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ImportanceThere is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C).ObjectiveTo determine whether the use of steroids within 2 days of admission for non–MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence.Design, Setting, and ParticipantsThis cohort study analyzed data retrospectively for children (ExposureAdministration of steroids within 2 days of admission.Main Outcomes and MeasuresLength of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching.ResultsA total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score–matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators.Conclusions and RelevanceSteroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.

Background: The incidence of invasive candidiasis (IC) is substantial among neonates treated in intensive care units1 because these patients are frequently not immunocompetent, often require invasive procedures (e.g.central venous catheter [CVC] insertion, mechanical ventilation) and frequently receive broad- spectrum antibiotics, parenteral nutrition, histamine-2-receptor blockers and steroids.2 Mortality is considerably high (20–30%), with high rates of long-term neurodevelopmental impairment in survivors.1 Recent guidelines for the management of IC recommend an echinocandin as first-line treatment.3 The European Medicines Agency has approved micafungin as the only echinocandin for neonatal use. Material/methods: This retrospective, observational study was conducted in the Paediatric Intensive Care Unit of the University Hospital Centre Split, Croatia, to assess the safety of micafungin for the treatment of suspected IC in preterm- and term neonates in clinical practice. Conditions for suspected IC were unexplained fever, signs of sepsis or apnoea, need for increased respiratory support, hypotonia or lethargy, abdominal distention, receipt of broad- spectrum antibiotics, parenteral nutrition, CVC or other predisposing risk factors.4 Data from all eligible neonates were collected. Results: Between September 2014 and September 2015, micafungin monotherapy was administered for the treatment of 13 neonates with suspected IC. The mean (±standard deviation [SD]) gestational age was 32.77±5.8 weeks and mean (±SD) birth weight was 2170.77±1224.59 g. Five neonates had birth weight

Aim: The aim of this study was to compare the level of stress in mothers of school-aged children born late preterm and admitted to the intensive care unit (ICU) with the level of maternal stress if a child was born late preterm and not admitted to the ICU as well as if a full-term child was admitted to the ICU. Methods: In this retrospective cohort study the data were gathered via telephone interview with mothers. The Parenting Stress Index/Short Form was used to determine the level of stress in mothers. Background demographic characteristics, medically relevant variables, and the level of stress were tested using the chi-square test and Kruskal- Wallis test. Logistic regression was used in order to identify predictors of significant level of stress. Results: Mothers of late preterm born children who were admitted to the ICU, as well as mothers of late preterm children who were not admitted had higher level of stress compared to mothers of full-term children. Namely, mothers of late preterm born children admitted to the ICU had 18- fold increase in risk for significant level of total stress (OR = 18.09 ; 95% CI 8.55 to 38.26) while 24-fold greater risk was observed in mothers of late preterm children who were not admitted to the ICU (OR = 24.05 ; 95% CI 10.66 to 54.26) in comparison to mothers of full-term born children. Conclusion: Results indicate that preterm birth and its complications are associated with a higher level of stress in mothers, that persists to school age.

The structure of pediatric intensive care populations of patients can differ substantially among units. The differences between the original population of patients, that the score was derived from, and populations of patients in units where the mortality prediction scoring system is applied to, as well as differences among the groups within the same patient population, can make the mortality prediction inaccurate. The parameters for the Paediatric Index of Mortality (PIM 2) score were collected prospectively for 591 consecutively patients admitted to the Pediatric Intensive Care Unit (PICU). The observed mortality (OM), the predicted mortality (PM), and the standardized mortality ratio (SMR) for diverse groups of patients were assessed separately. PM was higher than OM for surgical patients than for medical patients, and for urgent than for scheduled admissions. Within the diagnostic groups, SMR was < 1 in neurological patients, and in patients with respiratory diseases SMR was > 1. Within the age groups, SMR was > 1 in preschool children, and in adolescents SMR was < 1. When length of stay was analyzed, SMR was > 1 in long stay patients. The predictive power of the PIM 2 scoring system is not, therefore, equal for all groups of our population of patients. That means that the differences of structure of populations of patients can lead to inaccuracy of a mortality prediction model. This problem can be prominent in small units with small and uniform populations of patients.

Background Injury is an important factor in childhood morbidity and mortality, with road traffic injuries (RTA) taking the lead. Due to anatomic characteristics, the head is the most frequent site of severe injury in children. The outcome of patients in PICU is significantly dependent on the severity of brain lesion. Aim The aim of this study was to evaluate the functional outcome of patients with injuries treated in pediatric intensive care unit (PICU), with respect to the two important data: the leading injured body region and mechanism of injury. Methods In the period of 2008 to 2009 the data was obtained prospectively and outcome was assessed according to Pediatric Overall Performance Category (POPC) scale for 118 patients in PICU of the University Hospital of Split. Functional performance of patients was assessed as the baseline, pre-admission score (bPOPC) and the discharge functional score (dPOPC) was evaluated before transfer of patients from PICU. Results Head (63.5%) was the most common affected anatomic region, followed by abdomen (15.2%) and limbs (11.0%). The RTA was the leading cause of childhood injury (68%). Deterioration of functional morbidity (ΛP) was worse in children injured in RTA (0.0063) and it was significantly worse children with head injuries (0.0451). Conclusion The outcome expressed with POPC scale is primarily based on neurological functioning. The results of this study point to the importance of prevention of severe brain injury, which is associated with poor long-term outcome of injured children.

The author already published his experiences on 214 flexible fiberoptic bronchoscopy (FFB) in children, performed from 1999. to 2005. at Pediatric Clinic of University Hospital Split (Pavlov N, Eur Respir J, Vol. 26. Suppl 49. September 2005: 628). Further analysis of 180 FFB performed in period from 2006. to 2010. at Pediatric Clinic revealed that foreign bodies were diagnosed and successfully extracted using fiberbronchoscope (Fujinon YP-2, outer diameter 4.8 mm) in 7 cases: twice from trachea (bone particle and peanut) and 5 times from bronchi (peanuts). FFB were performed under deep sedation (Fentanyl, Midazolam), the procedure taking place in Pediatric intensive care unit (PICU), with pediatric intensivist on site. Foreign bodies were successfully extracted by basket and forceps for foreign body extraction. General rule is that aspirated airway foreign bodies in children are to be extracted by means of rigid bronchoscopy (RB). We wanted to address the issues a bronchoscopist faces when an airway foreign body is found during FFB, as well as an opportunity for foreign body to be extracted by means of FFB. By doing so a child is being spared of the risk of additional anesthesia as well as RB, a procedure more invasive than FFB.