{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:44:22Z","timestamp":1785930262063,"version":"3.56.0"},"reference-count":34,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>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\u2013ICP association, adjusting for hemodynamic (mean arterial pressure (MAP), heart rate) and clinical variables. The Mann\u2013Whitney U test compared parameters across a 20 mmHg ICP threshold, and the Kruskal\u2013Wallis 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 \u22120.609, p &lt; 0.001). Agitation was independently associated with higher ICP (estimate 0.856, p &lt; 0.001), and this effect was significantly modified by the patient\u2019s behavioral state, being attenuated during sleep and calm wakefulness compared with agitated wakefulness (sleep \u00d7 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 &lt; 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.<\/jats:p>","DOI":"10.3390\/jcm15156090","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T10:41:42Z","timestamp":1785926502000},"page":"6090","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Pain, Agitation, and Intracranial Pressure with Cerebral Near-Infrared Spectroscopy in Critically Ill Children: A Prospective Pilot Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3209-2697","authenticated-orcid":false,"given":"Fatih","family":"Durak","sequence":"first","affiliation":[{"name":"Department of Pediatric Intensive Care Unit, Medical Faculty, Izmir Katip Celebi University, Izmir 35030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1011-6106","authenticated-orcid":false,"given":"Emine Pinar","family":"Kulluoglu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit, Izmir City Hospital, Izmir 35030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3141-5077","authenticated-orcid":false,"given":"Necati","family":"Ozsevil","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit, Izmir City Hospital, Izmir 35030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2477-3991","authenticated-orcid":false,"given":"Berra","family":"Bilgin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Izmir City Hospital, Izmir 35030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5245-9786","authenticated-orcid":false,"given":"Gokcen","family":"Ozcifci","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit, Izmir City Hospital, Izmir 35030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/PCC.0000000000001737","article-title":"Management of Pediatric Severe Traumatic Brain Injury: 2019 Consensus and Guidelines-Based Algorithm for First and Second Tier Therapies","volume":"20","author":"Kochanek","year":"2019","journal-title":"Pediatr. 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