Pediatric Therapy Research Articles

Factors influencing circuit lifetime in paediatric continuous kidney replacement therapies – results from the EurAKId registry

BackgroundContinuous kidney replacement therapy (CKRT) has recently become the preferred kidney replacement modality for children with acute kidney injury (AKI). We hypothesise that CKRT technical parameters and treatment settings in addition to the clinical characteristics of patients may influence the circuit lifetime in children.MethodsThe study involved children included in the EurAKId registry (NCT 02960867), who underwent CKRT treatment. We analysed patient characteristics and CKRT parameters. The primary end point was mean circuit lifetime (MCL). Secondary end points were number of elective circuit changes and occurrence of dialysis-related complications.ResultsThe analysis was composed of 247 children who underwent 37,562 h of CKRT (median 78, IQR 37–165 h per patient). A total of 1357 circuits were utilised (3, IQR 2–6 per patient). MCL was longer in regional citrate anticoagulation (RCA), compared to heparin (HA) and no anticoagulation (NA) (42, IQR 32-58 h; 24, IQR 14-34 h; 18, IQR 12-24 h, respectively, p < 0.001). RCA was associated with longer MCL regardless of the patient’s age or dialyser surface. In multivariate analysis, MCL correlated with dialyser surface area (beta = 0.14, p = 0.016), left internal jugular vein vascular access site (beta = -0.37, p = 0.027), and the use of HA (beta = -0.14, p = 0.038) or NA (beta = -0.37, p < 0.001) vs. RCA. RCA was associated with the highest ratio of elective circuit changes and the lowest incidence of complications.ConclusionAnticoagulation modality, dialyser surface, and vascular access site influence MCL. RCA should be considered when choosing first-line anticoagulation for CKRT in children. Further efforts should focus on developing guidelines and clinical practice recommendations for paediatric CKRT.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Exploring Vacuum Compression Molding as a Preparation Method for Flexible-Dose Pediatric Orodispersible Films.

In recent years, solid dosage forms have gained interest in pediatric therapy because they can provide valuable benefits in terms of dose accuracy and stability. Particularly for orodispersible films (ODFs), the literature evidences increased acceptability and dose flexibility. Among the various available technologies for obtaining ODFs, such as solvent casting, hot-melt extrusion, and ink printing technologies, the solvent-free preparation methods exhibit significant advantages. This study investigated Vacuum Compression Molding (VCM) as a solvent-free manufacturing method for the preparation of flexible-dose pediatric orodispersible films. The experimental approach focused on selecting the appropriate plasticizer and ratios of the active pharmaceutical ingredient, diclofenac sodium, followed by the study of their impacts on the mechanical properties, disintegration time, and drug release profile of the ODFs. Additional investigations were performed to obtain insights regarding the solid-state properties. The ODFs obtained by VCM displayed adequate quality in terms of their critical characteristics. Therefore, this proof-of-concept study shows how VCM could be utilized as a standalone method for the production of small-scale ODFs, enabling the customization of doses to meet the individual needs of pediatric patients.

Healthcare professionals' perspectives towards the digitalisation of paediatric growth hormone therapies: expert panels in Italy and Korea.

To analyse the perspectives of healthcare professionals (HCPs) regarding the acceptance of digital health solutions for growth hormone (GH) deficiency care. This study identified factors impacting HCPs' intent to use and recommend digital solutions supporting recombinant-human growth hormone (r-hGH) therapy in Italy and Korea with a use case of connected drug delivery system (Aluetta® with Smartdot™) integrated in a platform for GH treatment support (the Growzen™ digital health ecosystem). Participatory workshops were conducted in Rome, Italy, and Seoul, Korea, to collect the perspectives of 22 HCPs on various predefined topics. HCPs were divided into two teams, each moderated by a facilitator. The workshops progressed in five phases: introduction of the project and experts, capturing views on the current context of digitalisation, perceived usefulness and ease of use of Aluetta® with Smartdot™, exploration of the perception of health technology evolution, and combined team recommendations. Data shared by HCPs on technology acceptance were independently analysed using thematic analysis, and relevant findings were shared and validated with experts. HCPs from both Italy and Korea perceived Aluetta® with Smartdot™ and the Growzen™ based digital health ecosystem as user-friendly, intuitive, and easy-to-use solutions. These solutions can result in increased adherence, a cost-effective healthcare system, and medication self-management. Although technology adoption and readiness may vary across countries, it was agreed that using digital solutions tailored to the needs of users may help in data-driven clinical decisions and strengthen HCP-patient relationships. HCPs' perspectives on the digitalisation in paediatric GH therapies suggested that digital solutions enable automatic, real-time injection data transmission to support adherence monitoring and evidence-based therapy, strengthen HCP-patient relationships, and empower patients throughout the GH treatment process.

"It Seems Much More Enjoyable Now": Parental Perception of Relational Change from Participating in Paediatric Autism Communication Therapy (PACT).

This qualitative study aims to examine parental experiences of feasibility and relational changes from participating in the Paediatric Autism Communication Therapy (PACT) intervention. Thirteen parents of children diagnosed with autism spectrum disorder (mean age 3.89 years) participated in semi-structured interviews. Thematic analysis was performed, inspired by an abductive approach informed by the theories of the attachment system, the caregiving system and mentalisation. Three overarching themes were identified: the struggle of fitting PACT into everyday life, the fruit of relational connection and the cascading relational effects of PACT. Parents were challenged regarding finding time for the intervention but adapted PACT to their individual needs and possibilities. All parents experienced relational improvement, and a cycle of positive relational change through PACT was identified. This study has several clinical implications. Therapists and clinics offering PACT interventions should encourage and support parents in their individual journey of implementing PACT into their everyday lives. Some of the parents described improvements in parental mentalisation, child attachment and mutual enjoyment in the parent-child relationship. Children with autism could benefit from parents increasing their sensitivity when caregiving, and clinicians may through interventions such as PACT facilitate this development.

Paediatric antiretroviral therapy challenges with emerging integrase resistance.

Universal antiretroviral (ART) coverage and virological suppression are fundamental to ending AIDS in children by 2030. Availability of new paediatric dolutegravir (DTG)-based ART formulations is a major breakthrough and will undoubtedly help achieve this goal, but treatment challenges still remain. Paediatric formulations remain limited compared to those for adults, especially for young children, those unable to tolerate DTG or with DTG-based first-line ART failure. Tenofovir alafenamide is virologically superior to standard-of-care backbone drugs in second-line, but paediatric formulations are not widely available. The roles of resistance testing and recycling of backbone drugs following first-line ART failure remain to be determined. Results of trials of novel treatment strategies including dual therapy and long-acting agents are awaited. Although numbers are currently small, safe and effective ART options are urgently required for children developing DTG resistance. The antiretroviral treatment gap between adults and children persists. The potential benefits from rollout of new paediatric DTG-based fixed-dose combination ART for first-line treatment are considerable. However, children remain disadvantaged when DTG-based first-line ART fails or cannot be used. Research efforts to address this inequity require prioritisation in order to ensure health outcomes are optimised for all ages in all settings.

Optimizing pediatric periprocedural pain management part II-Adjunct therapies to support the use of infiltrative anesthetics.

Pediatric procedure-related pain management is often incompletely understood, inadequately addressed, and critical in influencing a child's lifelong relationship with the larger healthcare community. We present a comprehensive review of infiltrative anesthetics, including a comparison of their mechanisms of action and relative safety and efficacy data to help guide clinical selection. We also describe the multimodal utilization of adjunct therapies-in series and in parallel-to support the optimization of pediatric periprocedural pain management, enhance the patient experience, and provide alternatives to sedation medication and general anesthesia.

Asthma prevention and recent advances in management

Asthma is the most frequent chronic disease of childhood, affecting up to 20 % of children worldwide. The authors present the current literature focusing on primary and secondary prevention of both early and late childhood asthma and the recent advances in management. The therapeutic tools for pediatric asthma have expanded significantly for both the non-severe and severe forms. The use of anti-inflammatory treatment, even for the mildest cases, and the withdrawal of symptomatic bronchodilation as monotherapy have been included in the most recent guidelines. The different biological therapies have revolutionized the therapeutical approach for severe uncontrolled asthma in children and adolescents.The main guidelines on asthma maintenance therapy in pediatrics suggest different approaches and describe different stages of asthma to determine the most appropriate treatment.

The Impact of Transparent Dressings on Phlebitis Incidence in Pediatric Intra Venous Therapy

Introduction: Hospitalization can be a traumatic experience for both children and their parents. During the hospitalization process, procedures such as installing an IV drip can lead to phlebitis infection. To prevent phlebitis, nurses often use transparent dressings when installing a child's IV. The aim of this study was to determine the relationship between the use of transparent dressings and the incidence of phlebitis during pediatric IV drips. Methods: This study employed a descriptive correlational research design with a cross-sectional approach. The total sample consisted of 40 individuals selected through accidental sampling. Data collection tools included questionnaires and observation sheets. Results: Among the 40 respondents, transparent dressings were used 100% of the time, and the incidence of phlebitis was observed in 2 respondents (5%). The results of the Spearman Rank analysis test showed a p-value of 0.288, indicating no significant relationship between the use of transparent dressings and the incidence of phlebitis in children's IV installations. The Spearman correlation coefficient between the use of transparent dressings and the incidence of phlebitis was 0.172, suggesting a very weak correlation. Discussion: Many factors can contribute to the development of phlebitis. While the use of transparent dressings can help nurses observe and detect signs of phlebitis more easily, this study found no significant correlation between their use and the incidence of phlebitis. However, transparent dressings can still be beneficial for early detection and intervention.

Citrate and low-dose heparin combined anticoagulation in pediatric continuous renal replacement therapy

There remains no optimal anticoagulation protocol for continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA) in pediatric patients with elevated D-dimer levels. We aimed to assess the effects of different anticoagulation strategies on the risk of CRRT filter clotting in these patients. Pediatric patients undergoing CRRT were retrospectively grouped based on pre-CRRT D-dimer levels and anticoagulant: D-RCA group (normal D-dimer, RCA only, n = 22), D+ RCA group (elevated D-dimer, RCA only, n = 50), and D+ RCA+ systemic heparin anticoagulation (SHA) group (elevated D-dimer, RCA combined with SHA, n = 55). The risk of filter clotting and incidence of bleeding were compared among the groups. Among the groups, the D+ RCA+ SHA group had the longest filter lifespan; further, the incidence of bleeding was not increased by concurrent use of low-dose heparin for anticoagulation. Moreover, concurrent heparin anticoagulation was associated with a decreased risk of filter clotting. Contrastingly, high pre-CRRT hemoglobin and D-dimer levels and post-filter ionized calcium level > 0.4 mmol/L were associated with an increased risk of filter clotting. RCA combined with low-dose heparin anticoagulation could reduce the risk of filter clotting and prolong filter lifespan without increasing the risk of bleeding in patients with elevated D-dimer levels undergoing CRRT.

Immune Microenvironment in Childhood Cancers: Characteristics and Therapeutic Challenges.

The tumor immune microenvironment is pivotal in cancer initiation, advancement, and regulation. Its molecular and cellular composition is critical throughout the disease, as it can influence the balance between suppressive and cytotoxic immune responses within the tumor's vicinity. Studies on the tumor immune microenvironment have enriched our understanding of the intricate interplay between tumors and their immunological surroundings in various human cancers. These studies illuminate the role of significant components of the immune microenvironment, which have not been extensively explored in pediatric tumors before and may influence the responsiveness or resistance to therapeutic agents. Our deepening understanding of the pediatric tumor immune microenvironment is helping to overcome challenges related to the effectiveness of existing therapeutic strategies, including immunotherapies. Although in the early stages, targeted therapies that modulate the tumor immune microenvironment of pediatric solid tumors hold promise for improved outcomes. Focusing on various aspects of tumor immune biology in pediatric patients presents a therapeutic opportunity that could improve treatment outcomes. This review offers a comprehensive examination of recent literature concerning profiling the immune microenvironment in various pediatric tumors. It seeks to condense research findings on characterizing the immune microenvironment in pediatric tumors and its impact on tumor development, metastasis, and response to therapeutic modalities. It covers the immune microenvironment's role in tumor development, interactions with tumor cells, and its impact on the tumor's response to immunotherapy. The review also discusses challenges targeting the immune microenvironment for pediatric cancer therapies.

Exploring behavior management strategies in pediatric group therapy

The iFriend outpatient group therapy program at Bradley Hospital promotes social competence in a school‐age population. The 10‐week‐program helps children ages 8–11 develop and practice social skills in a small group setting. The skills developed include understanding body language, finding shared interests, conversation initiation and closing, perspective taking, equitable communication, and problem solving. iFriend also aims to teach parents/guardians strategies to help their children integrate the targeted skills into daily life.

Pediatric Asthma Therapy Assessment Questionnaire for the Brazilian population: Cross-cultural adaptation and measurement properties.

To cross-culturally adapt the Pediatric Asthma Therapy Assessment Questionnaire (ATAQ) into Brazilian Portuguese and analyze its measurement properties. This exploratory methodological study included eight experts and 30 caregivers in the translation and cross-cultural adaptation steps. Thereafter, 118 caregivers of pediatric patients with asthma aged between 5 and 17 years were involved in the analysis of measurement properties. We analyzed the content, structural (exploratory and confirmatory factorial), construct (convergent and discriminant), and known-groups validities; floor and ceiling effects; and determined the cut-off point (receiver operator characteristic curve) to identify pediatric patients with uncontrolled asthma. Intraclass correlation coefficient (ICC) analyzed test-retest reliability with 54 caregivers, whereas Cronbach's α and composite reliability verified the internal consistency of the items. The committee of experts and caregivers found the instructions and response options relevant, understandable, and clear (K > 0.75). During the cross-cultural adaptation, three items (2, 4, and 12) were slightly modified by including terms to facilitate understanding. A two-factor structure (asthma control and patient-provider communication) was identified. Internal consistency (α > .67; composite reliability > 0.73) and test-retest reliability (ICC > 0.80) were acceptable. For construct and know-groups validities, 85.71% of the hypothesis were confirmed. A cut-off point of >3 for the control domain was considered adequate to identify pediatric patients with uncontrolled asthma (sensitivity: 86.21%; specificity: 80.90%). The Pediatric ATAQ was adequately adapted for Brazilian pediatric patients with asthma and produced valid and reliable measures for assessing asthma control. Therefore, it may be considered an adequate instrument for monitoring asthma control in the Brazilian pediatric population.

Financial toxicity during pediatric cancer therapy: A qualitative analysis.

11056 Background: Childhood cancer treatment may often result in adverse financial consequences—also termed financial toxicity (FT)—for patients and families. Limited research has specifically examined mechanisms and drivers of FT salient to pediatric oncology. Methods: Using a phenomenological approach, we conducted in-depth interviews with a purposive sample of English- and Spanish-speaking parents of children receiving treatment for cancer at our institution. Parents were interviewed 6-18 months after a first cancer diagnosis, a period chosen to balance accumulation of financial challenges after treatment initiation with minimal recall bias. Interviews were coded by 3 investigators using an inductive, open-ended approach. We performed thematic analysis of interview transcripts focused on elucidating the main components of FT and relationships between them, identifying ameliorating and exacerbating factors, and exploring the impact of FT on patient and family well-being. We organized relationships between themes into a conceptual framework. Results: We interviewed 21 parents (86% mothers, 59% &gt;40 years old, 33% non-Hispanic White, 47% college-educated, 42% of those reporting had a household income of $50-100k, equal proportions above/below this). We identified 5 themes. Four themes pertained to primary elements of FT: (1) increased out-of-pocket spending, often related to additional caregiving and household coordination needs; (2) reduced income, primarily from employment changes inadequately covered by paid leave; (3) new material hardship, with families unable to afford costs of living when previously able to do so; and (4) elevated psychological distress regarding finances. We also identified an additional theme pertaining to response behaviors directed at managing FT, effects of which could be positive (“adaptive behaviors”), negative (“maladaptive behaviors”), or mixed. Response behaviors included reducing discretionary spending, selling off assets, skipping meals, requesting money from strangers, and rummaging through discarded items. Several exacerbating and ameliorating factors pertinent to the development of FT emerged, including household location, composition, wealth, employment flexibility, resource provision, and duration and severity of treatment. Parents provided perspectives regarding policies or interventions to mitigate FT, such as toolkits to better connect families with financial resources and extended paid family leave. Conclusions: Families of children with cancer face a wide range of financial toxicity throughout treatment, and many of these experiences differ considerably from those of adult patients. Many families reported substantial impact and unmet needs. These findings will help inform the design of quantitative measures specific to pediatric cancer and identify unique targets for intervention development and policy change for children with cancer.

Targeting Histone 3 Variants Epigenetic Landscape and Inhibitory Immune Checkpoints: An Option for Paediatric Brain Tumours Therapy.

Despite little progress in survival rates with regular therapies, which do not provide complete care for curing pediatric brain tumors (PBTs), there is an urgent need for novel strategies to overcome the toxic effects of conventional therapies to treat PBTs. The co-inhibitory immune checkpoint molecules, e.g., CTLA-4, PD-1/PD-L1, etc., and epigenetic alterations in histone variants, e.g., H3K27me3 that help in immune evasion at tumor microenvironment have not gained much attention in PBTs treatment. However, key epigenetic mechanistic alterations, such as acetylation, methylation, phosphorylation, sumoylation, poly (ADP)-ribosylation, and ubiquitination in histone protein, are greatly acknowledged. The crucial checkpoints in pediatric brain tumors are cytotoxic T lymphocyte antigen-4 (CTLA-4), programmed cell death protein-1 (PD-1) and programmed death-ligand 1 (PDL1), OX-2 membrane glycoprotein (CD200), and indoleamine 2,3-dioxygenase (IDO). This review covers the state of knowledge on the role of multiple co-inhibitory immunological checkpoint proteins and histone epigenetic alterations in different cancers. We further discuss the processes behind these checkpoints, cell signalling, the current scenario of clinical and preclinical research and potential futuristic opportunities for immunotherapies in the treatment of pediatric brain tumors. Conclusively, this article further discusses the possibilities of these interventions to be used for better therapy options.

The effect of constraint-induced movement therapy for children with hemiplegic cerebral palsy in Vietnam

Purpose Pediatric constraint-induced movement therapy (CIMT) is an evidence-based treatment that has a long history of demonstrating efficacy for children with hemiparesis. The purpose of this study is to determine the effectiveness of a culturally responsive CIMT program for children with hemiplegic cerebral palsy (CP) developed for the Vietnam healthcare system. Methods Thirty children with hemiplegic CP (mean age = 2.88 years, age range: 1 to 8 yrs, 60% male) were recruited to a CIMT program (7.5 h/week, 4 weeks) developed for the cultural context of Vietnam. Motor abilities of the affected arm and participation in daily activities were evaluated at 3 time points (one-week prior to CIMT (baseline), one-week before (pre) and after (post) CIMT) using the Quality of Upper Extremity Skill Test (QUEST) and Pediatric Motor Activity Log-Revised (PMAL-R). Individual goals were measured using the Goal Attainment Scale (GAS). Results There were significant increases in the “How often scale” and “How Well” scales of the PMAL-R (0.75 and 0.75, p < 0.00)). Score of Grasp and Dissociated Movement items on the QUEST increased significantly (6.47 and 7.63, p < 0.001). Group GAS T-Scores were 52.19 indicating that children met individual goals. Conclusions A model of CIMT was successfully developed and delivered within the Vietnamese healthcare system. Future studies should explore the optimal model for CIMT in various regions of world where the delivery of rehabilitation services may vary.

Personalized Setup Optimization Strategies to Improve Clinical Workflow in Image-Guided Pediatric Particle Therapy

The purpose of this retrospective study was to simulate a daily pre-alignment strategy to mitigate systematic positioning errors in image-guided pediatric hadron therapy. All pediatric patients (32 patients, 853 fractions) treated from December 2021 and September 2022 at our Institution were retrospectively considered. For all fractions, daily correction vectors (CVs) resulting from image registration for patient positioning were retrieved in the form of txt files from the hospital database. For each fraction, an adjusted correction vector (V′) was then computed as the difference between the actual one (V) and the algebraic average of the previous ones, as to simulate patient pre-alignment before imaging. The Euclidean norm of each V′ was computed and normalized with respect to that of the corresponding V to derive N. Pre-correcting all the coordinate values led to a 46% average reduction (min 20%, max 60%) in CVs, considering the first 27 fractions (average value in this cohort of patients). Such a potential improvement (N &lt; 1) was observed for the most patients’ fractions (781/853, 91.6%). For the remaining 72/853 cases (8.4%), a remarkable worsening (N &gt; 2) involved only 7/853 (0.82%) fractions. The presented strategy shows promising outcomes in order to ameliorate pediatric patient setup before imaging. However, further investigations to identify patients most likely to benefit from this approach are warranted.

Survey of Thai Physicians' Practice in Pediatric Septic Shock.

(1) Background: Sepsis management in children is crucial, especially in emergency services. This study aims to evaluate Thai physicians' knowledge gaps in the emergency management of sepsis in children and to evaluate their adherence to the current sepsis clinical practice guidelines. (2) Methods: This is a cross-sectional survey of Thai physicians' management of septic shock in children. The survey was conducted through online questionnaires from March 2019-April 2019. (3) Results: Of the 366 responders, 362 (98.9%) were completed. Most of the responders were general practitioners (89.2%) and pediatricians (10.8%). The time from positive sepsis screening to being evaluated by physicians within 15 min was reported by 83.9%. The most common choice of fluid resuscitation was normal saline solution (77.3%). The practice of a fluid loading dose (20 mL/kg) consistent with the guidelines was 56.3%. The selection of the first vasoactive agent in warm shock (norepinephrine) and cold shock (epinephrine) according to recommendations in the guidelines was 74.3% and 36.2%, respectively. There was a significant difference between general practitioners and pediatricians in terms of knowledge about initial fluid resuscitation and the optimal vasoactive agent in cold shock (p-value < 0.001). In the multivariate model, factors associated with the guideline-based decision-making of vasoactive agent choice for cold shock were specialist training (pediatrician) and the completion of sepsis management training certification, with adjusted odds ratios (AORs) of 7.81 and 2.96, but working experience greater than ten years was inconsistent with the guideline-based decision-making (AOR 0.14). (4) Conclusions: Thai clinicians were unfamiliar with pediatric sepsis therapy standards, specifically the quantity of early fluid resuscitation and the appropriate vasoactive medications for cold shock. To encourage adherence to the guidelines, we propose a regularly required training course on pediatric sepsis management.

Fundamentals of rational antibiotic therapy in outpatient pediatrics

Antibiotics are one of the most prescribed groups of drugs in outpatient pediatric practice. To date, there are still disagreements about the need for the use of antibiotics and the optimal dosage regimen for many infections that pediatricians face daily. The authors conducted a search for publications in the PubMed, Google Scholar and eLibrary by the following keywords: «pediatric,» «antibiotics,» «antibiotic resistance,» «outpatient pediatrics» in English, and «педиатрия,» «антибиотики,» «антибиотикорезистентность,» «амбулаторная педиатрия» in Russian. Recent studies show that uncomplicated childhood infectious diseases in vaccinated children can be treated with shorter courses of antibiotics. The rational use of antibiotics in outpatient pediatric practice is of great importance for reducing resistance to them. Since the first step in choosing treatment tactics is to establish the etiology of the disease, future research should focus more on identifying potential biomarkers and diagnostic tests that allow rapid diagnosis of the etiology of an infectious disease, as well as optimizing the dosage and duration of antibiotic therapy courses.

Meropenem Disposition in Neonatal and Pediatric Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy.

This study aimed to characterize the impact of extracorporeal membrane oxygenation (ECMO) on the pharmacokinetics (PK) of meropenem in neonates and children and to provide recommendations for meropenem dosing in this specific population of patients. Therapeutic drug monitoring (152 meropenem plasma concentrations) data from 45 patients (38 received ECMO) with a body weight (BW) of 7.88 (3.62-11.97) kg (median (interquartile range)) and postnatal age of 3 (0-465) days were collected. The population PK analysis was performed using NONMEM V7.3.0. Monte Carlo simulations were performed to assess the probability of target achievement (PTA) for 40% of time the free drug remained above the minimum inhibitory concentration (fT > MIC) and 100% fT > MIC. BW was found to be a significant covariate for the volume of distribution (Vd) and clearance (CL). Additionally, continuous renal replacement therapy (CRRT) was associated with a two-fold increase in Vd. In the final model, the CL and Vd for a typical patient with a median BW of 7.88 kg that was off CRRT were 1.09 L/h (RSE = 8%) and 3.98 L (14%), respectively. ECMO did not affect meropenem PK, while superimposed CRRT significantly increased Vd. We concluded that current dosing regimens provide acceptably high PTA for MIC ≤ 4 mg/L for 40% fT > MIC, but individual dose adjustments are needed for 100% fT > MIC.

Respiratory Rate Oxygenation (ROX) index as predictor of high flow nasal cannula in pediatric patients in pediatric intensive care unit

BackgroundHigh-flow nasal cannula (HFNC) is often used in pediatric populations with respiratory distress. In adults, the respiratory-rate oxygenation (ROX) index is used as a predictor of HFNC therapy; however, children have age-associated differences in respiratory rate, thus may not be applicable to children. This study aims to find the reliability of ROX index and modified P-ROX index as predictors of HFNC therapy failure in pediatric patients.MethodsSubjects in this analytical cross-sectional study were taken from January 2023 until November 2023 in Cipto Mangunkusumo Hospital. Inclusion criteria are children aged 1 month to 18 years with respiratory distress and got HFNC therapy. Receiver operating characteristics (ROC) analysis was used to find mP-ROX index cutoff value as a predictor of HFNC failure. The area under curve (AUC) score of mP-ROX index was assessed at different time point.ResultsA total of 102 patients, with 70% of the population with pneumonia, were included in this study. There are significant differences in the ROX index between the successful and failed HFNC group therapy (p < 0.05). This study suggests that mP-ROX index is not useful as predictor of HFNC therapy in pediatrics. While ROX index < 5.52 at 60 min and < 5.68 at 90 min after HFNC initiation have a sensitivity of 90% and specificity of 71%, sensitivity of 78% and specificity of 76%, respectively.ConclusionmP-ROX index is not useful as a predictor of HFNC therapy in pediatrics. Meanwhile, ROX index at 60 min and 90 min after initiation of HFNC is useful as a predictor of HFNC failure.