ObjectiveChild restraint system (CRS) is designed to protect children from injury during motor vehicle crash (MVC). However, there is no regulation or enforcement of CRS use in Saudi Arabia. This study estimated the prevalence of CRS use and identified patterns of child transportation in Riyadh, Saudi Arabia.MethodsIn this cross-sectional study, a self-administered questionnaire was distributed across Riyadh targeting families who drove with children aged less than 5 years. The questionnaire inquired about CRS availability, patterns of child transportation if a CRS was unavailable, seat belt use by the driver and adult passengers, and the perception of CRS.ResultsOf 385 respondents, only 36.6% reported the availability of a CRS (95% CI: 31.8–41.7%), with only half of those reported consistent use 74 (52.2%). Nearly 30% of all children aged less than 5 years were restrained during car journeys. Sitting on the lap of an adult passenger on the front seat was the most common pattern of child transportation (54.5%). Approximately 13.5% of respondents were involved in an MVC while driving with children; 63.5% of these children were unprotected by any safety system. Seat belt use by drivers was low, with only 15.3% reporting constant use.ConclusionThe prevalence of CRS use in Riyadh is low, and safety practices are seldom used by drivers and passengers. In addition to legal enforcement of CRS use, implementation of a child transportation policy with age-appropriate height and weight specifications is imperative.

Background Sepsis remains a major cause of death, with high mortality and morbidity rates in children. The cause of mortality may be associated with several factors, including differences in cultures and the type of organism. This study was aimed at evaluating the characteristics and outcomes of negative bacterial blood culture compared to those of positive bacterial blood culture in children with severe sepsis/septic shock.

Background Mechanical power is a composite variable for energy transmitted to the respiratory system over time that may better capture risk for ventilator-induced lung injury than individual ventilator management components. We sought to evaluate if mechanical ventilation management with a high mechanical power is associated with fewer ventilator-free days (VFD) in children with pediatric acute respiratory distress syndrome (PARDS). Methods Retrospective analysis of a prospective observational international cohort study. Results There were 306 children from 55 pediatric intensive care units included. High mechanical power was associated with younger age, higher oxygenation index, a comorbid condition of bronchopulmonary dysplasia, higher tidal volume, higher delta pressure (peak inspiratory pressure—positive end-expiratory pressure), and higher respiratory rate. Higher mechanical power was associated with fewer 28-day VFD after controlling for confounding variables (per 0.1 J·min−1·Kg−1 Subdistribution Hazard Ratio (SHR) 0.93 (0.87, 0.98), p = 0.013). Higher mechanical power was not associated with higher intensive care unit mortality in multivariable analysis in the entire cohort (per 0.1 J·min−1·Kg−1 OR 1.12 [0.94, 1.32], p = 0.20). But was associated with higher mortality when excluding children who died due to neurologic reasons (per 0.1 J·min−1·Kg−1 OR 1.22 [1.01, 1.46], p = 0.036). In subgroup analyses by age, the association between higher mechanical power and fewer 28-day VFD remained only in children < 2-years-old (per 0.1 J·min−1·Kg−1 SHR 0.89 (0.82, 0.96), p = 0.005). Younger children were managed with lower tidal volume, higher delta pressure, higher respiratory rate, lower positive end-expiratory pressure, and higher PCO2 than older children. No individual ventilator management component mediated the effect of mechanical power on 28-day VFD. Conclusions Higher mechanical power is associated with fewer 28-day VFDs in children with PARDS. This association is strongest in children < 2-years-old in whom there are notable differences in mechanical ventilation management. While further validation is needed, these data highlight that ventilator management is associated with outcome in children with PARDS, and there may be subgroups of children with higher potential benefit from strategies to improve lung-protective ventilation. Take Home Message: Higher mechanical power is associated with fewer 28-day ventilator-free days in children with pediatric acute respiratory distress syndrome. This association is strongest in children <2-years-old in whom there are notable differences in mechanical ventilation management.

Fazio-Londe syndrome is a rare neurological disorder presenting with sensorineural deafness, bulbar palsy and respiratory compromise that is caused by mutation in the SLC52A3 gene, which encodes the intestinal (hRFT2) riboflavin transporter. We report a patient with early onset of Fazio-Londe syndrome as the first case report in Saudi Arabia with rapid regression to death at 24 months of age.