Validation of the SOS-PD scale for assessment of pediatric delirium: a multicenter study.

BACKGROUNDS: Reports of increasing incidence rates of delirium in critically ill children are reason for concern. We evaluated the measurement properties of the pediatric delirium component (PD-scale) of the Sophia Observation Withdrawal Symptoms scale Pediatric Delirium scale (SOS-PD scale). METHODS: In a multicenter prospective observational study in four Dutch pediatric ICUs (PICUs), patients aged ≥ 3 months and admitted for ≥ 48 h were assessed with the PD-scale thrice daily. Criterion validity was assessed: if the PD-scale score was ≥ 4, a child psychiatrist clinically assessed the presence or absence of PD according to the Diagnostic and statistical manual of mental disorders (DSM)-IV. In addition, the child psychiatrist assessed a randomly selected group to establish the false-negative rate. The construct validity was assessed by calculating the Pearson coefficient (rp) for correlation between the PD-scale and Cornell Assessment Pediatric Delirium (CAP-D) scores. Interrater reliability was determined by comparing paired nurse-researcher PD-scale assessments and calculating the intraclass correlation coefficient (ICC). RESULTS: Four hundred eighty-five patients with a median age of 27.0 months (IQR 8-102) were included, of whom 48 patients were diagnosed with delirium by the child psychiatrist. The PD-scale had overall sensitivity of 92.3% and specificity of 96.5% compared to the psychiatrist diagnosis for a cutoff score ≥4 points. The rp between the PD-scale and the CAP-D was 0.89 (CI 95%, 0.82-0.93; p < 0.001). The ICC of 75 paired nurse-researcher observations was 0.99 (95% CI, 0.98-0.99). CONCLUSIONS: The PD-scale has good reliability and validity for early screening of PD in critically ill children. It can be validly and reliably used by nurses to this aim.

Successful weaning from mechanical ventilation in a patient with surfactant protein C deficiency presenting with severe neonatal respiratory distress.

The clinical course and treatment in the first 2.5 years of life of a term-born girl with a severe onset of respiratory symptoms in the neonatal period caused by a p.Cys121Phe/C121F mutation in the gene of surfactant protein C (SFTPC) is described. During the first 9 months of life, she was mechanically ventilated. With methylprednisolone pulse therapy and oral prednisolone, she could eventually gradually be weaned from mechanical ventilation. At the age of 2.5 years, she is in a good clinical condition without any respiratory support and has a normal nutritional status and neurodevelopment. This clinical course with neonatal onset of respiratory insufficiency is remarkable since most patients with SFTPC mutations present with milder respiratory symptoms in the first years of life.

Negative delayed-enhancement magnetic resonance imaging of the heart suggests a diagnosis of neonatal transient myocardial ischaemia.

UNLABELLED: We report a term neonate presenting after birth with shock and cyanosis for which he was intubated. Echocardiography showed no contractions of the left ventricle. Systemic circulation was provided by the right ventricle via shunting through the arterial duct. Left ventricular dysfunction was confirmed by electrocardiography and increased troponin T levels. Hemodynamics quickly improved, and the child could be weaned of the ventilator without residual problems. We concluded that the patient suffered from transient myocardial ischaemia. At 3 weeks of life, we performed delayed-enhancement magnetic resonance imaging (DE-MRI) of the heart which did not show signs of permanent macroscopic damage of the myocardium. CONCLUSION: This is the first reported case report on the use of DE-MRI in a neonate with transient myocardial ischaemia. DE-MRI may provide information that helps to predict recovery in the acute stage of left ventricular dysfunction or at a later stage when absence of recovery of left ventricular function needs to be explained.

Acute respiratory distress syndrome: is it underrecognized in the pediatric intensive care unit?

OBJECTIVE: To describe the incidence of acute respiratory distress syndrome (ARDS) in mechanically ventilated children and to study whether ARDS is underrecognized in this patient population. DESIGN AND SETTING: Retrospective observational study in a single-center bed pediatric intensive care unit serving two Dutch provinces. PATIENTS: 533 mechanically ventilated children aged 0-16 years, all of whom met the North-American European Consensus Conference criteria for ARDS. MEASUREMENTS AND RESULTS: Chest radiographs were screened for the novel presence of bilateral infiltrates, in patients with bilateral infiltrates the PaO2/FIO2 ratio was calculated on two separate consecutive measurements. If below 200, the patient was classified as having ARDS. Left ventricular dysfunction was ruled out by echocardiography. The incidence was calculated by obtaining the number of children aged 0-16 years in our region. For each patient it was noted whether the patient was currently considered to have ARDS. Forty-one patients (7.7%) met the criteria for ARDS, with an incidence of 2.2 per 100,000 per year. The mortality rate was 20.4%. Thirty patients (73.1%) had primary ARDS, mainly from viral lower respiratory tract disease. Only ten patients (24.4%) currently had ARDS. CONCLUSIONS: The incidence of pediatric ARDS is low compared to that of adult ARDS, and further underestimated as most patients were diagnosed by their underlying diseases.