Background/Objectives: Early identification of pediatric sepsis complications in intensive care is challenging and requires improved diagnostic tools. This study aimed to compare the Phoenix Sepsis Score (PSS), pSOFA, PELOD-2, and PRISM III in assessing clinical complexity in children with septic and critical conditions in the PICU and to identify the most suitable scale for this patient cohort. Methods: Data were collected prospectively from 53 children between June 2022 and January 2024. Patients were categorized into septic (n = 42) and non-infectious SIRS (n = 11) and further classified by outcome—with/without complications (n = 23/30). The predictive accuracy of the scoring systems was evaluated by discrimination and calibration and by recalibration for the PSS for improved performance. Results: Respiratory (18.8%) and neurological complications (9.4%) were the most common adverse events. Clinical deterioration was observed in 43.4% of cases, including one fatality. Patients with complications stayed longer in the PICU (14 ± 10 days). In the patients with complications, all scoring systems had higher median values. Only PSS showed a significant difference (p = 0.0023). PSS demonstrated the highest overall predictive accuracy (76.2%) outperforming PRISM III (62.3%) and PELOD-2 (58.5%). The pSOFA scale showed high accuracy (88.0%) in identifying patients without complications. The strongest association was between chronic disease (hazard ratio Exp(B) = 1.718) and deteriorations, while mechanical ventilation suggested a reduced risk of complications (Exp(B) = 0.509). Conclusions: PSS showed superior predictive accuracy (76.2%) for deteriorations in pediatric patients with suspected infection and proved adaptable for further validation in larger populations.

Introduction. Paediatric intensive care units (PICUs) provide special and comprehensive care and treatment to critically ill children. These factors lead to the exposure of the personnel to stress and the risk of developing burnout syndrome. Methods and participants. In order to evaluate burnout syndrome among physicians employed at PICUs, we carried out our study between September and December of 2023. With the authors' consent, we used a survey that was published in June 2023 in Acta Paediatrica (https://onlinelibrary.wiley.com). The survey was distributed to the physicians working in the existing PICUs in Bulgaria after being translated and reviewed. Results. A total of 37/43 (83.7%) doctors and two clinical psychologists completed the survey. More women than men took part in the study. Of the respondents, 36% were paediatricians, and 30% were specialists in Anesthesiology and Intensive care. In total, 70.3% of the staff reported working between 40-50 hours/week, and 24.3% working more than 50 hours/week; 73% of the employees experienced an episode of overheating, depression, and anxiety. Of all, 75.6% felt exhausted from work, and 43.2% defined themselves as "crushed”. Despite the difficulties that the staff faced, the majority of the doctors express satisfaction with their work and would choose the same specialty again. Conclusion. This study presents for the first time quantitative data on Bulgarian physicians' burnout in PICUs. Burnout among healthcare professionals is a worldwide issue that has a detrimental effect on staff productivity, patient care quality, and hiring medical personnel. Specific solutions are required, such as the establishment of paediatric intensive care as a distinct specialty.

Anorexia nervosa is an eating disorder with a multisystemic nature, affecting female adolescents predominantly. The disease is potentially fatal with cardiac complications being the leading cause. We present a clinical case of a 16-year-old girl with anorexia nervosa after a mental trauma, hospitalized in our Clinic in an extremely severe, pre comatose state with weight 26 kg, BSA – 1.12 m2 and BMI – 10.4. On the background of severe abnormalities in homeostasis, bradycardia with left ventricular extrasystoles in bigeminy and episodes of tachycardia with a frequency of 238/min. Echocardiography revealed reduce in the heart size and the left ventricular muscle mass, MI – I + degree and a small, apical pericardial effusion. During the echocardiographic follow-up, there was signifi cant hypertrophy of the left ventricle with obstruction in the outfl ow tract, with a reduction in ventricular size, without signifi cant change in left ventricular muscle mass. As a result of long-term, comprehensive treatment, with the participation of a team of specialists, the patient achieved true behavioural criticality, improved food tolerance, weight gain up to 46 kg with BMI - 18.4 and normalization of cardiac anatomy. Cardiac complications of anorexia nervosa are common, varied, and potentially lethal and require targeted cardiac monitoring and treatment. Left ventricular hypertrophy with obstruction in the ventricular outfl ow tract, fi rst described in 2006, is a rare but potentially fatal cardiac complication in patients with the disease.