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This article reviews the definition, pathophysiology, etiology, assessment, and management of acute respiratory failure in children. Acute respiratory failure is the inability of the respiratory system to maintain oxygenation or eliminate carbon dioxide. Acute respiratory failure is a common cause for admission to a pediatric intensive care unit. Most causes of acute respiratory failure can be grouped into one of three categories: lung parenchymal disease, airway obstruction, or neuromuscular dysfunction. Many patients with acute respiratory failure are managed successfully with noninvasive respiratory support; however, in severe cases, patients may require intubation and mechanical ventilation. [ Pediatr Ann. 2018;47(7):e268–e273.]

Objective: Sedation may be needed for safe, effective completion of pediatric dental procedures. Procedural sedation is performed in a children's hospital based dental office. The three sedation approaches: a propofolonly (P-O) approach (2–3mg/kg titrated to the needed level of sedation), an approach that includes either IV ketamine (K+P) (0.25 or 0.5mg/kg) or IV fentanyl (F+P) (0.5–1mcg/kg) prior to propofol administration. We sought to determine safety and efficacy of various propofol based sedation protocols. Study Design: Retrospective review of 222 patients receiving a propofol-only (P-O), ketamine+propofol (K+P) or fentanyl+propofol (F+P) approach. Results: There were 44 patients in P-O group, 154 in K+P group and 24 in F+P group with mean age (4.8±3.4y) and mean weight (19.7±6.7kg). All the patients completed procedures successfully. Mild hypoxemia occurred in 24% of cases and resolved with nasal cannula. Mean total dose of propofol was similar in all groups (P-O 8.2mg/kg, K+P 9.5mg/kg, F+P 9.6mg/kg, p=0.15). Although procedure and recovery times were similar in all groups, discharge times in K+P group were significantly shorter than P-O group and F+P group respectively (K+P 9.35±8.93.min, P-O 13.57±10.42min, F+P 10.42±4.40 p= 0.002). Conclusion: Sedation can be accomplished safely and effectively in a children's hospital based dental office using propofol-based sedation.

This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in the interventional group and 66 patients in the historical control group. We evaluated the impact of weekly meetings (PEACE rounds) to establish goals of care for patients with longer than 10 days length of stay in the ICU for a year. Moral distress was measured intermittently and reported moral distress thermometer (MDT) scores fluctuated. \"Clinical situations\" represented the most frequent contributing factor to moral distress. Post intervention, overall moral distress scores, measured on the moral distress scale revised (MDS-R), were lower for respondents in all categories (non-significant), and on three specific items (significant). Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS (4.94 control vs 3.37 PEACE, p = 0.015), a statistically significant increase in both code status changes DNR (11 % control, 28 % PEACE, p = 0.013), and in-hospital death (9 % control, 25 % PEACE, p = 0.015), with no change in patient 30 or 365 day mortality. The addition of a clinical ethicist and senior intensivist to weekly inter-professional team meetings facilitated difficult conversations regarding realistic goals of care. The study demonstrated that the PEACE intervention had a positive impact on some factors that contribute to moral distress and can shorten PICU length of stay for some patients.

A variety of adverse effects are associated with the use of hypertonic sodium phosphate enemas and laxatives in children. We describe an unusual case of phosphate enema toxicity in a child that resulted in cardiopulmonary failure necessitating the use of extracorporeal membrane oxygenation. The toxicity associated with hypertonic sodium phosphate enemas is reviewed. Hypertonic sodium phosphate enemas can cause cardiopulmonary failure.

The world has changed forever as a result of the COVID-19 pandemic. Antimicrobial resistance is a primary global health concern that places a significant financial and health burden on nations. Patients with Campylobacter-caused infections were the subject of the retrospective investigation. The data show that children aged 1–6 are the most commonly affected by Campylobacter enteritis. Resistance levels fluctuated over the course of the two periods. Nine isolates were sensitive to macrolides, and only one was responsive to tetracycline, which indicated inadequate sensitivity across all classes throughout the pandemic. This pattern raises serious concerns about the potential impact on public health. Tetracyclines and fluoroquinolones rank highest in terms of bacterial resistance. Regardless of the species, macrolides remain a practical and sufficient treatment for Campylobacter enteritis. Reassurance is still provided by much lower numbers in the post-pandemic period. There is no evidence to support the alarming claims made in the international literature about macrolides in Romania.