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The resolution of inflammation is an active process that is coordinated by endogenous mediators. Previous studies have demonstrated the immunomodulatory properties of the axonal guidance proteins in the initial phase of acute inflammation. We hypothesized that the neuronal guidance protein neogenin (Neo1) modulates mechanisms of inflammation resolution. In murine peritonitis, Neo1 deficiency ([Neo1.sup.-/-]) resulted in higher efficacies in reducing neutrophil migration into injury sites, increasing neutrophil apoptosis, actuating PMN phagocytosis, and increasing the endogenous biosynthesis of specialized proresolving mediators, such as lipoxin A4, maresin-1, and protectin DX. Neo1 expression was limited to Neo1-expressing [Ly6C.sup.hi] monocytes, and Neo1 deficiency induced monocyte polarization toward an antiinflammatory and proresolving phenotype. Signaling network analysis revealed that [Neo1.sup.-/-] monocytes mediate their immunomodulatory effects specifically by activating the PI3K/AKT pathway and suppressing the TGF-[beta] pathway. In a cohort of 59 critically ill, intensive care unit (ICU) pediatric patients, we found a strong correlation between Neo1 blood plasma levels and abdominal compartment syndrome, Pediatric Risk of Mortality III (PRISM-III) score, and ICU length of stay and mortality. Together, these findings identify a crucial role for Neo1 in regulating tissue regeneration and resolution of inflammation, and determined Neo1 to be a predictor of morbidity and mortality in critically ill children affected by clinical inflammation., Introduction There are only a few targeting therapies for critically ill patients in the intensive care unit (ICU) who are suffering from complex and potentially life-threatening illnesses, such as acute [...]

Background The optimal fluid management in critically ill children is currently under investigation with several studies suggesting that hyperchloremia, chloride load, and the use of chloride-rich fluids contribute to worse outcomes. Methods This is a single-center retrospective cohort study of Pediatric Intensive Care Unit patients from 2008 to 2016 requiring continuous renal replacement therapy (CRRT). Patients were excluded if they had end-stage renal disease, a disorder of chloride transport, or concurrent provision of extracorporeal membrane oxygenation therapy. Results Patients (n = 66) were dichotomized into two groups (peak chloride (Cl) [greater than or equal to] 110 mmol/L vs. peak Cl < 110 mmol/L prior to CRRT initiation). Hyperchloremia was present in 39 (59%) children. Baseline characteristics were similar between groups. Fluid overload at CRRT initiation was more common in patients with hyperchloremia (11.5% IQR 3.8-22.4) compared to those without (5.5% IQR 0.9-13.9) (p = 0.04). Mortality was significantly higher in patients with hyperchloremia (n = 26, 67%) compared to those without (n = 8, 29%) (p = 0.006). Patients with hyperchloremia had 10.9 times greater odds of death compared to those without hyperchloremia, after adjusting for percent fluid overload, PRISM III score, time to initiation of CRRT, height, and weight (95% CI 2.4 to 49.5, p = 0.002). Conclusions Hyperchloremia is common among critically ill children prior to CRRT initiation. In this population, hyperchloremia is independently associated with mortality. Further studies are needed to determine the impact of hyperchloremia on all critically ill children and the impact of chloride load on outcomes., Author(s): Matthew F. Barhight [sup.1] [sup.2] , Jennifer Lusk [sup.1] , John Brinton [sup.3] , Timothy Stidham [sup.1] [sup.2] , Danielle E. Soranno [sup.2] [sup.4] [sup.5] , Sarah Faubel [sup.4] [...]

Byline: Preamrudee Poomthavorn (1), Rojjanee Lertbunrian (1), Aroonwan Preutthipan (1), Arporn Sriphrapradang (2), Patcharin Khlairit (1), Pat Mahachoklertwattana (1) Keywords: Free cortisol; Free cortisol index; Adrenal insufficiency; Critical illness; Adrenocorticotropic hormone test Abstract: Background In critical illness, serum total cortisol (TC) may not adequately reflect adrenal function because of reduced cortisol-binding globulin (CBG). Aim To evaluate adrenal function of critically ill children, using free cortisol index (FCI), calculated free cortisol (cFC), and TC levels. Methods Thirty-two critically ill and 36 healthy children were included. All children underwent the 1 ug cosyntropin test. TC and CBG levels were measured. Basal and peak TC, FCI, and cFC were determined. Results Basal and peak TC, FCI, and cFC of critically ill children were significantly higher than those of the controls. Compared with TC, both basal and peak FCI and cFC of the patients were higher than those of controls to a greater degree. Use of FCI or cFC to diagnose adrenal insufficiency (AI) reduced the frequency of diagnosis of AI by 50%. Conclusion FCI and cFC better reflect the dynamic changes of adrenal function of critically ill children. Author Affiliation: (1) Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand (2) Faculty of Medicine, Research Center, Ramathibodi Hospital, Mahidol University, Rama 6 Road, Bangkok, 10400, Thailand Article History: Registration Date: 30/03/2009 Received Date: 16/07/2008 Accepted Date: 17/11/2008 Online Date: 08/04/2009

Byline: Juan Mayordomo-Colunga (1), Alberto Medina (1), Corsino Rey (1), Juan Jose Diaz (2), Andres Concha (1), Marta Los Arcos (1), Sergio Menendez (1) Keywords: Non-invasive ventilation; Pediatrics; Respiratory monitoring Abstract: Objective Identification of predictive factors for non-invasive ventilation (NIV) failure and determination of NIV characteristics. Design Prospective observational study. Setting Paediatric Intensive Care Unit in a University Hospital. Patients and measurements A total of 116 episodes were included. Clinical data collected were respiratory rate (RR), heart rate and FiO.sub.2 before NIV began. Same data and expiratory and support pressures were collected at 1, 6, 12, 24 and 48 h. Conditions precipitating acute respiratory failure (ARF) were classified into two groups: type 1 (38 episodes) and type 2 (78 episodes). Ventilation--perfusion impairment was the main respiratory failure mechanism in type 1, and hypoventilation in type 2. Factors predicting NIV failure were determined by multivariate analysis. Results Most common admission diagnoses were pneumonia (81.6%) in type 1 and bronchiolitis (39.7%) and asthma (42.3%) in type 2. Complications secondary to NIV were detected in 23 episodes (20.2%). NIV success rate was 84.5% (68.4% in type 1 and 92.3% in type 2). Type 1 patients showed a higher risk of NIV failure compared to type 2 (OR 11.108 CI 95%, 2.578--47.863). A higher PRISM score (OR 1.138 CI 95%, 1.022--1.267), and a lower RR decrease at 1 h and at 6 h (OR 0.926 CI 95%, 0.860--0.997 and OR 0.911 CI 95%, 0.837--0.991, respectively) were also independently associated with NIV failure. Conclusions NIV is a useful respiratory support technique in paediatric patients. Type 1 group classification, higher PRISM score, and lower RR decrease during NIV were independent risk factors for NIV failure. Author Affiliation: (1) Paediatric Intensive Care Unit, Departamento de Pediatria, Hospital Universitario Central de Asturias, University of Oviedo, Celestino Villamil s/n, 33006, Oviedo, Asturias, Spain (2) Hospital San Agustin, Aviles, Asturias, Spain Article History: Registration Date: 21/10/2008 Received Date: 20/04/2008 Accepted Date: 19/10/2008 Online Date: 04/11/2008

Byline: Kirti. Naranje, Banani. Poddar, Arpita. Bhriguvanshi, Richa. Lal, Afzal. Azim, Ratender. Singh, Mohan. Gurjar, Arvind. Baronia Objectives: To find the incidence of hyperglycemia (blood glucose [BG] ≥150 mg/dl), hypoglycemia [...]

Byline: Martin C. J. Kneyber (1), Mohammed I. Hersi (1), Jos W. R. Twisk (2), Dick G. Markhorst (1), Frans B. Plotz (1) Keywords: Critically ill children; Erythrocyte transfusions; Mortality; Outcome assessment Abstract: Objective To test the hypothesis that RBC transfusion in critically ill children is independently associated with increased mortality and morbidity. Design Retrospective, descriptive epidemiologic cohort study. Setting Single-center experience of a nine-bed pediatric intensive care unit (PICU) facility. Patients Critically ill children without ongoing active blood loss aged 0a-months to 18a-years, excluding prematurely born infants or patients after cardiothoracic surgery, and patients with chronic anemia. Interventions None. Measurements and Results Data of 295 consecutive patients was studied. Of these patients, 13.4% had a Hb concentration less than 9.6a-g/dl. Sixty-seven (22.7%) of all patients were transfused, 39 only once. Transfused patients had a higher mortality (16.4 vs. 2.6%, pa- Conclusions RBC transfusion in critically ill children is independently associated with increased mortality and prolonged duration of mechanical ventilation, prolonged infusion of vaso-active agents and prolonged PICU stay. Author Affiliation: (1) Department of Pediatric Intensive Care, Office 8 D 12, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands (2) Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands Article History: Registration Date: 22/05/2007 Received Date: 12/07/2006 Accepted Date: 11/05/2007 Online Date: 16/06/2007

OBJECTIVE. We sought to inform decision-making for children and families by describing what is known and remains unknown about the impact of childhood critical illness and injury on families. This report also was designed as a tool for research planning and design so that meaningful studies are performed and duplication is avoided. DESIGN. After a national scholarship competition and the identification of 3 medical student summer scholars, a literature search was conducted by using the National Library of Medicine and a PubMed keyword search system at the National Institutes of Health. RESULTS. A total of 115 reports were reviewed and assigned to the 5 following categories characterizing the impact of pediatric critical illness/injury on families: stressors, needs, specific domains (psychological, physical, social), coping, and interventions. The reports reviewed indicate that pediatric critical illness and injury is stressful for the entire family. The effects on parents, siblings, and marital cohesion were variably described. Needs of family members (eg, rest, nutrition, communication) were identified as being unmet in many studies. Permanent impact on siblings and marital relationships has been considered detrimental, but these conclusions are not adequately quantified in presently available studies. Reviewed reports minimally investigated cultural diversity, effects on fathers versus mothers, siblings, socioeconomic status, and financial burden. Studies were often anecdotal and included small sample sizes. Methodologic limitations were numerous and varied and seriously narrowed the significance of the studies we reviewed. The reports that we evaluated were largely limited to those of English-speaking families, white people, and married mothers. CONCLUSIONS. Future research should use more rigorous methods in the measurement of impact of childhood critical illness and injury on families. Families of critically ill and injured children would benefit from the practitioners of pediatric critical care acquiring enhanced knowledge and sensitivity about family communication and dynamics. Key Words critically ill children, siblings, injury, family impact, PICU, PICUs FOR CRITICALLY ill and injured children are expanding in number and size. (1) A 1998 estimate that 200 children per 100 000 in a population will require intensive care [...]

Perioperative immune modulation using specialized enteral diets containing specific immunonutrients may improve postoperative outcomes in critically ill patients compared with standard formulas. A study from Italy involving 305 patents with histologically confirmed cancer of the gastrointestinal tract undergoing major elective surgery and preoperative weight loss

Byline: U.R. Mohan (), J. Britto (), P. Habibi (), C. Munter (), S. Nadel () Abstract: This study was performed to evaluate the hemodynamic status of children admitted to the intensive care unit, using suprasternal and transesophageal Doppler ultrasound, and to establish a suitable noninvasive technique to monitor trends in cardiac output in critically ill children. Twenty children were studied over a period of 6 months. The median age was 32.5 months and weight 14.5 kg. Minute distance (MD), which is a linear cardiac output parameter, was assessed. Seven simultaneous pairs of measurements of MD were made using transesophageal Doppler (TED) and suprasternal Doppler (SSD) by the same operator. Following a fluid challenge, seven repeat pairs of measurements were made. The mean percentage changes for MD by TED and SSD were 21.84 (SD 9.97) and 5.75 (SD 7.32). The average coefficients of variation for measurements of MD by TED and SSD were 2.34% and 15.98%, respectively. The mean difference in percentage change between MD, measured by TED and SSD, was 27.59 with a 95% confidence interval and wide limits of agreement. The repeatability of TED measurements was good, but the measurements by SSD were wide and erratic with poor reproducibility. Our study shows that TED is easy to use, reliable, and very useful for monitoring hemodynamic changes in critically ill children. Author Affiliation: () Pediatric Intensive Care Unit, Imperial College School of Medicine, St. Mary's Hospital, Norfolk Place, London, W2 1PG, United Kingdom, GB

Byline: Ingrid Prins (2), Frans B. Plotz (1), Cuno S.P.M Uiterwaal (3), Hans J. van Vught (2) Keywords: Dopamine Renal Urine volume Neonate Child Intensive care unit Abstract: Objectives: To assess the current use of low-dose dopamine ( Author Affiliation: (1) St. Antonius Hospital, Department of Pediatrics, P.O.Box 2500, 3430 EM Nieuwegein, The Netherlands (2) Department of Pediatric Intensive Care, Medical Center, University of Utrecht, The Netherlands (3) Julius Center for Patient Oriented Research, Department of Epidemiology, University of Utrecht, Utrecht, The Netherlands Article History: Received Date: 18/04/2000 Accepted Date: 05/10/2000 Article note: Final revision received: 22 September 2000 Electronic Publication

Byline: Rajeev. Kumar, Nirmal. Kumar Background and Aims: To validate the lactate clearance (LC) at 6 h for mortality prediction in Pediatric Intensive Care Unit (PICU)-admitted patients and its comparison [...]

Freestanding urgent care centers are not emergency departments or medical homes, yet they are sometimes used as a source of pediatric care. The purpose of this policy statement is to provide updated and expanded recommendations for ensuring appropriate stabilization in pediatric emergency situations and timely and appropriate transfer to a hospital for definitive care when necessary. urgent care, equipment standards, emergency preparedness, pediatric preparedness., Freestanding urgent care facilities remain a fixture in the provision of health services for children in some communities. Although the American Academy of Pediatrics does not encourage the routine use [...]

ABSTRACT Objective To evaluate changes in growth, nutritional status, body composition, and energy and nutrient intakes during illness and usual state of health in infants and young children with sickle [...]