RESUMO
Coronavirus disease 2019 (COVID-19) is an ongoing pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus. More than 5 million children have been infected in the United States. Risk factors for more severe disease progression include obesity, pulmonary disease, gastrointestinal disorders, and neurologic comorbidities. Children with COVID-19 are admitted to the pediatric intensive care unit because of severe acute COVID-19 illness or COVID-19-associated multisystem inflammatory syndrome in children. The delta surge of 2021 was responsible for an increased disease burden in children and points to the key role of vaccinating children against this sometimes-deadly disease.
Assuntos
COVID-19 , COVID-19/complicações , COVID-19/epidemiologia , Criança , Humanos , Unidades de Terapia Intensiva Pediátrica , Pandemias , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica , Estados Unidos/epidemiologiaRESUMO
Posttraumatic stress among pediatric critical care physicians in the United States in association with coronavirus disease 2019 patient care experiences. Our objective was to assess the prevalence of posttraumatic stress (PTS) and its association with COVID-19 patient care experiences among pediatric critical care physicians. Our study was a cross-sectional study of pediatric critical care physicians in the United States. We measured PTS which included posttraumatic stress disorder (PTSD) and subthreshold posttraumatic stress disorder (SubPTSD) using validated PTSD Checklist- 5 survey tool. Association of PTS with COVID-19 patient care experiences was analyzed using regression analysis. Prevalence of PTS was noted in 120 among 294 pediatric critical care physicians (41%; 95% CI, 35-47%). The predominant symptoms were that of hyperarousal and feelings of negative cognition and mood. Among our physicians with PTS, 19% had PTSD and 81% had SubPTSD. Demographic and practice characteristics were not significant for increased PTS on regression analysis. Posttraumatic stress was significantly associated with physicians testing positive or taking time off for COVID-19 illness, self-isolation, fear of infecting their loved ones, families scared of being infected, feeling helpless, patients expressing fears of dying, having pre-existing depression, anxiety, or insomnia, working beyond comfort level of training and having thoughts of quitting (p < 0.05). Thoughts of quitting was associated with the highest significant increase in PTS scores (coefficient:11.643; 95% CI:8.551,14.735; P < 0.01) followed by feeling of helplessness (coefficient:11.055; 95% CI: 8.484,13.624; P < 0.01) and need for additional medications for depression, anxiety and insomnia (coefficient: 10.980; 95% CI: 4.970, 16.990; P < 0.01). Posttraumatic stress is high in pediatric critical care physicians and is associated with various COVID-19 patient care experiences. Thoughts of quitting was associated with highest increase in posttraumatic stress score which could have major implications for the workforce in the future. Subthreshold posttraumatic stress disorder should be recognized, and mental health issues of pediatric critical care physicians addressed.
Assuntos
COVID-19 , Médicos , Transtornos de Estresse Pós-Traumáticos , COVID-19/epidemiologia , Criança , Cuidados Críticos , Estudos Transversais , Depressão/epidemiologia , Depressão/etiologia , Humanos , Médicos/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: To describe critically ill children's coagulation profile with the multisystem inflammatory syndrome (MIS-C) related to coronavirus. STUDY DESIGN: Single-center, observational study at a tertiary, pediatric intensive care unit (PICU) in children aged 1 month to 18 years. MEASUREMENTS AND MAIN RESULTS: Sixteen children, with a median age of 5.4 years (interquartile range [IQR] 2.1, 11.75), 56% female, admission Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score of 3.5 (IQR 2, 5), and median PICU length of stay 3 days (IQR 1.5, 4), met criteria of MIS-C. All patients received acetylsalicylic acid (80-100 mg/kg) and none received anticoagulation. Sixty-three percent (10/16) of children had out-of-normal range values on thromboelastography (TEG) (44% [7/16] with hypercoagulability and 19% [3/16] with hypocoagulability). Of those with hypercoagulability, 19% (3/16) had rapid clot formation, and 25% (4/16) had increased clot strength. In 69% (11/16) of children, there was impaired fibrinolysis (0% lysis at 30 minutes) on TEG. Seventy-five percent (12/16) of children had out-of-normal range value on standard coagulation assays (37.5% [6/16] with hypocoagulability and 37.5% [6/16] with hypercoagulability). TEG-G (clot strength as measured by TEG) value (ρ -.553, p = .033) and platelet count (ρ -.840, p < .0001) were correlated with admission PELOD-2 score. TEG-G value (ρ -.506, p = .04) and platelet count (ρ -.539, p = .03) were correlated with the duration of intensive care unit stay. CONCLUSIONS: Coagulation abnormalities are frequent in children with MIS-C. TEG parameter and platelet count are correlated with the severity of multiorgan dysfunction and the duration of intensive care stay. Multicenter studies are needed to confirm the clinical implications of these coagulation abnormalities.
Assuntos
Transtornos da Coagulação Sanguínea , Trombofilia , Transtornos da Coagulação Sanguínea/etiologia , Testes de Coagulação Sanguínea , Criança , Pré-Escolar , Estado Terminal , Feminino , Humanos , Masculino , TromboelastografiaRESUMO
We report findings on abdominal imaging in critically ill children admitted with MIS-C. On sonography, hepatomegaly, nephromegaly, gallbladder wall edema, ascites, intestinal inflammation and mesenteric lymphadenopathy were seen, while CT showed fluid-filled small bowel loops, mural thickening of the terminal ileum, diffuse lymphadenopathy, and moderate ascites.
Assuntos
Abdome/diagnóstico por imagem , COVID-19/diagnóstico por imagem , Inflamação/diagnóstico por imagem , Adolescente , Ascite/diagnóstico por imagem , COVID-19/fisiopatologia , COVID-19/terapia , Criança , Pré-Escolar , Estado Terminal , Feminino , Doenças da Vesícula Biliar/diagnóstico por imagem , Hepatomegalia/diagnóstico por imagem , Humanos , Íleo/diagnóstico por imagem , Lactente , Inflamação/tratamento farmacológico , Inflamação/fisiopatologia , Intestino Delgado/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Linfadenopatia/diagnóstico por imagem , Masculino , Linfadenite Mesentérica/diagnóstico por imagem , Síndrome de Linfonodos Mucocutâneos/diagnóstico por imagem , SARS-CoV-2 , UltrassonografiaRESUMO
Purulent pericarditis occurs rarely in the current antibiotic era. We describe clinical and echocardiographic features of purulent pericarditis in a previously healthy child with influenza and community-acquired methicillin-resistant Staphylococcus aureus co-infection. The child was already on appropriate antibiotics and had a very subtle clinical presentation, with prominent abdominal symptoms. Timely surgical drainage led to complete recovery.
Assuntos
Influenza Humana/complicações , Pericardite/microbiologia , Infecções Estafilocócicas/complicações , Antibacterianos/uso terapêutico , Pré-Escolar , Infecções Comunitárias Adquiridas , Humanos , Vírus da Influenza B , Masculino , Staphylococcus aureus Resistente à Meticilina , Pericardite/diagnóstico por imagem , Pericardite/tratamento farmacológico , Rifampina/uso terapêutico , Staphylococcus aureus , Vancomicina/uso terapêuticoRESUMO
OBJECTIVES: To estimate the prevalence of physician burnout, psychological distress, and its association with selected personal and practice characteristics among pediatric critical care physicians and to evaluate the relationship between burnout and psychological distress. DESIGN: Cross-sectional, online survey. SETTING: Pediatric critical care practices in the United States. SUBJECTS: Pediatric critical care physicians. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: A nonrandom sample of 253 physicians completed an online survey consisting of personal and practice characteristics, the Maslach Burnout Inventory, and the General Health Questionnaire. Nearly half of the participants (49%; 95% CI, 43-55%; n = 124) scored high burnout in at least one of the three subscales of the Maslach Burnout Inventory and 21% reported severe burnout. The risk of any burnout was about two times more in women physicians (odds ratio, 1.97; 95% CI, 1.2-3.4). Association between other personal or practice characteristics and burnout was not evident in this study, while regular physical exercise appeared to be protective. One third of all participants (30.5%) and 69% of those who experienced severe burnout screened positive for psychological distress. About 90% of the physicians reporting severe burnout have considered leaving their practice. CONCLUSIONS: Burnout is high among pediatric critical care physicians in the United States. About two thirds of the physicians with severe burnout met the screening criteria for psychological distress that suggests possible common mental disorders. Significant percentages of physicians experiencing burnout and considering to leave the profession has major implications for the critical care workforce.
Assuntos
Esgotamento Profissional/epidemiologia , Unidades de Terapia Intensiva Pediátrica , Pediatras/psicologia , Pediatras/estatística & dados numéricos , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Adulto , Esgotamento Profissional/diagnóstico , Esgotamento Profissional/psicologia , Estudos Transversais , Feminino , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Psicometria/estatística & dados numéricos , Estatística como Assunto , Inquéritos e Questionários , Estados Unidos , Recursos HumanosRESUMO
Pylorospasm can present with sonographic findings similar to hypertrophic pyloric stenosis. We present a rare case of methicillin-resistant Staphylococcus aureus subhepatic abscess causing pylorospasm in a neonate.
Assuntos
Abscesso Hepático/diagnóstico , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Estenose Pilórica Hipertrófica/diagnóstico , Infecções Estafilocócicas/diagnóstico , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Laparotomia , Abscesso Hepático/microbiologia , Abscesso Hepático/terapia , Estenose Pilórica Hipertrófica/microbiologia , Estenose Pilórica Hipertrófica/terapia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapiaRESUMO
Plastibell is one of the three most common devices used for neonatal circumcision in the United States, with a complication rate as low as 1.8%. The Plastibell circumcision device is commonly used under local anesthesia for religious circumcision in male neonates, because of cosmetic reasons and ease of use. Occasionally, instead of falling off, the device may get buried under the skin along the shaft of the penis, thereby obstructing the normal flow of urine. Furthermore, the foreskin of neonates is highly vascularized, and hence, hemorrhage and infection are possible when the skin is cut. Necrosis of penile skin, followed by urethral obstruction and renal failure, is a serious surgical mishap requiring immediate corrective surgery and medical attention. We report a case of fulminant urosepsis, acute renal failure, and pyelonephritis in a 4-day-old male neonate secondary to impaction of a Plastibell circumcision device. Immediate medical management was initiated with fluid resuscitation and mechanical ventilation; thereby correcting life threatening complications. Pediatricians and Emergency Department physicians should be cognizant of the complications from Plastibell circumcision device in order to institute appropriate and timely management in neonates.
RESUMO
OBJECTIVES: To evaluate the impact of nurse integrated rounds (NIRs) on self-reported comprehension, attitudes, and practices of nurses and resident physicians (RPs) in a pediatric intensive care unit (PICU). MATERIALS AND METHODS: A self-reported comprehension, attitude, and practice survey of RPs and nurses was done prior to (T0), 3 months (T3), and 15 months (T15) after initiation of NIRs in our PICU. Responses were graded on Likert-type scale from 1 to 5. The RPs, attending physicians, and nurses also ranked their overall perception of NIRs during these 3 survey time periods. RESULTS: All 3 components of the surveys showed statistically significant improvement (P < .05) from the T0 to T3 and T15 in RPs and nurses. A complete or almost complete reversal of attitude was noted for most questions in the attitude section in both RPs and nurses when T15 was compared to T0. The overall perception that NIRs was good for patient care also showed significant improvement in the survey of nurses and physicians. CONCLUSIONS: The NIRs are well accepted by nurses and physicians and are accompanied by self-reported improvements in comprehension, attitudes, and practices of nurses and RPs in the PICU.
Assuntos
Compreensão , Conhecimentos, Atitudes e Prática em Saúde , Unidades de Terapia Intensiva Pediátrica , Padrões de Prática em Enfermagem/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Autorrelato , Visitas de Preceptoria , Feminino , Humanos , Internato e Residência , Masculino , Inquéritos e Questionários , Recursos HumanosAssuntos
Anorexia/diagnóstico por imagem , Anorexia/etiologia , Ceco/anormalidades , Duodeno/anormalidades , Dismenorreia/etiologia , Interpretação de Imagem Assistida por Computador , Volvo Intestinal/congênito , Volvo Intestinal/diagnóstico por imagem , Jejuno/anormalidades , Tomografia Computadorizada por Raios X , Adolescente , Ceco/diagnóstico por imagem , Duodeno/diagnóstico por imagem , Dismenorreia/diagnóstico por imagem , Feminino , Humanos , Jejuno/diagnóstico por imagemRESUMO
The surgical correction of congenital cardiac lesions that are complicated by intercurrent respiratory syncytial virus (RSV) pneumonitis has traditionally been deferred for at least 6 to 8 weeks. The presumption is that using cardiopulmonary bypass will increase the risk of postoperative pulmonary complications. We present an infant who developed acute respiratory failure related to RSV pneumonitis and required urgent mechanical ventilation. Cardiac evaluation revealed a large nonrestrictive ventricular septal defect (VSD), aortic arch hypoplasia, normally functioning bicuspid aortic valve, and hemodynamic instability associated with markedly increased pulmonary blood flow. Separation from mechanical ventilation was unsuccessful preoperatively. He underwent VSD repair with cardiopulmonary bypass less than 4 weeks after initial RSV infection. He was extubated successfully within 72 hours of VSD repair. Approximately 6 weeks postoperatively, he developed a circumferential chylous pericardial effusion of unclear etiology--an exceedingly rare complication of VSD repair in early infancy in a non-Down syndrome patient. The chylous effusion was initially managed unsuccessfully with Portogen/Monogen and a percutaneously placed pericardial drain. Two weeks later, he underwent creation of a pleuropericardial window with successful resolution of the chylous effusion. It is of interest to pediatricians to be able to correctly time the repair of congenital heart disease lesions after RSV infection to minimize post-bypass pulmonary complications and yet avoid morbidity from undue delays in repair. In addition, chylopericardium can occur in infants after VSD repair, and dietary modification and catheter drainage may not be adequate.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Derrame Pericárdico/complicações , Insuficiência Respiratória/etiologia , Infecções por Vírus Respiratório Sincicial/complicações , Vírus Sinciciais Respiratórios , Diagnóstico Diferencial , Ecocardiografia , Comunicação Interventricular/complicações , Humanos , Lactente , Masculino , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/cirurgia , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/cirurgia , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/virologia , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
Atrioventricular (AV) block is a delay or an interruption in the transmission of an impulse from atria to ventricles due to an anatomic or a functional impairment in the conduction system. Atrioventricular block may be congenital or acquired. Electrocardiographic screening of asymptomatic school-aged children (median, 12.4 years) in Japan found the prevalence of a third-degree AV block to be 2 per 100,000. We report a case of asymptomatic complete AV block of unknown etiology in a 13-year-old child who did not require pacemaker placement. The importance of recognizing an asymptomatic complete AV block in the pediatric population, the classification and controversies of pacemaker placement, and the complications of pacemaker placement are discussed.
Assuntos
Bloqueio Atrioventricular/diagnóstico , Estomatite Aftosa/complicações , Adolescente , Doenças Assintomáticas , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/fisiopatologia , Eletrocardiografia , Serviço Hospitalar de Emergência , Teste de Esforço , Feminino , Frequência Cardíaca , Humanos , Achados Incidentais , Marca-Passo Artificial , Cooperação do PacienteRESUMO
OBJECTIVES: The study's objectives were to evaluate serial troponin concentrations as a marker of cardiac toxicity in children receiving intravenous terbutaline for status asthmaticus and to study if troponin concentrations are affected by severity of asthma and risk factors for severe asthma. METHODS: This was a prospective observational study in 20 consecutive patients who were admitted to a tertiary care pediatric intensive care unit for status asthmaticus and received intravenous terbutaline. Cardiac troponin I (cTnI) concentrations were measured half an hour before the bolus of intravenous terbutaline, 4 hours after terbutaline, and then every 24 hours until discontinuation of the continuous terbutaline infusion. RESULTS: Ten patients had cTnI concentrations greater than 0.03 ng/mL. Maximum cTnI concentrations were recorded after the terbutaline bolus in 6 patients, during terbutaline infusion in 3 patients, and before terbutaline use in 1 patient. Three of these 10 (3/10) patients showed increased cTnI concentrations before the terbutaline bolus. One patient had a significant elevation in cTnI concentration (peak level of 3.79 ng/mL) with electrocardiogram (ECG) changes of myocardial injury that normalized upon discontinuation of terbutaline. All other patients with elevated cTnI concentrations had normal ECG findings. CONCLUSIONS: Elevated cTnI concentrations were observed in 50% of patients treated with intravenous terbutaline for status asthmaticus. Clinically significant cardiotoxicity was not observed except in 1 patient in whom the abnormal ECG findings normalized upon discontinuation of terbutaline. There was no statistically significant difference in asthma severity or in the risk factors for severe asthma in children with and without elevation of cTnI concentrations.
Assuntos
Broncodilatadores/administração & dosagem , Coração/efeitos dos fármacos , Estado Asmático/tratamento farmacológico , Terbutalina/administração & dosagem , Troponina/sangue , Humanos , Infusões Intravenosas , Fatores de Risco , Estado Asmático/sangueRESUMO
Dislocation of the sternoclavicular joint (DSCJ) with posterior displacement of the clavicle is uncommon in children. This can lead to ipsilateral compression of the great vessels. Diagnosis may not be apparent on routine radiographs. Axial computed tomographic (CT) scan is the imaging of choice for diagnosis. Reconstruction and 3-dimensional (3D) views on CT scan may be helpful to define the anatomy before surgical reduction. We present 2 patients who had traumatic posterior DSCJ with compromise to their vascular structures. Patient 1 was a 13-year-old boy with posterior DSCJ on his left side that was not apparent on x-ray and that was diagnosed to have encroachment of the medial end of the clavicle on the left brachiocephalic vein on CT scan. Reconstruction and 3D views on CT scan were helpful in defining the anatomy before surgical reduction. The patient underwent emergent open reduction and internal fixation with complete recovery.Patient 2 was a 14-year-old boy with posterior DSCJ on the right side that was apparent on x-ray and was evaluated to have encroachment of the medial end of the clavicle on the right innominate artery with an associated paratracheal hematoma on CT scan. Reconstruction and 3D views on CT scan were also helpful in defining the anatomy before surgical reduction. The patient underwent a successful closed reduction with complete recovery.
Assuntos
Luxações Articulares/complicações , Articulação Esternoclavicular/lesões , Doenças Vasculares/etiologia , Adolescente , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Radiografia , Articulação Esternoclavicular/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagemRESUMO
A 5-month-old female infant presented with new-onset acute lymphoblastic leukemia and hyperleukocytosis with white blood cell count of 352 × 10(9) cells/L. She developed sinus pauses and hypoxemic respiratory failure. A manual single volume exchange blood transfusion was done with complete resolution of sinus pauses and hypoxemia.
Assuntos
Doenças do Sistema Nervoso Autônomo/complicações , Transfusão Total/métodos , Hipóxia/complicações , Leucocitose/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Parada Sinusal Cardíaca/etiologia , Antineoplásicos/uso terapêutico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Doenças do Sistema Nervoso Autônomo/terapia , Eletrocardiografia , Feminino , Seguimentos , Humanos , Hipóxia/sangue , Hipóxia/terapia , Lactente , Contagem de Leucócitos , Leucocitose/sangue , Leucocitose/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Insuficiência Respiratória , Parada Sinusal Cardíaca/fisiopatologia , Parada Sinusal Cardíaca/terapiaRESUMO
An 11-month-old male infant presented with history of bupropion ingestion (750 mg/kg). He developed seizures, respiratory failure, and severe hypotension with metabolic acidosis refractory to inotropic support. The patient received mechanical ventilation, intralipids, phenytoin, inotropic support (dopamine, norepinephrine, and epinephrine), and extracorporeal membrane oxygenation (ECMO). Inotropes were weaned upon initiation of ECMO and discontinued 66 hours after ingestion. Total ECMO duration was 71 hours. The patient was extubated on hospital day 8 and has not had any neurological sequelae upon 12-month follow-up examinations. We report for the first time successful use of ECMO after ingestion of a potentially fatal dose of bupropion.
Assuntos
Bupropiona/intoxicação , Oxigenação por Membrana Extracorpórea/métodos , Hipotensão/induzido quimicamente , Antidepressivos de Segunda Geração/intoxicação , Pressão Sanguínea/efeitos dos fármacos , Overdose de Drogas/complicações , Overdose de Drogas/terapia , Seguimentos , Humanos , Hipotensão/fisiopatologia , Hipotensão/terapia , Lactente , MasculinoRESUMO
OBJECTIVE: To report a case of lobar emphysema in an infant who had a congenital diaphragmatic hernia that was surgically repaired at birth. DESIGN: Case report. SETTING: Pediatric critical care unit in a tertiary care hospital. PATIENT: A 9-month-old infant who had massive hyperinflation of the right lung and respiratory failure. INTERVENTIONS: Confirmation of lobar hyperinflation of the right lung with ventilation and perfusion defects and surgical treatment with lobectomy. MEASUREMENTS AND MAIN RESULTS: Successful treatment of respiratory failure. CONCLUSION: Lobar emphysema can be a rare development in patients who had a congenital diaphragmatic hernia at birth. This can result in respiratory failure and needs surgical intervention.
Assuntos
Hérnias Diafragmáticas Congênitas , Enfisema Pulmonar/fisiopatologia , Hérnia Diafragmática/cirurgia , Humanos , Lactente , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Enfisema Pulmonar/etiologia , Enfisema Pulmonar/cirurgia , Radiografia , Resultado do TratamentoAssuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Oxigenação por Membrana Extracorpórea/métodos , Ventilação de Alta Frequência/métodos , Complicações Intraoperatórias/prevenção & controle , Surfactantes Pulmonares/uso terapêutico , Tetralogia de Fallot/terapia , Doença Aguda , Terapia Combinada/métodos , Gerenciamento Clínico , Feminino , Humanos , Lactente , Complicações Intraoperatórias/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Radiografia , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/cirurgiaRESUMO
OBJECTIVE: To assess the role of serial lactate levels in determining outcome after cardiopulmonary bypass surgery in children. DESIGN: Analysis of retrospectively collected data. SETTING: Cardiac intensive care unit of a tertiary care children's hospital. PATIENTS: Patients were 129 children who underwent surgery for congenital cardiac defects. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Patients were categorized for disease severity using the Risk Adjustment for Congenital Heart Surgery method. Blood lactate levels were obtained at admission to the cardiac intensive care unit and then serially until they were <2 mmol/L. Lactime, time during which the lactate remains >2 mmol/L, was noted for each patient. The primary outcome measured was mortality. Secondary outcomes measured were ventilator days and hospital days. Six patients died, and of these five were neonates. Nonsurvivors had higher initial postoperative lactate concentration (p = .01), peak postoperative lactate concentration (p = .003), and lactime (p = .05). In binomial logistic regression analysis, lactime was the strongest predictor of mortality (p = .03). The positive predictive value for all age groups was highest for lactime >48 hrs, with a positive predictive value of 60%, and among the neonates it was 75%. Initial lactate level >6 mmol/L had a positive predictive value of only 6%, and the peak lactate level >6 mmol/L had a positive predictive value of only 15%. Lactime also had a significant association with ventilator days and hospital days among the survivors (p = .001). CONCLUSIONS: Lactime was a useful predictor of mortality in children undergoing repair or palliation of congenital cardiac defects under cardiopulmonary bypass. Initial and peak lactate levels had a poor positive predictive value for mortality. Lactime also was associated with the number of ventilator days and hospital days in those who survived.