Determinants of Paediatric Cardiac Arrest and Post-Arrest Care in Community Emergency Departments

Presenter: Firn, Eliza

This qualitative study explored factors influencing paediatric cardiac arrest (CA) management in community emergency departments (CEDs). Using the EPIS (Exploration, Preparation, Implementation, Sustainment) framework, semi-structured interviews were conducted with 25 multidisciplinary clinicians across five community hospitals, achieving thematic saturation.

Key themes were largely related to internal (inner context) factors. Barriers included variable resource availability (e.g., time of day, staffing roles), high cognitive workload, workforce challenges (nursing shortages and limited experience), and lack of standardized protocols. Clinicians also reported unfamiliarity with paediatric equipment and weight-based dosing, as well as absence of post-arrest care protocols

Facilitators of effective care included pre-arrest briefings, calm leadership, and clear communication. Potential improvement strategies identified were multidisciplinary simulation training (including post-arrest care), development of unit-specific cognitive aids, and hands-on training for medication preparation and equipment use.

Paediatric cardiac arrest management in community emergency departments is shaped by significant internal system barriers, including resource variability, workforce limitations, and lack of standardization, while targeted strategies such as simulation training, cognitive aids, and improved team communication may enhance preparedness and clinical performance.

EEG Reactivity and Rotterdam Head CT Score Predict Early Favourable Outcome in Paediatric Severe TBI

Presenter: Lu, Xuexin

This retrospective 7-year study evaluated predictors of early favourable outcomes in children with severe traumatic brain injury (sTBI) using continuous EEG (cEEG) and Rotterdam CT score. A total of 54 patients (median age 8.9 years; median GCS 3) admitted to the PICU were included. Favourable outcome was defined as Paediatric Cerebral Performance Category (PCPC) score 1–3 at discharge.

In univariate analysis, favourable outcome was associated with higher GCS (OR 1.43, p=0.029), pupillary reactivity (OR 9.0, p=0.005), Rotterdam CT score <3 (OR 7.14, p=0.006), presence of cEEG reactivity (OR 20.0, p<0.001), and absence of seizures (p=0.02). It was inversely associated with injury severity score (ISS) (OR 0.87, p<0.001) and neurosurgical intervention (OR 0.188, p=0.004).

In multivariable analysis, independent predictors of favourable outcome were cEEG reactivity (OR 9.93, 95% CI 1.83–53.82, p=0.008) and Rotterdam CT score <3 (OR 12.14, 95% CI 1.02–145.10, p=0.049), while higher ISS remained negatively associated (OR 0.88, p=0.009).

In conclusion, cEEG reactivity and lower Rotterdam CT scores are strong independent predictors of favourable early outcomes in children with severe traumatic brain injury, while higher injury severity is associated with worse prognosis.

Malignant Pertussis Outcomes for Invasively Ventilated Children: A Multicentre Cohort Study

Presenter: Russi, Brett 

This multi-centre retrospective cohort study evaluated the association between admission white blood cell (WBC) count and inpatient mortality in critically ill infants (≤6 months) with malignant pertussis (MP), and described the use of exchange transfusion (ET) or leukapheresis (LA). Data from 273 ventilated infants across 91 hospitals were analysed.

The median admission WBC count was 25.4×10³ cells/µL (IQR: 13.7–50.9). Infants who died (12.5%) had significantly higher WBC counts compared to survivors (61.7×10³ [IQR: 48.7–71.4] vs 21.7×10³ cells/µL [IQR: 13–39.3]; p<0.001). Admission WBC count demonstrated good discriminatory ability for mortality (AUROC: 0.80; 95% CI: 0.72–0.88), with a threshold of 44.3×10³ cells/µL (sensitivity 79.4%, specificity 78.7%).

Eighteen infants (6.6%) underwent ET/LA at a median of 1 day after admission (IQR: 0.25–2). These patients had higher WBC counts (58.8×10³ vs 22.6×10³ cells/µL; p<0.001) and higher use of extracorporeal support (39% vs 11.8%; p<0.001) compared to those not receiving ET/LA, but there was no difference in mortality.

In multivariate analysis adjusting for age and Paediatric Risk of Mortality III score, admission WBC count was independently associated with mortality (adjusted odds ratio 1.04; 95% CI: 1.03–1.06; p<0.001), whereas ET/LA was not.

Overall, higher admission WBC count was associated with increased mortality and showed good predictive performance. The identified threshold may inform future prospective studies evaluating ET/LA.

Neighbourhood Child Opportunity Index 3.0 and Clinical Outcomes of Paediatric Critical Asthma

Presenter: Akande, Manzilat

This 6-month interim analysis of the multicentre CATCHUP study evaluated the association between neighbourhood-level Child Opportunity Index (COI) 3.0 and clinical outcomes in paediatric critical asthma (PCA) using a newly defined PCA criteria. The study included 501 children (age 2 to ≤18 years) admitted to US PICUs or general wards. The median age was 6 years (IQR: 4–9), with 63% of patients on public insurance and 39% identifying as Black/African American. Children were most commonly from very low (VL) COI ZIP codes (31%), followed by low (20%), moderate (17%), high (16%), and very high (15%) (p<0.001).

Positive pressure ventilation (PPV) was used in 37% of admissions overall, with similar rates across COI quintiles (34%, 36%, 39%, 37%, and 43%; p=0.71). There were no significant differences in median PICU length of stay (1.9–2.6 days; p=0.55) or hospital length of stay (3–3.1 days; p=0.71) across COI groups.

Although children with PCA were disproportionately from lower COI neighbourhoods, illness severity—measured by PPV use and length of stay—did not differ across COI quintiles. These findings suggest that neighbourhood factors may influence PCA incidence rather than severity.

Trends in Paediatric ICU Admissions for Vaccine-Preventable Diseases from 2001-2022

Presenter: Stucky, Sarah

This study analysed national trends in paediatric hospitalizations and ICU admissions for vaccine-preventable diseases (VPD) using data from 20 U.S. Among 2,630,769 paediatric admissions, 2.0% (n=52,494) were due to VPD.

VPD hospitalizations decreased from 2.0% in 2001 to 0.9% in 2010, then increased to 3.1% in 2022. Children with VPD were less likely to be non-Hispanic white (RR 0.91; 95% CI: 0.90–0.92) and more likely to have public insurance (RR 1.11; 95% CI: 1.10–1.12). Influenza was the most common VPD and increased significantly (0.33% to 2.82% of admissions; RR 8.44; 95% CI: 7.98–8.93), while rotavirus, pertussis, varicella, and meningococcus decreased over time.

ICU admission rates for VPD increased from 7.1% to 26.4% (RR 3.74; 95% CI: 3.44–4.07). In 2022, ICU admission prevalence was highest for Haemophilus influenzae type B (65.4%), pertussis (35.8%), influenza (26.3%), and varicella (20.9%). Among ICU patients, organ failure was more common in VPD cases compared to non-VPD (70.2% vs 49.6%), and increased over time (45.3% in 2001 to 80.0% in 2019). Patients with VPD had longer hospital stays (p<0.001) but similar mortality (1.90%) compared to those without VPD.In conclusion, VPD-related hospitalizations and ICU utilization increased over time, with higher illness severity among affected children.

Enteral Fructo-Oligosaccharide Preserves Gut Integrity and Microbial Diversity in Paediatric ARDS

Presenter: Mansour, Marwa

This subgroup analysis of a pilot randomized controlled trial evaluated the effects of fructo-oligosaccharide (FOS)-supplemented early enteral nutrition (EEN+FOS) versus EEN without FOS (EEN–FOS) in paediatric acute respiratory distress syndrome (PARDS). A total of 18 patients were included, with both groups receiving equivalent protein and caloric intake.

EEN+FOS was associated with greater gut microbial species richness and beta diversity, comparable to healthy controls, unlike the EEN–FOS group. It also showed increased relative abundance of butyrate-producing bacteria, including Faecalibacterium and Subdoligranulum. Markers of intestinal integrity were improved in the EEN+FOS group. Plasma intestinal fatty acid binding protein (iFABP) levels were significantly lower (p=0.003), indicating better epithelial integrity. Urine lactulose/mannitol ratios were also lower (p=0.02), suggesting reduced intestinal permeability.

There were no significant differences in systemic inflammatory markers TNF-α (p=0.6) and IL-6 (p=0.07). Mean faecal butyrate levels were higher in the EEN+FOS group (56.5 vs 5.2 mg/100 g), although this difference was not statistically significant (p=0.07).

FOS-supplemented EEN may improve gut microbiome diversity and intestinal barrier integrity in PARDS, although findings are limited by small sample size.

Shifting Hospitalization Patterns in Paediatric Spinal Muscular Atrophy in the Post-Spinraza Era

Presenter: Mercado-Arzuaga

This retrospective cohort study using the Paediatric Health Information System (2003–2023) evaluated the impact of Nusinersen (Spinraza) availability on clinical outcomes and the influence of socioeconomic factors in patients ≤21 years with spinal muscular atrophy (SMA). A total of 4,197 patients were included, with 2,770 in the pre-Spinraza era and 1,427 in the post-Spinraza era; 11.6% received Spinraza.

Following Spinraza availability, short hospital stays (0–3 days) increased, while longer stays (8–14 days) decreased (44.0% to 51.1% and 14.6% to 10.2%, respectively; p<0.001). Rates of palliative care consultation (3.9% to 6.4%) and feeding tube placement (25.7% to 31.9%) increased (p<0.001), while tracheostomy rates remained unchanged (12.4% to 11.6%; p=0.338). Mechanical ventilation rates declined (36.0% to 30.2%; p<0.001).

Spinraza use was independently associated with lower odds of mechanical ventilation (OR 0.53; 95% CI: 0.36–0.78; p<0.001). Public insurance was associated with higher odds of tracheostomy, feeding tube placement, mechanical ventilation, and palliative care use (ORs 1.39–1.83; p≤0.041), while income-based SES quintiles showed no significant associations.

The post-Spinraza era was associated with shorter hospital stays and reduced mechanical ventilation, although disparities persisted based on insurance status.

Frequency of Anaemia at Discharge in Critically Ill Children of a Tertiary Care Hospital

Presenter: Kamran, Zainab

This retrospective cohort study evaluated the prevalence of anaemia at discharge among children admitted to a public-sector PICU in Pakistan. The study included 457 patients aged 1 month to 15 years who had at least two haemoglobin (Hb) measurements, with the last recorded within 24 hours prior to discharge. The median age at admission was 10 months, and 57.5% were male. The most common admitting diagnoses were respiratory illnesses (52.7%), followed by miscellaneous conditions (23.2%, mostly infectious diseases), neurological disorders (17.3%), and cardiovascular conditions (6.6%).

At admission, 56.7% (n=259) of patients had anaemia (Hb <10 g/dL), including 13.5% with severe anaemia (Hb <7 g/dL). At discharge, anaemia prevalence increased to 63% (n=288), with 4.5% having severe anaemia. Only 37% (n=169) had Hb >10 g/dL at discharge. Among patients who were anaemic at admission, 76% remained anaemic at discharge, while 22.4% improved to Hb >10 g/dL. Among those with normal Hb at admission, 43.9% developed anaemia by discharge, while 56.1% maintained normal Hb levels.

Overall, anaemia was common at PICU discharge, with a substantial proportion of patients either remaining anaemic or developing new anaemia during hospitalization.

Undernutrition and Outcomes in Paediatric Multiorgan Dysfunction Syndrome

Presenter: Khan, Sidra

This retrospective study evaluated the impact of nutritional status and nutritional support on outcomes in 250 children (age 1 month–18 years) admitted to the PICU with multiple organ dysfunction syndrome (MODS). Among enrolled patients, 55% (n=138) were malnourished, including 32.8% severely and 22% moderately malnourished. 

Overall mortality was 55.6% (n=138), with similar rates across groups: 55.4% in well-nourished, 58.9% in moderately malnourished (adjusted OR 1.15; 95% CI: 0.60–2.22; p=0.569), and 54.9% in severely malnourished children (adjusted OR 0.98; 95% CI: 0.55–1.74; p=0.585).

Malnourished children had higher illness severity, with a higher mean Paediatric Logistic Organ Dysfunction (PELOD) score compared to well-nourished patients (21.02 vs 18.04; p=0.045). However, hospital stay was shorter in malnourished children (9.15 ± 6.66 vs 11.19 ± 9.09 days; p=0.021). Caloric adequacy was achieved in 35.6% of patients. PRISM III scores, Vasoactive-Inotropic Score (VIS), and use of mechanical ventilation, dialysis, and inotropes were similar across nutritional groups. Among survivors, disability occurred in 54% with no significant difference by nutritional status (p=0.659).

Undernutrition was not independently associated with mortality in paediatric MODS, although it was associated with higher illness severity.

Preliminary Definition of Hospital-Acquired Constipation Among Critically Ill Children 

Presenter: Zander, Emily

This prospective modified Delphi study (May–August 2025) aimed to develop a consensus definition for hospital-acquired constipation in critically ill children, where standard Rome IV criteria are not applicable. The study was conducted at a quaternary paediatric referral centre using electronic surveys of multidisciplinary experts.

Two rounds of questionnaires were completed by 23 and 20 respondents (response rates 55% and 48%), including intensivists (67%), gastroenterologists (21%), and general surgeons (9%), with 74.9% having >10 years of experience.

Consensus (>75% agreement) identified major criteria that independently define hospital-acquired constipation: dependence on manual evacuation, need for a chronic bowel regimen, and presence of faecal impaction on digital rectal examination.

Minor criteria, requiring ≥1 additional criterion for diagnosis, included Bristol stool types 1 or 2, symptoms such as straining or incomplete evacuation, excess faecal load on imaging, and prolonged intervals between stools (≥72 hours for ages 2–18 years; ≥96 hours for ages 0–2 years).

Overall, this study provides a preliminary expert consensus definition for hospital-acquired constipation in critically ill children to support future research.

 

Critical Care Congress 2026, March 22-24, Chicago.