Editor’s Choice Articles for December

This December 2024 issue of Pediatric Critical Care Medicine (PCCM) is the last in the print format and hence the last of my Editor’s Choice items. Everything changes in January 2025, volume 26, with new sections and a focus away from my choices in the print edition to “What’s New” and discoverable in the electronic edition. My final three Editor’s Choices articles, with editorials, are two on the diagnosis or determination of death using neurologic criteria (1–4), and a third about meropenem pharmacokinetics in sepsis (5,6). The educational theme in the PCCM Connections section is family-centered care (7). We highlight research in a 2014-2017 dataset from Uganda on the utility of the peripheral perfusion index in the PCCM International section (8). There is the latest addition to the “Writing for PCCM” series, with notes covering the use of administrative and clinical databases for research (9). Finally, there is a reflective PCCM Narrative written “to my nursing colleagues” (10). WHAT IS NEW IN OUR APPROACH TO DIAGNOSIS OR DETERMINATION OF DEATH USING NEUROLOGIC CRITERIA? Bach AM, McKinnon NK, Zhuang H, et al: Nuclear Medicine Cerebral Perfusion Studies as an Ancillary Test to Support Evaluation of Brain Death/Death by Neurological Criteria: Single-Center Experience in Infants, 2005–2022 (1). Aziz O, Main TBN, Hannon FR, Fraser JI: Diagnosis of Death Using Neurological Criteria in Children: The U.K. Experience, 2015–2023 (3). My first two Editor’s Choice articles are timely publications. Since 2020, there have been four major reports about brain death or death using neurologic criteria from international organizations including the World Brain Death Project (11), the Australia and New Zealand Intensive Care Society (12), the Canadian Clinical Practice Guideline group (13), and the American Academy of Neurology Guidelines subcommittee with the American Academy of Pediatrics, and others (14). Two questions arise from these reports: the utility and place of “ancillary” investigations in the very young, and gaps or variation in clinical experience and practice. The first question is addressed in a retrospective review of radionuclide cerebral perfusion studies in infants aged younger than 1 year at a single center in the United States (1), with a commentary written by an expert based in Canada (2), who is a well-known author in this field (15–17). The second question is covered in a national retrospective analysis of the scale of death using neurologic criteria in the United Kingdom (3). This report has an accompanying editorial by experts based in the United States and United Kingdom (4). WHAT ABOUT THE ANTIBIOTIC TARGET IN SEVERE SEPSIS? Paice K, Tang Girdwood S, Mizuno T, et al: Pharmacokinetic Factors Associated With Early Meropenem Target Attainment in Pediatric Severe Sepsis (5). My third Editor’s Choice article examines meropenem concentration-time profiles in 29 patients with severe sepsis, with a focus on concentration target attainment in relation to meropenem clearance. The accompanying editorial sets the scene and context of pharmacokinetic changes in critical illness, as well as a path for more research (6). Also look at a related pharmacokinetic/pharmacodynamic publication in this issue of PCCM from a collaborative in France describing the adequacy of beta-lactam antibiotic dosing during extracorporeal membrane oxygenation support (18). If these items capture your interest, then there is also a 2022 article from Belgium on risk factors associated with suboptimal beta-lactam therapy (including meropenem) in critically ill children (19). The accompanying editorial to the 2022 article (20), asked rhetorically “(is it) time to step up our game?” Moving forward at PCCM, this is the challenge for our researchers in 2025: more work is needed on antibiotic dosing and prescription optimization. “PCCM CONNECTIONS” FOR READERS The PCCM Connections educational topic this month is family-centered care. By way of introduction, begin by reading a report in this issue of PCCM describing qualitative, semistructured interviews in 39 family caregivers with details of their perspectives on provider continuity during prolonged hospitalization in the PICU (21). There is also an insightful editorial, which is both clinically grounded and illuminating (22). Next, take time to read a commentary that arose from an educational session at the World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS) Congress in Mexico, 2024 (23). A group comprising professionals from Australia, Canada, United Kingdom, and Uruguay outline a new field of focus for PCCM (7), and we welcome submissions to a new section in PCCM 2025 that will lead us forward in family-centered care. “PCCM INTERNATIONAL” FOR READERS The highlighted international content this month uses a 2014–2017 dataset of Ugandan children with Plasmodium falciparum severe malaria (7). A cohort of 600 children younger than 5 years with severe malaria, along with 120 asymptomatic community children, was studied post hoc to assess whether co-oximeter-derived peripheral perfusion index (PPI) data were associated with greater odds of mortality in severe malaria. This report is not the first time this year that we have seen material about a “perfusion index” in sepsis; also read the report on a pulse oximetry-derived PPI from a clinical research group in India (24). Taken together, this material is welcomed. In fact, it illustrates the value of cross-continent collaboration; a message that was conveyed in a 2023 editorial (25) about sepsis biomarkers in low- and middle-income countries (26), which stated the “…enormous potential in collaborative research efforts between institutions from differently resourced areas around the world. Ultimately these mutually beneficial relationships may lead to new understanding and improved care of critically ill children globally.” The new work on the PPI is another example of such collaboration, and we welcome more work at PCCM in 2025.

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