Intensive care medicine. Paediatric and neonatal最新文献

{"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}

{"title":"Evaluating associations between late intensive care admission and mortality, intensive care days, and organ dysfunctions: a secondary analysis of data from the EPOCH cluster randomized trial","authors":"Ari R. Joffe, Karen Dryden-Palmer, Leah Shadkowski, Helena Frndova, Vinay Nadkarni, George Tomlinson, Christopher Parshuram","doi":"10.1007/s44253-023-00019-w","DOIUrl":"https://doi.org/10.1007/s44253-023-00019-w","url":null,"abstract":"Abstract Purpose To determine whether late admission to pediatric intensive care (ICU) from hospital wards is associated with patient outcomes. Methods Secondary analysis of prospectively collected data from an international multicenter cluster-randomized trial. Clinical deterioration events with urgent ICU admission were defined as late if the Children’s Resuscitation Intensity Scale was > 2 (indicating critical care interventions started from 12 h pre- to 1 h post-urgent ICU admission). The association of late admission with primary outcomes (ICU and hospital mortality) was estimated using logistically generalized estimating equation models adjusted for PIM2 probability of death. Results There were 2979 clinical deterioration events in 2502 patients, including 620 (20.8%) late ICU admissions. ICU mortality of the last urgent ICU admission was 15.4% for late compared to 4.5% for non-late ICU admission (PIM-adjusted OR (95%CI) 1.63 (1.14, 2.33), p < 0.01). Hospital mortality was 19.7% in late compared to 6.0% for non-late urgent ICU admission (PIM-adjusted OR 1.56 (1.12, 2.16), p < 0.01). Late ICU admissions accounted for 20.9% of clinical deterioration events, and 90/179 (50.2.0%) of ICU and 103/222 (46.4%) of hospital deaths after clinical deterioration events. Secondary outcomes associated with late ICU admission included longer ICU stay (2.3 days, p = 0.02), more ventilation days (407/1000 ICU days, p < 0.0001), and more frequent treatment with dialysis, inhaled nitric oxide, and extracorporeal membrane oxygenation ( p < 0.01). Conclusion Late ICU admission from hospital wards was associated with higher ICU and hospital mortality, greater use of ICU technologies, and longer ICU stays. How to prevent late ICU admission and its consequences requires further study.","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"261 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135633977","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":"Distribution and trajectory of vital signs from high-frequency continuous monitoring during pediatric critical care transport","authors":"Zhiqiang Huo, John Booth, Thomas Monks, Philip Knight, Liam Watson, Mark Peters, Christina Pagel, Padmanabhan Ramnarayan, Kezhi Li","doi":"10.1007/s44253-023-00018-x","DOIUrl":"https://doi.org/10.1007/s44253-023-00018-x","url":null,"abstract":"Abstract Objective To describe comprehensively the distribution and progression of high-frequency continuous vital signs monitoring data for children during critical care transport and explore associations with patient age, diagnosis, and severity of illness. Design Retrospective cohort study using prospectively collected vital signs monitoring data linked to patient demographic and transport data. Setting A regional pediatric critical care transport team based in London, England. Patients Critically ill children (age ≤ 18 years) transported by the Children’s Acute Transport Service (CATS) at Great Ormond Street Hospital (GOSH) between January 2016 and May 2021 with available high-frequency vital signs monitoring data. Interventions None. Main results Numeric values of heart rate (HR), blood pressure (BP), respiratory rate (RR), oxygen saturations (SpO 2 ), and end-tidal carbon dioxide in ventilated children (etCO 2 ) were extracted at a frequency of one value per second totalling over 40 million data points. Age-varying vital signs (HR, BP, and RR) were standardized using Z scores. The distribution of vital signs measured in the first 10 min of monitoring during transport, and their progression through the transport, were analyzed by age group, diagnosis group and severity of illness group. A complete dataset comprising linked vital signs, patient and transport data was extracted from 1711 patients (27.7% of all transported patients). The study cohort consisted predominantly of infants (median age of 6 months, IQR 0–51), and respiratory illness (36.0%) was the most frequent diagnosis group. Most patients were invasively ventilated (70.7%). The Infection group had the highest average (+ 2.5) and range (− 5 to + 9) of HR Z scores, particularly in septic children. Infants and pre-school children demonstrated a greater reduction in the HR Z score from the beginning to the end of transport compared to older children. Conclusions Marked differences in the distribution and progression of vital signs between age groups, diagnosis groups, and severity of illness groups were observed by analyzing the high-frequency data collected during paediatric critical care transport.","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135537500","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":"Use of bi-caval cannulae for veno-venous ECMO in neonates and children","authors":"J. Awad, A. Numa, H. Ravindranathan, Peter Grant, A. Lahanas, Puneet Singh, K. Swil, Victoria Ward, Gary Williams","doi":"10.1007/s44253-023-00017-y","DOIUrl":"https://doi.org/10.1007/s44253-023-00017-y","url":null,"abstract":"","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"138 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90451502","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":"Inflammatory and coagulant responses after acute respiratory failure in children of different body habitus","authors":"Shan L. Ward, H. Flori, M. Dahmer, H. Weeks, A. Sapru, M. Quasney, M. Curley, Kathleen D. Liu, M. Matthay","doi":"10.1007/s44253-023-00015-0","DOIUrl":"https://doi.org/10.1007/s44253-023-00015-0","url":null,"abstract":"","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. Paediatric and neonatal","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74937182","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}