Background: Postoperative junctional ectopic tachycardia (JET) is a potentially life-threatening arrhythmia that may occur after congenital heart surgery, especially following tetralogy of Fallot (TOF) repair. It can cause hemodynamic instability due to atrioventricular dissociation. This study aimed to evaluate the incidence, risk factors, and outcomes of JET after TOF repair, with particular focus on management strategies and the impact of JET duration on recovery. Methods: This retrospective study included 114 pediatric patients who underwent TOF repair between 2015 and 2023. The study was approved by the institutional ethics committee (File No: 2023/09-31, Date: 10 October 2023). Postoperative JET was diagnosed based on standard electrocardiographic criteria. Perioperative variables, surgical techniques, and postoperative outcomes were analyzed. Results: JET occurred in 19 patients (16.7%). Compared with patients without JET, those with JET had higher complication rates (73.7% vs. 42.1%, p = 0.02), prolonged inotropic support, and increased mortality (15.8% vs. 2.1%, p = 0.024). Ionized calcium (p < 0.001) and pH levels (p < 0.037) were significantly lower in JET patients. Right ventricular outflow tract muscle resection was strongly associated with JET occurrence (p = 0.003). Although cardiopulmonary bypass and aortic cross-clamp times did not predict JET, both correlated with JET duration (p < 0.05). Conclusions: Postoperative JET remains a major concern following TOF repair, leading to adverse outcomes and longer recovery. Optimizing perioperative management may help reduce JET-related complications, though further multicenter prospective studies are needed to confirm these findings.

Background: Cardiac involvement in cystic echinococcosis is rare, particularly in children, and interventricular septal localization may cause life-threatening arrhythmias. Case presentation: An 11-year-old girl developed sudden cardiac arrest during biopsy of a dorsal hydatid cyst. After prolonged resuscitation, transthoracic echocardiography revealed a 5.3 × 4.6 cm cyst within the interventricular septum. Computed tomography demonstrated concomitant hepatic involvement. Serology confirmed echinococcosis. The patient subsequently developed recurrent ventricular arrhythmias and complete atrioventricular block, requiring urgent surgical excision and implantation of an implantable cardioverter-defibrillator, followed by albendazole therapy. Conclusion: This case highlights the risk of occult cardiac involvement in pediatric echinococcosis and underscores the importance of comprehensive pre-procedural evaluation.

Background: Routine surveillance for vancomycin-resistant enterococci (VRE) colonization remains the standard practice in many intensive care units. However, in high-acuity pediatric intensive care units (PICUs), where clinical VRE infections are uncommon, universal screening may impose substantial financial and operational burdens with uncertain clinical benefits. This study evaluates the necessity and value of universal VRE surveillance by describing the clinical characteristics and risk profiles of asymptomatic VRE-colonized patients in a newly established, high-acuity, 54-bed PICU. Methods: This single-center, retrospective cohort study included all patients with positive admission or weekly rectal VRE screening cultures between October 2023 and October 2024. Demographic, clinical, microbiologic (including species identification) and outcome variables were analyzed. Results: Among 1270 PICU admissions, 74 patients (5.8%) were colonized with VRE; 42 (56.8%) were positive on admission and 32 (43.2%) acquired colonization during hospitalization. Enterococcus faecium was the predominant species (97.3%). Despite frequent exposure to recognized risk factors, including central venous catheters (79.7%), urinary catheters (77.0%), prolonged PICU stays and carbapenem exposure (62.2%), no patient developed a clinical VRE infection. Conclusions: In this high-acuity PICU with robust infection prevention infrastructure, VRE colonization, including colonization with high-risk E. faecium strains, did not progress to clinical infection. These findings suggest that in high-acuity PICUs with established infection control excellence, the clinical yield of universal VRE screening may be marginal compared with its operational costs, supporting a transition toward targeted, risk-based surveillance.

Background/Objectives: Invasive intracranial pressure (ICP) monitoring is standard in pediatric neurocritical care, but the potential of non-invasive near-infrared spectroscopy (NIRS) and the bedside drivers of ICP remain under-explored. We evaluated the association between cerebral NIRS (rSO₂), pain and agitation, systemic hemodynamics, inflammatory markers, and invasive ICP in critically ill children. Methods: In this prospective pilot study, children undergoing external ventricular-drain-based ICP monitoring were followed with repeated measurements. Linear Mixed Models (LMM) with a random patient intercept were used to assess the NIRS–ICP association, adjusting for hemodynamic (mean arterial pressure (MAP), heart rate) and clinical variables. The Mann–Whitney U test compared parameters across a 20 mmHg ICP threshold, and the Kruskal–Wallis test compared ICP burden across etiology and outcome subgroups. Inflammatory markers (CRP, WBC, procalcitonin) were evaluated separately. Results: A total of 596 measurements from 21 patients were analyzed. Cerebral NIRS was the strongest independent predictor of ICP, showing a significant inverse association (estimate −0.609, p < 0.001). Agitation was independently associated with higher ICP (estimate 0.856, p < 0.001), and this effect was significantly modified by the patient’s behavioral state, being attenuated during sleep and calm wakefulness compared with agitated wakefulness (sleep × agitation interaction, p = 0.002). MAP retained an independent positive association with ICP (estimate 0.044, p = 0.019), whereas pain score did not. After adjustment for etiology and sex, these associations remained unchanged; etiology was itself an independent predictor of ICP (p = 0.001), whereas sex was not. Serum CRP independently predicted ICP (t = 2.382, p = 0.018), whereas WBC and procalcitonin did not. ICP burden differed by etiology, with intracranial masses and leukemia showing the highest loads (p < 0.001), but not across clinical-outcome groups (p = 0.192). Conclusions: Cerebral NIRS-derived rSO₂ was an independent inverse correlate of invasive ICP, and agitation was independently associated with ICP in a state-dependent manner, with its effect attenuated during sleep and calm wakefulness. CRP and etiology further shaped ICP burden. These findings support integrating non-invasive cerebral oximetry into multimodal pediatric neuromonitoring and highlight the value of managing distress to mitigate intracranial hypertension.

Background: Colistin has reemerged as a last-line treatment for multidrug-resistant (MDR) gram-negative infections in neonatal and pediatric intensive care units, but age-specific data on early laboratory changes during therapy remain limited. This study evaluated early renal, hepatic, and hematologic laboratory trajectories during intravenous colistin treatment in critically ill neonates and children. Materials and Methods: In this retrospective cohort study, patients who received intravenous colistin for ≥7 consecutive days in the neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) of a tertiary-care university hospital between January 2011 and March 2014 were included. Hematologic, renal, and hepatic parameters were compared between baseline and day 7. Microbiological findings were summarized. Results: Seventy-five patients were included: 25 neonates and 50 children. Klebsiella pneumoniae and Acinetobacter baumannii were the predominant pathogens in both cohorts. In neonates, no significant changes were observed in hematologic, renal, or hepatic parameters between baseline and day 7 (all P > 0.05). In the pediatric cohort, serum creatinine ( P = 0.044) and AST ( P = 0.044) increased significantly by day 7. Patients demonstrating these increases already had abnormal baseline values. Conclusions: Intravenous colistin was not associated with a significant early laboratory toxicity signal in neonates. In PICU patients, increases in serum creatinine and AST were observed, primarily among children with preexisting laboratory abnormalities, suggesting that underlying organ dysfunction may have contributed to these changes. These findings indicate age-related differences in laboratory trajectories during colistin exposure and require confirmation in prospective studies using standardized acute kidney injury definitions.