scholarly journals Salivary biomarkers may measure stress responses in critically ill children

2018 ◽  
Vol 6 ◽  
pp. 205031211880245 ◽  
Author(s):  
Despoina Tzira ◽  
Anargyroula Prezerakou ◽  
Ioannis Papadatos ◽  
Artemis Vintila ◽  
Anastasia Bartzeliotou ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Circadian Rhythm ◽  
Pediatric Intensive Care Unit ◽  
Risk Index ◽  
Pediatric Intensive Care ◽  
Index Score ◽  
Critically Ill Children ◽  
Salivary Biomarkers ◽  
Risk Index Score

Objective: Measurement of salivary biomarkers can provide important information regarding hypothalamic–pituitary–adrenal axis activity both under normal conditions as well as in response to psychological or physical stress. Our aim was to correlate salivary stress markers, such as cortisol, α-amylase and immunoglobulin A, with the Pediatric Risk Index Score of Mortality, underlying disease (pathologic, trauma and postoperative), need for mechanical ventilation/sedation and time lag between onset of illness and admission in children admitted in the pediatric intensive care unit. Methods: We enrolled 79 pediatric intensive care unit patients (2–14 years) over a 2-year period, which satisfy the including criteria, but finally salivary biomarkers were evaluated in 65 patients. Saliva samples were collected within 24 h of admission at 8 a.m., 2 p.m. and 8 p.m. to examine potential disruption of circadian rhythm. Results: Overall, the salivary biomarkers were increased; specifically, median values were (a) cortisol at 8 a.m.: 50.04 nmol/L, 2 p.m.: 30.69 nmol/L and 8 p.m.: 247.12 nmol/L; (b) α-amylase: at 8 a.m.: 22.567 U/L; 2 p.m.: 22.702 U/L and 8 p.m.: 21.484 U/L and (c) IgA at 8 a.m.: 95.10 mg/dL, 2 p.m.: 88.55 mg/dL and 8 p.m.: 80.80 mg/dL. Significantly higher levels were demonstrated in children younger than 6 years and those with Pediatric Risk Index Score of Mortality ⩾8 upon admission. Disturbances in circadian rhythm were observed. Cortisol circadian rhythm disturbance was observed only in children with Pediatric Risk Index Score of Mortality score ⩾8 upon admission while maintaining normal α-amylase circadian rhythm, which was associated with less than 3 days hospitalization in pediatric intensive care unit. No daily variance in IgA was observed. Conclusion: Salivary biomarkers may serve, in critically ill children, as a sensitive, non-invasive method, important for the early recognition of those at high risk and guiding intervention, before clinical deterioration, promoting the quality of health care in pediatric population.

scholarly journals Use of body composition and phase angle analysis for the assessment of nutritional status and clinical outcomes in critically ill children

2021 ◽  
Author(s):  
Zi-Hong Xiong ◽  
Xue-Mei Zheng ◽  
Guo-Ying Zhang ◽  
Meng-Jun Wu ◽  
Yi Qu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nutritional Status ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Phase Angle ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Duration Time

Abstract BackgroundMalnutrition is highly prevalent in critically ill children in the pediatric intensive care unit .We aimed to investigate the efficiency of bioelectrical impedance analysis (BIA) measurements and phase angle (PhA) analysis for the assessment of nutritional risk and clinical outcomes in critically ill children.MethodsThis single-center observational study included patients admitted to the Pediatric Intensive Care Unit (PICU) of Chengdu Women’s and Children’s Central Hospital. All patients underwent anthropometric measurement in the first 24 h of admission and underwent BIA measurements within 3 days after the admission. The patients were classified into different groups based on body mass index (BMI) for age. Electronic hospital medical records were reviewed to collect clinical data for each patient. All the obtained data were analyzed by the statistics method.ResultsThere were 204 patients enrolled in our study, of which 32.4% were diagnosed with malnutrition. We found that BMI, arm muscle circumference, fat mass, and %body fat were lower in the group with poorer nutritional status (P < 0.05). Evident differences in the score of the Pediatric Risk of Mortality and the duration of mechanical ventilation (MV) among the three groups with different nutritional statuses were observed (P < 0.05). Patients in the severely malnourished group had the longest duration of MV. In the MV groups, there were significant differences (P < 0.05) in albumin level, PhA, and extracellular water/total body water (ECW/TBW ratio). The ECW/TBW ratio and the time for PICU stay had a weak degree of correlation (Pearson correlation coefficient = 0.375). PhA showed a weak degree of correlation with the duration time of medical ventilation (coefficient of correlation = 0.398).ConclusionBIA can be considered an alternative way to assess nutritional status in critically ill children. ECW/TBW ratio and PhA were correlated with PICU stay and duration time of medical ventilation, respectively.

scholarly journals SAT-724 Endocrine Disruption by Phthalate Exposure in the Pediatric Intensive Care Unit

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
An Jacobs ◽  
Adrian Covaci ◽  
Govindan Malarvannan ◽  
Giulia Poma ◽  
Inge Derese ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Total Cortisol ◽  
Free Cortisol ◽  
Metabolite Concentrations ◽  
Dehp Exposure

Abstract Aim: Pediatric intensive care relies on plastic indwelling medical devices softened by phthalates. Phthalates leach into the circulation and concerns about toxicity were raised. Exceeding a certain threshold of di(2-ethylhexyl)phthalate (DEHP) exposure in the pediatric intensive care unit (PICU) has been associated with an attention deficit 4 years later (1). Moreover, DEHP and its metabolites have endocrine disrupting properties. Critically ill children reveal the non-thyroidal illness syndrome (2) and unexplained relatively low cortisol (3). Whether DEHP exposure in PICU has endocrine disruptive effects is unknown. We investigated whether DEHP exposure in the PICU, exceeding the previously identified “toxic” threshold for attention, is independently associated with thyroid- and HPA-axis alterations upon PICU discharge. Methods: In this preplanned secondary analysis of the PEPaNIC RCT (N=1440) (4), plasma DEHP metabolite concentrations (MEHP, 5OH-MEHP, 5cx-MEPP, 5oxo-MEHP) were quantified for all patients with a last PICU day sample (N=920). Minimal DEHP exposure was defined as the product of the total DEHP metabolite concentrations on the last PICU day and duration of PICU stay, with 0.551 µmol/L.days identified as “toxic” threshold (1). Serum TSH, total T4, total T3 and rT3 concentrations were quantified for patients with an available last day sample (N=913). For patients with a last day plasma sample and who did not receive corticosteroids (N=391), plasma ACTH, total cortisol, albumin and CBG concentrations were quantified and free cortisol calculated. Multivariable linear regression analyses, adjusted for baseline risk factors and for duration of PICU stay, assessed whether exceeding the previously determined threshold of toxic DEHP exposure was independently associated with the hormone levels on the last PICU day. Main results: Median total DEHP metabolite concentration was 0.101 (IQR 0.049 - 0.279) µmol/L on the last PICU day. Minimal DEHP exposure was 0.337 (IQR 0.161 - 0.880) µmol/l.days, and 328 patients (35.7%) exceeded the toxic threshold. Exceeding this threshold was independently associated with lower total T4 (P=0.002), total T3 (P=0.02) and total cortisol (P=0.001), and higher rT3 (P=0.01) concentrations on the last PICU day, but not with TSH, ACTH or free cortisol. Conclusion: Critically ill children had DHEP metabolites in plasma upon PICU discharge and more than a third were exposed to toxic levels. Toxic DEHP exposure was an independent contributor to the severity of the non-thyroidal illness phenotype and to lower cortisol upon PICU discharge. Future research should assess whether such endocrine-disruptive impact of DHEP exposure in the PICU plays a role in the long-term developmental legacy of critical illness in children. 1 Verstraete et al Intensive Care Med 2016 2 Jacobs et al Thyroid 2019 3 Jacobs et al Intensive Care Med 2019 4 Fivez et al N Engl J Med 2016

scholarly journals Incidence and etiology of acute kidney injury in children admitted to PICU using pRIFLE criteria

2018 ◽  
Vol 5 (3) ◽  
pp. 917
Author(s):  
Javid Maqbool ◽  
Aajaz Ahmad Mir ◽  
Nisar Ahmad Bhat ◽  
Waseem Qadir Moona
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Adverse Outcomes ◽  
Critically Ill Children ◽  
Consensus Definition ◽  
Schwartz Formula

Background: Acute kidney injury is a common problem highly associated with hospitalization. Acute Kidney Injury (AKI) is associated with severe morbidity and mortality especially in children. Lack of consensus definition has been major limitation in improving outcomes. This study tries to address the need of limited data on pediatric AKI. Detection of the incidence, etiological profile and outcome of AKI is important for the initiation of preventive and therapeutic strategies, identifying patients early to avoid renal replacement therapy.Methods: This prospective observational study was conducted in the pediatric intensive care unit (PICU) of tertiary hospital (GMC Srinagar) between January 2015 to December 2016.This is the only prospective study conducted in this hospital, all other studies conducted here and other higher centers were retrospective. Serum creatinine level was estimated on all patients on admission and alternate days till discharge from Pediatric Intensive Care Unit (PICU). Urine output was recorded. Estimated Creatinine- Clearance (eCrCL) was calculated using Schwartz formula. AKI diagnosis and staging was based on pRIFLE (pediatric RIFLE) criteria. eCrCl criteria was used to diagnose and stage AKI. Maximal stage that the patient progressed during the stay in PICU was assigned the stage for that case.Results: Of total 500 cases, 480 cases met inclusion criteria. Of them, the incidence of AKI was 154 (32.1%). Stage ‘Risk (R)’, ‘Injury (I)’ and ‘Failure (F)’ constituted 93(60.38%), 46 (29.8%) and15 (9.74%) respectively. Maximum AKI occurred in <1 year (30.5%). Infections were commonest etiology. Amongst infections sepsis (30.5%) was most common, followed by acute gastroenteritis (20.7%) and pneumonia (16.9%). Hypotension, nephrotoxic drugs, sepsis, need for mechanical ventilation were significant (p<0.001) risk factors for AKI. Pre-renal causes constituted 68% and intrinsic renal 32%.Conclusions: The incidence of AKI is high among critically ill children. AKI continues to be associated with adverse outcomes. pRIFLE staging system provides early identification and stratification of AKI. Infections are leading etiology of AKI in children. 

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