on behalf of the PENUT Trial Consortium* Objective To evaluate whether extremely low gestational age neonates (ELGANs) randomized to erythropoietin have better or worse kidney-related outcomes during hospitalization and at 22-26 months of corrected gestational age (cGA) compared with those randomized to placebo. Study designWe performed an ancillary study to a multicenter double-blind, placebo-controlled randomized clinical trial of erythropoietin in ELGANs. ResultsThe prevalence of severe (stage 2 or 3) acute kidney injury (AKI) was 18.2%. We did not find a statistically significant difference between those randomized to erythropoietin vs placebo for in-hospital primary (severe AKI) or secondary outcomes (any AKI and serum creatinine/cystatin C values at days 0, 7, 9, and 14). At 22-26 months of cGA, 16% of the cohort had an estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m 2 , 35.8% had urine albumin/creatinine ratio >30 mg/g, 23% had a systolic blood pressure (SBP) >95th percentile for age, and 40% had a diastolic blood pressure (DBP) >95th percentile for age. SBP >90th percentile occurred less often among recipients of erythropoietin (P < .04). This association remained even after controlling for gestational age, site, and sibship (aOR 0.6; 95% CI 0.39-0.92). We did not find statistically significant differences between treatment groups in eGFR, albumin/creatinine ratio, rates of SBP >95th percentile, or DBP >90th or >95th percentiles at the 2 year follow-up visit.Conclusions ELGANs have high rates of in-hospital AKI and kidney-related problems at 22-26 months of cGA.Recombinant erythropoietin may protect ELGANs against long-term elevated SBP but does not appear to protect from AKI, low eGFR, albuminuria, or elevated DBP at 22-26 months of cGA.

As the field of pediatric psychology expands and evolves, pediatric critical care settings hold considerable promise for our profession. Although extensive mental health needs have been recognized in patients and families affected by care in the pediatric intensive care unit (PICU), specifics regarding the need for, utilization of, and nature of pediatric psychology services have not yet been systematically examined. The current study provides a descriptive analysis of all consecutive referrals to a pediatric psychology consultation service within the critical care setting of a large metropolitan pediatric medical center from January 2006 through December 2009. During the study period, 611 pediatric psychology referrals (4.6% of PICU admissions) were generated. Consultations were initiated by interdisciplinary staff and spanned a diverse and farreaching range of behavioral health needs for patients and family members. Numerous factors were associated with increased need for pediatric psychology consultation, including longer than average hospitalizations, unanticipated critical care admissions, and previously healthy children who had sustained accidental trauma and those with new onset acute critical illness. Of note, the mortality rate within referred patients was significantly higher compared with the general PICU population, suggesting high need for pediatric psychology services during end-of-life care. Findings are discussed with respect to viable consultation models and training of pediatric psychologists who can function capably and confidently in the critical care setting.

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