Viruses and Mycoplasma pneumoniae are the main etiological agents of community-acquired pneumonia in hospitalized pediatric patients in Spain.

OBJECTIVES: To describe the etiology of community-acquired pneumonia (CAP) in hospitalized children in Spain and analyze the predictors of the etiology. HYPOTHESIS: The different etiological groups of pediatric CAP are associated with different clinical, radiographic, and analytical data. DESIGN: Observational, multicenter, and prospective study. PATIENT SELECTION: This study included children aged 1 month to 17 years with CAP, who were hospitalized between April 2012 and May 2019. METHODS: An extensive microbiological workup was performed. The clinical, radiographic, and analytical parameters were analyzed for three etiological groups. RESULTS: Among the 495 children included, at least one causative pathogen was identified in 262 (52.9%): pathogenic viruses in 155/262 (59.2%); atypical bacteria (AB), mainly Mycoplasma pneumonia, in 84/262 (32.1%); and typical bacteria (TyB) in 40/262 (15.3%). Consolidation was observed in 89/138 (64.5%) patients with viral CAP, 74/84 (88.1%) with CAP caused by AB, and 40/40 (100%) with CAP caused by TyB. Para-pneumonic pleural effusion (PPE) was observed in 112/495 (22.6%) patients, of which 61/112 (54.5%) presented a likely causative pathogen: viruses in 12/61 (19.7%); AB in 23/61 (37.7%); and TyB in 26/61 (42.6%). Viral etiology was significantly frequent in young patients and in those with low oxygen saturation, wheezing, no consolidation, and high lymphocyte counts. CAP patients with AB as the etiological agent had a significantly longer and less serious course as compared to those with other causative pathogens. CONCLUSIONS: Viruses and M. pneumoniae are the main causes of pediatric CAP in Spain. Wheezing, young age, and no consolidation on radiographs are indicative of viral etiology. Viruses and AB can also cause PPE. Since only a few cases can be directly attributed to TyB, the indications for antibiotics must be carefully considered in each patient.

Point-of-Care Echocardiography: A Useful Tool for Assessing Complex Arrhythmias in the Pediatric Intensive Care Unit.

OBJECTIVE: To demonstrate that the analysis of the atrioventricular, intraventricular, and interventricular asynchrony by point-of-care ultrasound (POCUS) could be an alternative tool for assessing complex arrhythmias in pediatric patients with congenital heart diseases, mainly when an epicardial register or electrophysiology study is not available. DESIGN: Descriptive, retrospective case series study. SETTING: The pediatric intensive care unit of a university-affiliated tertiary hospital in Spain. PATIENTS: The authors included 12 patients with congenital heart disease younger than 18 years admitted to the authors' pediatric intensive care unit (PICU) from January 2018 to December 2019, with complex arrhythmias after surgery, managed by performing a bedside echocardiography when an electrophysiology test or epicardial auriculogram was unavailable. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The authors included a total of 14 complex arrhythmias in 12 postsurgical patients in whom a comprehensive transthoracic electrocardiogram was not conclusive. The presence of atrioventricular, intraventricular, or interventricular asynchrony was assessed in standard echo views by performing M-mode and Doppler mitral inflow analysis, checking the heart motion. The final POCUS diagnoses were atrial flutter (n = 5), postsurgical atrioventricular block (n = 4), asynchrony induced by pacemaker (n = 2), junctional ectopic tachycardia (n = 1), nodal rhythm plus ventricular extrasystole (n = 1), and supraventricular tachycardia (n = 1). In all patients, regardless of the type of arrhythmia, detecting motion asynchrony was crucial for making the correct diagnosis. Offline cardiologist analysis of the POCUS scans showed full agreement. CONCLUSIONS: POCUS is a useful tool for initial diagnosis and management of complex arrhythmias in the PICU, mainly when epicardial auriculogram or electrophysiology studies are unavailable.

Factors associated with perioperative mortality in children and adolescents operated for tetralogy of Fallot: A sub-Saharan experience.

BACKGROUND: Patients with tetralogy of Fallot are now surviving to adulthood with timely surgical intervention. However, many patients in low-income countries have no access to surgical intervention. This paper reports the surgical access and perioperative mortality in a sub-Saharan center that was mainly dependent on visiting teams. METHODS: We reviewed records of patients operated from January 2009 to December 2014. We examined perioperative outcomes, primarily focusing on factors associated with perioperative mortality. RESULTS: During this period, 62 patients underwent surgery. Fifty-seven (91.9%) underwent primary repair, while 5 (6.5%) underwent palliative shunt surgery. Of the five patients with shunt surgery, four ultimately underwent total repair. Eight (12.9%) patients died during the perioperative period. Factors associated with perioperative mortality include repeated preoperative phlebotomy procedures (P < .001), repeated runs and long cardiopulmonary bypass time (P < .001), and aortic cross-clamp time (P < .001), narrow pulmonary artery (PA) valve annulus diameter (P = .022), narrow distal main PA diameter (P = .039), narrow left branch PA diameter (P = .049), and narrow right PA diameter (P = .039). Of these factors, cardiopulmonary bypass time/aortic cross-clamp time and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality. CONCLUSION: In this series of consecutive patients operated by a variety of humanitarian surgical teams, cardiopulmonary bypass time/aortic cross-clamp time, and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality risk. As some of these factors are modifiable, we suggest that they should be considered during patient selection and at the time of surgical intervention.

Are Pediatric Critical Personnel Satisfied With Their Lives? Prediction of Satisfaction With Life From Burnout, Posttraumatic Stress, and Posttraumatic Growth, and Comparison With Noncritical Pediatric Staff.

OBJECTIVES: Staff in PICUs shows high burnout, posttraumatic stress disorder symptoms, and posttraumatic growth levels. However, their levels of satisfaction with life and how positive and negative posttrauma outcomes relate to each other and contribute to predict satisfaction with life remain unknown. Thus, we attempted to explore these aspects and to compare the findings with data from pediatric professionals working in noncritical units. DESIGN: This is an observational multicentric, cross-sectional study. SETTING: The PICU of nine hospitals in Spain, and other pediatric units in the same hospitals. SUBJECTS: Two hundred ninety-eight PICU workers (57 physicians, 177 nurses, and 64 nursing assistants) and 189 professionals working in noncritical pediatric units (53 physicians, 104 nurses, and 32 nursing assistants). INTERVENTION: Participants completed the Maslach Burnout Inventory, the Trauma Screening Questionnaire, the Posttraumatic Growth Inventory, and the Satisfaction With Life Scale. MEASUREMENTS AND MAIN RESULTS: Of PICU staff, 16.4% were very satisfied with their lives, 34.2% were satisfied, 34.6% showed average satisfaction with life, and 14.8% were below average. No differences were found between PICU and non-PICU workers. Women reported lower satisfaction with life than men, and physicians reported higher satisfaction with life than other professional groups. The correlation between posttraumatic stress disorder and posttraumatic growth was low, but significant and positive. According to the path analysis with latent variables, 20% of the variance satisfaction with life could be predicted from burnout, posttraumatic stress disorder symptoms, and posttraumatic growth. Higher distress was inversely associated to satisfaction with life, whereas posttraumatic growth contributed to higher satisfaction with life. CONCLUSIONS: Posttraumatic growth can moderate the negative effect of traumatic work-related experiences in satisfaction with life. PICU and non-PICU workers were equally satisfied with their lives. Positive and negative impact of work-related potentially traumatic events can coexist in the same person. Interventions aimed at reducing distress and fostering posttraumatic growth could impact in an improvement in pediatric health professionals' satisfaction with life.

Burnout and posttraumatic stress in paediatric critical care personnel: Prediction from resilience and coping styles.

INTRODUCTION: Our aims were (1) to explore the prevalence of burnout syndrome (BOS) and posttraumatic stress disorder (PTSD) in a sample of Spanish staff working in the paediatric intensive care unit (PICU) and compare these rates with a sample of general paediatric staff and (2) to explore how resilience, coping strategies, and professional and demographic variables influence BOS and PTSD. MATERIALS AND METHODS: This is a multicentre, cross-sectional study. Data were collected in the PICU and in other paediatric wards of nine hospitals. Participants consisted of 298 PICU staff members (57 physicians, 177 nurses, and 64 nursing assistants) and 189 professionals working in non-critical paediatric units (53 physicians, 104 nurses, and 32 nursing assistants). They completed the Brief Resilience Scale, the Coping Strategies Questionnaire for healthcare providers, the Maslach Burnout Inventory, and the Trauma Screening Questionnaire. RESULTS: Fifty-six percent of PICU working staff reported burnout in at least one dimension (36.20% scored over the cut-off for emotional exhaustion, 27.20% for depersonalisation, and 20.10% for low personal accomplishment), and 20.1% reported PTSD. There were no differences in burnout and PTSD scores between PICU and non-PICU staff members, either among physicians, nurses, or nursing assistants. Higher burnout and PTSD rates emerged after the death of a child and/or conflicts with patients/families or colleagues. Around 30% of the variance in BOS and PTSD is predicted by a frequent usage of the emotion-focused coping style and an infrequent usage of the problem-focused coping style. DISCUSSION AND CONCLUSIONS: Interventions to prevent and treat distress among paediatric staff members are needed and should be focused on: (i) promoting active emotional processing of traumatic events and encouraging positive thinking; (ii) developing a sense of detached concern; (iii) improving the ability to solve interpersonal conflicts, and (iv) providing adequate training in end-of-life care.

Posttraumatic growth in pediatric intensive care personnel: Dependence on resilience and coping strategies.

OBJECTIVE: Staff in pediatric intensive care units (PICU) are inherently exposed to potentially traumatic events. Posttraumatic growth (PTG) is the occurrence of positive changes after experiencing a traumatic event. This study aims (a) to evaluate the prevalence of PTG in PICU staff, and whether their scores are different from those reported by professionals working in other pediatric units, (b) to explore the role of resilience and coping strategies in predicting PTG, and (c) to explore the relation of demographic and work-related variables with PTG. METHOD: Participants of this multicentric, cross sectional study were 298 PICU workers and 189 professionals working in noncritical pediatric units. They completed the Brief Resilience Scale, a Coping Strategies Questionnaire, the Posttraumatic Growth Inventory (PTGI), and provided demographic and work-related information. RESULTS: Of PICU staff, 68.8% experienced growth to a "great" or "very great" degree in at least one of the PTGI's dimensions. Higher PTG was reported following the death of a child or after a recent conflict with a work colleague. PICU workers and noncritical pediatric staff showed equivalent PTG levels. Multigroup path analysis with latent variables showed that emotion-focused coping was related to PTG only in PICU staff, whereas problem-focused coping was related to PTG in both groups. The relation between resilience and PTG was not significant. CONCLUSIONS: Work-related trauma can act as a catalyst for positive posttrauma changes. Modifying coping strategies may be a way to foster PTG in health care providers. (PsycINFO Database Record

Fluorosis y caries dental en niños de 6 a 12 años / Fluorosis and dental caries in children from 6 to 12 years old

El conocimiento de los factores de riesgo de la fluorosis y la caries dental es importante para disminuir la prevalencia de estas enfermedades. Se realizó un estudio descriptivo en niños de la zona rural de Ingenio Viejo, del municipio de Camagüey, con el objetivo de caracterizar la fluorosis y la caries dental, desde septiembre de 2011 hasta septiembre de 2012. La población de estudio estuvo conformada por 67 escolares, a los que se les determinó la presencia de fluorosis dental y los índices de dientes cariados, perdidos y obturados, en la dentición temporal y en la permanente (ceo-d y COP-D, respectivamente). Los factores de riesgo asociados a la caries dental que se tomaron en consideración fueron: susceptibilidad del esmalte, dieta cariogénica e higiene bucal deficiente. Se detectó la presencia de higiene bucal deficiente (71,6 por ciento) y dieta cariogénica (82,1 por ciento), sin embargo, el 29,8 por ciento y el 41,8 por ciento de los niños, respectivamente, aunque estuvieron sometidos a estos factores de riesgo no desarrollaron caries dental. El mayor por ciento de los niños sin caries (70,3 por ciento) presentó esmalte resistente. Se observó un índice ceo-d de 1,50 y COP-D de 0,20. De los pacientes sin fluorosis, el 60,6 por ciento no presentó caries dental (AU)

Knowing the risk factors for fluorosis and dental caries is important to reduce the prevalence of these diseases. A descriptive study was carried out in children from the rural area of Ingenio Viejo in Camagüey municipality, with the objective of characterizing fluorosis and dental caries from September, 2011 to September, 2012. The study population consisted of 67 schoolchildren to whom the presence of dental fluorosis, as well as rates of decay, missing, and filled primary and permanent teeth (ceo-d and COP-D, respectively) were determined. The risk factors associated to dental caries that were taken into consideration were: enamel susceptibility, cariogenic diet and poor oral hygiene. Despite the poor oral hygiene (71,6 percent) and the cariogenic diet (82,1 percent), the 29,8 percent and 41,8 percent of the children, respectively, although subjected to those risk factors, did not develop dental caries. The highest percentage of children without caries (70,3 percent) had resistant enamel. A CEO-d rate of 1,50 and COP-D of 0,20 were observed. Out of the patients without fluorosis, the 60,6 percent had no dental caries (AU)

Fluorosis dental en escolares de una zona rural de Camagüey / Dental fluorosis in schoolchildren from a rural area in Camagüey

El conocimiento de los factores de riesgo de la fluorosis dental es importante para disminuir la prevalencia de esta enfermedad. Determinar su severidad y evaluar los factores de riesgo asociados fue el objetivo de esta investigación, para lo cual se realizó un estudio descriptivo en los consultorios 46 y 64 de la zona rural de Ingenio Viejo, del municipio de Camagüey, en el período comprendido entre julio de 2011 y febrero de 2012. El universo estuvo constituido por 84 niños de seis a doce años y la muestra por 67 escolares. La fluorosis dental se clasificó en: leve, moderada y grave. Las concentraciones de flúor natural en el agua de consumo, la exposición a altas concentraciones del elemento y el tiempo de exposición al mismo, fueron los factores de riesgo asociados a la fluorosis dental estudiados. Al concluir el estudio, se observó un predominio de la fluorosis dental leve (52,9 por ciento), seguido de la moderada (38,2 por ciento). Las concentraciones de flúor natural encontradas en las aguas de consumo fueron óptimas (0,7 y 1,2 ppm) en el 44,8 por ciento de los casos y altas (1,7 y 2,0 ppm) en el 55,2 por ciento. El 81,8 por ciento de los casos sin fluorosis han estado expuestos a la acción del flúor solamente de uno a tres años, mientras que todos los niños con fluorosis dental lo han recibido por más de cuatro años, aumentando la severidad en la medida en que se incrementa el tiempo de exposición. El 36,4 por ciento de los niños que ingirieron flúor antes de los seis años no presentaron fluorosis dental (AU)

Knowing the risk factors of dental fluorosis is important to reduce the prevalence of this illness. A descriptive study was carried out with the objective to determine its seriousness and to evaluate its associated risk factors in the doctors offices 46 and 64 from the rural area of Ingenio Viejo in Camagüey from July, 2011 to February, 2012. The universe was made up of 84 children from six to twelve years old and the sample comprised 67 schoolchildren. The dental fluorosis was classified into: mild, moderate and severe. The concentrations of natural fluorine in the drinking water, the exposure to high concentrations of the element and the time of exposure were the associated risk factors. When the study was finished, there was a predominance of the mild dental fluorosis (52,9 percent), followed by the moderate one (38,2 percent). The concentrations of natural fluorine found in the drinking water were optimal (0,7 and 1,2 ppm) in the 44,8 percent of the cases and it was high (1,7 and 2,0 ppm) in the 55,2 percent. The 81,8 percent of the cases without fluorosis had been exposed to the action of fluorine only from one to three years, while all the children with dental fluorosis had received it for more than four years, increasing its seriousness as the time of exposure increased. The 36,4 percent of the children that consumed fluorine before six years old didn't present dental fluorosis (AU)

Características generales de la fluorosis dental / General characteristics of dental fluorosis

Se realizó una revisión bibliográfica, utilizando los recursos disponibles desde la red infomed, con el objetivo de describir las características generales de la fluorosis dental. Esta es la hipomineralización del esmalte dental y tiene tres formas de presentación: leve, moderada y severa. Su cuadro clínico esta dado principalmente por manchas blanquecinas que cubre una mínima superficie del diente, hasta manchas de color café oscuro y su complicación más temida es la fractura que causa una agresiva y acentuada pérdida de la estructura dentaria. Es causada por el acumulo excesivo de flúor en el diente. Su prevención está encaminada a la administración de flúor sistémico en las diferentes edades y entre las recomendaciones para evitarla se encuentra: usar en lo posible agua con el nivel adecuado de flúor, utilizar pastas de dientes con los contenidos óptimos de flúor, excepto en las zonas con aguas fluoradas y no aplicar las lacas fluoradas a estos niños (AU)

A bibliographical revision was carried out using the resources available in Infomed network, with the objective of describing the general characteristics of dental fluorosis, which is the hypo-mineralization of the dental enamel and has three presentation forms: light, moderate and severe. Its clinical manifestations are mainly presented by whitish spots that cover a minimal surface of the tooth, up to dark coffee color stains and its most alarming complication is the fracture that causes an aggressive and marked loss of the tooth structure. It is caused by the excessive accumulation of fluorine in the tooth. Its prevention is guided to the administration of systemic fluorine in different ages, and among the recommendations to avoid it, there are: to use water with the appropriate level of fluorine as it can be possible, to use toothpastes with the best contents of fluorine, except in the areas with fluoridated water and not to apply fluoridated lacquers to those children (AU)

Intervención educativa en salud bucal para gestantes / Oral health education in expectant mothers

El embarazo es un estado fisiológico modificado, en el cual el organismo materno sufre grandes cambios, por lo que se requiere de la gestante un proceso de autorregulación emocional y hábitos correctos de salud. Objetivo: evaluar el impacto de una estrategia de intervención educativa en salud bucal para gestantes. Método: se realizó un estudio de intervención comunitaria en la Clínica Estomatológica Ignacio Agramonte, del municipio Camagüey, desde enero hasta agosto de 2008. El universo se constituyó por las gestantes captadas desde diciembre de 2007 hasta abril de 2008 y la muestra no probabilística quedó integrada por 60 pacientes, igual número correspondió al universo de estudio. Se diagnosticaron factores de riesgo y problemas de salud bucal, se determinó el índice de higiene bucal y se aplicó una entrevista estructurada para obtener el nivel de información sobre salud bucal para luego implementar la estrategia educativa. Resultados: se detectó presencia de higiene bucal deficiente (83,3 %) y dieta cariogénica (78,3 %), el 76,6 % de las gestantes estaba afectada por enfermedad periodontal y el 61,6 % por caries dental. Al inicio de la investigación el nivel de información fue regular e insuficiente y la higiene bucal no aceptable (81,6 %); al finalizar los resultados fueron buenos y la higiene bucal aceptable (88,3%). Conclusiones: se destacaron el cepillado incorrecto y la dieta cariogénica como principales factores de riesgo para la salud bucal de las gestantes, y como afecciones bucales más frecuentes la enfermedad periodontal y la caries dental. Predominaron las evaluaciones de insuficiente y regular al analizar el nivel de información sobre salud bucal al inicio del estudio, y de bien y excelente al finalizar la intervención (AU)

Pregnancy is a modified physiological state, in which maternal organism suffers big changes, the expectant mother requires an emotional self-regulation process and correct habits of health. Objective: to evaluate the impact of an educational intervention strategy in oral health for expectant mothers. Method: a community intervention study at “Ignacio Agramonte” Odontology clinic in Camagüey municipality was conducted, from January to August 2008. The universe was constituted by pregnant women that came to the clinic from December 2007 to April 2008; the sample was integrated by 60 patients which coincide with the universe by non probabilistic sampling. Risk factors and oral health problems were found, the oral hygiene index was determined through the appropriate technique and the level of information on oral health was also obtained by means of an interview for implementing the educational intervention. Results: deficient oral hygiene (83,3 %) and cariogenic diet (78,3 %) was detected. The 76,6 % of pregnant women were affected by periodontal disease and the 61,6 % by dental caries. At the beginning of the investigation the level of information on oral health was regular and insufficient, and the oral hygiene was not acceptable (81,6 %). At the end of study the results were good and the oral hygiene was acceptable (88,3 %). Conclusions: incorrect brushing and cariogenic diet as main risk factors for pregnant´s oral health and as the most frequent oral affections the periodontal disease and dental caries. Insufficient and regular evaluations predominated when analyzing the level of information on oral health at the beginning of the study, good and excellent at the end of the intervention (AU)

Intervención educativa en salud bucal para gestantes / Oral health education in expectant mothers

El embarazo es un estado fisiológico modificado, en el cual el organismo materno sufre grandes cambios, por lo que se requiere de la gestante un proceso de autorregulación emocional y hábitos correctos de salud. Objetivo: evaluar el impacto de una estrategia de intervención educativa en salud bucal para gestantes. Método: se realizó un estudio de intervención comunitaria en la Clínica Estomatológica Ignacio Agramonte, del municipio Camagüey, desde enero hasta agosto de 2008. El universo se constituyó por las gestantes captadas desde diciembre de 2007 hasta abril de 2008 y la muestra no probabilística quedó integrada por 60 pacientes, igual número correspondió al universo de estudio. Se diagnosticaron factores de riesgo y problemas de salud bucal, se determinó el índice de higiene bucal y se aplicó una entrevista estructurada para obtener el nivel de información sobre salud bucal para luego implementar la estrategia educativa. Resultados: se detectó presencia de higiene bucal deficiente (83,3 %) y dieta cariogénica (78,3 %), el 76,6 % de las gestantes estaba afectada por enfermedad periodontal y el 61,6 % por caries dental. Al inicio de la investigación el nivel de información fue regular e insuficiente y la higiene bucal no aceptable (81,6 %); al finalizar los resultados fueron buenos y la higiene bucal aceptable (88,3%). Conclusiones: se destacaron el cepillado incorrecto y la dieta cariogénica como principales factores de riesgo para la salud bucal de las gestantes, y como afecciones bucales más frecuentes la enfermedad periodontal y la caries dental. Predominaron las evaluaciones de insuficiente y regular al analizar el nivel de información sobre salud bucal al inicio del estudio, y de bien y excelente al finalizar la intervención.

Pregnancy is a modified physiological state, in which maternal organism suffers big changes, the expectant mother requires an emotional self-regulation process and correct habits of health. Objective: to evaluate the impact of an educational intervention strategy in oral health for expectant mothers. Method: a community intervention study at “Ignacio Agramonte” Odontology clinic in Camagüey municipality was conducted, from January to August 2008. The universe was constituted by pregnant women that came to the clinic from December 2007 to April 2008; the sample was integrated by 60 patients which coincide with the universe by non probabilistic sampling. Risk factors and oral health problems were found, the oral hygiene index was determined through the appropriate technique and the level of information on oral health was also obtained by means of an interview for implementing the educational intervention. Results: deficient oral hygiene (83,3 %) and cariogenic diet (78,3 %) was detected. The 76,6 % of pregnant women were affected by periodontal disease and the 61,6 % by dental caries. At the beginning of the investigation the level of information on oral health was regular and insufficient, and the oral hygiene was not acceptable (81,6 %). At the end of study the results were good and the oral hygiene was acceptable (88,3 %). Conclusions: incorrect brushing and cariogenic diet as main risk factors for pregnant´s oral health and as the most frequent oral affections the periodontal disease and dental caries. Insufficient and regular evaluations predominated when analyzing the level of information on oral health at the beginning of the study, good and excellent at the end of the intervention.

Levels of N-terminal-pro-brain natriuretic peptide in congenital heart disease surgery and its value as a predictive biomarker.

OBJECTIVES: To explore the value of N-terminal-pro-brain natriuretic peptide (NT-ProBNP) as a predictive biomarker of postoperative cardiovascular surgery. METHODS: A prospective study of 68 patients (0-15 years), submitted to open-heart surgery was conducted. NT-ProBNP and other biochemical and clinical markers were measured preoperatively and during the first 48 postoperative hours. RESULTS: NT-ProBNP preoperative reduced one hour after surgery, increased significantly later, and remained without change between 12 hours and 48 hours postoperatively. Peak values (24 hours) were correlated with preoperative levels (R=0.73; P<0.001), risk adjustment congenital heart surgery-1 (R=0.37; P<0.002), length of cardiopulmonary bypass (CPB) (R=0.57; P<0.001); age (R=-0.55; P<0.001) and weight of patients (R=-0.46; P<0.001). Independent predictors of NT-ProBNP-peak were preoperative value (ß=0.42) and CPB length (ß=0.24; R(2) of model 0.63; P<0.001). The peak values were correlated to a maximum inotropic score (R=0.46; P<0.001), duration of inotropic therapy (R=0.44; P<0.001), duration of mechanical ventilation support (R=0.39; P<0.001) and length of stay in the Pediatric Intensive Care Unit (R=0.45; P<0.001). Independent predictors of enhanced intensive care unit stay, controlling by risk adjustment score, were high preoperative NT-ProBNP (OR 5.5, 95% CI 1.2-25.5), and high postoperative troponine (OR 10.5, 95% CI 2.2-49.2). CONCLUSIONS: NT-ProBNP concentration is dependent on time during the perioperative period, it peaks at 24 hours and depends on the preoperative value and CPB length. A high peptide level before surgery is an independent predictor of prolonged stay in intensive pediatric care.