Objectives This study aimed: (a) to compare the effects of continuous and intermittent infusions of vancomycinon the pharmacodynamics/pharmacokinetics (PK/PD) at a dose of 40 mg.kg-1.d-1 in children; (b) to compare the outcomes and the frequency of the drug-related adverse effects in this population. Methods This single-center randomized controlled trial enrolled children, admitted to the intensive care unit over a period of 36 months (June 1, 2017–June 1, 2020), and required vancomycin therapy. These children were randomly assigned to the CIV and IIV groups. The demographic, indices of PK/PD, outcomes, and drug-related adverse effects were collected and analyzed. Results Of the 92 patients randomized, 90 were included in the analysis and 2 patients dropped out of the trial. The study was conducted on two groups: the IIV group (n = 50) and the CIV group (n = 40) and various parameters were compared. The plateau concentration in the CIV group was higher than the trough concentration in the IIV group (15.22 mg.L-1 vs. 6.25 mg.L-1, P < 0.05). The AUC0–24/MIC of the IIV group was lower (median 391.45, IQR 251.45–898.16) compared to that of the CIV group (429.60, IQR 220.92–769.20; P > 0.05). None of the two groups showed any significant difference in the clinical prognosis or the drug-induced nephrotoxicity. Conclusions Therefore, CIV can assist in attaining the target concentrations of vancomycin more quickly in critically ill children, without increasing the dosage. Also, the children subjected to CIV demonstrated no difference in clinical efficacy and the rate of drug-related nephrotoxicity.

Aim: To assesses the severity and prognosis of pediatric acute respiratory distress syndrome (PARDS) based on a chest radiograph (CXR) scoring method. Methods: 116 PARDS and 463 CXRs were selected. General demographics, pulmonary complications, and 28‐day mortality of the patients were recorded. Subgroup divided by prognosis (survive, death) and etiology (infection, non-infection). CXR scores were calculated for each of the four quadrants by infiltration extent (0-4) and density (1-3). The ROC curve and survival curve were established, the cut-off score for predicting prognosis was set. Results: The agreement between two independent observers was excellent (ICC=0.98, 95%CI:0.97-0.99). The hospital length of stay of death group was shorter than survive group, whereas the percentage of pulmonary complication of death group were significantly higher than survival group (all p<0.05). Day 3 score was independently associated with better survival (p<0.001). The aera under the curve of ROC was 0.773 (95%CI:0.709-0.838). The cut-off score was 21 (sensitivity 71.7%, specificity 76.5%), OR was 9.268 (95%CI: 1.257-68.320). The pulmonary complication showed an OR of 3.678 (95%CI: 1.174-11.521) for the prediction. Conclusions: CXR score can be used in PARDS for predicting prognosis and has a great agreement among radiologist and pediatrician. Pulmonary complication, Day 3 score whether greater than 21 points have a strong predictive effectiveness.