Dynamic assessment of severity of illness in pediatric intensive care.

Severity of illness in 293 pediatric ICU patients was assessed by a daily estimate of ICU survival. The probability of nonsurvival was obtained by logistic regression analysis, using physiologic stability index (PSI) values from previous days as time-dependent covariates. Only PSI values from the previous 2 days gave statistically significant predictions of short-term (less than 24 h) outcome. When the prediction model derived from these data was tested prospectively on a separate set of 345 pediatric patients, there was excellent agreement between observed and predicted short-term mortality. Receiver operating characteristic curves for the 345 patients were statistically equivalent to those originally derived for the 293 patients, and this prediction model had significantly (p less than .025) more accuracy than prediction based on admission PSI. These results indicate that this model for daily risk assessment is statistically reliable and objective, as verified against eventual outcome. In the 345 patients, ICU mortality was predicted with 89% sensitivity and 91% specificity. This prediction model may be used to stratify patient groups for clinical studies, or identify very low-risk patients for potential early ICU discharge

Postanesthetic apnea and periodic breathing in infants

We designed this prospective study to determine the incidence of perioperative apnea and/or periodic breathing in infants undergoing general anesthesia for inguinal herniorrhaphy in the first year of life. We also attempted to define the age at which a prematurely born infant \u27outgrows\u27 possible apneic episodes. Eighty-six patients were studied. Thirty-eight infants were premature and 48 infants were full term. Seven of the full-term infants were ≤44 weeks conceptual age, and 41 were \u3e44 weeks conceptual age at the time of surgery. Periodic breathing was noted only in 14 ex-prematures with a conceptual age less than or equal to 44 weeks compared with those with a conceptual age greater than 44 weeks. These 14 (63.6%) had postoperative PB greater than 0.5% without bradycardia on pneumogram. Two of these patients showed PB as late as 5 h postoperatively. None of the patients in either group required endotracheal intubation or controlled ventilation postoperatively