bims-cliped 2026-04-05 papers

bims-cliped

Biomed News

on Clinical pediatrics

Issue of 2026–04–05
twenty-one papers selected by
Alyssa M. Portwood, Akron’s Children

Practice changing papers: A 2025 review of pediatric emergency medicine.
Routine daily chest radiographs in pediatric critical care: necessary standard or unwarranted practice?
Randomized controlled trial of intravenous dexamethasone to prevent relapse in the treatment of migraine in a pediatric emergency department.
Participation of children and adolescents in healthcare, prevention and health research: A dot survey.
Positional obstructive sleep apnea in pediatric down syndrome: Prevalence and therapy implications.
Achieving zero waitlist mortality for children on the pediatric liver transplant waitlist.
Brachial plexus birth injury in children and adolescents: A current concepts review.
Update on the treatment of allergic rhinitis in children.
Comparative efficacy and safety of biologic therapies in pediatric asthma: a comprehensive systematic review.
Beyond rural versus urban: A gradient of mortality risk among injured children across a four-level rurality scale.
Evaluating Clinical Outcomes in Children With Acute Osteomyelitis Treated With Intravenous Versus Oral Antimicrobial Therapy.
Cumulative dose in pediatric CT "frequent flyers": cohort results and risk review.
Psychological stress and treatment outcomes in children with nocturnal enuresis: A single-center prospective cohort study.
Long-Term Safety and Efficacy of Dupilumab Treatment in Children Aged 6 Months to 5 Years with Severe Atopic Dermatitis.
Clinical Practice Patterns for Discussing Hydroxyurea Initiation With Families of Children With Sickle Cell Disease.
Early versus interval appendectomy in children with complicated appendicitis: effects on hospital stay and occurrence of severe complications.
Models of care for hypertonia in childhood: a scoping review.
Child and parent perspectives in IBD management: a literature review and qualitative study.
Effective communication between nurses and caregivers of pediatric patients who use a language other than English: A concept analysis.
Analgesia and Imaging Practices in Pediatric Appendicitis: A 14-Year Retrospective Trend Analysis.
Skin injuries related to Octenidine-based antisepsis in neonatal and pediatric populations: a scoping review.

Am J Emerg Med. 2026 Mar 18. pii: S0735-6757(26)00133-6. [Epub ahead of print]104 162-171

Practice changing papers: A 2025 review of pediatric emergency medicine.

Emily Rose, Joshua S Easter.

  Most children receive emergency care by general emergency physicians and not in designated children's hospitals. There are unique considerations in the care of children that differ from the care of adults. Many management principles can be extrapolated from adult studies, but the unique pathophysiology of pediatric disease requires specialized attention and management updates. This article highlights ten impactful articles from 2025 whose findings can improve the care of children in the Emergency Department (ED). Given the challenges in evaluating pediatric conditions due to the rarity of negative outcomes, multiple systematic reviews were included to improve the ability to discern effects. Other included studies addressed important topics or were prospective in nature.

Keywords:  Abuse; Appendicitis; Fever; Meningitis; Pediatric resuscitation; Pharyngitis; Steroids; sepsis

DOI:  https://doi.org/10.1016/j.ajem.2026.03.009
Curr Opin Pediatr. 2026 Apr 01.

Routine daily chest radiographs in pediatric critical care: necessary standard or unwarranted practice?

Duane C Williams, Conrad Krawiec, Gregory Vorona.

   PURPOSE OF REVIEW: The routine use of daily chest radiographs in pediatric critical care remains common in the management of critically ill children. However, this practice has come under question. This review evaluates whether daily chest radiography is necessary.
RECENT FINDINGS: The evidence indicates that the practice of daily chest radiography does not significantly improve clinical outcomes in children. It also does not replace careful clinical assessment, exposes children to unnecessary radiation with potential long-term risk, and may reflect defensive medical practice rather than patient-centered decision-making.
SUMMARY: Providers should base imaging decisions on clinical findings and changes in patient condition rather than on a routine schedule of obtaining studies.

Keywords:  chest radiograph; clinical outcomes; defensive medicine; radiation exposure

DOI:  https://doi.org/10.1097/MOP.0000000000001565
Headache. 2026 Apr 03.

Randomized controlled trial of intravenous dexamethasone to prevent relapse in the treatment of migraine in a pediatric emergency department.

Geneviève Tourigny-Ruel, Benoit Bailey, Sabrina Jean-Charles, Jocelyn Gravel.

   OBJECTIVE: This study aimed to evaluate whether a single dose of intravenous dexamethasone, when added to standard abortive therapy, reduces relapse of migraine after emergency department (ED) discharge in children and adolescents.
BACKGROUND: Migraine is a leading cause of headache presentations to the ED for children and adolescents. Although corticosteroids have been suggested to reduce relapse in adults with acute migraine, their efficacy in children remains unknown.
METHODS: We conducted a randomized, double blind, placebo-controlled trial at the tertiary pediatric ED of the CHU Sainte-Justine in Montréal, Canada. Patients 8-17 years old with acute migraine attack requiring intravenous rescue therapy (metoclopramide with diphenhydramine) were randomized to receive dexamethasone (0.6 mg/kg iv, max 15 mg) or placebo before discharge. All participants were discharged on oral naproxen for 48 h. The primary outcome was relapse within 48 h, defined as recurrence or worsening of headache after initial improvement. Secondary outcomes included pain scores, return to school and activities, health care revisits, and adverse events. Analyses were performed using a modified intention-to-treat approach including all children who provided data for the primary outcome.
RESULTS: Between July 2013 and February 2025, 116 patients were enrolled, and 87 patients (75%) provided outcome data at 48 h. Median age was 14 years, and 85 patients (73%) were female. Relapse occurred in 39% (16 of 41) of the dexamethasone group versus 44% (20 of 46) of the placebo group (risk difference: -4%; 95% confidence interval, -32% to 24%). Pain scores, return to school, functional recovery, and health care consultations did not differ significantly between groups. Adverse events were infrequent and mild in both arms.
CONCLUSIONS: In this small clinical trial of children and adolescents with acute migraine attack treated in the ED, adjunctive dexamethasone did not reduce relapse rates nor improve functional outcomes compared with placebo. Although limited by low statistical power, these findings raise questions about the routine use of dexamethasone in migraine management of children and adolescents.

Keywords:  dexamethasone; emergency department; migraine; pediatrics; relapse

DOI:  https://doi.org/10.1111/head.70087
PLoS One. 2026 ;21(3): e0345911

Participation of children and adolescents in healthcare, prevention and health research: A dot survey.

Yvonne Stefanie Jordan, Daniel Troitzsch, Nils Pfeuffer, Luisa Tischler, Samuel Tomczyk, Neeltje van den Berg.

BACKGROUND: While adults are actively involved in medical decisions, this has long been neglected in the case of children and adolescents. Traditionally, parents and doctors make decisions for children, as children are often considered lacking cognitive maturity and the ability to make decisions. The involvement of children and adolescents can have many advantages. However, the needs of children and adolescents are not always sufficiently taken into account in the healthcare system.
OBJECTIVE: The aim of this study is to explore the opinions of children and adolescents as well as their parents with respect to the extent of participation across the three dimensions prevention, health care, and health research.
METHOD: The data was collected using the dot poster method. The survey was conducted at a public event both on site and online to ensure broad participation. The data was analyzed descriptively.
RESULTS: A total of 87 people took part in the survey. Thereof, 30 were under 18 years old (34.5%). Overall, the participation of children and adolescents in areas of the healthcare system was supported. The extent of participation varied depending on the age of the population under consideration and the age of the respondents. Younger respondents tended to be in favor of leaving health decisions to their parents and wanted a lesser form of participation. Respondents over the age of 18 favored a higher degree of participation by children and adolescents, particularly in research.
CONCLUSION: The results of this study emphasize the need to systematically examine and promote the participation of children and adolescents in the healthcare system. The differentiated consideration of the age groups enables a targeted approach and consideration of the different decision-making abilities. The results should serve as a basis for future research projects dealing with the development and implementation of participatory approaches in pediatric care and research.

DOI: https://doi.org/10.1371/journal.pone.0345911
Int J Pediatr Otorhinolaryngol. 2026 Mar 31. pii: S0165-5876(26)00103-5. [Epub ahead of print]204 112808

Positional obstructive sleep apnea in pediatric down syndrome: Prevalence and therapy implications.

Debra M Don, Beth Osterbauer, Emily Gillett, Sally Davidson Ward.

   BACKGROUND: Children with Down Syndrome (DS) may be uniquely predisposed to positional obstructive sleep apnea (POSA) due to their anatomic features. Our objective was to determine the prevalence and predisposing factors of POSA in a DS pediatric population in comparison to a control cohort.
METHODS: Overnight polysomnograms of children with and without DS were retrospectively reviewed between November 2016 and December 2023. Demographics and sleep data were collected; POSA was defined as an obstructive apnea-hypopnea index (OAHI) that was at least twice as high in the supine vs. non-supine position.
RESULTS: DS children had more severe OSA as evidenced by OAHI in different sleep states and body positions than controls. Prevalence of POSA was slightly higher in controls than DS group (48% vs. 36%, p = 0.078). The majority of control children with POSA exhibited mild OSA, while DS children with POSA had a more equal distribution in all OSA severity categories. DS was associated with a decreased odds of having POSA (OR 0.45, 95%CI: 0.2, 0.97, p = 0.042).
CONCLUSION: DS subjects demonstrated more severe OSA and a predisposition towards experiencing significant apneic events in all body positions and sleep stages. The expression of this clinical phenotype of OSA in DS children may be caused by multiple factors, but we hypothesize that it is due primarily to their hypotonia and greater airway collapsibility. Our findings suggest that positional therapy must be individualized for children with DS.

Keywords:  Child; Down syndrome; Sleep apnea

DOI:  https://doi.org/10.1016/j.ijporl.2026.112808
Am J Transplant. 2026 Mar 30. pii: S1600-6135(26)00180-2. [Epub ahead of print]

Achieving zero waitlist mortality for children on the pediatric liver transplant waitlist.

Elizabeth King, Carolyn Reuland, Bhargava Mullapudi, Christine Hwang, Clark Bonham, Deepak Vikraman, Kambiz Etesami, Patrick Healey, Joseph Magliocca, Majella Doyle, Arika Hoffman, Dominique Jan, Sarah Bellemare, Andre Dick, Jaimie D Nathan, Rachel Forbes, Ning Duan, Srinath Chinnakotla.

  Children with end-stage liver disease are at high risk of waitlist morbidity and mortality; children <1 year have the highest mortality of all age groups in the US (18.6 deaths per 100 patient-years). Pediatric candidates receive fewer offers of organs than adults, and excessive wait-times contribute to delays in development that can have lasting impact. Policy changes and outreach efforts have been insufficient to increase organ availability for children. Living donor liver transplantation (LDLT) is underutilized in the US, accounting for 14.6% of all pediatric transplants in 2023, compared with 46.2% in Canada. The ASTS Pediatric Committee therefore recommends promoting increased utilization of LDLT and incentivization and adoption of mandatory liver-splitting policies to safeguard these children, which could decrease pediatric waitlist mortality while increasing the number of liver transplants performed. Outcomes are similar between recipients of split-liver and whole-liver grafts in both pediatric and adult populations, but fewer than 5% of potentially splitable livers are currently used for split-liver transplantation in the US. In contrast, over 65% of pediatric patients in the United Kingdom receive a split-liver allograft, with excellent survival. Use of a center-based allocation system will support this mandate by reducing cold ischemia time and increasing liver availability.

Keywords:  allocation policy; outcomes; pediatric liver transplantation; waitlist mortality

DOI:  https://doi.org/10.1016/j.ajt.2026.03.025
J Child Orthop. 2026 Mar 24. 18632521261420152

Brachial plexus birth injury in children and adolescents: A current concepts review.

Taylor Shackleford, Kevin J Little.

  Brachial plexus birth injuries (BPBI), although rare, have a significant impact on patients and the healthcare system. While these conditions tend to be treated at specialty centers around the world that are well equipped to handle the complex needs of these patients, an understanding of the natural history, prognosis, and treatment options for this population is important for all pediatric orthopedic providers. This review aims to detail current concepts of the treatment of BPBI with a focus on clinical examination, operative indications, early surgical interventions, and long-term musculoskeletal sequelae.

Keywords:  Brachial plexus birth injury; nerve avulsion; nerve grafting; nerve transfer; sequelae of brachial plexus injury

DOI:  https://doi.org/10.1177/18632521261420152
Pediatr Allergy Immunol. 2026 Apr;37(4): e70329

Update on the treatment of allergic rhinitis in children.

Eleni Anastasiou, Paraskevi Xepapadaki, Julijana Asllani, Foteini Kapsouli, Aspasia Karavelia, Aikaterini Petta, Nikolaos G Papadopoulos.

  Allergic rhinitis (AR) is the most common chronic condition from childhood to adulthood and remains a major, often underestimated, contributor to impaired quality of life, school performance, and healthcare use. Although symptoms frequently begin early in life, pediatric AR is still underdiagnosed and inadequately treated, with important consequences for physical, emotional, and cognitive development. In this narrative review, we summarize recent evidence on the treatment of AR in children, highlighting age-specific challenges and evolving treatment concepts. International recommendations, particularly those from ARIA, support a stepwise, patient-centred approach focused on symptom control, safety, and long-term outcomes. Intranasal corticosteroids remain the cornerstone of therapy for moderate-to-severe disease, while second-generation antihistamines and intranasal antihistamines provide effective options for milder or intermittent symptoms. Fixed-dose intranasal steroid-antihistamine combinations are highly effective, providing options for children with more severe or uncontrolled AR. Allergen immunotherapy is the only disease-modifying intervention. Emerging strategies, including biologics and novel immunotherapy approaches, are promising but currently limited to specific contexts. Alongside pharmacotherapy, education, adherence support, and pragmatic environmental measures are essential to achieve sustained disease control. Ongoing gaps in the pediatric evidence-base highlight the need for age-adapted algorithms and long-term studies focusing on early intervention and disease modification.

Keywords:  allergen immunotherapy; allergic rhinitis; children; pharmacotherapy; treatment of allergic rhinitis

DOI:  https://doi.org/10.1111/pai.70329
Front Med (Lausanne). 2026 ;13 1722577

Comparative efficacy and safety of biologic therapies in pediatric asthma: a comprehensive systematic review.

Abdullah Alzayed.

   Background: Asthma remains one of the most prevalent chronic diseases among children, with severe cases posing significant challenges to symptom control, and quality of life (QoL). Biologic therapies have emerged as effective alternatives for severe asthma unresponsive to conventional therapies. However, limited evidence exists for their comparative efficacy and safety in pediatric populations. This systematic review aims to evaluate the efficacy and safety of five major biologic agents in children and adolescents with uncontrolled asthma.
Methods: A systematic literature search was conducted in PubMed, Web of Science, and Embase up to June 2025. Eligible studies included randomized and open label extensions involving pediatric asthma patients treated with at least one of the five biologic therapies including Dupilumab, Omalizumab, Mepolizumab, Lebrikizumab and Benralizumab. Outcomes assessed included exacerbation rates, lung function, asthma control, QoL, and adverse events. Risk of bias was assessed using RoB 2.0 and MINORS tools.
Results: This review included Twenty-five studies. Dupilumab consistently showed the most robust outcomes, significantly reducing exacerbations (by up to 64.7%), improving ACQ-7 scores, pulmonary function, and QoL. Omalizumab also showed reduced exacerbations and improved symptom control and QoL, with debatable results in pulmonary function. Mepolizumab demonstrated moderate benefits with variable efficacy and higher SAE rates. Benralizumab and Lebrikizumab yielded modest improvements in clinical outcomes. Safety profiles were generally favorable across biologics, with mild-to-moderate adverse events.
Conclusion: Among the reviewed biologics, Dupilumab showed the most consistent and sustained efficacy across clinical, and patient-reported outcomes in pediatric asthma. Omalizumab also proved effective, particularly in allergic and virus-induced exacerbations. This review underscores the importance of phenotype-directed therapy and supports dupilumab as a preferred option for long-term management of severe pediatric asthma.

Keywords:  asthma; asthma exacerbation safety; biologic therapy; pediatrics; quality of life

DOI:  https://doi.org/10.3389/fmed.2026.1722577
J Trauma Acute Care Surg. 2026 Mar 31.

Beyond rural versus urban: A gradient of mortality risk among injured children across a four-level rurality scale.

Minneapolis, Minnesota

   BACKGROUND: Children living in rural areas experience an increased incidence of injury and higher mortality relative to those in urban areas. Our aim was to better characterize rural-urban disparities in pediatric trauma outcomes among children admitted to US hospitals.
METHODS: This is a retrospective, observational study of US hospitalizations of injured children and adolescents <20 years of age using the Kids' Inpatient Database (2016, 2019, and 2022). We categorized children's home counties as large urban, small urban, micropolitan, and rural. We compared demographics and injury characteristics of injured children among differing levels of rurality. We determined the unadjusted and adjusted risk of inpatient mortality using quasibinomial logistic regression, accounting for survey design, by level of rurality.
RESULTS: A representative weighted 402,255 injured children were admitted in the survey years. The median age was 13 (IQR, 5-17) years and 39.1% were female. Motor vehicle crash (21.1%) and falls (21.1%) were the most common mechanisms of injury. As the level of rurality increased, the proportion of severely injured children (ISS >25) increased (7.0% large urban, 7.9% small urban, 9.6% micropolitan, and 10.9% rural areas). When adjusted for risk of mortality, compared to large urban counties, rural county was associated with 32% higher odds [odds ratio (OR), 1.32, 95% CI, 1.16-1.51], micropolitan 30% higher odds (OR, 1.30, 95% CI, 1.16-1.46), and small urban 22% higher odds (OR, 1.22, 95% CI, 1.12-1.32) of inpatient mortality.
CONCLUSIONS: Among injured children admitted to US hospitals, children residing outside of large urban areas have a higher risk of death independent of injury severity. To address disparities in pediatric rural injury outcomes, we must further investigate the root causes of this disparity, which may include nonoptimal location of pediatric trauma centers, long transport times, and low pediatric readiness in rural hospitals. (J Trauma Acute Care Surg. 2026;00:00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).
LEVEL OF EVIDENCE: Prognostic/Epidemiological; Level III.

Keywords:  Pediatric trauma; disparities; rural

DOI:  https://doi.org/10.1097/TA.0000000000004977
Cureus. 2026 Mar;18(3): e104551

Evaluating Clinical Outcomes in Children With Acute Osteomyelitis Treated With Intravenous Versus Oral Antimicrobial Therapy.

Tiffany Withrow, Hannah Lu, Ankita Desai, LeAnne Tripp.

   INTRODUCTION AND AIM: Osteomyelitis is an infection of the bone that typically requires hospitalization for diagnosis and initial treatment. For many years, it has been assumed that osteomyelitis must be treated with intravenous (IV) antibiotics for the full course of therapy. However, recent data have demonstrated the efficacy of oral (PO) antibiotics. In addition, studies comparing the efficacy of IV versus PO antibiotics in children with osteomyelitis have found that there was no increased incidence of treatment failure when patients were transitioned to PO antibiotics. The Infectious Diseases Society of America 2021 guideline on the management of acute hematogenous osteomyelitis recommends transitioning from IV to PO regimens when an acceptable PO antibiotic is available. This study aimed to evaluate the efficacy and use of IV versus PO antibiotic therapy for the treatment of osteomyelitis at a pediatric tertiary care center.
METHODS: This retrospective chart review evaluated patients under 18 years of age admitted from January 2019 to December 2021 with a diagnosis of acute osteomyelitis. Patients were grouped according to the route of antimicrobial administration prescribed at hospital discharge.
RESULTS: Fifty-one patients with osteomyelitis were included, with 19 and 32 patients in the PO and IV groups, respectively. There was no difference in the treatment failure rate between the two groups (IV=3 {9.4%} versus PO=2 {10.5%}; p=1.000). Patients in the IV group had higher rates of adverse drug events compared to the PO group (IV=9 {28.1%} versus PO=4 {21.1%}), with diarrhea and drug-induced neutropenia being the most common.
CONCLUSION: Oral therapy for osteomyelitis may be associated with fewer adverse events than IV therapy, with no difference in treatment failure.

Keywords:  antibiotics; bone and joint infections; children; infectious diseases; osteomyelitis; pediatrics

DOI:  https://doi.org/10.7759/cureus.104551
Pediatr Radiol. 2026 Mar 31.

Cumulative dose in pediatric CT "frequent flyers": cohort results and risk review.

Sjirk J Westra, Andrew E Ferretti, Theodore A Marschall, Xinhua Li, Kai Yang, Bob Liu, Madan M Rehani.

   BACKGROUND: Published surveys have documented increasing cumulative radiation doses from the increased use of CT over recent decades, but pediatric data on this are sparse.
OBJECTIVE: To determine what percentage of pediatric patients receive a high cumulative effective dose (CED) from repeated CT scans in our practice, and to examine the reasons for this.
MATERIALS AND METHODS: Our dose monitoring software maintains a record of CED in all patients undergoing CT. Those who received a CED ≥50 mSv and ≥100 mSv were tabulated for further analysis. The highest dose outliers were flagged for analysis of clinical rationales of CT use, calculation of cumulative absorbed dose profiles, and outcomes.
RESULTS: From 2013-2023, we performed CT in 10,199 patients aged 0-19 years, of whom 75% had one, 14% had two, 5% had three, 3% had four, and 3% had five or more CTs. Of our cohort, 97 (0.95%) reached the CED dose threshold of 50 mSv at age 16.0±3.0 (16.9) years [mean±SD (median)], and 20 (0.20%) also reached the 100 mSv threshold at age 16.2±1.8 (16.5) years. The highest CED values occurred in patients with serious and catastrophic conditions, in overweight adolescents, and because of repeated high-dose multiphasic acquisitions and CT-guided interventions.
CONCLUSION: Most of our patients (89%) had only 1-2 CT scans. Although only 0.95% and 0.20% of our pediatric patients experienced CEDs more than 50 mSv and 100 mSv (respectively) from repeated CT scans, these groups deserve close attention, as they often continue to accumulate doses throughout childhood and beyond.

Keywords:  Cancer; Children and young adults; Computed tomography; Cumulative effective dose; Ionizing radiation; Risk

DOI:  https://doi.org/10.1007/s00247-026-06598-y
J Pediatr Urol. 2026 Mar 17. pii: S1477-5131(26)00155-5. [Epub ahead of print] 105876

Psychological stress and treatment outcomes in children with nocturnal enuresis: A single-center prospective cohort study.

Sang Don Lee, So Won Kim, Yu Yeun Kang, Gi Bae Kim, Se Hyun Cha, Jae Min Chung.

   BACKGROUND: Nocturnal enuresis (NE) is frequently accompanied by emotional distress, including shame, anxiety, and social embarrassment. However, whether enuresis-related psychological stress influences treatment response remains unclear.
OBJECTIVE: To determine the prevalence of NE-related psychological stress and to evaluate whether baseline emotional distress is independently associated with treatment outcomes in children.
STUDY DESIGN: In this prospective cohort study, 257 children with NE (mean age 7.8 ± 2.0 years) were enrolled. Psychological stress was assessed using a structured two-step interview focused on emotional responses directly attributable to NE. Children were classified as non-stress only if they denied both global distress and all predefined emotional domains (shame, upset, anger, depressive mood, anxiety/fear). All patients received standardized urotherapy, with pharmacological treatment added as clinically indicated. Treatment response was categorized according to ICCS definitions. Multivariate logistic regression analysis was performed adjusting for age, sex, NE type, and baseline enuresis frequency.
RESULTS: Psychological stress was reported in 206 children (80.2%), with shame being the most frequently reported emotion (58.8%). Baseline clinical characteristics were comparable between groups. Treatment response rates at 3 months and final follow-up did not differ significantly between stress and non-stress groups. In multivariate analysis, psychological stress was not independently associated with treatment response (p = 0.770), whereas baseline enuresis frequency was independently associated with outcome (p = 0.039).
DISCUSSION: Although emotional distress was highly prevalent, it was not independently associated with treatment response when standardized therapy was applied. However, given the use of a non-validated stress assessment tool and limited power to detect small effect sizes, a modest association cannot be entirely excluded.
CONCLUSION: Psychological stress is common in children with NE but was not independently associated with treatment response in this prospective cohort.
CLINICAL/TRANSLATIONAL APPLICABILITY: Standardized treatment strategies for NE may be applied regardless of baseline emotional distress, while recognition and management of psychosocial burden remain important components of comprehensive care.

Keywords:  Behavior therapy; Drug therapy; Nocturnal enuresis; Psychological stress; Treatment outcome

DOI:  https://doi.org/10.1016/j.jpurol.2026.105876
Paediatr Drugs. 2026 Apr 02.

Long-Term Safety and Efficacy of Dupilumab Treatment in Children Aged 6 Months to 5 Years with Severe Atopic Dermatitis.

Amy S Paller, Andreas Pinter, Lara Wine Lee, Roland Aschoff, Jacek Zdybski, Christina Schnopp, Faisal A Khokhar, Amy H Praestgaard, Ashish Bansal, Brad Shumel, Mike Bastian.

BACKGROUND: Infants and young children with severe atopic dermatitis (AD) have a high burden of disease with a strong impact on quality of life. Here we assess long-term efficacy and safety of dupilumab in pediatric patients aged 6 months to 5 years with severe AD.
METHODS: This is a subgroup analysis of patients aged 6 months to 5 years enrolled in the ongoing LIBERTY AD PED open-label extension (OLE) study of dupilumab who had previously participated in the parent study LIBERTY AD PRESCHOOL part B and had severe AD (Investigator's Global Assessment [IGA] = 4) at parent study baseline. Patients received weight-tiered dupilumab every 4 weeks (200 mg for patients weighing 5 to < 15 kg; 300 mg for patients weighing 15 to < 30 kg). Key endpoints included the incidence and rate of treatment-emergent adverse events (TEAEs), the proportion of patients with a ≥ 75% improvement in Eczema Area and Severity Index (EASI-75) from parent study baseline, proportions of patients achieving IGA = 0/1 and IGA ≤ 2, and the proportion of patients with a ≥ 6-point improvement in Children's Dermatology Life Quality Index (CDLQI) for patients aged ≥ 4 years or Infants' Dermatitis Quality of Life (IDQoL) questionnaire for patients aged < 4 years.
RESULTS: This analysis included 121 patients, of whom 50 completed the week 104 visit. TEAEs were reported in 88% of patients; most TEAEs were mild or moderate and not related to treatment. Common TEAEs included upper respiratory tract infection, nasopharyngitis, and cough. Conjunctivitis events were reported in 19% of patients and were mild or moderate, with a median duration of 8 days. No conjunctivitis event led to treatment discontinuation, and most events resolved during the study. One drug-related event (severe urticaria) led to treatment discontinuation, but it was not serious and resolved over time. Serious TEAEs were reported in 17 patients (14%), including one drug-related pinworm event. No serious TEAE led to treatment discontinuation. By week 4 of the OLE study, patients who had received placebo in the parent study exhibited efficacy improvements comparable to patients who had received dupilumab. By week 104, 96% of patients achieved EASI-75 from parent study baseline, 27% of patients achieved an IGA score of 0/1 (clear/almost clear skin), 92% of patients achieved IGA ≤ 2 (clear skin to mild AD), and the least squares mean percent change in EASI from parent study baseline was - 89%. Additionally, 89% (23/26) of patients achieved a ≥ 6-point (clinically meaningful) improvement in CDLQI, and 100% (3/3) of patients achieved a ≥ 6-point improvement in IDQoL.
CONCLUSION: Long-term treatment with dupilumab for up to 2 years showed acceptable safety and sustained efficacy in signs, symptoms, and quality of life in patients aged 6 months to 5 years with severe AD, with a rapid improvement for patients who had received placebo in the parent study. Long-term safety in the OLE study was consistent with the short-term safety profile observed in the parent study, with no new safety signals detected. [Graphical abstract and plain language summary available] CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: NCT02612454 and NCT03346434 (part B).

DOI: https://doi.org/10.1007/s40272-026-00747-4
Pediatr Blood Cancer. 2026 Apr 02. e70292

Clinical Practice Patterns for Discussing Hydroxyurea Initiation With Families of Children With Sickle Cell Disease.

Aimee K Hildenbrand, Amy Lang, Anna M Hood, Benjamin Bear, Melissa A Alderfer, Charles T Quinn, Lori E Crosby.

   BACKGROUND: Despite robust evidence of safety and efficacy, hydroxyurea (HU) uptake remains low for children with sickle cell disease (SCD). Guidelines recommend use of shared decision-making for HU initiation, but limited resources exist to inform these conversations with families. This study examined practices among hematology providers when introducing HU to families of children with SCD.
PROCEDURE: In Study 1, 11 pediatric SCD clinics within the United States completed process maps delineating their practice for discussing HU initiation with families. Process maps were compared to summarize processes. In Study 2, individual semi-structured interviews were conducted with nine healthcare providers from one clinic from Study 1. Thematic and descriptive content analysis were used to summarize provider perspectives on existing processes.
RESULTS: Process maps highlighted the following common steps: (1) check in for appointment and obtain laboratory studies (n = 8); (2) medical provider discusses HU with family (n = 11); (3) family given HU materials (n = 8); and, (4) follow-up HU discussion at next visit (n = 6). Process variations were also identified. In Study 2, providers universally reported introducing HU shortly after diagnosis and strongly encouraging it for patients with disease complications. HU education was provided primarily via in-person conversation, written materials, and websites, focusing on its expected benefits, historical context, and side effects.
CONCLUSIONS: We identified both similarities and variations in clinical practice for HU initiation in children with SCD. Results highlight potential opportunities to improve the ways in which HU initiation is discussed with families of children with SCD.

Keywords:  children; clinical practice; hydroxyurea; initiation; sickle cell disease

DOI:  https://doi.org/10.1002/1545-5017.70292
Front Pediatr. 2026 ;14 1788720

Early versus interval appendectomy in children with complicated appendicitis: effects on hospital stay and occurrence of severe complications.

Yannick Schmidt, Franziska Cramer, Oliver Muensterer, Danielle S Wendling-Keim.

   Purpose: Acute appendicitis is a common pediatric emergency, yet optimal management of complicated cases remains debated. This study compares outcomes of early vs. interval appendectomy in children with perforated appendicitis.
Methods: A retrospective review of 254 patients (<18 years) treated between January 2012 and December 2023 was conducted. Twenty-two underwent interval appendectomy, and 232 underwent early appendectomy. Demographic and clinical data were analyzed using SPSS v29.0.1.0, with statistical significance defined as p < 0.05.
Results: Early appendectomy was associated with a significantly shorter cumulative hospital stay (mean 9.2 days) than interval appendectomy (mean 22.5 days; p < 0.001). Overall complication rates were higher in the interval group (10/22) compared to the early group (31/232; p < 0.001). However, severe complications, such as ileostomy creation, stump insufficiency, and ileocecal pole resection, occurred exclusively in the early appendectomy group.
Conclusion: Early appendectomy in children with complicated appendicitis results in shorter hospitalization and fewer overall complications but carries a risk of more severe postoperative events. Prospective studies are warranted to refine patient selection and optimize treatment strategies.

Keywords:  complicated appendicitis; early appendectomy; hospital stay; interval appendectomy; pediatric surgery; postoperative complications

DOI:  https://doi.org/10.3389/fped.2026.1788720
Arch Dis Child. 2026 Apr 01. pii: archdischild-2025-329725. [Epub ahead of print]

Models of care for hypertonia in childhood: a scoping review.

Ramyia Elangovan, Samantha Randall, Miranda Loveday, Sally Watts, Feilim Murphy, Daniel E Lumsden.

   BACKGROUND: Hypertonia is a common presentation in Paediatric clinics, but unifying operationalised models of care to guide a coordinated treatment approach currently lacking.
AIM: We reviewed the published literature on models of care for paediatric hypertonia, with the goal of identifying unifying themes successfully implemented globally that could underpin the development of a future care delivery model in the UK.
METHODS: We performed a scoping review as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension-Scoping Reviews. Our research question was: 'what existing data are available regarding models of care in paediatric hypertonia?'. A comprehensive search strategy was applied, using commonly used terms relating to healthcare models. We searched Embase, CINAHL and PubMed for relevant articles. Extracted data from included studies were qualitatively analysed for relevant themes.
RESULTS: 13 studies were included in the final analysis. We identified five themes: (1) patient-centred approach, (2) multidisciplinary team-working, (3) clear patient pathways, (4) evidence-based medicine and (5) integration of telemedicine. No study identified described an overall coordinated approach for the management of CYP with hypertonia, with individual studies instead focussing on either specific symptoms (eg, spasticity) or deliveries of specific interventions (eg, deep brain stimulation or Botox) to particular patient populations. No study specified national practice, with all studies outlining practices in particular hospitals/healthcare networks.
CONCLUSION: This scoping review identified useful themes that can be used to inform a unifying model of care for paediatric hypertonia, including considering how primary/secondary/tertiary/quaternary services can optimally organise service provision.

Keywords:  Neurology; Paediatrics; Qualitative research

DOI:  https://doi.org/10.1136/archdischild-2025-329725
Crohns Colitis 360. 2026 Jan;8(1): otag020

Child and parent perspectives in IBD management: a literature review and qualitative study.

Jennifer C deBruyn, Lara Hart, Gail MacKean, Nicole Staples, Amy Lee, Karen V MacDonald, Deborah A Marshall.

   Background: The therapeutic landscape and treatment goals for pediatric inflammatory bowel disease (IBD) continue to evolve. However, there remains a paucity of literature capturing the experiences and preferences of children with IBD and their parents on IBD management.
Methods: We conducted a literature review and qualitative study to describe perspectives and preferences of children with IBD and their parents regarding IBD treatment, treatment goals, and decision-making in IBD management. Articles were identified in MEDLINE and key study characteristics and findings were summarized to inform qualitative interviews. Children with IBD (11-18 years of age) and their parents were recruited through purposive sampling from a gastroenterology clinic for semi-structured telephone interviews until code saturation was reached in thematic analysis.
Results: In the literature review, 207 records were identified with nine studies ultimately included. Important aspects of IBD treatment included treatment efficacy, symptomatic improvements, and associated risks and side effects. Parents of children with IBD were concerned about the risks and preferred treatments with fewer long-term adverse effects; adolescents with IBD focused on immediate quality-of-life and short-term benefits. Ten parents and nine children with IBD (2.7-7.9 years disease duration) participated in interviews. Five major themes emerged: (1) overall impact of IBD and its management; (2) IBD treatment goals; (3) considerations for IBD management decisions on treatment; (4) considerations for IBD management decision on testing; and (5) shared decision-making.
Conclusions: Our findings highlight how children and parents contextualize the importance of IBD management within their lives, and draw attention to the need for personalized, patient-centered care and meaningful shared decision-making.

Keywords:  child; decision-making; inflammatory bowel diseases; parents; patient experiences

DOI:  https://doi.org/10.1093/crocol/otag020
Patient Educ Couns. 2026 Mar 26. pii: S0738-3991(26)00141-2. [Epub ahead of print]149 109608

Effective communication between nurses and caregivers of pediatric patients who use a language other than English: A concept analysis.

Tanner J Sergesketter, Wendy R Miller, Julie L Otte.

   OBJECTIVES: Despite the importance of effective communication between nurses and parents/caregivers to support the safety of pediatric patients, barriers to this communication exist between nurses and caregivers who use a language other than English (LOE). A concept analysis was conducted to develop a conceptual definition of effective communication between nurses and caregivers of pediatric patients who use an LOE, which has not previously been defined.
METHODS: A concept analysis was completed using Walker and Avant's method. Articles published between 2020 and 2025 were identified using PubMed, CINAHL Complete, and Web of Science.
RESULTS: Of the 310 identified articles, 32 were included. Effective communication between nurses and caregivers of pediatric patients who use an LOE is defined as "the frequent exchange of information between a nurse and caregiver of a pediatric patient in the caregiver's preferred/primary language other than English through professional language services that is reinforced by supplemental materials, is enhanced by nonverbal communication, and exhibits therapeutic communication techniques." Antecedents include early identification of caregivers' language preferences, access to professional language services, positive nurse-caregiver interpersonal relationships, and nursing education and training. Consequences include caregiver participation and engagement in care, caregiver understanding and comprehension, caregiver satisfaction, and safe, quality, equitable care.
CONCLUSIONS: Findings provide future directions for research to achieve a comprehensive understanding of the complexity and uniqueness of communication between nurses and caregivers of pediatric patients who use an LOE, which can then guide interventions aimed at improving nurse-caregiver communication and promoting safe, quality, equitable care.
PRACTICE IMPLICATIONS: A conceptual definition enables further advancement of the concept through generation of an operational definition, instrument development, and measurement tools, thereby permitting identification of the concept in clinical practice. The conceptual definition can also be used for theory construction or embedded within a preexisting theory to advance nursing theory.

Keywords:  Caregivers; Communication barriers; Concept analysis; Language other than English; Nursing; Parents; Pediatric

DOI:  https://doi.org/10.1016/j.pec.2026.109608
Pediatr Emerg Care. 2026 Apr 02.

Analgesia and Imaging Practices in Pediatric Appendicitis: A 14-Year Retrospective Trend Analysis.

Sahithi Pemmasani, Ryan T Davis, Julie George, Nathan M Novotny, Robert Swor, Margaret Menoch.

   OBJECTIVE: To examine 14-year temporal patterns and demographic differences in analgesic prescribing and imaging use among children with appendicitis in a tertiary pediatric emergency department (ED).
METHODS: We conducted a retrospective cross-sectional study of children <18 years presenting with acute appendicitis (ICD-9/10 codes) to a large urban pediatric ED from 2010 to 2023. Analgesic categories included ketorolac, ibuprofen, acetaminophen, opioids, combination therapy, or no analgesia. Imaging modalities included ultrasound (US), computed tomography (CT), both, or none. Primary outcomes were calendar-year trends in analgesic prescribing and imaging modality use. Secondary analyses evaluated demographic/clinical factors associated with analgesic and imaging patterns using multivariable logistics regression.
RESULTS: Among 2275 children (mean [SD] age, 11.0 [3.6] years; 59.7% male; 70.4% White). Overall, 62.9% received analgesics; 43.6% single agents, 19.3% combinations. Opioid-only prescribing declined (32.3% in 2010 to 8.4% in 2023), while combination analgesics (9.2% to 24.2%), acetaminophen only (6.9% to 21.4%), and ketorolac (0% to 9.8%) increased. CT-only imaging decreased sharply (53.1% to 5.1%), while US-only imaging increased (5.4% to 41.9%). In regression analyses, older age was associated with greater odds of ketorolac (AOR 1.17; 95% CI: 1.08-1.26) and opioid use (AOR 1.15; 95% CI: 1.09-1.21). Male sex was associated with higher odds of no analgesia (AOR 1.33; 95% CI: 1.10-1.62). Black children had greater odds of combination analgesics versus White peers (AOR 1.54; 95% CI: 1.06-2.26). Perforation was strongly associated with combination analgesics (AOR 1.84; 95% CI: 1.27-2.65).
CONCLUSIONS: In a single-center study, pediatric appendicitis care shifted toward reduced opioid and CT use and increased nonopioid multimodal analgesia and US-based imaging over 14 years.

Keywords:  CT scan; NSAIDs; analgesic; appendicitis; ketorolac; opioid; pediatric emergency; ultrasound

DOI:  https://doi.org/10.1097/PEC.0000000000003596
Cutan Ocul Toxicol. 2026 Mar 31. 1-10

Skin injuries related to Octenidine-based antisepsis in neonatal and pediatric populations: a scoping review.

Valentina Vanzi, Gabriele Caggianelli, Guido Ciprandi.

  Background: Octenidine-based antiseptics are increasingly used in neonatal and pediatric care for skin antisepsis and wound care, yet their cutaneous safety has not been systematically profiled.
Methods: This scoping review, based on JBI methodology, mapped evidence on skin injuries and local complications in neonates and children after octenidine-based use on intact skin or wounds.
Results: Of 242 records, six studies, all conducted in Europe (Germany 66.7%, Switzerland 16.7%, Poland 16.7%), were included (n = 30 patients). Two studies reported intact-skin antisepsis before procedures in 18 neonates while four papers addressed cleansing of traumatic, surgical, or infectious wounds in 12 infants or children. Formulations were mainly octenidine 0.1% with phenoxyethanol 2% (22/30; 73.3%), with aqueous 0.1% (6/30; 20.0%) and alcohol-based 0.1% (2/30; 6.7%) less frequent. Reported events ranged from transient erythema to bullous/erosive dermatitis, subcutaneous edema, fatty tissue necrosis, and phlegmon-like reactions. Management varied from conservative care to surgery, with scarring or contractures in some cases.
Conclusion: The available evidence, limited to case reports, case series, a survey and one small cohort, thereby preventing causal inference and incidence or prevalence estimates due to the absence of denominator data, nonetheless indicates injuries with both aqueous and alcohol-based products, raising concern for a potentially compound-related, rather than vehicle-specific, risk. Clinicians should consider judicious use of octenidine, monitor closely, and consider the potential utility of patch testing for delayed allergic reactions. Priority needs include multicenter studies, standardized skin outcomes, detailed exposure reporting, and pharmacovigilance or registries.

Keywords:  Octenidine; neonatal/pediatric wound care; scoping review; skin antisepsis; skin injury

DOI:  https://doi.org/10.1080/15569527.2026.2638830