Pediatric Index Of Mortality Research Articles

Comparison of Pediatric Risk of Mortality (PRISM III) score with Pediatric Index of Mortality (PIM III) score in Pediatric Intensive Care Unit: A Single center, prospective observational study from South India

Abstract Background: Pediatric risk of mortality (PRISM III) score and pediatric index of mortality (PIM III) scores are most recent versions of PRISM and PIM score used for mortality prediction in the Pediatric intensive care units (PICUs). This study aims to compare the performance of these two scores in children admitted to a tertiary PICU of South India. Subjects and Methods: This single-center, prospective observational study was conducted in PICU at a Tertiary Care Hospital in South India over a period of 20 months. A total of 214 cases admitted between the age groups of 1 month and 18 years were included in this study. PIM III and PRISM III scores were calculated. Quantitative correlation between the results of the score was analyzed by spearman test. Discrimination was assessed using the area under receiver operating characteristics curve and calibration using Hosmer–Lemeshow goodness-of-fit test. Results: Out of 214 children, observed mortality was 11 (5.1%). Estimated mortality using PRISM III and PIM III was 4 (1.86%) and 2 (0.93%), respectively. Although both scoring systems had good discrimination performance, PIM III score (0.934 [confidence interval (CI) 95%, 0.886–0.982]) had higher discrimination than PRISM III score(0.888 [CI 95%, 0.797–0.980]). PRISM III score (χ 2 = 4.469 and P = 0.484) had better calibration as compared to PIM III score (χ 2 = 16.093 and P = 0.041). Conclusions: Both PRISM III and PIM III score showed good discriminatory performance, however PRISM III had better calibration than PIM III score.

A study of clinical profile and outcome of shock in pediatric intensive care unit of Al-Ameen Medical College and Hospital, Vijayapura

Background: The clinical syndrome of shock, a clinical state characterized by inadequate tissue perfusion, is one of the most dramatic, dynamic and life-threatening problems faced by the physician in the critical care setting. Methods: This retrospective observational study analysed all critically ill children aged 1 month to 12 years who were admitted to our hospital’s Pediatric Intensive Care Unit (PICU) between January 2023 and December 2023, requiring mechanical ventilation and presenting with clinical evidence of shock. The majority of deaths in this cohort were attributed to decompensated shock. The Paediatric Index of Mortality 3 (PIM3) score was calculated for each patient to evaluate the severity of illness and predict outcomes. The authors meticulously documented the patterns of morbidity and mortality across different types of shock and assessed the outcomes in the PICU. All collected data were systematically compiled and tabulated for comprehensive analysis. Results: The frequency of shock in our PICU was 2.1% (n=257). However, among mechanically ventilated patients it was present in 104.31 patients. Septic shock was the most commonly encountered shock (62.6%). Out of 186 cases, 125 survived (67.2%), 61 died (32.8%). Shock had no correlation with PIM3 score and mortality. Conclusions: Shock is a significant cause of morbidity and mortality in children, especially those under 5 years of age. In our study, septic shock was identified as the most prevalent form of shock, with severe pneumonia being the leading cause. We found that mortality rates were higher in patients who required prolonged mechanical ventilation. To improve outcomes and management strategies, larger prospective multicentric studies in developing countries are highly recommended.

Severe Pneumonia in PICU Admissions: The Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN) Observational Cohort Study, 2020-2022.

Mortality from pneumonia is three times higher in Asia compared with industrialized countries. We aimed to determine the epidemiology, microbiology, and outcome of severe pneumonia in PICUs across the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN). Prospective multicenter observational study from June 2020 to September 2022. Fifteen PICUs in PACCMAN. All children younger than 18 years old diagnosed with pneumonia and admitted to the PICU. None. Clinical, microbiologic, and outcome data were recorded. The primary outcome was PICU mortality. Univariate and multivariable logistic regression was performed to investigate associations between PICU mortality and explanatory risk factors on presentation to the PICU. Among patients screened, 846 of 11,778 PICU patients (7.2%) with a median age of 1.2 years (interquartile range, 0.4-3.7 yr) had pneumonia. Respiratory syncytial virus was detected in 111 of 846 cases (13.1%). The most common bacteria were Staphylococcus species (71/846 [8.4%]) followed by Pseudomonas species (60/846 [7.1%]). Second-generation cephalosporins (322/846 [38.1%]) were the most common broad-spectrum antibiotics prescribed, followed by carbapenems (174/846 [20.6%]). Invasive mechanical ventilation and noninvasive respiratory support was provided in 438 of 846 (51.8%) and 500 of 846 (59.1%) patients, respectively. PICU mortality was 65 of 846 (7.7%). In the multivariable logistic regression model, age (adjusted odds ratio [aOR], 1.08; 95% CI, 1.00-1.16), Pediatric Index of Mortality 3 score (aOR, 1.03; 95% CI, 1.02-1.05), and drowsiness (aOR, 2.73; 95% CI, 1.24-6.00) were associated with greater odds of mortality. In the PACCMAN contributing PICUs, pneumonia is a frequent cause for admission (7%) and is associated with a greater odds of mortality.

Association of Hyperoxia During Cardiopulmonary Bypass and Postoperative Delirium in the Pediatric Cardiac ICU.

ICU delirium commonly complicates critical illness associated with factors such as cardiopulmonary bypass (CPB) time and the requirement of mechanical ventilation (MV). Recent reports associate hyperoxia with poorer outcomes in critically ill children. This study sought to determine whether hyperoxia on CPB in pediatric patients was associated with a higher prevalence of postoperative delirium. Secondary analysis of data obtained from a prospective cohort study. Twenty-two-bed pediatric cardiac ICU in a tertiary children's hospital. All patients (18 yr old or older) admitted post-CPB, with documented delirium assessment scores using the Preschool/Pediatric Confusion Assessment Method for the ICU and who were enrolled in the Precision Medicine in Pediatric Cardiology Cohort from February 2021 to November 2021. None. Of 148 patients, who underwent cardiac surgery, 35 had delirium within the first 72 hours (24%). There was no association between hyperoxia on CPB and postoperative delirium for all definitions of hyperoxia, including hyperoxic area under the curve above 5 predetermined Pao2 levels: 150 mm Hg (odds ratio [95% CI]: 1.176 [0.605-2.286], p = 0.633); 175 mm Hg (OR 1.177 [95% CI, 0.668-2.075], p = 0.572); 200 mm Hg (OR 1.235 [95% CI, 0.752-2.026], p = 0.405); 250 mm Hg (OR 1.204 [95% CI, 0.859-1.688], p = 0.281), 300 mm Hg (OR 1.178 [95% CI, 0.918-1.511], p = 0.199). In an additional exploratory analysis, comparing patients with delirium within 72 hours versus those without, only the z score for weight differed (mean [sd]: 0.09 [1.41] vs. -0.48 [1.82], p < 0.05). When comparing patients who developed delirium at any point during their ICU stay (n = 45, 30%), MV days, severity of illness (Pediatric Index of Mortality 3 Score) score, CPB time, and z score for weight were associated with delirium (p < 0.05). Postoperative delirium (72 hr from CPB) occurred in 24% of pediatric patients. Hyperoxia, defined in multiple ways, was not associated with delirium. On exploratory analysis, nutritional status (z score for weight) may be a significant factor in delirium risk. Further delineation of risk factors for postoperative delirium versus ICU delirium warrants additional study.

Comparison Between Mortality Scoring Systems in Pediatric Intensive Care Unit Reliability and Effectiveness

Purpose: In pediatric intensive care unit (PICU), high mortality risk is a significant issue. Risk adjustment tools are in place for early estimation of mortality risk. Pediatric Risk of Mortality(PRISM), Pediatric Index of Mortality(PIM), Pediatric Logistic Organ Dysfunction(PELOD) and Pediatric Sequential Organ Failure Assessment(PSOFA) are commonly used. The aim of this study was to evaluate the predictive performance of mortality using PRISM III, PIM3, PELOD-2, and PSOFA. Materials and Methods: This retrospective single-center study analysed patients aged between 1month-18years who were treated in PICU for various diseases between April and December2021. Their electronic records were retrospectively examined for demographic characteristics, medical and clinical expectations, and morbidity/mortality. Results: The study included 300 patients with a hospitalization period of 56.73±105.95 days. At the end of the study, 56(18.7%) patients had died.All scoring systems and mortality correlations were statistically significant(p

Associations of Patient and Parent Characteristics With Parental Decision Regret in the PICU: A Secondary Analysis of the 2015-2017 Navigate Randomized Comparative Trial.

To identify self-reported meaningful decisions made by parents in the PICU and to determine patient and parent characteristics associated with the development of parental decision regret, a measurable, self-reported outcome associated with psychologic morbidity. Secondary analysis of the Navigate randomized comparative trial (NCT02333396). Two tertiary, academic PICUs. Spanish- or English-speaking parents of PICU patients aged less than 18 years who were expected to remain in the PICU for greater than 24 hours from time of enrollment or who had a risk of mortality greater than 4% based on Pediatric Index of Mortality 2 score. None. Between April 2015 and March 2017, 233 parents of 209 patients completed a survey 3-5 weeks post-PICU discharge which included the Decision Regret Scale (DRS), a 5-item, 5-point Likert scale tool scored from 0 (no regret) to 100 (maximum regret). Two hundred nine patient/parent dyads were analyzed. The decisions parents reported as most important were categorized as: procedure, respiratory support, medical management, parent-staff interactions and communication, symptom management, fluid/electrolytes/nutrition, and no decision. Fifty-one percent of parents had some decision regret (DRS > 0) with 19% scoring in the moderate-severe range (DRS 26-100). The mean DRS score was 12.7 ( sd 18.1). Multivariable analysis showed that parental Hispanic ethnicity was associated with greater odds ratio (OR 3.12 [95% CI, 1.36-7.13]; p = 0.007) of mild regret. Being parents of a patient with an increased PICU length of stay (LOS) or underlying respiratory disease was associated with greater odds of moderate-severe regret (OR 1.03 [95% CI, 1.009-1.049]; p = 0.004 and OR 2.91 [95% CI, 1.22-6.94]; p = 0.02, respectively). Decision regret was experienced by half of PICU parents in the 2015-2017 Navigate study. The characteristics associated with decision regret (parental ethnicity, PICU LOS, and respiratory disease) are easily identifiable. Further study is needed to understand what contributes to regret in this population and what interventions could provide support and minimize the development of regret.

EXPLORING THE IMPACT OF PIM 3 SCORE ON CLINICAL DECISION-MAKING: A SINGLE-CENTER STUDY

Objective: In the dynamic landscape of healthcare, the quest for precision in clinical decision-making is pivotal. The Pediatric Index of Mortality 3 (PIM 3) score has emerged as a crucial metric in predicting mortality risk among critically ill children, shaping medical choices in pediatric intensive care units.&#x0D; Methods: This single-center study, conducted at [Your Institution's Name], employed a [research design] to analyze the impact of the PIM 3 score on clinical decision-making within the pediatric intensive care unit. The study included [number] critically ill pediatric patients aged 1 mo to 18 y, with data extracted from electronic health records. Statistical analyses, including correlation and regression models, were applied to explore relationships and identify factors influencing clinical decision-making.&#x0D; Results: Among the 581 patients, gender distribution and age demographics varied, with notable associations between diagnostic categories and outcomes. Survivors exhibited lower PIM 3 scores compared to nonsurvivors. Probability scores related to outcomes revealed distinct patterns, emphasizing the predictive utility of the PIM 3 score.&#x0D; Conclusion: The study demonstrated a correlation between higher PIM 3 scores and increased mortality risk, guiding clinical decision-making in critically ill pediatric patients. Bridging theory and practice, the findings provide valuable insights for enhancing bedside decision-making and improving the quality of care. Acknowledging contextual factors is crucial for a comprehensive understanding of decision-making processes.

Mortality in Patients with Leukemia and Lymphoma Urgently Admitted to the PICU: Secondary Analysis of Data from a Cluster Randomized Controlled Trial

AbstractObjectives were to describe the severity of illness in patients with leukemia or lymphoma urgently admitted to pediatric intensive care and explores the risk factors for mortality. A secondary analysis was performed of prospectively collected data from a cluster-randomized controlled trial in 21 children's hospitals from 2011 to 2015. Eligible patients were urgently admitted to intensive care and had a diagnosis of leukemia or lymphoma. Associations with intensive care mortality (primary outcome) were determined with multivariable generalized estimating equation with a logit link, accounting for clustering by site. Associations with time to intensive care mortality (secondary outcome) were determined with multivariable proportional hazards models. A total of 109 patients were included, age 115 (interquartile range [IQR] 42, 168) months and intensive care length of stay was 3 (IQR 2, 6) days. During the first hour in intensive care 36 (33%) were ventilated, and during intensive care 45 (41.3%) had at least 1 technology day. Day 1 Pediatric Logistic Organ Dysfunction (PELOD) score was ≥ 20 in 37 (33.9%), Pediatric Index of Mortality 2 mortality risk was &gt; 10% in 35 (32.1%), and Children's Resuscitation Intensity Scale (RISC) was ≥ 3 (late admission to intensive care) in 32 (31.7%). Intensive care mortality was 20/109 (18.3%); with intensive care stay ≥ 20 days mortality was 51%. Previous urgent pediatric intensive care unit (PICU) admission, mechanical ventilation, and day 1 PELOD score were associated with higher PICU mortality. Mechanical ventilation, day 1 PELOD score, and late admission to the PICU (RISC ≥ 2) were associated with time to death. Patients with leukemia and lymphoma urgently admitted to intensive care had mortality of 18.3%, an improvement from historical cohorts. Risk factors were not accurate enough to make individual patient care decisions.

Infant Intensive Care Unit: Is it Time to Change?

To assess the effect of the Infant intensive care unit (InICU), a specialized unit for critically ill infants established in 2016 in authors' hospital, on infant mortality and compare the outcome with the current Pediatric intensive care units (PICU). In this retrospective cross-sectional study, two groups were defined; the first included expired patients aged 1 moto 2 yadmitted to PICU before the establishment of the InICU (the PICU group). The second included age-matched expired patients admitted to the InICU (the InICU group). Data were recorded using a questionnaire. The authors found that the age, sex, underlying diseases, the leading cause of admission to the ICU, time of death, hospital and ICU length of stay, and the pediatric index of mortality 2 (PIM 2) score were same between the two groups. The incidence of mortality in the PICU group was 10.66 in 1000 person-month. This value was 6.37 for the InICU group (P-value <0.001). The relative risk of mortality of patients admitted to the PICU group compared to the InICU group was 1.67 (P-value <0.001). Establishment of age specific InICU for infants may be beneficial in reducing infant mortality.

Bioelectrical impedance phase angle and the mortality in critically ill children.

Phase angle (PhA) is a variable obtained from bioelectrical impedance analysis (BIA). It is highly sensitive and specific and is commonly used in clinical nutrition assessment. Recently, PhA has shown promise in predicting clinical outcomes, especially as a new indicator of mortality, but its use in pediatric research is limited. This study aims to investigate the association between PhA measured at admission using BIA and PICU length of stay (LOS) and 60-day mortality in critically ill children and adolescents. A consecutive series of pediatric patients in the PICU underwent BIA measurements within 72 h of admission. All patients met the inclusion and exclusion criteria. Patient demographics, anthropometric measurements, pediatric index of mortality 2 score (PIM-2), and laboratory exams were recorded. Kaplan-Meier (K-M) survival curves were constructed based on the critical PhA value to assess differences in survival status within the 60-day window. Multivariate cox regression model was employed to illustrate the relationship between PhA and 60-day mortality rates. The Youden's index method was used to identify the critical cut-off value for PhA in relation to mortality rates. ROC curves provided the area under the curve (AUC) and a 95% confidence interval (CI). A total of 205 pediatric patients (118 boys) were included, with a mean age of 9.2 years (±6.0). Survival curves indicated a cutoff value of 3.1°, with higher survival in patients with PhA ≥3.1° compared to those with PhA <3.1° (F = 10.51, p < 0.0001). The area under the ROC curve was 0.70, with a sensitivity of 0.65 and specificity of 0.72. Total hospital LOS was longer in the PhA <3.1° group compared to the PhA ≥3.1° group (p = 0.000). The PhA <3.1° group had a longer PICU LOS (adjusted for age and sex, HR 1.871, p = 0.000, log-rank test, p = 0.000). PhA and PIM-2 were two independently significant correlated variables (p < 0.05) for the 60-day mortality rate in this study. Low PhA in patients is associated with longer PICU LOS and an increased risk of PICU patient mortality. PhA not only serves as an indicator for monitoring pediatric nutrition but also as a prognostic indicator for PICU patients.

Pediatric Index of Mortality 2 Score of Patients with Chest Problems in Pediatric Intensive Care Unit as an Indicator of Efficacy of Management and Personel Practice

Pediatric Index of Mortality 2 Score of Patients with Chest Problems in Pediatric Intensive Care Unit as an Indicator of Efficacy of Management and Personel Practice

Cortisol levels associated with mortality in children with critical illness: a systematic review

Background Critically ill patients, including those with sepsis, have increased cortisol levels due to activation of the hypothalamic-pituitary-adrenal (HPA) axis or critical illness-related corticosteroid insufficiency (CIRCI).&#x0D; Objective To evaluate for a possible association between cortisol levels and mortality from sepsis in pediatric patients by systematic review of the literature.&#x0D; Methods A systematic review was conducted on studies involving critically ill children, including those with sepsis. We included studies published between 2011-2020 analyzing data on cortisol levels (total serum cortisol, serum-free cortisol, salivary cortisol, real-time free cortisol, basal serum cortisol and post-adrenocorticotropin hormone (ACTH) stimulation test, or basal salivary cortisol and post-ACTH stimulation test), the predictive score for mortality (Pediatric Logistic Organ Dysfunction/PELOD), Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality (PIM), Vasotropic Inotropic Score (VIS), or Pediatric Critical Illness Score (PCIS)], mortality (non-survivor percentage), and CIRCI percentage as an outcome in patients with critical illness, sepsis, and septic shock.&#x0D; Results Twenty-one observational studies were included in our systematic review, with a total of 2,212 subjects, 916 of whom had sepsis. Nineteen studies indicated a positive association between elevated cortisol levels and mortality in critically ill children, but 2 studies stated that there was no association with the CIRCI percentage of 32.3 and 84.3% respectively. The mortality percentage of critically ill patients with elevated cortisol levels and sepsis were 25.81 (2.7-60)% and 35.31 (6-60)%, respectively. The percentages of CIRCI in critically ill and sepsis patients were 21.91 (0-84.3)% and 21.35 (0-84.3)%, respectively.&#x0D; Conclusion Cortisol levels may increase or decrease in critically ill children. Elevated cortisol levels are associated with mortality in septic children. The effect of CIRCI on mortality in critically ill children cannot be concluded.

Evaluation of non-thyroidal illness syndrome in shock patients admitted to pediatric intensive care unit in a developing country

During critical illness, children my experience various changes in their thyroid hormone levels. Such changes are termed non-thyroidal illness syndrome (NTI). The extent of change correlates with the severity of the illness and its outcomes in critically ill patients. This study aimed to investigate the correlation between the severity of shock and thyroid hormone derangement. This prospective observational study included forty patients aged one month to five years who were admitted to the pediatric intensive care unit (PICU) with shock. Thyroid function tests were conducted on admission, after shock reversal, and five days later. NTI patterns were observed in 70% of patients. The PIM2 score showed a significant negative correlation with T3 (r = − 0.353, p = 0.026) and FT3 levels on admission (r = − 0.417, p = 0.007). Furthermore, after shock reversal, the PIM2 score continued to exhibit significant negative correlations with T4 (r = − 0.444, p = 0.004), T3 (r = − 0.329, p = 0.038), FT3 (r = − 0.355, p = 0.025), and FT4 levels (r = − 0.379, p = 0.016). Conclusion: This study underscores the high prevalence of NTI in PICU shock patients and suggests monitoring thyroid hormone levels for outcome prediction and treatment guidance. Further research is needed to optimize NTI management in critically ill children.What is Known:• Non-thyroidal illness syndrome (NTIS) is a condition observed in critically ill patients.• There has been limited research on NTI in children, and existing studies have generated conflicting results regarding the relationship between thyroid hormones and clinical outcomes in cases of sepsis and septic shock.What is New:• The study has revealed dynamic changes in free triiodothyronine (FT3) levels during the process of shock reversal and recovery in children who experienced shock.• A significant negative correlation was found between the Pediatric Index of Mortality 2 (PIM2) score and several thyroid hormone levels, including FT3 on admission and T4, FT3, and FT4 on shock reversal.

Predictive Value of PRISM-4, PIM-3, CRP, Albumin, CRP/Albumin Ratio and Lactate in Critically Ill Children.

The accurate prediction of the prognosis for critically ill children is crucial, with the Pediatric Index of Mortality (PIM) and Pediatric Risk of Mortality (PRISM) being extensively utilized for this purpose. Albumin, C-reactive protein (CRP), and lactate levels, which are indicative of inflammation and circulatory status in critically ill children, have not been incorporated into existing scoring systems. This retrospective cohort study evaluated the association between biological markers and the clinical outcomes in children with critical illnesses. PRISM-4 and PIM-3 death probability (DP), albumin, lactate, CRP, and CRP/albumin ratio were recorded upon admission. The accuracy of the indexes in predicting mortality were assessed by calculating the area under the curve (AUC). There were 942 patients included and the 28-day mortality rate was 7.9%. The AUC for PRISM-4, PIM-3, CRP, CRP/albumin ratio, albumin, and lactate were 0.923, 0.896, 0.798, 0.795, 0.751, 0.728, respectively. The findings in the subgroup analysis of septic patients were similar to those found in the overall population. Although CRP, CRP/albumin ratio, albumin, and lactate levels are all linked to mortality in children, CRP and the CRP/albumin ratio have lower predictive values than albumin and lactate. Incorporation of albumin and lactate into scoring systems will improve predictability.

Role of Albumin-corrected Anion Gap and Lactate Clearance in Predicting Mortality in Pediatric Intensive Care Patients.

Identifying mortality risk in critically ill children is central to diagnostic and treatment practices. For this purpose, scoring systems, such as the Pediatric Index of Mortality 3 (PIM 3), have been proposed; however, the role of biochemical markers, such as albumin-corrected anion gap (cAG) and lactate clearance (LC), in predicting mortality in pediatric intensive care unit (PICU) patients is yet to be explored. To evaluate the predictive value of the cAG and LC for mortality in pediatric patients admitted to a PICU. Retrospective single-center cohort study conducted at Akdeniz Hospital including patient data from eight medical-surgical PICU beds. Clinical and laboratory data from the time of PICU admission were collected, and patients were classified into based on their 0- and 6-hour of admission lactate levels into an LC(+) group (patients with normal or decreasing lactate levels) or an LC (-) group (increasing lactate levels). LC and cAG levels were compared using the Mann-Whitney U test and Student's t-test, respectively. Additionally, multiple logistic regression analysis was performed to evaluate the effect of LC and cAG on mortality. We included 825 patients in the study; the mortality rate was 8.6%. The absence of LC [adjusted odds ratio (AOR) =4.735; 95% confidence interval (CI): 2.163-10.367; p < 0.001], cAG (AOR =1.064; 95% CI: 1.010-1.122; p = 0.019) and PIM 3 (AOR = 1.871; 95% CI: 1.553-2.254; p < 0.001) were independent risk factors for mortality. Using the receiver operating characteristic curve analysis of PIM 3 as a predictor of mortality, area under the curve values of 0.832 (95% CI: 0.805-0.857; p < 0.001) for the original score and 0.858 for a revised PIM 3 score (based on the β coefficients obtained for cAG and LC; 95% CI 0.832-0.881; p < 0.001) were obtained, which was significantly different (p = 0.027). A cAG value > 18 at the time of PICU admission high lactate levels which do not decrease within 6 hours of hospitalization are associated with an increased risk of mortality. The revised PIM 3 score, which includes cAG and LC, is a better predictor of mortality than the classical PIM 3 score.

Severe Influenza Virus and Respiratory Syncytial Virus Infections in Intensive Care Over the Last 15 Years.

Influenza virus is a common agent of pediatric infections. Most cases are mild, but severe illness and death can occur. We aimed to analyze severe cases associated the influenza virus and compare it with respiratory syncytial virus(RSV). This is a retrospective study of 0-17-year-old patients admitted to the intensive care unit (ICU) of Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra (Pediatric Hospital, Coimbra Hospital and University Center), a tertiary pediatric hospital in Coimbra, Portugal, over the last 15 years (2008-2022) due to influenza virus infection. Clinical presentation, severity, and evolution were analyzed. A comparison of children with RSV infection admitted in the same period was performed. We identified 47 cases of influenza virus infection (34% coinfection with other viruses), median age of 2.3 years (interquartile range (IQR) 6.1), and 38% had comorbidities. The median admissions were three/year (maximum 11 in 2019). Influenza A was identified in 96%. Ninety-six percent had respiratory symptoms, 38% had neurologic symptoms, and 28% had sepsis. The main reason for admission was respiratory failure (68%). The mean pediatric index of mortality 2 (PIM2) at admission was 9±15.9%. Ventilatory support was necessary in 66%, vasoactive support in 19%, and blood products in 17%. The median length of stay was four days (IQR 5). There were four (8.5%) deaths. During the same study period, there were 171 RSV-related admissions. When comparing influenza (group A, without RSV coinfection) and RSV (group B), the first had a higher PIM2 on admission, greater need of ventilatory support, more complications, and higher mortality (p=0.001). The number of influenza virus infections admitted to ICU was much lower than RSV. However, influenza was more severe and associated with all deaths registered.

Effect of Phytonadione on Correction of Coagulopathy in Pediatric Patients With Septic Shock.

The purpose of this study was to evaluate phytonadione in children with septic shock with disseminated intravascular coagulopathy (DIC). The primary objective was to identify the number of patients with an international normalized ratio (INR), defined as ≤1.2, following phytonadione. Secondary objectives were to compare patients who achieved a normalized INR versus those with INR >1.2 and to determine factors associated with a normalized INR. A retrospective study of children <18 years of age receiving phytonadione from October 1, 2013, to August 31, 2020, with a diagnosis of septic shock, were included. Data collection included demographics, phytonadione regimen, INR values, Pediatric Index of Mortality 2 (PIM2) and Pediatric Risk of Mortality III (PRISM III) scores, fresh frozen plasma (FFP) and cryoprecipitate use. A logistic regression model and generalized linear model were used to explore factors associated with a normalized INR and evaluate phytonadione dosing. Data for initial phytonadione course for 156 patients were evaluated. Sixty-six (42.3%) patients had a normalized INR. Most patients (n = 145; 92.9%) received ≤3 phytonadione doses, with the largest reduction in INR occurring after the second dose. In the logistic regression model, baseline INR, FFP, cryoprecipitate, vasopressors, PIM2, PRISM III, or cumulative phytonadione dose were not associated with achieving a normalized INR. Less than half of patients achieved a normalized INR. The median cumulative dose of phytonadione and receipt of FFP or cryoprecipitate was not associated with an increased odds of a normalized INR. Future studies are needed to further explore phytonadione use in children with sepsis-induced coagulopathy.

Nomogram to predict feeding intolerance in critically ill children.

Feed intolerance (FI) is significantly associated with poor prognosis in critically ill patients. This study aimed to understand the characteristics of children with FI and identify the factors predicting FI in critically ill children. This retrospective cohort study was conducted between January 2017 and June 2022 in the Pediatric Intensive Care Unit of a specialized children's hospital. Eighteen factors, including age, body mass index for age z-score (BAZ) < -2, paediatric index of mortality (PIM)3 score, Glasgow coma scale score, mechanical ventilation (MV), enteral nutrition delay, vasoactive drugs, sedatives, sepsis, heart disease, neurological disease, hypokalemia, arterial PH < 7.35, arterial partial pressure of oxygen (PaO2), blood glucose, hemoglobin, total protein, and albumin, were retrieved to predict FI. The outcome was FI during PICU stay. During the study period, a total of 854 children were included, of which 215 children developed FI. Six predictors of FI were selected: PIM3 score, MV, sepsis, hypokalemia, albumin, and PaO2. Multivariate logistic regression analysis showed that higher PIM3 score, MV, sepsis, hypokalemia, and lower PaO2 were independent risk factors for FI, whereas higher albumin was an independent protective factor for FI. The C-index of the predictive nomogram of 0.943 was confirmed at internal validation to be 0.940, indicating a good predictive value of the model. Decision curve analysis shows good clinical applicability of the nomogram in predicting FI. Conclusion: The nomogram was verified to have a good prediction performance based on discrimination, calibration, and clinical decision analysis. What is Known: • Research has demonstrated that gastrointestinal (GI) dysfunction is not only a fundamental element of Multiple Organ Dysfunction Syndrome (MODS), but also the initiator of MODS. • Previous study has demonstrated a significant association between FI and poor prognosis in critically ill patients. What is New: • We excluded patients with primary gastrointestinal tract disease from our study, and we observed an incidence of FI of 25.2% in the Pediatric Intensive Care Unit (PICU). • Our study revealed that PIM3 score, MV, sepsis, hypokalemia, albumin, and PaO2 are significant predictors of FI.

Comparison of PRISM IV and PIM III prognostic scores as mortality indicators among paediatric intensive care unit patients &amp;nbsp;

Introduction: Identifying prognosis of patients admitted in the paediatric intensive care unit (PICU) is of paramount importance to better allocate medical resources, reduce patient-doctor conflict and for overall better patient care. Many scoring systems have been formulated to accomplish this task including paediatric risk of mortality (PRISM) IV and paediatric index of mortality (PIM) III.Objectives: To compare PRISM IV and PIM III as prognostic scoring tools in the PICU of a tertiary healthcare centreMethod: This prospective observational study was conducted in the PICU, Dhiraj hospital, SBKS MI&amp;RC, Gujarat, India, from March 2021 to September 2022. It included all patients from age 1 month to 18 years who were admitted in the PICU for &gt;24 hours and gave consent for this study. They were thoroughly examined and investigations were done within the first hour of admission as per standard guidelines and their PRISM IV and PIM III scores were calculated and data were analysed.Results: A total of 74 patients was enrolled in this study. Whilst 43 (58.1%) patients were discharged, 18 (24.3%)] were discharged against medical advice(DAMA) moribund, 4 were DAMA (non-moribund) and 9 (12.2%) died. Receiver Operating Characteristic (ROC) curves were made for both PRISM IV and PIM III scores. Discriminatory powers of PIM III (AUC 0.725; 95% CI: 0.609 to 0.823) and PRISM IV (AUC 0.8; 95% CI: 0.691 to 0.884) were acceptable. Whilst PRISM IV was the better predictor of mortality at cut off point of &gt;4 with area under curve of 0.8 for correctly predicting mortality, this difference was not statistically significant (p value=0.354). Multivariate logistic regression analysis showed that the duration of stay(days) and PRISM IV value &gt;4 were significant independent risk factors of mortality after adjusting for confounding factors.Conclusions: Both PRISM IV and PIM III were good prognostic scoring tools in the PICU of the tertiary healthcare centre. Multivariate logistic regression analysis showed that the duration of stay(days) and PRISM IV value &gt;4 were significant independent risk factors of mortality after adjusting for confounding factors.

Performance of pediatric index of mortality-2, pediatric index of mortality-3 and pediatric risk of mortality IV in an Egyptian pediatric intensive care unit.

Performance of pediatric index of mortality-2, pediatric index of mortality-3 and pediatric risk of mortality IV in an Egyptian pediatric intensive care unit.