 2 h, and pH increasing from 7.20 [7.16-7.27] to 7.36 [7.33-7.41]. Fifty-six percent of patients avoided intubation, whereas all intubated patients were extubated during ECCO₂R. The median support duration was 5 [4-7] days. No hemolysis was documented. One bleeding episode and one clotting event occurred; no thrombotic or cannulation-related complications were observed. Femoral vein cannulation with a large-caliber dual-lumen cannula for ECCO₂R appears feasible and safe. This strategy may offer technical and clinical advantages over conventional ECCO₂R systems, warranting prospective investigation.

The aim of the study is to evaluate the association between platelet (PLT) parameters and the need for treatment of retinopathy of prematurity (ROP) in preterm infants. This single-center, retrospective cohort study was conducted at the neonatal intensive care unit of Fukushima Medical University Hospital between January 1, 2011, and December 31, 2023. The present study included preterm infants born before 30 weeks of gestation. Medical records were reviewed for 1,836 infants, of whom 187 met the inclusion criteria. Data on PLT parameters and ROP treatment were extracted from the medical records. Receiver operating characteristic (ROC) analysis was used to determine cut-off values for PLT parameters associated with the need for ROP treatment. Multiple logistic regression analyses were performed to assess the association between ROP treatment and PLT parameters at birth and on day of life (DOL) 28. Among the 187 infants included, 42.8% required treatment for ROP. After adjusting for confounders, an association was found between ROP treatment and plateletcrit (PCT) values < 0.23% (odds ratio [OR]: 3.44; 95% confidence interval [CI]: 1.37-8.63) and platelet mass index (PMI) values < 2303.0 fL/nL (OR: 4.50; 95% CI: 1.77-11.41) at birth. Infants born before 30 weeks of gestation with PCT values < 0.23% and PMI values < 2303.0 fL/nL at birth had an increased risk of developing ROP warranting treatment.

Prematurity, defined as birth before 37 weeks of gestation, is the leading cause of mortality in children under five, affecting ~11% of live births worldwide (≈15 million annually). Despite advances in neonatal care, preterm infants remain at high risk of complications. In neonatal intensive care units, gastric residuals (GRs) are routinely monitored to guide enteral feeding, yet their microbial composition remains poorly understood. We performed metagenomic sequencing of 199 stool and 69 GR samples from 39 preterm infants during hospitalization to characterize stomach and gut microbiomes. To our knowledge, this is the first metagenomic sequencing of the GR in premature infants. We identified 11 GR microbialclusters, commonly dominated by Staphylococcus, Streptococcus, and Klebsiella, with microbial diversity correlating with aspiration frequency. Colonization was dynamic: early GR samples were enriched with Staphylococcus epidermidis and Bradyrhizobium, while later samples featured Escherichia coli, Staphylococcus hominis, and Streptococcus thermophilus. Stool samples formed eight microbialclusters, frequently enriched with Enterobacteriaceae. S. epidermidis was linked to higher gestational age and lower richness, whereas Bifidobacterium breve, a beneficial commensal, appeared later. Comparative analysis showed overlap between gut and gastric microbiota, with GR samples more dynamic and less subject-specific. Strain-level analysis revealed both individual-specific and widely shared taxa, including a pathogenic Klebsiella aerogenes strain associated with bacteremia, detectable a week before clinical isolation. These findings provide new insights into microbial colonization dynamics of preterm infants.

Red blood cell distribution width to albumin ratio (RAR) is a novel biomarker and its prognostic effect on critically ill patients with sepsis has not been extensively investigated. The objective of this study was to investigate the association between RAR and prognosis in older patients with sepsis. We performed a retrospective cohort study utilizing the eICU Collaborative Research Database to examine the relationship between the RAR and patient outcomes in sepsis cases. The primary endpoint was all-cause mortality within 28 days of intensive care unit admission. To explore this association, we employed multivariate regression analysis and conducted subgroup analyses. Additionally, receiver operating characteristic curves and Kaplan-Meier survival analysis were utilized to assess prognostic value and survival differences, respectively. The study included 17,321 eligible patients. It was observed that the median of RAR was notably higher in patients who did not survive compared to those who did at the 28-day mark. Participants were categorized into 3 groups based on their RAR values, revealing a significantly increased risk of 28-day mortality in the group with elevated RAR. The association between RAR and 28-day mortality risk appeared potentially nonlinear. Kaplan-Meier survival analysis indicated that those in the higher RAR group experienced increased 28-day mortality. Our study shows that RAR is significantly associated with poor clinical prognosis in sepsis. The higher RAR is an independent predictor of 28-day mortality in older patients with sepsis.

Hypophosphatemia is common in critically ill children, but its clinical implications in dengue shock syndrome (DSS) remain uncertain. This retrospective single-center study, conducted in 2022 at a tertiary pediatric intensive care unit in Vietnam, investigated the association between marked phosphorus reduction and clinical outcomes in children with DSS requiring mechanical ventilation (MV). Fifty-seven children with DSS on MV and complete phosphorus profiles were enrolled. Propensity score matching adjusted for key confounders including age, serum calcium, metabolic acidosis, and creatinine levels. The primary outcome was in-hospital mortality; secondary outcomes included the duration of MV and vasopressor use. Stepwise logistic and linear regression analyses were applied. The median patient age was 6 years (interquartile range [IQR]: 4-9). Twenty-one patients (37%) developed severe hypophosphatemia during pediatric intensive care unit admission. Overall mortality was 28% (16/57). Median MV duration was 5 days (IQR: 3-6), and vasopressor support lasted a median of 3 days (IQR: 1-5). While severe hypophosphatemia was not associated with mortality, it was significantly correlated with prolonged MV and vasopressor requirements. These findings suggest that severe hypophosphatemia may contribute to extended organ support. Timely recognition and correction of phosphorus deficits could provide potential clinical benefits in this vulnerable population.

Human Adenovirus (HAdV) is a common cause of acute respiratory infections, typically mild in healthy individuals. However, in late 2022, an outbreak of severe acute respiratory infection caused by HAdV emerged among children in Colombia and other countries. We described an HAdV outbreak between February 2022 and April 2023. Children with severe acute respiratory infection and HAdV infection confirmed by polymerase chain reaction were included in 4 institutions in Antioquia, Colombia. Our study investigated the clinical manifestations and circulating HAdV genotypes before, during and after this HAdV outbreak. A total of 133 HAdV cases were analyzed, 37 (27.8%) cases were classified as the preoutbreak group, 88 (66.1%) as the outbreak and 8 (6.0%) as the postoutbreak group. Predominant symptoms were fever (87.0%), rhinorrhea (57.1%) and dyspnea (36.8%). The need for intensive care unit admission and supplemental oxygen increased during the outbreak and peaked in the postoutbreak period. Phylogenetic analysis revealed that 71.4% (10/14) of preoutbreak sequences belonged to genotype HAdV-C89, while during the outbreak, 75.6% (28/37) were HAdV-B3. Clinical symptoms did not significantly differ between HAdV-C89 and HAdV-B3 infections, but children infected with HAdV-B3 were significantly older. This study highlights the shifting dynamics of HAdV genotypes in children and their epidemiological impact. The emergence of HAdV-B3 in the post-COVID-19 period contributed to a severe acute respiratory infection outbreak, emphasizing the need for ongoing surveillance.

To determine whether administration of antenatal corticosteroids to patients with twin gestations at risk for late preterm delivery is associated with reduced risk for neonatal respiratory morbidity compared with unexposed twins. This was a multicenter, retrospective cohort study in a large, urban health network (2013-2022) of patients with twin gestations at risk for preterm delivery between 34 0/7 and 36 6/7 weeks of gestation. Patients were excluded if they received antenatal corticosteroids before 34 weeks of gestation or had pregestational diabetes, single-twin death before 34 weeks, or oral steroid exposure during pregnancy. Neonates were excluded if they had major congenital anomalies. The primary outcome was a composite of neonatal respiratory morbidity requiring respiratory support within 72 hours of birth, including continuous positive airway pressure (CPAP) or high-flow nasal cannula for 2 hours or more, supplemental oxygen of 30% for 2 hours or more, extracorporeal membrane oxygenation, mechanical ventilation, and fetal or neonatal death. Secondary outcomes included neonatal hypoglycemia and indications for neonatal intensive care unit (NICU) admission. Adjusted and unadjusted relative risks with 95% CIs were calculated. During the study period, 366 twin gestations and 722 patient-neonate dyads were included: 162 gestations (321 neonates) in the exposed group and 204 (401 neonates) in the unexposed group. There was no difference in the composite outcome of respiratory morbidity in those exposed to antenatal corticosteroids (23.4% vs 20.4%, P=.40, adjusted relative risk [RR] 1.00, 95% CI, 0.71-1.42). The composite was driven mostly by rates of CPAP use (21.2% vs 18.5%, P=.41, adjusted RR 1.05, 95% CI, 0.73-1.53) and high-flow nasal cannula use (6.2% vs 2.2%, P=.02, RR 2.77, 95% CI, 1.16-6.66). Antenatal corticosteroid exposure was associated with a lower risk of need for supplemental oxygen (0.6% vs 3.5%, P=.02, RR 0.18, 95% CI, 0.04-0.79) and mechanical ventilation (0.6% vs 3.2%, P=.03, RR 0.19, 95% CI, 0.04-0.87). Although antenatal corticosteroids exposure was not associated with higher rates of hypoglycemia (44.2% vs 41.7%, P=.57, adjusted RR 0.99, 95% CI, 0.82-1.19), exposure was associated with a higher risk of having hypoglycemia as the only indication for NICU admission (10.3% vs 5.2%, P=.03, RR 1.96, 95% CI, 1.07-3.59). In a large, multicenter, network-wide retrospective cohort study of patients with twin gestations at risk for late preterm birth, antenatal corticosteroid use was not associated with a decrease in overall respiratory morbidity but was associated with a decreased risk of need for supplemental oxygen and mechanical ventilation, as well as a higher risk of NICU admission for hypoglycemia. These results underscore the ongoing need to elucidate the risks and benefits of late preterm antenatal corticosteroids for patients with twin gestations at risk for late preterm birth.