• Laura R A Schouten, Floor Veltkamp, Albert P Bos, Job B M van Woensel, Ary Serpa Neto, Marcus J Schultz, and Roelie M Wösten-van Asperen.
• 1Department of Pediatric Intensive Care, Academic Medical Center, Amsterdam, The Netherlands. 2Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands. 3Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands. 4Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil.
• Crit. Care Med. 2016 Apr 1; 44 (4): 819-29.

ObjectivesOur understanding of the acute respiratory distress syndrome in children is limited, and literature is dominated by investigations in adult patients. Recent preclinical studies suggest that the susceptibility to and severity of acute respiratory distress syndrome in children could differ from that in adults. We assessed the incidence and mortality of acute respiratory distress syndrome reported in children in studies published in the last two decades.Data SourcesMedline, Embase, and CINAHL databases were searched up to August 2014.Study SelectionArticles reporting study data on population- or PICU-based incidence and mortality of acute respiratory distress syndrome in children (> 36 wk gestation and < 18 yr old) were selected.Data ExtractionTwo authors independently collected data and assessed methodological quality and risk of bias of selected studies. Pooled estimates of incidence and mortality were calculated using random-effects models. To explore heterogeneity, influence of study characteristics, including median year of conduct, study location, inclusion and exclusion criteria, and study design and quality, was assessed by meta-regression analysis.Data SynthesisTwenty-nine studies reported on incidence and 32 on mortality. Pooled weighted estimate of the population-based and PICU-based incidence of pediatric acute respiratory distress syndrome was 3.5 (95% CI, 2.2-5.7) cases per 100,000 person years and 2.3% (95% CI, 1.9-2.9), respectively. Pooled weighted mortality was 33.7% (95% CI, 28.6-39.7). There were no trends over time, but mortality was significantly associated with study location.ConclusionsThis systematic review and meta-analysis shows a low incidence but a high mortality. Its results also indicate that both incidence and mortality of pediatric acute respiratory distress syndrome have not changed over the last two decades and that mortality depends on the geographic location of studies.

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