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Background Acute kidney injury (AKI) increases the morbidity of critically ill children. Thus, it is necessary to identify better renal biomarkers to follow the outcome of these patients. This prospective case–control study explored the clinical value of a urinary biomarker profile comprised of neutrophil gelatinase lipocalin (uNGAL), fibroblast growth factor-2 (uFGF-2), and epidermal growth factor (uEGF) to follow these patients. Methods Urine samples were collected from 21 healthy children, and 39 critically ill children (mean age 7.5 years±6.97 SD) admitted to a pediatric intensive care unit with sepsis or requiring extra corporeal membrane oxygenation (ECMO). uNGAL, uFGF-2, and uEGF levels were measured using ELISA kits during the first 24 h of admission to PICU, at peak of illness, and upon resolution of the critical illness. Results On admission, the uNGAL and uFGF-2 levels were increased, and the uEGF levels were decreased, in critically ill children with AKI (n=19) compared to those without AKI (n=20), and healthy controls. A biomarker score using the combined cut-off values of uNGAL, uFGF-2, and uEGF (AUC=0.90) showed the highest specificity to identify children with AKI, relative to each biomarker alone. uNGAL and uFGF-2 on admission showed high sensitivity and specificity to predict mortality (AUC=0.82). Conclusions The biomarker profile comprised of uNGAL, uFGF-2, and uEGF increased the specificity to detect AKI in critically ill children, when compared to each biomarker used alone. uNGAL and uFGF-2 may also predict the risk of death. Further validation of these findings in a large sample size is warranted.

Objective and background: Objective monitoring of cough may be preferred to subjective reporting of the symptom in clinical and research settings. Therefore, a self-contained, ambulatory cough monitoring system is needed that is non-invasive, usable for children and adults of all ages, inexpensive, and highly accurate with easy to use analysis software.Methodology: After development of a new device, 15 subjects with frequent coughing were recorded with the novel cough monitor and a simultaneous video recording in order to validate the monitor compared with a gold standard. Two investigators independently analyzed the recordings and counted the number of coughs during the study period from both the cough monitor and the video recording.Results: When measuring agreement between the two investigators, the sample concordance correlation coefficient for audio counts was 0.998 (p < 0.001). In the comparison of video counts, the sample concordance correlation coefficient was 0.997 (p < 0.001). For the comparison of investigator 1's video counts to the corresponding audio counts, the sample concordance correlation coefficient was 0.968 (p = 0.026). For the comparison of investigator 2's video counts to the corresponding counts, the sample concordance correlation coefficient was 0.973 (p = 0.015). Conclusion:We have developed and piloted a new, valid, and reproducible method of objectively recording and analyzing cough. This device appears to be useful for subjects of any age and in clinical and research settings.

OBJECTIVES: To describe trends in critical illness from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children over the course of the COVID-19 pandemic. We hypothesized that PICU admission rates were higher in the Omicron period compared with the original outbreak but that fewer patients needed endotracheal intubation. DESIGN: Retrospective cohort study. SETTING: This study took place in nine U.S. PICUs over 3 weeks in January 2022 (Omicron period) compared with 3 weeks in March 2020 (original period). PATIENTS: Patients less than or equal to 21 years old who screened positive for SARS-CoV-2 infection by polymerase chain reaction or hospital-based rapid antigen test and were admitted to a PICU or intermediate care unit were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 267 patients (239 Omicron and 28 original) were reviewed. Forty-five patients in the Omicron cohort had incidental SARS-CoV-2 and were excluded from analysis. The Omicron cohort patients were younger compared with the original cohort patients (median [interquartile range], 6 yr [1.3–13.3 yr] vs 14 yr [8.3–17.3 yr]; p = 0.001). The Omicron period, compared with the original period, was associated with an average increase in COVID-19–related PICU admissions of 13 patients per institution (95% CI, 6–36; p = 0.008), which represents a seven-fold increase in the absolute number admissions. We failed to identify an association between cohort period (Omicron vs original) and odds of intubation (odds ratio, 0.7; 95% CI, 0.3–1.7). However, we cannot exclude the possibility of up to 70% reduction in intubation. CONCLUSIONS: COVID-19–related PICU admissions were seven times higher in the Omicron wave compared with the original outbreak. We could not exclude the possibility of up to 70% reduction in use of intubation in the Omicron versus original epoch, which may represent differences in PICU/hospital admission policy in the later period, or pattern of disease, or possibly the impact of vaccination.

Rationale: Children contribute to 5% of coronavirus disease of 2019 (COVID-19)related hospitalizations in the United States. There is mounting evidence suggesting childhood asthma is a risk factor for severe disease. We hypothesized that asthma is associated with longer length of stay (LOS) and need for respiratory support among children admitted to pediatric intensive care unit (PICU) with COVID-19. Methods:We reviewed 150 charts of children and young adults with a positive severe acute respiratory syndrome coronavirus 2polymerase chain reaction test admitted to the PICU at Children's National Hospital, Washington, DC between 2020 and 2021. We recorded demographics, anthropometrics, past medical history, clinical course, laboratory findings, imaging, medication usage, respiratory support, and outcomes. Functional Status Scale (FSS), which measures an Intensive Care Unitpatient's physical function, was used to characterize children with multiple comorbidities; FSS and obesity were included as covariates in multivariate analysis.Statistical analysis was performed using SPSS v25.0.Results: Sixty-Eight patients ages 0-21 years met inclusion criteria. Median age was 14.9 years, 55.9% were female, median Body Mass Index percentile was 62, and 42.6% were African American. Compared with those without asthma, patients with asthma averaged longer LOS (20.7 vs. 10.2 days, p = 0.02), with longer PICU stay (15.9 vs. 7.6 days, p = 0.033) and prolonged maximum respiratory support (8.3 vs. 3.3 days, p = 0.016).Adjusted for obesity and poor physical function (FSS > 6), asthma remained a significant predictor of hospital LOS, PICU LOS, and days on maximum respiratory support. Conclusion: Asthma can cause severe disease with prolonged need for maximum respiratory support among children with COVID-19. K E Y W O R D S asthma and early wheeze, critical care, mechanical ventilation, oxygenation and therapy 1 | BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease of 2019 (COVID-19), has affected 91 million individuals in the United States (US) and led to over 1 million deaths as of July 2022. 1 Nineteen percent of COVID-19 cases have been in children less than 18 years of age. As of March 3, 2022, children made up 1.3%-4.7% of all cumulative COVID-19-related hospitalizations in the United States, 2 and up to 30% of pediatric hospitalizations were in the pediatric intensive care unit (PICU). 3