Karolina Grekov

All Publications

• Pediatric State of the Science Kentor, R. A., Silverstein, A., Cantrell, K., Fortier, M. A., Grekov, K., McBee, J., McGuire, A., Mikkelsen, M. ELSEVIER SCIENCE INC. 2026: e831

  View details for DOI 10.1016/j.jpainsymman.2026.04.094

  View details for Web of Science ID 001779085600022

• Why Pediatric Ethics Needs a Theory of Goodness. The Hastings Center report Tate, T., Schiff, J. C., Grekov, K., Burford, A. 2026; 56 (2): 43-45

  Abstract

  We begin this commentary with a brief analysis of "Making Medical Decisions for Children with Profound Cognitive Disabilities: Pluralism and the Best Interest Standard," by Pierce Randall, and "A Life Worth Sustaining? Bestowed Worth and Pediatric Care," by Daniel T. Kim and Xiang Yu, in the same issue of the Hastings Center Report. These two articles examine decision-making for children with profound cognitive disabilities and critique the relational potential standard found in pediatric ethics. We agree with the authors that the relational potential standard risks using children as a means to other people's ends. We also raise two additional concerns: the standard is incongruent with parents' self-descriptions, and it neglects the concept of goodness, which we take to be the fundamental concern of pediatric ethical analysis. We close with a brief discussion of goodness and consider how goodness might serve as the lodestar of pediatric ethics.

  View details for DOI 10.1002/hast.70053

  View details for PubMedID 41840778

• Exploring how claims of 'suffering' are operationalized in pediatric critical care. Journal of pain and symptom management Grekov, K., Batten, J., Tate, T., Anand, K. J., Magnus, D., Halley, M. C. 2025

  Abstract

  Identifying when a child is suffering can be incredibly challenging. Understanding how the term 'suffering' is used in pediatric critical care - and specifically end of life care - is critical for clinical decision-making, communication, and goal-setting between healthcare providers and families. To gain insight into this complex question, we employed ethnographic methods to explore the underlying meanings and goals associated with the use of this term by clinicians, patients, and families in the Pediatric Intensive Care Unit (PICU).To explore how the term 'suffering' is operationalized by clinicians and families in Pediatric Intensive Care Units (PICUs) and its implications for decision-making.This study was conducted in three specialized PICUs within a large tertiary children's hospital. This exploratory qualitative study used ethnographic methods, including narrative literature review, analysis of verbatim transcripts of 30 care conferences and 50 ethnographic observations involving physicians, nurses, and families. Analyses employed an iterative, interpretive approach to identify key themes across data sources.This study identified three main themes: 1) 'Suffering' was rarely defined, 2) Discussions of patient 'suffering' included collateral impacts on providers and families, in addition to impacts on patient experience; and 3) Physicians used 'suffering' to pivot goals of care, while parents used it variably.These findings suggest that 'suffering' is often invoked in the PICU with little specificity, is used to signal provider or caregiver distress, and is used with the intention to shift goals of care in a manner not always consistent with family values or interpretations. Recognizing the implicit messages conveyed through language may support families and healthcare providers to better communicate their goals and preferences, fostering collaborative decision-making and enhancing patient outcomes in the PICU and during end-of-life care.

  View details for DOI 10.1016/j.jpainsymman.2025.05.005

  View details for PubMedID 40389182

• Child Neurology: Remarkable Recovery From Severe Acute Necrotizing Encephalopathy. Neurology Silverman, A., Sasaki, M., Espindola Lima, J. E., Cheronis, C., Lin, G. L., Johnson, A., Dahmoush, H., Archer, E., Grekov, K., LaRocca, T. J., Van Haren, K. 2024; 103 (8): e209877

  Abstract

  A previously healthy 6-year-old girl presented with several days of fever before a generalized seizure. Laboratory investigation revealed elevated liver enzymes, normal ammonia, and positive influenza A through respiratory PCR. Brain MRI demonstrated extensive, bilateral lesions in the cerebral and cerebellar white matter, thalami, basal ganglia, and brainstem. She was diagnosed with acute necrotizing encephalopathy, a rare parainfectious encephalitis commonly associated with influenza. Genetic variants have been implicated (e.g., RANBP2 and RNH1), but our patient's rapid genome was nondiagnostic. Her 1-month hospitalization was complicated by prolonged encephalopathy and intracranial pressure crises requiring hyperosmolar therapy, sedation, intermittent paralysis, and hypothermia. Concomitantly, she received pulse corticosteroids, plasmapheresis, and oseltamivir. Three months after illness onset, she achieved a remarkable recovery with a normal neurologic examination. Although prognosis may comprise considerable morbidity and mortality, prompt recognition, immunotherapy, and intensive care can achieve positive neurodevelopmental outcomes. Our discussion concludes with a focus on the intrinsic uncertainties of neuroprognostication in the pediatric intensive care unit.

  View details for DOI 10.1212/WNL.0000000000209877

  View details for PubMedID 39298704