Platelets are crucial for maintaining physiological equilibrium, thrombosis formation, inflammation, bacterial defense, wound repair, angiogenesis, and tumorigenesis. In the Pediatric Intensive Care Unit (PICU), children frequently exhibit platelet reductions or functional alterations due to diverse pathological conditions, which significantly influence disease progression and therapeutic approaches. We analyzed the association between platelets count and its derived parameters and all-cause mortality. Adjusted smoothing spline plots, subgroup analysis and segmented multivariate logistic regression analysis were conducted to estimate the relative risk between proportional risk between platelets and all-cause mortality. Of the 11625 children, 677 (5.82%) died. After adjusting for confounders, there was a negative association between platelets and the risk of all-cause mortality in PICU. For every 100 × 10^9/L increase in platelets, the risk of death was reduced by 17% (adjusted OR = 0.83, 95% CI: 0.78, 0.89). The results of sensitivity analysis showed that in different stratified analyses (age, ICU category,WBC Count), the effect of platelets count on all-cause mortality remained stable. After adjusting for inflammation, nutrition, and liver function factors, platelets reduction is still an independent risk factor for PICU all-cause mortality.

OBJECTIVE: We developed a new nomogram for the prediction of mortality risk in children in pediatric intensive care units (PICU).
METHODS: We conducted a retrospective analysis using the PICU Public Database, a study that included a total of 10,538 children, to develop a new risk model for mortality in children in the intensive care units (ICU). The prediction model was analyzed using multivariate logistic regression with predictors including age and physiological indicators, and the prediction model was presented as a nomogram. The performance of the nomogram was evaluated based on its discriminative power and was internally validated.
RESULTS: Predictors contained in the individualized prediction nomogram included the neutrophils, platelets, albumin, lactate, oxygen saturation (P<0.1). The area under the receiver operating characteristic (ROC) curve for this prediction model is 0.7638 (95% CI: 0.7415-0.7861), which has effective discriminatory power. The area under the ROC curve of the prediction model in the validation dataset is 0.7404 (95% CI: 0.7016-0.7793), which is still effectively discriminative.
CONCLUSIONS: The mortality risk prediction model constructed in this study can be easily used for individualized prediction of mortality risk in children in pediatric intensive care units.

OBJECTIVE: Our aim was to assess the relationship between serum lactate levels at intensive care unit (ICU) admission and all-cause mortality in the pediatric ICU.
METHODS: We used the pediatric intensive care (PIC) database (a large pediatric intensive care database in China from 2010 to 2018) to conduct a retrospective analysis to evaluate the serum lactate levels at ICU admission of 12,213 critically ill children admitted to the ICU. We analyzed the association between serum lactate and all-cause mortality. Adjusted smoothing spline plots, subgroup analysis, and segmented multivariate logistic regression analysis were conducted to estimate the relative risk between proportional risk between serum lactate and all-cause mortality.
RESULTS: Of the 12,213 children, 755 (6.18%) died. After fully adjusting for confounding factors, serum lactate was an independent risk factor for all-cause mortality in pediatric ICU (adjusted OR=1.14, 95% CI: 1.12, 1.17). The results of sensitivity analysis showed that in different stratified analyses, the effect of serum lactate on all-cause mortality remained stable.
CONCLUSIONS: Admission serum lactate is a risk factor, which is independent of the presence of acid-base disorders, inflammation, malnutrition, and renal or hepatic dysfunction, for all-cause mortality in the pediatric intensive care unit.

Background: Deviations from the optimal vancomycin dosing may occur in the neonatal and pediatric population due to inconsistencies in the recommended dosing algorithms. This study aims to collect the expert opinions of clinicians who practice in the neonatal or pediatric intensive care units (NICU/PICUs) of 12 major medical centers in Hong Kong. Methods: This was a multicenter, cross-sectional study. Eligible physicians and pharmacists completed a structured questionnaire to identify the challenges they encountered when selecting the initial intermittent vancomycin dosing. They also answered questions concerning therapeutic monitoring services (TDM) for vancomycin, including the targeted trough levels for empirical vancomycin regimens administered for complicated and uncomplicated infections. Results: A total of 23 physicians and 43 pharmacists completed the survey. The top clinical parameters reported as most important for determining the initial vancomycin dosing were renal function (90.9%), post-menstrual/postnatal age (81.8%), body weight (66.7%), and suspected/documented pathogen (53.0%). Respondents reported challenges such as difficulties in determining the optimal initial dose for a targeted level (53.0%), inconsistencies between dosing references (43.9%) and a lack of clear hospital guidelines (27.3%). Half of the pharmacists (48.8%) reported that they had helped to interpret the TDM results and recommend vancomycin dose adjustments in >75% of cases. For methicillin-resistant Staphylococcus aureus infection, physicians, and pharmacists reported target trough levels of ~10-15 and 15-20 mg/L, respectively. For suspected moderate/uncomplicated Gram-positive infections physicians tended to prefer a lower trough range of 5-10 mg/L, while pharmacists preferred a range of 10-15 mg/L. Conclusions: Our results demonstrate that clinicians used varying vancomycin dosing guidelines in their practices. The multidisciplinary TDM service in Hong Kong can be improved further by establishing a standardized dosing guideline and implementing a well-structured, evidence-based service protocol. Future work includes conducting drug utilization studies to evaluate real-world antimicrobial usage patterns and the impact on tangible clinical outcomes, and developing pharmacokinetic-guided dose calculator for antimicrobials in critically ill neonates and pediatric patients.