Hearing screening outcomes in pediatric critical care survivors: a 1-year report

Background Hearing loss is a potentially serious complication that can occur after surviving a critical illness. Study on screening for hearing problems in pediatric critical care survivors beyond the neonatal period is lacking. This study aimed to identify the prevalence of abnormal hearing screening outcomes using transitory evoked otoacoustic emission (TEOAE) screening in children who survived critical illness and to find possible associating factors for abnormal hearing screening results. Methods This study was a single-center, prospective, observational study. All children underwent otoscopy to exclude external and middle ear abnormalities before undergoing TEOAE screening. The screening was conducted before hospital discharge. Descriptive statistics, chi-square, and logistic regression tests were used for data analysis. Results A total of 92 children were enrolled. Abnormal TEOAE responses were identified in 26 participants (28.3%). Children with abnormal responses were significantly younger than those with normal responses with a median age of 10.0 months and 43.5 months, respectively (P<0.001). Positive association with abnormal responses was found in children younger than 12 months of age (adjusted odds ratio [OR], 3.07; 95% confidence interval [CI], 1.06–8.90) and children with underlying genetic conditions (adjusted OR, 6.95; 95% CI, 1.49–32.54). Conclusions Our study demonstrates a high prevalence of abnormal TEOAE screening responses in children surviving critical illness, especially in patients younger than 12 months of age. More extensive studies should be performed to identify the prevalence and associated risk factors of hearing problems in critically ill children

Comparison of three non-invasive hemodynamic monitoring methods in critically ill children.

INTRODUCTION:Hemodynamic parameters measurements were widely conducted using pulmonary artery catheter (PAC) with thermodilution as a reference standard. Due to its technical difficulties in children, transthoracic echocardiography (TTE) has been widely employed instead. Nonetheless, TTE requires expertise and is time-consuming. Noninvasive cardiac output monitoring such as ultrasonic cardiac output monitor (USCOM) and electrical velocimetry (EV) can be performed rapidly with less expertise requirement. Presently, there are inconsistent evidences, variable precision, and reproducibility of EV, USCOM and TTE measurements. Our objective was to compare USCOM, EV and TTE in hemodynamic measurements in critically ill children. MATERIALS AND METHODS:This was a single center, prospective observational study in critically ill children. Children with congenital heart diseases and unstable hemodynamics were excluded. Simultaneous measurements of hemodynamic parameters were conducted using USCOM, EV, and TTE. Inter-rater reliability was determined. Bland-Altman plots were used to analyse agreement of assessed parameters. RESULTS:Analysis was performed in 121 patients with mean age of 4.9 years old and 56.2% of male population. Interrater reliability showed acceptable agreement in all measured parameters (stroke volume (SV), cardiac output (CO), velocity time integral (VTI), inotropy (INO), flow time corrected (FTC), aortic valve diameter (AV), systemic vascular resistance (SVR), and stroke volume variation (SVV); (Cronbach's alpha 0.76-0.98). Percentages of error in all parameters were acceptable by Bland-Altman analysis (9.2-28.8%) except SVR (30.8%) and SVV (257.1%). CONCLUSION:Three noninvasive methods might be used interchangeably in pediatric critical care settings with stable hemodynamics. Interpretation of SVV and SVR measurements must be done with prudence

Comparison of three non-invasive hemodynamic monitoring methods in critically ill children - Fig 4

<p>Bland-Altman analysis of afterload: Systemic vascular resistance (A) Systemic vascular resistance index (B). X-axis illustrated average measurements of standard from using ICON. Y-axis demonstrated mean bias using USCOM.</p

Comparison of three non-invasive hemodynamic monitoring methods in critically ill children - Fig 2

<p>Bland-Altman analysis of overall results: Cardiac output (A), cardiac index (B). X-axis illustrated average measurements of standard from using TTE. Y-axis demonstrated mean bias using other modalities.</p

Comparison of three non-invasive hemodynamic monitoring methods in critically ill children - Fig 3

<p>Bland-Altman analysis of preload: Stroke volume (A), Corrected flow time (B) and Stroke volume variation (C). X-axis illustrated average measurements of standard from using TTE or ICON. Y-axis demonstrated mean bias using other modalities.</p

Flow diagram showing the screening and enrollment of patients.

<p>Flow diagram showing the screening and enrollment of patients.</p

Baseline characteristics of patients who were admitted with critically ill conditions.

<p>Baseline characteristics of patients who were admitted with critically ill conditions.</p

Bland-Altman results summary.

<p>Bland-Altman results summary.</p

Hemodynamic parameters were categorized by preload, afterload and others.

<p>Hemodynamic parameters were categorized by preload, afterload and others.</p