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1,112 results on '"Thomas, Neal J."'

1. Identification and transcriptomic assessment of latent profile pediatric septic shock phenotypes

Author

Atreya, Mihir R., Huang, Min, Moore, Andrew R., Zheng, Hong, Hasin-Brumshtein, Yehudit, Fitzgerald, Julie C., Weiss, Scott L., Cvijanovich, Natalie Z., Bigham, Michael T., Jain, Parag N., Schwarz, Adam J., Lutfi, Riad, Nowak, Jeffrey, Thomas, Neal J., Quasney, Michael, Dahmer, Mary K., Baines, Torrey, Haileselassie, Bereketeab, Lautz, Andrew J., Stanski, Natalja L., Standage, Stephen W., Kaplan, Jennifer M., Zingarelli, Basilia, Sahay, Rashmi, Zhang, Bin, Sweeney, Timothy E., Khatri, Purvesh, Sanchez-Pinto, L. Nelson, and Kamaleswaran, Rishikesan

Published
2024
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2. Diagnostic Validation of the Updated Pediatric Sepsis Biomarker Risk II for Acute Kidney Injury Prediction Model in Pediatric Septic Shock*

Author

Stanski, Natalja L., Zhang, Bin, Cvijanovich, Natalie Z., Fitzgerald, Julie C., Bigham, Michael T., Jain, Parag N., Schwarz, Adam J., Lutfi, Riad, Allen, Geoffrey L., Thomas, Neal J., Baines, Torrey, Haileselassie, Bereketeab, Weiss, Scott L., Atreya, Mihir R., Lautz, Andrew J., Zingarelli, Basilia, Standage, Stephen W., Kaplan, Jennifer, and Goldstein, Stuart L.

Published
2024
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3. Immunocompromised-Associated Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study*

Author

Gertz, Shira J., Bhalla, Anoopindar, Chima, Ranjit S., Emeriaud, Guillaume, Fitzgerald, Julie C., Hsing, Deyin D., Jeyapalan, Asumthia S., Pike, Francis, Sallee, Colin J., Thomas, Neal J., Yehya, Nadir, Rowan, Courtney M., Sforza, Jesica, Poterala, Rossana, Fernandez, Analia, Avila Vera, Antonio, Orqueda, Daniel, Agueda Vidal, Nilda, Rosemary, Deheza, Turon, Gonzalo, Monjes, Cecilia, Fernando Espanol, Segundo, Siaba Serrate, Alejandro, Iolster, Thomas, Torres, Silvio, Cinquegrani, Karina, Jose Montes, Maria, Capocasa, Patricia, Ferreyra, Marcela, Castellani, Pablo, Giampieri, Martin, Pedraza, Claudia, Martin Landry, Luis, Althabe, Maria, Vanesa Fortini, Yanina, Botta, Priscila, Paziencia, Fernando, Erickson, Simon, Barr, Samantha, Shea, Sara, Butt, Warwick, Delzoppo, Carmel, Pintimalla, Alyssa, Martinez Leon, Alejandro Fabio, Guzman Rivera, Gustavo Alfredo, Jouvet, Philippe, Emeriaud, Guillaume, Dumitrascu, Mariana, Ellen French, Mary, Caro, Daniel, Castillo, I, Andres, E., Cruces Romero, Pablo, Medina, Tania, Pavez Madrid, Paula, Cortez, Ambar, Alvear, Jimena, Acuna, Carlos, Diaz, Franco, Jose Nunez, Maria, Wegner Araya, Adriana, Godoy Mundaca, Loreto, Chen, Yang, Perez Lozano, German, Pardo Carrero, Rosalba, Lopez Alarcon, Yurika Paola, Mazzillo Vega, Liliana, Maria Izquierdo, Ledys, Piñeres Olave, Byron Enrique, Zuluaga Orrego, Cesar, Quinonez Lopez, Deyanira, Vasquez Hoyos, Pablo, Vavrina, Martin, Zurek, Jiri, Campos-Miño, Santiago, Yerovi, Rocio, Bridier, Armelle, Payen, Valerie, Milesi, Christophe, Bourgoin, Pierre, Travert, Brendan, Genuini, Mathieu, Starck, Julie, Maria, Matthieu, Guichoux, Julie, Baudin, Florent, Briassoulis, George, Ilia, Stavroula, Di Nardo, Matteo, Camporesi, Anna, Chiusolo, Fabrizio, Shime, Nobuaki, Ohshimo, Shinichiro, Kida, Yoshiko, Kyo, Michihito, Tabata, Yuichi, Fong Tang, Swee, Wern Tai, Chian, See Lum, Lucy Chai, Elghuwael, Ismail, Jimenez Rivera, Nestor Javier, Jarillo Quijada, Alberto E, Kneyber, Martin, Dijkstra, Sandra, Beca, John, Sherring, Claire, Miriam, Rea, Vargas G, Sonia I, Vasquez Miranda, Daniel, Ramirez Cortez, Grimaldo, Tantalean, Jose, Pagowska-Klimek, Izabela, Gil Escobar, Carlos, Sousa Moniz, Marta, Camilo, Cristina, Hazwani, Tarek, Aldairi, Nedaa, Al Amoudi, Ahmed, Alahmadti, Ahmad, Taylor, Ryan, Mendizabal, Mikel, Goni Orayen, Concepcion, Lopez Fernandez, Yolanda, Ramon Valle, Juan, Martinez, Lidia, Pilar Orive, Javier, Brezmes, Marta, Lopez-Herce, Jesus, Parrilla, Julio, Gaboli, Mirella, Gonzalez Gomez, Jose Manuel, Morales Martinez, Antonio, Alapont, Vicent Modesto I, Sanchez Diaz, Juan Ignacio, Llorente de la Fuente, Ana M., Palanca Arias, Daniel, Madurga Revilla, Paula, Martinez de Azagra, Amelia, Garcia Gonzalez, Maria, Arjona Villanueva, David, Garcia Casas, Paula, Brio Sanagustin, Sonia, Pons Odena, Marti, Medina, Alberto, Onate Vergara, Eider, Rodriguez Campoy, Patricia, Reyes Dominguez, Susana, Dursun, Oguz, Atike Ongun, Ebru, Kamit Can, Fulya, Berna Anil, Ayse, Baines, Paul, Walsh, Laura, Jones, Dawn, Sadasivam, Kalaimaran, Mildner, Reinout, Plunkett, Adrian, Lillie, Jon, Tibby, Shane, Wellman, Paul, Belfield, Holly, Brierley, Joe, Dominguez, Troy E., Abaleke, Eugenia, Feinstein, Yael, Deep, Akash, Sundararajan, Santosh, Oruganti, Siva, Silvestre, Catarina, Weitz, James, Sheward, Victoria, Macrae, Duncan, Aramburo, Angela, Fortune, Peter-Marc, Subramanian, Gayathri, Jennings, Claire, Dwarakanathan, Buvana, Inwald, David, Feather, Calandra, Agbeko, Rachel, Lawton-Woodhall, Angela, McIntyre, Karen, Sykes, Kim, Pappachan, Jon, Gale, Helen, Mellish, Christie, McCorkell, Jenni, Torero, Luis, Nofziger, Ryan, Latifi, Samir, Anthony, Heather, Sanders, Ron, Hefley, Glenda, Virk, Manpreet, Jaimon, Nancy, Maddux, Aline B., Mourani, Peter M., Ralston, Kimberly, Sierra, Yamila, Khemani, Robinder, Newth, Christopher, Bhalla, Anoopindar, Kwok, Jeni, Morzov, Rica, Mahapatra, Sidharth, Truemper, Edward, Kustka, Lucinda, Nett, Sholeen T., Singleton, Marcy, Dean Jarvis, J., Yehya, Nadir, Napolitano, Natalie, Murphy, Marie, Ronan, Laurie, Morgan, Ryan, Kubis, Sherri, Broden, Elizabeth, Willson, Douglas, Henderson, Grace, Gedeit, Rainer, Murkowski, Kathy, Woods, Katherine, Kasch, Mary, Han, Yong Y, Affolter, Jeremy T, Tieves, Kelly S, Hughes-Schalk, Amber, Chima, Ranjit S., Krallman, Kelli, Stoneman, Erin, Benken, Laura, Yunger, Toni, Schneider, James, Sweberg, Todd, Kessel, Aaron, Carroll, Christopher L., Santanelli, James, Ackerman, Kate G, Cullimore, Melissa, Rowan, Courtney, Bales, Melissa, Keith Dockery, W., Jafari-Namin, Shirin, Barry, Dana, Jane’t, Keary, Alibrahim, Omar, Patankar, Nikhil, Qiao, Haiping, Gertz, Shira, Su, Felice, Haileselassie, Bereketeab, Song, Hanqiu, Bysani, Kris, Monjure, Tracey, Beltramo, Fernando, Totapally, Balagangadhar, Govantes, Beatriz, Coates, Bria, Wellisch, Lawren, Allen, Kiona, Shukla, Avani, Thomas, Neal J., Spear, Debbie, Shein, Steven L., Gertz, Shira, Parker, Margaret M., Sloniewsky, Daniel, Allen, Christine, Harrell, Amy, Pinto, Neethi, Kniola, Allison, Rodgers, Chiara, Cvijanovich, Natalie, Typpo, Katri, Kelley, Connor, King, Caroline, Sapru, Anil, Ratiu, Anna, Ashtari, Neda, Sikora, Lindsay, Jeyapalan, Asumthia S., Coronado-Munoz, Alvaro, Flori, Heidi, Dahmer, Mary K., Jayachandran, Chaandini, Hume, Janet, Nerheim, Dan, Smith, Rebecca, Spaeder, Michael, Adu-Darko, Michelle, Smith, Lincoln, Hartmann, Silvia, Sullivan, Erin, Merritt, Courtney, Al-Subu, Awni, Blom, Andrea, Lin, John C., Spinella, Philip, Hsing, Deyin D., Pon, Steve, Brian Estil, Jim, Gautam, Richa, Giuliano, John S., Jr, and Tala, Joana

Published
2024
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6. Machine learning-driven identification of the gene-expression signature associated with a persistent multiple organ dysfunction trajectory in critical illness

Author

Cvijanovich, Natalie Z., Fitzgerald, Julie C., Weiss, Scott L., Bigham, Michael T., Jain, Parag N., Schwarz, Adam J., Lutfi, Riad, Nowak, Jeffrey, Allen, Geoffrey L., Thomas, Neal J., Grunwell, Jocelyn R., Baines, Torrey, Quasney, Michael, Haileselassie, Bereketeab, Lindsell, Chris J., Atreya, Mihir R., Banerjee, Shayantan, Lautz, Andrew J., Alder, Matthew N., Varisco, Brian M., Wong, Hector R., Muszynski, Jennifer A., Hall, Mark W., Sanchez-Pinto, L. Nelson, and Kamaleswaran, Rishikesan

Published
2024
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7. External validation of the modified sepsis renal angina index for prediction of severe acute kidney injury in children with septic shock

Author

Stanski, Natalja L., Basu, Rajit K., Cvijanovich, Natalie Z., Fitzgerald, Julie C., Bigham, Michael T., Jain, Parag N., Schwarz, Adam J., Lutfi, Riad, Thomas, Neal J., Baines, Torrey, Haileselassie, Bereketeab, Weiss, Scott L., Atreya, Mihir R., Lautz, Andrew J., Zingarelli, Basilia, Standage, Stephen W., Kaplan, Jennifer, Chawla, Lakhmir S., and Goldstein, Stuart L.

Published
2023
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8. Prognostic and predictive value of endothelial dysfunction biomarkers in sepsis-associated acute kidney injury: risk-stratified analysis from a prospective observational cohort of pediatric septic shock

Author

Atreya, Mihir R., Cvijanovich, Natalie Z., Fitzgerald, Julie C., Weiss, Scott L., Bigham, Michael T., Jain, Parag N., Schwarz, Adam J., Lutfi, Riad, Nowak, Jeffrey, Allen, Geoffrey L., Thomas, Neal J., Grunwell, Jocelyn R., Baines, Torrey, Quasney, Michael, Haileselassie, Bereketeab, Alder, Matthew N., Goldstein, Stuart L., and Stanski, Natalja L.

Published
2023
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9. Detrimental effects of PCSK9 loss-of-function in the pediatric host response to sepsis are mediated through independent influence on Angiopoietin-1

Author

Atreya, Mihir R., Cvijanovich, Natalie Z., Fitzgerald, Julie C., Weiss, Scott L., Bigham, Michael T., Jain, Parag N., Schwarz, Adam J., Lutfi, Riad, Nowak, Jeffrey, Allen, Geoffrey L., Thomas, Neal J., Grunwell, Jocelyn R., Baines, Torrey, Quasney, Michael, Haileselassie, Bereketeab, Alder, Matthew N., Lahni, Patrick, Ripberger, Scarlett, Ekunwe, Adesuwa, Campbell, Kyle R., Walley, Keith R., and Standage, Stephen W.

Published
2023
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11. Revisiting Post-ICU Admission Fluid Balance Across Pediatric Sepsis Mortality Risk Strata: A Secondary Analysis of a Prospective Observational Cohort Study

Author

Atreya, Mihir R., Cvijanovich, Natalie Z., Fitzgerald, Julie C., Weiss, Scott L., Bigham, Michael T., Jain, Parag N., Abulebda, Kamal, Lutfi, Riad, Nowak, Jeffrey, Thomas, Neal J., Baines, Torrey, Quasney, Michael, Haileselassie, Bereketeab, Sahay, Rashmi, Zhang, Bin, Alder, Matthew N., Stanski, Natalja L., and Goldstein, Stuart L.

Published
2024
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12. The authors reply

Author

Ündar, Akif, Kunselman, Allen R., Barbaro, Ryan P., Alexander, Peta, Patel, Krishna, and Thomas, Neal J.

Published
2024
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15. The Modified Clinical Progression Scale for Pediatric Patients: Evaluation as a Severity Metric and Outcome Measure in Severe Acute Viral Respiratory Illness

Author

Leland, Shannon B., Staffa, Steven J., Newhams, Margaret M., Khemani, Robinder G., Marshall, John C., Young, Cameron C., Maddux, Aline B., Hall, Mark W., Weiss, Scott L., Schwarz, Adam J., Coates, Bria M., Sanders, Ronald C., Jr, Kong, Michele, Thomas, Neal J., Nofziger, Ryan A., Cullimore, Melissa L., Halasa, Natasha B., Loftis, Laura L., Cvijanovich, Natalie Z., Schuster, Jennifer E., Flori, Heidi, Gertz, Shira J., Hume, Janet R., Olson, Samantha M., Patel, Manish M., Zurakowski, David, and Randolph, Adrienne G.

Published
2023
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16. Association of Asthma With Treatments and Outcomes in Children With Critical Influenza

Author

Kong, Michele, Murdock, Meghan, Sanders, Ronald C., Jr., Irby, Katherine, Hefley, Glenda, Maddux, Aline B., Mourani, Peter M., Van, Kevin A., Mansour, Rachel, Miller, Kristen R., Grunwell, Jocelyn R., Coates, Bria M., Shukla, Avani, Chavez, Jairo, Randolph, Adrienne G., Newhams, Margaret M., Chen, Sabrina R., Jung, Emily, Flori, Heidi R., Dahmer, Mary K., Jayachandran, Chaandini, Hume, Janet R., Goertzen, Lexie, Faanes, Brittany, Schuster, Jennifer E., Bledsoe, Megan C., Clark, Shannon E., Cullimore, Melissa L., Wellman, Rachel L., Gertz, Shira J., Nofziger, Ryan A., Twinem, Nicole, Shein, Steven L., Rasal, Rajashri, Hall, Mark W., Flowers, Maggie, Steele, Lisa, Weiss, Scott L., Bush, Jenny L., Burnett, Ryan H., Thomas, Neal J., Spear, Debra, Halasa, Natasha B., Stewart, Laura S., Lynch, Tricia L., Olson, Samantha M., Patel, Manish M., Miller, Kristen, Patel, Manish, Fitzpatrick, Anne M., and Phipatanakul, Wanda

Published
2023
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17. The association of early post-resuscitation hypotension with discharge survival following targeted temperature management for pediatric in-hospital cardiac arrest

Author

Topjian, Alexis A, Telford, Russell, Holubkov, Richard, Nadkarni, Vinay M, Berg, Robert A, Dean, J Michael, Moler, Frank W, Investigators, for the Therapeutic Hypothermia after Pediatric Cardiac Arrest Trial, Meert, Kathleen L, Hutchinson, Jamie S, Newth, Christopher JL, Bennett, Kimberly S, Berger, John T, Pineda, Jose A, Koch, Joshua D, Schleien, Charles L, Dalton, Heidi J, Ofori-Amanfo, George, Goodman, Denise M, Fink, Ericka L, McQuillen, Patrick, Zimmerman, Jerry J, Thomas, Neal J, van der Jagt, Elise W, Porter, Melissa B, Meyer, Michael T, Harrison, Rick, Pham, Nga, Schwarz, Adam J, Nowak, Jeffrey E, Alten, Jeffrey, Wheeler, Derek S, Bhalala, Utpal S, Lidsky, Karen, Lloyd, Eric, Mathur, Mudit, Shah, Samir, Theodore, Wu, Theodorou, Andreas A, Sanders, Ronald C, Silverstein, Faye S, Christensen, James R, Slomine, Beth S, Pemberton, Victoria L, and Browning, Brittan

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Physical Injury - Accidents and Adverse Effects, Clinical Research, Pediatric, Heart Disease, Cardiovascular, Clinical Trials and Supportive Activities, Child, Preschool, Extracorporeal Membrane Oxygenation, Female, Heart Arrest, Hospitalization, Humans, Hypotension, Hypothermia, Induced, Infant, Male, Patient Discharge, Survival Rate, Time Factors, Targeted temperature management, Cardiac arrest, Child, Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) Trial Investigators, Nursing, Public Health and Health Services, Emergency & Critical Care Medicine, Clinical sciences, Public health
Abstract

AimApproximately 40% of children who have an in-hospital cardiac arrest (IHCA) in the US survive to discharge. We aimed to evaluate the impact of post-cardiac arrest hypotension during targeted temperature management following IHCA on survival to discharge.MethodsThis is a secondary analysis of the therapeutic hypothermia after pediatric cardiac arrest in-hospital (THAPCA-IH) trial. "Early hypotension" was defined as a systolic blood pressure less than the fifth percentile for age and sex for patients not treated with extracorporeal membrane oxygenation (ECMO) or a mean arterial pressure less than fifth percentile for age and sex for patients treated with ECMO during the first 6 h of temperature intervention. The primary outcome was survival to hospital discharge.ResultsOf 299 children, 142 (47%) patients did not receive ECMO and 157 (53%) received ECMO. Forty-two of 142 (29.6%) non-ECMO patients had systolic hypotension. Twenty-three of 157 (14.7%) ECMO patients had mean arterial hypotension. After controlling for confounders of interest, non-ECMO patients who had early systolic hypotension were less likely to survive to hospital discharge (40.5% vs. 72%; adjusted OR [aOR] 0.34; 95%CI, 0.12-0.93). There was no difference in survival to discharge by blood pressure groups for children treated with ECMO (30.4% vs. 49.3%; aOR = 0.60; 95%CI, 0.22-1.63).ConclusionsIn this secondary analysis of the THAPCA-IH trial, in patients not treated with ECMO, systolic hypotension within 6 h of temperature intervention was associated with lower odds of discharge survival. Blood pressure groups in patients treated with ECMO were not associated with survival to discharge.

Published
2019

18. Paediatric acute respiratory distress syndrome incidence and epidemiology (PARDIE): an international, observational study

Author

Khemani, Robinder G, Smith, Lincoln, Lopez-Fernandez, Yolanda M, Kwok, Jeni, Morzov, Rica, Klein, Margaret J, Yehya, Nadir, Willson, Douglas, Kneyber, Martin CJ, Lillie, Jon, Fernandez, Analia, Newth, Christopher JL, Jouvet, Philippe, Thomas, Neal J, Investigators, Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology, Abaleke, Eugenia, Ackerman, Kate G, Acuña, Carlos, Adu-Darko, Michelle, Affolter, Jeremy T, Agbeko, Rachel, Amoudi, Ahmed Al, Alahmadti, Ahmad, Aldairi, Nedaa, Alibrahim, Omar, Allen, Kiona, Allen, Christine, Al-Subu, Awni, Althabe, María, Alvear, Jimena, Anil, Ayse Berna, Anthony, Heather, Aramburo, Angela, Villanueva, David Arjona, Ashtari, Neda, Vera, Antonio Ávila, Baines, Paul, Bales, Melissa, Barr, Samantha, Barry, Dana, Baudin, Florent, Beca, John, Belfield, Holly, Beltramo, Fernando, Benken, Laura, Bhalla, Anoopindar, Blom, Andrea, Botta, Priscila, Bourgoin, Pierre, Brezmes, Marta, Briassoulis, George, Bridier, Armelle, Brierley, Joe, Sanagustin, Sonia Brio, Broden, Elizabeth, Butt, Warwick, Bysani, Kris, Camilo, Cristina, Camporesi, Anna, Campos-Miño, Santiago, Can, Fulya Kamit, Capocasa, Patricia, Caro, Daniel, Carroll, Christopher, Castellani, Pablo, Castillo, Andres E, Chen, Yang, Chima, Ranjit S, Chiusolo, Fabrizio, Cinquegrani, Karina, Coates, Bria, Coronado-Munoz, Alvaro, Cortéz, Ambar, Romero, Pablo Cruces, Cullimore, Melissa, Cvijanovich, Natalie, Dahmer, Mary K, Deep, Akash, Delzoppo, Carmel, Di Nardo, Matteo, Díaz, Franco, Dijkstra, Sandra, Dockery, W Keith, Dominguez, Troy E, Dumitrascu, Mariana, Dursun, Oguz, Dwarakanathan, Buvana, Elghuwael, Ismail, Emeriaud, Guillaume, Erickson, Simon, Español, Segundo Fernando, Estil, Jim Brian, Feather, Calandra, Feinstein, Yael, Fernández, Analía, Ferreyra, Marcela, Flori, Heidi, Fortini, Yanina Vanesa, Fortune, Peter-Marc, and French, Mary Ellen

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Pediatric, Lung, Clinical Research, 4.1 Discovery and preclinical testing of markers and technologies, Detection, screening and diagnosis, Respiratory, Good Health and Well Being, Acute Lung Injury, Age Factors, Area Under Curve, Cause of Death, Child, Child, Preschool, Combined Modality Therapy, Cross-Sectional Studies, Female, Hospital Mortality, Humans, Intensive Care Units, Pediatric, Internationality, Kaplan-Meier Estimate, Male, Prognosis, Prospective Studies, Respiratory Distress Syndrome, Severity of Illness Index, Sex Factors, Survival Analysis, United States, Pediatric Acute Respiratory Distress syndrome Incidence and Epidemiology (PARDIE) Investigators, Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, Public Health and Health Services, Other Medical and Health Sciences, Cardiovascular medicine and haematology, Clinical sciences
Abstract

BackgroundPaediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury Consensus Conference (PALICC) definition was developed to overcome limitations of the Berlin definition, which was designed and validated for adults. We aimed to determine the incidence and outcomes of children who meet the PALICC definition of PARDS.MethodsIn this international, prospective, cross-sectional, observational study, 145 paediatric intensive care units (PICUs) from 27 countries were recruited, and over a continuous 5 day period across 10 weeks all patients were screened for enrolment. Patients were included if they had a new diagnosis of PARDS that met PALICC criteria during the study week. Exclusion criteria included meeting PARDS criteria more than 24 h before screening, cyanotic heart disease, active perinatal lung disease, and preparation or recovery from a cardiac intervention. Data were collected on the PICU characteristics, patient demographics, and elements of PARDS (ie, PARDS risk factors, hypoxaemia severity metrics, type of ventilation), comorbidities, chest imaging, arterial blood gas measurements, and pulse oximetry. The primary outcome was PICU mortality. Secondary outcomes included 90 day mortality, duration of invasive mechanical and non-invasive ventilation, and cause of death.FindingsBetween May 9, 2016, and June 16, 2017, during the 10 study weeks, 23 280 patients were admitted to participating PICUs, of whom 744 (3·2%) were identified as having PARDS. 95% (708 of 744) of patients had complete data for analysis, with 17% (121 of 708; 95% CI 14-20) mortality, whereas only 32% (230 of 708) of patients met Berlin criteria with 27% (61 of 230) mortality. Based on hypoxaemia severity at PARDS diagnosis, mortality was similar among those who were non-invasively ventilated and with mild or moderate PARDS (10-15%), but higher for those with severe PARDS (33% [54 of 165; 95% CI 26-41]). 50% (80 of 160) of non-invasively ventilated patients with PARDS were subsequently intubated, with 25% (20 of 80; 95% CI 16-36) mortality. By use of PALICC PARDS definition, severity of PARDS at 6 h after initial diagnosis (area under the curve [AUC] 0·69, 95% CI 0·62-0·76) discriminates PICU mortality better than severity at PARDS diagnosis (AUC 0·64, 0·58-0·71), and outperforms Berlin severity groups at 6 h (0·64, 0·58-0·70; p=0·01).InterpretationThe PALICC definition identified more children as having PARDS than the Berlin definition, and PALICC PARDS severity groupings improved the stratification of mortality risk, particularly when applied 6 h after PARDS diagnosis. The PALICC PARDS framework should be considered for use in future epidemiological and therapeutic research among children with PARDS.FundingUniversity of Southern California Clinical Translational Science Institute, Sainte Justine Children's Hospital, University of Montreal, Canada, Réseau en Santé Respiratoire du Fonds de Recherche Quebec-Santé, and Children's Hospital Los Angeles, Department of Anesthesiology and Critical Care Medicine.

Published
2019

21. Noninvasive Ventilation for Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study*

Author

Emeriaud, Guillaume, Pons-Òdena, Marti, Bhalla, Anoopindar K., Shein, Steven L., Killien, Elizabeth Y., Modesto i Alapont, Vicent, Rowan, Courtney, Baudin, Florent, Lin, John C., Grégoire, Gabrielle, Napolitano, Natalie, Mayordomo-Colunga, Juan, Diaz, Franco, Cruces, Pablo, Medina, Alberto, Smith, Lincoln, Khemani, Robinder G., Sforza, Jesica, Poterala, Rossana, Fernandez, Analia, Avila Vera, Antonio, Orqueda, Daniel, Agueda Vidal, Nilda, Rosemary, Deheza, Turon, Gonzalo, Monjes, Cecilia, Espanol, Segundo Fernando, Serrate, Alejandro Siaba, Iolster, Thomas, Torres, Silvio, Cinquegrani, Karina, Jose Montes, Maria, Capocasa, Patricia, Ferreyra, Marcela, Castellani, Pablo, Giampieri, Martin, Pedraza, Claudia, Landry, Luis Martin, Althabe, Maria, Fortini, Yanina Vanesa, Botta, Priscila, Paziencia, Fernando, Erickson, Simon, Barr, Samantha, Shea, Sara, Butt, Warwick, Delzoppo, Carmel, Pintimalla, Alyssa, Leon, Alejandro Fabio Martinez, Rivera, Gustavo Alfredo Guzman, Jouvet, Philippe, Emeriaud, Guillaume, Dumitrascu, Mariana, Ellen French, Mary, Caro I, Daniel, Castillo, Andres E., Romero, Pablo Cruces, Medina, Tania, Madrid, Paula Pavez, Cortez, Ambar, Alvear, Jimena, Acuna, Carlos, Diaz, Franco, Nunez, Maria Jose, Araya, Adriana Wegner, Mundaca, Loreto Godoy, Chen, Yang, Lozano, German Perez, Carrero, Rosalba Pardo, Alarcon, Yurika Paola Lopez, Vega, Liliana Mazzillo, Izquierdo, Ledys Maria, Olave, Byron Enrique Piñeres, Orrego, Cesar Zuluaga, Lopez, Deyanira Quinonez, Hoyos, Pablo Vasquez, Vavrina, Martin, Zurek, Jiri, Campos-Miño, Santiago, Yerovi, Rocio, Bridier, Armelle, Payen, Valerie, Milesi, Christophe, Bourgoin, Pierre, Travert, Brendan, Genuini, Mathieu, Starck, Julie, Maria, Matthieu, Guichoux, Julie, Baudin, Florent, Briassoulis, George, Ilia, Stavroula, Di Nardo, Matteo, Camporesi, Anna, Chiusolo, Fabrizio, Shime, Nobuaki, Ohshimo, Shinichiro, Kida, Yoshiko, Kyo, Michihito, Tabata, Yuichi, Tang, Swee Fong, Tai, Chian Wern, Lum, Lucy Chai See, Elghuwael, Ismail, Rivera, Nestor Javier Jimenez, Jarillo Quijada, Alberto E, Kneyber, Martin, Dijkstra, Sandra, Beca, John, Sherring, Claire, Rea, Miriam, Vargas G, Sonia I, Miranda, Daniel Vasquez, Cortez, Grimaldo Ramirez, Tantalean, Jose, Pagowska-Klimek, Izabela, Escobar, Carlos Gil, Moniz, Marta Sousa, Camilo, Cristina, Hazwani, Tarek, Aldairi, Nedaa, Al Amoudi, Ahmed, Alahmadti, Ahmad, Taylor, Ryan, Mendizabal, Mikel, Orayen, Concepcion Goni, Fernandez, Yolanda Lopez, Valle, Juan Ramon, Martinez, Lidia, Orive, Javier Pilar, Brezmes, Marta, Lopez-Herce, Jesus, Parrilla, Julio, Gaboli, Mirella, Gomez, Jose Manuel Gonzalez, Morales Martinez, Antonio, Alapont, Vicent Modesto I, Diaz, Juan Ignacio Sanchez, Llorente de la Fuente, Ana M., Palanca Arias, Daniel, Madurga Revilla, Paula, Martinez de Azagra, Amelia, Garcia Gonzalez, Maria, Arjona Villanueva, David, Garcia Casas, Paula, Brio Sanagustin, Sonia, Pons Odena, Marti, Medina, Alberto, Onate Vergara, Eider, Rodriguez Campoy, Patricia, Reyes Dominguez, Susana, Dursun, Oguz, Atike Ongun, Ebru, Kamit Can, Fulya, Berna Anil, Ayse, Baines, Paul, Walsh, Laura, Jones, Dawn, Sadasivam, Kalaimaran, Mildner, Reinout, Plunkett, Adrian, Lillie, Jon, Tibby, Shane, Wellman, Paul, Belfield, Holly, Brierley, Joe, Dominguez, Troy E., Abaleke, Eugenia, Feinstein, Yael, Deep, Akash, Sundararajan, Santosh, Oruganti, Siva, Silvestre, Catarina, Weitz, James, Sheward, Victoria, Macrae, Duncan, Aramburo, Angela, Fortune, Peter-Marc, Subramanian, Gayathri, Jennings, Claire, Dwarakanathan, Buvana, Inwald, David, Feather, Calandra, Agbeko, Rachel, Lawton-Woodhall, Angela, McIntyre, Karen, Sykes, Kim, Pappachan, Jon, Gale, Helen, Mellish, Christie, McCorkell, Jenni, Torero, Luis, Nofziger, Ryan, Latifi, Samir, Anthony, Heather, Sanders, Ron, Hefley, Glenda, Virk, Manpreet, Jaimon, Nancy, Maddux, Aline B., Mourani, Peter M., Ralston, Kimberly, Sierra, Yamila, Khemani, Robinder, Newth, Christopher, Bhalla, Anoopindar, Kwok, Jeni, Morzov, Rica, Mahapatra, Sidharth, Truemper, Edward, Kustka, Lucinda, Nett, Sholeen T., Singleton, Marcy, Dean Jarvis, J., Yehya, Nadir, Napolitano, Natalie, Murphy, Marie, Ronan, Laurie, Morgan, Ryan, Kubis, Sherri, Broden, Elizabeth, Willson, Douglas, Henderson, Grace, Gedeit, Rainer, Murkowski, Kathy, Woods, Katherine, Kasch, Mary, Han, Yong Y, Affolter, Jeremy T, Tieves, Kelly S, Hughes-Schalk, Amber, Chima, Ranjit S., Krallman, Kelli, Stoneman, Erin, Benken, Laura, Yunger, Toni, Schneider, James, Sweberg, Todd, Kessel, Aaron, Carroll, Christopher L., Santanelli, James, Ackerman, Kate G, Cullimore, Melissa, Rowan, Courtney, Bales, Melissa, Keith Dockery, W., Jafari-Namin, Shirin, Barry, Dana, Jane’t, Keary, Alibrahim, Omar, Patankar, Nikhil, Qiao, Haiping, Gertz, Shira, Su, Felice, Haileselassie, Bereketeab, Song, Hanqiu, Bysani, Kris, Monjure, Tracey, Beltramo, Fernando, Totapally, Balagangadhar, Govantes, Beatriz, Coates, Bria, Wellisch, Lawren, Allen, Kiona, Shukla, Avani, Thomas, Neal J., Spear, Debbie, Shein, Steven L., Gertz, Shira, Parker, Margaret M., Sloniewsky, Daniel, Allen, Christine, Harrell, Amy, Pinto, Neethi, Kniola, Allison, Rodgers, Chiara, Cvijanovich, Natalie, Typpo, Katri, Kelley, Connor, King, Caroline, Sapru, Anil, Ratiu, Anna, Ashtari, Neda, Sikora, Lindsay, Jeyapalan, Asumthia S., Coronado-Munoz, Alvaro, Flori, Heidi, Dahmer, Mary K., Jayachandran, Chaandini, Hume, Janet, Nerheim, Dan, Smith, Rebecca, Spaeder, Michael, Adu-Darko, Michelle, Smith, Lincoln, Hartmann, Silvia, Sullivan, Erin, Merritt, Courtney, Al-Subu, Awni, Blom, Andrea, Lin, John C., Spinella, Philip, Hsing, Deyin D., Pon, Steve, Brian Estil, Jim, Gautam, Richa, Giuliano, John S., Jr, and Tala, Joana

Published
2023
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24. Association of Interventions With Outcomes in Children At-Risk for Pediatric Acute Respiratory Distress Syndrome: A Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Study*

Author

Hamill, Grant S., Remy, Kenneth E., Slain, Katherine N., Sallee, Colin J., Khemani, Robinder, Smith, Lincoln, Shein, Steven L., Agueda Vidal, Nilda, Rosemary, Deheza, Turon, Gonzalo, Monjes, Cecilia, Jose Montes, Maria, Capocasa, Patricia, Ferreyra, Marcela, Paziencia, Fernando, Erickson, Simon, Barr, Samantha, Shea, Sara, Chen, Yang, Lopez Alarcon, Yurika Paola, Vasquez Hoyos, Pablo, Campos-Miño, Santiago, Yerovi, Rocio, Bourgoin, Pierre, Briassoulis, George, Ilia, Stavroula, Chiusolo, Fabrizio, Hazwani, Tarek, Aldairi, Nedaa, Al Amoudi, Ahmed, Alahmadti, Ahmad, Lopez Fernandez, Yolanda, Ramon Valle, Juan, Martinez, Lidia, Pilar Orive, Javier, Brezmes, Marta, Lopez-Herce, Jesus, Martinez de Azagra, Amelia, Reyes Dominguez, Susana, Kamit Can, Fulya, Berna Anil, Ayse, Silvestre, Catarina, Khemani, Robinder, Newth, Christopher, Bhalla, Anoopindar, Kwok, Jeni, Morzov, Rica, Mahapatra, Sidharth, Truemper, Edward, Kustka, Lucinda, Yehya, Nadir, Napolitano, Natalie, Murphy, Marie, Ronan, Laurie, Morgan, Ryan, Kubis, Sherri, Broden, Elizabeth, Gedeit, Rainer, Murkowski, Kathy, Woods, Katherine, Kasch, Mary, Han, Yong Y., Affolter, Jeremy T., Tieves, Kelly S., Hughes-Schalk, Amber, Chima, Ranjit S., Krallman, Kelli, Stoneman, Erin, Benken, Laura, Yunger, Toni, Rowan, Courtney, Bales, Melissa, Coates, Bria, Wellisch, Lawren, Allen, Kiona, Shukla, Avani, Thomas, Neal J., Spear, Debbie, Shein, Steven L., Allen, Christine, Harrell, Amy, Sapru, Anil, Ratiu, Anna, Ashtari, Neda, Flori, Heidi, Dahmer, Mary K., Jayachandran, Chaandini, Smith, Lincoln, Hartmann, Silvia, Sullivan, Erin, Merritt, Courtney, Al-Subu, Awni, Blom, Andrea, Hsing, Deyin D., Pon, Steve, Brian Estil, Jim, Gautam, Richa, Giuliano, John S., Jr, and Tala, Joana

Published
2023
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26. Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2)

Author

Emeriaud, Guillaume, López-Fernández, Yolanda M., Iyer, Narayan Prabhu, Bembea, Melania M., Agulnik, Asya, Barbaro, Ryan P., Baudin, Florent, Bhalla, Anoopindar, Brunow de Carvalho, Werther, Carroll, Christopher L., Cheifetz, Ira M., Chisti, Mohammod J., Cruces, Pablo, Curley, Martha A. Q., Dahmer, Mary K., Dalton, Heidi J., Erickson, Simon J., Essouri, Sandrine, Fernández, Analía, Flori, Heidi R., Grunwell, Jocelyn R., Jouvet, Philippe, Killien, Elizabeth Y., Kneyber, Martin C. J., Kudchadkar, Sapna R., Korang, Steven Kwasi, Lee, Jan Hau, Macrae, Duncan J., Maddux, Aline, Modesto i Alapont, Vicent, Morrow, Brenda M., Nadkarni, Vinay M., Napolitano, Natalie, Newth, Christopher J. L., Pons-Odena, Martí, Quasney, Michael W., Rajapreyar, Prakadeshwari, Rambaud, Jerome, Randolph, Adrienne G., Rimensberger, Peter, Rowan, Courtney M., Sanchez-Pinto, L. Nelson, Sapru, Anil, Sauthier, Michael, Shein, Steve L., Smith, Lincoln S., Steffen, Katerine, Takeuchi, Muneyuki, Thomas, Neal J., Tse, Sze Man, Valentine, Stacey, Ward, Shan, Watson, R. Scott, Yehya, Nadir, Zimmerman, Jerry J., Khemani, Robinder G., Emeriaud, Guillaume, López-Fernández, Yolanda M., Khemani, Robinder G., Iyer, Narayan Prabhu, Bembea, Melania, Korang, Steven Kwasi, Steffen, Katherine M., Yehya, Nadir, Smith, Lincoln, Thomas, Neal J., Zimmerman, Jerry J., Erickson, Simon J., Shein, Steven L., Grunwell, Jocelyn R., Dahmer, Mary K., Sapru, Anil, Quasney, Michael W., Flori, Heidi R., Fernandez, Analia, Alapont, Vicent Modesto i, Rimensberger, Peter, Cheifetz, Ira, Rowan, Courtney, Randolph, Adrienne G., Kneyber, Martin, Valentine, Stacey, Kudchadkar, Sapna, Ward, Shan, Nadkarni, Vinay, Curley, Martha A.Q., Bhalla, Anoopindar, Baudin, Florent, Takeuchi, Muneyuki, Cruces, Pablo, Carroll, Christopher L., Napolitano, Natalie, Pons-Odena, Marti, Essouri, Sandrine, Rambaud, Jérome, Barbaro, Ryan, Macrae, Duncan, Dalton, Heidi, Killien, Elizabeth, Maddux, Aline, Tse, Sze Man, Watson, Scott, Sanchez-Pinto, L. Nelson, Sauthier, Michaël, Rajapreyar, Prakadeshwari, Jouvet, Philippe, Newth, Christopher, Morrow, Brenda, Agulnik, Asya, de Carvalho, Werther Brunow, Chisti, Mohamod, Lee, Jan Hau, Lobner, Katie, Kysh, Lynn, Pincivy, Alix, and Dodin, Philippe

Published
2023
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29. A Master Protocol Template for Pediatric ARDS Studies.

Author

Miller, Andrew G., Curley, Martha A. Q., Destrampe, Claire, Flori, Heidi, Khemani, Robinder, Ohmer, Amy, Thomas, Neal J., Yehya, Nadir, Ward, Shan, West, Leanne, Zimmerman, Kanecia O., Venkatachalam, Saranya, Sutton, Sonya, and Hornik, Christoph P.

Subjects
ADRENOCORTICAL hormones, MORTALITY, ADULT respiratory distress syndrome, INTERPROFESSIONAL relations, CLINICAL trials, LYING down position, META-analysis, RESEARCH protocols, REACTIVE oxygen species, OXYGEN in the body, MEDICAL research, ARTIFICIAL respiration, HEALTH care teams
Abstract

BACKGROUND: Pediatric ARDS is associated with significant morbidity and mortality. High-quality data from clinical trials in children are limited due to numerous barriers to their design and execution. Here we describe the collaborative development of a master protocol as a tool to address some of these barriers and support the conduct of pediatric ARDS studies. METHODS: Using PubMed, we performed a literature search of randomized controlled trials (RCTs) in pediatric ARDS to characterize the current state and evaluate potential benefit of harmonized master protocols. We used a multi-stakeholder, collaborative, and team science-oriented process to develop a master protocol template with links to common data elements (CDEs) for pediatric ARDS trials. RESULTS: We identified 11 RCTs that enrolled between 14-200 total subjects per trial. Interventions included mechanical ventilation, prone positioning, corticosteroids, and surfactant. Studies displayed significant heterogeneity in ARDS definition, design, inclusion and exclusion criteria, and reported outcomes. Mortality was reported in 91% of trials and ventilator-free days in 73%. The trial heterogeneity made pooled analysis unfeasible. These findings underscore the need for a method to facilitate combined analysis of future trials through standardization of trial elements. As a potential solution, we developed a master protocol, iteratively revised with input from a multidisciplinary panel of experts and organized into 3 categories: instructions and general information, templated language, and a series of text options of common pediatric ARDS trial scenarios. Finally, we linked master protocol sections to relevant CDEs previously defined for pediatric ARDS and captured in a series of electronic case report forms. CONCLUSIONS: The majority of pediatric ARDS trials identified were small and heterogeneous in study design and outcome reporting. Using a master protocol template for pediatric ARDS trials with CDEs would support combining and comparing pediatric ARDS trial findings and increase the knowledge base. [ABSTRACT FROM AUTHOR]

Published
2024
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30. Association of SNP-SNP interactions of surfactant protein genes with severity of respiratory syncytial virus infection in children.

Author

Gandhi, Chintan K., Depicolzuane, Lynnlee C., Chen, Chixiang, Roberts, Catherine M., Sicher, Natalie, Wegerson, Katelyn Johnson, Thomas, Neal J., Wu, Rongling, and Floros, Joanna

Subjects
SINGLE nucleotide polymorphisms, GENETIC variation, RESPIRATORY syncytial virus, VIRAL proteins, SURFACE active agents
Abstract

The severity of respiratory syncytial virus (RSV) may be linked to host genetic susceptibility. Surfactant protein (SP) genetic variants have been associated with RSV severity, but the impact of single-nucleotide polymorphism (SNP)-SNP interactions remains unexplored. Therefore, we used a novel statistical model to investigate the association of SNP-SNP interactions of SFTP genes with RSV severity in two- and three-interaction models. We analyzed available genotype and clinical data from prospectively enrolled 405 children diagnosed with RSV, categorizing them into moderate or severe RSV groups. Using Wang's statistical model, we studied significant associations of SNP-SNP interactions with RSV severity in a case-control design. We observed, first, association of three interactions with increased risk of severe RSV in a two-SNP model. One intragenic interaction was between SNPs of SFTPA2, and the other two were intergenic, involving SNPs of hydrophilic and hydrophobic SPs alone. We also observed, second, association of 22 interactions with RSV severity in a three-SNP model. Among these, 20 were unique, with 12 and 10 interactions associated with increased or decreased risk of RSV severity, respectively, and included at least one SNP of either SFTPA1 or SFTPA2. All interactions were intergenic except one, among SNPs of SFTPA1. The remaining interactions were either among SNPs of hydrophilic SPs alone (n = 8) or among SNPs of both hydrophilic or hydrophobic SPs (n = 11). Our findings indicate that SNPs of all SFTPs may contribute to genetic susceptibility to RSV severity. However, the predominant involvement of SFTPA1 and/or SFTPA2 SNPs in these interactions underscores their significance in RSV severity. NEW & NOTEWORTHY: Although surfactant protein (SP) genetic variants are associated with respiratory syncytial virus (RSV) severity, the impact of single-nucleotide polymorphism (SNP)-SNP interactions of SP genes remained unexplored. Using advanced statistical models, we uncovered 22 SNP-SNP interactions associated with RSV severity, with notable involvement of SFTPA1 and SFTPA2 SNPs. This highlights the comprehensive role of all SPs in genetic susceptibility to RSV severity, shedding light on potential avenues for targeted interventions. [ABSTRACT FROM AUTHOR]

Published
2024
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32. Integrated PERSEVERE and endothelial biomarker risk model predicts death and persistent MODS in pediatric septic shock: a secondary analysis of a prospective observational study

Author

Atreya, Mihir R., Cvijanovich, Natalie Z., Fitzgerald, Julie C., Weiss, Scott L., Bigham, Michael T., Jain, Parag N., Schwarz, Adam J., Lutfi, Riad, Nowak, Jeffrey, Allen, Geoffrey L., Thomas, Neal J., Grunwell, Jocelyn R., Baines, Torrey, Quasney, Michael, Haileselassie, Bereketeab, Lindsell, Christopher J., Alder, Matthew N., and Wong, Hector R.

Published
2022
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35. Recalibration of the Renal Angina Index for Pediatric Septic Shock

Author

Stanski, Natalja L., Wong, Hector R., Basu, Rajit K., Cvijanovich, Natalie Z., Fitzgerald, Julie C., Weiss, Scott L., Bigham, Michael T., Jain, Parag N., Schwarz, Adam, Lutfi, Riad, Nowak, Jeffrey, Allen, Geoffrey L., Thomas, Neal J., Grunwell, Jocelyn R., Quasney, Michael, Haileselassie, Bereketeab, Chawla, Lakhmir S., and Goldstein, Stuart L.

Published
2021
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36. Association of Delayed Antimicrobial Therapy with One-Year Mortality in Pediatric Sepsis

Author

Han, Moonjoo, Fitzgerald, Julie C, Balamuth, Fran, Keele, Luke, Alpern, Elizabeth R, Lavelle, Jane, Chilutti, Marianne, Grundmeier, Robert W, Nadkarni, Vinay M, Thomas, Neal J, and Weiss, Scott L

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Sepsis, Hematology, Infectious Diseases, Infection, Inflammatory and immune system, Good Health and Well Being, Adolescent, Anti-Bacterial Agents, Child, Child, Preschool, Female, Hospital Mortality, Humans, Infant, Intensive Care Units, Intensive Care Units, Pediatric, Logistic Models, Male, Retrospective Studies, Shock, Septic, Emergency & Critical Care Medicine, Clinical sciences
Abstract

ObjectiveDelayed antimicrobial therapy in sepsis is associated with increased hospital mortality, but the impact of antimicrobial timing on long-term outcomes is unknown. We tested the hypothesis that hourly delays to antimicrobial therapy are associated with 1-year mortality in pediatric severe sepsis.DesignRetrospective observational study.SettingQuaternary academic pediatric intensive care unit (PICU) from February 1, 2012 to June 30, 2013.PatientsOne hundred sixty patients aged ≤21 years treated for severe sepsis.InterventionsNone.Measurements and main resultsWe tested the association of hourly delays from sepsis recognition to antimicrobial administration with 1-year mortality using multivariable Cox and logistic regression. Overall 1-year mortality was 24% (39 patients), of whom 46% died after index PICU discharge. Median time from sepsis recognition to antimicrobial therapy was 137 min (IQR 65-287). After adjusting for severity of illness and comorbid conditions, hourly delays up to 3 h were not associated with 1-year mortality. However, increased 1-year mortality was evident in patients who received antimicrobials ≤1 h (aOR 3.8, 95% CI 1.2, 11.7) or >3 h (aOR 3.5, 95% CI 1.3, 9.8) compared with patients who received antimicrobials within 1 to 3 h from sepsis recognition. For the subset of patients who survived index PICU admission, antimicrobial therapy ≤1 h was also associated with increased 1-year mortality (aOR 5.5, 95% CI 1.1, 27.4), while antimicrobial therapy >3 h was not associated with 1-year mortality (aOR 2.2, 95% CI 0.5, 11.0).ConclusionsHourly delays to antimicrobial therapy, up to 3 h, were not associated with 1-year mortality in pediatric severe sepsis in this study. The finding that antimicrobial therapy ≤1 h from sepsis recognition was associated with increased 1-year mortality should be regarded as hypothesis-generating for future studies.

Published
2017

37. Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children

Author

Moler, Frank W, Silverstein, Faye S, Holubkov, Richard, Slomine, Beth S, Christensen, James R, Nadkarni, Vinay M, Meert, Kathleen L, Browning, Brittan, Pemberton, Victoria L, Page, Kent, Gildea, Marianne R, Scholefield, Barnaby R, Shankaran, Seetha, Hutchison, Jamie S, Berger, John T, Ofori-Amanfo, George, Newth, Christopher JL, Topjian, Alexis, Bennett, Kimberly S, Koch, Joshua D, Pham, Nga, Chanani, Nikhil K, Pineda, Jose A, Harrison, Rick, Dalton, Heidi J, Alten, Jeffrey, Schleien, Charles L, Goodman, Denise M, Zimmerman, Jerry J, Bhalala, Utpal S, Schwarz, Adam J, Porter, Melissa B, Shah, Samir, Fink, Ericka L, McQuillen, Patrick, Wu, Theodore, Skellett, Sophie, Thomas, Neal J, Nowak, Jeffrey E, Baines, Paul B, Pappachan, John, Mathur, Mudit, Lloyd, Eric, van der Jagt, Elise W, Dobyns, Emily L, Meyer, Michael T, Sanders, Ronald C, Clark, Amy E, and Dean, J Michael

Subjects
Clinical Trials and Supportive Activities, Pediatric, Cardiovascular, Clinical Research, Heart Disease, Genetics, Adolescent, Body Temperature, Child, Child, Preschool, Coma, Female, Heart Arrest, Hospitalization, Hospitals, Pediatric, Humans, Hypothermia, Induced, Infant, Infant, Newborn, Male, Survival Analysis, Treatment Failure, THAPCA Trial Investigators, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundTargeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are limited.MethodsIn a trial conducted at 37 children's hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a score of 70 or higher on the Vineland Adaptive Behavior Scales, second edition (VABS-II, on which scores range from 20 to 160, with higher scores indicating better function), was evaluated among patients who had had a VABS-II score of at least 70 before the cardiac arrest.ResultsThe trial was terminated because of futility after 329 patients had undergone randomization. Among the 257 patients who had a VABS-II score of at least 70 before cardiac arrest and who could be evaluated, the rate of the primary efficacy outcome did not differ significantly between the hypothermia group and the normothermia group (36% [48 of 133 patients] and 39% [48 of 124 patients], respectively; relative risk, 0.92; 95% confidence interval [CI], 0.67 to 1.27; P=0.63). Among 317 patients who could be evaluated for change in neurobehavioral function, the change in VABS-II score from baseline to 12 months did not differ significantly between the groups (P=0.70). Among 327 patients who could be evaluated for 1-year survival, the rate of 1-year survival did not differ significantly between the hypothermia group and the normothermia group (49% [81 of 166 patients] and 46% [74 of 161 patients], respectively; relative risk, 1.07; 95% CI, 0.85 to 1.34; P=0.56). The incidences of blood-product use, infection, and serious adverse events, as well as 28-day mortality, did not differ significantly between groups.ConclusionsAmong comatose children who survived in-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a favorable functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute; THAPCA-IH ClinicalTrials.gov number, NCT00880087 .).

Published
2017

39. A Multi-Center Retrospective Database Evaluation of Pediatric Subjects Diagnosed With Methemoglobinemia.

Author

Sinha, Neha, Lichak, Brooke, Thomas, Neal J, and Krawiec, Conrad

Abstract

Background: Methemoglobinemia requires early identification and treatment, but limited knowledge exists regarding the current therapeutic approach taken by clinicians as well as the outcomes that occur in children. Objectives: To determine the current prevalence of this rare disease in the pediatric population, evaluate the impact of methemoglobin and functional hemoglobin levels, and assess how this disease is approached by clinicians. We hypothesize that methemoglobinemia prevalence is low and more methylene blue use would be observed in subjects with functional hemoglobin levels less than 7 g/dL. Design: This was a retrospective observational cohort study utilizing deidentified TriNetX® electronic health record (EHR) data. Methods: Using a multicenter EHR database, we evaluated subjective characteristics, diagnostic, laboratory results, medication, and procedural codes. Results: Ninety-eight children (mean age 5.3 ± 5.3 years) from 53 healthcare organizations were included. Methemoglobinemia prevalence was 0.0015% with an overall 30-day mortality of 6.1%. Subjects with methemoglobin percentages greater than 20% had a higher frequency of methylene blue administration (70.6% versus 24.7%, P =.0005). Critical care service requirements and methylene blue administration were similar in the subjects with functional hemoglobin less than 7 g/dL and more than 7 g/dL groups. Overall, 13 (13.2%) subjects underwent glucose-6-phosphate dehydrogenase deficiency (G6PD) testing. Conclusion: In our study, we found methemoglobinemia prevalence in children is low, there is a low frequency of G6PD testing despite methylene blue hemolysis risk, and subjects appeared to be treated similarly despite a low functional hemoglobin. These findings highlight the continued critical nature of this disease and may highlight opportunities for education aimed at improving care in children diagnosed with methemoglobinemia, particularly related to G6PD testing. [ABSTRACT FROM AUTHOR]

Published
2024
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40. A Pilot Study of Saliva MicroRNA Signatures in Children with Moderate-to-Severe Traumatic Brain Injury.

Author

Ciancaglini, Robert, Botash, Ann S., Armijo-Garcia, Veronica, Hymel, Kent P., Thomas, Neal J., and Hicks, Steven D.

Subjects
BRAIN injuries, CHILDREN'S injuries, GENE expression, CHILD mortality, NUCLEIC acids
Abstract

Background/Objectives: Traumatic brain injury (TBI) is a leading cause of death and disability in children. Currently, no biological test can predict outcomes in pediatric TBI, complicating medical management. This study sought to identify brain-related micro-ribosomal nucleic acids (miRNAs) in saliva associated with moderate-to-severe TBI in children, offering a potential non-invasive, prognostic tool. Methods: A case-control design was used, enrolling participants ≤ 18 years old from three pediatric trauma centers. Participants were divided into moderate-to-severe TBI and non-TBI trauma control groups. Saliva samples were collected within 24 h of injury, with additional samples at 24–48 h and >48 h post-injury from the TBI group. miRNA profiles were visualized with partial least squares discriminant analysis (PLSDA) and hierarchical clustering. Mann–Whitney testing was used to compare miRNAs between groups, and mixed models were used to assess longitudinal expression patterns. DIANA miRPath v3.0 was used to interrogate the physiological functions of miRNAs. Results: Twenty-three participants were enrolled (14 TBI, nine controls). TBI and control groups displayed complete separation of miRNA profiles on PLSDA. Three miRNAs were elevated (adj. p < 0.05) in TBI (miR-1255b-5p, miR-3142, and miR-4320), and two were lower (miR-326 and miR-4646-5p). Three miRNAs (miR-3907, miR-4254, and miR-1273g-5p) showed temporal changes post-injury. Brain-related targets of these miRNAs included the glutamatergic synapse and GRIN2B. Conclusions: This study shows that saliva miRNA profiles in children with moderate-to-severe TBI may differ from those with non-TBI trauma and exhibit temporal changes post-injury. These miRNAs could serve as non-invasive biomarkers for prognosticating pediatric TBI outcomes. Further studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Association of early hypotension in pediatric sepsis with development of new or persistent acute kidney injury

Author

Fitzgerald, Julie C., Ross, Michelle E., Thomas, Neal J., Weiss, Scott L., Balamuth, Fran, Chilutti, Marianne, Grundmeier, Robert W., and Anderson, Amanda Hyre

Subjects
Acute renal failure -- Risk factors -- Development and progression, Sepsis -- Complications and side effects -- Care and treatment, Hypotension -- Complications and side effects, Pediatric research, Health
Abstract

Objective To determine how hypotension in the first 48 h of sepsis management impacts acute kidney injury (AKI) development and persistence. Study design Retrospective study of patients > 1 month to < 20 years old with sepsis in a pediatric ICU between November 2012 and January 2015 (n = 217). All systolic blood pressure (SBP) data documented within 48 h after sepsis recognition were collected and converted to percentiles for age, sex, and height. Time below SBP percentiles and below pediatric advanced life support (PALS) targets was calculated by summing elapsed time under SBP thresholds during the first 48 h. The primary outcome was new or persistent AKI, defined as stage 2 or 3 AKI present between sepsis day 3-7 using Kidney Disease: Improving Global Outcomes creatinine definitions. Secondary outcomes included AKI-free days (days alive and free of AKI) and time to kidney recovery. Results Fifty of 217 sepsis patients (23%) had new or persistent AKI. Patients with AKI spent a median of 35 min under the first SBP percentile, versus 4 min in those without AKI. After adjustment for potential confounders, the odds of AKI increased by 9% with each doubling of minutes spent under this threshold (p = 0.03). Time under the first SBP percentile was also associated with fewer AKI-free days (p = 0.02). Time spent under PALS targets was not associated with AKI. Conclusions The duration of severe systolic hypotension in the first 48 h of pediatric sepsis management is associated with AKI incidence and duration when defined by age, sex, and height norms, but not by PALS definitions., Author(s): Julie C. Fitzgerald [sup.1] [sup.2] , Michelle E. Ross [sup.3] , Neal J. Thomas [sup.4] , Scott L. Weiss [sup.1] [sup.2] , Fran Balamuth [sup.5] [sup.6] , Marianne Chilutti [...]

Published
2021
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42. RIG-I and TLR4 responses and adverse outcomes in pediatric influenza-related critical illness

Author

Sanders, Ronald C., Jr., Irby, Olivia K., Hefley, Glenda, Tellez, David, Typpo, Katri, Markovitz, Barry, Flori, Heidi, Cvijanovich, Natalie, Anas, Nick, Schwarz, Adam, Vargas-Shiraishi, Ofelia, Sapru, Anil, McQuillen, Patrick, Czaja, Angela, Mourani, Peter, Paden, Matthew, Tarquinio, Keiko, Stone, Cheryl L., Wardenburg, Juliane Bubeck, Pinto, Neethi, Montgomery, Vicki, Sullivan, Janice E., Randolph, Adrienne G., Agan, Anna A., Ash, Stephanie, Mistry, Anushay, Newhams, Margaret, Kurachek, Stephen C., Doctor, Allan, Hartman, Mary, Truemper, Edward, Mahapatra, Sidharth, Dawson, Machelle, Ackerman, Kate, Daugherty, L. Eugene, Nofziger, Ryan, Shein, Steve, Hall, Mark W., Steele, Lisa, Hanson-Huber, Lisa, Thomas, Neal J., Spear, Debra, Fitzgerald, Julie, Weiss, Scott, Bush, Jenny L., Graham, Kathryn, Higgerson, Renee, Christie, LeeAnn, Loftis, Laura L., Jaimon, Nancy, Gedeit, Rainer, Murkowski, Kathy, Novak, Tanya, McDonald, Douglas R., Newhams, Margaret M., Mistry, Anushay J., Panoskaltsis-Mortari, Angela, Mourani, Peter M., Weiss, Scott L., Tarquinio, Keiko M., Hartman, Mary E., and Junger, Wolfgang G.

Published
2020
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43. Long-Term Neurobehavioral and Quality of Life Outcomes of Critically Ill Children after Glycemic Control

Author

Srinivasan, Vijay, Mourani, Peter M., Chima, Ranjit, Thomas, Neal J., Li, Simon, Pinto, Alan, Newth, Christopher, Hassinger, Amanda, Bysani, Kris, Rehder, Kyle J., Faustino, Edward Vincent, Kandil, Sarah, Hirshberg, Eliotte, Wintergerst, Kupper, Schwarz, Adam, Bagdure, Dayanand, Marsillio, Lauren, Cvijanovich, Natalie, Pham, Nga, Quasney, Michael, Flori, Heidi, Federman, Myke, Nett, Sholeen, Pinto, Neethi, Viteri, Shirley, Schneider, James, Medar, Shivanand, Sapru, Anil, McQuillen, Patrick, Babbitt, Christopher, Lin, John C., Jouvet, Philippe, Yanay, Ofer, Allen, Christine, Asaro, Lisa, Coughlin-Wells, Kerry, French, Jaclyn, Natarajan, Aruna, Biagas, Katherine V., Hinton, Veronica J., Hasbani, Natalie R., Luckett, Peter M., Wypij, David, Nadkarni, Vinay M., and Agus, Michael S.D.

Published
2020
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45. Machine learning-driven identification of the gene-expression signature associated with a persistent multiple organ dysfunction trajectory in critical illness

Author

Atreya, Mihir R., primary, Banerjee, Shayantan, additional, Lautz, Andrew J., additional, Alder, Matthew N., additional, Varisco, Brian M., additional, Wong, Hector R., additional, Muszynski, Jennifer A., additional, Hall, Mark W., additional, Sanchez-Pinto, L. Nelson, additional, Kamaleswaran, Rishikesan, additional, Cvijanovich, Natalie Z., additional, Fitzgerald, Julie C., additional, Weiss, Scott L., additional, Bigham, Michael T., additional, Jain, Parag N., additional, Schwarz, Adam J., additional, Lutfi, Riad, additional, Nowak, Jeffrey, additional, Allen, Geoffrey L., additional, Thomas, Neal J., additional, Grunwell, Jocelyn R., additional, Baines, Torrey, additional, Quasney, Michael, additional, Haileselassie, Bereketeab, additional, and Lindsell, Chris J., additional

Published
2024
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48. Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest in Children

Author

Moler, Frank W, Silverstein, Faye S, Holubkov, Richard, Slomine, Beth S, Christensen, James R, Nadkarni, Vinay M, Meert, Kathleen L, Clark, Amy E, Browning, Brittan, Pemberton, Victoria L, Page, Kent, Shankaran, Seetha, Hutchison, Jamie S, Newth, Christopher JL, Bennett, Kimberly S, Berger, John T, Topjian, Alexis, Pineda, Jose A, Koch, Joshua D, Schleien, Charles L, Dalton, Heidi J, Ofori-Amanfo, George, Goodman, Denise M, Fink, Ericka L, McQuillen, Patrick, Zimmerman, Jerry J, Thomas, Neal J, van der Jagt, Elise W, Porter, Melissa B, Meyer, Michael T, Harrison, Rick, Pham, Nga, Schwarz, Adam J, Nowak, Jeffrey E, Alten, Jeffrey, Wheeler, Derek S, Bhalala, Utpal S, Lidsky, Karen, Lloyd, Eric, Mathur, Mudit, Shah, Samir, Wu, Theodore, Theodorou, Andreas A, Sanders, Ronald C, and Dean, J Michael

Subjects
Cardiovascular, Clinical Research, Clinical Trials and Supportive Activities, Heart Disease, Adolescent, Child, Child, Preschool, Female, Humans, Hypothermia, Induced, Infant, Male, Out-of-Hospital Cardiac Arrest, Treatment Outcome, Unconsciousness, THAPCA Trial Investigators, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundTherapeutic hypothermia is recommended for comatose adults after witnessed out-of-hospital cardiac arrest, but data about this intervention in children are limited.MethodsWe conducted this trial of two targeted temperature interventions at 38 children's hospitals involving children who remained unconscious after out-of-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose patients who were older than 2 days and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a Vineland Adaptive Behavior Scales, second edition (VABS-II), score of 70 or higher (on a scale from 20 to 160, with higher scores indicating better function), was evaluated among patients with a VABS-II score of at least 70 before cardiac arrest.ResultsA total of 295 patients underwent randomization. Among the 260 patients with data that could be evaluated and who had a VABS-II score of at least 70 before cardiac arrest, there was no significant difference in the primary outcome between the hypothermia group and the normothermia group (20% vs. 12%; relative likelihood, 1.54; 95% confidence interval [CI], 0.86 to 2.76; P=0.14). Among all the patients with data that could be evaluated, the change in the VABS-II score from baseline to 12 months was not significantly different (P=0.13) and 1-year survival was similar (38% in the hypothermia group vs. 29% in the normothermia group; relative likelihood, 1.29; 95% CI, 0.93 to 1.79; P=0.13). The groups had similar incidences of infection and serious arrhythmias, as well as similar use of blood products and 28-day mortality.ConclusionsIn comatose children who survived out-of-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a good functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute and others; THAPCA-OH ClinicalTrials.gov number, NCT00878644.).

Published
2015

49. The association of early post-resuscitation hypotension with discharge survival following targeted temperature management for pediatric in-hospital cardiac arrest

Author

Moler, Frank W., Meert, Kathleen L., Hutchinson, Jamie S., Newth, Christopher J.L., Bennett, Kimberly S., Berger, John T., Topjian, Alexis A., Pineda, Jose A., Koch, Joshua D., Schleien, Charles L., Dalton, Heidi J., Ofori-Amanfo, George, Goodman, Denise M., Fink, Ericka L., McQuillen, Patrick, Zimmerman, Jerry J., Thomas, Neal J., van der Jagt, Elise W., Porter, Melissa B., Meyer, Michael T., Harrison, Rick, Pham, Nga, Schwarz, Adam J., Nowak, Jeffrey E., Alten, Jeffrey, Wheeler, Derek S., Bhalala, Utpal S., Lidsky, Karen, Lloyd, Eric, Mathur, Mudit, Shah, Samir, Theodore, Wu, Theodorou, Andreas A., Sanders, Ronald C., Jr., Silverstein, Faye S., Christensen, James R., Slomine, Beth S., Pemberton, Victoria L., Browning, Brittan, Holubkov, Richard, Michael Dean, J., Telford, Russell, Nadkarni, Vinay M., Berg, Robert A., and Dean, J. Michael

Published
2019
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