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Objectives: Skeletal muscle wasting is a common occurrence in critical illness, often resulting in intensive care unit (ICU)‐acquired weakness. This study aims to identify clinical factors associated with muscle decay in mechanically ventilated critically ill children. Utilizing point‐of‐care ultrasound, a noninvasive and cost‐effective tool, we assess muscle decay through ultrasound of the quadriceps femoris. Methods: A prospective observational study was conducted in a single‐center quaternary‐care pediatric intensive care unit at a children's hospital. A convenience sample of 103 sedated and mechanically ventilated patients were enrolled in this study. Ultrasound measurements of quadriceps femoris muscle thickness were taken, and daily muscle decay rates were calculated. Demographic, clinical, and outcome data were analyzed for correlations with muscle decay. Results: Among the enrolled patients, 67 had repeat measurements. Muscle thickness change aligned with prior studies, with a mean daily change of −1.9% [IQR −0.8, −5.0]. Adequate cumulative caloric intake (>60% of goal) correlated with less muscle decay compared with inadequate intake (−1.8 vs −2.4%, P <.001). Average daily muscle change correlated with both ICU and hospital length of stay (LOS) (r =.328, P =.007 and r =.393, P =.001). No significant correlations emerged between muscle change and mortality, disease severity, fluid balance, early mobilization, steroid exposure, or sedative and paralytic use. Conclusion: This study demonstrates early and frequent muscle decay in critically ill children, as detected by point‐of‐care ultrasound. Average daily muscle decay was associated with longer ICU and hospital LOS. Adequate cumulative caloric intake is linked to reduced muscle decay. These findings contribute to understanding muscle wasting in critically ill pediatric patients. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Background Acute kidney injury (AKI) increases the morbidity of critically ill children. Thus, it is necessary to identify better renal biomarkers to follow the outcome of these patients. This prospective case-control study explored the clinical value of a urinary biomarker profile comprised of neutrophil gelatinase lipocalin (uNGAL), fibroblast growth factor-2 (uFGF-2), and epidermal growth factor (uEGF) to follow these patients. Methods Urine samples were collected from 21 healthy children, and 39 critically ill children (mean age 7.5 years ± 6.97 SD) admitted to a pediatric intensive care unit with sepsis or requiring extra corporeal membrane oxygenation (ECMO). uNGAL, uFGF-2, and uEGF levels were measured using ELISA kits during the first 24 h of admission to PICU, at peak of illness, and upon resolution of the critical illness. Results On admission, the uNGAL and uFGF-2 levels were increased, and the uEGF levels were decreased, in critically ill children with AKI (n = 19) compared to those without AKI (n = 20), and healthy controls. A biomarker score using the combined cut-off values of uNGAL, uFGF-2, and uEGF (AUC = 0.90) showed the highest specificity to identify children with AKI, relative to each biomarker alone. uNGAL and uFGF-2 on admission showed high sensitivity and specificity to predict mortality (AUC = 0.82). Conclusions The biomarker profile comprised of uNGAL, uFGF-2, and uEGF increased the specificity to detect AKI in critically ill children, when compared to each biomarker used alone. uNGAL and uFGF-2 may also predict the risk of death. Further validation of these findings in a large sample size is warranted. Keywords Acute kidney injury * Neutrophil gelatinase lipocalin (NGAL) * Fibroblast growth factor (FGF-2) * Epidermal growth factor (EGF) * Biomarkers * Sepsis, Introduction Acute kidney injury (AKI) is considered an independent risk factor for mortality in critically ill children admitted to pediatric intensive care units [1-7]. The current management of these patients [...]

Objective and Background: Objective monitoring of cough may be preferred to subjective reporting of the symptom in clinical and research settings. Therefore, a self-contained, ambulatory cough monitoring system is needed that is non-invasive, usable for children and adults of all ages, inexpensive, and highly accurate with easy to use analysis software., Methodology: After development of a new device, 15 subjects with frequent coughing were recorded with the novel cough monitor and a simultaneous video recording in order to validate the monitor compared with a gold standard. Two investigators independently analyzed the recordings and counted the number of coughs during the study period from both the cough monitor and the video recording., Results: When measuring agreement between the two investigators, the sample concordance correlation coefficient for audio counts was 0.998 (p < 0.001). In the comparison of video counts, the sample concordance correlation coefficient was 0.997 (p < 0.001). For the comparison of investigator 1's video counts to the corresponding audio counts, the sample concordance correlation coefficient was 0.968 (p = 0.026). For the comparison of investigator 2's video counts to the corresponding counts, the sample concordance correlation coefficient was 0.973 (p = 0.015)., Conclusion: We have developed and piloted a new, valid, and reproducible method of objectively recording and analyzing cough. This device appears to be useful for subjects of any age and in clinical and research settings.