Objective: To describe light and sound characteristics in the rooms of critically ill children. Design: Prospective observational cohort study, with continuously measured light and sound levels. Setting: Tertiary care pediatric intensive care unit (PICU), with a newly constructed expansion and an older, pre-existing section. Patients: Critically ill patients 0-18 years old, requiring respiratory or cardiovascular support. Patients with severe cognitive preconditions were excluded. Measurements and Main Results: One hundred patients were enrolled, totaling 602 patient-days. The twenty-four hour median illuminance was 16 (IQR 5-53) lux (lx). Daytime (07:00-21:00) median light level was 27 lx (IQR 13-82), compared with 4 lx (IQR 1-10) overnight (22:00-06:00). Peak light levels occurred midday between 11:00 and 14:00, with a median of 48 lx (IQR 24-119). Daytime median illuminance trended higher over the course of admission, whereas light levels overnight were consistent. Midday light levels were higher in newly constructed rooms: 78 lx (IQR 30-143) vs. 26 lx (IQR 20-40) in existing rooms. The twenty-four hour median equivalent sound level (LAeq) was 60 (IQR 55-64) decibels (dB). Median daytime LAeq was 62 dB (IQR 58-65) and 56 dB (IQR 52-61) overnight. On average, 35% of patients experienced at least one sound peak >80 dB every hour from 22:00 to 06:00. Overnight peaks, but not median sound levels nor daytime peaks, decreased over the course of admission. There was no difference in sound between new and pre-existing rooms. Conclusions: This study describes continuously measured light and sound in PICU rooms. Light levels were low even during daytime hours, while sound levels were consistently higher than World Health Organization hospital room recommendations of <35 dB. Given the relevance of light and sound to sleep/wake patterns, and evidence of post-intensive care syndromes, the clinical effects of light and sound on critically ill children should be further explored as potentially modifiable environmental factors.

Fluid overload is a common complication of critical illness, associated with increased morbidity and mortality. Pulmonary fluid status is difficult to evaluate clinically and many clinicians utilize chest X-ray (CXR) to identify fluid overload. Adult data have shown lung ultrasound (LUS) to be a more sensitive modality. Our objective was to determine the performance of LUS for detecting fluid overload, with comparison to CXR, in critically ill children. We conducted a systematic review using multiple electronic databases and included studies from inception to November 15, 2020. The sensitivity and specificity of each test were evaluated. Out of 1,209 studies screened, 4 met eligibility criteria. Overall, CXR is reported to have low sensitivity (44–58%) and moderate specificity (52–94%) to detect fluid overload, while LUS is reported to have high sensitivity (90–100%) and specificity (94–100%). Overall, the quality of evidence was moderate, and the gold standard was different in each study. Our systematic review suggests LUS is more sensitive and specific than CXR to identify pulmonary fluid overload in critically ill children. Considering the clinical burden of fluid overload and the relative ease of obtaining LUS, further evaluation of LUS to diagnose volume overload is warranted.

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Late-onset neonatal sepsis (LOS) is a bloodstream bacterial infection that occurs during the first two months of life. Despite improved clinical care, LOS remains a significant contributor to neonatal mortality. Clinical observations suggest neonates exhibit unique immune responses and excessive inflammation during sepsis compared to adults and older children, however, factors contributing to these differences remain poorly understood. Two common routes of pathogen entry for neonates are direct introduction of a pathogen into the bloodstream, or the translocation of a gut-resident pathobiont. Our lab has developed a mouse model of LOS that disrupts goblet cell homeostasis to increase gut permeability and facilitate the translocation of virulent bacterial species such as E. coli. During both intraperitoneal and oral infection, we observe several key features of clinical LOS including increased pro-inflammatory serum cytokines, organ failure, and death in 5 day-old pups, but not 15 day-old pups. Strikingly, we have found robust activation of γδ+ T cells in 5 day-old pups, following infection, independent of pathogen entry route. This γδ+ T cell activation occurred in an age-dependent manner and was absent in 15 day-old pups. γδ+ T cell activation in 5 day-old pups was also associated with a pro-inflammatory cytokine profile that was absent in older pups. Finally, 5 day-old TCRδ−/− pups were protected from mortality during LOS, suggesting that γδ+ T cells may also contribute to mortality in this model. This study sheds light on the unique responses of γδ+ T cells to bloodstream infection during two distinct periods of early life.