{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:09:49Z","timestamp":1792177789220,"version":"4.4.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Extracorporeal blood purification therapies, such as hemoadsorption, are increasingly utilized in intensive care to modulate inflammation, improve organ function, and reduce vasoactive support. However, data on their use in neonatal and pediatric populations remain limited, particularly in low-resource settings. This study aimed to evaluate clinical and laboratory outcomes in critically ill pediatric patients receiving hemoadsorption therapy alongside extracorporeal organ support.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a single-center retrospective cohort study in a tertiary neonatal and pediatric intensive care unit in Latin America. Eleven critically ill patients received hemoadsorption using CytoSorb<jats:sup>\u00ae<\/jats:sup> or Oxiris<jats:sup>\u00ae<\/jats:sup> in combination with continuous renal replacement therapy (CRRT) and\/or extracorporeal membrane oxygenation (ECMO). We assessed organ dysfunction scores (PELOD-2), vasoactive-inotropic score (VIS), inflammatory markers (CRP, lactate), oxygenation parameters, and liver and hematologic profiles before and after therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Hemoadsorption was associated with reductions in PELOD-2 (median 11\u20137; <jats:italic>p<\/jats:italic>\u202f=\u202f0.036) and VIS (median 75\u20136; <jats:italic>p<\/jats:italic>\u202f=\u202f0.014). Lactate levels decreased significantly (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001), and oxygenation improved (PaO\u2082\/FiO\u2082, median 69\u2013104; <jats:italic>p<\/jats:italic>\u202f=\u202f0.042). CRP levels declined without reaching statistical significance. Liver and hematologic markers remained largely unchanged. 28-day-mortality was 54.5%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Hemoadsorption in conjunction with CRRT and\/or ECMO showed potential to improve hemodynamic stability, oxygenation, and inflammation in critically ill pediatric patients. These findings support further investigation of hemoadsorption as an adjunctive therapy in pediatric critical care, especially in resource-limited environments.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1650118","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T05:27:37Z","timestamp":1758778057000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Hemoadsorption in critically ill neonatal and pediatric patients: a retrospective cohort study from a Latin American tertiary center"],"prefix":"10.3389","volume":"12","author":[{"given":"Byron Enrique","family":"Pi\u00f1eres-Olave","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jhojan Sebastian","family":"Herrera-Vargas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Tibaduiza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Marin-Agudelo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Piedad","family":"Sarmiento","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Salazar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Ni\u00f1o-Jaimes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Arango-Mesa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"147","DOI":"10.3233\/PIC-13068","article-title":"History of pediatric critical care medicine","volume":"2","author":"Levin","year":"2013","journal-title":"J Pediatr Intensive Care"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"71","DOI":"10.2147\/PHMT.S389404","article-title":"Factors associated with the outcome of a Pediatric patients admitted to intensive care unit in resource-limited setup: cross-sectional study","volume":"14","author":"Dendir","year":"2023","journal-title":"Pediatric Health Med Ther"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"49","DOI":"10.3389\/fped.2018.00049","article-title":"Pediatric critical care in resource-limited settings-overview and lessons learned","volume":"6","author":"Slusher","year":"2018","journal-title":"Front Pediatr"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/s40124-023-00286-3","article-title":"Pediatric Sepsis: a summary of current definitions and management recommendations","volume":"11","author":"Miranda","year":"2023","journal-title":"Curr Pediatr Rep"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"151332","DOI":"10.1016\/j.sempedsurg.2023.151332","article-title":"Managing the kidney - the role of continuous renal replacement therapy in neonatal and pediatric ECMO","volume":"32","author":"Totapally","year":"2023","journal-title":"Semin Pediatr Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"109","DOI":"10.21037\/acs.2018.09.08","article-title":"Extracorporeal membrane oxygenation support in pediatrics","volume":"8","author":"Erdil","year":"2019","journal-title":"Ann Cardiothorac Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"78","DOI":"10.3389\/fped.2018.00078","article-title":"Adjunctive therapies during extracorporeal membrane oxygenation to enhance multiple organ support in critically ill children","volume":"6","author":"Canter","year":"2018","journal-title":"Front Pediatr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1093\/ndt\/gfae089","article-title":"Hemoadsorption: consensus report of the 30th acute disease quality initiative workgroup","volume":"39","author":"Bellomo","year":"2024","journal-title":"Nephrol Dial Transplant"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1186\/s40635-025-00740-0","article-title":"Haemoadsorption to remove inflammatory mediators in sepsis: past, present, and future","volume":"13","author":"Waalders","year":"2025","journal-title":"Intensive Care Med Exp"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"7199","DOI":"10.3390\/jcm12237199","article-title":"Adjunctive hemoadsorption therapy with CytoSorb in patients with septic\/Vasoplegic shock: a best practice consensus statement","volume":"12","author":"Mitzner","year":"2023","journal-title":"J Clin Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e0220444","DOI":"10.1371\/journal.pone.0220444","article-title":"Endotoxin and cytokine reducing properties of the oXiris membrane in patients with septic shock: a randomized crossover double-blind study","volume":"14","author":"Broman","year":"2019","journal-title":"PLoS One"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1259384","DOI":"10.3389\/fped.2023.1259384","article-title":"Impact of CytoSorb and CKRT on hemodynamics in pediatric patients with septic shock: the PedCyto study","volume":"11","author":"Bottari","year":"2023","journal-title":"Front Pediatr"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1948","DOI":"10.1007\/s00134-016-4574-2","article-title":"Refractory septic shock in children: a European Society of Paediatric and Neonatal Intensive Care definition","volume":"42","author":"Morin","year":"2016","journal-title":"Intensive Care Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1097\/PCC.0000000000003147","article-title":"Executive summary of the second international guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PALICC-2)","volume":"24","author":"Emeriaud","year":"2023","journal-title":"Pediatr Crit Care Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1074465","DOI":"10.3389\/fimmu.2023.1074465","article-title":"Effect of extracorporeal hemoadsorption in critically ill patients with COVID-19: a narrative review","volume":"14","author":"Chang","year":"2023","journal-title":"Front Immunol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/s13054-022-04009-w","article-title":"Hemoperfusion: technical aspects and state of the art","volume":"26","author":"Ronco","year":"2022","journal-title":"Crit Care"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1186\/s13054-023-04391-z","article-title":"CytoSorb hemoperfusion markedly attenuates circulating cytokine concentrations during systemic inflammation in humans in vivo","volume":"27","author":"Jansen","year":"2023","journal-title":"Crit Care"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s13054-024-04802-9","article-title":"Potential correlation between hemodynamic improvement and an immune-modulation effect in pediatric patients with septic shock treated with renal replacement therapy and CytoSorb\u00ae: an insight from the PedCyto study","volume":"28","author":"Bottari","year":"2024","journal-title":"Crit Care"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1177\/03913988251313885","article-title":"The pattern of cytokine profile in children received extracorporeal blood purification","volume":"48","author":"Hui","year":"2025","journal-title":"Int J Artif Organs"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"6587","DOI":"10.3390\/jcm13216587","article-title":"Hemoperfusion with CytoSorb\u00ae in Pediatric patients: a monocentric case series","volume":"13","author":"Rihar","year":"2024","journal-title":"J Clin Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.3390\/jpm13071113","article-title":"Haemoadsorption combined with continuous renal replacement therapy in abdominal sepsis: case report series","volume":"13","author":"S\u00e1nchez-Mor\u00e1n","year":"2023","journal-title":"J Pers Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1435","DOI":"10.3390\/biomedicines12071435","article-title":"The sublingual microcirculation in critically ill children with septic shock undergoing Hemoadsorption: a pilot study","volume":"12","author":"Bottari","year":"2024","journal-title":"Biomedicine"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"3068","DOI":"10.3390\/biomedicines11113068","article-title":"Hemoadsorption as adjuvant therapy in acute respiratory distress syndrome (ARDS): a systematic review and meta-analysis","volume":"11","author":"Szigetv\u00e1ry","year":"2023","journal-title":"Biomedicine"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"89026","DOI":"10.5492\/wjccm.v13.i1.89026","article-title":"Systematic review with expert consensus on use of extracorporeal hemoadsorption in septic shock: an Indian perspective","volume":"13","author":"Mehta","year":"2024","journal-title":"World J Crit Care Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1650118\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T05:27:38Z","timestamp":1758778058000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1650118\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,25]]},"references-count":24,"alternative-id":["10.3389\/fmed.2025.1650118"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1650118","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,25]]},"article-number":"1650118"}}