Search Results (95)

Background/Objectives: Moderate or severe asthma exacerbations may require pharmacological interventions in addition to standard treatment. In this context, magnesium sulfate has been proposed as a second-line therapeutic option, owing to its physiological effects on bronchial smooth muscle. Therefore, the objective of this meta-analysis is to determine the effectiveness of intravenous or nebulized magnesium sulfate in patients with a moderate-to-severe asthmatic crisis. Methods: This systematic review and meta-analysis included randomized controlled trials published between 1990 and 2024, using the PubMed, Scopus, Science Direct, Web of Science, LILACS, Cochrane Library, Springer, and Scielo databases. The risk of bias was assessed using the RoB 2 tool, the quality of evidence with the Jadad scale, and the certainty of the evidence per outcome was evaluated following the GRADE guidelines. The meta-analysis was developed using the statistical software Jamovi 2.3.28^® and RevMan 5.4^®. Results: Fourteen studies with a total of 2242 patients with a moderate-to-severe asthmatic crisis were included. Of these, ten studies evaluated the severity score, eight evaluated hospitalization, five evaluated the length of the hospital stay, and three evaluated intensive care unit admission. The meta-analysis demonstrates that the use of magnesium sulfate is associated with a statistically significant reduction in the risk of hospitalization (RR: 0.79, 95% CI: from 0.67 to 0.94, p = 0.02). However, no effects were observed on the severity score (SMD: −0.37, 95% CI: from −0.92 to 0.17, p = 0.16), the length of the hospital stay (SMD: −0.75, 95% CI: from −1.90 to 0.40, p = 0.14), or admission to intensive care units (RR: 0.62, 95% CI: from 0.28 to 1.36, p = 0.23). Subgroup and sensitivity analyses did not yield significant findings or produce any modification of the effect. Conclusions: Magnesium sulfate reduces hospitalizations in moderate-to-severe pediatric asthma, although it does not improve other relevant clinical outcomes. Full article

Introduction: Post-Intensive Care Syndrome in Pediatrics (PICS-P) for families is a growing concern as receiving care in the Pediatric Intensive Care Unit (PICU) improves child survival. PICU parental stress may cause post-discharge psychiatric symptoms. Understanding personality-related distress is key for early intervention. This study examined whether parental personality traits correlate with such symptoms for PICS-P prevention. Methods: A cohort pilot study was conducted at a Japanese university hospital PICU (eight beds, 200–300 annual admissions, mandatory critical care consultation) between January and September 2022. Participants were parents of children admitted for longer than 1 week. Personality traits were investigated using the Big-Five-based test, and psychiatric symptoms were investigated using the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the PTSD Checklist-5 (PCL-5). The correlation between personality traits and psychiatric symptoms was investigated. Results: Among the 53 subjects who met the inclusion criteria, 25 gave consent to participate in this study. The correlation analysis revealed distinct patterns. Agreeableness demonstrated negative correlations: a moderately significant negative correlation with PTSD symptoms (ρ = −0.612, p < 0.05) and non-significant negative correlations with anxiety (ρ = −0.238) and depression (ρ = −0.060). Conversely, neuroticism exhibited positive correlations: a moderately significant positive correlation with anxiety symptoms (ρ = 0.539, p < 0.05), alongside non-significant positive correlations with depression (ρ = 0.318) and PTSD symptoms (ρ = 0.327). Regarding other personality traits, extraversion showed negative correlations with anxiety (ρ = −0.282), depression (ρ = −0.399), and PTSD (ρ = −0.438), conscientiousness displayed positive correlations with anxiety (ρ = 0.318), depression (ρ = 0.127), and PTSD (ρ = 0.467), while openness exhibited negative correlations with anxiety (ρ = −0.333), depression (ρ = −0.312), and PTSD (ρ = −0.309), although none of these associations were statistically significant. Conclusions: Lower levels of agreeableness and higher levels of neuroticism in parents are significantly associated with increased PTSD and anxiety symptoms, respectively, in the PICU setting. These personality traits may serve as predictors of parental psychological distress, suggesting their utility in informing targeted PICS-P interventions and preventative strategies. Full article

Background/Objectives: Transitioning from pediatric to adult services can be challenging for youth with complex chronic health conditions, especially those with multi-morbidity. These youth often require extra coordination and support during this phase of their healthcare journey. Building upon existing provincial and national initiatives for transitions from pediatric to adult healthcare services, we have developed a hospital-wide program within one of Canada’s largest children’s hospitals that incorporates an integrated care model aimed at better serving these patients and improving outcomes. Methods: Guided by provincial quality standards, an environmental scan and knowledge user engagement were conducted to develop the program, followed by an implementation phase, where the model was piloted. Ongoing learnings from the pilot continue to inform program implementation and evaluation. Results: The Transition to Adult Care (TAC) program offers disease-agnostic care to youth with complex needs for 1–3 years, including 1-year post-transfer, addressing the fragmentation of care across multiple services, organizations and providers. Our interdisciplinary team works in partnership with youth and caregivers to deliver transition navigation, easing the burden on patients and families by tailoring transition supports to each individual youth and caregiver. Preliminary data from the pilot revealed a lack of awareness about transition resources and timelines; however, with early engagement and flexible support beyond age 18, youth were able to complete their transition successfully. Conclusions: The TAC program demonstrates a systems-level approach to improving transition to adult care for youth with complex health needs by integrating individualized support, cross-sectoral collaboration, and continuous quality improvement. Early engagement, flexible post-transfer support, and close partnership with youth, caregivers, and providers are key to facilitating transition. These learnings can inform broader implementation efforts and help address persistent gaps in transitional care across healthcare systems. Full article

Objective: To evaluate the clinical, radiological, and bronchoscopic features of pediatric patients admitted to the pediatric intensive care unit (PICU) with suspected foreign body aspiration (FBA), and to compare the diagnostic performance of chest radiography (CXR) and computed tomography (CT). Methods: We retrospectively analyzed 71 children admitted to the PICU of Kayseri City Training and Research Hospital for suspected tracheobronchial FBA between January 2020 and December 2024. Demographic data, clinical presentations, imaging findings, bronchoscopic results, and outcomes were recorded. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CXR and CT were calculated using bronchoscopy as the reference standard. Results: The mean age was 2.61 ± 3.59 years, and 66.1% were male. Organic materials were the most commonly aspirated objects, especially in children aged 0–3 years. The right main bronchus was the most frequently affected site. CXR had a sensitivity of 94.9% (95% CI: 83.1–98.6) and a specificity of 71.0% (95% CI: 53.4–83.9), while CT had a sensitivity of 63.2% (95% CI: 41.0–80.9) and a specificity of 100% (95% CI: 87.5–100.0). Bronchoscopy revealed no foreign body in 45.1% of cases. Most patients (94.4%) fully recovered; complications included two deaths, one lobectomy, and one case of hypoxic sequelae. Conclusion: FBA remains a critical pediatric emergency, particularly in young children. CXR is a highly sensitive and accessible screening tool, while CT offers high specificity but lower sensitivity. Prompt diagnosis and bronchoscopy by experienced teams ensure favorable outcomes. Full article

Objective: To explore the experiences and self-efficacy of parent-caregivers providing care for a child with a tracheostomy tube. Study Design: Parent-caregivers completed surveys and participated in semi-structured interviews about their experiences learning to care for their child with a tracheostomy tube. Survey data were analyzed using descriptive statistics. Interviews were transcribed verbatim and analyzed thematically through coding. Results: Fifteen parent-caregivers participated in the survey, 13 of whom completed an interview. After receiving a tracheostomy, children were hospitalized a median of 6 months prior to discharge home. At the time of our study, children had been home for a median of 3.5 years. Parent-caregivers felt more prepared to perform routine daily care compared to triaging a change in medical status. Parent-caregiver self-efficacy in performing tracheostomy care skills improved with experience at home. Four themes were identified from interviews: new identity formation, enduring education, child and family biopsychosocial support, and establishing normalcy. Parent-caregivers shared that education was more than just acquiring skills; it also involved discovering diverse ways of learning and building confidence in one’s own abilities to fulfill the many types of roles they serve to successfully care for and keep their child safe while supporting their social and emotional needs as parent-caregivers. Conclusions: Parent-caregivers’ reflections on their experiences provide critical insight into their psychosocial needs and challenges in providing care to children with tracheostomies. Further investigation of lived experiences is vital to shaping a community that can support families of medically complex children. Full article

Pediatric delirium (PD) is an acute neuropsychiatric syndrome marked by fluctuating disturbances in attention and cognition, frequently observed in pediatric intensive care units (PICUs) and associated with increased morbidity, mortality, and long-term cognitive impairment. Despite its clinical significance, PD remains underdiagnosed due to challenges inherent in assessing consciousness and cognition in children at varying developmental stages. Several bedside tools have been developed and validated in recent years, including the Cornell Assessment of Pediatric Delirium (CAPD), PreSchool Confusion Assessment Method for the Intensive Care Unit (psCAM-ICU); Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU), and Sophia Observation Withdrawal Symptoms—Pediatric Delirium Scale (SOS-PD), enhancing early recognition and management of PD in critically ill children. This narrative review explores the historical background, epidemiology, risk factors, pathophysiology, clinical subtypes, diagnostic tools, and current prevention and treatment strategies for PD from newborns to 21 years old. The screening tools available and the integration of non-pharmacological interventions, such as environmental modifications and family-centered care, as well as cautious and selective pharmacological management, are emphasized in this review. Early identification and targeted interventions are essential to mitigate the adverse outcomes associated with PD. Full article

Background: The Korean Pediatric Emergency Tape (KPET), developed using 2005 anthropometric data, aims to improve weight estimation in Korean children. However, its validity has not been evaluated using recent large-scale data. This study evaluates the accuracy of the KPET compared with the latest version of the Broselow Tape (BT) using contemporary national anthropometric datasets. Methods: A cross-sectional analysis was conducted using pooled data from the 2019 National Health Screening Program for Infants and Children (NHSPIC, age 0–5) and the 2018–2019 Student Health Examination Sample Survey in Korea (SHESS, age 6–12). Accuracy was assessed by the proportion of estimates within 10% (PW10) and 20% (PW20) of measured weight, and by concordance between estimated and measured weight color zones. Results: Data from 1,992,646 (KPET) and 1,987,504 (BT) children were analyzed. In NHSPIC, the KPET showed slightly lower overall accuracy than the BT (PW10: 72.7% vs. 74.0%) but outperformed the BT in infants (PW10: 72.1% vs. 67.4%). In SHESS, the KPET consistently underperformed compared with the BT (PW10: 49.5% vs. 52.9%). The KPET showed higher concordance only in infants. Both tapes showed a trend of underestimation with increasing age, more pronounced in the KPET. Conclusion: The KPET showed lower overall performance than the BT but outperformed the BT in infants. Its accuracy declines in older children and tends to underestimate weight. Regular updates using recent anthropometric data are necessary to ensure accurate weight estimation and reflect current growth trends in Korean children. Full article

Background: As national and international reports reveal, significant health care transition (HCT) service disparities exist for youth and young adults with intellectual and developmental disabilities (YYAs with IDD). The development of the HCT model necessitates informed perspectives from a broad constituency, including consumers and families. Parents’ retrospective perspectives of their sons’ or daughters’ HCT experiences are presented to enlarge the understanding of the service need. Methodology: Eleven parents were recruited virtually from parent support/disability advocate groups via an email distribution list of the Children’s Hospital Los Angeles University Center for Excellence in Developmental Disabilities. Parents who consented to participate were interviewed by phone using an interview guide with 11 open-ended items. Three questions focused on the barriers and facilitators associated with the HCT experience are reported. Findings: Four major themes were generated from the analysis of data gathered from parents pertaining to their sons’ or daughters’ health care transition experiences, focusing on the transfer of care. Two major themes were related to HCT barriers—Pediatric Care Contrasted with Adult-Focused Care and Transfer of Care Barriers—and two were related to HCT facilitators—Transfer of Care Facilitators and Transfer of Care Recommendations. Each of the major themes included subthemes. Conclusions: Parents openly shared their sons’ or daughters’ HCT experiences, which illuminated the scope of their challenges and the assistance received. These insights provide rich descriptions of the barriers they and their adult children faced as they proceeded with navigating new systems of health care. The reported data find support in other previously conducted studies. Full article

Background: Neonates, particularly those born prematurely or with low birth weight, face an elevated risk of developing Acute Kidney Injury (AKI) due to various factors. Perinatal and maternal considerations, often linked to preterm delivery, contribute to this heightened risk. Methods: A retrospective study of neonates admitted to the intensive care unit at a single Israeli Hospital who were diagnosed as having AKI. The study includes follow-up data on these children. Results: During the study period, 971 neonates were admitted to the Pediatric Intensive Care Unit (PICU), and 47 cases had a documented diagnosis of AKI. Thirty-four of them had available long-term data and were included in this analysis. A total of 13 out of 26 subjects with available blood pressure measurements had high blood pressure for their age percentile compatible with the definition of hypertension, and 6 out of 34 (17.6%) had proteinuria. Conclusions: These findings underscore the importance of increased clinical awareness and structured long-term follow-up for neonates who experience AKI. Full article

Background/Objectives: Family perceptions of family-centered services are important for improving processes and outcomes of services for children with disabilities or developmental risk. The Measure of Processes of Care 20-item version (MPOC-20) assesses family-centered practice from parents’ perspectives. This study examined for the first time the psychometric properties of the first Spanish version of the MPOC-20 in children with disabilities aged 0–18 years. Methods: A total of 659 families from 51 care services across Spain completed the MPOC-20, with participants randomly divided into two samples: one for exploratory factor analysis (EFA) and the other for confirmatory factor analysis (CFA). Results: The results confirmed a two-factor model, with the best fit for the dimensions of providing comprehensive and supportive care and providing information. Internal consistency analysis indicated strong reliability of the factor scores. Conclusions: The Spanish version of the MPOC-20 demonstrated good psychometric properties and is recommended for assessing the quality of family-centered services. Full article

Background/Objectives: Inserting umbilical venous catheters is a common procedure in neonatal intensive care units. However, this maneuver is potentially associated with early and late complications, some of which can be severe. Several strategies have been described in the literature to minimize the risk of such complications. The recently described SIUVeC (Safe Insertion Umbilical Venous Catheter) protocol incorporates all the innovations suggested by the latest literature, with the intention of reducing the risk associated with this procedure. The purpose of this paper is to report the outcomes of the systematic implementation of this protocol. Methods: Infants were enrolled in this prospective study if they were eligible for umbilical venous catheter placement. Results: A total of 449 infants were enrolled in the study. In total, 407 (90.6%) catheters were successfully placed in the proper position, at the inferior cavo–atrial junction. A total of 89.9% of the catheters were removed electively, without any complications. Conclusions: The SIUVeC protocol demonstrates an effective strategy for the safe elective insertion of umbilical venous catheters. Full article

Background/Objectives: Prenatal adverse events may influence the development of complications of prematurity, including patent ductus arteriosus (PDA). We conducted a systematic review and Bayesian model-averaged (BMA) meta-analysis of observational studies exploring the association between hypertensive disorders of pregnancy (HDP) and the risk of PDA in preterm infants. Methods: PubMed/Medline and Embase databases were searched. We used BMA analysis to calculate Bayes factors (BFs). The BF₁₀ is the ratio of the probability of the data under the alternative hypothesis (H₁, presence of association) over the probability of the data under the null hypothesis (H₀, absence of association). Results: We included 41 studies (58,004 infants). BMA analysis showed moderate evidence in favour of H₀ for the association between HDP and any PDA (BF₁₀ = 0.20) as well as for the association between HDP and hemodynamically significant PDA (BF₁₀ = 0.27). Subgroup analyses based on the subtype of HDP showed that the moderate evidence in favour of H₀ was only conclusive (i.e., BF₁₀ < 0.33) for the associations of any PDA with preeclampsia (BF₁₀ = 0.30) and hemodynamically significant PDA with preeclampsia (BF₁₀ = 0.17). Conclusions: The currently available evidence suggests a lack of association between HDP and the risk of developing PDA. Full article

Pediatric Intensive Care Units (PICUs) provide specialized care for critically ill children. Developing and managing these units in South Asia remains challenging. Resource limitations and infrastructural disparities are leading to challenging conditions. Above all, nurses play a pivotal role in delivering quality critical care. Effective nursing practices can curb hospital-acquired infections (HAIs), ensure medication safety, and enable protocols such as the ICU Liberation Bundle. In South Asia, another challenge is the proper management of the nursing workforce. Nurse-to-patient ratios are highly disproportionate, contributing to nurse burnout. This review highlights the country-specific challenges and circumstances. There is no one-size-fits-all solution; effective strategies vary based on each country’s context. With context-specific solutions, nurses can bridge the gap between healthcare teams and families, ultimately improving patient outcomes. Full article

Background/Objectives: Mothers of infants admitted to the neonatal intensive care unit (NICU) experience significant stress, which can have lasting effects on mental health and parent–infant bonding. This mixed-methods study aimed to explore maternal stress response, coping, and resilience by examining physiological stress markers and maternal narratives. Methods: A total of 28 mothers who had an infant hospitalized in the NICU within the past three years participated in a two-hour laboratory session, which included stress induction using the Trier Social Stress Test (TSST). Salivary cortisol (sCort) and heart rate variability (HRV) were measured to assess physiological responses. Results: Qualitative analysis of maternal narratives identified two distinct response patterns: an anger/trauma (AT) group (n = 7) and a gratitude/optimism (GO) group (n = 6), with the remaining 15 mothers classified as a mixed (M) group. GO mothers exhibited significantly higher cortisol reactivity during recovery compared to AT mothers (p < 0.01). While GO mothers had higher baseline HF-HRV, no significant between-group differences were found in HRV responses. Conclusions: Findings suggest that maternal perception of NICU experiences is associated with distinct physiological stress response patterns, highlighting the importance of stress appraisal and coping in maternal well-being. Full article

Genetic testing is rapidly becoming standard practice in the care of critically ill newborns within NICUs. Numerous studies have demonstrated the utility of genetic testing, including changes in clinical care, improved diagnostic certainty, and cost savings, related to a reduced length of hospital stay. Changes in clinical management reported in previous studies also included redirection to comfort or end-of-life care. However, it has been difficult to study the influence of genetic testing in the redirection of care decisions within the NICU because of the complexity of the medical decision-making process. Redirection of care decisions are deeply personal for each individual family and often must be made in the setting of clinical instability and diagnostic and prognostic uncertainty. A recent study exploring the impact of genetic testing in redirection of care decisions by surveying palliative care providers suggested genetic testing plays a minor role in decisions to redirect to end-of-life care or in the implementation of DNR/DNI orders. However, factors such inadequate treatment options were found to be important in redirection of care decisions, implying the need for further investigation to clarify the role of genetic testing. Future studies will need to focus on how genetic information affects healthcare provider recommendations regarding palliative care and how families use this information to make end-of-life care decisions. Full article