Research

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12 pages, 1623 KiB

Open AccessArticle

Implementing Rounding Checklists in a Pediatric Oncologic Intensive Care Unit

by Mary Katherine Gardner, Patricia J. Amado, Muhummad Usman Baig, Sana Mohiuddin, Avis Harden, Linette J. Ewing, Shehla Razvi, Jose A. Cortes, Rodrigo Mejia, Demetrios Petropoulos, Priti Tewari and Ali H. Ahmad

Children 2022, 9(4), 580; https://doi.org/10.3390/children9040580 - 18 Apr 2022

Cited by 1 | Viewed by 5209

Abstract

Standardized rounding checklists during multidisciplinary rounds (MDR) can reduce medical errors and decrease length of pediatric intensive care unit (PICU) and hospital stay. We added a standardized process for MDR in our oncologic PICU. Our study was a quality improvement initiative, utilizing a [...] Read more.

Standardized rounding checklists during multidisciplinary rounds (MDR) can reduce medical errors and decrease length of pediatric intensive care unit (PICU) and hospital stay. We added a standardized process for MDR in our oncologic PICU. Our study was a quality improvement initiative, utilizing a four-stage Plan–Do–Study–Act (PDSA) model to standardize MDR in our PICU over 3 months, from January 2020 to March 2020. We distributed surveys to PICU RNs to assess their understanding regarding communication during MDR. We created a standardized rounding checklist that addressed key elements during MDR. Safety event reports before and after implementation of our initiative were retrospectively reviewed to assess our initiative’s impact on safety events. Our intervention increased standardization of PICU MDR from 0% to 70% over three months, from January 2020 to March 2020. We sustained a rate of zero for CLABSI, CAUTI, and VAP during the 12-month period prior to, during, and post-intervention. Implementation of a standardized rounding checklist may improve closed-loop communication amongst the healthcare team, facilitate dialogue between patients’ families and the healthcare team, and reduce safety events. Additional staffing for resource RNs, who assist with high acuity patients, has also facilitated bedside RN participation in MDR, without interruptions in clinical care. Full article

(This article belongs to the Special Issue Advances in Pediatric Critical Care)

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12 pages, 607 KiB

Open AccessArticle

Loss of Health Promoting Bacteria in the Gastrointestinal Microbiome of PICU Infants with Bronchiolitis: A Single-Center Feasibility Study

by Madeleine M. Russell, Mara L. Leimanis-Laurens, Sihan Bu, Gigi A. Kinney, Shao Thing Teoh, Ruth-Anne L. McKee, Karen Ferguson, John W. Winters, Sophia Y. Lunt, Jeremy W. Prokop, Surender Rajasekaran and Sarah S. Comstock

Children 2022, 9(1), 114; https://doi.org/10.3390/children9010114 - 17 Jan 2022

Cited by 2 | Viewed by 2559

Abstract

The feasibility of gastrointestinal (GI) microbiome work in a pediatric intensive care unit (PICU) to determine the GI microbiota composition of infants as compared to control infants from the same hospital was investigated. In a single-site observational study at an urban quaternary care [...] Read more.

The feasibility of gastrointestinal (GI) microbiome work in a pediatric intensive care unit (PICU) to determine the GI microbiota composition of infants as compared to control infants from the same hospital was investigated. In a single-site observational study at an urban quaternary care children’s hospital in Western Michigan, subjects less than 6 months of age, admitted to the PICU with severe respiratory syncytial virus (RSV) bronchiolitis, were compared to similarly aged control subjects undergoing procedural sedation in the outpatient department. GI microbiome samples were collected at admission (n = 20) and 72 h (n = 19) or at time of sedation (n = 10). GI bacteria were analyzed by sequencing the V4 region of the 16S rRNA gene. Alpha and beta diversity were calculated. Mechanical ventilation was required for the majority (n = 14) of study patients, and antibiotics were given at baseline (n = 8) and 72 h (n = 9). Control subjects’ bacterial communities contained more Porphyromonas, and Prevotella (p = 0.004) than those of PICU infants. The ratio of Prevotella to Bacteroides was greater in the control than the RSV infants (mean ± SD—1.27 ± 0.85 vs. 0.61 ± 0.75: p = 0.03). Bacterial communities of PICU infants were less diverse than those of controls with a loss of potentially protective populations. Full article

(This article belongs to the Special Issue Advances in Pediatric Critical Care)

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12 pages, 633 KiB

Open AccessArticle

Risk Factors Associated with Mechanical Ventilation in Critical Bronchiolitis

by Rachel K. Marlow, Sydney Brouillette, Vannessa Williams, Ariann Lenihan, Nichole Nemec, Joseph D. Lukowski, Cheng Zheng, Melissa L. Cullimore and Sidharth Mahapatra

Children 2021, 8(11), 1035; https://doi.org/10.3390/children8111035 - 11 Nov 2021

Cited by 2 | Viewed by 2354

Abstract

The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance [...] Read more.

The American Academy of Pediatrics (AAP) recommends supportive care for the management of bronchiolitis. However, patients admitted to the intensive care unit with severe (critical) bronchiolitis define a unique group with varying needs for both non-invasive and invasive respiratory support. Currently, no guidance exists to help clinicians discern who will progress to invasive mechanical support. Here, we sought to identify key clinical features that distinguish pediatric patients with critical bronchiolitis requiring invasive mechanical ventilation from those that did not. We conducted a retrospective cohort study at a tertiary pediatric medical center. Children ≤2 years old admitted to the pediatric intensive care unit (PICU) from January 2015 to December 2019 with acute bronchiolitis were studied. Patients were divided into non-invasive respiratory support (NRS) and invasive mechanical ventilation (IMV) groups; the IMV group was further subdivided depending on timing of intubation relative to PICU admission. Of the 573 qualifying patients, 133 (23%) required invasive mechanical ventilation. Median age and weight were lower in the IMV group, while incidence of prematurity and pre-existing neurologic or genetic conditions were higher compared to the NRS group. Multi-microbial pneumonias were diagnosed more commonly in the IMV group, in turn associated with higher severity of illness scores, longer PICU lengths of stay, and more antibiotic usage. Within the IMV group, those intubated earlier had a shorter duration of mechanical ventilation and PICU length of stay, associated with lower pathogen load and, in turn, shorter antibiotic duration. Taken together, our data reveal that critically ill patients with bronchiolitis who require mechanical ventilation possess high risk features, including younger age, history of prematurity, neurologic or genetic co-morbidities, and a propensity for multi-microbial infections. Full article

(This article belongs to the Special Issue Advances in Pediatric Critical Care)

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10 pages, 237 KiB

Open AccessArticle

Feasibility of Race by Sex Intersectionality Research on Suicidality in the Adolescent Brain Cognitive Development (ABCD) Study

by Shervin Assari, Shanika Boyce and Mohsen Bazargan

Children 2021, 8(6), 437; https://doi.org/10.3390/children8060437 - 23 May 2021

Cited by 1 | Viewed by 2135

Abstract

Intersectional research on childhood suicidality requires studies with a reliable and valid measure of suicidality, as well as a large sample size that shows some variability of suicidality across sex by race intersectional groups. Objectives: We aimed to investigate the feasibility of intersectionality [...] Read more.

Intersectional research on childhood suicidality requires studies with a reliable and valid measure of suicidality, as well as a large sample size that shows some variability of suicidality across sex by race intersectional groups. Objectives: We aimed to investigate the feasibility of intersectionality research on childhood suicidality in the Adolescent Brain Cognitive Development (ABCD) study. We specifically explored the reliability and validity of the measure, sample size, and variability of suicidality across sex by race intersectional groups. Methods: We used cross-sectional data (wave 1) from the ABCD study, which sampled 9013 non-Hispanic white (NHW) or non-Hispanic black (NHB) children between the ages of 9 and 10 between years 2016 and 2018. Four intersectional groups were built based on race and sex: NHW males (n = 3554), NHW females (n = 3158), NHB males (n = 1164), and NHB females (n = 1137). Outcome measure was the count of suicidality symptoms, reflecting all positive history and symptoms of suicidal ideas, plans, and attempts. To validate our measure, we tested the correlation between our suicidality measure and depression and Child Behavior Checklist (CBCL) sub-scores. Cronbach alpha was calculated for reliability across each intersectional group. We also compared groups for suicidality. Results: We observed some suicidality history in observed 3.2% (n = 101) of NHW females, 4.9% (n = 175) of NHW males, 5.4% (n = 61) of NHB females, and 5.8% (n = 68) of NHB males. Our measure’s reliability was acceptable in all race by sex groups (Cronbach alpha higher than 0.70+ in all intersectional groups). Our measure was valid in all intersectional groups, documented by a positive correlation with depression and CBCL sub-scores. We could successfully model suicidality across sex by race groups, using multivariable models. Conclusion: Given the high sample size, reliability, and validity of the suicidality measure, variability of suicidality, it is feasible to investigate correlates of suicidality across race by sex intersections in the ABCD study. We also found evidence of higher suicidality in NHB than NHW children in the ABCD study. The ABCD rich data in domains of social context, self-report, schools, parenting, psychopathology, personality, and brain imaging provides a unique opportunity to study intersectional differences in neural circuits associated with youth suicidality. Full article

(This article belongs to the Special Issue Advances in Pediatric Critical Care)

10 pages, 675 KiB

Open AccessArticle

A Retrospective Analysis of Feeding Practices and Complications in Patients with Critical Bronchiolitis on Non-Invasive Respiratory Support

by Ariann Lenihan, Vannessa Ramos, Nichole Nemec, Joseph Lukowski, Junghyae Lee, K M. Kendall and Sidharth Mahapatra

Children 2021, 8(5), 410; https://doi.org/10.3390/children8050410 - 18 May 2021

Cited by 5 | Viewed by 2534

Abstract

Limited data exist regarding feeding pediatric patients managed on non-invasive respiratory support (NRS) modes that augment oxygenation and ventilation in the setting of acute respiratory failure. We conducted a retrospective cohort study to explore the safety of feeding patients managed on NRS with [...] Read more.

Limited data exist regarding feeding pediatric patients managed on non-invasive respiratory support (NRS) modes that augment oxygenation and ventilation in the setting of acute respiratory failure. We conducted a retrospective cohort study to explore the safety of feeding patients managed on NRS with acute respiratory failure secondary to bronchiolitis. Children up to two years old with critical bronchiolitis managed on continuous positive airway pressure, bilevel positive airway pressure, or RAM cannula were included. Of the 178 eligible patients, 64 were reportedly nil per os (NPO), while 114 received enteral nutrition (EN). Overall equivalent in severity of illness, younger patients populated the EN group, while the NPO group experienced a higher incidence of intubation. Duration of stay in the pediatric intensive care unit and non-invasive respiratory support were shorter in the NPO group, though intubation eliminated the former difference. Within the EN group, ninety percent had feeds initiated within 48 h and 94% reached full feeds within 7 days of NRS initiation, with an 8% complication and <1% aspiration rate. Reported complications did not result in escalation of respiratory support. Notably, a significant improvement in heart rate and respiratory rate was noted after feeds initiation. Taken together, our study supports the practice of early enteral nutrition in patients with critical bronchiolitis requiring NRS. Full article

(This article belongs to the Special Issue Advances in Pediatric Critical Care)

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10 pages, 456 KiB

Open AccessArticle

“Difficult to Sedate”: Successful Implementation of a Benzodiazepine-Sparing Analgosedation-Protocol in Mechanically Ventilated Children

by Nataly Shildt, Chani Traube, Mary Dealmeida, Ishaan Dave, Scott Gillespie, Whitney Moore, Lillian D. Long and Pradip P. Kamat

Children 2021, 8(5), 348; https://doi.org/10.3390/children8050348 - 28 Apr 2021

Cited by 8 | Viewed by 4379

Abstract

We sought to evaluate the success rate of a benzodiazepine-sparing analgosedation protocol (ASP) in mechanically ventilated children and determine the effect of compliance with ASP on in-hospital outcome measures. In this single center study from a quaternary pediatric intensive care unit, our objective [...] Read more.

We sought to evaluate the success rate of a benzodiazepine-sparing analgosedation protocol (ASP) in mechanically ventilated children and determine the effect of compliance with ASP on in-hospital outcome measures. In this single center study from a quaternary pediatric intensive care unit, our objective was to evaluate the ASP protocol, which included opiate and dexmedetomidine infusions and was used as first-line sedation for all intubated patients. In this study we included 424 patients. Sixty-nine percent (n = 293) were successfully sedated with the ASP. Thirty-one percent (n = 131) deviated from the ASP and received benzodiazepine infusions. Children sedated with the ASP had decrease in opiate withdrawal (OR 0.16, 0.08–0.32), decreased duration of mechanical ventilation (adjusted mean duration 1.81 vs. 3.39 days, p = 0.018), and decreased PICU length of stay (adjusted mean 3.15 vs. 4.7 days, p = 0.011), when compared to the cohort of children who received continuous benzodiazepine infusions. Using ASP, we report that 69% of mechanically ventilated children were successfully managed with no requirement for continuous benzodiazepine infusions. The 69% who were successfully managed with ASP included infants, severely ill patients, and children with chromosomal disorders and developmental disabilities. Use of ASP was associated with decreased need for methadone use, decreased duration of mechanical ventilation, and decreased ICU and hospital length of stay. Full article

(This article belongs to the Special Issue Advances in Pediatric Critical Care)

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12 pages, 1774 KiB

Open AccessArticle

The Feasibility of Studying Metabolites in PICU Multi-Organ Dysfunction Syndrome Patients over an 8-Day Course Using an Untargeted Approach

by Mara Leimanis-Laurens, Danny Gil, Andrew Kampfschulte, Claire Krohn, Elizabeth Prentice, Dominic Sanfilippo, Jeremy W. Prokop, Todd A. Lydic and Surender Rajasekaran

Children 2021, 8(2), 151; https://doi.org/10.3390/children8020151 - 18 Feb 2021

Cited by 2 | Viewed by 2017

Abstract

Metabolites are generated from critical biological functions and metabolism. This pediatric study reviewed plasma metabolites in patients suffering from multi-organ dysfunction syndrome (MODS) in the pediatric intensive care unit (PICU) using an untargeted metabolomics approach. Patients meeting the criteria for MODS were screened [...] Read more.

Metabolites are generated from critical biological functions and metabolism. This pediatric study reviewed plasma metabolites in patients suffering from multi-organ dysfunction syndrome (MODS) in the pediatric intensive care unit (PICU) using an untargeted metabolomics approach. Patients meeting the criteria for MODS were screened for eligibility and consented (n = 24), and blood samples were collected at baseline, 72 h, and 8 days; control patients (n = 4) presented for routine sedation in an outpatient setting. A subset of MODS patients (n = 8) required additional support with veno-atrial extracorporeal membrane oxygenation (VA-ECMO) therapy. Metabolites from thawed blood plasma were determined from ion pairing reversed-phase liquid chromatography–mass spectrometry (LC-MS) analysis. Chromatographic peak alignment, identification, relative quantitation, and statistical and bioinformatics evaluation were performed using MAVEN and MetaboAnalyst 4.0. Metabolite analysis revealed 115 peaks per sample. From the partial least squares-discriminant analysis (PLS-DA) with variance of importance (VIP) scores above ≥2.0, 7 dynamic metabolites emerged over the three time points: tauro-chenodeoxycholic acid (TCDCA), hexose, p-hydroxybenzoate, hydroxyphenylacetic acid (HPLA), 2_3-dihydroxybenzoic acid, 2-keto-isovalerate, and deoxyribose phosphate. After Bonferroni adjustment for repeated measures, hexose and p-hydroxybenzoate were significant at one time point or more. Kendall’s tau-b test was used for internal validation of creatinine. Metabolites may be benign or significant in describing a patient’s pathophysiology and require operator interpretation. Full article

(This article belongs to the Special Issue Advances in Pediatric Critical Care)

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11 pages, 1019 KiB

Open AccessArticle

Understanding Suicide in Our Community through the Lens of the Pediatric ICU: An Epidemiological Review (2011–2017) of One Midwestern City in the US

by Andrew Kampfschulte, Matthew Oram, Alejandra M. Escobar Vasco, Brittany Essenmacher, Amy Herbig, Aniruddh Behere, Mara L. Leimanis-Laurens and Surender Rajasekaran

Children 2021, 8(2), 59; https://doi.org/10.3390/children8020059 - 20 Jan 2021

Cited by 1 | Viewed by 1755

Abstract

Suicide frequency has tripled for some pediatric age groups over the last decade, of which, serious attempts result in pediatric intensive care unit (PICU) admissions. We paired clinical, aggregate geospatial, and temporal demographics to understand local community variables to determine if epidemiological patterns [...] Read more.

Suicide frequency has tripled for some pediatric age groups over the last decade, of which, serious attempts result in pediatric intensive care unit (PICU) admissions. We paired clinical, aggregate geospatial, and temporal demographics to understand local community variables to determine if epidemiological patterns emerge that associate with risk for PICU admission. Data were extracted at an urban, high-volume, quaternary care facility from January 2011 to December 2017 via ICD 10 codes associated with suicide. Clinical, socioeconomic, geographical, and temporal variables were reviewed. In total, 1036 patients over the age of 9 were included, of which n = 161 were PICU admissions. Females represented higher proportions of all suicide-related hospital admissions (67.9%). Looking at race/ethnicity, PICU admissions were largely Caucasian (83.2%); Blacks and Hispanics had lower odds of PICU admissions (OR: 0.49; 0.17, respectively). PICU-admitted patients were older (16.0 vs. 15.5; p = 0.0001), with lower basal metabolic index (23.0 vs. 22.0; p = 0.0013), and presented in summer months (OR: 1.51, p = 0.044). Time-series decomposition showed seasonal peaks in June and August. Local regions outside the city limits identified higher numbers of PICU admissions. PICUs serve discrete geographical regions and are a source of information, when paired with clinical geospatial/seasonal analyses, highlighting clinical and societal risk factors associated with PICU admissions. Full article

(This article belongs to the Special Issue Advances in Pediatric Critical Care)

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9 pages, 358 KiB

Open AccessArticle

The Use of a Kinetic Therapy Rotational Bed in Pediatric Acute Respiratory Distress Syndrome: A Case Series

by Daniel T. Cater, Aimee R. Ealy, Erin Kramer, Samer Abu-Sultaneh and Courtney M. Rowan

Children 2020, 7(12), 303; https://doi.org/10.3390/children7120303 - 17 Dec 2020

Viewed by 2555

Abstract

Patients with acute respiratory distress syndrome (ARDS) commonly have dependent atelectasis and heterogeneous lung disease. Due to the heterogenous lung volumes seen, the application of positive end expiratory pressure (PEEP) can have both beneficial and deleterious effects. Alternating supine and prone positioning may [...] Read more.

Patients with acute respiratory distress syndrome (ARDS) commonly have dependent atelectasis and heterogeneous lung disease. Due to the heterogenous lung volumes seen, the application of positive end expiratory pressure (PEEP) can have both beneficial and deleterious effects. Alternating supine and prone positioning may be beneficial in ARDS by providing more homogenous distribution of PEEP and decreasing intrapulmonary shunt. In pediatrics, the pediatric acute lung injury and consensus conference (PALICC) recommended to consider it in severe pediatric ARDS (PARDS). Manually prone positioning patients can be burdensome in larger patients. In adults, the use of rotational beds has eased care of these patients. There is little published data about rotational bed therapy in children. Therefore, we sought to describe the use of a rotational bed in children with PARDS. We performed a retrospective case series of children who utilized a rotational bed as an adjunctive therapy for their PARDS. Patient data were collected and analyzed. Descriptive statistical analyses were performed and reported. Oxygenation indices (OI) pre- and post-prone positioning were analyzed. Twelve patients with PARDS were treated with a rotational bed with minimal adverse events. There were no complications noted. Three patients had malfunctioning of their arterial line while on the rotational bed. Oxygenation indices improved over time in 11 of the 12 patients included in the study while on the rotational bed. Rotational beds can be safely utilized in pediatric patients. In larger children with PARDS, where it may be more difficult to perform a manual prone position, use of a rotational bed can be considered a safe alternative. Full article

(This article belongs to the Special Issue Advances in Pediatric Critical Care)

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Review

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15 pages, 1079 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Long-Term Outcomes and the Post-Intensive Care Syndrome in Critically Ill Children: A North American Perspective

by Alan G. Woodruff and Karen Choong

Children 2021, 8(4), 254; https://doi.org/10.3390/children8040254 - 24 Mar 2021

Cited by 30 | Viewed by 5683

Abstract

Advances in medical and surgical care for children in the pediatric intensive care unit (PICU) have led to vast reductions in mortality, but survivors often leave with newly acquired or worsened morbidity. Emerging evidence reveals that survivors of pediatric critical illness may experience [...] Read more.

Advances in medical and surgical care for children in the pediatric intensive care unit (PICU) have led to vast reductions in mortality, but survivors often leave with newly acquired or worsened morbidity. Emerging evidence reveals that survivors of pediatric critical illness may experience a constellation of physical, emotional, cognitive, and social impairments, collectively known as the “post-intensive care syndrome in pediatrics” (PICs-P). The spectrum of PICs-P manifestations within each domain are heterogeneous. This is attributed to the wide age and developmental diversity of children admitted to PICUs and the high prevalence of chronic complex conditions. PICs-P recovery follows variable trajectories based on numerous patient, family, and environmental factors. Those who improve tend to do so within less than a year of discharge. A small proportion, however, may actually worsen over time. There are many gaps in our current understanding of PICs-P. A unified approach to screening, preventing, and treating PICs-P-related morbidity has been hindered by disparate research methodology. Initiatives are underway to harmonize clinical and research priorities, validate new and existing epidemiologic and patient-specific tools for the prediction or monitoring of outcomes, and define research priorities for investigators interested in long-term outcomes. Full article

(This article belongs to the Special Issue Advances in Pediatric Critical Care)

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19 pages, 460 KiB

Open AccessReview

Nursing Perspective of the Humanized Care of the Neonate and Family: A Systematic Review

by Sagrario Gómez-Cantarino, Inmaculada García-Valdivieso, Mercedes Dios-Aguado, Benito Yáñez-Araque, Brigida Molina Gallego and Eva Moncunill-Martínez

Children 2021, 8(1), 35; https://doi.org/10.3390/children8010035 - 09 Jan 2021

Cited by 8 | Viewed by 3840

Abstract

This systematic review aims to determine the extent to which published research articles show the perspective of health professionals in neonatal intensive care units (NICU), as facilitators of family empowerment. Studies conducted between 2013 and 2020 were retrieved from five databases (PubMed, Cochrane, [...] Read more.

This systematic review aims to determine the extent to which published research articles show the perspective of health professionals in neonatal intensive care units (NICU), as facilitators of family empowerment. Studies conducted between 2013 and 2020 were retrieved from five databases (PubMed, Cochrane, CINHAL, Scopus, and Google Scholar). The search was carried out from January to October 2020. A total of 40 articles were used, of which 13 studies (quantitative and qualitative) were included in this systematic review. Its methodological quality was assessed using the mixed methods assessment tool (MMAT). In these, the opinions and perspectives of professionals on the permanence and participation of parents were valued. In addition, the training, experiences, and educational needs of nursing within the NICU were determined. The crucial role of health professionals in the humanization of care and its effect on the neonate-family binomial was estimated. However, conceptual changes are needed within the neonatal intensive care units. To implement humanization in daily care, family participation should be encouraged in them. For this, it is necessary to modify hospital health policies to allow changes in the infrastructure that facilitate open doors 24 h a day in special services. Full article

(This article belongs to the Special Issue Advances in Pediatric Critical Care)

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25 pages, 888 KiB

Open AccessReview

Relevance of Biomarkers Currently in Use or Research for Practical Diagnosis Approach of Neonatal Early-Onset Sepsis

by Maura-Adelina Hincu, Gabriela-Ildiko Zonda, Gabriela Dumitrita Stanciu, Dragos Nemescu and Luminita Paduraru

Children 2020, 7(12), 309; https://doi.org/10.3390/children7120309 - 20 Dec 2020

Cited by 26 | Viewed by 4681

Abstract

Neonatal early-onset sepsis (EOS) is defined as an invasive infection that occurs in the first 72 h of life. The incidence of EOS varies from 0.5–2% live births in developed countries, up to 9.8% live births in low resource settings, generating a high [...] Read more.

Neonatal early-onset sepsis (EOS) is defined as an invasive infection that occurs in the first 72 h of life. The incidence of EOS varies from 0.5–2% live births in developed countries, up to 9.8% live births in low resource settings, generating a high mortality rate, especially in extremely low birth weight neonates. Clinical signs are nonspecific, leading to a late diagnosis and high mortality. Currently, there are several markers used for sepsis evaluation, such as hematological indices, acute phase reactants, cytokines, which by themselves do not show acceptable sensitivity and specificity for the diagnosis of EOS in neonates. Newer and more selective markers have surfaced recently, such as presepsin and endocan, but they are currently only in the experimental research stages. This comprehensive review article is based on the role of biomarkers currently in use or in the research phase from a basic, translational, and clinical viewpoint that helps us to improve the quality of neonatal early-onset sepsis diagnosis and management. Full article

(This article belongs to the Special Issue Advances in Pediatric Critical Care)

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