Importance:Prone positioning has been shown to improve respiratory mechanics and oxygenation, but its clinical benefit in infants with acute viral bronchiolitis receiving high-flow nasal cannula (HFNC) support remains unknown. Objective:To investigate whether prone positioning in infants with moderate to severe acute bronchiolitis and HFNC support reduces escalation to noninvasive or invasive ventilation. Design, Setting, and Participants:Multicenter, randomized, open-label trial conducted in 15 pediatric intermediate or intensive care units in France. Infants aged 6 months or younger admitted for 24 hours or less with a diagnosis of acute bronchiolitis with moderate to severe respiratory distress requiring HFNC support were enrolled between January 2021 and November 2023 and followed up until hospital discharge (last patient discharged on December 11, 2023). Interventions:Participants were randomly assigned to the prone position (n = 221) or supine position (n = 230). Infants in the prone position group received prone positioning for 24 hours or longer during the first 48 hours. All participants received standardized HFNC support at 2 L/kg/min. Main Outcomes and Measures:The primary outcome was the need for escalation of care to noninvasive or invasive ventilation within the first 72 hours, according to prespecified criteria. Secondary outcomes included treatment failure, determined by an independent clinical adjudication committee; tolerance of prone positioning; length of hospital stay; duration of respiratory support; infant comfort; and adverse events. Results:Among 451 infants randomized, 446 were included in the primary analysis (median age, 41 [IQR, 19-72] days; 54% male). Escalation of care occurred in 80 infants (17.9%), with no significant difference between the prone position (33/220 [15.0%]) and supine position (47/226 [20.8%]) groups (adjusted odds ratio, 0.66 [95% CI, 0.40-1.07]; P = .09). Secondary outcomes did not differ significantly between the 2 groups. In the safety analysis, serious adverse events occurred in 2 of 180 infants (1.1%) in the prone position group and 2 of 264 (0.8%) in the supine position group. Conclusions and Relevance:Prone positioning in infants with moderate to severe bronchiolitis receiving HFNC support did not significantly reduce escalation of care. However, the wide 95% confidence interval around the observed odds ratio suggests that this study was not definitive and further research is warranted. Trial Registration:ClinicalTrials.gov Identifier: NCT03976895.

OBJECTIVES:To explore the perspectives of healthcare professionals and the experience of families concerning post-PICU follow-up to identify key points for the further development of these programs. DESIGN:Qualitative study. SETTING:PICUs in France involved in post-PICU patient follow-up. SUBJECTS:Sixteen healthcare professionals involved in post-PICU follow-up at 11 centers, and 18 family participants in enrolled in longitudinal post-PICU follow-up at a tertiary center, took part in semi-structured interviews and observations from January 2022 to June 2024. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Three main themes emerged. First, therapeutic alliance as a cornerstone: families stressed the importance of maintaining relationships with PICU professionals throughout follow-up, which facilitated recovery and helped them deal with periods of doubt. Second, professional commitment despite institutional constraints: healthcare providers were highly motivated to maintain follow-up programs despite limited resources. Third, barriers to follow-up engagement: families reported a financial burden, and emotional challenges related to traumatic memories during consultations. CONCLUSIONS:Our study highlights the need for structured support for post-PICU follow-up programs that take account of both institutional constraints and family needs. The work suggests that maintenance of the therapeutic relationships established during the PICU stay is crucial for successful follow-up. Future guidelines should address resource allocation and accessibility while preserving the human dimension of care.

Background:Community-acquired bacterial infections (CABIs) remain a leading cause of pediatric morbidity and mortality. This study aimed to provide a contemporary description of pediatric CABIs requiring admission to pediatric intensive care units (PICUs) in France. Methods:The CAPRICE study is a prospective, multicenter cohort including all children with suspected CABIs who were admitted to 28 French PICUs from January to December 2024. Demographic, clinical, microbiologic, and outcome data were prospectively collected. The primary outcome was mortality at day 28 and secondary outcomes included sequelae at day 28, PICU length of stay, and total hospital stay. Independent predictors of mortality were identified by multivariable logistic regression. Results:Among 897 children, the median age was 1.9 years (IQR 0.2-8.8); 55% were male, and 30% had a chronic condition. The leading infections were lower respiratory tract infection (43%), meningitis (20%), and ear-nose-throat infections (13%). Septic shock occurred in 17% of cases. A pathogen was identified in 89% of cases: Bordetella pertussis (22%) and Mycoplasma pneumoniae (15%) were predominant, followed by Streptococcus pneumoniae (13%), and Staphylococcus aureus (11%). In all, 34% patients had viral co-infection and 70% required organ support. Overall mortality was 7%, increasing to 19% with septic shock. Independent predictors of death included multiple organ failure, meningitis, and B. pertussis infection. Sequelae occurred in 15% of survivors. Conclusions:Severe CABIs in French PICUs in 2024 were mainly caused by B. pertussis and M. pneumoniae, followed by S. pneumoniae and S. aureus. Mortality and morbidity of these infections remain substantial.

Objective:Advances in paediatric intensive care have resulted in a growing population of survivors exposed to long-term morbidity. Paediatric post-intensive care syndrome (PICS-p) encompasses new or worsened physical, cognitive, psychological/psychiatric, and socio-familial impairments that may affect children and their families after discharge from the paediatric intensive care unit (PICU). Despite increasing recognition of PICS-p, post-PICU follow-up remains highly heterogeneous worldwide, and systematic screening and management strategies are rarely integrated into routine care. These guidelines were issued at the initiative of the French national health authority (Haute Autorité de Santé: HAS) to improve the prevention, identification, and management of PICS-p. Design:Clinical practice guidelines developed following the HAS standardized methodology (Recommandations de Bonne Pratique), including systematic literature review, multidisciplinary expert elaboration, formal external review, and HAS board approval. Reporting follows the AGREE II framework. Methods:Clinical questions were predefined by HAS project leads. A systematic literature search ([dates]) was conducted across Embase, EmCare, Medline, and the Cochrane Library, prioritising guidelines, meta-analyses, and systematic reviews. Two field experts drafted initial recommendations, graded A (established evidence) to Expert Opinion (absence of evidence). An 18-member multidisciplinary working group refined the draft through two in-person meetings. A 52-member external review panel formally voted on agreement for each recommendation. The final version was approved by the HAS board. Results:Fourty recommendations were issued: 5 with a moderate level of evidence (grade B), 8 low level (grade C) and 27 very low (expert opinion). Strong agreement by the panel of experts was achieved for all recommendations except for one (moderate). The recommendations define PICS-p as a prevalent, multidimensional condition and emphasize systematic, repeated screening of children and families from PICU admission through the first year after discharge. Key preventive strategies include implementation of ABCDEFGH bundle, early mobilization, optimized analgesia and sedation, delirium prevention, and family-centred psychological support. Structured care pathways and pragmatic screening tools are proposed to ensure continuity of care. Conclusion:These guidelines emphasize the importance of structured, multidisciplinary, and family-centred strategies, to improve the prevention, early identification, and management of PICS-p and optimize long-term outcomes for children and their families.

L’épidémie récente de coqueluche, débutée en 2024 en France, nous a rappelé la gravité de cette infection chez le nourrisson, avec 23 décès d’enfants dont 20 de moins de 1 an. La coqueluche est une maladie infectieuse respiratoire, causée par les bactéries du genre Bordetella, dont la clinique typique est bénigne chez l’enfant et l’adulte. Les formes sévères du nourrisson, caractérisées de « malignes », ont quant à elles la particularité de se présenter sous la forme d’une détresse respiratoire avec une hypertension artérielle pulmonaire et une hyperleucocytose nécessitant une prise en charge spécialisée en service de soins critiques. Dans cette mise au point nous détaillons les spécificités de la coqueluche maligne ainsi que sa prise en charge en service de soins critiques pédiatriques.

Importance: Prone positioning has been shown to improve respiratory mechanics and oxygenation, but its clinical benefit in infants with acute viral bronchiolitis receiving high-flow nasal cannula (HFNC) support remains unknown. Objective: To investigate whether prone positioning in infants with moderate to severe acute bronchiolitis and HFNC support reduces escalation to noninvasive or invasive ventilation. Design, Setting, and Participants: Multicenter, randomized, open-label trial conducted in 15 pediatric intermediate or intensive care units in France. Infants aged 6 months or younger admitted for 24 hours or less with a diagnosis of acute bronchiolitis with moderate to severe respiratory distress requiring HFNC support were enrolled between January 2021 and November 2023 and followed up until hospital discharge (last patient discharged on December 11, 2023). Interventions: Participants were randomly assigned to the prone position (n = 221) or supine position (n = 230). Infants in the prone position group received prone positioning for 24 hours or longer during the first 48 hours. All participants received standardized HFNC support at 2 L/kg/min. Main Outcomes and Measures: The primary outcome was the need for escalation of care to noninvasive or invasive ventilation within the first 72 hours, according to prespecified criteria. Secondary outcomes included treatment failure, determined by an independent clinical adjudication committee; tolerance of prone positioning; length of hospital stay; duration of respiratory support; infant comfort; and adverse events. Results: Among 451 infants randomized, 446 were included in the primary analysis (median age, 41 [IQR, 19-72] days; 54% male). Escalation of care occurred in 80 infants (17.9%), with no significant difference between the prone position (33/220 [15.0%]) and supine position (47/226 [20.8%]) groups (adjusted odds ratio, 0.66 [95% CI, 0.40-1.07]; P = .09). Secondary outcomes did not differ significantly between the 2 groups. In the safety analysis, serious adverse events occurred in 2 of 180 infants (1.1%) in the prone position group and 2 of 264 (0.8%) in the supine position group. Conclusions and Relevance: Prone positioning in infants with moderate to severe bronchiolitis receiving HFNC support did not significantly reduce escalation of care. However, the wide 95% confidence interval around the observed odds ratio suggests that this study was not definitive and further research is warranted. Trial Registration: ClinicalTrials.gov Identifier: NCT03976895.

Introduction:The COVID-19 pandemic led many countries to implement non-pharmaceutical interventions (NPIs), substantially altering paediatric healthcare. This study evaluated the impact of NPIs on morbidity and non-SARS-CoV-2 infections in paediatric intensive care units (PICUs) during the first wave of the COVID-19 pandemic. Methods:A descriptive, retrospective cohort study was conducted across three geographically distinct PICUs in Canada and France, covering January 2016 to July 2020. To assess the impact of NPIs, disease categories, patient morbidity, the length of PICU stay, mortality and the spectrum of non-SARS-CoV-2 viruses detected from April to July in 2016-2019 were compared with the same period in 2020. Additionally, a time-series analysis of non-SARS-CoV-2 virus-related PICU admissions was performed. Results:Among 12 873 patients, median age was 28.8 months (IQR 5.4-111.0), 32.3% required invasive mechanical ventilation, median PICU stay was 3.0 days (IQR 1.6-5.0) and mortality was 3.2%. Comparing the prepandemic and pandemic eras during April-July, the proportion of respiratory admissions declined significantly (29.4% vs 19.4%, p<0.01), while that of postoperative admissions remained stable (25.2% vs 22.9%, p=0.23). No significant differences were seen in ventilation use, length of stay or mortality. Time-series analysis showed a decreasing trend in non-SARS-CoV-2 viral admissions after the index date: OR 0.57 (95% CI 0.31 to 1.02) in weeks 0 to <2, 0.14 (0.08 to 0.25) in weeks 2 to <4 and 0.04 (0.02 to 0.06) in weeks 4 to 6. Conclusion:NPIs implemented during the early phase of the COVID-19 pandemic influenced PICU utilisation and reduced non-SARS-CoV-2 viral infections. Quantitative estimates of such impacts can inform surge capacity planning and the time-limited implementation of NPIs in future pandemics.

BACKGROUND:Radiation-induced late fecal incontinence (LFI) is one of the most quality-of-life impairing symptoms in prostate cancer. We aimed to assess the impact of radiotherapy (RT) technique and dose-volume effects on LFI using a robust score. METHODS:We identified 409 patients who underwent curative intent using standard fractionated radiation therapy, 190 of them were finally included and analyzed. The severity of LFI was assessed using the Jorge & Wexner score. RESULTS:With a median follow-up of 55 months (range 15-96) months, LFI crude rate was 11.5%. In the multivariate analyses, image-guided radiotherapy (IGRT), rectal maximum dose (Dmax) and anal canal minimum dose (Dmin) were significantly associated with LFI risk. The use of IGRT was associated with lower risk of LFI (p = 0.02); higher rectum Dmax (≥ 68.4 Gy; p = 0.02) and anal canal Dmin (≥ 6.4 Gy; p = 0.04) were associated with increased risk. CONCLUSION:Our results suggest a significant impact of the total dose delivered to the anorectal volumes and the use of IGRT to spare organs at risk during radiation delivery.

INTRODUCTION:There is no consensus on indications and modalities of drainage procedures for bacterial pleuropneumonia in children. This study aimed to analyze the clinical course following drainage procedures and the different techniques used. METHOD:This retrospective single-center study included children with drained bacterial pleuropneumonia at a French University Hospital, from January 1, 2011, to December 31, 2023. RESULTS:Thirty-three children were included, with a median age of 3.3 years. The most frequently identified pathogens were Staphylococcus aureus (n = 13; 39 %), Streptococcus pyogenes (GAS) (n = 9; 27 %), and Streptococcus pneumoniae (n = 5; 15 %). Indications for pleural drainage included respiratory distress (n = 16; 48 %) and persistent/abundant pleural effusion (n = 7; 21 %). 73 % of cases presented mediastinal deviation. Percutaneous drainage was performed for 23 patients (70 %) and surgical drainage for 10 patients (30 %). Drainage cultures were positive in 14/27 cases (52 %) after a median of 3 days (IQR: 1.2-5.5) of antibiotics. After drainage, the median durations of fever, intravenous antibiotics, and hospitalization were 8 (IQR: 4.2-14), 11 (IQR: 8.5-15), and 15.5 days (IQR: 8.7-18.5), respectively. Univariate analysis showed that children with percutaneous drainage had longer post drainage fever (12 vs. 5.3 days, p = 0.01) and ventilation durations (7 vs. 2.25 days, p = 0.02) than those with surgical drainage. CONCLUSION:The cohort had severe cases, with percutaneous drainage more commonly used. Positive drainage cultures highlighted the challenges of antibiotic penetration and supported the role of drainage in selected cases. Despite favorable medium-term outcomes, post-drainage recovery was prolonged, with extended durations of hospitalization, persistent fever, and prolonged antibiotic treatment.

BACKGROUND:Pneumococcal meningitis is a leading cause of bacterial meningitis and the most deadly pneumococcal disease in children worldwide. There is a paucity of evidence concerning the benefit of dexamethasone to prevent death in paediatric pneumococcal meningitis. We aimed to compare the effect of early adjunctive therapy with dexamethasone versus no dexamethasone on death in children with pneumococcal meningitis. METHODS:We did a non-randomised, comparative, multicentre, retrospective, quasi-experimental, propensity score-based study using data from a French national surveillance system of pneumococcal meningitis in children that collates data for 238 French paediatric wards working with 168 microbiology laboratories. We compared outcomes of adjunctive therapy with dexamethasone treatment (0·15 mg/kg every 6 h, for 4 days, per national guidelines) given within 12 h of antibiotic treatment versus no dexamethasone among all children aged 0-17 years with confirmed pneumococcal meningitis who had been hospitalised in one of the participating centres between Jan 1, 2005, and Nov 1, 2022. The primary outcome was 30-day all-cause death after hospital admission. The main propensity score analysis was based on inverse probability treatment weighting (IPTW), allowing adjustment for initial severity and baseline characteristics. Sensitivity analyses, such as propensity score matching, were done to assess the robustness of the results. FINDINGS:Between Jan 1, 2005, and Nov 1, 2022, 1765 cases of pneumococcal meningitis were reported to the National Surveillance System of Paediatric Bacterial Meningitis. 534 were excluded from the analysis and 1231 were included, with a median age of 1·1 years (IQR 0·5-5·0, range 0-17·9). 495 (40%) of 1231 patients were female, 716 (58%) were male, and 20 (1%) were missing data for sex. 650 (53%) of 1231 children received dexamethasone and 581 (47%) children did not receive dexamethasone. 108 (9%) of 1231 patients died. Within 30 days of hospitalisation, 105 (9%) patients died, 36 (6%) of 650 in the dexamethasone group and 69 (12%) of 581 in the no dexamethasone group. After IPTW, the adjusted 30-day death rate was 6% in the dexamethasone group and 12% in the no dexamethasone group (marginal odds ratio 0·39, 95% CI 0·23-0·65). All sensitivity analyses gave similar results. INTERPRETATION:Adjunctive dexamethasone within 12 h of starting antibiotic treatment was associated with a reduced 30-day risk of death in children hospitalised with pneumococcal meningitis. Our findings support the use of dexamethasone to reduce the risk of death in paediatric pneumococcal meningitis. FUNDING:Pfizer, ACTIV, and National Institute of Health and Medical Research (Inserm) Centre.

Forty-two questions were evaluated concerning management of emergencies and critical illnesses in paediatric and adult patients with sickle cell disease. The assessment covered the following areas: patient referral, vaso-occlusive crisis, acute chest syndrome, transfusion therapy, and priapism. The patient referral category included guidelines for admission to intensive care unit and management at specialized reference centers. The vaso-occlusive crisis topic encompassed pain management, hydration, incentive spirometry, and target oxygen saturation levels. For acute chest syndrome, the focus areas included imaging techniques such as lung ultrasound, computed tomography scans, and echocardiography; treatment with systemic corticosteroids; non-invasive ventilation; prophylactic and therapeutic anticoagulation; and procalcitonin and antibiotic therapy. The section on transfusion therapy addressed indications and methods of transfusion, as well as the diagnosis and prediction of delayed hemolytic transfusion reactions. A total of 45 recommendations were proposed, including 14 specific to adults, 13 specific to pediatrics, and 18 applicable to both adults and children, along with three therapeutic algorithms. The Grade of Recommendation Assessment, Development, and Evaluation (GRADE) methodology was adhered to throughout the process. Sixteen recommendations were based on a low level of evidence (GRADE 2+ or 2−), while 26 were based on evidence that could not be classified under the GRADE system and were therefore considered expert opinions. Finally, for three aspects of sickle cell disease management, the experts concluded that no reliable recommendations could be made based on the current state of knowledge. The recommendations and therapeutic algorithms received strong agreement from the experts.

Introduction Unplanned readmissions to the pediatric intensive care unit (PICU) following cardiac surgery remain poorly understood. Such readmissions are associated with increased morbidity and present significant challenges to healthcare. This study aimed to identify characteristics associated with unplanned PICU readmission during the same hospitalization following cardiac surgery.Method We conducted a retrospective analysis using prospectively collected data from a tertiary care children's hospital from January 2015 to January 2021. All pediatric patients who underwent cardiac surgery and were transferred alive from the PICU were included. Each patient readmitted to the PICU was matched to two controls based on age and PELOD score at the time of initial PICU admission postsurgery to identify factors associated with readmission among 72 variables.Results Of the 956 patients discharged alive from the PICU after cardiac surgery, 23 (2.4%) required unplanned readmission. Over half (12/23, 52.2%) of these readmissions occurred within 48 h of PICU discharge. Univariate analysis identified preoperative arrhythmias (P = .037) and postoperative single-ventricle physiology (P = .024) as potential risk factors for readmission. Male sex appeared to be a protective factor against unplanned PICU readmission (P = .026). Although preoperative vasopressor requirement, postoperative altered ventricular function and known pleural effusion at PICU discharge were not significantly associated with PICU readmission, these factors showed a trend toward significance. After multivariate analysis, postoperative single-ventricle physiology remained the sole independent risk factor associated with unplanned PICU readmission with an odds ratio of 8.6 (95% confidence interval, 1.9-46.5).Conclusion While unscheduled PICU readmissions following cardiac surgery are rare, postoperative single-ventricle physiology emerged as an independent risk factor.

ObjectiveIt is now well established that post-intensive care syndrome is frequent in critically ill children after discharge from the Pediatric Intensive Care Unit (PICU). Nevertheless, post-intensive care follow-up is highly heterogenous worldwide and is not considered routine care in many countries. The purpose of this viewpoint was to report the reflections of the French PICU society working group on how to implement post-PICU follow-up.MethodsA working group was set up within the Groupe Francophone de Reanimation et d’Urgences Pédiatriques (GFRUP) to provide conceptual and practical guidance for developing post-PICU follow-up. The working group included psychologists, PICU physicians, physiotherapists, and nurses, from different French PICUs. Five virtual meetings have been held.ResultsFirst, we described in this work the objectives of the follow-up program and the population to be targeted. We also provided a framework to implement post-PICU follow-up in clinical practice. Finally, we detailed the potential obstacles and challenges to consider.ConclusionAlthough implementing a post-PICU follow-up program is a challenge, the benefits could be significant for both patient and relatives, as well as for the health care professionals involved.

Although pediatric post-intensive care syndrome is frequent and impacts the child's quality of life in various aspects, there are currently no guidelines regarding post-pediatric intensive care unit (PICU) follow-up. The aim of this study was to describe post-PICU follow-up in France. Among the 37 French PICUs, only 67 % had a consultation service, mostly performed by pediatric intensivists (95 %). Post-intensive care evaluation was the main objective for 46 % of these centers, whereas others focused on specific patient populations. Post-intensive care follow-up is highly heterogeneous and developing such consultation services appears to be a main challenge for PICU teams.

BackgroundSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for an important mortality rate worldwide. We aimed to evaluate the actual imputability of SARS-CoV-2 on the mortality rate associated with SARS-CoV-2-related illnesses in the pediatric intensive care unit (PICU). Secondary objectives were to identify risk factors for death.MethodsThis national multicenter comparative study comprised all patients under 18 years old with positive SARS-CoV-2 polymerase chain reactions (PCRs) [acute corona virus disease 2019 (COVID-19) or incidental SARS-CoV-2 infection] and/or pediatric inflammatory multisystem syndrome (PIMS) recorded in the French PICU registry (PICURe) between September 1, 2021, and August 31, 2022. Included patients were classified and compared according to their living status at the end of their PICU stay. Deceased patients were evaluated by four experts in the field of pediatric infectiology and/or pediatric intensive care. The imputability of SARS-CoV-2 as the cause of death was classified into four categories: certain, very probable, possible, or unlikely, and was defined by any of the first three categories.ResultsThere were 948 patients included of which 43 died (4.5%). From this, 26 deaths (67%) could be attributed to SARS-CoV-2 infection, with an overall mortality rate of 2.8%. The imputability of death to SARS-CoV-2 was considered certain in only one case (0.1%). Deceased patients suffered more often from comorbidities, especially heart disease, neurological disorders, hematological disease, cancer, and obesity. None of the deceased patients were admitted for pediatric inflammatory multisystem syndrome (PIMS). Mortality risk factors were male gender, cardiac comorbidities, cancer, and acute respiratory distress syndrome.ConclusionsSARS-CoV-2 mortality in the French pediatric population was low. Even though the imputability of SARS-CoV-2 on mortality was considered in almost two-thirds of cases, this imputability was considered certain in only one case.

BACKGROUND:Most children admitted to a paediatric intensive care unit (PICU) now survive because of improvements in care. Many studies have identified the psychological, functional, cognitive and social impact of PICU admission on a child and their family. However, expert recommendations on follow-up are lacking. AIM:To identify the strategies of clinical follow-up after PICU discharge performed from 2001 to 2021. STUDY DESIGN:This scoping review was undertaken between January and April 2021 using three databases: PubMed, EMBASE and CINAHL. The search strategy consisted of a combination of keywords, including PICU, post-PICU discharge and follow-up in articles published between 2001 and 2021. The results are reported according to PRISMA-ScR guidelines. RESULTS:Six-hundred and fifty-two articles were identified and 68 were analysed. Median age was 4.5 years and the two main reasons for PICU admission were cardiorespiratory failure and sepsis. Median length of PICU stay was 8 days. Most follow-up was carried out by research units (88%), while 6% of studies reported follow-up by a multidisciplinary PICU team. The most common follow-up schedule included an assessment at PICU discharge, and then at 3, 6 and 12 months. Follow-up for >1 year was reported in 20% of studies. One third of studies focused on follow-up quality of life and neurological outcomes. Parental emotional impact was assessed in 7% of studies. CONCLUSION:Follow-up after PICU discharge was highly heterogeneous regarding timing, health care professionals involved and assessment methods. There is an urgent need for standardization and coordination of PICU follow-up because of the increasing number of patients impacted by a PICU stay. RELEVANCE TO CLINICAL PRACTICE:Although most patients admitted to a paediatric intensive care unit (PICU) now survive; they may develop paediatric post-intensive care syndrome (PICS-P). To our knowledge, there are currently no clinical guidelines regarding follow-up after PICU discharge. This review summarizes current approaches to follow-up after PICU discharge, including how it is carried out, who is involved and what the main aims of assessment are.

Adrenal insufficiency (AI) is one of the most life-threatening disorders resulting from adrenal cortex dysfunction. Symptoms and signs of AI are often nonspecific, and the diagnosis can be missed and lead to the development of AI with severe hypotension and hypovolemic shock.We report the case of a 13-year-old child admitted for cardiac arrest following severe hypovolemic shock. The patient initially presented with isolated mild abdominal pain and vomiting together with unexplained hyponatremia. He was discharged after an initial short hospitalization with rehydration but with persistent hyponatremia. After discharge, he had persistent refractory vomiting, finally leading to severe dehydration and extreme asthenia. He was admitted to pediatric intensive care after prolonged hypovolemic cardiac arrest with severe anoxic encephalopathy leading to brain death. After re-interviewing, the child's parents reported that he had experienced polydipsia, a pronounced taste for salt with excessive consumption of pickles lasting for months, and a darkened skin since their last vacation 6 months earlier. A diagnosis of autoimmune Addison's disease was made.Primary AI is a rare life-threatening disease that can lead to hypovolemic shock. The clinical symptoms and laboratory findings are nonspecific, and the diagnosis should be suspected in the presence of unexplained collapse, hypotension, vomiting, or diarrhea, especially in the case of hyponatremia.

Background Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis, resulting in 3 million hospitalizations each year worldwide. Nirsevimab is a monoclonal antibody against RSV that has an extended half-life. Its postlicensure real-world effectiveness against RSV-associated bronchiolitis is unclear.Methods We conducted a prospective, multicenter, matched case-control study to analyze the effectiveness of nirsevimab therapy against hospitalization for RSV-associated bronchiolitis in infants younger than 12 months of age. Case patients were infants younger than 12 months of age who were hospitalized for RSV-associated bronchiolitis between October 15 and December 10, 2023. Control patients were infants with clinical visits to the same hospitals for conditions unrelated to RSV infection. Case patients were matched to control patients in a 2:1 ratio on the basis of age, date of hospital visit, and study center. We calculated the effectiveness of nirsevimab therapy against hospitalization for RSV-associated bronchiolitis (primary outcome) by means of a multivariate conditional logistic-regression model with adjustment for confounders. Several sensitivity analyses were performed.Results The study included 1035 infants, of whom 690 were case patients (median age, 3.1 months; interquartile range, 1.8 to 5.3) and 345 were matched control patients (median age, 3.4 months; interquartile range, 1.6 to 5.6). Overall, 60 case patients (8.7%) and 97 control patients (28.1%) had received nirsevimab previously. The estimated adjusted effectiveness of nirsevimab therapy against hospitalization for RSV-associated bronchiolitis was 83.0% (95% confidence interval [CI], 73.4 to 89.2). Sensitivity analyses gave results similar to those of the primary analysis. The effectiveness of nirsevimab therapy against RSV-associated bronchiolitis resulting in critical care was 69.6% (95% CI, 42.9 to 83.8) (27 of 193 case patients [14.0%] vs. 47 of 146 matched control patients [32.2%]) and against RSV-associated bronchiolitis resulting in ventilatory support was 67.2% (95% CI, 38.6 to 82.5) (27 of 189 case patients [14.3%] vs. 46 of 151 matched control patients [30.5%]).Conclusions In a real-world setting, nirsevimab therapy was effective in reducing the risk of hospitalized RSV-associated bronchiolitis. (Funded by the National Agency for AIDS Research-Emerging Infectious Disease and others; ENVIE ClinicalTrials.gov number, NCT06030505.) Respiratory syncytial virus is a leading cause of bronchiolitis. In a prospective, multicenter, matched case-control study involving infants in France, nirsevimab decreased RSV-associated hospitalization by 83%.

BACKGROUND:Paediatric sepsis is the leading cause of death in children under 5 years. No studies have evaluated the application of the Surviving Sepsis Campaign 2020 (SSC-2020) guidelines in paediatric emergency departments (PEDs). OBJECTIVE:To assess physician adherence to the SSC-2020 fluid resuscitation guidelines in children with suspected septic shock in PEDs. METHODS:This was a prospective multicentre observational study conducted in 21 French hospitals over 5 sequential weeks, between November 2021 and March 2022. Children with suspected septic shock and who received antimicrobial therapy within 72 hours were included. Primary outcome was SSC-2020 fluid resuscitation guidelines adherence (low 0-24%; moderate 25-74%; high 75-100%) according to: bolus volume of 10-20 mL/kg each, exclusive administration of balanced crystalloids at 1 and 24 hours of management, and initiation of fluid resuscitation within 1 hour of septic shock recognition. RESULTS:63 children were included. 10 (16%) children had severe sepsis and 2 (3%) met the definition of septic shock. Compared with the SSC-2020 guidelines, 43 (68%) patients received boluses of 10-20 mL/kg; fluid resuscitation was initiated within 1 hour of septic shock recognition in 42 (76%) cases; balanced crystalloids were the only fluids administrated in 35 (56%) and 34 (55%) children at 1 and 24 hours of management, respectively. Main barriers reported by physicians were difficult intravenous access (43%), lack of team training (29%), workload constraints (28%), and absence or out-of-date protocols (24%). CONCLUSIONS:This study found high adherence for fluid resuscitation initiation but moderate adherence for bolus volume and fluid choice. TRIAL REGISTRATION NUMBER:NCT05066464.