Pediatric patients in the neonatal intensive care unit (NICU) and the pediatric intensive care unit (PICU) have a high incidence rate of genetic diseases, and early rapid etiological diagnosis and targeted interventions can help to reduce mortality or improve prognosis. Whole-genome sequencing covers more comprehensive information including point mutation, copy number, and structural and rearrangement variations in the intron region and has become one of the powerful diagnostic tools for genetic diseases. Sequencing data require highly professional judgment and interpretation and are returned for clinical application after several weeks, which cannot meet the need for the diagnosis and treatment of genetic diseases in children. This article introduces the clinical application of rapid whole-genome sequencing in the NICU/PICU and briefly describes related techniques of artificial intelligence-rapid whole-genome sequencing diagnostic system, a rapid high-throughput automated platform for the diagnosis of genetic diseases. The diagnostic system introduces artificial intelligence into the processing of data after whole-genome sequencing and can solve the problems of long time and professional interpretation required for routine genome sequencing and provide a rapid diagnostic regimen for critically ill children suspected of genetic diseases within 24 hours, and therefore, it holds promise for clinical application.
Artificial Intelligence ; Child ; Critical Illness ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Intensive Care Units, Pediatric ; Whole Genome Sequencing

Anti-Infective Agents/therapeutic use* ; Child ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units ; Intensive Care Units, Neonatal ; Intensive Care Units, Pediatric

Introduction: Healthcare-associated infections (HCAIs) are a common complication of prolonged hospital stay, leading to increased morbidity and mortality. This study aims to determine the effectiveness of daily chlorhexidine bathing in reducing HCAIs in the pediatric intensive care unit (PICU). Methodology: This is a randomized controlled, observer-blinded study conducted over a 6-month period. Included were 2 months to 18-year-old patients admitted to the PICU, randomly assigned to daily bathing with 2% chlorhexidine or to the standard practice of bathing with plain soap and water. Primary outcome was the incidence of HCAI in each group. Results: A total of 50 patients were enrolled in the study. Overall incidence of HCAI was lower in the chlorhexidine group compared to the control group (12% versus 36%, RR=0.33, 95% CI 0.10 – 1.09, p=0.047). Incidence density rate was lower in the chlorhexidine group (5.91 versus 21.03 infections per 1000 person-days, p=0.049). Ventilator-associated pneumonia and bloodstream infections were lower in the chlorhexidine group, but results were not statistically significant. There were no significant differences in mortality rates and length of hospital stay. One adverse event of transient rash occurred in the chlorhexidine group. Conclusion Daily chlorhexidine bathing may be more effective in reducing HCAIs in the PICU compared to standard care.
Chlorhexidine ; Intensive Care Units, Pediatric

INTRODUCTIONMortality risk prediction scores are important for benchmarking quality of care in paediatric intensive care units (PICUs). We aimed to benchmark PICU outcomes at our hospital against the Pediatric Index of Mortality 2 (PIM2) mortality risk prediction score, and evaluate differences in diagnosis on admission and outcomes between Malaysian and immigrant children.

METHODSWe prospectively collected demographic and clinical data on paediatric medical patients admitted to the PICU of Sabah Women's and Children's Hospital in Kota Kinabalu, Sabah, Malaysia. The PIM2 risk score for mortality was tabulated.

RESULTSOf the 131 patients who met the inclusion criteria, data was available for 115 patients. The mean age of the patients was 2.6 ± 3.8 years, with 79% of the cohort aged less than five years. Patients were mainly of Kadazan (38%) and Bajau (30%) descent, and 26% of patients were non-citizens. Leading diagnoses on admission were respiratory (37%), neurological (18%) and infectious (17%) disorders. Out of the 29 patients who died, 23 (79%) were Malaysians and the main mortality diagnostic categories were respiratory disorder (22%), septicaemia (22%), haemato-oncological disease (17%) and neurological disorder (13%). Calculated standardised mortality ratios (SMRs) were not significantly > 1 for any patient category for variables such as age and admission diagnosis. However, infants less than two years old with comorbidities were significantly worse (SMR 2.61, 95% confidence interval 1.02-6.66).

CONCLUSIONThe patient profile at our centre was similar to that reported from other PICUs in Asia. The PIM2 score is a useful mortality risk prediction model for our population.

Adolescent ; Borneo ; Child ; Child, Preschool ; Comorbidity ; Critical Care ; methods ; Critical Illness ; mortality ; Female ; Humans ; Infant ; Intensive Care Units, Neonatal ; Intensive Care Units, Pediatric ; Malaysia ; Male ; Mortality ; Prospective Studies ; Quality of Health Care ; Risk Assessment ; Severity of Illness Index

Child ; China ; Critical Illness ; Humans ; Intensive Care Units, Pediatric ; Pediatrics

In April 2018, the Group of Pediatric Disasters, Pediatric Society, Chinese Medical Association and Pediatric Committee, Medical Association of Chinese People's Liberation Army issued the disaster response plans in the pediatric intensive care unit (PICU). This article outlines the development of the plans and the implementation of PICU disaster rescue, along with ethical issues in the context of disasters and psychological reconstruction after a disaster.
Child ; Disaster Planning ; Humans ; Intensive Care Units, Pediatric

Objective: To investigate the differences in clinical characteristics, diagnosis, and treatment of pediatric septic shock in pediatric intensive care unit (PICU) among hospitals of different levels. Methods: This retrospective study enrolled 368 children with septic shock treated in the PICU of Beijing Children's Hospital, Henan Children's Hospital, and Baoding Children's Hospital from January 2018 to December 2021. Their clinical data were collected, including the general information, location of onset (community or hospital-acquired), severity, pathogen positivity, consistence of guideline (the rate of standard attainment at 6 h after resuscitation and the rate of anti-infective drug administration within 1 h after diagnosis), treatment, and in-hospital mortality. The 3 hospitals were national, provincial, and municipal, respectively. Furthermore, the patients were divided into the tumor group and the non-tumor group, and into the in-hospital referral group and the outpatient or emergency admission group. Chi-square test and Mann-Whitney U test were used to analyze the data. Results: The 368 patients aged 32 (11, 98) months, of whom 223 were males and 145 females. There were 215, 107, and 46 patients with septic shock, with males of 141, 51, and 31 cases, from the national, provincial, and municipal hospitals, respectively. The difference in pediatric risk of mortality Ⅲ (PRISM Ⅲ) scores among the national,provincial and municipal group was statistically significant (26(19, 32) vs.19(12, 26) vs. 12(6, 19), Z=60.25,P<0.001). The difference in community acquired septic shock among the national,provincial and municipal group was statistically significant (31.6%(68/215) vs. 84.1%(90/107) vs. 91.3%(42/46), χ²=108.26,P<0.001). There were no significant differences in compliance with guidelines among the 3 groups (P>0.05). The main bacteria detected in the national group were Klebsiella pneumoniae (15.4% (12/78)) and Staphylococcus aureus (15.4% (12/78)); in the provincial group were Staphylococcus aureus (19.0% (12/63)) and Pseudomonas aeruginosa (12.7% (8/63)), and in the municipal group were Streptococcus pneumoniae (40.0% (10/25)) and Enteric bacilli (16.0% (4/25)). The difference in the proportion of virus and the proportion of 3 or more initial antimicrobials used among the national,provincial and municipal group was statistically significant (27.7% (43/155) vs. 14.9% (13/87) vs. 9.1% (3/33), 22.8%(49/215) vs. 11.2%(12/107) vs. 6.5%(3/46), χ²=8.82, 10.99, both P<0.05). There was no difference in the in-hospital mortality among the 3 groups (P>0.05). Regarding the subgroups of tumor and non-tumor, the national group had higher PRISM Ⅲ (31(24, 38) vs. 22 (21, 28) vs.16 (9, 22), 24 (18, 30) vs. 17(8, 24) vs. 10 (5, 16), Z=30.34, 10.45, both P<0.001), and it was the same for the subgroups of in-hospital referral and out-patient or emergency admission (29 (21, 39) vs. 23 (17, 30) vs. 15 (10, 29), 23 (17, 29) vs. 18 (10, 24) vs. 11 (5, 16), Z=20.33, 14.25, both P<0.001) as compared to the provincial and municipal group. There was no significant difference in the in-hospital mortality among the 2 pairs of subgroups (all P>0.05). Conclusion: There are differences in the severity, location of onset, pathogen composition, and initial antibiotics of pediatric septic shock in children's hospitals of different levels, but no differences in compliance with guidelines and in-hospital survival rate.
Female ; Male ; Humans ; Child ; Retrospective Studies ; Shock, Septic/therapy* ; Hospitalization ; Intensive Care Units, Pediatric ; Hospitals, Pediatric

The purpose of this study was to reveal what influences the divergent methodological researches have brought the nursing practice in during the past 3 decades. The nursing record sheets ie, the nursing discourses were analyzed to know the knowledges that were recorded, accepted and communicated in nursing practice at pediatric intensive care units, and unclosed the philosophical and methodological position of that knowledges. The texts were 13 sheets, 3 kinds of nursing record(7 24hours flow charts, 4 nursing information record sheets and 2 transfer record sheets) used at 4 hospitals. The unit of analysis was 'word'. First, all words of the sheets were listed up, clustered into categories based on their contents. And then, the larger conceptual themes were drawn to elucidate the effect of the knowledge/power and the philosophical and methodological position of that knowledges. To enhanced the validity of the analysis, the data were analyzed by two researchers. The 'words' were classified into 3 categories; 'general information', 'assessment' and 'intervention'. The conceptual themes of the texts were 'the gaze for quantification and objectification' and 'technical/assimilated caring'. This themes reflected the logic positivistic and biomedical view that had dominated at clinical practice. Nursing has endeavored to resist the logic- positivistic knowledge/power and to established the nursing knowledge/power based on multiple philosophies and methodologies, especially phenomenological-interpretative. But the results of this study revealed that such efforts in nursing theory and research couldn't influenced the knowledge of practice. Logic positivism was yet so strong and the biomedical model yet dominated in the clinical practice. It identified that the borrowed theory and the knowledge from the received view gave nursing the power. But they were modalities that reinforced the dominant, medical power. Nursing has investigate the other positions (feminism, Habermas' critical social theory and Foucault's discourse theory). This positions suggest different assumptions but share the common concepts; equality, emancipation and freedom. The important point is how make these concepts the practical for nursing knowledge/ power in practice. We must recognize that the praxis at clinical setting take place at the field unlike theoretical praxis. The change of clinical practice is the social, economic and political change.
Freedom ; Intensive Care Units* ; Intensive Care Units, Pediatric ; Critical Care* ; Logic ; Nursing Records ; Nursing Theory ; Nursing* ; Philosophy ; Child Health

Continuous renal replacement therapy (CRRT) has been used in critically ill children for more than 20 years in the world, but in Korea, although it is becoming the preferred method of acute therapy in pediatric intensive care units, there has been a few experiences and no consensus of CRRT up to now. This review describes the basic technique of CRRT, highlights the between the adult and pediatric prescription, and elaborates on the main controversies in the application of CRRT in children.
Adult ; Child ; Consensus ; Critical Illness ; Humans ; Intensive Care Units ; Intensive Care Units, Pediatric ; Korea ; Prescriptions ; Renal Replacement Therapy

Child ; Critical Care ; Humans ; Intensive Care Units, Pediatric ; Medical Records ; Severity of Illness Index