Modified RIFLE criteria in critically ill children with acute kidney injury

A classification system has been proposed to standardize the definition of acute kidney injury in adults. These criteria of risk, injury, failure, loss, and end-stage renal disease were given the acronym of RIFLE. We have modified the criteria based on 150 critically ill pediatric RIFLE (pRIFLE) patients to assess acute kidney injury incidence and course along with renal and/or non-renal comorbidities. Of these children, 11 required dialysis and 24 died. Patients without acute kidney injury in the first week of intensive care admission were less likely to subsequently develop renal Injury or Failure; however, 82% of acute kidney injury occurred in this initial week. Within this group of 123 children, 60 reached pRIFLEmax for Risk, 32 reached Injury, and 31 reached Failure. Acute kidney injury during admission was an independent predictor of intensive care; hospital length of stay and an increased risk of death independent of the Pediatric Risk of Mortality (PRISM II) score (odds ratio 3.0). Our results show that a majority of critically ill children develop acute kidney injury by pRIFLE criteria and do so early in the course of intensive care. Acute kidney injury is associated with mortality and may lead to increased hospital costs. We suggest that the pRIFLE criteria serves to characterize the pattern of acute kidney injury in critically ill children.

Pre-, peri-, and postnatal trauma in subjects with attention-deficit hyperactivity disorder

OBJECTIVE

To review research on pre-, peri-, and postnatal stress and their potential relation to attention-deficit hyperactivity disorder (ADHD).

METHOD

We selected and critically reviewed 51 research reports from the medical and psychology literature, between January 1, 1976 and May 1, 2001, based on the subjects of pre-, peri-, or postnatal stress and ADHD.

RESULTS

Children with ADHD show higher percentages of pre-, peri-, or postnatal insult, compared with unaffected children; however, the relative influence of various factors is still controversial.

CONCLUSIONS

The etiology of ADHD encompasses genetic and environmental factors. Pre-, peri-, and postnatal stressors are environmental factors that may play a role in its etiology. Future research should carefully examine interactions between genetic predisposition and environmental factors as etiologies of ADHD.

Effectiveness of a social skills training program using self/other perspective-taking: a nine-month follow-up

Using a pre/posttest design, with a nine-month follow-up, a new, "modified" social skills training program, which incorporates the concept of self/other perspective-taking, was evaluated and compared to a traditional social skills program in a sample of 36 children. Students in the modified group showed more short- and long-term improvement in behavior than did those in the traditional social skills training group. Implications for practice and research are discussed.