In children who suffer out of hospital cardiac arrest, targeted hypothermia at 33.0 C confers no benefit when compared to targeted normothermia at 36.8 C. Level of evidence: 2B (RCT with wide CIs)Appraised by: Andrew Claxton Citation: Moler FW, Silverstein FS, Holubkov R and the THAPCA Trial Investigators. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Eng

BACKGROUND-Targeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after inhospital cardiac arrest are limited.

A small but growing population of children with medical complexity (CMC), often covered by Medicaid, consumes a high proportion of pediatric healthcare spending. In this article, we first describe the expenditures of CMC with Medicaid across the care continuum. We report the increasingly large amount of spending on hospital care for CMC relative to the small amount of primary care and home care spending. We then present a business case that 1) estimates how cost savings might be achieved for CMC from reductions in potentially reducible hospital and emergency department use and 2) shows how the savings could underwrite investments in outpatient and community care. We conclude by discussing the importance of these findings in the context of Medicaid quality of care and healthcare reform.

Early postoperative fluid overload is independently associated with worse outcomes in pediatric cardiac surgery patients who are 2 weeks to 18 years old. Patients with fluid overload have higher rates of postcardiopulmonary bypass acute kidney injury, and the occurrence of fluid overload precedes acute kidney injury. However, acute kidney injury is not consistently associated with fluid overload.