Hypoxia at admission is associated with increased mortality in critically ill children, whereas the association with hyperoxia is less clear. The cohort study demonstrated a U-shaped association between admission PaO2 and mortality. Further examination is needed to explore the effect of hyperoxia upon mortality prediction accuracy.

AimsTo determine whether the paediatric intensive care (PIC) population weight distribution differs from the UK reference population and whether weight-for-age at admission is an independent risk factor for mortality.MethodsAdmission weight-for-age standard deviation scores (SDS) were calculated for all PIC admissions (March 2003–December 2011) to Great Ormond Street Hospital: this is the number of standard deviations (SD) between a child’s weight and the UK mean weight-for-age. Categorised into nine SDS groups, standardised mortality ratios (SMR) and logistic regression were used to assess the relationship between weight-for-age at admission and risk-adjusted mortality.ResultsOut of 12,458 admissions, mean weight-for-age was 1.04 SD below the UK reference population mean (p < 0.0001). Based on 942 deaths, risk-adjusted mortality was lowest in those with mild-to-moderately raised weight-for-age (SDS 0.5–2.5) and highest in children with extreme under- or overweight (SDS < −3.5 and SDS > +3.5). Logistic regression indicated that age, gender, ethnicity and weight-for-age are independent risk factors for mortality. South Asian and ‘other’ ethnicities had significantly increased risk of death compared to children of white and black ethnic origin.ConclusionThe PIC population mean weight-for-age is significantly lower than the UK reference mean. The extremes of weight-for-age are over-represented, especially underweight. Weight-for-age at admission is an independent risk factor for mortality. A U-shaped association between weight and risk-adjusted mortality exists, with the lowest risk of death in children who are mild-to-moderately overweight. Future studies should determine the impact of malnutrition on risk-adjusted mortality and investigate the aetiology of risk disparities with ethnicity.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-014-3381-x) contains supplementary material, which is available to authorized users.

The new accident and emergency (A&E) unplanned reattendance rate clinical quality indicator is intended to drive reduction of avoidable reattendances. Validation data for reattendance rates in children are awaited. The aim of this three site observational study is to establish the rate and reasons for unplanned reattendance to UK paediatric A&Es. Each centre undertook retrospective case note review of children attending at least twice within 7 days. Unplanned reattendance rates at the three centres were 5.1%, 5.2% and 4.4%. Reducing unnecessary unplanned reattendances is beneficial for patients, service capacity and efficacy. This study has identified two groups for targeting reattendance reduction: parents of children returning with the same diagnosis, severity unchanged and parents who bypass primary care resources. Clear communication and early involvement of experienced clinicians are paramount. This study has indicated that a 1%-5% unplanned reattendance rate is realistic, achievable and can drive improvement in children's services.

Key PointsQuestionIn critically ill children clinically assessed to require noninvasive respiratory support following extubation, is the first-line use of high-flow nasal cannula (HFNC) therapy noninferior to continuous positive airway pressure (CPAP) in terms of time to liberation from all forms of respiratory support?FindingsIn this randomized, noninferiority trial of 600 children clinically assessed to require noninvasive respiratory support following extubation, the median time to liberation was 50.5 hours for HFNC vs 42.9 hours for CPAP. The 1-sided 97.5% confidence limit for the hazard ratio was 0.70, which failed to meet the noninferiority margin of 0.75.MeaningAmong critically ill children requiring noninvasive respiratory support following extubation, HFNC compared with CPAP following extubation failed to meet the criterion for noninferiority for time to liberation from respiratory support.