Association of Parental Interactions and Therapies with Cerebral Oxygenation Variability in the Neonatal Intensive Care Unit.

Objective:  This study evaluated the association of parental interactions and therapies with cerebral oxygenation (rScO) and rScO variability in infants using near-infrared spectroscopy.

Study Design:  Prospective pilot study in clinically stable infants admitted to the neonatal intensive care unit (NICU). Infants were monitored continuously for 48 hours, and rScO during parental interactions and therapies was compared with periods of no activity.

The Pediatric Data Science and Analytics Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators Network: Use of Supervised Machine Learning Applications in Pediatric Critical Care Medicine Research.

Objective: Perform a scoping review of supervised machine learning in pediatric critical care to identify published applications, methodologies, and implementation frequency to inform best practices for the development, validation, and reporting of predictive models in pediatric critical care.

Design: Scoping review and expert opinion.

Setting: We queried CINAHL Plus with Full Text (EBSCO), Cochrane Library (Wiley), Embase (Elsevier), Ovid Medline, and PubMed for articles published between 2000 and 2022 related to machine learning concepts and pediatric critical illness.

The Impact of Nasal Intubation on Feeding Outcomes in Neonates Requiring Cardiac Surgery: A Randomized Control Trial.

Neonates who require surgery for congenital heart disease (CHD) frequently have difficulty with oral feeds post-operatively and may require a feeding tube at hospital discharge. The purpose of this study was to determine the effect of oral or nasal intubation route on feeding method at hospital discharge. This was a non-blinded randomized control trial of 62 neonates who underwent surgery for CHD between 2018 and 2021.

Changes in Cerebral Regional Oxygen Saturation Variability in Neonates Undergoing Cardiac Surgery: A Prospective Cohort Study.

Near-infrared spectroscopy is routinely used in the monitoring of cerebral regional oxygen saturation (crSO) in neonates following congenital heart surgery. Decreased postoperative crSO variability in these patients is associated with worse clinical outcomes, including neurodevelopmental outcomes. We sought to explore changes in crSO variability between the preoperative and postoperative periods and associations with short-term clinical outcomes in neonates undergoing cardiac surgery.

Individual illness dynamics: An analysis of children with sepsis admitted to the pediatric intensive care unit.

Illness dynamics and patterns of recovery may be essential features in understanding the critical illness course. We propose a method to characterize individual illness dynamics in patients who experienced sepsis in the pediatric intensive care unit. We defined illness states based on illness severity scores generated from a multi-variable prediction model.

Association of Early Postoperative Regional Oxygen Saturation Measures and Development of Necrotizing Enterocolitis in Neonates Following Cardiac Surgery.

Necrotizing enterocolitis (NEC) is a relatively common complication in neonates with single ventricle physiology following heart surgery. Near-infrared spectroscopy (NIRS) is used to measure regional oxygen saturations in neonates in the postoperative period. We sought to investigate the association of somatic regional oxygen saturation (srSO) and cerebral regional oxygen saturation (crSO) in the early postoperative period and the subsequent development of NEC.

Implementation of a Regional Oxygen Saturation Thought Algorithm and Association with Clinical Outcomes in Pediatric Patients Following Cardiac Surgery.

Near infrared spectroscopy is routinely used in the noninvasive monitoring of cerebral and somatic regional oxygen saturation (rSO) in pediatric patients following surgery for congenital heart disease. We sought to evaluate the association of a bedside rSO thought algorithm with clinical outcomes in a cohort of pediatric patients following cardiac surgery. This was a single-center retrospective cohort study of patients admitted following cardiac surgery over a 42-month period.

Signatures of illness in children requiring unplanned intubation in the pediatric intensive care unit: A retrospective cohort machine-learning study.

Acute respiratory failure requiring the initiation of invasive mechanical ventilation remains commonplace in the pediatric intensive care unit (PICU). Early recognition of patients at risk for respiratory failure may provide clinicians with the opportunity to intervene and potentially improve outcomes. Through the development of a random forest model to identify patients at risk for requiring unplanned intubation, we tested the hypothesis that subtle signatures of illness are present in physiological and biochemical time series of PICU patients in the early stages of respiratory decompensation.

Gastrostomy tube placement in congenital cardiac surgery: a multi-institutional database study.

Introduction: Neonates and infants who undergo congenital cardiac surgery frequently have difficulty with feeding. The factors that predispose these patients to require a gastrostomy tube have not been well defined. We aimed to report the incidence and describe hospital outcomes and characteristics in neonates and infants undergoing congenital cardiac surgery who required gastrostomy tube placement.

Risk Factors for Sepsis-Associated Acute Kidney Injury in the PICU: A Retrospective Cohort Study.

Objectives: Acute kidney injury (AKI), particularly of greater severity and longer duration, is associated with increased morbidity and mortality in the pediatric population. AKI frequently occurs during sepsis, yet the knowledge of risk factors for sepsis-associated AKI in the PICU is limited. We aimed to identify risk factors for AKI that develops or persists after 72 hours from sepsis recognition in pediatric patients with severe sepsis.

Patterns of Organ Dysfunction in Critically Ill Children Based on PODIUM Criteria.

Objectives: The goal of this study was to determine the incidence, prognostic performance, and generalizability of the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) organ dysfunction criteria using electronic health record (EHR) data. Additionally, we sought to compare the performance of the PODIUM criteria with the organ dysfunction criteria proposed by the 2005 International Pediatric Sepsis Consensus Conference (IPSCC).

Methods: Retrospective observational cohort study of critically ill children at 2 medical centers in the United States between 2010 and 2018.

Pediatric Organ Dysfunction Information Update Mandate (PODIUM) Contemporary Organ Dysfunction Criteria: Executive Summary.

Prior criteria for organ dysfunction in critically ill children were based mainly on expert opinion. We convened the Pediatric Organ Dysfunction Information Update Mandate (PODIUM) expert panel to summarize data characterizing single and multiple organ dysfunction and to derive contemporary criteria for pediatric organ dysfunction. The panel was composed of 88 members representing 47 institutions and 7 countries.

Dynamic Transitions of Pediatric Sepsis: A Markov Chain Analysis.

Pediatric sepsis is a heterogeneous disease with varying physiological dynamics associated with recovery, disability, and mortality. Using risk scores generated from a sepsis prediction model to define illness states, we used Markov chain modeling to describe disease dynamics over time by describing how children transition among illness states. We analyzed 18,666 illness state transitions over 157 pediatric intensive care unit admissions in the 3 days following blood cultures for suspected sepsis.

Hospital Survival After Surgical Repair of Truncus Arteriosus with Interrupted Aortic Arch: Results from a Multi-institutional Database.

Truncus arteriosus (TA) is a major congenital cardiac malformation that requires surgical repair in the first few weeks of life. Interrupted aortic arch (IAA) is an associated malformation that significantly impacts the complexity of the TA operation. The aim of this study was to (1) define the comorbid conditions associated with TA and (2) determine the hospital survival and morbidity of patients with TA with and without an IAA.

Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis.

Background: Current approaches to early detection of clinical deterioration in children have relied on intermittent track-and-trigger warning scores such as the Pediatric Early Warning Score (PEWS) that rely on periodic assessment and vital sign entry. There are limited data on the utility of these scores prior to events of decompensation leading to pediatric intensive care unit (PICU) transfer.

Objective: The purpose of our study was to determine the accuracy of recorded PEWS scores, assess clinical reasons for transfer, and describe the monitoring practices prior to PICU transfer involving acute decompensation.

Adenoviral Respiratory Infection-Associated Mortality in Children: A Retrospective Case Series.

Viral respiratory infections are a leading cause of illness and hospitalization in young children worldwide. Case fatality rates in pediatric patients with adenoviral lower respiratory tract infection requiring intensive care unit (ICU) admission have been reported between 7 and 22%. We investigated the demographics and clinical characteristics in pediatric mortalities associated with adenoviral respiratory infection at 12 academic children's hospitals in the United States.

Cerebral regional oxygen saturation variability in neonates following cardiac surgery.

Background: Reduced cerebral regional oxygen saturation (crSO) variability in neonates, as measured by near-infrared spectroscopy, following cardiac surgery with deep hypothermic circulatory arrest (DHCA) is associated with poor neurodevelopmental outcomes. We sought to evaluate the variability of crSO in a cohort of neonates following cardiac surgery with brief or no exposure to DHCA.

Methods: Variability of averaged 1-min crSO values was calculated for the first 48 h following cardiac surgery in consecutive neonates over a 30-month period.

Pediatric Cardiopulmonary Resuscitation Tasks and Hands-Off Time: A Descriptive Analysis Using Video Review.

Objectives: To characterize tasks performed during cardiopulmonary resuscitation in association with hands-off time, using video recordings of resuscitation events.

Design: Single-center, prospective, observational trial.

Setting: Twenty-six bed cardiac ICU in a quaternary care free standing pediatric academic hospital.

Outcomes of Day 1 Multiple Organ Dysfunction Syndrome in the PICU.

Objectives: We sought to describe current outcomes of Multiple Organ Dysfunction Syndrome present on day 1 of PICU admission.

Design: Retrospective observational cohort study.

Setting: Virtual Pediatric Systems, LLC, database admissions, January 2014 and December 2015.

Epidemiology of Blood Culture Utilization in a Cohort of Critically Ill Children.

Blood culture acquisition is integral in the assessment of patients with sepsis, though there exists a lack of clarity relating to clinical states that warrant acquisition. We investigated the clinical status of critically ill children in the timeframe proximate to acquisition of blood cultures. The associated rates of systemic inflammatory response syndrome (72%) and sepsis (57%) with blood culture acquisition were relatively low suggesting a potential overutilization of blood cultures.

Predictive analytics in the pediatric intensive care unit for early identification of sepsis: capturing the context of age.

Background: Early recognition of patients at risk for sepsis is paramount to improve clinical outcomes. We hypothesized that subtle signatures of illness are present in physiological and biochemical time series of pediatric-intensive care unit (PICU) patients in the early stages of sepsis.

Methods: We developed multivariate models in a retrospective observational cohort to predict the clinical diagnosis of sepsis in children.

Economic implications of outpatient cardiac catheterisation in infants with single ventricle congenital heart disease.

Background: Resource utilisation for infants with single ventricle CHD remains high without well-studied ways to decrease economic burden. Same-day discharge following cardiac catheterisation has been shown to be safe and effective in children with CHD, but those with single ventricle physiology are commonly excluded. The purpose of this study was to investigate the economic implications of planned same-day discharge following cardiac catheterisation versus universal overnight hospital admission in infants with single ventricle CHD.