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Research Progress in Pediatric Critical Care Medicine
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Research Progress in Pediatric Critical Care Medicine

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Pediatrics".

Deadline for manuscript submissions: closed (30 November 2024) | Viewed by 7427

Special Issue Editors

Dr. Lama Elbahlawan

E-Mail Website
Guest Editor
Division of Critical Care Medicine, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
Interests: acute lung injury; pediatric critical care medicine; pediatric medicine
Dr. Jennifer Ann McArthur

E-Mail Website
Guest Editor
Division of Critical Care, St. Jude Children's Research Hospital, Memphis, TN, USA
Interests: pediatric oncology; pediatric hematopoietic cell transplant; pediatric critical care medicine

Special Issue Information

Dear Colleagues, 

This Special Issue of “Pediatric Critical Care Medicine” aims to provide a comprehensive overview of the challenges and progress in the management of critically ill children. In particular, the management of multi-organ dysfunction is complex with observed worse outcomes and a higher mortality rate. New insights have emerged to outline the pathogenesis of organ failure, and new therapies have evolved to address organ support as well as to amelerioate the inflammatory response that can exacerbate organ dysfunction. In addition, this issue emphasizes the management of treatment-related complications in pediatric oncology patients, including chemotherapy-induced complications, infectious complications, and organ toxicities. It explores evidence-based interventions and multidisciplinary approaches to mitigate these challenges.

In conclusion, this Special Issue provides a comprehensive overview of pediatric critical care, with an emphasis on early diagnosis, multidisciplinary collaboration, and therapeutic advances. We welcome original articles or review manuscripts on “Research Progress in Pediatric Critical Care Medicine”.

Dr. Lama Elbahlawan
Dr. Jennifer Ann McArthur
Guest Editors

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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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

  • acute renal failure
  • acute respiratory failure
  • pediatric oncology
  • pediatric ICU
  • pediatric critical care medicine
  • multi-organ dysfunction

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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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14 pages, 1158 KiB  
Article
Redirection of Care for Neonates with Hypoxic-Ischemic Encephalopathy Receiving Therapeutic Hypothermia
by Deborah F. L. Gubler, Adriana Wenger, Vinzenz Boos, Rabia Liamlahi, Cornelia Hagmann, Barbara Brotschi and Beate Grass
J. Clin. Med. 2025, 14(2), 317; https://doi.org/10.3390/jcm14020317 - 7 Jan 2025
Viewed by 954
Abstract
Background/Objectives: Hypoxic-ischemic encephalopathy (HIE) in late preterm and term neonates accounts for neonatal mortality and unfavorable neurodevelopmental outcomes in survivors despite therapeutic hypothermia (TH) for neuroprotection. The circumstances of death in neonates with HIE, including involvement of neonatal palliative care (NPC) specialists [...] Read more.
Background/Objectives: Hypoxic-ischemic encephalopathy (HIE) in late preterm and term neonates accounts for neonatal mortality and unfavorable neurodevelopmental outcomes in survivors despite therapeutic hypothermia (TH) for neuroprotection. The circumstances of death in neonates with HIE, including involvement of neonatal palliative care (NPC) specialists and neurodevelopmental follow-up at 18–24 months in survivors, warrant further evaluation. Methods: A retrospective multicenter cohort study including neonates ≥ 35 weeks gestational age with moderate to severe HIE receiving TH, registered in the Swiss National Asphyxia and Cooling Register between 2011 and 2021. Neurodevelopmental follow-up at 18–24 months in survivors was assessed. The groups of survivors and deaths were compared regarding perinatal demographic and HIE data. Prognostic factors leading to redirection of care (ROC) were depicted. Results: A total of 137 neonates were included, with 23 (16.8%) deaths and 114 (83.2%) survivors. All but one death (95.7%) occurred after ROC, with death on a median of 3.5 (2–6) days of life. Severe encephalopathy was indicated by a Sarnat score of 3 on admission, seizures were more frequent, and blood lactate values were higher on postnatal days 1 to 4 in neonates who died. Lactate in worst blood gas analysis (unit-adjusted odds ratio 1.25, 95% CI 1.02–1.54, p = 0.0352) was the only variable independently associated with ROC. NPC specialists were involved in one case. Of 114 survivors, 88 (77.2%) had neurodevelopmental assessments, and 21 (23.9%) of those had unfavorable outcomes (moderate to severe disability). Conclusions: Death in neonates with moderate to severe HIE receiving TH almost exclusively occurred after ROC. Parents thus had to make critical decisions and accompany their neonate at end-of-life within the first week of life. Involvement of NPC specialists is encouraged in ROC so that there is continuity of care for the families whether the neonate survives or not. Full article
(This article belongs to the Special Issue Research Progress in Pediatric Critical Care Medicine)
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11 pages, 422 KiB  
Article
Impact of a Bundle of Interventions on the Spectrum of Parenteral Drug Preparation Errors in a Neonatal and Pediatric Intensive Care Unit
by Sabine von Hobe, Mark Schoberer, Thorsten Orlikowsky, Julia Müller, Nina Kusch and Albrecht Eisert
J. Clin. Med. 2024, 13(20), 6053; https://doi.org/10.3390/jcm13206053 - 11 Oct 2024
Viewed by 1020
Abstract
Background/Objectives: This study aimed to evaluate the impact of a bundle of interventions on the error rates in preparing parenteral medications in a neonatal and pediatric intensive care unit (NICU/PICU). Methods: We conducted a prospective interventional study in a NICU/PICU in [...] Read more.
Background/Objectives: This study aimed to evaluate the impact of a bundle of interventions on the error rates in preparing parenteral medications in a neonatal and pediatric intensive care unit (NICU/PICU). Methods: We conducted a prospective interventional study in a NICU/PICU in a tertiary university hospital as a follow-up to a prior study in the same setting. A clinical pharmacist and a pharmacy technician (PT) analyzed the workflow of drug preparation on the ward, identified high-alert medications, and defined a bundle of five interventions, which include the following: Drug Labeling: 1. EN ISO-DIVI labeling; Training: 2. Standardized preparation process on the ward; 3. eLearning Program; 4. Expert Consultations; and Location of Preparation: 5. Transfer of the preparation of high-alert medications and standardized preparations to the central pharmacy. After implementing the bundle of interventions, we observed the preparation process on the ward to evaluate if the implementation of the interventions had an impact on the quality of the drug preparation. Results: We observed 262 preparations in the NICU/PICU. Each single step of the preparation process was defined as an error opportunity. We defined seven error categories with an overall error opportunity of 1413. In total, we observed 11 errors (0.78%). The reduction in the overall error rate from 1.32% in the former study to 0.78% per preparation opportunity demonstrated that the implemented interventions were effective in enhancing medication safety. Conclusions: This study provides evidence that a bundle of interventions, including standardizing drug labeling, enhancing training, and centralizing the preparation of high-alert medications, can reduce medication errors in NICU/PICU settings. Full article
(This article belongs to the Special Issue Research Progress in Pediatric Critical Care Medicine)
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Review

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13 pages, 1699 KiB  
Review
Fluid Overload in Children Following Hematopoietic Cell Transplant: A Comprehensive Review
by Lama Elbahlawan, Amr Qudeimat, Ray Morrison and Alexandra Schaller
J. Clin. Med. 2024, 13(21), 6348; https://doi.org/10.3390/jcm13216348 - 23 Oct 2024
Viewed by 1579
Abstract
Fluid overload significantly increases morbidity and mortality in critically ill children. Following hematopoietic cell transplant (HCT), children are at a high risk of fluid accumulation due to essential increased fluid intake for nutrition, blood products, and antimicrobials. In addition, many complications predispose these [...] Read more.
Fluid overload significantly increases morbidity and mortality in critically ill children. Following hematopoietic cell transplant (HCT), children are at a high risk of fluid accumulation due to essential increased fluid intake for nutrition, blood products, and antimicrobials. In addition, many complications predispose these children to capillary leak and fluid overload (FO), such as sinusoidal obstruction syndrome, engraftment syndrome, sepsis, and acute kidney injury (AKI). FO > 10% occurs in nearly half of children following HCT and is associated with a lower PICU survival rate. In addition, in children with acute respiratory failure post HCT, each 1% increase in cumulative fluid balance on d 3 increases the odds of PICU mortality by 3%. Furthermore, FO worsens AKI. Tools such as the renal angina index and urinary biomarkers such as neutrophil gelatinase-associated lipocalin can help identify patients at risk of AKI and FO. Early detection, prevention, and intervention are crucial to improving outcomes in this population. Management strategies include fluid restriction, diuretics, and continuous kidney replacement therapy (CKRT) when FO exceeds 10% and other measures have failed. Full article
(This article belongs to the Special Issue Research Progress in Pediatric Critical Care Medicine)
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14 pages, 309 KiB  
Review
Acute Kidney Injury in Neonatal Intensive Care Unit: Epidemiology, Diagnosis and Risk Factors
by Valeria Chirico, Antonio Lacquaniti, Filippo Tripodi, Giovanni Conti, Lucia Marseglia, Paolo Monardo, Eloisa Gitto and Roberto Chimenz
J. Clin. Med. 2024, 13(12), 3446; https://doi.org/10.3390/jcm13123446 - 13 Jun 2024
Cited by 6 | Viewed by 3334
Abstract
Acute kidney injury (AKI) is associated with long-term consequences and poor outcomes in the neonatal intensive care unit. Its precocious diagnosis represents one of the hardest challenges in clinical practice due to the lack of sensitive and specific biomarkers. Currently, neonatal AKI is [...] Read more.
Acute kidney injury (AKI) is associated with long-term consequences and poor outcomes in the neonatal intensive care unit. Its precocious diagnosis represents one of the hardest challenges in clinical practice due to the lack of sensitive and specific biomarkers. Currently, neonatal AKI is defined with urinary markers and serum creatinine (sCr), with limitations in early detection and individual treatment. Biomarkers and risk factor scores were studied to predict neonatal AKI, to early identify the stage of injury and not the damage and to anticipate late increases in sCr levels, which occurred when the renal function already began to decline. Sepsis is the leading cause of AKI, and sepsis-related AKI is one of the main causes of high mortality. Moreover, preterm neonates, as well as patients with post-neonatal asphyxia or after cardiac surgery, are at a high risk for AKI. Critical patients are frequently exposed to nephrotoxic medications, representing a potentially preventable cause of AKI. This review highlights the definition of neonatal AKI, its diagnosis and new biomarkers available in clinical practice and in the near future. We analyze the risk factors involving patients with AKI, their outcomes and the risk for the transition from acute damage to chronic kidney disease. Full article
(This article belongs to the Special Issue Research Progress in Pediatric Critical Care Medicine)
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