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19 pages, 1111 KB

Open AccessArticle

Retrospective Evaluation of Patients Admitted to the Emergency Department Due to Anaphylaxis in Children: A Single-Center Study from Türkiye

by Emre Aygün, Ezgi Yalçın Güngören, İrem Çırpıcı and Sevgi Sipahi Çimen

Children 2026, 13(2), 203; https://doi.org/10.3390/children13020203 - 31 Jan 2026

Viewed by 648

Abstract

Background: Management of pediatric anaphylaxis in the emergency department remains clinically important. The research investigated pediatric anaphylaxis medical indicators together with physician adherence to international treatment protocols at a Turkish tertiary medical center. Methods: Between September 2014 and July 2025, 166 pediatric anaphylaxis [...] Read more.

Background: Management of pediatric anaphylaxis in the emergency department remains clinically important. The research investigated pediatric anaphylaxis medical indicators together with physician adherence to international treatment protocols at a Turkish tertiary medical center. Methods: Between September 2014 and July 2025, 166 pediatric anaphylaxis patients were retrospectively reviewed for triggering factors, clinical findings, treatment approaches, and quality indicators. Results: The mean age of the patients was 7.4 ± 5.6 years. Food allergy was the main cause with 53%, followed by drugs with 24.7%. Food allergy in infants was 85.7%, while drug reactions in adolescents reached 37.2% (p < 0.001). Skin findings were present in 93.4% of the patients, and respiratory symptoms were present in 67.5% of the patients. Epinephrine was administered to 97.6% of patients, 95.2% of whom were given intramuscularly. The rate of epinephrine administration in the first 30 min was 61.1%. Drug-induced anaphylaxis showed the highest proportion of severe cases (81.6%, p < 0.001). A biphasic reaction was seen in 6%. The auto-injector prescription rate was 7.8%, and the allergist referral rate was 15.7%. No deaths were observed. Conclusions: While acute-phase management largely adheres to international guidelines, significant gaps persist in post-discharge care with low auto-injector prescription and allergist referral rates. Full article

(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)

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14 pages, 615 KB

Open AccessArticle

Clinical Characteristics and Outcomes of Pediatric Oncology Patients Admitted to the Pediatric Intensive Care Unit: A Single Center Experience in Saudi Arabia

by Wafaa Aljizani, Fatmah Othman, Faisal Alrashed, Faisal Althaqeel and Obaid Alfuraydi

Children 2026, 13(1), 58; https://doi.org/10.3390/children13010058 - 31 Dec 2025

Viewed by 745

Abstract

Background/Objectives: Advances in pediatric oncology have improved survival; however, critically ill children with cancer remain at high risk for adverse outcomes and frequently require admission to the pediatric intensive care unit (PICU). Despite the rising burden of pediatric cancer in Saudi Arabia, data [...] Read more.

Background/Objectives: Advances in pediatric oncology have improved survival; however, critically ill children with cancer remain at high risk for adverse outcomes and frequently require admission to the pediatric intensive care unit (PICU). Despite the rising burden of pediatric cancer in Saudi Arabia, data on PICU utilization and outcomes remain limited. This study aimed to describe the clinical characteristics, critical care interventions, and outcomes of pediatric oncology patients admitted to a tertiary PICU and to identify predictors of mortality. Methods: This is a retrospective cohort study was conducted including pediatric oncology patients (<14 years) admitted to the PICU at King Abdullah Specialized Children’s Hospital, Riyadh, between 2015 and 2021. Demographic, oncologic, and clinical variables; admission indications; PRISM-IV scores; and PICU interventions were collected. Predictors of mortality were evaluated using Cox proportional hazards modeling. Results: A total of 126 pediatric oncology patients were admitted to the PICU during the study period. The median age was 6 years (IQR 3–11), and 59% were female. Hematologic malignancies accounted for 63% of admissions. Sepsis (41%) and respiratory failure (21%) were the leading indications for PICU admission. Comorbidities were present in 33% of patients, and 70% had received prior therapeutic interventions, most commonly chemotherapy. Organ dysfunction occurred in 39% of patients, including 32% with multiorgan failure. Mechanical ventilation was required in 35% of patients, vasopressor support in 30%, and dialysis in a smaller proportion. The overall mortality rate was 19%, with more than half of deaths occurring during the PICU stay. Non-survivors had higher rates of comorbidities and invasive organ support, and higher PRISM scores. Mechanical ventilation (HR 3.02; 95% CI 1.16–7.60) and prior therapeutic interventions (HR 3.19; 95% CI 1.24–8.19) were independent predictors of mortality. Conclusions: Pediatric oncology patients admitted to the PICU experience substantial morbidity and mortality, underscoring the need for early risk identification and optimized supportive care. Full article

(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)

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10 pages, 6304 KB

Open AccessEditor’s ChoiceArticle

Foreign Bodies in Lower Airway in Children: Brief Review and Clinical Experience

by Stoyan Markov, Petya Markova, Ivanka Karavelikova and Hristina Halacheva

Children 2025, 12(1), 67; https://doi.org/10.3390/children12010067 - 7 Jan 2025

Cited by 3 | Viewed by 4019

Abstract

Background: Foreign body aspiration is a preventable occurrence that carries a high risk of mortality in the pediatric population. Clinically, foreign body aspiration manifests as cough, followed by choking, which might not be given any consideration by the caregivers of the child. An [...] Read more.

Background: Foreign body aspiration is a preventable occurrence that carries a high risk of mortality in the pediatric population. Clinically, foreign body aspiration manifests as cough, followed by choking, which might not be given any consideration by the caregivers of the child. An episode of sudden wheezing can also raise the suspicion of a foreign body in the lower respiratory tract. The clinical findings depend on the type, size, and localization of the foreign body and include persistent cough, localized airway resistance, localized or diffuse wheezing, and difficulty breathing. A bronchoscopy is the procedure of choice for the removal of foreign bodies. Flexible bronchoscopy is increasingly being used as the initial diagnostic procedure in children with an uncertain history of choking, in the absence of physical and radiological lung changes, and in chronic complaints requiring the exclusion of a foreign body in the airways. Thus, the aim of this study was to describe our clinical experience with lower respiratory tract foreign body extraction in children over a period of five years. Materials and Methods: Over a 5-year period, 154 patients under the age of 18 underwent a bronchoscopy due to a suspected foreign body in the lower respiratory tract. Of these patients, 92% had an incident leading to acute respiratory distress, and 8% had no definite data on such an event in the anamnesis. Results: A foreign body in the respiratory tract was found in and extracted from 50 patients, and foreign bodies were absent in 104 of the cases. Conclusions: If a foreign body enters the lower respiratory tract, immediate and adequate actions are required to solve the problem. A bronchoscopy should be conducted in every suspected case of foreign body aspiration. Full article

(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)

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16 pages, 665 KB

Open AccessArticle

Epidemiological and Clinical Characteristics of Pediatric Acute Drug Intoxications: A Retrospective Analysis

by Cristina Elena Singer, Renata-Maria Văruț, Maria Singer, Simona Cosoveanu, Jaqueline Abdul Razzak, Madalina Elena Popescu, Simina Gaman, Ileana Octavia Petrescu and Cristina Popescu

Children 2025, 12(1), 44; https://doi.org/10.3390/children12010044 - 30 Dec 2024

Cited by 5 | Viewed by 3368

Abstract

Background/Objectives: Acute drug intoxications (ADIs) are a significant concern in pediatric healthcare, contributing to both accidental and intentional morbidity. This study aimed to analyze the demographic, clinical, and therapeutic characteristics of pediatric ADI cases to identify trends and inform preventive strategies. Methods: This [...] Read more.

Background/Objectives: Acute drug intoxications (ADIs) are a significant concern in pediatric healthcare, contributing to both accidental and intentional morbidity. This study aimed to analyze the demographic, clinical, and therapeutic characteristics of pediatric ADI cases to identify trends and inform preventive strategies. Methods: This retrospective study included 120 cases of pediatric ADI admitted to the Second Pediatric Clinic of Craiova County Emergency Clinical Hospital in 2022 and 2023. The inclusion criteria encompassed children aged 0–17 years with confirmed pharmaceutical intoxications. Cases involving mixed poisonings or non-pharmaceutical substances were excluded. Clinical severity was classified using the Poisoning Severity Score (PSS). Data on demographics, substances involved, clinical presentations, interventions, and outcomes were analyzed. Results: The majority of cases occurred in females (73.3%) and urban residents (77.5%). Accidental intoxications were prevalent in children aged 1–5 years (45%), while intentional ingestions were common in adolescents (47.5%). The most frequently implicated substances included antibiotics (46.7%), benzodiazepines (20.8%), and acetaminophen (15.8%). Severity was classified as mild (44.2%), moderate (26.6%), or severe (29.2%), while treatment primarily included supportive care, intravenous fluids (62.5%), and antidotes (35.8%). Severe cases required respiratory support in 29.2% of the instances. Hospitalization duration significantly decreased from 2022 (3.8 ± 1.9 days) to 2023 (2.3 ± 0.9 days) (p < 0.05), and no fatalities were recorded. Conclusions: Pediatric ADIs predominantly involve accidental ingestions in young children and intentional overdoses in adolescents. Targeted public health strategies, such as parental education, adolescent mental health support, and improved rural healthcare access, are essential to reduce incidence and severity. These findings underscore the need for focused prevention and optimized clinical management. Full article

(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)

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Review

Jump to: Research

22 pages, 1119 KB

Open AccessReview

Septic Cardiomyopathy: Age-Dependent Physiology and Hemodynamic Aspects—A Narrative Review

by Marianna Miliaraki, George Briassoulis, Evangelia Dardamani, Panagiotis Briassoulis and Stavroula Ilia

Children 2026, 13(2), 239; https://doi.org/10.3390/children13020239 - 8 Feb 2026

Viewed by 1539

Abstract

Background: Septic cardiomyopathy (SCM) is a dynamic and heterogeneous complication of sepsis, driven by systemic inflammation, autonomic dysregulation, and microcirculatory alterations. Pediatric and adult patients share common pathophysiologic mechanisms, but age-dependent differences in cardiovascular physiology produce distinct hemodynamic responses. Methods: A structured narrative [...] Read more.

Background: Septic cardiomyopathy (SCM) is a dynamic and heterogeneous complication of sepsis, driven by systemic inflammation, autonomic dysregulation, and microcirculatory alterations. Pediatric and adult patients share common pathophysiologic mechanisms, but age-dependent differences in cardiovascular physiology produce distinct hemodynamic responses. Methods: A structured narrative review of clinical and experimental studies published between 2000 and 2025 was conducted via PubMed and major critical care literature. Studies were included if they addressed SCM pathophysiology, hemodynamic monitoring, and therapeutic strategies across age groups, while studies focusing on non-septic cardiac dysfunction were excluded. Results: Adult SCM often presents as hyperdynamic, vasoplegic states, whereas pediatric patients more frequently exhibit hypodynamic profiles, reflecting developmental differences in myocardial reserve and autonomic regulation. Evidence suggests that isolated conventional echocardiographic parameters may underestimate myocardial impairment, whereas advanced modalities, including myocardial strain echocardiography and multimodal hemodynamic monitoring, may serve as complementary tools to detect subtle or evolving myocardial dysfunction. Pediatric evidence remains limited, and therapeutic guidance is largely extrapolated from adult studies. Conclusions: SCM should be approached as a time-dependent, physiology-driven condition, requiring repeated, integrated multimodal cardiovascular assessment to guide individualized management. Age-specific hemodynamic profiles highlight the need for standardized diagnostics, prospective validation of monitoring tools, and phenotype-guided interventions to improve outcomes in both adult and pediatric sepsis. Full article

(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)

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24 pages, 921 KB

Open AccessReview

Neonatal and Pediatric Transport: A Contemporary Review

by Keith Meyer and Balagangadhar R. Totapally

Children 2026, 13(2), 175; https://doi.org/10.3390/children13020175 - 27 Jan 2026

Viewed by 2275

Abstract

Safe transport of critically ill infants and children is an essential component of high-quality, pediatric regionalized care. The modern transport environment blends principles of critical care medicine, aviation physiology, provider training, and coordinated systems of care. This review provides an updated examination of [...] Read more.

Safe transport of critically ill infants and children is an essential component of high-quality, pediatric regionalized care. The modern transport environment blends principles of critical care medicine, aviation physiology, provider training, and coordinated systems of care. This review provides an updated examination of current practices in neonatal and pediatric transport, including team structure, clinical bundles, operational considerations, and emerging technologies. Special attention is given to rapidly evolving areas, including data-informed dispatch, real-time clinical decision support, and next-generation devices. The review closes with a discussion of future priorities for research, workforce development, and system design. Full article

(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)

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14 pages, 555 KB

Open AccessReview

Blood Product Transfusion and Coagulopathy in Children with Traumatic Brain Injury: A Narrative Review

by Robert Marcel T. Huibonhoa, Niranjan Vijayakumar, Daniel Kelly, Oliver Karam and Madhuradhar Chegondi

Children 2026, 13(1), 104; https://doi.org/10.3390/children13010104 - 11 Jan 2026

Viewed by 773

Abstract

Traumatic brain injury (TBI) is a leading cause of critical illness and mortality in children. Transfusion of blood products, a common intervention in the management of pediatric TBI, has important implications for related principles, including trauma-induced coagulopathy, cerebral perfusion, and cerebral oxygen delivery. [...] Read more.

Traumatic brain injury (TBI) is a leading cause of critical illness and mortality in children. Transfusion of blood products, a common intervention in the management of pediatric TBI, has important implications for related principles, including trauma-induced coagulopathy, cerebral perfusion, and cerebral oxygen delivery. Knowledge gaps persist due to the limited availability of pediatric-specific data regarding blood product transfusion in TBI. In particular, there is a lack of prospective studies defining appropriate specific laboratory thresholds and transfusion targets, as well as insufficient evidence to guide the weighing of potential benefits against transfusion-related risks in this population. Although blood product transfusion in pediatric TBI has been associated with worse clinical outcomes, the underlying mechanisms and contributing factors remain poorly understood. In this review, we aimed to describe the pediatric literature on component and whole blood product transfusion in children with TBI and the pathophysiological mechanisms underlying the development of coagulopathy in this population. In addition, we incorporated available pediatric guidelines and recommendations specific to the setting of acute brain injury. Full article

(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)

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Graphical abstract

19 pages, 1292 KB

Open AccessReview

Status Epilepsy Syndromes Made Easy: Pediatric Perspectives

by Kam Lun Ellis Hon, Alexander K. C. Leung, Karen K. Y. Leung and Alcy R. Torres

Children 2025, 12(12), 1709; https://doi.org/10.3390/children12121709 - 17 Dec 2025

Viewed by 996

Abstract

Introduction: Refractory Status Epilepsy Syndrome is a heterogeneous group of diseases associated with status epilepsy. Literature and definition have been conflicting and confusing in terms of their nomenclatures. New-onset refractory status epilepticus (NORSE) is a syndrome characterized by new onset refractory seizures [...] Read more.

Introduction: Refractory Status Epilepsy Syndrome is a heterogeneous group of diseases associated with status epilepsy. Literature and definition have been conflicting and confusing in terms of their nomenclatures. New-onset refractory status epilepticus (NORSE) is a syndrome characterized by new onset refractory seizures in a previously health child. Febrile infection-related epilepsy syndrome (FIRES) is a similar syndrome now considered a variant of NORSE and is defined as a febrile event taking place between twenty-four hours and two weeks prior to the commencement of refractory status epilepticus. An autoimmune or inflammatory etiology is often implied in both conditions because infection is rarely identified. Aim: This review provides an update on hypotheses, etiology, pathophysiology, clinical features, diagnosis, laboratory evaluation, treatment, and perspectives for NORSE/FIRES. Methods: A PubMed Clinical Queries search is performed using keywords of NORSE and FIRES, on human subjects up to May 2025. All reviews, systematic reviews, case series and case reports were included. Results: Seizures are typically recalcitrant in NORSE/FIRES. Treatments include anti-seizure medications (ASM), ketogenic diet, immunotherapy (intravenous immunoglobulin ± plasmapheresis ± corticosteroid). The prognosis is usually poor. Most children would suffer refractory epilepsy and associated cognitive impairment if they survived. Guidelines and new consensus on NORSE/FIRES terminology have aided clinicians in managing status epilepticus in a previously healthy child that occurs ± a minor febrile episode. When an autoimmune or paraneoplastic condition is subsequently identified, the condition will be named accordingly. Conclusions: NORSE and FIRES are similar conditions except that vagus nerve stimulation appears to be more efficacious in NORSE than FIRES. We propose to define these heterogeneous and confusing conditions as “NOSES” as a two-criteria syndrome: New Onset + Status Epilepticus Syndrome, lasting for over 24 h despite the use of two standard ASM. Autoimmune, paraneoplastic and infectious encephalitis are specific diagnoses of NOSES with etiology subsequently identified. Full article

(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)

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13 pages, 264 KB

Open AccessReview

Advance Care Planning Conversations in Pediatric Patients with Refractory Oncologic Disease

by Aqsa Khan, Ajay Gupta, Andy Liu and Ali H. Ahmad

Children 2025, 12(4), 479; https://doi.org/10.3390/children12040479 - 8 Apr 2025

Cited by 1 | Viewed by 2635

Abstract

Advance care planning (ACP) involves longitudinal communication between the patient and physician to explore the patient’s wishes and goals while relaying accurate diagnostic and prognostic information to support informed and shared medical decision-making. In pediatrics, it also uniquely involves the parents or legal [...] Read more.

Advance care planning (ACP) involves longitudinal communication between the patient and physician to explore the patient’s wishes and goals while relaying accurate diagnostic and prognostic information to support informed and shared medical decision-making. In pediatrics, it also uniquely involves the parents or legal guardians as the primary medical decision-makers. ACP ideally leads to the implementation of advanced directives (ADs) and can be a difficult concept to discuss with pediatric patients and families with refractory oncologic disease, given the distinctive burdens that accompany this population. Many obstacles can delay the initiation of these conversations with these families, although existing literature supports beginning ACP conversations at the time of initial diagnosis and treatment. Parents or legal guardians often serve as the sole decision maker for pediatric patients but there has also been a shift in the literature to include children/adolescents in conversations regarding ADs and other aspects of end-of-life (EOL) care, an essential aspect of patient-centered ACP. This guidance is unfortunately not often translated into clinical practice. In this review, we aim to define and discuss the current status, obstacles, and benefits surrounding early initiation of ACP conversations with children or adolescents with advanced cancer and their families. We also discuss how physicians and the medical team, including pediatric palliative care, can increase the degree of pediatric patient involvement in ACP and EOL discussions, as developmentally appropriate, and mitigate delays in discussing ACP with these families and patients. Full article

(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)

27 pages, 1886 KB

Open AccessReview

Thrombocytopenia in Critically Ill Children: A Review for Practicing Clinicians

by Balagangadhar R. Totapally, Abhinav Totapally and Paul A. Martinez

Children 2025, 12(1), 83; https://doi.org/10.3390/children12010083 - 12 Jan 2025

Cited by 1 | Viewed by 6267

Abstract

Thrombocytopenia frequently occurs in patients before, during, and after admission to Pediatric Intensive Care Units (PICUs). In critically ill children, it is often due to multifactorial causes and can be a sign of significant organ dysfunction. This review summarizes the potential causes/mechanisms of [...] Read more.

Thrombocytopenia frequently occurs in patients before, during, and after admission to Pediatric Intensive Care Units (PICUs). In critically ill children, it is often due to multifactorial causes and can be a sign of significant organ dysfunction. This review summarizes the potential causes/mechanisms of thrombocytopenia in acutely ill children, their identification, and treatments, with special attention paid to septic patients. The mechanisms of thrombocytopenia include decreased production and sequestration, but the most common reason is increased destruction or consumption. This review specifically reviews and compares the presentation, pathogenesis, and treatment of disseminated intravascular coagulation (DIC) and the thrombotic microangiopathic spectrum (TMA), including thrombocytopenia-associated multiorgan failure (TAMOF), hemolytic uremic syndrome, and other diagnoses. The other etiologies discussed include HLH/MAS, immune thrombocytopenia, and dilutional thrombocytopenia. Finally, this review analyzes platelet transfusions, the various thresholds, and complications. Full article

(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)

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