Respiratory Syncytial Virus and US Pediatric Intensive Care Utilization.

Importance: Bronchiolitis is the most common diagnosis necessitating respiratory support and pediatric intensive care, and respiratory syncytial virus (RSV) is the most common cause of bronchiolitis. In 2023, the monoclonal antibody nirsevimab and the maternal RSVpreF vaccine were implemented to prevent RSV in infants.

Objective: To determine the potential association of novel RSV prevention strategies with pediatric intensive care unit (ICU) utilization.

External evaluation of the Dynamic Criticality Index: A machine learning model to predict future need for ICU care in hospitalized pediatric patients.

Objective: To assess the single site performance of the Dynamic Criticality Index (CI-D) models developed from a multi-institutional database to predict future care. Secondarily, to assess future care-location predictions in a single institution when CI-D models are re-developed using single-site data with identical variables and modeling methods. Four CI-D models were assessed for predicting care locations >6-12 hours, >12-18 hours, >18-24 hours, and >24-30 hours in the future.

Hospital survival following pediatric HSCT: changes in complications, ICU therapies and outcomes over 10 years.

Introduction: Hematopoietic stem cell transplantation (HSCT) is an increasingly utilized therapy for malignant and non-malignant pediatric diseases. HSCT complications, including infection, organ dysfunction, and graft-versus-host-disease (GVHD) often require intensive care unit (ICU) therapies and are associated with mortality. Our aims were to identify the HSCT characteristics, complications and ICU therapies associated with (1) survival, and (2) survival changes over a ten-year period in a national dataset.

The Association of the Lactate-Albumin Ratio With Mortality and Multiple Organ Dysfunction in PICU Patients.

Objectives: To compare the relative associations of lactate, albumin, and the lactate-albumin ratio (LAR) measured early in disease course against mortality and prevalence of multiple organ dysfunction syndrome (MODS) in a general sample of critically ill pediatric patients.

Design: Retrospective analysis of the Health Facts (Cerner Corporation, Kansas City, MO) national database.

Setting: U.

Clinical Instability Is a Sign of Severity of Illness: A Cohort Study.

Objectives: Test the hypothesis that within patient clinical instability measured by deterioration and improvement in mortality risk over 3-, 6-, 9-, and 12-hour time intervals is indicative of increasing severity of illness.

Design: Analysis of electronic health data from January 1, 2018, to February 29, 2020.

Setting: PICU and cardiac ICU at an academic children's hospital.

The criticality Index-mortality: A dynamic machine learning prediction algorithm for mortality prediction in children cared for in an ICU.

Background: The Criticality Index-Mortality uses physiology, therapy, and intensity of care to compute mortality risk for pediatric ICU patients. If the frequency of mortality risk computations were increased to every 3 h with model performance that could improve the assessment of severity of illness, it could be utilized to monitor patients for significant mortality risk change.

Objectives: To assess the performance of a dynamic method of updating mortality risk every 3 h using the Criticality Index-Mortality methodology and identify variables that are significant contributors to mortality risk predictions.

Implementation of a Pediatric Delirium Screening Program in a Pediatric Intensive Care Unit.

Background: Knowledge of and screening for delirium are important to patient care. As bedside caregivers, nurses are in a strategic position to observe changes that may indicate delirium.

Objective: To institute a delirium screening protocol in a pediatric intensive care unit using the Cornell Assessment of Pediatric Delirium.

Association of Congenital and Acquired Cardiovascular Conditions With COVID-19 Severity Among Pediatric Patients in the US.

Importance: Identifying the associations between severe COVID-19 and individual cardiovascular conditions in pediatric patients may inform treatment.

Objective: To assess the association between previous or preexisting cardiovascular conditions and severity of COVID-19 in pediatric patients.

Design, Setting, And Participants: This retrospective cohort study used data from a large, multicenter, electronic health records database in the US.

National Intravenous Acetaminophen Use in Pediatric Inpatients From 2011-2016.

Objective: To 1) determine current intravenous (IV) acetaminophen use in pediatric inpatients; and 2) determine the association between opioid medication duration when used with or without IV acetaminophen.

Methods: A retrospective analysis of pediatric inpatients exposed to IV acetaminophen from January 2011 to June 2016, using the national database Health Facts.

Results: Eighteen thousand one hundred ninety-seven (2.

Dynamic Mortality Risk Predictions for Children in ICUs: Development and Validation of Machine Learning Models.

Objectives: Assess a machine learning method of serially updated mortality risk.

Design: Retrospective analysis of a national database (Health Facts; Cerner Corporation, Kansas City, MO).

Setting: Hospitals caring for children in ICUs.

Association of Intravenous Acetaminophen Administration With the Duration of Intravenous Opioid Use Among Hospitalized Pediatric Patients.

Importance: Adoption of multimodal pain regimens that incorporate nonopioid analgesic medications to reduce inpatient opioid administration can prevent serious opioid-related adverse effects in children, including tolerance, withdrawal, delirium, and respiratory depression. Intravenous (IV) acetaminophen is in widespread pediatric use; however, its effectiveness as an opioid-sparing agent has not been evaluated in general pediatric inpatients.

Objective: To determine if IV acetaminophen administered prior to IV opioids is associated with a reduction in the total duration of IV opioids administered compared with IV opioids administered without IV acetaminophen in general pediatric inpatients.

Predicting Future Care Requirements Using Machine Learning for Pediatric Intensive and Routine Care Inpatients.

Unlabelled: Develop and compare separate prediction models for ICU and non-ICU care for hospitalized children in four future time periods (6-12, 12-18, 18-24, and 24-30 hr) and assess these models in an independent cohort and simulated children's hospital.

Design: Predictive modeling used cohorts from the Health Facts database (Cerner Corporation, Kansas City, MO).

Setting: Children hospitalized in ICUs.

The Association of Laboratory Test Abnormalities With Mortality Risk in Pediatric Intensive Care.

Objectives: To determine the bivariable associations between abnormalities of 28 common laboratory tests and hospital mortality and determine how mortality risks changes when the ranges are evaluated in the context of commonly used laboratory test panels.

Design: A 2009-2016 cohort from the Health Facts (Cerner Corporation, Kansas City, MO) database.

Setting: Hospitals caring for children in ICUs.

Pediatric Mortality and Acute Kidney Injury Are Associated with Chloride Abnormalities in Intensive Care Units in the United States: A Multicenter Observational Study.

Our objective was to determine in children in the intensive care unit (ICU) the incidence of hyperchloremia (>110 mmol/L) and hypochloremia (<98 mmol/L), the association of diagnoses with chloride abnormalities, and the associations of mortality and acute kidney injury (AKI) with chloride abnormalities. We analyzed the initial, maximum, and minimum chloride measurements of 14,684 children in the ICU with ≥1 chloride measurement in the Health Facts database between 2009 and 2016. For hyperchloremia and hypochloremia compared with normochloremia, mortality rates increased three to fivefold and AKI rates increased 1.

Criticality: A New Concept of Severity of Illness for Hospitalized Children.

Objectives: To validate the conceptual framework of "criticality," a new pediatric inpatient severity measure based on physiology, therapy, and therapeutic intensity calibrated to care intensity, operationalized as ICU care.

Design: Deep neural network analysis of a pediatric cohort from the Health Facts (Cerner Corporation, Kansas City, MO) national database.

Setting: Hospitals with pediatric routine inpatient and ICU care.

Severity Trajectories of Pediatric Inpatients Using the Criticality Index.

Objectives: To assess severity of illness trajectories described by the Criticality Index for survivors and deaths in five patient groups defined by the sequence of patient care in ICU and routine patient care locations.

Design: The Criticality Index developed using a calibrated, deep neural network, measures severity of illness using physiology, therapies, and therapeutic intensity. Criticality Index values in sequential 6-hour time periods described severity trajectories.

Medications for Children Receiving Intensive Care: A National Sample.

Objective: To examine medication administration records through electronic health record data to provide a broad description of the pharmaceutical exposure of critically ill children.

Design: Retrospective cohort study using the Cerner Health Facts database.

Setting: United States.

Sedation, Analgesia, and Neuromuscular Blockade: An Assessment of Practices From 2009 to 2016 in a National Sample of 66,443 Pediatric Patients Cared for in the ICU.

Objectives: To describe the pharmaceutical management of sedation, analgesia, and neuromuscular blockade medications administered to children in ICUs.

Design: A retrospective analysis using data extracted from the national database Health Facts.

Setting: One hundred sixty-one ICUs in the United States with pediatric admissions.

Emphysematous pyelonephritis in renal allograft related to antibody-mediated rejection: A case report and literature review.

Emphysematous pyelonephritis (EPN) is a rare condition which can rapidly progress to sepsis and multiple organ failure with high mortality. We experienced a rare case of EPN in a renal allograft related to antibody-mediated rejection (AMR). The patient received a deceased donor kidney transplant due to end-stage renal disease secondary to diabetes mellitus.

Delirium in the Pediatric Cardiac Extracorporeal Membrane Oxygenation Patient Population: A Case Series.

Objective: To determine the prevalence of delirium in children who require extracorporeal membrane oxygenation.

Design: Prospective observational longitudinal cohort study.

Setting: Urban academic cardiothoracic ICU.

Delirium in Pediatric Critical Care.

Delirium occurs frequently in the critically ill child. It is a syndrome characterized by an acute onset and fluctuating course, with behaviors that reflect a disturbance in awareness and cognition. Delirium represents global cerebral dysfunction due to the direct physiologic effects of an underlying medical illness or its treatment.

Perioperative Ketorolac Use: A Potential Risk Factor for Renal Dysfunction After Live-Donor Nephrectomy.

BACKGROUND Ketorolac is a nonsteroidal anti-inflammatory drug indicated for pain control after surgeries in many fields. The aim of this study was to evaluate the impact of ketorolac use after live-donor nephrectomy (LDN). MATERIAL AND METHODS We reviewed data on 251 patients who underwent laparoscopic LDN from April 2008 to March 2016.

Delirium in Children After Cardiac Bypass Surgery.

Objectives: To describe the incidence of delirium in pediatric patients after cardiac bypass surgery and explore associated risk factors and effect of delirium on in-hospital outcomes.

Design: Prospective observational single-center study.

Setting: Fourteen-bed pediatric cardiothoracic ICU.