Impact of Hemolysis on Acute Kidney Injury and Mortality in Children Supported with Cardiac Extracorporeal Membrane Oxygenation.

Intravascular hemolysis with elevated plasma-free hemoglobin (PFH) complicates extracorporeal membrane oxygenation (ECMO). In 50 consecutive pediatric cardiac patients requiring ECMO, we sought to describe the relationship between PFH and clinical outcomes; primary outcomes were acute kidney injury (AKI) and prolonged (>14 days) renal replacement therapy (RRT). Median age was 35 days, median weight 3.9 kg, and median ECMO duration 4.2 days. Seventy-eight percent (39/50) weaned off ECMO; survival to discharge was 50% (25/50). Seventy percent (35/50) had AKI on ECMO. Seventy-seven percent (30/39) required RRT post-ECMO; median duration was 5.2 days (0, 14.2). Prolonged RRT was associated with higher daily PFH (67.5 mg/dL [54.1, 102.5] vs. 46.7 mg/dL [40, 72.6], p = .025) and higher peak PFH (120 mg/dL [90, 200] vs. 60 mg/dL [40, 135], p = .016). After adjusting for ECMO duration and oliguria/elevated creatinine on ECMO day 0, peak PFH >90 mg/dL was associated with prolonged RRT (operating room [OR] = 18, confidence interval [CI] 1.9-167.8). Patients who died had higher daily PFH (65 mg/dL [51.6, 111.7] vs. 42.5 mg/dL [37.5, 60], p = .0040). Adjusting for ECMO duration and blood product administration, daily PFH >53 mg/dL was associated with mortality (OR 4.8, CI 1.01-23.3). Elevated PFH during pediatric cardiac ECMO is associated with prolonged RRT and non-survival to discharge. Initiatives to decrease PFH burden may improve clinical outcomes.

Turning on lanthanide luminescence via nanoencapsulation.

Encapsulation of macrocyclic europium(III) chelates by discrete, monodisperse SiO2 nanoparticles (NPs) has been carried out, and the resulting significant enhancement of metal-derived luminescence has been studied to rationalize this dramatic effect. The tetraiminodiphenolate motif chosen for this study is easily synthesized and incorporated into the NP matrix under ambient conditions. The free complex exhibits primarily weak ligand-derived emission at room temperature, typical for these compounds, and displays intense metal-centered luminescence from the europium only when cooled to 77 K. Upon encapsulation by the NPs, however, europium-derived luminescence is visibly "turned on" at room temperature, yielding strong emission peaks characteristic of europium(III) with a corresponding enhancement factor of 6 × 10(6). The similar ligand singlet and triplet excited-state energies determined for the free complex (20820 and 17670 cm(-1), respectively) versus the encapsulated complex (20620 and 17730 cm(-1)) indicate that encapsulation does not affect the energy levels of the ligand appreciably. Instead, a detailed analysis of the metal-centered emission and ligand singlet and triplet emission bands for the free and encapsulated complexes reveals that the enhanced metal emission is due to the rigid environment afforded by the silica NP matrix affecting vibrationally mediated energy transfer. Further, the metal-centered emission lifetimes in methanol versus deuterated methanol indicate a decrease in the number of coordinated solvent molecules upon encapsulation, changing from an average of 3.3 to 2.1 bound methanol molecules and reducing the known quenching effect on europium-centered luminescence due to nearby OH vibrations.