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The Surgical Critical Care Committee has identified the following literature reviews to help identify best-practice and appropriate standards for clinical management of pediatric surgical disease.

If you have questions, contact Samir Gadepalli.

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Literature Reviews

Visual abstracts offer a quick snapshot of the articles.  Follow APSA on Facebook and Twitter.

Other articles you may find interesting:
Bacterial and Fungal Etiology of Sepsis in Children in the United States: Reconsidering Empiric Therapy
Prout AJ et al. Crit Care Med. 2019 Nov 27 PMID 31789702

Bleeding Assessment Scale in Critically Ill Children (BASIC): Physician-Driven Diagnostic Criteria for Bleeding Severity
Nellis ME et al. Crit Care Med. 2019 Dec;47(12)1766-1772 PMID 31567407

Effect of Gastric Residual Evaluation on Enteral Intake in Extremely Preterm Infants: A Randomized Clinical Trial
Parker LA, Weaver M, Murgas Torrazza RJ, Shuster J, Li N, Krueger C, Neu J
JAMA Pediatr. 2019 Jun 1;173(6):534-543. doi: 10.1001/jamapediatrics.2019.0800
PMID: 31034045

Click here to view the Visual Abstract.

What this study adds
This was a single center randomized clinical trial comparing the omission of gastric residual evaluation with prefeed gastric residual evaluation. The authors found that among extremely preterm infants, the omission of gastric residual evaluation increased the delivery of enteral nutrition as well as improved weight gain, especially at week 5 and 6 after birth, and led to earlier hospital discharge. When controlled for gestational age, infants in the no residual group were discharged on average 8 days earlier. In addition, the no residual group was not found to have an increased incidence of NEC or ventilator associated pneunmonia.

Other articles you might find interesting:
Mortality of Critically Ill Children Requiring Continuous Renal Replacement Therapy: Effect of Fluid Overload, Underlying Disease, and Timing of Initiation
Cortina G, McRae R, Hoq M, Donath S, Chiletti R, Arvandi M, Gothe RM, Joannidis M, Butt W
Pediatr Crit Care Med. 2019 Apr;20(4):314-322. doi: 10.1097/PCC.0000000000001806
PMID: 30431556

Extracorporeal Cardiopulmonary Resuscitation: One-Year Survival and Neurobehavioral Outcome Among Infants and Children With In-Hospital Cardiac Arrest
Meert KL, Guerguerian AM, Barbaro R, Slomine BS, Christensen JR, Berger J, Topjian A, Bembea M, Tabbutt S, Fink EL, Schwartz SM, Nadkarni VM, Telford R, Dean JM, Moler FW; Therapeutic Hypothermia After Pediatric Cardiac Arrest (THAPCA) Trial Investigators
Crit Care Med. 2019 Mar;47(3):393-402. doi: 10.1097/CCM.0000000000003545
PMID: 30422861

Neurologic Outcomes After Extracorporeal Membrane Oxygenation: A Systematic Review
Boyle et al. Pediatr Crit Care Med. 2018 Aug;19(8):760-766. 
PMID: 29894448
A wide range of disabilities were identified on a systematic review of neurologic outcomes after extracorporeal life support in children including behavior problems (16 to 46%) and severe motor impairment (12%). The quality of life, evaluated at school age or adolescence, was more than one standard deviation below the population mean at their respective groups. The study highlights a need for consistent, long term follow up in pediatric patients after ECMO and counseling of expectations for parents and families.

*Click here to view the Visual Abstract.

Other articles you might find interesting:
The Rate of PD Catheter Complication does not Increase with Simultaneous Abdominal Surgery
Miyata t al. J Pediatr Surg. 2018 Aug;53(8):1499-1503. 
PMID: 29249456 

Cardiac Index Changes With Fluid Bolus Therapy in Children With Sepsis – An Observational Study
Long et al. Pediatr Crit Care Med. 2018 Jun;19(6):513-518. 
PMID: 29533353

Short-term Neurodevelopmental Outcome in Congenital Diaphragmatic Hernia: The Impact of Extracorporeal Membrane Oxygenation and Timing of Repair
Danzer, et al. Pediatr Crit Care Med. 2018 Jan;19(1):64-74 PMID: 29303891
This retrospective study assessed neurodevelopmental outcomes at a median age of 22 months. The authors found that the need for extracorporeal membrane oxygenation in patients with congenital diaphragmatic hernias is associated with worse neurocognitive and neuromotor outcomes. They also found that the need for congenital diaphragmatic hernia repair while on extracorporeal support is associated with worse cognitive and motor scores. Twenty percent of congenital diaphragmatic hernia survivors repaired on extracorporeal membrane oxygenation (ECMO) support scored within the average range for all composite domains. Based on this analysis it may be that children who can be successfully weaned off ECMO support and undergo a delayed CDH repair have improved outcomes with decreased mortality and neurodevelopmental sequelae.

Other articles you might find interesting:
Initiating Nutritional Support Before 72 Hours is Associated with Favorable Outcome After Severe Traumatic Brain Injury in Children: A Secondary Analysis of a Randomized, Controlled Trial of Therapeutic Hypothermia
Meinert, et al. Pediatr Crit Care Med. 2018 Apr;19(4):345-352 PMID: 29370008

Renal Replacement Therapy in the Critically Ill Child
Westrope, et al. Pediatr Crit Care Med. 2018 Mar;19(3):210-217 PMID: 29315136

Vascular Access in Critically Ill Pediatric Patients With Obesity.
Halvorson EE, Case D, Skelton JA, McCrory MC.
Pediatr Crit Care Med. 2018 Jan;19(1):1-8. 
Question: Are children with obesity more likely to require vascular device insertion and do they develop more complications associated with that access?
Findings: 120,272 patients were admitted to the PICU in 94 US hospitals. 73,964 vascular devices were placed in 45,409 patients (38% of total cohort). Placement of vascular access devices decreased with increasing BMI. Overall, there were more device complications associated with class 3 obesity, and more mechanical and bleeding complications associated with all classes of obesity. 
Meaning: Vascular access devices may be more difficult to place in obese patients, and may be one of the contributing factors to the reduced number of devices. Patients with obesity, especially those in increased BMI categories, although less likely to have a more permanent device placed, were more likely to keep those devices in place upon discharge. This may be due to concerns about being able to regain access should the patient return to the PICU. Obese patients may also have had increased complications because their total device time was also longer.

Cannulating the contraindicated: effect of low birth weight on mortality in neonates with congenital diaphragmatic hernia on extracorporeal membrane oxygenation.
Delaplain PT, Zhang L, Chen Y, Nguyen DV, Di Nardo M, Cleary JP, Yu PT, Guner YS.
J Pediatr Surg. 2017 Dec;52(12):2018-2025. 
Question: Do infants with CDH requiring ECMO with either a birth weight of <2 kg or a gestational age at birth of <34 weeks have an increased risk of death?
Findings: In the ELSO registry between 1988 and 2015, 7564 neonates with CDH were treated with ECMO, 100 of which had a BW <2kg. Patients with birth weight <2 kg had an increased risk of death, but did not have an increased risk of neurologic complications. However, those patients with gestational age at birth of <34 weeks did have an increased risk of neurologic complications.
Meaning: Birth weight of <2 kg and a gestational age of <34 weeks are typically listed as cutoffs for use of ECMO in the management of CDH. This study suggests that given improved strategies for anticoagulation and ventilator management, ECMO may be safe to offer in this population, however it may lead to increased neurologic complications. Additionally, long-term neurodevelopmental outcomes were not evaluated.

Short-Term Neurodevelopmental Outcome in Congenital Diaphragmatic Hernia: The Impact of Extracorporeal Membrane Oxygenation and Timing of Repair.
Danzer E, Hoffman C, D’Agostino JA, Connelly JT, Waqar LN, Gerdes M, Bernbaum J, Rintoul NE, Herkert LM, Peranteau WH, Flake AW, Adzick NS, Hedrick HL.
Pediatr Crit Care Med. 2018 Jan;19(1):64-74. 
Question: Does the need for ECMO and timing of repair of CDH affect neurodevelopmental outcome?
Findings: 212 total patients were enrolled in follow-up program, 24% of which had required ECMO. Children with CDH that required ECMO had lower cognitive and motor composite scores (Bayley Scales of Infant Development) at a median age of 22 month. Additionally, patients that required CDH repair while on ECMO had deficits in multiple domains. 
Meaning: Overall, patients with CDH score lower on neurodevelopmental scales than patients without CDH. Additionally, the need for ECMO in these patients is associated with significant neurodevelopmental delays or deficits. Timing of CDH repair may represent a modifiable risk factor for poor neurodevelopmental outcome. 

Dexmedetomidine for Sedation During Noninvasive Ventilation in Pediatric Patients.
Venkatraman R, Hungerford JL, Hall MW, Moore-Clingenpeel M, Tobias JD.
Pediatr Crit Care Med. 2017 Sep;18(9):831-837.
Summary: Over the past 10 years or so the use of dexmedetomidine has become progressively more and more widespread. In many centers it is now routinely used as the first line agent for sedation in the PICU. In addition, because of its safety profile when it comes to hypotension and respiratory depression, many have begun to use Dexmedetomidine with weening protocols, post extubation, and with non-invasive ventilation. However, very little data has been collected and published in children for these uses.

This study is a single center retrospective report collecting data on the use of Dexmedetomidine, specifically in children while receiving non-invasive ventilation. The results demonstrate a reasonable safety profile, and to some extent validates a practice that is an evolving trend in many institutions.

The American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: Executive Summary.  
Davis AL, et al.
Pediatr Crit Care Med. 2017;  Sep;18(9):884-890.
PubMed PMID: 28723883.
Summary: Guidelines for the care of septic shock in pediatrics were developed in 2002 and updated in 2007, and have become standards throughout the country.   The American College of Critical Care Medicine has now finalized the next update and provided an executive summary of the key points of these guidelines.  The new recommendations advocate hospital specific guidelines that address three key issues: recognition of sepsis, resuscitation and stabilization, and performance.  Practical examples of potential bundles to address each of these issues are provided in the summary.

Functional Outcome After Intracranial Pressure Monitoring for Children With Severe Traumatic Brain Injury.
Bennett TD, DeWitt PE, Greene TH, Srivastava R, Riva-Cambrin J, Nance ML,  Bratton SL, Runyan DK, Dean JM, Keenan HT
JAMA Pediatr. 2017 Oct 1;171(10):965-971.
PMID: 28846763.
Summary: The widespread use of intracranial pressure monitors for severe traumatic brain injury in children has been a passionately debated topic over the past several years, with conflicting expert opinion and low likelihood of a true randomized controlled trial to settle the questions.   This study collected data from two large national databases and used sophisticated statistical analysis on cohorts of patients to look at outcome measures with and without the use of ICP monitoring.   They concluded there was no association between ICP monitor use and functional survival. 

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition
Mehta NM, Skillman HE, Irving SY, Coss-Bu JA, Vermilyea S, Farrington EA, McKeever L, Hall AM, Goday PS, Braunschweig C.
Pediatr Crit Care Med. 2017 Jul;18(7):675-715
PMID: 28691958

Neurodevelopmental outcomes in infants undergoing general anesthesia
Nestor KA, Zeidan M, Boncore E, Richardson A, Alex G, Weiss M, Islam S.
J Pediatr Surg. 2017 Jun;52(6):895-900
PMID: 28342581 

Centrifugal pumps and hemolysis in pediatric extracorporeal membrane oxygenation (ECMO) patients: An analysis of Extracorporeal Life Support Organization (ELSO) registry data
O’Brien C, Monteagudo J, Schad C, Cheung E, Middlesworth W4
J Pediatr Surg. 2017 Jun;52(6):975-978
PMID: 28359588

Comparative Effectiveness of Nonsteroidal Anti-inflammatory Drug Treatment vs No Treatment for Patent Ductus Arteriosus in Preterm Infants
Slaughter JL, Reagan PB, Newman TB, Klebanoff MA.
JAMA Pediatr. 2017 Mar 6;171(3):e164354. doi: 10.1001/jamapediatrics.2016.4354. Epub 2017 Mar 6.
PMID: 28046188

Pulmonary Hypertension Therapy and a Systematic Review of Efficacy and Safety of PDE-5 Inhibitors
Unegbu C, Noje C, Coulson JD, Segal JB, Romer L.
Pediatrics. 2017 Mar;139(3). pii: e20161450. doi: 10.1542/peds.2016-1450.
PMID: 28235796 

Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children
Moler FW et al
N Engl J Med. 2017 Jan 26;376(4):318-329. doi: 10.1056/NEJMoa1610493. Epub 2017 Jan 24.
PMID: 28118559 

Effect of Inhaled Nitric Oxide on Outcomes in Children with Acute Lung Injury: Propensity Matched Analysis From a Linked Database
Gupta P, Richardson T, Hall M, Bertoch D, Hebbar KB, Fortenberry JD, Wetzel RC.
Crit Care Med 2016 Oct; 44(10): 1901-9.
PMID: 27163193 

Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults
Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL; AWARE Investigators.
N Engl J Med. 2017 Jan;376(1):11-20.
PMID: 27959707 

New Medical and Surgical Insights into Neonatal Necrotizing Enterocolitis: A Review
Frost BL, Modi BP, Jaksic T, Caplan MS.
JAMA Pediatr 2017 Jan; 171(1): 83-88.
PMID: 27893069

Impact of Weight Extremes on Clinical Outcomes in Pediatric Acute Respiratory Distress Syndrome
Ward SL, Gildengorin V, Valentine SL, Sapru A, Curley MA, Thomas N, Willson DF, Flori HR.
Crit Care Med. 2016 Nov;44(11):2052-2059.
PMID: 27355525

Prediction of Catheter-Associated Thrombosis in Critically Ill Children
Marquez A, Shabanova V, Faustino EV; Northeast Pediatric Critical Care Research Consortium.
Pediatr Crit Care Med. 2016 Sep 22.
PMID: 27662566

Persistent Challenges in Pediatric Pulmonary Hypertension
Hopper RK, Abman SH, Ivy DD.
chest 2016 Jul;150(1):226-36. doi: 10.1016/j.chest.2016.01.007. Epub 2016 Jan 22.
PMID: 26836930  

High-Dose Erythropoietin and Hypothermia for Hypoxic-Ischemic Encephalopathy: A Phase II Trial
Wu YW, Mathur AM, Chang T, McKinstry RC, Mulkey SB, Mayock DE, Van Meurs KP, Rogers EE, Gonzalez FF, Comstock BA, Juul SE, Msall ME, Bonifacio SL, Glass HC, Massaro AN, Dong L, Tan KW, Heagerty PJ, Ballard RA.
Pediatrics. 2016 Jun;137(6). pii: e20160191. doi: 10.1542/peds.2016-0191. Epub 2016 May 2.
PMID: 27244862

Evaluation of the “Early” Use of Albumin in Children with Extensive Burns: A Randomized Controlled Trial
Pediatr Crit Care Med. 2016 Jun;17(6):e280-6. doi: 10.1097/PCC.0000000000000728.
Müller Dittrich MH, Brunow de Carvalho W, Lopes Lavado E.
PMID: 27077832

Recommendations for the Use of Inhaled Nitric Oxide Therapy in Premature Newborns with Severe Pulmonary Hypertension
Kinsella JP, Steinhorn RH, Krishnan US, Feinstein JA, Adatia I, Austin ED, Rosenzweig EB, Everett AD, Fineman JR, Hanna BD, Hopper RK, Humpl T, Ivy DD, Keller RL, Mullen MP, Raj JU, Wessel DL, Abman SH.
J Pediatr. 2016 Mar;170:312-4. doi: 10.1016/j.jpeds.2015.11.050. Epub 2015 Dec 15.
PubMed PMID: 26703869.

New Modes in Non-invasive Ventilation
Rabec C, Emeriaud G, Amadeo A, Fauroux B, Georges M.
Paediatr Respir Rev. 2016 Mar;18:73-84. doi:10.1016/j.prrv.2015.10.004. Epub 2015 Oct 24. Review.
PubMed PMID: 26688194.

Obesity and Mortality Risk in Critically Ill Children
Ross PA, Newth CJ, Leung D, Wetzel RC, Khemani RG.
Pediatrics. 2016 Mar;137(3):1-8. doi:10.1542/peds.2015-2035. Epub 2016 Feb 16.
PubMed PMID: 26908670.

Mortality Among Injured Children Treated at Different Trauma Center Types
Sathya C, Alali AS, Wales PW, Scales DC, Karanicolas PJ, Burd RS, Nance ML, Xiong W, Nathens AB.
JAMA Surg. 2015 Sep;150(9):874-81. doi: 10.1001/jamasurg.2015.1121.
PMID: 26106848
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Maintenance Intravenous Fluids in Acutely Ill Patients
Moritz ML, Ayus JC.
N Engl J Med. 2016 Jan 21;374(3):290-1. doi: 10.1056/NEJMc1513887. No abstract available.
PMID: 26789888

Ventilatory support in children with pediatric acute respiratory distress syndrome: proceedings from the Pediatric Acute Lung Injury Consensus Conference
Rimensberger PC, Cheifetz IM; Pediatric Acute Lung Injury Consensus Conference Group.
Pediatr Crit Care Med. 2015 Jun;16(5 Suppl 1):S51-60. doi: 10.1097/PCC.0000000000000433.
PMID: 26035364
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Mortality Among Injured Children Treated at Different Trauma Center Types
Sathya C, Alali AS, Wales PW, Scales DC, Karanicolas PJ, Burd RS, Nance ML, Xiong W, Nathens AB.
JAMA Surg. 2015 Sep;150(9):874-81. doi: 10.1001/jamasurg.2015.1121.
PMID: 26106848
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