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As pediatricians, we all have to deal with new childhood inflammatory disorder due to COVID 19: the Multisystem Inflammatory Syndrome in Children (MIS-C). The recent article by Savorgnan et al. on the physiologic profiles associated with MIS-C proposed a classification through the "MIS-C severity score" (MSS). The authors also identified a combination of seven variables collected during the first 3 h of admission in the PICU that contributes to stratify MIS-C severity with an area under the receiver operating characteristic curve (AUC)0.90. This work represents an important first step in the development of a MIS-C severity score and is a call for collaborative groups to validate the prediction model through multicenter studies and thereby refine the management of MIS-C. IMPACT: The recent article by Savorgnan et al. on physiologic profile associated with MIS-C represents an important first step in the development of an MIS-C severity score and is a call for collaborative groups to validate the prediction model through multicenter studies and thereby refine the management of MIS-C. Our manuscript helps in the methodology interpretation of the manuscript by Savorgnan et al. And our manuscript promotes collaborative work on MIS-C.

BACKGROUND Few studies have characterized follow-up after pediatric acute kidney injury (AKI). Our aim was to describe outpatient AKI follow-up after pediatric intensive care unit (PICU) admission. METHODS Two-center retrospective cohort study (0-18 years; PICU survivors (2003-2005); noncardiac surgery; and no baseline kidney disease). Provincial administrative databases were used to determine outcomes. EXPOSURE AKI (KDIGO (Kidney Disease: Improving Global Outcomes) definitions). OUTCOMES post-discharge nephrology, family physician, pediatrician, and non-nephrology specialist visits. Regression was used to evaluate factors associated with the presence of nephrology follow-up (Cox) and the number of nephrology and family physician or pediatrician visits (Poisson), among AKI survivors. RESULTS Of n = 2041, 355 (17%) had any AKI; 64/355 (18%) had nephrology; 198 (56%) had family physician or pediatrician; and 338 (95%) had family physician, pediatrician, or non-nephrology specialist follow-up by 1 year post discharge. Only 44/142 (31%) stage 2-3 AKI patients had nephrology follow-up by 1 year. Inpatient nephrology consult (adjusted hazard ratio (aHR) 7.76 [95% confidence interval (CI) 4.89-12.30]), kidney admission diagnosis (aHR 4.26 [2.21-8.18]), and AKI non-recovery by discharge (aHR 2.65 [1.55-4.55]) were associated with 1-year nephrology follow-up among any AKI survivors. CONCLUSIONS Nephrology follow-up after AKI was uncommon, but nearly all AKI survivors had follow-up with non-nephrologist physicians. This suggests that AKI follow-up knowledge translation strategies for non-nephrology providers should be a priority. IMPACT Pediatric AKI survivors have high long-term rates of chronic kidney disease (CKD) and hypertension, justifying regular kidney health surveillance after AKI. However, there is limited pediatric data on follow-up after AKI, including the factors associated with nephrology referral and extent of non-nephrology follow-up. We found that only one-fifth of all AKI survivors and one-third of severe AKI (stage 2-3) survivors have nephrology follow-up within 1 year post discharge. However, 95% are seen by a family physician, pediatrician, or non-nephrology specialist within 1 year post discharge. This suggests that knowledge translation strategies for AKI follow-up should be targeted at non-nephrology healthcare providers.

Few studies have characterized follow-up after pediatric acute kidney injury (AKI). Our aim was to describe outpatient AKI follow-up after pediatric intensive care unit (PICU) admission.Two-center retrospective cohort study (0-18 years; PICU survivors (2003-2005); noncardiac surgery; and no baseline kidney disease). Provincial administrative databases were used to determine outcomes.AKI (KDIGO (Kidney Disease: Improving Global Outcomes) definitions).post-discharge nephrology, family physician, pediatrician, and non-nephrology specialist visits. Regression was used to evaluate factors associated with the presence of nephrology follow-up (Cox) and the number of nephrology and family physician or pediatrician visits (Poisson), among AKI survivors.Of n = 2041, 355 (17%) had any AKI; 64/355 (18%) had nephrology; 198 (56%) had family physician or pediatrician; and 338 (95%) had family physician, pediatrician, or non-nephrology specialist follow-up by 1 year post discharge. Only 44/142 (31%) stage 2-3 AKI patients had nephrology follow-up by 1 year. Inpatient nephrology consult (adjusted hazard ratio (aHR) 7.76 [95% confidence interval (CI) 4.89-12.30]), kidney admission diagnosis (aHR 4.26 [2.21-8.18]), and AKI non-recovery by discharge (aHR 2.65 [1.55-4.55]) were associated with 1-year nephrology follow-up among any AKI survivors.Nephrology follow-up after AKI was uncommon, but nearly all AKI survivors had follow-up with non-nephrologist physicians. This suggests that AKI follow-up knowledge translation strategies for non-nephrology providers should be a priority.Pediatric AKI survivors have high long-term rates of chronic kidney disease (CKD) and hypertension, justifying regular kidney health surveillance after AKI. However, there is limited pediatric data on follow-up after AKI, including the factors associated with nephrology referral and extent of non-nephrology follow-up. We found that only one-fifth of all AKI survivors and one-third of severe AKI (stage 2-3) survivors have nephrology follow-up within 1 year post discharge. However, 95% are seen by a family physician, pediatrician, or non-nephrology specialist within 1 year post discharge. This suggests that knowledge translation strategies for AKI follow-up should be targeted at non-nephrology healthcare providers.

Neurally adjusted ventilatory assist (NAVA) is a mode of ventilation controlled by the electrical activity of the diaphragm (Edi). The aim was to evaluate patient-ventilator interaction in infants during NAVA as compared with conventional ventilation.Infants were successively ventilated with NAVA, pressure control ventilation (PCV), and pressure support ventilation (PSV). Edi and ventilator pressure (Pvent) waveforms were compared and their variability was assessed by coefficients of variation.Ten patients (mean age 4.3 ± 2.4 mo and weight 5.9 ± 2.2 kg) were studied. In PCV and PSV, 4 ± 4.6% and 6.5 ± 7.7% of the neural efforts failed to trigger the ventilator. This did not occur during NAVA. Trigger delays were shorter with NAVA as compared with PCV and PSV (93 ± 20 ms vs. 193 ± 87 ms and 135 ± 29 ms). During PCV and PSV, the ventilator cycled off before the end of neural inspiration in 12 ± 13% and 21 ± 19% of the breaths (0 ± 0% during NAVA). During PCV and PSV, 24 ± 11% and 25 ± 9% of the neural breath cycle was asynchronous with the ventilator as compared with 11 ± 3% with NAVA. A large variability was observed for Edi in all modes, which was transmitted into Pvent during NAVA (coefficient of variation: 24 ± 8%) and not in PCV (coefficient of variation 2 ± 1%) or PSV (2 ± 2%).NAVA improves patient-ventilator interaction and delivers adequate ventilation with variable pressure in infants.

A kinetic modeling of leucine plasma concentration changes is proposed to describe the plasma leucine reduction rate during continuous extracorporeal removal therapy (CECRT) in neonates with maple syrup urine disease. Data were obtained from seven neonates using a bicompartmental model for the best fitted curve of plasma leucine decrease during CECRT. During the first 3 h, leucine plasma levels decreased according to an exponential curve: [Leu](t) = [Leu](i) x 0.95 x 10(-0.09t) where [Leu](t) is the leucine plasma level (mumol/L) at time t (h) during CECRT and [Leu](I) is the initial plasma level. From h 4 to the end of CECRT, a second exponential curve was observed: [Leu](t) = [Leu](i) x 0.74 x 10(-0.05t). Plasma leucine levels obtained from three other neonates were similar to those predicted by the model. The apparent distribution volumes for leucine that correspond to the two exponential equations obtained were calculated from the leucine mass removal collected in the spent dialysate and ultrafiltrate. The distribution volume was 34 +/- 3% of body weight during the first 3 h of CECRT and 72 +/- 7% from h 4 to the end of CECRT. These figures are similar to known values for the extracellular water compartment and for total body water in the newborn. The findings suggest that leucine handling during CECRT is similar to that of nonprotein-bound small-molecular-weight solutes such as urea.