Characteristics of critical Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2) infection in children is not well understood. This study described the clinical characteristics of children admitted to intensive care units (ICU) and explored factors associated with the need for invasive ventilation or mortality. A multicenter, retrospective, cohort study was conducted over eight medical centers, including all patients younger than 18 years of age and admitted to the ICU due to a direct consequence of coronavirus disease 2019 (COVID-19). Patients who were admitted to the ICU for any alternate reason and tested positive for SARS-CoV-2 by screening test, and patients who were admitted due to multi-inflammatory syndrome in children, were excluded. Demographic, laboratory, imaging, and clinical data were collected. Descriptive statistics were used to compare survivors and non-survivors. Fine and Gray’s hazard model was used to estimate the association between clinical variables and ICU death. During the study period, 25 pediatric COVID-19 patients received care in the ICUs. The median age was 2.78 years (IQR 0.21–8.51), and 60% were male. Only three patients were reported to be previously healthy at admission. Nine (36%) patients required invasive mechanical ventilation, including two were on extracorporeal membrane oxygenation. Four (16%) patients died during ICU care. In univariate analysis, the presence of comorbidity (HR 0.0001; 95%CI 0.00001–0.00016), platelets count (HR 0.99; 95% CI 0.98–0.99), elevated procalcitonin (HR 1.05; 95%CI 1.016–1.09), and circulatory compromise (HR 16.34; 95%CI 1.99–134.35), all at the time of ICU admission, were associated with in-ICU mortality. Our findings suggest that children admitted to the ICU with SARS-CoV-2 infection, generally, have a favorable outcome. Low platelets count, elevated procalcitonin, presence of comorbidity, and shock at the time of ICU admission were associated with death. This study may shed more light on the disease dynamics of critical pediatric COVID-19.

Background: Delirium, a neuropsychiatric syndrome characterized by acute disruptions in attention and awareness, significantly impacts children in Pediatric Intensive Care Units (PICUs), leading to prolonged hospitalization, increased infection risk, and dependence on mechanical ventilation. Despite growing recognition, its true burden and risk factors in children remain poorly understood. This prospective cohort study investigated the prevalence, characteristics, and potential therapeutic targets for delirium in 890 children admitted to a tertiary PICU between January and December 2022. Delirium was screened every 12 hours using the validated Cornell Assessment of Pediatric Delirium (CAPD). We analyzed data on demographics, comorbidities, medications, interventions, and clinical outcomes to identify associations with the development of delirium. Our study revealed a high prevalence of delirium, affecting 69.4% (95% CI: 66.33–72.3) of admitted children. Notably, infants were disproportionately affected, accounting for 33.5% of delirium cases. Respiratory diagnoses were significantly associated with delirium (78.6%), while oncology cases had the lowest prevalence (29.4%). Opioid use was identified as a risk factor, increasing the risk of delirium by 45.2%. Furthermore, 97.6% of children with withdrawal syndrome also experienced delirium, highlighting a strong association between these conditions. Delirium was significantly associated with longer PICU stays, and all 20 mortalities during the study period occurred in delirious patients. The adjusted odds ratios from multi-level regression modeling further elucidated the risk factors associated with the development of delirium. This study demonstrates a high prevalence of delirium in PICUs, with infants and those with respiratory diagnoses being particularly vulnerable. Opioid use and withdrawal syndrome emerged as risk factors. Further research is needed to elucidate the mechanisms underlying these associations and develop targeted interventions to prevent, manage, and improve outcomes for children suffering from delirium in critical care settings.

Objective: Idiopathic pulmonary hemosiderosis (IPH) is a rare pediatric disorder characterized by recurrent alveolar hemorrhage leading to iron‐deficiency anemia and diffuse pulmonary infiltrates. Its diagnosis is frequently delayed because early manifestations often mimic common respiratory or hematologic conditions. High‐dose corticosteroids remain the mainstay of acute management, yet prolonged steroid dependence is associated with significant sequelae. Emerging evidence suggests that B cell–directed therapy, including rituximab, may offer a steroid‐sparing alternative in refractory pediatric IPH. Clinical Presentation and Intervention: We describe an uncommon case of steroid‐dependent IPH. Her clinical course was marked by recurrent hypoxemic episodes, diffuse alveolar bleeding, and severe anemia, leading to multiple admissions to intensive care and repeated transfusion requirements. Although she received prolonged therapy with corticosteroids, hydroxychloroquine, and azathioprine, she consistently relapsed whenever steroid doses were reduced. Rituximab was introduced as a steroid‐sparing strategy, after which she demonstrated significant clinical improvement and durable remission. Conclusion: This case illustrates the diagnostic challenges of pediatric IPH when early features are incomplete and underscores the potential value of Rituximab as a steroid‐sparing option in refractory disease. The patient′s sustained remission following B cell–directed therapy supports its emerging role in IPH, though larger, well‐designed studies are needed to better define its long‐term safety and optimal use in children.

Critical pertussis carries high mortality, yet early risk stratification remains challenging. Although hyperleukocytosis and pulmonary hypertension (PHT) are linked to poor outcomes, the prognostic role of white blood cell (WBC) trajectories and optimal thresholds remains unclear. This study identified predictors of mortality and characterized WBC dynamics, and optimal WBC threshold for treatment in children admitted to pediatric intensive care units (PICUs) with pertussis. A retrospective cohort study across 35 PICUs in six Gulf Cooperation Council countries (July 2022-December 2024) included children with laboratory-confirmed pertussis and PICU stay > 6 h. Demographic and clinical data were collected. WBC counts were recorded at emergency presentation, PICU admission, and peak values. Predictors of mortality were analyzed using logistic regression. The WBC threshold was estimated using ROC curves The optimal threshold was identified using Youden Index. Of 204 children, 31(15.2%) died. Non-survivors were younger and had shorter duration of symptoms. They more frequently required leukoreduction, inotropic support, and nitric oxide therapy. Independent predictors of mortality included underweight status (aOR 7.59; 95%CI 2.125-27.12), PHT (aOR 3.69; 95% CI 1.06-12.78), elevated day-1 PELOD score (aOR 1.32; 95%CI 1.11-1.56), and peak WBC (aOR 1.05; 95%CI 1.02-1.09). Peak WBC strongly discriminated mortality (AUC 0.86), with an optimal cut-off of 51.5 × 10⁹/L for correctly identifying the mortality. Two phenotypes emerged: apnea and respiratory distress (RD). In unadjusted comparisons, the RD group had higher WBC, PHT prevalence, PICU stays, and mortality. Mortality in critical pertussis remains high. Underweight status, severity of illness on presentation, peak WBC, and PHT were determinants of poor outcome, while phenotype stratification highlighted distinct clinical presentations.

Objectives: Critical pertussis is a life-threatening illness that predominantly affects young infants, with substantial morbidity and mortality. In this study, we aimed to describe the epidemiology, clinical features, and variability in management of pediatric critical pertussis in the Gulf Cooperation Council (GCC) region. Design: Multinational retrospective cohort study conducted between July 2022 and December 2024. Setting: Thirty-five PICUs in the six GCC countries. Patients: Children 16 years old or younger with laboratory-confirmed pertussis (by polymerase chain reaction or culture) admitted to a PICU. Interventions: None. Measurements and Main Results: A total of 204 cases of critical pertussis were identified. Median (interquartile range [IQR]) age was 53 days (IQR, 36.5–89 d). Most patients (91.2%) were healthy before PICU admission. Comorbidities included acyanotic congenital heart disease (3.9%) or respiratory disease (2.9%). Only 17.3% had received infant pertussis vaccination and 4.1% had mothers vaccinated during pregnancy. The median duration of hospital stay was 9 days (IQR, 6–16 d), and PICU stay was 5 days (IQR, 3–10 d). Hyperleukocytosis (> 30 × 10 ⁹ /L) occurred in 49.5%. Respiratory distress (47.6%) and apnea (28.4%) were the main reasons for PICU admission. Management varied widely: leukoreduction was performed in 27.4%, with significant variation in practice across countries. Use of high-flow nasal cannula and mechanical also varied across the region. Extracorporeal membrane oxygenation was rarely used (1.5%). Echocardiography was obtained in nearly half of the cohort, and revealed pulmonary hypertension in 24 patients. Overall mortality was 15.2%, most commonly attributed to septic shock and respiratory failure. Conclusions: Critical pertussis predominantly affects young infants, with substantial morbidity, mortality, and wide variation in management practices. Our cohort from 2022 to 2024 highlights our GCC regional need for standardized care protocols and strengthened prevention.

Background The lack of centralized pediatric critical care data in Kuwait has limited benchmarking, outcome evaluation, and resource planning. This study describes the development and implementation of Kuwait’s first nationwide PICU registry and evaluates its feasibility and early utility. Methods A centralized registry was implemented across seven governmental PICUs serving over 870,000 children. Demographics, diagnoses, interventions, outcomes, and infection data were retrospectively collected at discharge by site coordinators. Data were entered into a secure, encrypted platform using de-identified records and role-based access, with centralized validation performed every tercile. Results During the implementation phase, 2086 of 2364 admissions were captured. Registry accuracy compared with manual admission logs was 88.2%, demonstrating feasibility and data reliability. Inter-hospital variability in clinical practices and resource utilization was identified. The registry also enabled early detection of infection trends and supported proactive staffing and equipment planning. Conclusion Kuwait’s national PICU registry is feasible, reliable, and operationally effective. It addresses critical data gaps, enhances transparency, supports evidence-based decision-making, and provides a foundation for national quality improvement and future benchmarking initiatives. Impact Demonstrates feasibility, reliability, and operational effectiveness of a national PICU registry in real-world pediatric critical care. Enables early detection of infection trends and supports strategic planning for staffing and equipment. Presents one of the first national PICU registry models in the Middle East, addressing fragmented data systems. Offers practical strategies for standardization, data validation, and inter-hospital coordination, supported by physician champions and stakeholder engagement. Bridges critical data gaps, strengthens quality monitoring and benchmarking, and provides a scalable framework for broader pediatric specialties and international research.