Pediatric Critical Care Medicine最新文献

{"title":"Pneumonia Requiring Respiratory Support in the PICU: Single-Center Study of Admission Plasma Nucleosome, Histone, and Citrullinated Histone H3 Levels in Relation to Complications.","authors":"Bin Li, Cuifen Li, Yunxiang Mao, Fangling Dong, Xishu Deng, Ling Hang, Tinghao Wu, Weihua Shou, Bo Zhang, Li Li, Tiesong Zhang, Lei Guo, Shufang Xiao","doi":"10.1097/PCC.0000000000003785","DOIUrl":"10.1097/PCC.0000000000003785","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate plasma nucleosome, histone H3 (H3), and citrullinated histone H3 (CitH3) levels in PICU patients with viral or bacterial pneumonia, and the associations with pediatric acute respiratory distress syndrome (PARDS) and sepsis.</p><p><strong>Design: </strong>Single-center observational study of plasma nucleosome, H3, and CitH3 levels collected within 24 hours of PICU admission in patients with pneumonia requiring respiratory support.</p><p><strong>Setting: </strong>A children's hospital PICU in Yunnan, China.</p><p><strong>Patients: </strong>Pneumonia patients and healthy controls seen during 2022-2024.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 152 children (0.3-12 years old) with severe pneumonia were enrolled and, post hoc, 47 met the 2024 Phoenix criteria for sepsis, and 45 met the 2023 criteria for PARDS. Pneumonia in comparison with 22 controls was associated with higher levels of all three markers (nucleosome, p = 0.0006; H3, p = 0.003; and CitH3, p = 0.029). In comparison with non-sepsis and non-PARDS cases, the sepsis and PARDS categories were associated with higher levels of all three markers (sepsis, p < 0.0001, p = 0.015, p < 0.0001; PARDS, p = 0.003, p < 0.0001, p = 0.0002). The area under the receiver operating characteristic curve (AUROC) analysis with nucleosome level using the sepsis endpoint was 0.79 (95% CI, 0.71-0.87), p < 0.0001. The relationship between H3 and PARDS vs. non-ARDS patients was AUROC 0.83 (95% CI, 0.75-0.91), p < 0.0001; and there was a negative correlation with Pa o2 to F io2 of r -0.63 ( p < 0.0001). Regarding, the association between bacterial vs. viral etiology of pneumonia, the combination of plasma CitH3 and C-reactive protein showed AUROC of 0.84 (95% CI, 0.76-0.92), p < 0.0001.</p><p><strong>Conclusions: </strong>In PICU patients with pneumonia requiring respiratory support, we detected significant plasma of nucleosome, H3, and CitH3 within the first 24 hours of admission. Furthermore, categorization as PARDS or sepsis was associated with higher levels of these biomarkers.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1041-e1050"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601124","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":"Pediatric Palliative Care Subcompetencies for Pediatric Critical Care Medicine Fellowship Trainees.","authors":"Kelly A Lyons, Rachel Ashworth, Lauren Rissman, Natalie Henderson, Michael Certo, Kathryn Palumbo, Mindy Dickerman, Moshe Cohn, Amanda Alladin, Danielle DeCourcey","doi":"10.1097/PCC.0000000000003773","DOIUrl":"10.1097/PCC.0000000000003773","url":null,"abstract":"<p><strong>Objectives: </strong>Integration of pediatric palliative care (PPC) and pediatric critical care medicine (PCCM) is essential in providing high-quality patient care. To date, no standardized or recommended framework for educating PCCM fellowship trainees in palliative care exists. We aimed to develop PPC subcompetencies for PCCM fellows within the constructs of the established Accreditation Council for Graduate Medical Education (ACGME) six core competencies.</p><p><strong>Design and setting: </strong>An eight-member multicenter panel consisting of joint PPC and PCCM clinicians with expertise in fellow education curricula design used a modified Delphi method to construct subcompetencies for PPC within the ACGME core competency domains (patient care, medical knowledge, interpersonal/communication skills, professionalism, problem-based learning, and system-based practice). The process for development involved the following steps: 1) literature search, 2) evaluation of the ACGME program requirements for PPC and PCCM, 3) consensus meetings and evaluation to generate core knowledge, skills, and experiences needed using rating scales to sequentially prioritize curriculum content, and 4) selection and approval by multicenter team. Complete agreement was necessary for subcompetency inclusion.</p><p><strong>Main results: </strong>Following the multi-step review process, 20 subcompetencies mapped to the core competency domains were included. A majority of subcompetencies were within the medical knowledge domain. Subcompetencies were further mapped to suggested entrustable professional activities and to specific recommended training years for subcompetency completion.</p><p><strong>Conclusions: </strong>We present the first recommended PPC subcompetencies for PCCM fellows. Utilization of subcompetencies for fellow trainees is necessary to build primary palliative skills and improve confidence in delivering palliative care medicine within the pediatric critical care setting. Future efforts are needed to determine best practices for teaching and measuring competence. Recommended subcompetencies have the potential to standardize national PPC curricula for PCCM fellowship programs.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1063-e1069"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302672","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":"Hyperprocalcitonemia and Endothelial and Microcirculatory Dysfunction in Children With Sepsis and Septic Shock: Single-Center Observational Cohort Study in Colombia, 2021-2024.","authors":"Briam Beltrán Hernandez, Jaime Fernández-Sarmiento, Hernando Mulett, Maria Carolina Niño Ariza, Valeria Aguirre Gutierrez, Carolina Cárdenas, María Paula Cardona, Tatiana Bernal Sierra, Marisol Cabezas Rosas, Lina Garzón Angel, Mauricio Sarta, Juan Pablo Fernández-Sarta, Isabella La Rotta, Juanita Buelvas-Pérez, Laura Sofia Rodriguez, Maria José Barrera Suárez, Niranjan Kissoon","doi":"10.1097/PCC.0000000000003782","DOIUrl":"10.1097/PCC.0000000000003782","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the association between hyperprocalcitonemia and endothelial and microcirculatory dysfunction in children with sepsis and septic shock and clinical outcomes.</p><p><strong>Design: </strong>A prospective observational cohort study, 2021-2024.</p><p><strong>Setting: </strong>A tertiary PICU with 15 medical-surgical beds in a university hospital.</p><p><strong>Patients: </strong>We included children with sepsis and/or septic shock who had serum procalcitonin measured at admission, 24 hours, and 48 hours, simultaneously with microcirculatory assessment using sublingual videomicroscopy and biomarkers of endothelial injury (syndecan-1, angiopoietin-2, and endocan). Hyperprocalcitonemia was defined as procalcitonin greater than 2 ng/mL.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>In 230 patients, 43.9% (101/230) had hyperprocalcitonemia at PICU admission. After adjusting for confounders, children with hyperprocalcitonemia, compared with those with normal procalcitonin, had higher adjusted odds ratio (aOR [95% CI]) of reduced capillary blood flow at 24 hours (aOR, 1.35 [95% CI, 1.08-1.72]) and 48 hours (aOR, 1.14 [95% CI, 1.04-1.24]) after admission. At 24 hours, children with hyperprocalcitonemia compared with those without hyperprocalcitonemia had higher median (interquartile range [IQR]) syndecan-1 levels (125.87 ng/mL [IQR, 49.56-224.30 ng/mL] vs. 107.71 ng/mL [IQR, 62.82-156.55 ng/mL], respectively; p < 0.01) and greater odds of angiopoietin-2 elevation (aOR, 2.28 [95% CI, 1.08-5.17]; p = 0.042). Hyperprocalcitonemia with severe endothelial/microcirculatory dysfunction was associated with fluid overload greater than 10% (aOR, 2.01 [95% CI, 1.06-3.80]; p = 0.033), multiple organ dysfunction (aOR, 1.87 [95% CI, 1.01-3.57]; p = 0.041), and mortality (aOR, 1.66 [95% CI, 1.06-2.61]; p = 0.022). We failed to identify differences in capillary density (4-6 µm), angiopoietin-2, or Endocan between children with and without hyperprocalcitonemia at PICU admission.</p><p><strong>Conclusions: </strong>Children with sepsis and septic shock with hyperprocalcitonemia represent a phenotype characterized by endothelial and microvascular dysfunction, which is associated with worse clinical outcomes. Our study suggests that preserving microvascular integrity may be a therapeutic target to reduce microcirculatory damage and improve outcomes.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1024-e1033"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485477","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":"Beyond Staying Alive….","authors":"Julia A Heneghan, Neethi P Pinto","doi":"10.1097/PCC.0000000000003779","DOIUrl":"10.1097/PCC.0000000000003779","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1057-e1059"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286076","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":"Hyperlactatemia in Critically Ill Children: Modeling Early Recovery Kinetics After Initiation of Extracorporeal Membrane Oxygenation.","authors":"Cheuk C Au, Frederick Vonberg, Matthew Luchette, Kerri LaRovere, Ravi R Thiagarajan, Robert C Tasker, Alireza Akhondi-Asl","doi":"10.1097/PCC.0000000000003776","DOIUrl":"10.1097/PCC.0000000000003776","url":null,"abstract":"<p><strong>Objectives: </strong>Blood lactate concentration ([Lac] b ) reflects the balance among production, clearance (C l[Lac] ), and volume of distribution. We have observed dramatic improvement in [Lac] b in critically ill patients after starting support with extracorporeal membrane oxygenation (ECMO) and discontinuing vasopressors. Here, we evaluated such [Lac] b profiles to develop a mathematical model of recovery kinetics. We then examined the interrelationships between maximum [Lac] b and model-derived parameters of lactate production, endogenous lactate transfer, and C l[Lac] .</p><p><strong>Design: </strong>Mathematical modeling using a convenience sample.</p><p><strong>Setting: </strong>Quaternary U.S. academic children's hospital.</p><p><strong>Participants: </strong>A retrospective sample of 25 ECMO patients (from birth to < 18 yr) with serial [Lac] b measurements during the first 30 hours after initiation of ECMO.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurement and main results: </strong>The median (interquartile range [IQR]) age of ptients was 17 days (IQR 3-152 d), and the median weight was 3.3 kg (IQR 2.7-4.7 kg). At the initiation of ECMO, the mean peak [Lac] b was 16.7 mmol/L (95% CI, 14.3-20.0 mmol/L). Recovery in [Lac] b could be described using a one-compartment, bi-exponential, open model of kinetics. Solving the model equation showed starting lactate load was 17.7 mmol/kg (95% CI, 14.6-20.7 mmol/kg) and C l[Lac] was 19.7 mL/min (95% CI, 3.0-36.4 mL/min). The interrelationship between maximum [Lac] b and model-derived parameters in children requiring ECMO at the limits of cardiopulmonary survival showed: 1) lactate production ranged from 2.3 to 6.4 µmol/kg/min (95% CI), 2) initial endogenous lactate transfer velocity, 82.5-1301.0 µmol/kg/min, 3) high initial [Lac] b levels suggested severely impaired C l[Lac] , 4) a strong correlation was observed between model-derived velocity and transfer parameters (rho 0.75; p < 0.0001), at levels exceeding those seen in high-intensity endurance exercise, and 5) upon achieving steady state, lactate production and C l[Lac] were balanced.</p><p><strong>Conclusions: </strong>At the time of maximal cardiopulmonary instability requiring ECMO initiation, our model of [Lac] b recovery indicated that high initial [Lac] b reflected severely impaired and reduced C l[Lac] . This modeling approach may also be applicable to assessing changes in lactate kinetics in other forms of critical illness.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1034-e1040"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497617","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":"Infant Organ Donation After Death by Circulatory Criteria: A Literature Scoping Review.","authors":"Julia R St Louis, Matthew J Weiss, Sarah Al-Ayass, Shayna T Tierney, Amy L Wright, Sonny Dhanani, Kimberley Widger","doi":"10.1097/PCC.0000000000003771","DOIUrl":"10.1097/PCC.0000000000003771","url":null,"abstract":"<p><strong>Objectives: </strong>Infant organ donation is rare but when it does occur, infants are more commonly eligible for donation after circulatory death (DCD) than donation after neurological death. The aims of this scoping review were to identify: 1) existing research, ethical, and policy information about infant organ DCD and 2) knowledge gaps to guide future research.</p><p><strong>Data sources: </strong>A literature search of MEDLINE, Embase, CINAHL, Scopus, and the Web of Science up to 2024. No other date or search limits were applied. A gray literature search for policy and clinical guideline documents was also conducted.</p><p><strong>Study selection: </strong>Two reviewers independently screened titles and abstracts, then article full texts. The search yielded 8176 unique publications of which 33 were included in this review. The gray literature search yielded six relevant documents.</p><p><strong>Data extraction: </strong>Data were extracted by one reviewer according to the type of article (e.g., donor audit; time to death studies; transplant outcome studies; ethical commentary; position; or policy statements).</p><p><strong>Data synthesis: </strong>The article narratives fell into six topics, including: 1) donor audits and criteria; 2) donor care and referral practices; 3) predictors of time to death; 4) transplant outcomes; 5) ethical issues; and 6) strategies to increase infant organ donation. Donor audits suggest that infant donors are under-recognized, despite good transplantation outcomes in transplant reports. While some predictors of time to death were identified, further research is needed. Several ethical issues were highlighted including debate about permanence vs. irreversibility of death as a requirement for DCD. Families of all potentially eligible infants should be offered the option for donation as part of routine care, with high-quality end-of-life care provided regardless of whether donation occurs.</p><p><strong>Conclusions: </strong>Infant DCD remains an uncommon practice worldwide. Ongoing research is crucial to furthering the field of infant DCD and increasing the number of available organs.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1009-e1016"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249067","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":"The authors reply.","authors":"Luregn J Schlapbach, Halden F Scott, Nelson Sanchez-Pinto, Tellen Bennett, R Scott Watson","doi":"10.1097/PCC.0000000000003786","DOIUrl":"10.1097/PCC.0000000000003786","url":null,"abstract":"","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e1082-e1083"},"PeriodicalIF":4.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12483315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541818","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":"Early Blood Biomarkers and MRI Injury After Cardiac Arrest: Secondary Analysis of the 2017-2020 Personalized Outcomes After Child Cardiac Arrest Study.","authors":"Anna M Janas, Kristen R Miller, Rafael Ceschin, Peter M Mourani, Christopher M Ruzas, Tellen D Bennett, Ericka L Fink, Aline B Maddux","doi":"10.1097/PCC.0000000000003756","DOIUrl":"10.1097/PCC.0000000000003756","url":null,"abstract":"<p><strong>Objectives: </strong>Brain MRI is used to inform prognosis of pediatric cardiac arrest (CA). We analyzed the association between early levels of four brain injury biomarkers and pattern of brain injury on MRI.</p><p><strong>Design, setting, and patients: </strong>This secondary analysis of a multicenter prospective cohort study in 14 U.S. hospitals (from May 16, 2017, to August 19, 2020) recruited children 48 hours to 17 years old who were resuscitated after CA and had a brain MRI within 14 days postarrest.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Brain MRI injury score was calculated as a sum of T2- and diffusion-weighted imaging lesions. We used the Kruskal-Wallis test to compare maximum biomarker values on days 1-3 between three categories of MRI injury severity (i.e., no injury, mild-moderate injury, and severe injury). Maximum neurofilament light chain (NfL), tubulin-associated unit, glial fibrillary acidic protein, and ubiquitin C-terminal hydrolase L1 levels were associated with severity of total injury, gray matter injury, and white matter injury. Using logistic regression, individual biomarker levels were associated with presence of injury on MRI after adjusting for age, presence of congenital heart disease, and severity of illness using Pediatric Index of Mortality 3 score. Of 40 patients with injury on MRI and 1-year outcome data, median (interquartile range [IQR]) NfL levels were higher in the 15 patients who died compared with the 21 patients with favorable outcome (7.10 pg/mL [IQR, 5.94-7.51 pg/mL] vs. 5.10 pg/mL [IQR, 4.10-5.94 pg/mL]; log transformed; p < 0.001), but we failed to identify a difference in levels between those with unfavorable outcome (Vineland Adaptive Behavior Score < 70, n = 4) vs. favorable outcome.</p><p><strong>Conclusions: </strong>Blood biomarkers measured early after injury are associated with MRI injury and may provide additional information for prognostication when incorporated in a multimodal evaluation.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e915-e923"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976221","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":"Diabetic Ketoacidosis and Venous Thromboembolism: A North American Virtual Pediatric Systems Registry Study, 2014-2023.","authors":"Kristin M DeMayo, Elizabeth E Havlicek, Jamie Palumbo, Gerardo Soto-Campos, Marisol Betensky, Neil A Goldenberg, Anthony A Sochet","doi":"10.1097/PCC.0000000000003769","DOIUrl":"10.1097/PCC.0000000000003769","url":null,"abstract":"<p><strong>Objectives: </strong>To estimate the occurrence rate of venous thromboembolism (VTE) among critically ill children and young adults with diabetic ketoacidosis (DKA) and evaluate putative prothrombotic risk factors using a multicenter data registry.</p><p><strong>Design: </strong>Multicenter, observational, retrospective study utilizing a cohort derived from the Virtual Pediatric Systems database from October 1, 2014, to December 31, 2023.</p><p><strong>Setting: </strong>One hundred thirty-nine North American PICUs.</p><p><strong>Patients: </strong>Critically ill children and young adults older than 30 days to younger than 21 years old with principal admission diagnosis of DKA, excluding neonates, postcardiac surgical patients, and children with length of stay (LOS) less than 1 day.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Of 21,549 encounters, 62 (0.29%) developed VTE (mean annual rate, 0.29% ± 0.06%) and 32 of 62 (55%) were hospital-acquired VTE. Patients with, as compared to without, VTE experienced greater rates of sepsis (43.6% vs. 0.7%), cerebral edema (17.7% vs. 3.1%), central venous catheterization (CVC: 66.1% vs. 3.8%), invasive mechanical ventilation (46.8% vs. 2.3%), and a greater LOS (median, 4.9 d [interquartile range (IQR), 2.6-12.2 d] vs. 1.4 d [IQR, 1.1-1.9 d]; all p < 0.001). Regarding DKA-specific prothrombotic risk factors, those with (as compared to without) VTE had more severe acidosis (median admission pH, 6.96 [IQR, 6.82-7.13] vs. 7.07 [IQR, 6.96-7.18]), hyperglycemia (median, 590 mg/dL [IQR, 453-834 mg/dL] vs. 406 mg/dL [IQR, 310-548 mg/dL]), and reduced Glasgow Coma Scale scores (median, 12 [IQR, 6-14] vs. 15 [IQR, 14-15]; all p < 0.001). In an adjusted model, the presence of a CVC (adjusted odds ratio, 23.27; 95% CI, 6.63-81.6; p < 0.001) and concurrent sepsis/infection (odds ratio, 6.69; 95% CI, 2.37-18.87; p < 0.001) were associated with VTE.</p><p><strong>Conclusions: </strong>In this multicenter observational study of critically ill children and young adults hospitalized with DKA, the estimated occurrence rate of VTE was 0.29% and, in an adjusted model, associated with CVC and concurrent infection/sepsis.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e924-e934"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174421","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":"Pediatric Sepsis Phenotype in a Single-Center Cohort Covering 2010-2020: Evolution in Day 1-Day 3 Trajectory and Potential Prognostic Value.","authors":"Zachary Aldewereld, Christopher Horvat, Gilles Clermont","doi":"10.1097/PCC.0000000000003708","DOIUrl":"10.1097/PCC.0000000000003708","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the utility of day 3 sepsis phenotype classifications compared with day 1 and whether these could be reliably identified using routine clinical data on day 1.</p><p><strong>Design: </strong>Retrospective cohort study of pediatric patients managed 2010-2014 and 2018-2020.</p><p><strong>Setting: </strong>Academic children's hospital.</p><p><strong>Patients: </strong>One thousand eight hundred twenty-eight children (1 mo to 18 yr old) admitted to the PICU with suspected infection who received a minimum of 7 days of systemic antibiotics.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Subjects showed significant evolution of phenotype from day 1 to day 3, with 31.7-60.9% remaining the same type. Outcomes were worst in those classifying as type D on day 3, with mortality as high as 16.6% in those that were classified as type D on both days 1 and 3, as well as 11.3% in those initially classified as type C (a lower mortality type) on day 1 but type D on day 3. Accurate statistical prediction of day 3 types using multinomial logistic regression and random forest and day 1 data was poor, despite attempts to improve performance.</p><p><strong>Conclusions: </strong>In our retrospective cohort of patients with sepsis, we identified significant evolution in phenotype over the first 3 days of illness. Day 3 phenotypes may provide more accurate statistical prediction of outcomes, but identification of day 3 phenotypes using data available early in the course of illness is challenging. New methods will likely be required to improve performance in this area.</p>","PeriodicalId":19760,"journal":{"name":"Pediatric Critical Care Medicine","volume":" ","pages":"e909-e914"},"PeriodicalIF":4.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524091","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}