Biomarkers of acute kidney injury in pediatric cardiac surgery.

Acute kidney injury (AKI) is characterized by a sudden decrease in kidney function. Children with congenital heart disease are a special group at risk of developing AKI. We performed a systematic review of the literature to search for studies reporting the usefulness of novel urine, serum, and plasma biomarkers in the diagnosis and progression of AKI and their association with clinical outcomes in children undergoing pediatric cardiac surgery. In thirty studies, we analyzed the capacity to predict AKI and poor outcomes of five biomarkers: Cystatin C, Neutrophil gelatinase-associated lipocalin, Interleukin-18, Kidney injury molecule-1, and Liver fatty acid-binding protein. In conclusion, we suggest the need for further meta-analyses with the availability of additional studies.

Pediatric Critical Care Resource Use by Children with Medical Complexity.

OBJECTIVES: To examine the proportionate use of critical care resources among children of differing medical complexity admitted to pediatric intensive care units (ICUs) in tertiary-care children's hospitals. STUDY DESIGN: This is a retrospective, cross-sectional study of all children (<19 years of age) admitted to a pediatric ICU between January 1, 2012, and December 31, 2013, in the Pediatric Health Information Systems database. Using the Pediatric Medical Complexity Algorithm, we assigned patients to 1 of 3 categories: no chronic disease, noncomplex chronic disease (NC-CD), or complex chronic disease (C-CD). Baseline demographics, hospital costs, and critical care resource use were stratified by these groups and summarized. RESULTS: Of 136 133 children with pediatric ICU admissions, 53.0% were categorized as having C-CD. At the individual-encounter level, ICU resource use was greatest among patients with C-CD compared with children with NC-CD and no chronic disease. At the hospital level, patients with C-CD accounted for more than 75% of all examined ICU resources, including ventilation days, ICU costs, extracorporeal membrane oxygenation runs, and arterial and central venous catheters. Children with a progressive condition accounted for one-half of all ICU resources. In contrast, patients with no chronic disease and NC-CD accounted for less than one-quarter of all ICU therapies. CONCLUSION: Children with medical complexity disproportionately use the majority of ICU resources in children's hospitals. Efforts to improve quality and provide cost-effective care should focus on this population.

Racial disparities in failure-to-rescue among children undergoing congenital heart surgery.

OBJECTIVE: To determine if racial/ethnic disparities exist among children undergoing congenital heart surgery, using failure-to-rescue (FTR) as a measure of hospital-based quality. STUDY DESIGN: This is a retrospective, repeated cross-sectional analysis using admissions from the 2003, 2006, and 2009 Kids' Inpatient Database. All pediatric admissions (≤ 18 years) with a Risk Adjustment for Congenital Heart Surgery procedure were included. Logistic regression models examining complications, FTR, and overall mortality were constructed. RESULTS: Hispanic ethnicity (OR 1.13, 95% CI 1.01-1.26) was associated with increased odds of experiencing a complication when compared with white race. However, black race (OR 1.66, 95% CI 1.33-2.07) and other race/ethnicity (OR 1.40, 95% CI 1.10-1.79) were risk factors for FTR. Although Hispanic ethnicity was associated with increased odds of experiencing a complication, it was not associated with FTR. In hospital fixed-effects models, black race and other race/ethnicity remained as "within hospital" risk factors for FTR. CONCLUSIONS: Black children and children of other race/ethnicity had higher rates of mortality after experiencing a complication. This suggests that racial disparities may exist in hospital-based cardiac care or response to care.