The presence of family members during invasive procedures in neonatal and pediatric intensive care units is limited, despite its emotional benefits. Exploring parents' experiences in these contexts can help us move toward more family-centered models of care. (I) To explore the experiences of parents of pediatric and neonatal patients admitted to intensive care units regarding being present during invasive procedures; (II) Understand the needs, limitations, and suggestions for improvement expressed by parents regarding their presence during invasive procedures. Qualitative phenomenological study based on in-depth interviews with parents of pediatric patients admitted to an intensive care unit. The thematic analysis followed the approach of Braun and Clarke, and the COREQ guidelines were respected. 22 parents participated in the study. Two major themes emerged from the analysis: (1) The influence of family presence during invasive procedures, and (2) Parents' needs. Participants viewed being present as essential to fulfilling their role as caregivers, providing comfort to their children, and strengthening emotional bonds. They endorsed being present, despite the emotional burden entailed. They identified the following key needs: receiving clear information, having emotional support, having the freedom to decide whether to be present, and having a private and safe environment. Parents view being present during procedures as a right and a way of exercising their parental role. It promotes the emotional well-being of the child and strengthens their relationship with professionals. The presence of family members should be encouraged through specific training for staff and support personnel. Safe environments must be created, and teams must foster a sensitive approach toward the active role of parents in caregiving.

Effect of diary intervention on sleep quality and risk of stress disorders among critically ill children in pediatric intensive care units and on their parents' anxiety level: A randomized controlled trial.

Impact of soybean oil lipid emulsion on clinical outcomes in critically ill pediatric patients.

Family-centred care interventions in paediatric intensive care units: a scoping review.

Introduction: Sepsis is a leading cause of morbidity, mortality and hospitalisation. Severity score is therefore vital to improve the outcome of patients with sepsis and septic shock. VISmax score (Maximum Vasoactive-Inotropic Score) is simpler and easier to use compared to other scales such as Paediatric Risk of Mortality Score (PRISM) Paediatric Logistic Organ Dysfunction score (PELOD) and Paediatric Sequential Organ Failure Assessment score (pSOFA) score. Aim: To determine the association of VISmax score with outcome of critically-ill children in Paediatric Intensive Care Unit (PICU) and also to evaluate the association between VISmax score and PRISM III score to predict the outcome in PICU. Materials and Methods: This prospective cohort study was done in PICU of a Gandhi Medical College and associated Hamidiya hospital, a tertiary care hospital of central India during the period of September 2022- October 2023. The study population included 330 critically-ill children between 1-13 years of age with the requirement of Vasoactive medications since admission. Maximal VIS score (VISmax) in the initial six hours after admission was calculated using the highest doses of vasoactive and inotropic medications administered. Five categories of VISmax were established: 0-5, >5-15, >15-30, >30-45, and >45 points. The association of different categories of VISmax with outcome of children in term of mortality was evaluated using Student’s t-test. Results: A total of 330 patients satisfying the inclusion criteria were included in study with a mean age of five years (IQR 1-13 years) and male (n=188) outnumbered female. The median VISmax was 10.0 (IQR: 0.0-37.0). The (median (IQR) VISmax of non survivors was significantly higher than that of survivors (37.0 (10-54.0) vs. 5.0 (5.0-18.0); p-value <0.001). Significant association was found between VISmax in the first six hours of admission and outcome. A positive correlation between PRISM III and VISmax scores (r-value=0.362, p-value <0.001), indicating that these two severity measures align in assessing patient acuity. Mortality was 10.9% overall and 46.34% in the highest VISmax group (>45 points). Conclusion: VISmax in the first six hours of admission in PICU was significantly associated with outcome and mortality, hence can be used to guide intensive therapy accordingly

Respiratory physiotherapy is a treatment option for children on paediatric intensive care units (PICUs), aiming to facilitate airway clearance and improve ventilation. Given the vulnerable nature of this patient group, safety and adverse events related to respiratory physiotherapy are important considerations. The aim of this qualitative study was to understand what physiotherapists perceive to be risk factors for instability and adverse events and how they manage these. This study involved virtual semi-structured interviews and focus groups with PICU physiotherapists. Sixteen interviews and two focus groups (n=7) were completed. These were audio-recorded and transcribed verbatim. Framework analysis was used. From the interview analysis, a framework Strategies for managing instability and adverse events was developed. Two frameworks were developed from the focus group analysis: Instability and adverse events and Managing instability and adverse events. Physiotherapists provided a comprehensive list of perceived risk factors for instability and adverse events, including clinical presentations and support required. Practical strategies were reported to promote efficiency, including readiness of equipment and two-person treatments. Physiotherapists described accepting short-term unwanted effects for longer-term improvement, discussed in terms of risk versus benefit. The patient's parents/family were involved in the sharing of responsibility for treatment decisions. Multidisciplinary team involvement included collaborative discussion with practical assistance as required. This study provides novel data about physiotherapists' management of instability and adverse events in PICUs. Preparation and planning, involving the multidisciplinary team, family inclusion, reacting and adapting, and accepting instability were important strategies. The findings from this study highlight several areas that require consideration from a workforce support and education perspective.

To adapt and validate a good practice manual on humanisation, originally designed for adult critical care patients, to the paediatric intensive care unit (PICU) context. A methodological study to adapt and validate a clinical practice manual was conducted using a three-round Delphi consensus technique between February and October 2023 with 53 experts (56.6% nurses, 28.3% physicians, 15.1% other professionals) from 15 Spanish hospitals. In the first round, participants evaluated 160 practices from the Manual of Good Practices in Humanization for Adult Intensive Care Units (HU-CI Project) and adapted them to the paediatric context. In the second round, they validated these modifications and 30 additional proposals. In the third round, the consensus practices were classified into three levels. Consensus was defined as ≥75% agreement. Of 57 initial participants, 53 completed the three Delphi rounds, resulting in a 93% retention rate. Among participants, 79.2% were women, 56.6% were nurses, and 94.4% had experience in PICUs. From the original 160 initial practices, 47.4% (n=76) reached consensus without modification, 16.9% (n=27) were modified, and 35.6% (n=57) were discarded. Additionally, 30 new practices were proposed and accepted, resulting in 132 final practices. These were categorised as basic (65%, n=86), advanced (22%, n=29), and excellent (13%, n=17). This study adapted and validated the first humanisation manual specifically for PICUs, providing a structured, measurable framework that may promote child- and family-centred care and support continuous quality improvement. The consensus-validated practices provide PICU teams with a structured, measurable framework that may help promote child- and family-centred care. Nursing staff play a key role in daily implementation of family involvement, communication, and comfort measures, whilst the three-level classification allows progressive evaluation of PICU humanisation according to unit resources.

Utility and Prognostic Implications of Continuous Electroencephalogram Monitoring in Pediatric Intensive Care.

Invasive mechanical ventilation (IMV) is widely used in pediatric intensive care units. Acute lower respiratory infection is its primary indication; it is characterized by increased inspiratory and expiratory resistance, as well as decreased lung compliance. It can progress to acute respiratory distress syndrome, which poses a challenge in optimizing IMV. Although different ventilatory modes are not presumed to generate significant clinical differences, there is a marked preference for the pressure control mode in pediatrics. In predominantly obstructive conditions, volume control mode ensures ventilation regardless of the degree of inspiratory resistance, allowing for extended expiratory time and preventing hyperinflation. In restrictive conditions, pressure control enables ventilation to be adjusted to protective parameters, albeit with the potential risk of inducing damage due to higher flow rates. The physiological basis of the different ventilation modes and their clinical application are reviewed.

Introduction: In the recently published National Family Health Survey (NFHS)-5 data, Anand district’s performance was not promising in terms of nutrition of mother and child; and being the only tertiary care teaching hospital in the district, there is a need to generate the study data. Aim: To evaluate the anthropometric profile of paediatric patients across different age groups at a Tertiary Care Centre, and to study its association with maternal education and occupation. Also, to compare the anthropometry indicators of NFHS-5 of Anand district with anthropometry of hospitalised children. Materials and Methods: The present retrospective observational study was conducted at the Department of Paediatrics of Pramukhswami Medical College and Shree Krishna Hospital in Anand district in Gujarat state between January 2023 to December 2023. A total of 1099 patients admitted under the Paediatric Department between the age groups of one month to 18 years in the Paediatric Ward and Paediatric Intensive Care Unit were included. All pertinent baseline details and their anthropometry were measured and plotted on World Health Organisation (WHO) and Indian Academy of Paediatrics (IAP) growth charts. Expected age values were calculated, and Z-scores were determined for classification. Mothers were also surveyed about their education and employment status. The Chi-square test was used to study the association between maternal education and occupation, and the Z-test for proportion compared results with NFHS 5 data. Results: A total of 1099 paediatric patients were admitted during the study period. The median (Q1,Q3) age of study cohort was 67(21,137) months and males were 651(59.24%). Among all patients, 70% were stunted and 85% were underweight. Data for children under 5 significantly differed from NFHS-5 data (p<0.001), with higher rates of stunting (69.5% vs. 38.4%), underweight (84.8% vs. 46.6%), wasting (77.8% vs. 28.6%), and severe wasting (29.6% vs.10.9%). Maternal education and occupation were linked to child growth, with stunting associated with maternal education and underweight linked to maternal occupation in older children. Conclusion: The study revealed higher prevalence rates of stunting, wasting, and underweight among indoor paediatric patients compared to NFHS-5 data for the Anand district.

Pediatric malnutrition, is defined as an imbalance between nutrient intake and requirements leading to cumulative energy, protein, or micronutrient deficits, is highly prevalent among critically ill children and negatively affects growth and recovery. Early enteral nutrition (EEN) is increasingly recognized as a key strategy to prevent or address malnutrition in pediatric intensive care units (PICUs). Although emerging evidence suggests that EEN improves clinical outcomes, uncertainty persists regarding its feasibility and impact in this population. This scoping review aimed to map existing evidence on the use of EEN in critically ill children, evaluate its effects on key clinical outcomes including mechanical ventilation duration, length of stay, and infection risk; and identify barriers and facilitators to its implementation in pediatric intensive care settings. A scoping review was conducted following Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Searches were performed in PubMed, Embase, Scopus, CINAHL, and the Cochrane Library. Studies were eligible if they involved children aged 1month to 18years and initiated enteral nutrition within 48h of PICU admission. Keywords included child, critical illness, enteral nutrition, intensive care units, and pediatrics. Studies in English or Italian were included without date restrictions. Sixteen thousand seven hundred ninety-nine records were identified; 15,556 were screened after duplicates were removed, and 14 studies met inclusion criteria (USA n=6; Asia n=4; Africa n=3; Europe n=1). Most were cohort studies, with one randomized trial. EEN was consistently associated with shorter mechanical ventilation duration (5.86±3.63 vs 11.96±9.17days, p=0.002), reduced PICU and hospital length of stay (4 vs 11.5days, p<0.001), and lower infection rates (16.7% vs 41.1%, p=0.001). Barriers to EEN included hemodynamic instability, gastrointestinal intolerance, and procedural interruptions, while facilitators included multidisciplinary teamwork, nurse-led feeding protocols, and standardized nutritional guidelines. EEN initiated within 24-48h was generally associated with favorable clinical outcomes; however, evidence on feasibility and safety remains limited and heterogeneous. Strengthening nursing autonomy and implementing standardized feeding pathways may enhance timely nutrition delivery and support recovery in pediatric intensive care. Pediatric intensive care nurses play a pivotal role in initiating and monitoring EEN. Empowering nurses through evidence-based feeding protocols and multidisciplinary education can promote timely nutrition delivery and improve recovery in critically ill children.

Parents' perception of family-centered care in the pediatric intensive care unit: a systematic review of qualitative studies.

Sleep health is an overlooked but important part of children's health and development. The health consequences associated with poor sleep health may impact recovery during critical illness. Explore sleep health among children in the pediatric intensive care unit (PICU) receiving usual care or a nurse-led chronotherapeutic care bundle. Secondary analysis of the RESTORE Resilience (R2) trial. Parent-reported baseline sleep health was compared with PICU sleep health, including compliance with baseline sleep behaviors, alertness levels, and actigraphy-based measures of sleep timing, efficiency, and duration. In 52 R2 participants (6 months to 17 years), 49 provided prehospital sleep data and 22/49 (45%) had atypical baseline sleep health. Participants had irregular PICU sleep behaviors and spent ≥ 25% of PICU days sedated. Children experienced little daytime activity consolidation and short, fragmented sleep episodes. Total sleep time was within 1 hour of baseline on 23 (11%) study days. There were few associations between baseline and PICU sleep health or between R2 bundle implementation and PICU sleep health. Critically ill children demonstrated disrupted sleep health. Results will inform nurse-led interventions to promote sleep in the PICU.

Development and validation of a workload prediction tool for nurses in pediatric intensive care units - The QuantI2S tool.

Variations in the compassion experience of Jordanian pediatric nurses: A comparative study using cluster analysis.

Nurses play a critical role in the insertion and maintenance of PIVC, and in monitoring and preventing complications and failures associated with this procedure. This study aimed to assess paediatric nurses' knowledge and confidence in the insertion and maintenance of peripheral intravenous catheters for paediatric patients in Saudi Arabia. A cross-sectional study was employed in this study METHODS: This study was conducted among 160 nurses working in paediatric wards, paediatric intensive care units, neonatal intensive care units, paediatric emergency units, and daycare units. The nurses completed an online survey using validated questionnaires to evaluate self-reported knowledge and confidence in PIVC insertion and maintenance. The study findings revealed that the nurses participating had inadequate knowledge of PIVC insertion (mean score: 4.47 ± 1.57) and maintenance (mean score: 5.5 ± 2.11) but high confidence in their ability to perform these procedures (mean score: 41.23 ± 7.37 for insertion and 38.33 ± 6.80 for maintenance). No significant association was observed between nurses' demographic variables, such as age, gender, level of education, working area, training, and experience, and their knowledge or confidence in PIVC insertion and maintenance. Based on the study findings, it highlights gaps in paediatric nurses' PIVC insertion and maintenance practice. Addressing these gaps requires targeted education and skill training, which can potentially lead to enhanced success rates for procedures, decrease complications, as well as increase the safety and quality of care given to critically ill paediatric patients.

The ethical considerations surrounding organ-preserving cardiopulmonary resuscitation (OP-CPR) in pediatric patients with brain death highlight tensions between preserving organ viability and respecting bodily integrity. This article explores these complexities through the case of JJ, a 12-year-old patient declared dead by neurological criteria, whose parents authorized organ donation. When JJ experienced cardiovascular collapse before organ procurement, the organ procurement organization's off-site director instructed hospital staff to perform OP-CPR, prompting ethical concerns from the pediatric intensive care unit (PICU) team. This Ethics Rounds article presents 3 perspectives on OP-CPR: (1) An ethicist working for an organ procurement organization asserts that OP-CPR aligns with the family's intent and the principle of justice by increasing organ availability; (2) 2 pediatric intensive care attendings and bioethicists argue OP-CPR may not be ethically justified due to the low likelihood of achieving the primary goal, potential harm to the donor's dignity and personhood, and concerns about poor communication and lack of explicit permission; and (3) 3 nurses reveal challenges related to communication, moral distress, and institutional policies that pertain to the practice of OP-CPR. The article underscores the need for clear guidelines, improved collaboration between PICU teams and organ procurement organizations, and ethical frameworks that address both conscientious objection and conscientious commitment in the context of OP-CPR.

Circuit survival (CS) is critical for the maintenance of continuous kidney replacement therapy (CKRT). Regional citrate anticoagulation (RCA) is widely used, effective, and relatively safe; however, it is associated with complications such as citrate accumulation (CA). We aimed to analyze how a lower citrate infusion dose (CID) protocol could impact CS and risks for CA. This retrospective single-center cohort study compared the efficacy and safety of standard CID (3.0mmol/L) and low CID (2.2-2.5mmol/L) at initial administration in patients receiving RCA for CKRT in a pediatric intensive care unit. A total of 127 patients received 239 circuits (115 circuits in 55 recipients of standard CID, and 124 filters in 72 recipients of low CID). When filter life was limited to 72h, median CS for all filters was similar between the standard and low CID groups (51.0h [IQR: 25.0-72.0] vs. 49.5h [IQR: 24.0-72.0]; p = 0.857). CS was also similar in circuits terminated due to clotting (standard CID: 38.0h [IQR: 20.0-58.0], low CID: 37.5h [IQR: 18.0-55.0]). Recipients of the low CID protocol had significantly lower frequencies of metabolic alkalosis, CA, and hypocalcemia. Multivariate regression identified two independent CA risk factors: longer circuit runtime (OR 1.013, 95% CI 1.002-1.025) and higher weight-adjusted blood flow rates (OR 1.208, 95% CI 1.022-1.427). Administering a low CID when initializing RCA significantly reduces the likelihood of citrate-related complications while maintaining anticoagulant efficacy.

Background: Bangladesh has been experiencing large dengue outbreaks since 2019, the 2023 outbreak is the largest on record. Comparing dengue profiles and out comes between outbreaks is crucial for enhancing our understanding of dengue and improving clinical and public health responses to future outbreaks. This study com pared the profile and outcome of dengue patients admitted to the Pediatric Inten sive Care Unit (PICU) of a tertiary-level hospital in Chattogram, Bangladesh, during the 2022 and 2023 outbreaks. Materials and methods: This record-based study included 81 laboratory-confirmed dengue children admitted to the PICU of Chittagong Medical College Hospital. Using SPSS Windows version 23.0, the demographics, clinical manifestations, and outcomes of the cases were compared between two outbreaks. Results: Twenty-three and 58 patients were admitted between 2022 and 2023, respectively. Median age of children was 5 years in both years. Males were affected more, with a male-female ratio of 1.5:1 in 2022, which was reversed in 2023 with a male-to-female ratio of 0.9:1. Persistent vomiting and abdominal pain was noticed to be significantly higher among patients in 2023. The median length of PICU stay was significantly higher in 2023 than in 2022 (8 vs. 5 days, p&lt;0.001). The PICU mortality rate was lower in 2023 than in 2022 (13.8% vs. 21.7%), though it was not statistically significant. Conclusion: Though the number of PICU-admitted cases is increasing, the mortality rate is decreasing with appropriate management. So, for district-level hospitals in Bangladesh, establishing a pediatric intensive care unit is the demand of time to manage this severe variety of dengue pediatric cases. &gt;&lt;0.001) The PICU mortality rate was lower in 2023 than in 2022 (13.8% vs. 21.7%), though it was not statistically significant. Conclusion: Though the number of PICU-admitted cases is increasing, the mortality rate is decreasing with appropriate management. So, for district-level hospitals in Bangladesh, establishing a pediatric intensive care unit is the demand of time to manage this severe variety of dengue pediatric cases Chatt Maa Shi Hosp Med Coll J; Vol.24 (2); July 2025; Page 62-65

Objective: To determine the incidence and risk stratification of pediatric acute respiratory distress syndrome (PARDS) in mechanically ventilated (MV) patients admitted at the pediatric intensive care unit (PICU). Study Design: Prospective Observational study. Setting: The PICU of National Institute of Child Health, Karachi, Pakistan. Period: April 2024 to March 2025. Methods: A total of 200 children aged 1 month to &lt; 18 years admitted to the PICU with PARDS, and undergoing MV were included. Risk stratification was done on the basis of oxygenation index (OI) categorizing as mild (4 ≤ OI &lt; 8), moderate (8 ≤ OI &lt; 16), and severe (OI ≥ 16). Duration of MV, use of inotropes, PICU stay duration, and mortality were documented and compared with respect to PARDS severity using chi-square test, and Kruskal-Wallis test, taking p&lt;0.05 as significant. Results: Among 200 children, 111 (55.5%) were female, and overall median age was 8.00 (IQR, 4.00–12.00) years. Regarding PARDS categorizations, 24 (12.0%) had mild, 82 (41.0%) moderate, and 94 (47.0%) severe PARDS. Inotropic support was required in 84 (42.0%) patients. Median duration of MV, and PICU stay were 8.00 (5.00–11.00), and 16.00 (12.00–23.00) days, respectively, increasing significantly with severity (p&lt;0.001). Mortality was highest in severe PARDS (21.3%) compared to moderate (2.4%) and mild cases (4.2%) (p&lt;0.001). Conclusion: The PALICC definition and stratification system for PARDS effectively categorize mechanically ventilated pediatric patients into distinct severity groups associated with clinically meaningful differences in ventilator requirements, PICU stay, and mortality.