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Children
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Addressing Challenges in Pediatric Critical Care Medicine (2nd Edition)
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Addressing Challenges in Pediatric Critical Care Medicine (2nd Edition)

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Emergency Medicine & Intensive Care Medicine".

Deadline for manuscript submissions: 10 July 2026 | Viewed by 1233

Special Issue Editor

Dr. Balagangadhar Totapally

E-Mail Website
Guest Editor
Division of Critical Care Medicine, Nicklaus Children’s Hospital, 3100 SW 62nd Avenue, Miami, FL 33165, USA
Interests: pediatric critical care (sepsis, organ dysfunction, etc.); database research; outcome research
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The healthcare landscape is changing rapidly around the world with increased technology use and the application of AI in medical practice. Although the pediatric critical care subspecialty is young, it is maturing rapidly. As a society, we have established guidelines for many pressing issues, and publications in the field are rapidly growing. However, several challenges in the management of acutely ill or injured children still persist, and new challenges are appearing. The continued increase in children with chronic illnesses poses a major challenge. Cost containment is another pressing issue that threatens healthcare in general. This Special Issue aims to address challenges in pediatric critical care that are practical problems in both high-income and low–middle-income countries in managing acutely ill or injured children. We are soliciting original research, meta-analyses, systematic analyses, or review articles in any discipline pertaining to the care of acutely ill or injured children.

Dr. Balagangadhar Totapally
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • child
  • critical care
  • chronic illness
  • equitable care
  • injury
  • organ failure/organ support
  • infection/sepsis
  • quality improvement
  • global health

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (2 papers)

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Research

16 pages, 516 KB  
Article
Pediatric Shock Across Acute Emergencies: Age Patterns, Etiologic Subtypes, and Bedside Clinical Indicators in a Single-Centre Cohort
by Cristina Elena Singer, Ion Dorin Pluta, Ștefănița Bianca Vintilescu, Popescu Elena Madalina, George Alin Stoica, Renata-Maria Varut, Pirscoveanu Denisa Floriana Vasilica, Virginia Radulescu, Nuica Valentina Geanina, Denisa Preoteasa, Mocanu Andreea Gabriela and Carmen Sirbulet
Children 2026, 13(3), 366; https://doi.org/10.3390/children13030366 - 4 Mar 2026
Viewed by 674
Abstract
Background/Objectives: Pediatric shock is a final common pathway of cardiovascular failure across diverse emergencies, yet data from mixed emergency cohorts outside intensive care units remain limited. This study aimed to describe the distribution, etiologic subtypes, and clinical correlates of shock in children presenting [...] Read more.
Background/Objectives: Pediatric shock is a final common pathway of cardiovascular failure across diverse emergencies, yet data from mixed emergency cohorts outside intensive care units remain limited. This study aimed to describe the distribution, etiologic subtypes, and clinical correlates of shock in children presenting within a diagnosis-based emergency cohort. Methods: A retrospective single-centre study was conducted in children aged 0–16 years presenting with selected acute pediatric emergencies, among whom cases with and without shock were compared. Shock was defined using documented diagnoses and compatible hemodynamic features, and multiple etiologic types of shock were analyzed, including hypovolemic, septic, cardiogenic, and anaphylactic shock. Demographic and diagnostic variables—age, length of stay, organ support, age strata, and selected comorbidities—and baseline clinical features were compared between children with and without shock using non-parametric and χ2/Fisher’s exact tests. Results: Within the prespecified diagnosis-based analytic cohort, 36/128 children (28.1%) met the study criteria for shock and occurred across all prespecified acute pediatric emergency groups, with the highest proportional burden in heart failure and meningitis; this proportion should not be interpreted as an emergency-department prevalence estimate. Children with shock were younger, with clustering in infants < 1 year and those aged 5–9 years, and tended to stay longer in hospital. Pre-existing cardiac disease, severe dehydration, and altered mental status/coma were more frequent among children with shock. Septic and cardiogenic shock required the most intensive organ support. Conclusions: In this pediatric emergency cohort, shock emerged as a clinically relevant and etiologically heterogeneous complication across diverse acute presentations, with a distinct age-related vulnerability pattern and consistent associations with readily identifiable bedside clinical features. Simple bedside information—particularly cardiac comorbidity, dehydration, and altered consciousness—may assist the early recognition of children with evolving circulatory failure and support closer monitoring and timely escalation of care. By focusing on a mixed emergency population outside the intensive care unit, this study provides a real-world clinical perspective that may help refine early bedside assessment and improve vigilance for shock in pediatric emergency departments. Full article
(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine (2nd Edition))
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13 pages, 1140 KB  
Article
A Retrospective Epidemiological Study of Mortality in a Pediatric Intensive Care Unit: Trends, Causes, and Risk Factors (2014–2023)
by Zhiping Zou, Jie Cheng, Xiaoyu Xiong, Dapeng Chen, Liping Tan and Hongdong Li
Children 2026, 13(3), 337; https://doi.org/10.3390/children13030337 - 27 Feb 2026
Viewed by 336
Abstract
Background: Continuous monitoring of mortality trends and a thorough understanding of death epidemiology in Pediatric Intensive Care Units (PICUs) are critical for healthcare quality assessment, rational resource allocation, and quality improvement initiatives. This study aimed to analyze a decade-long mortality rate, its [...] Read more.
Background: Continuous monitoring of mortality trends and a thorough understanding of death epidemiology in Pediatric Intensive Care Units (PICUs) are critical for healthcare quality assessment, rational resource allocation, and quality improvement initiatives. This study aimed to analyze a decade-long mortality rate, its temporal trends, and the primary causes of death and to elucidate the independent risk factors for early death within a PICU cohort. Methods: This retrospective cohort study included all PICU admissions at the Children’s Hospital of Chongqing Medical University from 1 January 2014, to 31 December 2023. Data collection covered demographic characteristics, primary diagnoses, comorbidities, requirements for mechanical ventilation or vasoactive drugs, lengths of stay, and patient outcomes. The multivariate logistic regression analysis was used to determine independent risk factors associated with early death. Results: Among 21,910 ICU admissions, the overall mortality rate was 2.3% (n = 512), with a historical range of 0.41% to 5.71%, indicating a gradual decline after 2019. Early mortality (death within 24 h of admission) accounted for 13.9% (71/512) of all deaths. Patients in the early mortality group presented with more severe disease conditions, including shock, sepsis, and postoperative status (p < 0.05). Laboratory findings at admission revealed significantly higher procalcitonin and lactate levels, along with lower albumin levels, in this group than in children who died >24 h after admission (p < 0.05). Multivariate analysis revealed that a need for invasive mechanical ventilation (OR = 3.03; 95% CI: 1.68–5.58; p < 0.001), elevated lactate levels (OR = 1.10; 95% CI: 1.02–1.17; p = 0.009), and postoperative status (OR = 0.29; 95% CI: 0.09–0.73; p = 0.017) were independent risk factors for early mortality. Conclusions: Despite an overall decline in mortality since 2019, early mortality among high-risk patients—such as those requiring invasive mechanical ventilation or those presenting with elevated lactate levels—requires attention. Prompt recognition of these risk profiles and timely intervention are crucial for improving outcomes in children. Full article
(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine (2nd Edition))
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