Pediatric Risk Research Articles

What the COVID-19 Pandemic Teaches Us About Pediatric Iatrogenic Risk

Iatrogenic morbidity and mortality are pediatric public health risks. This article considers how the COVID-19 pandemic illuminates these risks, as clinicians have been forced to navigate increased diagnostic uncertainty and changes to pediatric health care systems, including closures, limited staffing, and new infection control guidelines.

WGS trio sequencing at diagnosis of cancer: adult and paediatric patients show different genomic cancer risks

The genetic risk landscapes of adult and paediatric cancers are quantitatively and qualitatively different. Adult cancer is a common but sporadic phenomenon: fewer than 10% of adult cancer patients carry a cancer risk allele, predominantly in genes involved in DNA maintenance. In contrast, paediatric cancer is a rare disease in which germline cancer risk alleles are observed at a higher frequency and in a broader set of genes, including regulators of signalling and development. Beyond these general observations, much remains unknown about the link between germline genotype and paediatric cancer risk. To address this, we report a systematic whole genome analysis and clinical curation of over 1,000 paediatric cancer patients and their relatives, incorporating the TARGET, PRISM, and PREDICT studies. In an interim analysis, we find that over 18% of unselected childhood cancer patients carry reportable germline cancer risk alleles. We discuss this result and related work expanding gene cancer relationships, examining the diagnostic utility of familial sequencing, and leveraging the trio design to establish whether polygenic risk might also contribute to childhood cancer.

Air quality, meteorological variability and pediatric respiratory syncytial virus infections in Singapore

Respiratory syncytial virus (RSV) is an important cause of respiratory illness among children. While studies have focused on the air-quality and climate dependence of RSV infections, few have been undertaken in South-East Asia where the burden of respiratory illness is among the highest across the globe. This study aimed to determine the relationships between climatic factors and air quality with RSV infections among children in Singapore. We obtained all laboratory-confirmed reports of RSV infections in children below 5 years old from the largest public hospital specializing in pediatric healthcare in Singapore. We assessed the independent cumulative effects of air quality and meteorological factors on RSV infection risk using the Distributed Lag Non-Linear Model (DLNM) framework in negative binomial models adjusted for long-term trend, seasonality and changes in the diagnostic systems. We included 15,715 laboratory-confirmed RSV reports from 2009 to 2019. Daily maximum temperature exhibited a complex, non-linear association with RSV infections. Absolute humidity (Relative Risk, 90th percentile [RR90th percentile]: 1.170, 95% CI: [1.102, 1.242]) was positively associated with RSV risk. Higher levels of particulate matter of aerodynamic diameter of less than (i) 2.5 µm (PM2.5), (ii) 10 µm (PM10), carbon monoxide (CO) and sulfur dioxide (SO2) were associated with lower RSV infection risk. RSV infections exhibited both annual and within-year seasonality. Our findings suggest that falls in ambient temperature and rises in absolute humidity exacerbated pediatric RSV infection risk while increases in air pollutant concentrations were associated with lowered infection risk. These meteorological factors, together with the predictable seasonality of RSV infections, can inform the timing of mitigation measures aimed at reducing transmission.

Extracorporeal Therapies in Children with Acute Liver Failure: A Single-Center Experience.

The aim of this study is to determine the indication, timing, and administration of extracorporeal therapies such as total plasma exchange and continuous renal replacement therapy in children with acute liver failure or acute-on-chronic liver failure. This study is conducted as a retrospective, single-center study. Between January 2016 and December 2021, pediatric acute liver failure or acute-on-chronic liver failure patients for whom total plasma exchange and/or continuous renal replacement therapy was performed were included in this study. Thirty-four children with acute liver failure or acute-on-chronic liver failure were included during the study period. The children comprised 14 (41.1%) males, and the median age of the patients was 54 months (5-21). Twenty-four patients (70.6%) had pediatric acute liver failure, and 10 patients (29.4%) had acute-on-chronic liver failure. Patients' median model for end-stage liver disease and pediatric end-stage liver disease scores were 24.7/23.5, respectively. Total plasma exchange therapy was performed on all patients whereas continuous renal replacement therapy was performed on 13 patients (38.2%). The median duration of continuous renal replacement therapy was 2.5 days (2-24). The median number of the total plasma exchange sessions was 3 (1-20). The median length of stay in pediatric intensive care unit was 4.5 (2-74) days. Eleven (32.5%) patients had 1 or more improvements in hepatic encephalopathy scores after extracorporeal therapy. Eleven (32.5%) patients died. There was a significant difference between the survivors and non-survivors with respect to levels of albumin, ammonia, pediatric risk of mortality scores, and pre-hepatic encephalopathy scores. Liver transplantation was performed in 4 of 24 pediatric acute liver failure patients, and all of them survived. Total plasma exchange and continuous renal replacement therapy are life-saving, and both methods may reduce morbidity and mortality, also bridging to liver transplantation.

Genetic variants in m5C modification core genes are associated with the risk of Chinese pediatric acute lymphoblastic leukemia: A five-center case-control study.

To explore the functions of the polymorphisms in 5-methylcytosine (m5C) modification-related coding genes on the susceptibility of pediatric acute lymphoblastic leukemia (ALL). Case-control study and multinomial logistic regression analysis were performed to construct models to evaluate the susceptibility of pediatric ALL. The relationship between five functional SNPs in m5C modification-coding genes and pediatric ALL risk was analyzed. Genotyping of 808 cases and 1,340 healthy samples from South China was identified using a TaqMan assay; odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate the relationship between the five selected SNPs and pediatric ALL susceptibility. Among the five analyzed SNPs, NOL1 rs3764909 and NSUN4 rs10252 variants significantly increased the susceptibility of pediatric ALL, while NSUN3 rs7653521, NSUN5 rs1880948, and NSUN6 rs3740102 variants were not associated with the risk of ALL. Stratification analyses demonstrated that NOL1 rs3764909 C>A exhibited a significant association with increased pediatric ALL risk in subgroups of common B ALL, pre-B ALL, T-cell ALL, low and middle risk, other gene fusion types, non-gene fusion, hypodiploid, normal diploid, primitive lymphocytes in marrow < 5% on week 12, and minimal residual disease (MRD) <0.01% on week 12 after induced therapy; NSUN4 rs10252 G>A was related to increased risk of ALL children in subgroups of age ≥ 120 months, normal white blood cell (WBC) number, middle risk, non-gene fusion, MRD ≥ 0.01 on days 15-19, and primitive lymphocytes in marrow < 5% on day 33 after induced therapy. Compared with the reference haplotype CAGTA, children who harbored haplotypes CCGTG and ACATA were remarkably related to increased ALL susceptibility. rs3764909 and rs10252 varieties of alleles were not associated with MRD levels after the selected chemotherapeutics. In conclusion, NOL1 rs3764909 and NSUN4 rs10252 variants were enhanced by pediatric ALL risk and were suggested to be potential biomarkers for pediatric ALL.

Pediatric Overweight, Fatness and Risk for Dyslipidemia Are Related to Diet: A Cross-Sectional Study in 9-year-old Children.

Pediatric overweight, dyslipidemia and insulin resistance can result from unhealthy lifestyle habits and increase morbidity and mortality in adulthood. Herein, we evaluated the relationship between diet and physical activity patterns with the metabolic health of 9-year-old school children. Measurements included anthropometry, adiposity, lipid, and glycemic profiles. Questionnaires evaluated diet and physical activity. Exploratory factor analysis (EFA) screened for diet patterns, and multilevel models evaluated diet and physical activity patterns against overweight, dyslipidemia, and insulin resistance markers across schools and children. EFA highlighted two diet patterns, Western and Traditional. Food rich in fat, salt, and sugar and fewer vegetables and fruits defined the Western pattern. The Traditional pattern, linked to healthier eating habits, had analogies to the Mediterranean diet. Overall, 39% of the children were overweight (including the obese), while 62% presented cardiovascular risk factors on their lipid profiles. Normal-weight children presented 60% high cholesterol incidence. Global insulin resistance incidence was 4.1%, but almost doubled among the overweight/obese. The Westernized diet consistently linked to worse cardiovascular risk markers, even independently of physical practice. Intensive or competitive physical activity was associated with decreased triglycerides (p = 0.003), regardless of diet. Future prospective studies are warranted to validate these results externally.

Magnetic resonance imaging protocols in pediatric stroke.

Neuroimaging protocols play an important role in the timely evaluation and treatment of pediatric stroke and its mimics. MRI protocols for stroke in the pediatric population should be guided by the clinical scenario and neurologic examination, with consideration of age, suspected infarct type and underlying risk factors. Acute stroke diagnosis and causes in pediatric age groups can differ significantly from those in adult populations, and delay in stroke diagnosis among children is a common problem. An awareness of pediatric stroke presentations and risk factors among pediatric emergency physicians, neurologists, pediatricians, subspecialists and radiologists is critical to ensuring timely diagnosis. Given special considerations related to unique pediatric stroke risk factors and the need for sedation in some children, expert consensus guidelines for the imaging of suspected pediatric infarct have been proposed. In this article the authors review standard and rapid MRI protocols for the diagnosis of pediatric stroke, as well as the key differences between pediatric and adult stroke imaging.

Breastfeeding enrichment of B. longum subsp. infantis mitigates the effect of antibiotics on the microbiota and childhood asthma risk

Early antibiotic exposure is linked to persistent disruption of the infant gut microbiome and subsequent elevated pediatric asthma risk. Breastfeeding acts as a primary modulator of the gut microbiome during early life, but its effect on asthma development has remained unclear. We harnessed the CHILD cohort to interrogate the influence of breastfeeding on antibiotic-associated asthma risk in a subset of children (n= 2,521). We then profiled the infant microbiomes in a subset of these children (n= 1,338) using shotgun metagenomic sequencing and compared human milk oligosaccharide and fatty acid composition from paired maternal human milk samples for 561 of these infants. Children who took antibiotics without breastfeeding had 3-fold higher asthma odds, whereas there was no such association in children who received antibiotics while breastfeeding. This benefit was associated with widespread "re-balancing" of taxonomic and functional components of the infant microbiome. Functional changes associated with asthma protection were linked to enriched Bifidobacterium longum subsp. infantis colonization. Network analysis identified a selection of fucosylated human milk oligosaccharides in paired maternal samples that were positively associated with B.infantis and these broader functional changes. Our data suggest that breastfeeding and antibiotics have opposing effects on the infant microbiome and that breastfeeding enrichment of B.infantis is associated with reduced antibiotic-associated asthma risk. This work was supported in part by the Canadian Institutes of Health Research; the Allergy, Genes and Environment Network of Centres of Excellence; Genome Canada; and Genome British Columbia.

Adults Are Not Just Large Kids: Caring for Adults in Pediatric Hospitals.

Adults Are Not Just Large Kids: Caring for Adults in Pediatric Hospitals.

Association of RNA m7G Modification Gene Polymorphisms with Pediatric Glioma Risk.

Glioma stemming from glial cells of the central nervous system (CNS) is one of the leading causes of cancer death in childhood. The genetic predisposition of glioma is not fully understood. METTL1-WDR4 methyltransferase complex is implicated in tumorigenesis by catalyzing N7-methylguanosine (m7G) modification of RNA. This study is aimed at determining the association of glioma risk with three polymorphisms (rs2291617, rs10877013, and rs10877012) in METTL1 and five polymorphisms (rs2156315 rs2156316, rs6586250, rs15736, and rs2248490) in WDR4 gene in children of Chinese Han. We enrolled 314 cases and 380 controls from three independent hospitals. Genotypes of these polymorphisms were determined using the TaqMan assay. We found the WDR4 gene rs15736 was significantly associated with reduced glioma risk (GA/AA vs. GG: adjusted odds ratio = 0.63, 95%confidence interval = 0.42 - 0.94, P = 0.023) out of the eight studied polymorphisms. Stratified analyses showed that the association of rs15736 with the risk of glioma remained significant in children aged 60 months or older, girls, the subgroups with astrocytic tumors, or grade I + II glioma. We also found the combined effects of five WDR4 gene polymorphisms on glioma risk. Finally, expression quantitative trait locus (eQTL) analyses elucidated that the rs15736 polymorphism was related to the expression level of WDR4 and neighboring gene cystathionine-beta-synthase (CBS). Our finding provided evidence of a causal association between WDR4 gene polymorphisms and glioma susceptibility in Chinese Han children.

High dose chemotherapy with autologous stem cell rescue for pediatric high risk brain tumours -Case series

High dose chemotherapy with autologous stem cell rescue for pediatric high risk brain tumours -Case series

Non-alcoholic fatty liver disease in children.

Non-alcoholic fatty liver disease (NAFLD) has become the most common liver disease in the paediatric age. The growing prevalence of NAFLD and its advanced phenotype, non-alcoholic steatohepatitis (NASH), in children and adolescents parallels similar trends in obesity and type 2 diabetes mellitus. This trend may have serious long-term implications, including hepatic and extra-hepatic morbidity and mortality, the latter being related mostly due to cardiovascular disease and malignancies. This narrative review, which included 237 articles, summarizes current evidence on paediatric NAFLD, including pathophysiology, risk factors, complications, prevention and treatment (existing and emerging). Early recognition of NAFLD followed by timely and adequate management seems to be important on an individual basis. A global "call to action" regarding paediatric NAFLD seems appropriate to mitigate the burden of this disease.

Data, Anomalies; a Call to Cease and Desist.

Data, Anomalies; a Call to Cease and Desist.

Predictive Value of Urinary Neutrophil Gelatinase-Associated Lipocalin in Detection of Severe Acute Kidney Injury in Critically Ill Children

Aims and Objectives: The primary objective was to determine the positive and negative predictive values, sensitivity, and specificity of urinary neutrophil gelatinase-associated lipocalin (uNGAL) for diagnosis of severe acute kidney injury (AKI). The secondary objectives were to find the association between uNGAL with day-3 cumulative fluid balance (CFB), requirement of kidney replacement therapy (KRT), and length of pediatric intensive care unit (PICU) stay. Materials and Methods: In this prospective cohort, uNGAL was done by chromatography on patients admitted at PICU in a tertiary care hospital with Pediatric Risk of Mortality III (PRISM III) score of &gt;10. AKI was defined by KDIGO 2012 criteria. Urinary NGAL was done on all patients (&gt;3 months to ≤12 years) with PRISM III score &gt;10 on day 1 and day 3 of PICU admission who had no AKI on admission. Results: Out of 288 patients admitted with PRISM III score &gt;10 and normal kidney function on admission, 58.3% developed AKI and 29.9% developed severe AKI. Day-3 uNGAL was found to be superior to day-1 uNGAL in detecting AKI with 96.4% sensitivity, 84.4% specificity, 85.04% PPV, and 96.26% NPV. The percentage increase in day-3 CFB and risk of requiring KRT was significantly (P &lt; 0.001) higher in the groups with raised day-1 uNGAL and day-3 uNGAL. The length of PICU stay was significantly correlated to the group with raised day-3 uNGAL (P &lt; 0.001). Conclusion: Urinary NGAL had a good predictive value in detecting severe AKI in critically ill children. It is also associated with requirement of KRT and day-3 CFB. Duration of PICU stay was significantly associated with day-3 uNGAL (P &lt; 0.001).

Predictive value of Pv-aCO2/Ca-vO2 combined blood lactate concentration for primary peritonitis-related septic shock in children

To investigate the prognostic value of the ratio of veno-arterial carbon dioxide partial pressure difference to arterio-venous oxygen content difference (Pv-aCO2/Ca-vO2) in children with primary peritonitis-related septic shock. A retrospective study was conducted. Sixty-three children with primary peritonitis-related septic shock admitted to department of intensive care unit of the Children's Hospital Affiliated to Xi'an Jiaotong University from December 2016 to December 2021 were enrolled. The 28-day all-cause mortality was the primary endpoint event. The children were divided into survival group and death group according to the prognosis. The baseline data, blood gas analysis, blood routine, coagulation, inflammatory status, critical score and other related clinical data of the two groups were statistics. The factors affecting the prognosis were analyzed by binary Logistic regression, and the predictability of risk factors were tested by the receiver operator characteristic curve (ROC curve). The risk factors were stratified according to the cut-off, Kaplan-Meier survival curve analysis compared the prognostic differences between the groups. A total of 63 children were enrolled, including 30 males and 33 females, the average age (5.6±4.0) years old, 16 cases died in 28 days, with mortality was 25.4%. There were no significant differences in gender, age, body weight and pathogen distribution between the two groups. The proportion of mechanical ventilation, surgical intervention, vasoactive drug application, and procalcitonin, C-reactive protein, activated partial thromboplastin time, serum lactate (Lac), Pv-aCO2/Ca-vO2, pediatric sequential organ failure assessment, pediatric risk of mortality III in the death group were higher than those in the survival group. Platelet count, fibrinogen, mean arterial pressure were lower than those in the survival group, and the differences were statistically significant. Binary Logistic regression analysis showed that Lac and Pv-aCO2/Ca-vO2 were independent risk factors affecting the prognosis of children [odds ratio (OR) and 95% confidence interval (95%CI) were 2.01 (1.15-3.21), 2.37 (1.41-3.22), respectively, both P < 0.01]. ROC curve analysis showed that the area under curve (AUC) of Lac, Pv-aCO2/Ca-vO2 and their combination were 0.745, 0.876 and 0.923, the sensitivity were 75%, 85% and 88%, and the specificity were 71%, 87% and 91%, respectively. Risk factors were stratified according to cut-off, and Kaplan-Meier survival curve analysis showed that the 28-day cumulative probability of survival of Lac ≥ 4 mmol/L group was lower than that in Lac < 4 mmol/L group [64.29% (18/28) vs. 82.86% (29/35), P < 0.05]. Pv-aCO2/Ca-vO2 ≥ 1.6 group 28-day cumulative probability of survival was less than Pv-aCO2/Ca-vO2 < 1.6 group [62.07% (18/29) vs. 85.29% (29/34), P < 0.01]. After a hierarchical combination of the two sets of indicator variables, the 28-day cumulative probability of survival of Pv-aCO2/Ca-vO2 ≥ 1.6 and Lac ≥ 4 mmol/L group significantly lower than that of the other three groups (Log-rank test, χ2 = 7.910, P = 0.017). Pv-aCO2/Ca-vO2 combined with Lac has a good predictive value for the prognosis of children with peritonitis-related septic shock.

Early period intensive care follow-up after liver transplantation in children: a single center experience.

Liver transplantation (LT) is a well-established, life-saving treatment for children with irreversible acute and chronic liver failure (LF). We aimed to evaluate the factors associated with morbidity and mortality in the early period of LT in children by reviewing our pediatric intensive care unit (PICU) experience. We reviewed children`s medical records followed in the PICU after LT between May 2015-August 2021, including demographic parameters, indications for LT, operative variables, respiratory and circulatory support requirements, LT-related complications and survival. During this period, 40 pediatric patients who underwent LT were evaluated. LT was performed in 35 (87.5%) cases of chronic liver disease and 5 (12.5%) cases of acute liver failure. Twenty-four patients had chronic liver failure due to cholestatic liver disease. The patients` Pediatric Risk of Mortality (PRISM) III score was 18.82±SD (2-58) at PICU admission. 1-year survival was 87.5%, and overall survival was 85%. Younger age, low body weight, preoperative pediatric end-stage liver disease (PELD), and model for end-stage liver disease (MELD) values of 20 and higher were important risk factors for unfavorable outcomes after living donor liver transplantation (LDLT). These risk factors are both associated with technically more challenging vascular and bile duct reconstruction and higher complication rates, and increased mortality during the early period after LT. The early period of optimum PICU management in pediatric LT recipients is crucial for successful outcomes, which is also related to the patients` characteristics, disease severity scores, and surgical procedures.

Mortality Rate and Risk Factors in Pediatric Intensive Care Unit of Imam Hossein Children's Hospital in Isfahan: A Prospective Cross-Sectional Study.

Various studies have conducted to report the mortality rates and its risk factors in pediatric intensive care unit. This study aimed to determine the mortality prevalence and risk factors in PICU of Imam Hossein Children's Hospital in Isfahan, which is the main referral pediatric hospital in the center of Iran. This study was performed on 311 patients during a period of 9 months. The questionnaire which included age, gender, length of stay in the PICU and hospital, mortality, history of resuscitation in other wards and readmission, the causes and sources of hospitalization, pediatric risk of mortality (PRISM)-III score, respiratory supports, morbidities like nosocomial infections, acute kidney injury (AKI), multiple organ dysfunction syndrome (MODS) confirmed by pediatric sequential organ failure assessment score (P-SOFA) and glycemic disorders was filled out. One hundred and seventy-seven (56.9%) were males and 103 (33%) were belonged to the age group of 12-59 months. The most prevalent causes of hospitalization were status epilepticus (12.9%) and pneumonia (11.2%). Mortality rate was 12.2%. The significant factors associated with mortality were readmission and history of resuscitation. PRISM-III index showed a significant difference between nonsurvivors and survivors (7.05 ± 6.36 vs. 3.36 ± 4.34, P = 0.001). Complications like AKI, hypoglycemia, MODS and disseminated intravascular coagulation (DIC), length of mechanical ventilation significantly correlated with mortality. Mortality rate was less than that of other developing countries (12.2%) and this was associated with some risk factors included readmission, history of resuscitation, PRISM-III Index; complications like AKI, acute respiratory distress syndrome (ARDS), DIC, mechanical ventilation duration, MODS, hypoglycemia, and P-SOFA index.

Key process and outcome indicators on quality and safety of care for critically ill pediatric patients according to international standard organization protocols: a four-year follow-up study

The European Society of Intensive Care Medicine (ESICM) suggests nine quality and safety indicators of care for critically ill patients. The aim of the present study was to examine the Key Process and Outcome Indicators (KPOIs) chosen according to International Standard Organization (ISO) protocols in a Greek Pediatric Intensive Care Unit (PICU). Two structure, one process, and four outcome indicators were examined in a stepwise approach according to Observe-Plan-Do-Study-Act (OPDSA) cycles, in an observational four-year cohort study (2017–2020). Two structure indicators—that ICUs fulfil national requirements to provide intensive care and 24-h consultant availability were requirements for the creation of the PICU and considered standards of care. One process indicator—Standardized Handover Procedure was transformed from handwritten (2017–2018) into electronic form (2019–2020) and 100% compliance rates throughout the four years were recorded. 96, 85, 103 and 94 patients were admitted in 2017, 2018, 2019 and 2020 with median (IQR) Pediatric Risk of Mortality III-24 h scores of 10 (6.25–17), 10 (6–13), 8 (5–13) and 8 (6.75–12), respectively. Mortality rates were 24%, 11.8%, 17.5%, 16%, and Standardized Mortality Ratio (SMR) were 1.42, 0.92, 1.56 and 1.33, correspondingly. No early (&lt;48 h after PICU discharge) readmissions were recorded for 2017 and 2018, only 1 in 2019 (0.8%) and none in 2020. Catheter Related Bloodstream Infection rates were 1.37:1000, 1.37:1000, 1.26:1000 and 1.39:1000 catheter days, respectively. Unplanned extubation rate was 10.30% in 2019 and 5.72% and 3.91:1000 ventilation days in 2020. In conclusion, ISO implementation of our unit was the trigger for internal PICU audit and external benchmarking. OPDSA cycles, following small steps at a time, in an iterate cycle of evolution, facilitated our actions. The majority of the KPOIs examined in our study was within international PICUs reference values.

The Amount of Knowledge Awareness on the Caries Risk Assessment Tools and It’s Management Strategies in Children among Dental Students

Introduction: Early detection of risk factors and implementation of oral health preventative activities can help to slow or stop the spread of caries. As a result, dentists must be well-versed in a variety of approaches and early preventative methods.&#x0D; Aim of the Study: The aim of the study is to create knowledge and awareness on the caries risk assessment tools and it’s management strategies in children among dental students.&#x0D; Methodology: A questionnaire survey was carried out online containing 10 questions and was sent to 100 students on the caries risk assessment tools and it’s management strategies in children among dental students. An online survey was conducted using survey planet software and the data was collected and completely analysed for statistical difference.&#x0D; Results: According to our findings, the majority of undergraduates believe that a child should see a dentist between the ages of 12 and 22, and that specific information gained from a systematic assessment of caries risk guides the dentist in the decision-making process for treatment and preventive protocols for children (66 percent of undergraduates and 18 percent of postgraduates).&#x0D; Conclusion: Dental practitioners have a critical role in preventing and minimising the severity of ECC in young children, and they can use preventive treatment regimens to assess their paediatric patients' caries risk.

Procalcitonin Level and Organ Dysfunction in Children with Sepsis: A Prospective Observational Study

Background: Procalcitonin is produced in response to endotoxin or mediators released in response to bacterial infections and are reported to be sensitive predictor of sepsis and multiple organ failure. The main aim of this study was to correlate procalcitonin levels with the severity of organ dysfunction in children with sepsis.&#x0D; Materials and Methods: A prospective observational study was done among children aged &gt;1 month - 18 years admitted for sepsis in level 4 pediatric intensive care unit at Rainbow children Hospital, Hyderabad from July 2018 to January 2020. Children with sepsis due to burns and trauma were excluded. Procalcitonin levels were assessed on days 1 and 5 and were analyzed using descriptive statistics. P value of &lt; 0.05 was considered significant wherever applicable.&#x0D; Results: Among 369 cases, procalcitonin levels showed positive correlation with severity of illness and multiorgan failure as evidenced by pediatric risk of mortality III score (mean score 6.44 ± 3.79) and worst sepsis-related organ failure assessment score (mean score 7.11 ± 4.27) respectively. Duration of non-invasive ventilation, invasive ventilation, pediatric intensive care unit stay, and mortality were significantly high in children with higher procalcitonin level. Mean procalcitonin level were significantly higher in culture positive cases (65.79 ± 77.10) compared to culture negative cases (37.99 ± 45.81).&#x0D; Conclusion: In this study, positive correlation was observed between procalcitonin level and multiple organ dysfunctions in sepsis and septic shock.