Predictors Of Outcome In Children Research Articles

SpO2/FiO2 as a predictor of high flow nasal cannula outcomes in children with acute hypoxemic respiratory failure

The high-flow nasal cannula (HFNC) is a useful treatment modality for acute hypoxemic respiratory failure (AHRF) in children. We compared the ability of the oxygen saturation to fraction of inspired oxygen ratio (S/F) and arterial oxygen partial pressure to fraction of inspired oxygen ratio (P/F) to predict HFNC outcomes in children with AHRF. This study included children treated with HFNC due to AHRF from April 2013 to March 2019 at the Severance Children’s Hospital. HFNC failure was defined as the need for mechanical ventilation. Trends of S/F and P/F during HFNC were analyzed. To predict HFNC outcomes, a nomogram was constructed based on predictive factors. A total of 139 patients with arterial blood gas data were included in the S/F and P/F analyses. S/F < 230 at initiation showed high prediction accuracy for HFNC failure (area under the receiver operating characteristic curve: 0.751). Univariate analyses identified S/F < 230 at HFNC initiation and < 200 at 2 h (odds ratio [OR] 12.83, 95% CI 5.06–35.84), and hemato-oncologic disease (OR 3.79, 95% CI 1.12–12.78) as significant predictive factors of HFNC failure. The constructed nomogram had a highly predictive performance, with a concordance index of 0.765 and 0.831 for the exploratory and validation groups, respectively. S/F may be used as a predictor of HFNC outcomes. Our nomogram with S/F for HFNC failure within 2 h may prevent delayed intubation in children with AHRF.

Peg-Asparaginase Administration on Day 3 of Remission Induction Accelerates MRD Response in Children with B-Cell Precursor Acute Lymphoblastic Leukemia

To improve the outcome of children with standard and intermediate risk acute lymphoblastic leukemia (ALL) by the addition of PEG-asparaginase (PEG) on day 3 of remission induction was one of the key aims of trial ALL MB-2008 (J. Roumjantseva et al, Pediatriya, 2009). Therapy was designed based on previous MB-group studies (A. Karachunsky et al, Leukemia, 2008). Aim of the present study was to evaluate the influence of day 3 PEG on the end-induction MRD-status which is one of the significant predictors of outcome in children with B-cell precursor ALL (BCP-ALL).Patients and methods. In total, 474 patients (242 boys and 232 girls aged 1 to 17 years (median 5 years 8 months) were studied. Inclusion criteria were: BCP-ALL, treatment according to protocol ALL MB-2008, compliance with standard risk group (SRG, n=266) and intermediate risk group (ImRG, n=208) criteria according to the protocol stratification system, and availability of end-induction (day 36) bone marrow (BM) samples. Remission induction of ALL MB-2008 consisted of oral dexamethasone (6mg/m2 daily), 5 injections of vincristine (1,5 mg/m2), 0-2 injections of daunorubicin (DNR, 45 mg/m2) and 6 triple intrathecal injections. Patients were randomized in respect to PEG administration on day 3. SRG patients were divided into three groups (PEG+DNR+, PEG+DNR- and PEG-DNR+); ImRG patients were split into two (PEG+DNR+ and PEG-DNR+). MRD detection was performed by multicolor flow cytometry (MFC) in three reference laboratories. Samples with a tumor cell level above 0.01% were considered MRD-positive. Outcome parameters were event-free survival (EFS) and cumulative incidence of relapse (CIR). Median of follow up was 5 years.Results. Outcome in 474 study group patients was not significantly different from outcome of 2310 children with BCP-ALL enrolled in SRG and ImRG of ALL MB-2008 trial in whom MRD was not studied: EFS was 0.86±0.02 and 0.84±0.01, respectively, p=0.14, and CIR was 0.12±0.02 and 0.09±0.01, p=0.38.MFC MRD data obtained at day 36 had a significant impact on prognosis in SRG patients. EFS as well as CIR were worse for patients with MRD >0.1% (n=26; EFS 0.47±0.15, CIR 0.49±0.17) compared with 248 patients with low/negative MRD (EFS 0.94±0.2, CIR 0.05±0.02, p<0.001). Nevertheless, the distribution of MRD levels was completely different dependent on randomization arms: in arm PEG-DNR+ (n=92) 18.5% of patients belonged to the group with unfavorable MRD compared with only 6.2% in arm PEG+DNR- (n=80, p=0.017) and 4.3% in arm PEG+DNR+ (n=94, p=0.002). Interestingly, in two PEG+ arms the number of patients with high MRD was not significantly different (p=0.558). Despite the lower proportion of high MRD levels in PEG+ arms MRD maintained its prognostic significance also in these patients. EFS was 0.65±0.16 and CIR 0.35±0.18 in 9 children with MRD ≥0.1 compared with EFS 0.94±0.02 and CIR 0.05±0.02 in 165 patients of the low MRD group (p<0.001 for both EFS and CIR).In ImRG, MFC MRD data disclosed a prognostic value, as well. EFS was 0.92±0.03 and CIR 0.06±0.02 for 143 patients with MRD-negativity on day 36; in contrast, outcome of 78 MRD-positive patients was significantly inferior (EFS 0.73±0.06, CIR 0.25±0.06, p<0.001 for both comparisons). Like in SRG, in ImRG the distribution of MRD levels was different between two randomization arms. In PEG-DNR+ group (n=93) only 54.8% of patients were MRD-negative at the end of remission induction. In contrast, in PEG+DNR+ group (n=115) the proportion of patients with favorable MRD results was significantly higher (76.5%, p=0.001). Again even with low number of MRD-positive cases in PEG+ arm, day 36 MRD disclosed a significant influence on outcome: In 88 MRD-negative patients EFS was 0.93±0.03 and CIR 0.05+0.03, significantly better than in 27 MRD-positive patients (EFS 0.80+0.08 and CIR 0.17+0.08, p=0.025 and p=0.019, respectively).Conclusions. Administration of PEG at day 3 of remission induction leads to a more rapid MRD response in children both with standard-risk and intermediate-risk BCP-ALL. In SRG, rapidity of MRD clearance in PEG+ arms was independent of the additional administration of daunorubicin. We conclude that end-induction MRD data are independent predictors of outcome despite the small proportion of MRD-positive patients after the implementation PEG during induction. DisclosuresNo relevant conflicts of interest to declare.

The Role of Social Skills in Predicting Treatment-Recovery in Children with a Social Anxiety Disorder

The current study investigated the role of social skills and its interaction with social anxiety as predictors of treatment outcome in children with an anxiety disorder either with or without a social anxiety disorder (SoAD). In total, 133 children (aged 8 to 13) with an anxiety disorder received a 10-session cognitive behavioral treatment (FRIENDS program). Pre- to post treatment Reliable Change (RC) and Treatment-Recovery (TR) were assessed from a multi-informant perspective, by including diagnostic information (ADIS C/P), child-reported anxiety symptoms (MASC) and parent-reported internalizing symptoms (CBCL-Int). Social skills were assessed with the parent-rated Social Skills Rating System (assertion, self-control, responsibility). Results showed that 1) parents of children with a SoAD reported significantly less favorable use of assertive and responsible social behavior in their children pre-treatment than parents of children without SoAD, 2) children with higher social skills had a better treatment recovery, and 3) children with anxiety and higher responsible behavior pre-treatment and without a SoAD had a better treatment recovery, but this effect did not show for children with SoAD. In conclusion, better use of social behavior increased the likelihood of treatment recovery but not of reliable change. Further studies on the role of social skills in the treatment of childhood (social) anxiety are needed to investigate the mechanisms by which social skills impact treatment outcome.

Predictors of outcomes in children with Central Nervous System tuberculosis

BackgroundCentral Nervous system tuberculosis (CNS–Tb) is the most lethal form of extra-pulmonary tuberculosis in children. The lack of markers of outcome provides little information on the efficacy of the current treatment protocols for CNS–Tb and thus results in a higher mortality rate than other extrapulmonary manifestations of tuberculosis. This study aims to identify significant factors that will reliably predict the outcomes at discharge in children admitted with CNS–Tb. Methods and materialThis is a prospective observational study in children with neurotuberculosis admitted at a tertiary care hospital. Clinical presentations at the time of admission were studied. Outcomes at the end of in-patient care (completely cured, survival with some/severe disability or death) were correlated with clinical, laboratory, microbiological, and radiological parameters. Univariate and multivariate analyses were applied to study the parameters and a p-value ≤ 0.05 with a confidence interval (CI) of 95% was considered as statistically significant. FindingsThe study included 100 children between 4 months and 12 years of age with a mean of 5.84 (±3.5) years. At discharge, 55% of children recovered completely, 20% had some or severe disability and 25% died. On multivariate analysis, high CSF protein (p = 0.050) and drug resistance (p = 0.034) were highly associated with fatality. Meningeal enhancements with basal exudates (p = 0.021) and CSF lymphocyte count >90% were highly associated with survival with disability. Stage I disease at presentation (p < 0.0001) was the only variable associated with complete recovery. InterpretationReliable prognostic markers for CNS–Tb can aid in predicting the efficacy of the current treatment and the anticipated outcome in the children with this disease. FundingThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Caregiver Behaviors and Child Distress in Trauma Narration and Processing Sessions of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an effective treatment for children impacted by trauma, and non-offending caregivers play an important role in this treatment. This study aims to identify correlates of four caregiver variables that have been identified as predictors of child outcomes in TF-CBT: support, cognitive-emotional processing, avoidance, and blame/criticism. Audio recorded sessions were coded from a community effectiveness trial of TF-CBT that included 71 child-caregiver dyads participating in the trauma narration and processing phase of treatment. Regression analyses were conducted to examine caregiver trauma history and child baseline symptoms (internalizing, externalizing, and posttraumatic stress disorder [PTSD] symptoms) as predictors of caregiver behavior during the trauma processing sessions. Caregivers who reported exposure to more trauma types exhibited more in-session avoidance and also processing during the trauma processing phase of treatment. Child symptoms at baseline did not predict caregiver in-session behaviors. Bivariate correlations were used to investigate concurrent associations between mean levels of in-session caregiver behaviors and in-session child distress (negative emotion, hopelessness, negative behaviors). More caregiver blame/criticism was associated with more in-session child distress on all three measures. Caregiver avoidance was associated with more child negative emotion and hopelessness. Findings may help identify therapeutic targets when working with caregivers to promote change and enhance TF-CBT outcomes.

Reflective functioning and empathy among mothers of school-aged children: Charting the space between.

Parental child-focused reflective functioning (RF)-understanding children's behavior as a function of mental states-and parental empathy-understanding, resonating with, and feeling concern for children's emotions-have each been linked to sensitive caregiving and children's attachment security in separate studies, but they have been neither directly compared nor have researchers tested whether they interact in predicting child outcomes. In this article, we offer theoretical perspectives regarding differences between the constructs, potential points of connection, and ways in which these constructs may function together. Then we test these ideas empirically with 2 samples of mothers of school-age children, exploring their unique and interactive associations with parenting sensitivity, children's attachment security, and children's emotion regulation. In Study 1, mothers (N = 105) watched their children completing a stressor task (i.e., an impossible puzzle); mothers then answered interview questions, from which separate teams coded state-like RF and empathy. In Study 2, mothers (N = 72) completed the Parent Development Interview, coded separately for trait-like parental RF and empathy. Results of the 2 studies converged, revealing moderate positive associations between parental RF and empathy. Further, both RF and empathy were positively associated with specific child outcomes (e.g., attachment security); also, there were unique patterns of association (e.g., parental empathy was uniquely associated with child physiological regulation [neuroendocrine reactivity]) and evidence that critical levels of both are important (e.g., for supportive parenting, accuracy of emotion judgment). Parental RF and empathy might be related to each other and to distinguishable capacities that contribute to attachment and related outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Predicting child outcomes in Bhutan: Contributions of parenting support and early childhood education programmes

The Royal Government of Bhutan has increasingly emphasised Early Childhood Care and Development (ECCD). The Ministries of Education and Health provide services to support child development, including health care, Care for Child Development (C4CD) and centre-based ECCD programmes. C4CD is an evidence-based parenting programme for children younger than 36 months, while centre-based programmes are provided for children aged 3–5 years. This study examined the association of participation in C4CD and ECCD programmes with child development. A list of 54 randomly selected ECCD centres from nine districts in Bhutan was generated. We surveyed 232 parents of 3–5-year-olds from the 54 centres and another 245 parents from nearby areas whose 3–5-year-old children were not attending ECCD programmes. Parents reported on home-based activities and early childhood development. Controlling for sociodemographic variables, we found that both ECCD attendance and C4CD participation were positively associated with child developmental outcomes, particularly in the Learning and Psychosocial Well-being domains. Children who were attending ECCD programmes had higher developmental outcomes than non-attenders, and the gap between the two groups was greatest among older children. Parents who participated in C4CD provided more stimulating home learning environments than other parents, with most variability within home learning environments observed within subsample of parents whose children did not attend ECCD programmes. In addition, the frequency of home-based activities fully mediated the relationship between C4CD participation and child developmental outcomes. The findings support the scaling up of both ECCD and C4CD programmes.

Lactate Clearance at 24 of Hours as Predictors of Outcome in Children with Shock

Background: Monitoring of tissue perfusion markers like lactate and its clearance is necessary for early recognition of shock in sick children which will enable the caregiver to initiate an appropriate and timely therapy. Objective: To study the blood lactate clearance at 24 hours of admission and its prognostic importance in predicting the outcomes in children with shock. Methods: This was a “prospective observational” study, conducted in NICU and PICU at Sparsh multispeciality hospital, Bhilai and Jagannath hospital, Bhubaneswar over 80 children presented with shock, from January 2018 to December 2020. Blood lactate level at admission and after 24 hours were evaluated and lactate clearance was compared with mortality. Results: In lactate clearance &gt;20% group, mortality was only 3.8% wherein LC&lt;20% group, mortality was 52.17%. In Lactate clearance &lt; 10% group, inotropes (p0.0002), ventilator support (p-0.0015) were needed more than Lactate clearance &gt; 20% group. When initial lactate &gt;6mmol/dl, 35% of neonates died in comparison to 11.76% in the group having initial lactate &lt;6mmol/dl. The average lactate clearance among the survivors was 28.35% and among the non-survivors was 5.73% (P &lt;0.001). AUC between lactate clearance and mortality was 0.73 suggestive of a good correlation. Conclusion: Lactate clearance of less than 10% at 24 hours of admission showed a good correlation in predicting the mortality in children with shock.

Prognostic factors and predictors of outcome in children with autism spectrum disorder: the role of the paediatrician

BackgroundAutism spectrum disorder is a complex condition with wide variation in type and severity that involves persistent challenges in social interaction, speech and nonverbal communication, restricted/repetitive behaviours and adaptive behaviours. In recent years, research has deepened the study of the predictive factors of optimal outcome, intended as indicators of positive trajectory in children with a previous diagnosis of autism who, after a therapeutic path, show a significant reduction in the “core” symptoms of autism and a positive evolution in social, adaptive, affective, and relational skills.MethodsThe study included 40 children aged 21 to 66 months, enrolled between 2015 and 2016 for an autism spectrum disorder clinical suspicious. Children were re-evaluated after at least 2 years of therapy and they were divided into two groups: the ASD-ASD group included children with a confirmed diagnosis of ASD, and the ASD-OO comparison group included children who no longer met the criteria for an autism classification. The aim of this retrospective study was to investigate the presence of cognitive, emotional and relational predictors capable of predicting the presence of optimal outcome in with a diagnosis of autism; the predictors taken into consideration were the intelligence quotient, the play, the emotional contagion and the understanding of other’s intentions. In this way, it is possible to support clinicians in defining a more complete diagnostic framework of autism, using assessment tools that can be administered quickly and therefore suitable for short observation sessions in paediatric patients.ResultsThe findings showed that 15 out of 40 children, after at least for 2 years, no longer fell into the diagnostic ASD category based on the ADOS-2, DSM-5 and clinical criteria. The children in the ASD-OO group initially had a higher IQ than those in the ASD-ASD group, lower severity of autistic symptoms, greater understanding of intentions, more emotional contagion, and better quality of play. The results suggest that the initial coexistence of skills in these areas at the time of the first diagnostic assessment may allow us to predict the possibility of achieving optimal outcome after 2 years of therapy.ConclusionsThe data of this study highlight the importance of considering, during assessment, intelligence quotient, play, emotional contagion, and understanding of the intentions of others as potential prognostic predictors that can become useful tools for clinicians and paediatricians. This allows us to focus attention, in both the diagnostic and prognostic phases, on emotional-relational variables that can support the clinician in defining a more complete diagnostic framework and in planning a more personalized therapeutic path.

Predictors of outcome in children with disorders of mitochondrial metabolism in the pediatric intensive care unit.

BackgroundThe aim of this study was to identify factors predicting outcome in patients with mitochondrial disease admitted to pediatric intensive care units (PICU).MethodsRetrospective study of 2434 patients (age <21 years) admitted to a PICU from 1 January 2006 through 31 March 2016 and captured in the Virtual Pediatric Systems database with ICD9 diagnosis 277.87, disorders of mitochondrial metabolism. Factors influencing mortality and prolonged length of stay (≥14 days) were analyzed using logistic regression.ResultsPredictors independently affecting mortality (adjusted odds ratios and 95% confidence intervals, p < 0.05): age 1–23 months 3.4 (1.7–6.6) and mechanical ventilation 4.7 (2.6–8.6) were risk factors; post-operative 0.2 (0.1–0.6), readmission 0.5 (0.3–0.9), and neurologic reason for admittance 0.3 (0.1–0.9) were factors reducing risk. Predictors affecting prolonged length of stay: mechanical ventilation 7.4 (5.2–10.3) and infectious reason for admittance 2.0 (1.3–3.2) were risk factors, post-operative patients 0.3 (0.2–0.5) had lower risk. The utility of PRISM and PIM2 scores in this patient group was evaluated.ConclusionsThe single most predictive factor for both mortality and prolonged length of stay is the presence of mechanical ventilation. Age 1–23 months is a risk factor for mortality, and infectious reason for admittance indicates risk for prolonged length of stay.Impact Presence of mechanical ventilation is the factor most strongly associated with negative outcome in patients with mitochondrial disease in pediatric intensive care.Age 1–23 months is a risk factor for mortality, and infectious reason for admittance indicates risk for prolonged length of stayPRISM3 and PIM2 are not as accurate in patients with mitochondrial disease as in a mixed patient population

Clinical features and outcome of pediatric acute lymphoblastic leukemia with low peripheral blood blast cell count at diagnosis.

Peripheral blood (PB) blast cell count on day 8 of prednisone therapy has been considered one of the strongest predictors of outcome in children with acute lymphoblastic leukemia (ALL). However, little is known about the clinical features and prognostic impact of PB blast cell count at diagnosis in these patients. The aim of this study was to evaluate the relationship between initial PB blast cell count and clinical prognosis of pediatric ALL.The study comprised 367 patients with ALL, aged 0 to 14 years, enrolled and treated using the Chinese Children's Leukemia Group-ALL 2008 protocol between 2011 and 2015. The majority (91.6%) of patients were B-cell precursor ALL (BCP ALL), and 8.4% were T-cell ALL (T-ALL).Patients with BCP ALL in the low PB blast cell count group (<1 × 109/L) had significantly superior survival rates to those in the high count group (≥30 × 109/L). In T-ALL, the low count group showed significantly inferior survival rates compared to both the intermediate count group (1–29.9 × 109/L) and high count group. Multivariate analysis revealed that the initial white blood cell count and minimal residual disease at the end of induction therapy were independently predictive of BCP ALL outcome, while risk stratification was shown to be an independent prognostic factor for T-ALL outcome.These results indicated that low blast cell count in PB at diagnosis was associated with different clinical outcomes in patients with BCP ALL and T-ALL, although it was not an independent outcome predictor by multivariate analysis.

Clinical Profile and Predictors of Outcome in Children with Acute Fulminant Myocarditis Receiving Intensive Care: A Single Center Experience.

Acute myocarditis in children is associated with high morbidity and mortality, with limited data on intravenous immunoglobulin (IVIG) treatment and outcome. Our goal was to describe clinical, treatment profile, and predictors of outcome in children with acute fulminant myocarditis (AFM) receiving intensive care. Case records of 120 children with clinical diagnosis of acute myocarditis from January 2008 to December 2018 were analyzed retrospectively. AFM was seen in 89 (74.2%) children of which nearly two-thirds (54 [60.7%]) were hypotensive at admission. The median (interquartile range [IQR]) ejection fraction on echocardiography was 25 (18.5-36%). Eighty-two children (68.3%) received IVIG. Intensive care needs were mechanical ventilation ( n = 71; 59.2%) and inotrope support ( n = 89; 74.2%); median inotrope score being 30 (IQR: 20-55). Twenty-one children died (17.5%). Fever ( p = 0.004), arrhythmia ( p = 0.03), shock ( p = 0.015), higher inotrope score ( p = 0.0001), need for ventilation ( p = 0.025), acidosis ( p = 0.013), AKI ( p = 0.0001), transaminitis ( p = 0.0001), and multiorgan dysfunction ( p = 0.0001) were associated with mortality. The mortality was significantly less in IVIG treated group (12.1 vs. 28.9%; p = 0.02). On multiple logistic regression, MODS ( p = 0.002) was independent predictor of mortality while IVIG treatment ( p = 0.004) was favorably associated with survival. AFM complicated by multiorgan dysfunction carried a poor prognosis. IVIG was associated with survival benefit.

Serum phosphate level as a predictor of outcome in children with acute liver failure

Serum phosphate level as a predictor of outcome in children with acute liver failure

Predicting the postoperative blood coagulation state of children with congenital heart disease by machine learning based on real-world data.

BackgroundPostoperative blood coagulation assessment of children with congenital heart disease (CHD) has been developed using a conventional statistical approach. In this study, the machine learning (ML) was used to predict postoperative blood coagulation function of children with CHD, and assess an array of ML models.MethodsThis was a retrospective and data mining study. Based on the samples of 1,690 children with CHD, and screening data based on demographic characteristics, conventional coagulation tests (CCTs) and complete blood count (CBC), with a precise data selection process, and the support of data mining and ML algorithms including Decision tree, Naive Bayes, Support Vector Machine (SVM), Adaptive Boost (AdaBoost) and Random Forest model, and explored the best prediction models of postoperative blood coagulation function for children with CHD by models performance measured in the area under the receiver operating characteristic (ROC) curve (AUC), calibration or Lift curves, and further verified the reliability of the models with statistical tests.ResultsIn primary objective prediction, as decision tree, Naive Bayes, SVM, the AUC of our prediction algorithm was 0.81, 0.82, 0.82, respectively. The accuracy rate of the overall forecast has reached more than 75%. Subsequently, we furtherly build improved models. Among them, the true positive rate of the AdaBoost, Random Forest and SVM prediction models reached more than 80% in the ROC curve. These overall accuracy rate indicated a good classification model. Combined calibration curves and Lift curves, the better fit is the SVM model, which predicted postoperative abnormal coagulation, Lift =2.2, postoperative normal coagulation, Lift =1.8. The statistical results furtherly proved the reliability of ML models. The age, sex, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), white blood cell count (WBC) and platelet count (PLT) were the key features for predicting the postoperative blood coagulation state of children with CHD.ConclusionsML technology and data mining algorithms may be used for outcome prediction in children with CHD for postoperative blood coagulation state based on the bulk of clinical data, especially CBC indictors from the real world.

Оценка эффективности использования прогностических шкал у детей с нейроинфекциями

Accurate assessment of the disease severity and outcome prediction in children with neuroinfections is one of the most challenging problems in pediatric intensive care. Objective. To evaluate performance characteristics of several prognostic scales used in children with infections of the central nervous system (CNS). Patients and methods. We examined 100 children with a mean age of 3.5 years. Mean length of stay in the intensive care unit was 9.5 days; mean duration of ventilation was 6.0 days. The death rate was 11%. To evaluate patients’ condition, we used the following scales: PELOD2, PELOD, PRISM3, and pSOFA. Results. We found that 65% of patients had depressed consciousness; 22% of patients had high-grade fever. The stroke volume and ejection fraction were near the lower reference limit, while 20% of children had their ejection fraction ≤ 60%. Leukocytosis was observed in 51 children; 37 children had anemia. Hyponatremia was registered in 17% of cases. Severe hypocoagulation was observed in 7% of cases in patients with generalized meningococcal infection. We found that thrombocytopenia (117 × 109 cells/L) and SpO2/FiO2 ratio &lt;200 mm Hg were the main predictors of death. The рSOFA scale demonstrated the highest accuracy among the scales studied (AUC = 0.717). Conclusion. The рSOFA scale is a highly sensitive and specific scale for the assessment of death risk in children with CNS infections, which allows us to recommend it for routine clinical practice. Key words: CNS infections, children, prognostic scales, PELOD, PELOD-2, рSOFA, SOFA

Liver Transplantation in Children and Impact of Intraoperative Goal Directed Therapies on Postoperative Outcome

Background: Liver transplantation is a hemorrhagic surgery with high postoperative complication rates in terms of organ dysfunction and infections. We conducted a retrospective observational monocentric study that had the objectives of determining predictors of postoperative outcome in children. In the initial cohort, 19 children underwent liver transplantation. A description of the postoperative outcomes of these patients was undertaken. Objective: To describe intraoperative and postoperative outcomes in children undergoing liver transplantation and to propose intraoperative management implementation measures for postoperative outcome improvement. Methods: Secondary analysis of liver transplanted patients included in the initial study. Results: There were 19 patients who underwent liver transplantation with a median age of 31[2-154] months. Five patients had re-operations (26.3%). Fourteen (73.7%) had intraoperative and/or postoperative complications. Five (26.3%) had intraoperative hemorrhagic shock. One (5.3%) had postoperative respiratory failure, one (5.3%) had postoperative multiple organ failure, two (10.5%) had postoperative neurologic failure and five (26.3%) had cardio-circulatory failure. One (5.3%) had postoperative pulmonary sepsis, five (26.3%) had postoperative abdominal sepsis, and six (31.6%) had postoperative septicemia. Intra-operative transfusion rate was 100%. In-hospital mortality rate was 10.5% (two patients). Conclusion: There were multiple postoperative adverse outcome predictors. Optimal intraoperative patient management with transfusion guided by point-of-care viscoelastic devices and goal-directed fluid and hemodynamic therapy with validated parameters and tools in children is a possible pathway to upgrade postoperative evolution in pediatric liver transplantation.

Major Abdominal Surgery, Neurosurgery, Orthopedic Surgery in Children aged between 10 and 18 Years and Postoperative Outcome

Background: In a previously conducted monocentric retrospective study, predictors of postoperative outcome in children included American Society of Anesthesiologists score, transfusion, emergency interventions, surgery and age. A study has been undertaken to describe postoperative outcome in patients aged between 10 and 18 years included in the initial study in abdominal surgery, neurosurgery and orthopedics. Aims: To describe postoperative outcome in children aged between 10 and 18 years. Methods: Secondary analysis of postoperative outcome in children aged between 10 and 18 years included retrospectively in the initial study of 594 patients. The study was approved by the Ethics Committee. Results: There were 221 children with a mean age of 165.5±24.3 months in abdominal surgery, neurosurgery and orthopedics. 16.3% patients had intra-operative or postoperative complications. Intra-operatively, 3.2% had hemorrhagic shock, 0.45% anaphylaxis and 0.45% respiratory failure. Postoperatively, 3.2% had neurologic failure, 2.3% respiratory failure, 0.45% cardio-circulatory failure, 0.45% endocrinal failure, 0.45% had hepatic failure, 0.45% multiple organ failure, and 0.45% had renal failure. In-hospital mortality rate was 0.45%. Conclusion: These results emphasize the importance of optimizing intra-operative management in critically ill patients in major surgery with goal directed therapies in order to improve postoperative outcome.

The accuracy of serum ferritin as predictor of outcome in children diagnosed with sepsis admitted at the PICU Of a tertiary government hospital

The accuracy of serum ferritin as predictor of outcome in children diagnosed with sepsis admitted at the PICU Of a tertiary government hospital

ADHD at Age 7 and Functional Impairments at Age 10.

Attention-deficit/hyperactivity disorder (ADHD) cohort studies have typically involved clinical samples and have usually recruited children across wide age ranges, limiting generalizability across complexity and developmental stage. We compared academic, emotional-behavioral and social functioning at age 10, and predictors of outcomes, in a nonreferred cohort of children recruited at age 7, between those with full-syndrome (FS) ADHD and controls with no ADHD. This was a prospective cohort study with a 3-year follow-up period. Children were recruited from 43 socioeconomically diverse schools in Melbourne, Australia. Multi-informant outcomes at age 10 were academic functioning (Wide Range Achievement Test 4; Social Skills Improvement System), emotional-behavioral functioning (Strengths and Difficulties Questionnaire total), and social functioning (Strengths and Difficulties Questionnaire peer problems). Outcomes were compared across the groups by using adjusted random-effects linear regression analyses. In total, 477 children (62% male) were recruited at a mean (SD) age of 7.3 years (0.4). There were 179 participants with FS ADHD, 86 with ST ADHD, and 212 controls. Sample retention was 78.2% at 3-year follow-up. Both the FS and ST groups were functioning worse than controls on almost all outcome measures. The best predictors of outcome for children with ADHD were working memory (academic outcome, P < .001), ADHD symptom severity (emotional-behavioral outcome, parent: P < .001; teacher: P < .01), and autism spectrum disorder symptoms (emotional-behavioral outcome, parent P = .003; social outcome, parent P = .001). Children with FS and ST ADHD at age 7 experience persisting functional impairments across domains at age 10. The predictors identified at age 7 present potential targets for intervention to ameliorate impairments.

Admission platelet count and indices as predictors of outcome in children with severe Sepsis: a prospective hospital-based study

BackgroundSepsis is still one of the main causes of infants and children mortality especially in developing, economically challenged countries with limited resources. Our objective in this study was to determine, the prognostic value of platelet count, mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) in critically ill infants and children with severe sepsis, as they are readily available biomarkers, that can guide clinicians during managing of severe sepsis.MethodsSixty children were included; they were diagnosed with severe sepsis according to the international pediatric sepsis consensus conference criteria. At admission to Pediatric intensive care unit, complete blood count with platelet count and parameters (MPV, PDW and PCT) and C-reactive protein (CRP) level were determined for all children. Also, assessment of the Pediatric Risk of Mortality (PRISM III) score was done to all. These children were followed up till discharge from hospital or death. Accordingly, they were grouped into: (1) Survivor group: included 41 children. (2) Non-survivor group: included 19 children.ResultsPlatelet count and PCT were significantly lower (p < 0.001) and MPV was significantly higher in non-survivor than survivors (p = 0.004). MPV/PLT, MPV/PCT, PDW/PLT, PDW/PCT ratios were found to be significantly higher in the non-survivors than survivor (p < 0.001 in all). PCT with sensitivity = 94.74%, was the most sensitive platelet parameter for prediction of death, while MPV/PCT was the most sensitive ratio (sensitivity = 94.7%).ConclusionThrombocytopenia, platelet indices and their ratios, especially plateletcrit and MPV/PCT, are readily available, sensitive, prognostic markers, that can identify the severe sepsis patients with poorest outcome.