Intensive care medicine. Paediatric and neonatal最新文献

{"title":"International survey on immunological diagnostics in children with sepsis.","authors":"Nina Schöbi, Philipp K A Agyeman, Vanessa Sancho-Shimizu, Johannes Trück, Julie C Fitzgerald, Luregn J Schlapbach","doi":"10.1007/s44253-026-00120-w","DOIUrl":"10.1007/s44253-026-00120-w","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a leading cause of death and disability in children and it affects in up to 50% previously healthy children who have access to health care. Undiagnosed inborn error of immunity, considered to be rare at population level, may underlie host immune dysregulation and result in exceptionally high risk for life-threatening infections.</p><p><strong>Methods: </strong>From May 2023 to March 2024, physicians involved in the care of children with sepsis were questioned regarding their follow-up investigation practice in paediatric patients after community-acquired sepsis. This survey was distributed through three international societies.</p><p><strong>Results: </strong>A total of 168 responses from 50 countries were analysed. The majority (82%), reported to have more than 10 years of experience. More than half (53%) stated to work in Paediatric Infectious Diseases. Major variability across respondents was observed in the approach to different scenarios of patients with sepsis. Severity of presentation, and unusual presentations increased the likelihood of ordering immunological investigations. Only 7% reported to have access to a standardised sepsis specific guideline to immunologically investigate paediatric patients after sepsis.</p><p><strong>Conclusion: </strong>The results of this survey highlight a broad range of practices surrounding immunological investigations of children with sepsis. A consensus-based algorithm for standardised immunological and genetic testing in paediatric patients after sepsis could guide practice and inform future studies in the field.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s44253-026-00120-w.</p>","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"4 1","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a diagnostic model for late-onset neonatal sepsis using the haematological profile: a retrospective cohort study.","authors":"Emily Hyde, Janno Schouten, Jarob Saker, H R Taal, H Russcher, Eliane Wenstedt, Stephen Kennedy, Manu Vatish, Mark Anthony","doi":"10.1007/s44253-026-00121-9","DOIUrl":"10.1007/s44253-026-00121-9","url":null,"abstract":"<p><strong>Purpose: </strong>Neonates admitted to intensive care units are at high risk of hospital-acquired infections. While blood cultures remain the gold standard for sepsis diagnosis, they do not detect infection in every case. Host immune response markers, such as C-reactive protein and procalcitonin, can assist in earlier detection but also have limitations and carry additional costs. We have developed a Neonatal Intensive Care Infection Score (NICIS), which leverages extended complete blood count (CBC+Diff + EIP) parameters, which may require specific analyser configuration or software licensing, to extract additional diagnostic value.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of neonates admitted to the Neonatal Intensive Care Unit at the John Radcliffe Hospital (Oxford, UK) over one year. Eighteen CBC+Diff + EIP parameters were initially considered based on their ability to differentiate culture-positive patients from those without clinical suspicion of infection. NICIS was developed as a weighted score and validated internally using a temporally distinct dataset and externally using a four-year retrospective cohort from Erasmus University Medical Center (Rotterdam, The Netherlands).</p><p><strong>Results: </strong>Incorporating eight CBC+Diff + EIP parameters, NICIS values ranged from 0 to 25, with higher scores indicating a greater likelihood of sepsis. NICIS achieved an area under the curve of 0.906 in training, 0.879 in internal validation, and 0.841 in external validation, outperforming C-reactive protein and total white blood cell count in all datasets.</p><p><strong>Conclusions: </strong>NICIS provides an interpretable tool for sepsis detection using routinely collected CBC+Diff + EIP data without additional sampling. Its performance across internal and external cohorts suggests sufficient diagnostic accuracy, although prospective studies are warranted to further assess generalisability and clinical utility.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s44253-026-00121-9.</p>","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"4 1","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13314925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in Paediatric intensive care mortality by biological sex: a study of English PICUs using linked administrative datasets.","authors":"Ofran Almossawi, Bianca L De Stavola, Katie Harron, Richard G Feltbower, Joseph Ward, Simon Nadel","doi":"10.1007/s44253-026-00130-8","DOIUrl":"10.1007/s44253-026-00130-8","url":null,"abstract":"<p><strong>Objective: </strong>To determine if there is a causal relationship between sex and mortality in Paediatric Intensive Care Units (PICUs).</p><p><strong>Methods: </strong>A multi-centre, population-based cohort study of English PICUs, designed using the potential outcomes framework and doubly robust methods. Participants were children aged 0 to 8 years with at least one admission to PICU between January 2010 and December 2019, with linked PICU and hospital records. The exposure was biological sex, and the main outcome was the causal difference in mortality between females in PICU and their counterfactual mortality if these females were hypothetically male (Average Treatment effect in the Treated; ATT).</p><p><strong>Results: </strong>There were 48,500 children, of whom 20,412 (42.1%) were females and 28,088 (57.9%) were males and with a median age at first PICU admission of 0.5 (IQR 0.08-2.02) years. During the first admission, 1,760 (3.63%) children died; of whom, 777/20,412 (3.81%) were female and 983/28,088 (3.50%) were male. The doubly robust estimated causal mortality risk difference captured by the ATT (i.e. excess mortality for girls in PICU), was 0.31% (95% CI 0.01-0.61).</p><p><strong>Conclusions: </strong>Although boys have a higher rate of death than girls by age in the general population, this mortality trend is reversed in PICU. Evidence of this increased female mortality persists after applying doubly robust causal methods, indicating a causal link. The supposition that all pre-pubertal children have the same responses to critical illness and their management should be re-examined.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s44253-026-00130-8.</p>","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"4 1","pages":"19"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148610858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contributors to perceived workload strain in the pediatric intensive care unit.","authors":"Candace Collins, Dustin Hansen, Amanda Levin, James Fackler, Michael Rosen, Salar Khaleghzadegan, Gayane Yenokyan, David C Stockwell","doi":"10.1007/s44253-026-00126-4","DOIUrl":"10.1007/s44253-026-00126-4","url":null,"abstract":"<p><strong>Objectives: </strong>Patient outcomes worsen during periods of high intensive care units (ICU) capacity strain. Common metrics used to determine workload strain are overall patient census, turnover, and various patient acuity surrogates. We aimed to identify factors that increase perceived workload strain in the pediatric intensive care unit (PICU) using the NASA Task Load Index (TLX) and single item stress scores (SISS).</p><p><strong>Methods: </strong>This is a single-center, prospective observational study with survey and electronic medical record (EMR) data. We used multiple NASA TLX and SISS metrics per PICU shift as markers of perceived workload strain. These data, collected from physician fellows and PICU charge nurses, were compared to various objective unit- and patient-level factors. We used exploratory visual techniques as well as linear mixed-effect models to characterize relationships between strain and individual variables. Data was collected during the COVID-19 pandemic between October 2020 and April 2021.</p><p><strong>Results: </strong>Workload strain was perceived to be higher during day shifts than night shifts and higher for physicians than nurses. Patient volume, turnover, and acuity metrics as well as reported strain showed significant variation during data collection. Patient-level factors associated with increased strain included more patients per shift requiring renal replacement therapy or mechanical/positive pressure ventilation. Unit-level factors associated with increased strain included increases in the totals of patients admitted and discharged, number of blood draws, patient hours, and continuous medication infusions.</p><p><strong>Conclusions: </strong>We find that the PICU is a dynamic environment with variable demands and thresholds beyond which healthcare workers begin to feel increased strain. These findings provide depth and granularity for the study of workload strain in the PICU and could have implications for future improvements in patient care.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s44253-026-00126-4.</p>","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"4 1","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid exposure on the preterm brain: qualitative and quantitative MRI analysis.","authors":"S de Munck, F Savvopoulos, J Dudink, M H G Dremmen, L C C Toussaint-Duyster, N Bouw, M J Vermeulen, N E M van Haren, G E van den Bosch","doi":"10.1007/s44253-025-00105-1","DOIUrl":"10.1007/s44253-025-00105-1","url":null,"abstract":"<p><strong>Aim: </strong>To explore whether opioid exposure (morphine or fentanyl) in the neonatal intensive care unit is associated with altered neurodevelopmental outcome in preterm infants, and whether this association is modified by qualitative (brain lesions) or quantitative (volumetric) brain MRI measures obtained around 30 weeks postmenstrual age (PMA).</p><p><strong>Method: </strong>This retrospective cohort study included 280 infants born ≤ 30 weeks of gestation (2008-2016), scanned at 1.5T before 33 weeks PMA. Brain injury was scored by paediatric (neuro)radiologists; brain volumes were obtained via automated segmentation (dHCP-pipeline). Neurodevelopmental outcome was assessed at age 2 (Bayley-III) and age 5 (WPPSI-III, M-ABC-2). Associations between opioid exposure, brain measures, and outcome were examined using multivariable regression and interaction models.</p><p><strong>Results: </strong>Opioid exposure was associated with lower cognitive scores at age 2, but not with IQ at age 5. Motor scores at age 5 were lower in children exposed to opioids. Opioid administration was associated with increased risk of intraventricular haemorrhage and post haemorrhagic ventricular dilatation, but not with brain volumes. No significant interaction between opioid administration and brain injury or volume on outcome was demonstrated.</p><p><strong>Interpretation: </strong>Opioid exposure in preterm neonates is associated with poorer neurodevelopmental outcome in early childhood, but not with early brain injury or structural volumetrics on MRI after birth. Long-term follow up and longitudinal brain imaging may provide greater insight in the association between opioid administration and poor neurodevelopmental outcome. Thus far, quantitative or qualitative brain metrics around 30 weeks PMA have not been proven useful.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s44253-025-00105-1.</p>","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"4 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12858512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of analgosedation with dexmedetomidine in critically ill mechanically ventilated children: a systematic review and meta-analysis of randomized controlled trials.","authors":"David J Zorko, Jennifer A Klowak, Michael Vu, Yen-Mei Z Mayer, Alexandra Pysklywec, Kimberley Lewis, Karen Choong","doi":"10.1007/s44253-025-00091-4","DOIUrl":"10.1007/s44253-025-00091-4","url":null,"abstract":"<p><strong>Objective: </strong>Dexmedetomidine is an increasingly popular analgosedative in critically ill children receiving invasive mechanical ventilation (IMV). We conducted a systematic review to evaluate the efficacy of dexmedetomidine compared to other analgosedatives in this population.</p><p><strong>Data sources: </strong>Seven electronic databases and trial registries to July 2024, without language restrictions.</p><p><strong>Study selection: </strong>Randomized controlled trials comparing dexmedetomidine to other analgosedatives in critically ill children receiving IMV.</p><p><strong>Data extraction and synthesis: </strong>Independently and in duplicate, we conducted data extraction, risk of bias assessment, and certainty assessment using Grading of Recommendations, Assessment, Development, and Evaluation. We conducted random-effects meta-analyses, calculating pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals.</p><p><strong>Results: </strong>We identified 12 trials (<i>n</i> = 592 patients). Pooled analyses demonstrated dexmedetomidine has little to no effect on IMV duration (MD -2.2 h [-3.3, -1.1]; moderate certainty), clinically important bradycardia (RR 1.42 [0.45, 4.49]; moderate certainty), or clinically important hypotension (RR 1.35 [0.48, 3.82]; moderate certainty). Dexmedetomidine may reduce delirium risk (RR 0.83 [0.64, 1.07]; low certainty), but impact on withdrawal is uncertain (RR 0.93 [0.55, 1.59]; very low certainty). A narrative synthesis was used to evaluate dexmedetomidine sedation efficacy, demonstrating very low certainty in attaining sedation target. One trial reported on long-term outcomes.</p><p><strong>Conclusions: </strong>Twelve trials evaluating dexmedetomidine have been conducted to date, with low or very low certainty for its impact upon delirium, withdrawal, and long-term outcomes. Future analgosedation trials require attention to intervention design, outcome selection and reporting to improve certainty in critical outcomes.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s44253-025-00091-4.</p>","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"3 1","pages":"30"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding infant stress in neonatal and pediatric intensive care: a scoping review.","authors":"Christine Riley, Christopher Mastropietro, Ashley Darcy-Mahoney, Christine Pintz, Quiping Pearl Zhou, Pamela S Hinds","doi":"10.1007/s44253-025-00083-4","DOIUrl":"10.1007/s44253-025-00083-4","url":null,"abstract":"<p><p>Infants in intensive care environments encounter numerous stressors which may overlap or occur in close proximity. Recent literature suggests stressful encounters in the neonatal or early infant period are harmful to physiological, functional, and structural systems, both acutely and longitudinally. Identifying these stressors and assessing the stress burden in this vulnerable population is crucial for developing care models that minimize unnecessary stress, thereby enhancing recovery and survival. This scoping review identified sources of stress encountered by infants hospitalized in intensive care environments, as reported in empiric literature. A total of 51 studies met eligibility criteria. Identified stressors were categorized into environmental stressors, stressors associated with routine care, and stressors associated with noxious or painful procedures. Studies predominately focused on premature infants in neonatal intensive care units; research on stressors in general pediatric intensive care units or among infants with congenital heart disease or other congenital anomalies is lacking. Evaluation of infant stress varied across studies, though most utilized vital sign alterations, biochemical markers, biophysical assessment, or observational scales by clinician report. Across studies, findings suggest stress experienced by infants in intensive care settings may contribute to physiological disruptions and developmental vulnerabilities.</p>","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"3 1","pages":"40"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The promise of biomarkers: precision medicine will pave a roadmap for pediatric acute kidney injury management in critically ill children.","authors":"Natalja L Stanski, Jun Oh, Rajit K Basu","doi":"10.1007/s44253-025-00086-1","DOIUrl":"10.1007/s44253-025-00086-1","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is common in critically ill children and neonates and imparts an increased risk for morbidity and mortality. Despite a growing recognition of the untoward consequences of AKI, its management continues to rely on supportive care alone, after numerous clinical trials have failed to identify effective disease-modifying therapies. This failure to advance the field is likely due in large part to the heterogeneity of AKI, which demands a precision approach to diagnosis and management. Despite the emergence of several novel AKI biomarkers with the ability to refine the AKI diagnosis beyond what is afforded by changes in serum creatinine and/or urine output alone, widespread translation of these biomarkers to practice has been limited. In this review, we outline a roadmap for AKI risk-stratification, diagnosis, management, and follow-up that is rooted in precision medicine principles and feasible with the tools currently available in pediatric ICUs. This roadmap highlights the importance of dynamic (as opposed to static) assessment of the critically ill child with, at-risk for, and recovering from AKI, and introduces the concept of theragnostic biomarkers that are both the target of and change with treatment, thus helping guide the therapeutic approach. Finally, we highlight the need for re-defining appropriate endpoints in AKI clinical trials testing the interventions proposed here (and others) to ensure we are identifying treatments that will meaningfully improve outcomes for critically ill children with AKI.</p>","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"3 1","pages":"35"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-flow nasal oxygen in infants and children for early respiratory management of pneumonia-induced acute hypoxemic respiratory failure: the CENTURI randomized clinical trial","authors":"Sasidaran Kandasamy, R. Rameshkumar, Thangavelu Sangaralingam, N. Krishnamoorthy, N. C. G. Shankar, Vimalraj Vijayakumar, B. Sridharan","doi":"10.1007/s44253-024-00031-8","DOIUrl":"https://doi.org/10.1007/s44253-024-00031-8","url":null,"abstract":"","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"52 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140356331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of primary nasotracheal intubation in the pediatric intensive care unit (PICU).","authors":"Laurence Ducharme-Crevier, Jamie Furlong-Dillard, Philipp Jung, Fabrizio Chiusolo, Matthew P Malone, Shashikanth Ambati, Simon J Parsons, Conrad Krawiec, Awni Al-Subu, Lee A Polikoff, Natalie Napolitano, Keiko M Tarquinio, Asha Shenoi, Andrea Talukdar, Palen P Mallory, John S Giuliano, Ryan K Breuer, Krista Kierys, Serena P Kelly, Makoto Motomura, Ron C Sanders, Ashley Freeman, Yuki Nagai, Lily B Glater-Welt, Joseph Wilson, Mervin Loi, Michelle Adu-Darko, Justine Shults, Vinay Nadkarni, Guillaume Emeriaud, Akira Nishisaki","doi":"10.1007/s44253-024-00035-4","DOIUrl":"10.1007/s44253-024-00035-4","url":null,"abstract":"<p><strong>Background: </strong>Nasal tracheal intubation (TI) represents a minority of all TI in the pediatric intensive care unit (PICU). The risks and benefits of nasal TI are not well quantified. As such, safety and descriptive data regarding this practice are warranted.</p><p><strong>Methods: </strong>We evaluated the association between TI route and safety outcomes in a prospectively collected quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from 2013 to 2020. The primary outcome was severe desaturation (SpO₂ > 20% from baseline) and/or severe adverse TI-associated events (TIAEs), using NEAR4KIDS definitions. To balance patient, provider, and practice covariates, we utilized propensity score (PS) matching to compare the outcomes of nasal vs. oral TI.</p><p><strong>Results: </strong>A total of 22,741 TIs [nasal 870 (3.8%), oral 21,871 (96.2%)] were reported from 60 PICUs. Infants were represented in higher proportion in the nasal TI than the oral TI (75.9%, vs 46.2%), as well as children with cardiac conditions (46.9% vs. 14.4%), both <i>p</i> < 0.001. Severe desaturation or severe TIAE occurred in 23.7% of nasal and 22.5% of oral TI (non-adjusted <i>p</i> = 0.408). With PS matching, the prevalence of severe desaturation and or severe adverse TIAEs was 23.6% of nasal vs. 19.8% of oral TI (absolute difference 3.8%, 95% confidence interval (CI): - 0.07, 7.7%), <i>p</i> = 0.055. First attempt success rate was 72.1% of nasal TI versus 69.2% of oral TI, <i>p</i> = 0.072. With PS matching, the success rate was not different between two groups (nasal 72.2% vs. oral 71.5%, <i>p</i> = 0.759).</p><p><strong>Conclusion: </strong>In this large international prospective cohort study, the risk of severe peri-intubation complications was not significantly higher. Nasal TI is used in a minority of TI in PICUs, with substantial differences in patient, provider, and practice compared to oral TI.A prospective multicenter trial may be warranted to address the potential selection bias and to confirm the safety of nasal TI.</p>","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"2 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10891187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}