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The pattern of early multiorgan system failure and death, minimal relative cost of CVVH/D provision, and potential for improved outcome with initiation of CVVH/D at lesser degrees of fluid overload are factors that may support early initiation of CVVH/D in critically ill children with acute renal failure.

A variety of patient features are associated with an increase in extubation failure rate, and serious outcome consequences characterize the extubation failure population in PICUs.

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ABSTRACT. Background. Hemoptysis is uncommon in pediatric practice. We reviewed 10 years of experience with hemoptysis in a tertiary pediatric hospital to identify patient characteristics and predictors of mortality.Methods. Patients were divided into four age groups (0 to 5, 6 to 10, 11 to 20, and >20 years). Hemoptysis was defined as mild (<150 mL/day), large (150 to 400 mL/day), or massive (>400 mL/day). Fever was defined as 38.5°C.Results. A total of 228 patients (115 males and 113 females) with 246 episodes of hemoptysis were identified and grouped according to primary diagnosis. There were 149 patients in the cystic fibrosis (CF) group, 37 in the congenital heart disease (CHD) group, and 42 in the Other group. Age was significantly higher in the CF group compared with the CHD and Other groups. Length of stay was significantly prolonged in the CF group compared with the Other group. The overall mortality was 13%. After initial analysis, mortality predictors were age, amount of hemoptysis, receipt of blood products, and fever. After stratification, we found: 1) in the >20-year age group, there was a difference in mortality when comparing CF patients with CHD patients; 2) for patients who received blood products, there were differences in mortality in patients with CF, CHD, and Other diagnoses; 3) for patients who received blood, there were differences in mortality only for the 0-to 5-year age group; and 4) the amount of hemoptysis was predictive for mortality only in CHD patients.Conclusions. Hemoptysis presented in young adult CF patients and in adolescent CHD patients. Young adult CF patients with hemoptysis had a higher risk of mortality compared with young adult CHD patients.

OBJECTIVE: To review recent health policies related to measuring child health care quality, the selection processes of national child health quality measures, the nationally recommended quality measures for child mental health care and their evidence strength, the progress made toward developing new measures, and early lessons learned from these national efforts.METHODS: Methods used included description of the selection process of child health care quality measures from 2 independent national initiatives, the recommended quality measures for child mental health care, and the strength of scientific evidence supporting them. RESULTS:Of the child health quality measures recommended or endorsed during these national initiatives, only 9 unique measures were related to child mental health. CONCLUSIONS:The development of new child mental health quality measures poses methodologic challenges that will require a paradigm shift to align research with its accelerated pace. Pediatrics 2013;131: S38-S49 AUTHORS:

Community-based case managers are more effective than traditional Medicaid/SCHIP outreach and enrollment in insuring uninsured Latino children. Case management may be a useful mechanism to reduce the number of uninsured children, especially among high-risk populations.