Publications by authors named "Aline B Maddux"
Objectives: To describe frequency of, and risk factors, for change in caregiver employment among critically ill children with acute respiratory failure.
Design: Preplanned secondary analysis of prospective cohort dataset, 2018-2021.
Setting: Quaternary Children's Hospital PICU.
Article Synopsis
- Viral lower respiratory tract infection (vLRTI) significantly impacts global child health, prompting research into the host immune responses using proteomics for better understanding and diagnosis.
- The study analyzed 1,305 proteins from tracheal aspirate and plasma of 62 critically ill children, finding 200 differentially expressed proteins that reveal key immune responses, with a robust nine-protein TA classifier showing high diagnostic accuracy (AUC of 0.96).
- It also highlighted the limited correlation between tracheal aspirate and plasma proteins and examined how viral load and bacterial co-infections influence immune signaling pathways.
Article Synopsis
- Viral lower respiratory tract infection (vLRTI) is a major cause of pediatric hospitalization and mortality globally, yet the immune responses involved are not well understood.
- A study analyzed over 1,300 proteins in tracheal aspirate and plasma from critically ill children, identifying significant protein changes linked to vLRTI and developing a diagnostic tool with high accuracy.
- Key findings included increased interferon and T cell responses in the lower airway, distinct protein profiles in plasma, and novel protein biomarkers that could enhance diagnostic approaches for severe vLRTI.
Introduction: Sepsis-induced degradation of endothelial glycocalyx heparan sulfate (HS) contributes to the pulmonary microvascular endothelial injury characteristic of acute respiratory distress syndrome (ARDS) pathogenesis. Our objectives were to (1) examine relationships between plasma indices of HS degradation and protein biomarkers of endothelial injury and (2) identify patient subgroups characterized by distinct profiles of HS degradation in children with ARDS. Methods: We analyzed prospectively collected plasma (2018-2020) from a cohort of invasively mechanically ventilated children (aged >1 month to <18 years) with ARDS.
View Article and Find Full Text PDFObjectives: To determine the frequency of and risk factors for increased post-sepsis healthcare utilization compared with pre-sepsis healthcare utilization.
Design: Retrospective observational cohort study.
Setting: Years 2016-2019 MarketScan Commercial and Medicaid Database.
Article Synopsis
- During the COVID-19 pandemic, a case series highlighted four pediatric patients who developed severe lung injuries requiring ECMO support due to acute COVID-19 pneumonia.
- The study revealed that all four patients successfully underwent extubation and achieved some mobility while on ECMO, with durations of support ranging from 35 to 152 days and hospital stays from 52 to 167 days.
- Out of the four patients, three survived, with two maintaining normal functional status at discharge, while one had significant motor deficits but received ongoing respiratory support.
Pediatric COVID-19 vaccination is effective in preventing COVID-19-related hospitalization, but duration of protection of the original monovalent vaccine during SARS-CoV-2 Omicron predominance merits evaluation, particularly given low coverage with updated COVID-19 vaccines. During December 19, 2021-October 29, 2023, the Overcoming COVID-19 Network evaluated vaccine effectiveness (VE) of ≥2 original monovalent COVID-19 mRNA vaccine doses against COVID-19-related hospitalization and critical illness among U.S.
View Article and Find Full Text PDFArticle Synopsis
- A study investigated the impact of pre-existing immunocompromising conditions (ICCs) on pediatric patients with acute COVID-19 admitted to intensive care across 55 hospitals in the U.S.!
- Out of 1,274 patients, 105 had ICCs, which were linked to higher in-hospital mortality (11.4% vs. 4.6%) and longer hospital stays, although initial disease severity was similar between those with and without ICCs.!
- Despite the challenges, most patients with ICCs survived and left the hospital without new severe health issues, highlighting a positive aspect of the outcomes for these vulnerable patients.!
Objectives: To describe family healthcare burden and health resource utilization in pediatric survivors of acute respiratory distress syndrome (ARDS) at 3 and 9 months.
Design: Secondary analysis of a prospective multisite cohort study.
Setting: Eight academic PICUs in the United States (2019-2020).
Article Synopsis
- The study developed a 7-point Desirability of Outcome Ranking (DOOR) scale to assess outcomes in children with septic shock, aiming to link it to their health-related quality of life (HRQL) or death over three months.
- * It involved a secondary analysis of data from the Life After Pediatric Sepsis Evaluation study conducted in 12 U.S. Pediatric Intensive Care Units (PICUs) from 2013 to 2017, focusing on patients aged 1 month to 18 years with septic shock.
- * The findings revealed fair correlations between the PCC-DOOR scores measured at 7, 14, and 21 days post-admission and outcomes related to HRQL or death, suggesting the scale could be
Objectives: To characterize health-related quality of life (HRQL) and functional recovery trajectories and risk factors for prolonged impairments among critically ill children receiving greater than or equal to 3 days of invasive ventilation.
Design: Prospective cohort study.
Setting: Quaternary children's hospital PICU.
Background: Many children with severe traumatic brain injury (TBI) receive magnetic resonance imaging (MRI) during hospitalization. There are insufficient data on how different patterns of injury on early MRI inform outcomes.
Methods: Children (3-17 years) admitted in 2010-2021 for severe TBI (Glasgow Coma Scale [GCS] score < 9) were identified using our site's trauma registry.
Article Synopsis
- A study analyzed the clinical characteristics and vaccination status of young children hospitalized for acute COVID-19 across 28 pediatric hospitals in the U.S. from September 2022 to May 2023.
- Of the 597 children examined, only 4.5% had completed their primary COVID-19 vaccination series, while 7.0% had started but not completed it, with the majority being unvaccinated.
- Most children admitted with severe COVID-19, including those requiring intensive care, were previously healthy and had not initiated vaccination, highlighting a concerning gap in immunization among vaccine-eligible young kids.
Objectives: To evaluate for associations between a child's neighborhood, as categorized by Child Opportunity Index (COI 2.0), and 1) PICU mortality, 2) severity of illness at PICU admission, and 3) PICU length of stay (LOS).
Design: Retrospective cohort study.
Objective: To identify risk factors for persistent impairments after pediatric hospitalization for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C) during the SARS-CoV-2 pandemic.
Methods: Across 25 U.S.
Effectiveness of Maternal mRNA COVID-19 Vaccination During Pregnancy Against COVID-19-Associated Hospitalizations in Infants Aged <6 Months During SARS-CoV-2 Omicron Predominance - 20 States, March 9, 2022-May 31, 2023.
MMWR Morb Mortal Wkly Rep
September 2023
Article Synopsis
- Infants under 6 months are not eligible for COVID-19 vaccines, but maternal vaccination during pregnancy can help protect these infants from being hospitalized due to COVID-19.
- A study found that vaccinated mothers showed a 35% effectiveness in preventing COVID-19-related hospitalizations in infants under 6 months and 54% for those under 3 months.
- Vaccinated mothers had lower rates of severe outcomes for their infants, such as intensive care unit admissions and the need for mechanical ventilation, highlighting the importance of vaccination for expectant mothers.*
Objectives: Viral lower respiratory tract infection (vLRTI) contributes to substantial morbidity and mortality in children. Diagnosis is typically confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) of nasopharyngeal specimens in hospitalized patients; however, it is unknown whether nasopharyngeal detection accurately reflects presence of virus in the lower respiratory tract (LRT). This study evaluates agreement between viral detection from nasopharyngeal specimens by RT-PCR compared with metagenomic next-generation RNA sequencing (RNA-Seq) from tracheal aspirates (TAs).
View Article and Find Full Text PDFBackground: Sepsis-associated destruction of the pulmonary microvascular endothelial glycocalyx (EGCX) creates a vulnerable endothelial surface, contributing to the development of acute respiratory distress syndrome (ARDS). Constituents of the EGCX shed into circulation, glycosaminoglycans and proteoglycans, may serve as biomarkers of endothelial dysfunction. We sought to define the patterns of plasma EGCX degradation products in children with sepsis-associated pediatric ARDS (PARDS), and test their association with clinical outcomes.
View Article and Find Full Text PDFImportance: Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTIs) and infant hospitalization worldwide.
Objective: To evaluate the characteristics and outcomes of RSV-related critical illness in US infants during peak 2022 RSV transmission.
Design, Setting, And Participants: This cross-sectional study used a public health prospective surveillance registry in 39 pediatric hospitals across 27 US states.
Objectives: To develop, evaluate, and explore the use of a pediatric ordinal score as a potential clinical trial outcome metric in children hospitalized with acute hypoxic respiratory failure caused by viral respiratory infections.
Design: We modified the World Health Organization Clinical Progression Scale for pediatric patients (CPS-Ped) and assigned CPS-Ped at admission, days 2-4, 7, and 14. We identified predictors of clinical improvement (day 14 CPS-Ped ≤ 2 or a three-point decrease) using competing risks regression and compared clinical improvement to hospital length of stay (LOS) and ventilator-free days.
Importance: Acute neurological involvement occurs in some patients with multisystem inflammatory syndrome in children (MIS-C), but few data report neurological and psychological sequelae, and no investigations include direct assessments of cognitive function 6 to 12 months after discharge.
Objective: To characterize neurological, psychological, and quality of life sequelae after MIS-C.
Design, Setting, And Participants: This cross-sectional cohort study was conducted in the US and Canada.
Importance: Morbidity and mortality after pediatric cardiac arrest are chiefly due to hypoxic-ischemic brain injury. Brain features seen on magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) after arrest may identify injury and aid in outcome assessments.
Objective: To analyze the association of brain lesions seen on T2-weighted MRI and diffusion-weighted imaging and N-acetylaspartate (NAA) and lactate concentrations seen on MRS with 1-year outcomes after pediatric cardiac arrest.