Education on organ donation and transplantation in primary school; teachers' support and the first results of a teaching module.

Unlabelled: Organ and tissue donation can also involve children. Because of its sensitivity, this topic requires careful decision making. Children have the ability to carefully reflect on this subject and enjoy participating in family discussions about it.

Short-term effects of neuromuscular blockade on global and regional lung mechanics, oxygenation and ventilation in pediatric acute hypoxemic respiratory failure.

Background: Neuromuscular blockade (NMB) has been shown to improve outcome in acute respiratory distress syndrome (ARDS) in adults, challenging maintaining spontaneous breathing when there is severe lung injury. We tested in a prospective physiological study the hypothesis that continuous administration of NMB agents in mechanically ventilated children with severe acute hypoxemic respiratory failure (AHRF) improves the oxygenation index without a redistribution of tidal volume V toward non-dependent lung zones.

Methods: Oxygenation index, PaO/FiO ratio, lung mechanics (plateau pressure, mean airway pressure, respiratory system compliance and resistance), hemodynamics (heart rate, central venous and arterial blood pressures), oxygenation [oxygenation index (OI), PaO/FiO and SpO/FiO], ventilation (physiological dead space-to-V ratio) and electrical impedance tomography measured changes in end-expiratory lung volume (EELV), and V distribution was measured before and 15 min after the start of continuous infusion of rocuronium 1 mg/kg.

Suffering in children: opinions from parents and health-care professionals.

Unlabelled: Alleviation of suffering is considered to be one of the important goals of medical interventions. Understanding of what constitutes suffering in children admitted to a pediatric intensive care unit (PICU) is lacking. This study aims to assess perceptions by parents, doctors, and nurses of suffering in critically ill children.

An online explorative study towards parents' opinions about organ donation: from individual decisions to family discussions.

Background: Parental decisions about organ donation by their child are influenced by many factors. One of these factors may be a previous discussion under non-crisis circumstances. The question then arises whether parents have thought about this topic for themselves and discussed it with each other or with their child.

Infants with severe respiratory syncytial virus needed less ventilator time with nasal continuous airways pressure then invasive mechanical ventilation.

Aim: Nasal continuous positive airway pressure (NCPAP) has been proposed as an early first-line support for infants with severe respiratory syncytial virus (RSV) infection. We hypothesised that infants <6 months with severe RSV would require shorter ventilator support on NCPAP than invasive mechanical ventilation (IMV).

Methods: Retrospective cohort analysis of infants admitted to two paediatric intensive care units, one primarily using NCPAP and one exclusively using IMV, between January 2008 and February 2010.

Mortality prediction models for pediatric intensive care: comparison of overall and subgroup specific performance.

Aim: To validate paediatric index of mortality (PIM) and pediatric risk of mortality (PRISM) models within the overall population as well as in specific subgroups in pediatric intensive care units (PICUs).

Methods: Variants of PIM and PRISM prediction models were compared with respect to calibration (agreement between predicted risks and observed mortality) and discrimination (area under the receiver operating characteristic curve, AUC). We considered performance in the overall study population and in subgroups, defined by diagnoses, age and urgency at admission, and length of stay (LoS) at the PICU.

Transfusion of leukocyte-depleted RBCs is independently associated with increased morbidity after pediatric cardiac surgery.

Objective: To test the hypothesis that transfusion of leukocyte-depleted RBC preparations within the first 48 hours of PICU stay was independently associated with prolonged duration of mechanical ventilation, irrespective of surgery type and disease severity.

Design: Retrospective, observational study.

Setting: Single-center PICU in The Netherlands.

Children as donors: a national study to assess procurement of organs and tissues in pediatric intensive care units.

A shortage of size-matched organs and tissues is the key factor limiting transplantation in children. Empirical data on procurement from pediatric donors is sparse. This study investigated donor identification, parental consent, and effectuation rates, as well as adherence to the national protocol.

Implantable continuous Doppler monitoring device for detection of hepatic artery thrombosis after liver transplantation.

Background: Early hepatic artery thrombosis (eHAT) after liver transplantation occurs in 3% of adults and 8% of children and often results in retransplantation. eHAT is initially asymptomatic and arterial patency is monitored with percutaneous Doppler ultrasound screening (pDUS). The aim of the study is to analyze the diagnostic accuracy of "continuous" Doppler registration (CONDOR) using an implantable miniature Doppler.

Key factors in paediatric organ and tissue donation: an overview of literature in a chronological working model.

There is a growing shortage of size-matched organs and tissues for children. Although examples of substandard care are reported in the literature, there is no overview of the paediatric donation process. The aim of the study is to gain insight into the chain of events, practices and procedures in paediatric donation.

Children's opinions about organ donation: a first step to assent?

Background: Parents have to decide about organ donation after the death of their child. Although most parents probably would like to respect their child's intentions, parents often are not aware of their child's wishes. This requires insight into children's opinions about donation.

A qualitative study exploring the experiences of parents of children admitted to seven Dutch pediatric intensive care units.

Purpose: To explore parents' experiences during the admission of their children to a pediatric intensive care unit (PICU).

Method: Qualitative method using in-depth interviews. Thematic analysis was applied to capture parents' experiences.

Differences in the perceptions of parents and healthcare professionals on pediatric intensive care practices.

Objective: To explore similarities and differences in perceptions on pediatric intensive care practices between parents and staff by using data from two studies.

Design: A two-round Delphi method among nurses and physicians followed by an empiric survey among parents.

Settings: Pediatric intensive care units at eight university medical centers.

Construction and psychometric testing of the EMPATHIC questionnaire measuring parent satisfaction in the pediatric intensive care unit.

Purpose: To construct and test the reliability and validity of the EMpowerment of PArents in THe Intensive Care (EMPATHIC) questionnaire measuring parent satisfaction in the pediatric intensive care unit (PICU).

Methods: Structured development and psychometric testing of a parent satisfaction-with-care instrument with the results of two cohorts of parents (n = 2,046) from eight PICUs in the Netherlands.

Results: In the first cohort, 667/1,055 (63%) parents participated followed by 551/991 (56%) parents in the second cohort.

Off-hours admission and mortality in two pediatric intensive care units without 24-h in-house senior staff attendance.

Purpose: To compare risk-adjusted mortality of children non-electively admitted during off-hours with risk-adjusted mortality of children admitted during office hours to two pediatric intensive care units (PICUs) without 24-h in-house attendance of senior staff.

Design: Prospective observational study, performed between January 2003 and December 2007, in two PICUs without 24-h in-house attendance of senior staff, located in tertiary referral children's hospitals in the Netherlands.

Methods: Standardized mortality rates (SMRs) of patients admitted during off-hours were compared to SMRs of patients admitted during office hours using Pediatric Index of Mortality (PIM1) and Pediatric Risk of Mortality (PRISM2) scores.

Pandemic influenza and pediatric intensive care.

Objective: To assess the adequacy of preparedness planning for an influenza pandemic by modeling the pediatric surge capacity of healthcare facility and pediatric intensive care unit (PICU) requirements over time. Governments and Public Health authorities have planned preparedness activities and training for a flu pandemic. PICU facilities will be the limiting factor in healthcare provision for children but detailed analyses for needs and demands in PICU care have not been published.

Perceptions of parents on satisfaction with care in the pediatric intensive care unit: the EMPATHIC study.

Purpose: To identify parental perceptions on pediatric intensive care-related satisfaction items within the framework of developing a Dutch pediatric intensive care unit (PICU) satisfaction instrument.

Methods: Prospective cohort study in tertiary PICUs at seven university medical centers in The Netherlands.

Participants: Parents of 1,042 children discharged from a PICU.

Buccal vs. nasogastric tube administration of tacrolimus after pediatric liver transplantation.

Tacrolimus is an important drug for immunosuppression after liver transplantation. Bioavailability of enterally administered tacrolimus is poor, and further reduced by gastric residuals or by enteral nutrition. Buccal administration might be an alternative route especially in children.

Routine enteral nutrition in neonates on extracorporeal membrane oxygenation.

Objectives: To evaluate over a 5-yr period the feasibility and tolerance of a protocol of routine enteral nutrition in neonates requiring extracorporeal membrane oxygenation (ECMO).

Design: Retrospective medical chart review.

Setting: Level III children's hospital, pediatric surgical intensive care unit.

Glutamine supplementation of parenteral nutrition does not improve intestinal permeability, nitrogen balance, or outcome in newborns and infants undergoing digestive-tract surgery: results from a double-blind, randomized, controlled trial.

Objective: To assess the effect of isocaloric isonitrogenous parenteral glutamine supplementation on intestinal permeability and nitrogen loss in newborns and infants after major digestive-tract surgery.

Summary Background Data: Glutamine supplementation in critically ill and surgical adults may normalize intestinal permeability, attenuate nitrogen loss, improve survival, and lower the incidence of nosocomial infections. Previous studies in critically ill children were limited to very-low-birthweight infants and had equivocal results.

The effect of cumulative energy and protein deficiency on anthropometric parameters in a pediatric ICU population.

Background And Aims: Nutritional support is essential in the care of critically ill children since inadequate feeding increases morbidity and negatively affects growth. We aimed to compare cumulative energy and protein intakes with recommended dietary intakes (RDA) and examine relationships between accumulated balances and anthropometric parameters.

Methods: Prospective, observational study.

Heterotopic pancreatic tissue presenting as a solid and cystic lung lesion: a very unusual bronchopulmonary foregut malformation.

We describe the history and lung pathology of a premature female infant, who presented with respiratory distress immediately after birth. A thoracic computerized tomography scan showed abnormalities suggestive of congenital cystic adenomatoid malformation of the left lung. In addition, echocardiography revealed a tetralogy of Fallot.