Patients admitted to a pediatric intensive care unit (PICU) need individualized nutrition support that is tailored to their particular disease severity, nutritional status, and therapeutic interventions. We aim to evaluate how calories and proteins are provided during the first seven days of hospitalization for children in critical condition with organ dysfunction (OD). A single-center retrospective cohort study of children aged 2-18 years, mechanically ventilated > 48 h, and admitted > 7 days to a PICU from 2016 to 2017 was carried out. Nutrition support included enteral and parenteral nutrition. We calculated scores for the Pediatric Sequential Organ Failure Assessment (pSOFA) on days 1 and 3 of admission, with OD defined as a score > 5. Of 4199 patient admissions, 164 children were included. The prevalence of OD for days 1 and 3 was 79.3% and 78.7%, respectively. On day 3, when pSOFA scores trended upward, decreased, or remained unchanged, median (IQR) caloric intake was 0 (0-15), 9.2 (0-25), and 22 (1-43) kcal/kg/day, respectively (p = 0.0032); when pSOFA scores trended upward, decreased, or remained unchanged, protein intake was 0 (0-0.64), 0.44 (0-1.25), and 0.66 (0.04-1.67) g/kg/day, respectively (p = 0.0023). Organ dysfunction was prevalent through the first 72 h of a PICU stay. When the pSOFA scores trended downward or remained unchanged, caloric and protein intakes were higher than those that trended upward.

Critically ill children admitted to the pediatric intensive care unit (PICU) face a substantial risk of morbidity and mortality, regardless of whether they are in developed or developing countries. To aid in treatment planning, various prognostic scoring systems have been developed to predict the likelihood of morbidity and death in these young patients. While the sequential organ failure assessment (SOFA) score has been validated as an independent risk predictor for adult mortality in cases of confirmed or suspected sepsis, it is not suitable for use in children due to its lack of age normalization. Children in critical condition often exhibit significant deviations from the normal physiological balance of their bodies. These deviations from the typical range of physiological variables can be leveraged to estimate the extent of these variations and create scoring systems. In this context, the pediatric SOFA (pSOFA) score was developed by modifying the original SOFA score and incorporating age-adjusted cutoffs for various bodily systems. The objective of this review is to assess the effectiveness of the pSOFA score in predicting sepsis-related mortality in pediatric patients within the PICU setting.

BACKGROUND: Pediatric acute pancreatitis (AP) is rare but increasing. Severe AP is associated with higher morbidity and mortality. However, there are no universally accepted prognostic criteria for AP.
METHODS: This retrospective study included children with AP admitted to an intensive care unit (ICU) of our tertiary pediatric center between January 2009 and December 2018. The severity of organ dysfunction in AP was assessed according to the modified Atlanta criteria using the Pediatric Sequential Organ Failure Assessment (pSOFA) and Computed Tomography Severity Index (CTSI).
RESULTS: Seventy acute episodes of AP were evaluated in 55 children with primary pancreatitis. In addition, secondary AP was diagnosed in 15 patients originally admitted to ICU for different indications. Mild AP [no organ dysfunction, normal computed tomography (CT) finding] was the most prevalent (64/85 episodes in 49 children), followed by moderate AP (15 children; pSOFA 2-9 points, CTSI 3-4 points on admission). Severe AP (pSOFA 4-17 points, CTSI 6-10 points) was diagnosed in 6 children with traumatic or secondary AP. The most frequent etiologies of primary AP episodes were idiopathic (39%) and biliary (31%). Children with idiopathic AP had frequent relapses and comorbidities. Hereditary AP was typically mild, but presented with high pancreatic enzyme levels and recurrence rates. Admission at ICU and an interval without enteral nutrition (EN) were relatively short in drug-induced AP and relatively long in secondary and traumatic AP. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 13 patients with biliary AP and in 4 patients with traumatic AP. No AP-related death was observed.
CONCLUSIONS: pSOFA score accurately reflects the severity and prognosis of AP in children.

UNASSIGNED: This study aimed to investigate whether the ventilation duration for children undergoing invasive mechanical ventilation (IMV) in pediatric intensive care unit (PICU) is correlated with pediatric sequential organ failure (pSOFA) score, white blood cell (WBC) count, blood lactate level, and duration of fever.
UNASSIGNED: Retrospectively reviewed that the medical records of patients who received IMV in the PICU of Jingzhou Central Hospital between January 2018 and December 2020. According to the duration of IMV in diagnosis-related groups, these patients were divided into two groups: group A, ventilation duration <96 h, and group B, ventilation duration ≥96 h. Each group\'s pSOFA scores, WBC counts, blood lactate levels, and durations of fever were compared. Logistic regression analysis was used to analyze the clinical risk factors of ventilation duration ≥96 h, and the receiver operator characteristic (ROC) curve was drawn.
UNASSIGNED: A total of 42 patients were included, including 23 in group A and 19 in group B. The difference in pSOFA score between group A and group B was statistically significant (P < 0.05), while the differences in blood lactate level, duration of fever, and WBC count between the two groups were not statistically significant (P > 0.05). Logistic regression analysis was conducted to analyze the influencing factors of mechanical ventilation duration ≥96 h. An ROC curve was drawn with pSOFA score as a test variable and duration of mechanical ventilation ≥96 h as a state variable, revealing that the area under the curve was 0.76 (SE = 0.075, 95% CI: 0.614-0.906, P = 0.005). The sensitivity and specificity were 68.4 and 73.9%, respectively, and the corresponding pSOFA score was 7.5.
UNASSIGNED: When the pSOFA score ≥8, the risk of mechanical ventilation duration ≥96 h increases.

OBJECTIVE: We compared the performance of plasma lactate with high-sensitivity C-reactive protein (hs-CRP), and paediatric sepsis-related organ failure assessment (pSOFA) score for predicting mortality in septic children.
METHODS: Serial plasma lactate and hs-CRP levels and pSOFA score was assessed during early hospital stay in septic children.
RESULTS: Out of 149 participants, 45 died. Plasma lactate at 0 h and 6 h was significantly higher, and lactate clearance was significantly lower in non-survivors. The optimal cut-off of plasma lactate at 6h for identifying mortality was 2.5 mmol/L (sensitivity 85% and specificity 74%). pSOFA score had the best predictive ability for mortality (AUC 0.89) followed by hs-CRP at 0 h (AUC 0.86), hs-CRP at 48 h (AUC 0.83), plasma lactate levels at 6 h (AUC 0.83), and plasma lactate at 0 h (AUC 0.67).
CONCLUSIONS: pSOFA score, hs-CRP and hyperlactemia at 6 h can identify septic children at risk of dying.