Anthropology in the PICU: Addressing the Local Worlds of Families in an Otherwise Foreign Land.

Critical illness is a scary, and often previously unknown, experience for children and their families. To best assist pediatric critically ill patients and their caregivers, it is imperative to understand their local worlds outside of the PICU and what matters to them most. Anthropology, and its ethnographic lens and mode of inquiry, is an underutilized aspect of multidisciplinary care and research in pediatric critical care but has much to offer as exemplified herein.

An emerging role for endothelial barrier support therapy for congenital disorders of glycosylation.

Congenital disorders of glycosylation (CDGs) are clinically heterogeneous disorders defined by a decreased ability to modify biomolecules with oligosaccharides. Critical disruptions in protein recognition, interaction, binding, and anchoring lead to broad physiological effects. Patients present with endocrinopathy, immunodeficiency, hepatopathy, coagulopathy, and neurodevelopmental impairment. Patients may experience mortality/morbidity associated with shock physiology that is frequently culture negative and poorly responsive to standard care. Oedema, pleural and pericardial effusions, ascites, proteinuria, and protein-losing enteropathy are observed with an exaggerated inflammatory response. The negative serum protein steady state results from several mechanisms including reduced hepatic synthesis and secretion, increased consumption, and extravasation. Disruption of the glycocalyx, a layer of glycosylated proteins that lines the endothelium preventing thrombosis and extravasation, is a suspected cause of endothelial dysfunction in CDG patients. We performed a retrospective review of CDG patients admitted to our institution with acute illness over the past 2 years. Longitudinal clinical and laboratory data collected during the sick and well states were assessed for biomarkers of inflammation and efficacy of interventions. Six patients representing 4 CDG subtypes and 14 hospitalisations were identified. Acute D-dimer elevation, proteinuria, decreased serum total protein levels, coagulation proteins, and albumin were observed with acute illness. Infusion of fresh frozen plasma, and in some cases protein C concentrate, was associated with clinical and biomarker improvement. This was notable with intra-patient comparison of treated vs untreated courses. Use of endothelial barrier support therapy may reduce endothelial permeability by restoring both regulatory serum protein homeostasis and supporting the glycocalyx and is likely a critical component of care for this population.

Acute Pancreatitis in a Patient with Maple Syrup Urine Disease: A Management Paradox.

Maple syrup urine disease (MSUD) is an inborn error of metabolism that causes elevated leucine in the setting of acute illnesses. We describe an 8-year-old boy with MSUD who developed acute pancreatitis and subsequent leucinosis. This case highlights the complexities of fluid management in patients with MSUD.

Chest pain and anxiety in an adolescent: an unusual etiology.

Chest pain in children is commonly caused by benign etiologies but may be caused by conditions that carry significant morbidity if not treated. Emergency medicine physicians must identify the patients that require further evaluation and treatment. We describe a case of a 13-year-old boy with 10 months of progressive chest pain that had been attributed to anxiety and was ultimately diagnosed as an esophageal duplication cyst requiring surgical repair.

Individuals' experiences in U.S. immigration detention during the early period of the COVID-19 pandemic: major challenges and public health implications.

BACKGROUND: Individuals held in carceral settings were significantly impacted by the COVID-19 pandemic. However, limited research exists of the direct experiences of individuals detained by the United States (U.S.) Immigration and Customs Enforcement (ICE). This study illustrates the major challenges described by individuals held in ICE's immigration detention centers during the initial spread of COVID-19. METHODS: We interviewed 50 individuals who were released from ICE detention between March 15, 2020 until August 31, 2020. Participants were recruited through immigration attorneys. Responses to a semi-structured interview were documented. Quotes from these interviews were thematically analyzed. RESULTS: Study participants were detained in 22 different ICE detention centers, which were located across 12 states, in both county (41%) and privately-contracted facilities (59%). The major themes that emerged from interviews included inadequate protections against COVID-19, denial of physical and mental healthcare, and experiences of retaliation in response to self-advocacy. These issues perpetuated emotions of fear, distrust, and helplessness in individuals in immigration detention centers. CONCLUSIONS: This study represents the largest analysis of experiences of ICE-detained immigrants during the early months of the COVID-19 pandemic. To ensure the rights to health and wellbeing for this population, further actions should include improving public health conditions, protecting against human rights violations, addressing barriers to healthcare access, ensuring transparency about conditions in detention centers, and moving toward decarceration.

Homelessness in the United States: Implications for Critically Ill Children.

Homelessness is a growing crisis in the United States (U.S.). Across the country, children represent a large proportion of the homeless population. When these children experience critical illness, it poses significant and specific burdens to the child and family, compounded by the social stressors inherent in being housing insecure. Yet research on homelessness in critically ill children remains limited. Here, we provide an overview of the current U.S. homeless population, discuss what is currently known about homelessness and critical illness to inform future research, and close with a proposed homelessness screening and intervention model for use in the pediatric intensive care unit that can further be applied to all pediatric inpatient settings.

Trauma-Informed Care for Hospitalized Adolescents.

Purpose of Review: Exposure to trauma accelerates during the adolescence, and due to increased behavioral and psychiatric vulnerability during this developmental period, traumatic events during this time are more likely to cause a lasting impact. In this article, we use three case studies of hospitalized adolescents to illustrate the application of trauma-informed principles of care with this unique population. Recent Findings: Adolescents today are caught in the crosshairs of two syndemics-racism and other structural inequities and the COVID-19 pandemic. Increased hospitalizations and mental health diagnoses during the past two years signal toxic levels of stress affecting this group. Trauma-informed care promotes health, healing, and equity. Summary: This concept of the "trauma-informed approach" is still novel; through examples and practice, providers can learn to universally apply the trauma-informed care framework to every patient encounter to address the harmful effects of trauma and promote recovery and resilience.

Suicide rates of migrants in United States immigration detention (2010-2020).

OBJECTIVE: We determined the annual suicide rate of migrants detained by U.S. Immigration and Customs Enforcement (ICE) in the past decade. METHODS: We performed a retrospective cohort analysis of the annual suicide rates for ICE detainees from federal fiscal years (FY) 2010-2020. Death date and cause of death were directly extracted from publicly available ICE Freedom of Information Act (FOIA) Library, ICE death reports, and ICE press releases. Annual suicide rates were calculated as suicides per 100,000 person-years and suicides per 100,000 admissions. RESULTS: From 2010-2019, the mean number of suicides per 100,000 person-years was 3.3 (standard deviation (SD): 2.6). In 2020, the suicide rate increased 5.3 times the prior 10-year average to 17.4 suicides per 100,000 person-years. When calculating suicide rate based on admissions per FY, the mean number of suicides from 2010-2019 per 100,000 admissions was 0.3 (SD: 0.3). In 2020, the suicide rate increased 11.0 times the prior 10-year average to 3.4 suicides per 100,000 admissions. CONCLUSION: In 2020, the detainee suicide rate increased substantially compared to the past decade. This may point to a worsening mental health crisis in ICE detention.

Forensic Medical Evaluation of Children Seeking Asylum: A Guide for Pediatricians.

Applications for asylum in the United States have increased significantly in the past decade, including those by children fleeing persecution. Pediatricians may serve as a resource for children seeking asylum by participating in specialized training and performing forensic medical evaluations for use in the legal process. A forensic medical evaluation comprises an interview to elicit a narrative of reported abuse, a psychological assessment, and/or a medical assessment. Evaluators document an impression of the consistency of medical and psychological findings with the trauma, which forms the legal basis for a child's asylum claim. This article provides guidance to pediatrician evaluators with an emphasis on an age- and development-specific approach to a forensic medical evaluation of children seeking asylum. Collaboration with primary care pediatricians and community partners about asylum evaluations is important to building support for immigrant children who have experienced trauma. [Pediatr Ann. 2020;49(5):e215-e221.].