Pediatric Critical Care Medicine最新文献

{"title":"Critical Pertussis in the PICU: Multinational Study in the Gulf Cooperation Council Region, 2022-2024.","authors":"Mohammad Alghounaim, Naila A Shaheen, Abdulrahman Aldaithan, Saif Awlad Thani, Yasser Kazzaz, Abdulla Alfraij","doi":"10.1097/PCC.0000000000003956","DOIUrl":"10.1097/PCC.0000000000003956","url":null,"abstract":"<p><strong>Objectives: </strong>Critical pertussis is a life-threatening illness that predominantly affects young infants, with substantial morbidity and mortality. In this study, we aimed to describe the epidemiology, clinical features, and variability in management of pediatric critical pertussis in the Gulf Cooperation Council (GCC) region.</p><p><strong>Design: </strong>Multinational retrospective cohort study conducted between July 2022 and December 2024.</p><p><strong>Setting: </strong>Thirty-five PICUs in the six GCC countries.</p><p><strong>Patients: </strong>Children 16 years old or younger with laboratory-confirmed pertussis (by polymerase chain reaction or culture) admitted to a PICU.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 204 cases of critical pertussis were identified. Median (interquartile range [IQR]) age was 53 days (IQR, 36.5-89 d). Most patients (91.2%) were healthy before PICU admission. Comorbidities included acyanotic congenital heart disease (3.9%) or respiratory disease (2.9%). Only 17.3% had received infant pertussis vaccination and 4.1% had mothers vaccinated during pregnancy. The median duration of hospital stay was 9 days (IQR, 6-16 d), and PICU stay was 5 days (IQR, 3-10 d). Hyperleukocytosis (> 30 × 10 9 /L) occurred in 49.5%. Respiratory distress (47.6%) and apnea (28.4%) were the main reasons for PICU admission. Management varied widely: leukoreduction was performed in 27.4%, with significant variation in practice across countries. Use of high-flow nasal cannula and mechanical also varied across the region. Extracorporeal membrane oxygenation was rarely used (1.5%). Echocardiography was obtained in nearly half of the cohort, and revealed pulmonary hypertension in 24 patients. Overall mortality was 15.2%, most commonly attributed to septic shock and respiratory failure.</p><p><strong>Conclusions: </strong>Critical pertussis predominantly affects young infants, with substantial morbidity, mortality, and wide variation in management practices. Our cohort from 2022 to 2024 highlights our GCC regional need for standardized care protocols and strengthened prevention.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1106-1115"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147949182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Holding Out for a Healthcare Hero: Rising to the Challenge of End-of-Life Care in the PICU.","authors":"Pravin Rr, Jan Hau Lee","doi":"10.1097/PCC.0000000000003992","DOIUrl":"10.1097/PCC.0000000000003992","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1172-1174"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden and Outcomes of Sepsis Using Phoenix Criteria: Single-Center Cohort Study in a South African PICU, 2024.","authors":"Ashleigh T Sent, Shamiel Salie, Brenda M Morrow","doi":"10.1097/PCC.0000000000003993","DOIUrl":"10.1097/PCC.0000000000003993","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the burden and outcomes of pediatric sepsis using the Phoenix sepsis criteria in a South African PICU and to assess the Phoenix Sepsis Score (PSS) discriminatory performance for mortality and length of stay (LOS) in this setting.</p><p><strong>Design: </strong>Single-center, retrospective cohort.</p><p><strong>Setting: </strong>PICU at Red Cross War Memorial Children's Hospital, Cape Town, South Africa.</p><p><strong>Patients: </strong>Emergency medical admissions during 2024, excluding preterm infants (< 37 wk postconceptual age), birth hospitalizations, surgical and palliative admissions, nosocomial sepsis (> 48 hr after admission), patients with incomplete data for sepsis classification, and PICU readmissions during the same hospitalization.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of 1124 admissions screened, 332 children met inclusion criteria. The median age was 12 months (interquartile range [IQR], 3-45.8 mo). Based on the Phoenix criteria, 137 of 332 (41.3%) had sepsis and 101 of 332 (30.4%) had septic shock. Compared with nonsepsis cases, sepsis was associated with younger age, worse illness severity (median pediatric index of mortality, 0.07 vs. 0.02; p < 0.001), higher need for invasive ventilation (71.5% vs. 31.8%; p < 0.001), and higher mortality (19.7% vs. 4.1%; p < 0.001). Each one-point increase in PSS doubled the odds of mortality (adjusted odds ratio, 2.21 [95% CI, 1.8-2.8]; p < 0.001) and increased LOS by 1.3 days (95% CI, 0.86-1.77 d; p < 0.001). The PSS showed strong discriminatory capacity for mortality (with area under the receiver operating characteristic curve 0.894 [95% CI, 0.83-0.96]). The optimal mortality threshold was PSS greater than or equal to 4 (negative predictive value, 97.6%).</p><p><strong>Conclusions: </strong>In 2024, in our PICU setting, sepsis accounted for a high proportion of emergency medical admissions and deaths. The PSS demonstrated strong discriminatory performance for mortality and LOS, providing preliminary evidence supporting its feasibility as a risk-stratification tool in this South African PICU setting.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1063-1074"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning From International Pediatric Critical Care Research: 1) End-of-Life Perspectives; 2) Sepsis Score and Severity of Illness.","authors":"Robert C Tasker","doi":"10.1097/PCC.0000000000004040","DOIUrl":"https://doi.org/10.1097/PCC.0000000000004040","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"27 9","pages":"1167-1169"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet Transfusion Practices for Critically Ill Children: A 28-Day Point-Prevalence Study in Three European Countries in 2023.","authors":"Laura Butragueño-Laiseca, Avishay Sarfatti, Samiran Ray, Simon J Stanworth, Michael J Carter, Belén Calderón-Llopis, Pablo Álvarez, Andrea Leal, Eduardo López, Elvira Morteruel, Roi Campos Rodríguez, Maria Francesca Caligiuri, Salvatore Perdichizzi, Luigi Dei Giudici, Fabrizio Chiusolo","doi":"10.1097/PCC.0000000000004011","DOIUrl":"10.1097/PCC.0000000000004011","url":null,"abstract":"<p><strong>Objectives: </strong>To study the prevalence, indications, thresholds, and outcomes of platelet transfusions in critically ill children in three European countries.</p><p><strong>Design: </strong>International 4-week point-prevalence study in 2023.</p><p><strong>Setting: </strong>Forty-four PICUs across Spain, the United Kingdom, and Italy.</p><p><strong>Patients: </strong>PICU patients of 1 month to 17 years old receiving platelet transfusions.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>During four prespecified 7-day blocks, 110 of 2713 (4.1% [95% CI, 3.4-4.9%]) patients received at least one platelet transfusion, accounting for 253 transfusions. The primary indication was a low platelet count (PC) (54% [95% CI, 48-60%]), and 83% (95% CI, 77.7-87.4%) were prophylactic indications. Active bleeding was the main reason for transfusion in only 17% of cases (12.6-22.2). Median pretransfusion PC was 36 × 10 9 cells/L. PC differed significantly across diagnostic subgroups and indications. It was higher in postsurgery cardiac (83 × 10 9 cells/L) and nonsurgery cardiac patients (61 × 10 9 cells/L) and lower in septic shock (24 × 10 9 cells/L) and hemato-oncological conditions (23 × 10 9 cells/L). Posttransfusion (2 hr) PC increment was 42 × 10 9 /L, but by 12-24 hours it decreased to 13 × 10 9 /L, regardless of patient diagnosis or reason for transfusion. Viscoelastic testing was performed in only seven events (2.8%). The 28-day PICU mortality was 21.8% (95% CI, 14.6-30.4%). The number and total dose of transfusions were associated with mortality, even after adjusting for the Pediatric Index of Mortality III score.</p><p><strong>Conclusions: </strong>In 44 European PICUs in 28 days during 2023, 4% of admitted patients received platelet transfusions. PC was the primary reason for transfusion, with substantial variability between subgroups and indications. There were a high number of prophylactic transfusions, and exceeding the recommended restrictive threshold was common. The observed change in the patients' PC is not related to the reason for the platelet transfusion or the patient's diagnosis. Viscoelastic testing is still rarely performed. These results support the need for pediatric trials to define safe and effective platelet thresholds and to evaluate the role of other transfusion triggers in critically ill children.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1075-1086"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urinary Neutrophil Gelatinase-Associated Lipocalin and Serum Cystatin C as Early Biomarkers of Acute Kidney Injury in Critically Ill Children: Single-Center PICU Cohort, 2024-2025.","authors":"Ana Rita Fradique, Mariana Ferreira, Alexandra Costa Rodrigues, Margarida Marques, Carla Pinto, Andrea Dias","doi":"10.1097/PCC.0000000000003984","DOIUrl":"https://doi.org/10.1097/PCC.0000000000003984","url":null,"abstract":"<p><strong>Introduction: </strong>We have explored the use of early biomarkers for the timely identification of acute kidney injury (AKI) in critically ill children.</p><p><strong>Design: </strong>Single-center cohort study.</p><p><strong>Setting: </strong>Tertiary medical-surgical PICU in Coimbra, Portugal.</p><p><strong>Patients: </strong>Pediatric patients admitted for longer than 48 hours over a 10-month period during 2024-2025.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and results: </strong>Among 75 patients (55.3% male; median age 3.9 yr), 22 patients (29.3%) developed AKI (defined by Kidney Disease Improving Global Outcomes criteria) on day 1. On comparing those with or without AKI, urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels were elevated on day 1 (p < 0.001), day 2 (p = 0.003), and day 3 (p = 0.013) in AKI patients. Cystatin-C (Cys-C) was only increased on day 1 (p = 0.013). Shock (p < 0.001) and vasoactive drug use (p = 0.007) were more commonly present in AKI patients, who also had lower albumin (p = 0.012), platelets (p = 0.001), and bicarbonate level (p = 0.032). AKI patients also had higher C-reactive protein (CRP; p = 0.018), procalcitonin (p = 0.002), and lactate concentration (p = 0.022). Shock and CRP were associated with greater odds (presented as odds ratio [OR] with 95% CI) of AKI, respectively as: OR, 6.10 (95% CI, 1.50-16.52); p = 0.002; and OR, 1.07 (95% CI, 1.00-1.12); p = 0.022; as well as day 1 Renal Angina Index (RAI; OR, 1.10 [95% CI, 1.03-1.17]; p = 0.005). On day 1, the discrimination performance (using the area under the receiver operating characteristic curve [AUC]) for AKI was good-to-excellent for, respectively: uNGAL, 0.847 (95% CI, 0.74-0.96); p value of less than 0.001; and blood urea nitrogen, 0.848 (95% CI, 0.75-0.95); p value of less than 0.001. Regarding uNGAL, the pretest probability of AKI was 29.3%, and the posttest probability of AKI on finding a uNGAL greater than 87 ng/mL rose to 73.1%, which leaves significant diagnostic uncertainty. Also, the day 1 RAI was an acceptable to good discriminator of the severity of AKI in those identified with AKI: AUC, 0.796 (95% CI, 0.60-0.99); p = 0.019.</p><p><strong>Conclusions: </strong>In our PICU cohort, day 1 uNGAL level greater than 87 ng/mL has good-to-excellent discriminative capacity in identifying AKI, but the diagnostic uncertainty of AKI remains.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":"27 9","pages":"1043-1053"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sibling Presence in the PICU: Single-Site Point Prevalence Study.","authors":"Jessica Appleyard, Beverley Copnell, Alyssia Haling, Joseph C Manning, Ashleigh E Butler","doi":"10.1097/PCC.0000000000003985","DOIUrl":"10.1097/PCC.0000000000003985","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the point prevalence of PICU patients with siblings, and if they have siblings, whether they visited the PICU and their interactions.</p><p><strong>Design: </strong>A single-site point prevalence study conducted in a specialist Australian PICU. Survey data were collected at eight time points over a 3-week period, from February 13, 2025, to March 4, 2025. Eight PPS time points included four weekdays and four weekend days. The survey was completed by bedside PICU nurses who collected information on patient characteristics, the existence of siblings, details related to sibling visits in the PICU, and any nursing staff concerns. Data were summarized using descriptive and inferential statistics. Associations between variables were investigated using chi-square and Mann-Whitney U tests.</p><p><strong>Setting: </strong>A 22-bed quaternary care PICU in Australia.</p><p><strong>Patients: </strong>All patients were admitted to the PICU at the point of data collection.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The survey was completed for 159 of 163 patients (97.5%) admitted to the PICU on a prevalence study day. Overall, 100 of 159 patients (62.9%) had siblings. Only 28 of 100 patients (28%) had one or more siblings visit on a prevalence study day: eight sibling visits occurred on weekdays and 20 on weekends. A total of 32 siblings visited these 28 patients. Siblings of 1-4 years old visited more often than other age groups. We failed to identify an association between the occurrence of a sibling visit and distance from the hospital, patient length of stay, or intubation status.</p><p><strong>Conclusions: </strong>In this point prevalence study carried out on our PICU in Australia, in 2025, we found that around two-thirds of admissions had siblings. However, sibling visits were limited, primarily occurring on weekends. Our results will inform future planning of PICU family-centered care models with out-of-hours professional support.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1087-1095"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized Treatment Effects of Therapeutic Hypothermia in Children Postcardiac Arrest: A Reanalysis of Two Randomized Clinical Trials.","authors":"Daniel R Balcarcel, Garrett P Keim, Sanjiv D Mehta, Michael O Harhay, Blanca E Himes, Wouter A C van Amsterdam, Frank Moler, Matthew P Kirschen, Alexis A Topjian, Nadir Yehya","doi":"10.1097/PCC.0000000000004010","DOIUrl":"10.1097/PCC.0000000000004010","url":null,"abstract":"<p><strong>Objectives: </strong>To use patient characteristics to estimate individualized treatment effects (ITE) of hypothermia vs. normothermia after pediatric cardiac arrest.</p><p><strong>Design: </strong>Secondary, exploratory analysis of two pediatric randomized controlled trials (RCTs), Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH; NCT00878644) and Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital In-Hospital (THAPCA-IH; NCT00880087), using a causal forest machine learning model to estimate ITEs within each trial.</p><p><strong>Setting: </strong>THAPCA-OH was conducted at 38 children's hospitals across the United States and Canada. THAPCA-IH was conducted at 37 children's hospitals across the United States, Canada, and the United Kingdom.</p><p><strong>Patients: </strong>Pediatric patients aged 48 hours to 18 years who remained comatose within 6 hours after return of circulation following cardiac arrest and were randomized in THAPCA-OH and THAPCA-IH to normothermia or therapeutic hypothermia for 48 hours. Patients with a baseline Vineland Adaptive Behavior Scales, Second Edition (VABS-II) score less than 70 were excluded.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The final cohorts included 260 patients in THAPCA-OH and 257 in THAPCA-IH. The primary outcome was survival at 1 year with VABS-II greater than or equal to 70 (favorable outcome). In THAPCA-OH, estimated ITEs (calculated as the individualized absolute risk difference [iARD] between hypothermia and normothermia, positive favoring hypothermia) ranged from -0.01 to 0.16. Patients were grouped into tertiles of estimated ITE within each trial. In THAPCA-OH, the tertile with the greatest estimated benefit from hypothermia had an observed absolute risk difference (ARD; hypothermia minus normothermia) of 0.18 (95% CI, 0.02-0.34). In THAPCA-IH, estimated ITEs ranged from -0.17 to 0.13. The tertile estimated to benefit most from hypothermia had an ARD of 0.27 (95% CI, 0.07-0.48), whereas the tertile estimated to benefit from normothermia had an ARD of -0.20 (95% CI, -0.40 to -0.01).</p><p><strong>Conclusions: </strong>These analyses suggest heterogeneity of treatment effect may exist in postcardiac arrest temperature management warranting further study.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1148-1158"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Piperacillin Population Pharmacokinetics in Children Supported With Extracorporeal Membrane Oxygenation.","authors":"Adrien Arsène, Mehdi Oualha, Jérôme Rambaud, Sihem Benaboud, Saik Urien, Marion Grimaud, Sylvain Renolleau, Pierre-Louis Léger, Déborah Hirt, Jean-Marc Tréluyer, Agathe Béranger","doi":"10.1097/PCC.0000000000004016","DOIUrl":"10.1097/PCC.0000000000004016","url":null,"abstract":"<p><strong>Objective: </strong>To characterize piperacillin population pharmacokinetics (PK) in critically ill children with and without extracorporeal membrane oxygenation (ECMO) support and to optimize piperacillin dosing regimens to attain the PK target of 100% free time above minimum inhibitory concentration (fT > minimum inhibitory concentration).</p><p><strong>Design: </strong>Post hoc secondary analysis of a two-center, population PK modeling and simulation study (registered at clinicaltrials.gov , NCT02539407).</p><p><strong>Settings: </strong>PICUs at tertiary care centers, September 2015-November 2021.</p><p><strong>Patients: </strong>Thirty-three children supported with ECMO and 50 non-ECMO control patients treated with piperacillin (± tazobactam).</p><p><strong>Interventions: </strong>Administration of piperacillin at 300 mg/kg/d by continuous infusion or 75 mg/kg every 6 hours by intermittent infusion.</p><p><strong>Measurements and main results: </strong>A one-compartment linear-elimination model described best the piperacillin data. Clearance was driven by body weight and estimated glomerular filtration rate (eGFR). In a typical 11-kg patient, ECMO circuit volume-to-weight ratio increased the volume of distribution by 34%. Monte Carlo simulations across eGFR strata (30-60, 60-90, 90-150, 150-200, 200-300 mL/min/1.73 m 2 ) showed that a continuous infusion of 300 mg/kg/d allowed greater than or equal to 90% of target attainment in all groups. Patients with an eGFR greater than 200 mL/min/1.73 m 2 required 400 mg/kg/d to have 90% of target attainment.</p><p><strong>Conclusions: </strong>Continuous infusion of 300 mg/kg/d piperacillin reliably achieves PK target across all renal-function ranges in children undergoing support with ECMO. Dose escalation to 400 mg/kg/d is required for augmented renal clearance (eGFR > 200 mL/min/1.73 m 2 ).</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1138-1147"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Near-Infrared Spectroscopy and Brain Injury in Neonates on Extracorporeal Membrane Oxygenation: Single-Center Retrospective Cohort, 2018-2024.","authors":"Kyusang Yoo, Soo Hyun Kim, Keon Hee Seol, Jung Kwak, Tae-Gyeong Kim, Bo Kyung Jin, Joo Hyung Roh, Ha Na Lee, Jiyoon Jeong, Chae Young Kim, Euiseok Jung, Byong Sop Lee","doi":"10.1097/PCC.0000000000003977","DOIUrl":"10.1097/PCC.0000000000003977","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the association between cerebral near-infrared spectroscopy (NIRS)-derived parameters and moderate-to-severe brain injury in neonates supported with extracorporeal membrane oxygenation (ECMO).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Single tertiary neonatal ICU (NICU) in Korea.</p><p><strong>Patients: </strong>Neonates admitted to the NICU (from November 2018 to June 2024) undergoing ECMO with cerebral NIRS monitoring. Neonates with cardiac arrest before ECMO initiation were excluded.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>We reviewed the medical records of 33 neonates with a median (interquartile range [IQR]) gestational age of 38.1 weeks (IQR, 37.5-38.7 wk) and birth weight of 2938 g (IQR, 2585-3360 g). Brain injury severity was classified according to neuroimaging reports using cerebral MRI and head ultrasound scans (HUS). Patients were divided into a normal-to-mild brain injury group (20/33) and a moderate-to-severe injury group (13/33). Compared with the normal-to-mild injury group, moderate-to-severe brain injury was associated with lower minimum regional cerebral oxygen saturation (rSc o2 ; median 20% vs. 46%; p = 0.016), longer duration with rSc o2 less than 50% (median, 48.0 vs. 3.5 hr; p = 0.029), prolonged periods of rSc o2 decline greater than 20% from baseline (median 80.0 vs. 20.0 hr; p = 0.027), and higher cumulative hypoxia burden (median, 407.0 vs. 6.0%·hr; p = 0.034). The receiver operating characteristic curve analysis identified thresholds associated with moderate-to-severe brain injury as follows: minimum rSc o2 of 21%, duration of rSc o2 less than 50% of 44 hours, duration of rSc o2 decline greater than 20% of 46 hours, and cumulative hypoxia burden of 320%·hours.</p><p><strong>Conclusions: </strong>In this 2018-2024 cohort, cerebral NIRS parameters were associated with moderate-to-severe brain injury identified using MRI and HUS. Lower rSc o2 and greater desaturation exposure were associated with the presence of moderate-to-severe injury by discharge. The potential for early risk stratification of neonates on ECMO requires confirmation in prospective studies.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"1096-1105"},"PeriodicalIF":4.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}