Measurements and Main Results: De-identified data collected as part of routine clinical care was analysed. All children were diagnosed and staged for AKI based on the level of serum creatinine above the upper limit of reference interval (ULRI) values according to published guidance. Severe AKI was defined as stage 2/3 AKI. Uni-and multi-variable analyses were performed to study the association between demographic data, clinical features, markers of inflammation and cardiac injury, and severe AKI. Over the study period, 116 patients with PIMS-TS were admitted to 15 UK PICUs. Any-stage AKI occurred in 48/116 patients (41.4%), and severe AKI in 32/116 (27.6%) patients, which was mostly evident at admission (24/32, 75%). In univariable analysis, body mass index, hyperferritinemia, high C-reactive protein (CRP), Pediatric Index of Mortality 3 (PIM3) score, vasoactive medication and invasive mechanical ventilation (IMV) were associated with severe AKI. In multivariable logistic regression, hyperferritinemia was associated with severe AKI (compared to non-severe AKI, adjusted odds ratio 1.04, 95% CI 1.01-1.08, p=0.04). Severe AKI was associated with longer PICU stay (median 5 days [IQR 4,7] vs 3 days [IQR 1.5,5], p<0.001) and increased duration of IMV (median 4 days [IQR 2,6] vs 2 days [IQR 1,3], p=0.04). Conclusions: Severe AKI occurred in just over a quarter of children admitted to UK PICUs with PIMS-TS. Hyperferritinemia was significantly associated with severe AKI. Severe AKI was associated with increased duration of stay and ventilation. Although short-term outcomes for AKI in PIMS-TS appear good, long-term outcomes are unknown.

No abstract

ObjectivesPatients from ethnic minority groups and key workers are over-represented among adults hospitalised or dying from COVID-19. In this population-based retrospective cohort, we describe the association of ethnicity, socioeconomic and family key worker status with incidence and severity of Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS).SettingEvelina London Children’s Hospital (ELCH), the tertiary paediatric hospital for the South Thames Retrieval Service (STRS) region.Participants70 children with PIMS-TS admitted 14 February 2020–2 June 2020.Outcome measuresIncidence and crude ORs are presented, comparing ethnicity and socioeconomic status of our cohort and the catchment population, using census data and Index of Multiple Deprivation (IMD). Regression is used to estimate the association of ethnicity and IMD with admission duration and requirement for intensive care, inotropes and ventilation.ResultsIncidence was significantly higher in children from black (25.0 cases per 100 000 population), Asian (6.4/100 000) and other (17.8/100 000) ethnic groups, compared with 1.6/100 000 in white ethnic groups (ORs 15.7, 4.0 and 11.2, respectively). Incidence was higher in the three most deprived quintiles compared with the least deprived quintile (eg, 8.1/100 000 in quintile 1 vs 1.6/100 000 in quintile 5, OR 5.2). Proportions of families with key workers (50%) exceeded catchment proportions. Admission length of stay was 38% longer in children from black ethnic groups than white (95% CI 4% to 82%; median 8 days vs 6 days). 9/10 children requiring ventilation were from black ethnic groups.ConclusionsChildren in ethnic minority groups, living in more deprived areas and in key worker families are over-represented. Children in black ethnic groups had longer admissions; ethnicity may be associated with ventilation requirement.This project was registered with the ELCH audit and service evaluation team, ref. no 11186.

Objectives: Management of mechanically ventilated patients with bronchiolitis is not standardized and duration of mechanical ventilation has been shown to vary widely between centers. The aim of this study was to examine practice in a large number of U.K. PICUs with a view to identify if early management choices relating to fluid prescription, sedative agent use, and endotracheal tube (ETT) placement were associated with differences in duration of invasive mechanical ventilation (IMV). Design: Retrospective multicenter cohort study. Primary outcome was duration of IMV. A hierarchical gamma generalized linear model was used to test for associations between practice variables (sedative and neuromuscular blocking agents, route of endotracheal intubation at 24 hr and fluid balance at 48 hr) and duration of IMV after adjustment for known confounders. Setting: Thirteen U.K. PICUs. Duration of 2 months between November and December 2019. Patients: Three hundred fifty infants receiving IMV for bronchiolitis. Excluded were patients receiving long-term ventilation, extracorporeal life support, or who died before separation from IMV. Interventions: None. Measurements and Main Results: After adjustment for confounders, several variables were associated with an increase in the geometric mean duration of IMV (expressed as a percentage) including: nasal ETT use, 16% (95% CI, 1–32%); neuromuscular blockade use, 39% (95% CI, 21–61%); and fluid balance at 48 hr, 13% per 100 mL/kg positive fluid balance (95% CI, –1% to 28%). The association of sedative use varied with class of agent. The use of an alpha-2 agonist alone was associated with a reduction in duration of IMV by 19% in relation to no sedative agent (95% CI, –31 to –5%), whereas benzodiazepine uses alone or with alpha-2 agonist in combination were similar to using neither agent. Conclusions: Early management strategies for bronchiolitis were associated with the duration of IMV across U.K. centers after adjustment for confounders. Future work should prospectively assess the impact of fluid restriction, route of endotracheal intubation, and alpha-2 agonist use on duration of IMV in infants with bronchiolitis, with the aim of reducing seasonal bed pressure.