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Objective This study aimed to evaluate aerobic capacity in children and adolescents following a diagnosis of Multisystem Inflammatory Syndrome in Children (MIS-C) compared to healthy matched controls. Design Prospective cohort study. Setting Quaternary Pediatric intensive care unit and Pediatric cardiology unit. Participants 14 children diagnosed with MIS-C. Interventions None. Measurements Cardiopulmonary fitness parameters at the time of post-Pediatric intensive care unit follow-up (mean 3.6 months) such as maximum oxygen uptake (VO 2max ) and the first ventilatory anaerobic threshold (VAT), as a marker of muscular deconditioning. Main Results A total of 14 patients (12 boys) with a confirmed diagnosis of MIS-C and 70 healthy children were included. The median age was 13.2 years (range 10.7-13.6 years). All participants had a normal echocardiogram and normal lung function at the time of cardiopulmonary exercise test. As measured by VO 2max Z-score, exercise capacity was significantly lower in the MIS-C group compared to healthy controls (median-0.91 vs 0.13, p < 0.01), and a significantly higher proportion of children in the MIS-C group had impaired aerobic capacity (VO 2max Z-score<-1.64) compared to controls (29% vs. 3%, p < 0.01). The VAT was also significantly lower in the MIS-C group with a higher proportion of children with an impaired VAT (VAT Z-score<-1.64) compared to controls (43% vs. 3%, p = 0.03). Impaired aerobic capacity in the MIS-C group was associated with higher BMI, higher PELOD 2 score and lower platelet count at the PICU admission, and lower hemoglobin level at the cardiopulmonary exercise test time. Conclusions This study suggests that children with MIS-C experience significant reductions in aerobic capacity compared to healthy controls, primarily due to muscular deconditioning. These findings highlight the importance of considering post-ICU consultations and implementing strategies to address physical deconditioning in this population.

Shock is a life-threatening condition, and its timely recognition is essential for adequate management. Pediatric patients with congenital heart disease admitted to a cardiac intensive care unit (CICU) after surgical corrections are particularly at risk of low cardiac output syndrome (LCOS) and shock. Blood lactate levels and venous oxygen saturation (ScVO2) are usually used as shock biomarkers to monitor the efficacy of resuscitation efforts, but they are plagued by some limitations. Carbon dioxide (CO2)-derived parameters, namely veno-arterial CO2 difference (ΔCCO2) and the VCO2/VO2 ratio, may represent a potentially valuable addition as sensitive biomarkers to assess tissue perfusion and cellular oxygenation and may represent a valuable addition in shock monitoring. These variables have been mostly studied in the adult population, with a strong association between ΔCCO2 or VCO2/VO2 ratio and mortality. In children, particularly in CICU, few studies looked at these parameters, while they reported promising results on the use of CO2-derived indices for patients’ management after cardiac surgeries. This review focuses on the physiological and pathophysiological determinants of ΔCCO2 and VCO2/VO2 ratio while summarizing the actual state of knowledge on the use of CO2-derived indices as hemodynamical markers in CICU.

Infective endocarditis due to Kingella kingae is a rare but serious invasive infection that occurs mostly in children. Recent advances in nucleic acid amplification testing as well as in cardiac imaging have enabled more accurate diagnosis. A good understanding of the epidemiology and virulence factors remains crucial to guide the therapeutic approach. Here, we synthesize the current state of knowledge on epidemiological features, pathophysiological insights, complications, and therapy regarding Kingella kingae endocarditis in children and adults. Finally, throughout this comprehensive review, knowledge gaps and areas for future research are also identified.

Background Despite widespread vaccination programs, pertussis continues circulating within populations and remains a life-threatening infection in infants. While several mortality risk factors have been described, a comprehensive synthesis is lacking. We conducted a meta-analysis of studies investigating mortality risk factors in Pertussis infections and validated those factors in a large cohort. Methods Observational studies published in English were systematically searched in PubMed, EMBASE, and LiSSa databases from 01/2000 to 06/2024. The search yielded 816 unique citations. The primary outcome was mortality before discharge from the Pediatric Intensive Care Unit (PICU). Two independent reviewers assessed the risk of bias and extracted data. A REML-random effect model was used to calculate pooled prevalence and conduct the analysis. The identified risk factors were subsequently evaluated in a monocentric cohort of patients admitted to a tertiary hospital’s PICU for severe pertussis between January 1996 and December 2020. Data analysis was conducted between June and August 2024. Results Seventeen studies, including 2,725 patients, met the inclusion criteria. The pooled prevalence of mechanical ventilation, continuous renal replacement therapy, and Extracorporeal Membrane Oxygenation support were 55% (95% CI: 40–70; I 2  = 98), 15% (95% CI: 3–27; I 2  = 95), and 8% (95% CI: 3–12; I 2  = 93), respectively. The pooled mortality incidence was 19% (95% CI:12–26; I 2  = 96). Identified mortality risk factors included elevated heart rate, presence of pulmonary hypertension, presence of seizures, and elevated white blood cell (WBC) count. Validation in an 83-patient cohort (median age: 45 days, IQR: 30–55) revealed a mortality rate of 12%. Risk factors identified in the meta-analysis were significantly associated with non-survival in the cohort. A mortality prediction score was developed incorporating age < 30 days, heart rate > 200/min, and WBC > 30 G/l, achieving an area under the curve of 0.92 (95% CI: 0.86–0.99). Conclusion This meta-analysis identified a simple yet effective score to assess the severity of pertussis infection in infants admitted to PICU. Accurate risk stratification may enable timely treatment of critically ill patients, potentially improving outcomes. Trial registration : The study protocol was registered on PROSPERO: CRD42024582057. Graphic abstract

Data describing the use of extracorporeal membrane oxygenation (ECMO) in pediatric acute liver failure (PALF) are scarce. Thus, we aimed to describe the use of ECMO in patients with PALF using the data from the Extracorporeal Life Support Organization (ELSO) Registry between January 1, 2010, to December 31, 2022. We described patients’ characteristics at ECMO initiation, outcome, and factors associated with mortality. A total of 335 children underwent ECMO support in the context of PALF. Veno-arterial (VA) ECMO was the most prevalent mode (66.6%), followed by veno-venous (VV) ECMO (33.4%). Extracorporeal cardiopulmonary resuscitation (ECPR) was used in 21.5% of the cardiac arrest. In-hospital mortality was 66.6%. Both higher lactate (OR 1.128, CI 1.06–1.209, p < 0.001) and PaCO 2 (OR 1.022, CI 1.001–1.047, p 0.05) levels before ECMO reported greater odds of mortality. Low body weight, persistence of hyperlactatemia (OR 0.985, CI 0.973–0.997, p 0.013), and hyperbilirubinemia (OR 2.477, CI 1.042–6.100, p 0.045) after 24 h from ECMO deployment were associated to greater odds of mortality. Conclusions : Our results suggest that the use of ECMO for the management of respiratory and cardiac failure in patients with PALF should be considered with caution and that further research is needed to understand its role in this specific high-risk population. What is known: • Pediatric acute liver failure (PALF) is a clinical syndrome associated with significant morbidity and mortality. • Data on the use of extracorporeal membrane oxygenation (ECMO) in the context of PALF are scarce and controversial. What is new: • ECMO to manage acute respiratory and/or cardiac failure in the context of PALF should be considered with caution. • Bleeding and thrombotic complications in children with acute liver failure receiving ECMO are similar to the ones reported in the general pediatric population.

The population of patients with congenital heart disease is constantly growing with an increasing number of individuals reaching adulthood. A significant proportion of these children and young adults will suffer from tachyarrhythmias due to the abnormal anatomy, the hemodynamic burden, or as a sequela of surgical treatment. Depending on the underlying mechanism, arrhythmias may arise in the early postoperative period (hours to days after surgery) or in the late postoperative period (usually years after surgery). A good understanding of the electrophysiological characteristics and pathophysiological mechanisms is therefore crucial to guide the therapeutic approach. Here, we synthesize the current state of knowledge on epidemiological features, risk factors, pathophysiological insights, electrophysiological features, and therapy regarding tachyarrhythmias in children and young adults undergoing reparative surgery for congenital heart disease. The evolution and latest data on treatment options, including pharmacological therapy, ablation procedures, device therapy decision, and thromboprophylaxis, are summarized. Finally, throughout this comprehensive review, knowledge gaps and areas for future research are also identified.

Purpose Children with congenital heart disease (CHD) from low- to middle-income countries (LMIC) are suspected to have a high prevalence of antibiotic-resistant microorganisms (ARMOs) carriage, but data are currently lacking. Carriage of ARMOs could impact the post-operative course in pediatric intensive care unit (PICU). The aim of the study was to assess the prevalence of ARMOs carriage in children with CHD from LMIC and its impact on post-operative outcomes. Methods This was a retrospective monocentric study from 01/2019 to 12/2022. Included patients were children (0–18 years) from a LMIC admitted after CHD surgery and with AMRO screening performed the week before. Infections and post-operative evolution were compared based on ARMOs carriage status. Findings Among 224 surgeries (median age 38.5 months (IQR 22–85.5)), ARMOs carriage was evidenced in 95 cases (42.4%). Main organisms isolated were Extended Spectrum Beta-Lactamase (ESBL) producing E. coli (75/224) 33.5%)) and ESBL- K. pneumoniae (30/224) 13.4%)). Median mechanical ventilation duration was 1 day (IQR 0–1), PICU stay 3 days (IQR 2–4) and hospital stay 6.5 days (IQR 5–10). A total of 17 infectious episodes occurred in 15 patients, mostly consisting in hospital-acquired pneumonia (HAP) (12/17). Only two infections were caused by a colonizing ARMO. Occurrence of infections and patients’ outcome were similar between ARMO carriers and non-carriers. Higher use of carbapenems (6 (6.3%) vs 1 (0.8%), p  = 0.04) and a trend to a higher use of vancomycin (14 (13.7%) vs 9 (6.9%), p  = 0.04) in case of ARMOs carriage. Applying current guidelines, negative swab screening could have led to sparing most of empirical vancomycin therapy (11/12) for HAP based on current guidelines. Conclusion Prevalence of AMROs carriage is high in children from LMIC and has a limited impact on patients’ outcome. However, ARMOs carriage leads to higher consumption of antibiotics. Screening may help saving use of broad-spectrum antibiotic in non-carrier patients.

Shock is a life-threatening condition, and its timely recognition is essential for adequate management. Pediatric patients with congenital heart disease admitted to a cardiac intensive care unit (CICU) after surgical corrections are particularly at risk of low cardiac output syndrome (LCOS) and shock. Blood lactate levels and venous oxygen saturation (ScVO ) are usually used as shock biomarkers to monitor the efficacy of resuscitation efforts, but they are plagued by some limitations. Carbon dioxide (CO )-derived parameters, namely veno-arterial CO difference (ΔCCO ) and the VCO /VO ratio, may represent a potentially valuable addition as sensitive biomarkers to assess tissue perfusion and cellular oxygenation and may represent a valuable addition in shock monitoring. These variables have been mostly studied in the adult population, with a strong association between ΔCCO or VCO /VO ratio and mortality. In children, particularly in CICU, few studies looked at these parameters, while they reported promising results on the use of CO -derived indices for patients' management after cardiac surgeries. This review focuses on the physiological and pathophysiological determinants of ΔCCO and VCO /VO ratio while summarizing the actual state of knowledge on the use of CO -derived indices as hemodynamical markers in CICU.

Shock is a life-threatening condition, and its timely recognition is essential for adequate management. Pediatric patients with congenital heart disease admitted to a cardiac intensive care unit (CICU) after surgical corrections are particularly at risk of low cardiac output syndrome (LCOS) and shock. Blood lactate levels and venous oxygen saturation (ScVO[sub.2]) are usually used as shock biomarkers to monitor the efficacy of resuscitation efforts, but they are plagued by some limitations. Carbon dioxide (CO[sub.2])-derived parameters, namely veno-arterial CO[sub.2] difference (ΔCCO[sub.2]) and the VCO[sub.2]/VO[sub.2] ratio, may represent a potentially valuable addition as sensitive biomarkers to assess tissue perfusion and cellular oxygenation and may represent a valuable addition in shock monitoring. These variables have been mostly studied in the adult population, with a strong association between ΔCCO[sub.2] or VCO[sub.2]/VO[sub.2] ratio and mortality. In children, particularly in CICU, few studies looked at these parameters, while they reported promising results on the use of CO[sub.2]-derived indices for patients' management after cardiac surgeries. This review focuses on the physiological and pathophysiological determinants of ΔCCO[sub.2] and VCO[sub.2]/VO[sub.2] ratio while summarizing the actual state of knowledge on the use of CO[sub.2]-derived indices as hemodynamical markers in CICU.