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Children
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Addressing Challenges in Pediatric Critical Care Medicine
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Addressing Challenges in Pediatric Critical Care Medicine

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 November 2025 | Viewed by 4510

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 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 100 words) can be sent to the Editorial Office for announcement on this website.

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 (4 papers)

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Research

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10 pages, 6304 KiB  
Article
Foreign Bodies in Lower Airway in Children: Brief Review and Clinical Experience
by Stoyan Markov, Petya Markova, Ivanka Karavelikova and Hristina Halacheva
Children 2025, 12(1), 67; https://doi.org/10.3390/children12010067 - 7 Jan 2025
Cited by 1 | Viewed by 934
Abstract
Background: Foreign body aspiration is a preventable occurrence that carries a high risk of mortality in the pediatric population. Clinically, foreign body aspiration manifests as cough, followed by choking, which might not be given any consideration by the caregivers of the child. An [...] Read more.
Background: Foreign body aspiration is a preventable occurrence that carries a high risk of mortality in the pediatric population. Clinically, foreign body aspiration manifests as cough, followed by choking, which might not be given any consideration by the caregivers of the child. An episode of sudden wheezing can also raise the suspicion of a foreign body in the lower respiratory tract. The clinical findings depend on the type, size, and localization of the foreign body and include persistent cough, localized airway resistance, localized or diffuse wheezing, and difficulty breathing. A bronchoscopy is the procedure of choice for the removal of foreign bodies. Flexible bronchoscopy is increasingly being used as the initial diagnostic procedure in children with an uncertain history of choking, in the absence of physical and radiological lung changes, and in chronic complaints requiring the exclusion of a foreign body in the airways. Thus, the aim of this study was to describe our clinical experience with lower respiratory tract foreign body extraction in children over a period of five years. Materials and Methods: Over a 5-year period, 154 patients under the age of 18 underwent a bronchoscopy due to a suspected foreign body in the lower respiratory tract. Of these patients, 92% had an incident leading to acute respiratory distress, and 8% had no definite data on such an event in the anamnesis. Results: A foreign body in the respiratory tract was found in and extracted from 50 patients, and foreign bodies were absent in 104 of the cases. Conclusions: If a foreign body enters the lower respiratory tract, immediate and adequate actions are required to solve the problem. A bronchoscopy should be conducted in every suspected case of foreign body aspiration. Full article
(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)
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16 pages, 665 KiB  
Article
Epidemiological and Clinical Characteristics of Pediatric Acute Drug Intoxications: A Retrospective Analysis
by Cristina Elena Singer, Renata-Maria Văruț, Maria Singer, Simona Cosoveanu, Jaqueline Abdul Razzak, Madalina Elena Popescu, Simina Gaman, Ileana Octavia Petrescu and Cristina Popescu
Children 2025, 12(1), 44; https://doi.org/10.3390/children12010044 - 30 Dec 2024
Cited by 2 | Viewed by 1045
Abstract
Background/Objectives: Acute drug intoxications (ADIs) are a significant concern in pediatric healthcare, contributing to both accidental and intentional morbidity. This study aimed to analyze the demographic, clinical, and therapeutic characteristics of pediatric ADI cases to identify trends and inform preventive strategies. Methods: This [...] Read more.
Background/Objectives: Acute drug intoxications (ADIs) are a significant concern in pediatric healthcare, contributing to both accidental and intentional morbidity. This study aimed to analyze the demographic, clinical, and therapeutic characteristics of pediatric ADI cases to identify trends and inform preventive strategies. Methods: This retrospective study included 120 cases of pediatric ADI admitted to the Second Pediatric Clinic of Craiova County Emergency Clinical Hospital in 2022 and 2023. The inclusion criteria encompassed children aged 0–17 years with confirmed pharmaceutical intoxications. Cases involving mixed poisonings or non-pharmaceutical substances were excluded. Clinical severity was classified using the Poisoning Severity Score (PSS). Data on demographics, substances involved, clinical presentations, interventions, and outcomes were analyzed. Results: The majority of cases occurred in females (73.3%) and urban residents (77.5%). Accidental intoxications were prevalent in children aged 1–5 years (45%), while intentional ingestions were common in adolescents (47.5%). The most frequently implicated substances included antibiotics (46.7%), benzodiazepines (20.8%), and acetaminophen (15.8%). Severity was classified as mild (44.2%), moderate (26.6%), or severe (29.2%), while treatment primarily included supportive care, intravenous fluids (62.5%), and antidotes (35.8%). Severe cases required respiratory support in 29.2% of the instances. Hospitalization duration significantly decreased from 2022 (3.8 ± 1.9 days) to 2023 (2.3 ± 0.9 days) (p < 0.05), and no fatalities were recorded. Conclusions: Pediatric ADIs predominantly involve accidental ingestions in young children and intentional overdoses in adolescents. Targeted public health strategies, such as parental education, adolescent mental health support, and improved rural healthcare access, are essential to reduce incidence and severity. These findings underscore the need for focused prevention and optimized clinical management. Full article
(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)
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Review

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13 pages, 264 KiB  
Review
Advance Care Planning Conversations in Pediatric Patients with Refractory Oncologic Disease
by Aqsa Khan, Ajay Gupta, Andy Liu and Ali H. Ahmad
Children 2025, 12(4), 479; https://doi.org/10.3390/children12040479 - 8 Apr 2025
Viewed by 447
Abstract
Advance care planning (ACP) involves longitudinal communication between the patient and physician to explore the patient’s wishes and goals while relaying accurate diagnostic and prognostic information to support informed and shared medical decision-making. In pediatrics, it also uniquely involves the parents or legal [...] Read more.
Advance care planning (ACP) involves longitudinal communication between the patient and physician to explore the patient’s wishes and goals while relaying accurate diagnostic and prognostic information to support informed and shared medical decision-making. In pediatrics, it also uniquely involves the parents or legal guardians as the primary medical decision-makers. ACP ideally leads to the implementation of advanced directives (ADs) and can be a difficult concept to discuss with pediatric patients and families with refractory oncologic disease, given the distinctive burdens that accompany this population. Many obstacles can delay the initiation of these conversations with these families, although existing literature supports beginning ACP conversations at the time of initial diagnosis and treatment. Parents or legal guardians often serve as the sole decision maker for pediatric patients but there has also been a shift in the literature to include children/adolescents in conversations regarding ADs and other aspects of end-of-life (EOL) care, an essential aspect of patient-centered ACP. This guidance is unfortunately not often translated into clinical practice. In this review, we aim to define and discuss the current status, obstacles, and benefits surrounding early initiation of ACP conversations with children or adolescents with advanced cancer and their families. We also discuss how physicians and the medical team, including pediatric palliative care, can increase the degree of pediatric patient involvement in ACP and EOL discussions, as developmentally appropriate, and mitigate delays in discussing ACP with these families and patients. Full article
(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)
27 pages, 1886 KiB  
Review
Thrombocytopenia in Critically Ill Children: A Review for Practicing Clinicians
by Balagangadhar R. Totapally, Abhinav Totapally and Paul A. Martinez
Children 2025, 12(1), 83; https://doi.org/10.3390/children12010083 - 12 Jan 2025
Viewed by 1631
Abstract
Thrombocytopenia frequently occurs in patients before, during, and after admission to Pediatric Intensive Care Units (PICUs). In critically ill children, it is often due to multifactorial causes and can be a sign of significant organ dysfunction. This review summarizes the potential causes/mechanisms of [...] Read more.
Thrombocytopenia frequently occurs in patients before, during, and after admission to Pediatric Intensive Care Units (PICUs). In critically ill children, it is often due to multifactorial causes and can be a sign of significant organ dysfunction. This review summarizes the potential causes/mechanisms of thrombocytopenia in acutely ill children, their identification, and treatments, with special attention paid to septic patients. The mechanisms of thrombocytopenia include decreased production and sequestration, but the most common reason is increased destruction or consumption. This review specifically reviews and compares the presentation, pathogenesis, and treatment of disseminated intravascular coagulation (DIC) and the thrombotic microangiopathic spectrum (TMA), including thrombocytopenia-associated multiorgan failure (TAMOF), hemolytic uremic syndrome, and other diagnoses. The other etiologies discussed include HLH/MAS, immune thrombocytopenia, and dilutional thrombocytopenia. Finally, this review analyzes platelet transfusions, the various thresholds, and complications. Full article
(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)
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