bims-cliped Biomed News
on Clinical pediatrics
Issue of 2026–04–26
24 papers selected by
Alyssa M. Portwood, Akron’s Children
  1. Preparation for Pediatric Emergencies in the Office: Policy Statement.
  2. Preparation for Pediatric Emergencies in the Office: Technical Report.
  3. Etiology and Outcomes of Pediatric Chest Pain in the ED: A Systematic Review.
  4. Capacity Strain in US Children's Hospitals: A Mixed-Methods Study of Measurement and Mitigation.
  5. National trends in pediatric sepsis hospitalizations, case mix, and mortality, 2016-2022.
  6. Implementation of a Standardized Management Algorithm for Cannabis Hyperemesis Syndrome in a Pediatric Emergency Department.
  7. Medical, social, and relational health risks and childhood asthma severity, National Survey of Children's Health, 2020-2024.
  8. Surgical Site Infections and Perioperative Antibiotic Use in Children with Medical Complexity.
  9. An Innovative Approach to Enhanced Care Management for High-Need Pediatric Medicaid Members: Retrospective Cohort Study.
  10. Performance of Open-Source LLMs in Identifying Pediatric Pneumonia From Free-Text Chest Radiograph Reports.
  11. Managing and Communicating Diagnostic Uncertainty in Pediatric Emergency Care: National Insights and Opportunities for Intervention.
  12. Enhancing Prehospital Care for Medically Complex Children: The Evolution of the STARS Program.
  13. Intraoperative Care and Challenges in Children with Medical Complexity.
  14. Paediatric Central Venous Access Devices: An Evidence and Gap Map of Global Research.
  15. Contemporary management of acute mastoiditis in children: Insights from a U.S. national database.
  16. Perspectives on Interdisciplinary Perioperative Care for Children with Medical Complexity.
  17. Oral Health in Children With Congenital Heart Diseases: A Comprehensive Narrative Review.
  18. Descriptive epidemiology of pediatric tennis injuries: insights from a decade of National data.
  19. Children Hospitalized With Pneumonia Who Complete Oral Antibiotic Treatment Without Complications.
  20. A systematic review of the Wide Awake Local Anesthesia no Tourniquet (WALANT) approach in pediatric hand surgery.
  21. Development of a clinical indicator-based severity scoring system for pediatric atopic dermatitis and evaluation of dupilumab treatment outcomes.
  22. Subclavian approach without ultrasound guidance is safe and effective for pediatric central venous access.
  23. Pediatric Hemp-Derived Cannabinoid and Δ9-THC Exposures: A National Poison Data Study.
  24. Opioid stewardship program implementation in pediatric surgeries: A systematic review.
  1. Pediatrics. 2026 Apr 20. pii: e2026076621. [Epub ahead of print]
    Preparation for Pediatric Emergencies in the Office: Policy Statement.
    Committee on Practice and Ambulatory Medicine
      Although not common, pediatric emergencies present in the medical office setting, and offices that care for children and adolescents can prepare for these emergencies. Offices vary depending on their location and office setting, patient population, and distance to an emergency department or hospital. Consequently, these factors should be taken into account in the planning process. This statement updates the recommendations from the 2007 American Academy of Pediatrics (AAP) practice guideline "Preparation for Emergencies in the Offices of Pediatricians and Pediatric Primary Care Providers." An accompanying technical report contains explanations and evidence for these recommendations and can be found at https://doi.org/10.1542/peds.2026-076622. This policy statement and companion technical report can be used as a guide to help create an individualized approach to emergencies that occur in offices that care for children, including both primary care and subspecialty practices. An accompanying checklist summarizes steps that medical offices can take to assess their readiness for pediatric emergencies.
    DOI:  https://doi.org/10.1542/peds.2026-076621
  2. Pediatrics. 2026 Apr 20. pii: e2026076622. [Epub ahead of print]
    Preparation for Pediatric Emergencies in the Office: Technical Report.
    Committee on Practice and Ambulatory Medicine
      Medical emergencies in the pediatric office setting are infrequent but high-stakes scenarios. Advanced preparation will ensure that children who experience emergencies in the pediatric office receive optimal care and improved clinical outcomes. Optimizing pediatric office readiness for emergencies requires consideration of the unique aspects of each office practice, the types of patients and emergencies that might be seen, the resources available on site, and the resources of the larger emergency care system of which the pediatric office is a part. Important aspects of readiness include conducting an office-based readiness assessment reviewing annually, establishing and maintaining emergency protocols, stocking essential equipment and medications, and training office personnel to recognize and respond to emergencies. The information and resources in this technical report can be used to facilitate provision of high-quality care when pediatric emergencies occur in the office setting.
    DOI:  https://doi.org/10.1542/peds.2026-076622
  3. Cureus. 2026 Mar;18(3): e105526
    Etiology and Outcomes of Pediatric Chest Pain in the ED: A Systematic Review.
    Maha Mohamed Sallam Mohamed, Hagar Elhag Mohamed Elamin, Suha Mahmoud, Aya Abdalla, Sara Khalel Mohammed, Sarah Othman Hussien Abdaallah, Gihan Hassan Ali Ahmed, Hallah M Suliman.
      Chest pain is a frequent complaint among children presenting to EDs, often raising concerns about underlying cardiac disease. This systematic review aimed to synthesize available evidence on the etiology, clinical outcomes, and prognosis of pediatric chest pain in ED settings. A systematic search of PubMed, BMJ Journals, Scopus, IEEE Xplore, and Web of Science was conducted to identify relevant studies. Studies reporting original data on children (<19 years) presenting with chest pain in ED settings were included. Study quality was assessed using the Newcastle-Ottawa Scale. Due to heterogeneity among the studies, a narrative synthesis of the findings was performed. Six retrospective studies comprising 14,871 patients from five countries met the inclusion criteria. Idiopathic chest pain was the most common etiology, accounting for 24.4%-45.4% of cases. Musculoskeletal (4.7%-33.0%), respiratory (2.9%-17.7%), and psychogenic causes (6.0%-21.6%) were also frequently reported. Cardiac etiology was rare in unselected populations (0.9%-1.5%), although a higher prevalence (7.1%) was observed in ambulance-attended cohorts. Hospitalization rates ranged from 0.3% to 7.2%, and cardiac interventions were required in fewer than 0.3% of patients. Mortality was reported to be below 0.2% across all studies. Five studies were rated as good quality, while one study was rated as fair quality. Pediatric chest pain in ED settings is predominantly benign, with idiopathic causes being the most common and cardiac pathology being rare. Mortality is exceptionally low, supporting reassurance and targeted evaluation rather than routine extensive diagnostic testing.
    Keywords:  cardiac causes; emergency department; etiology; pediatric chest pain; systematic review
    DOI:  https://doi.org/10.7759/cureus.105526
  4. Pediatrics. 2026 Apr 24.
    Capacity Strain in US Children's Hospitals: A Mixed-Methods Study of Measurement and Mitigation.
    Elizabeth C Kuhn, Sage R Myers, Christopher E Gaw, Lauren M McDaniel, Emily R Kane, Evan S Fieldston, Elizabeth Salazar, Caryn Kerman, Allison Ballantine, Samuel Gottlieb, Corrie E McDaniel.
       BACKGROUND: Regionalization of pediatric inpatient care has concentrated demand within children's hospitals and increased concerns about capacity strain. Although hospitals track metrics and deploy mitigation strategies, little is known about how institutions define strain and translate signals into operational decisions.
    METHODS: We conducted a national mixed-methods study of US children's hospitals. Operational leaders from hospitals receiving Children's Hospitals Graduate Medical Education funding completed a cross-sectional survey assessing strain metrics, mitigation strategies, and decision drivers. We used descriptive statistics to summarize responses. We then interviewed a purposive sample to explore how hospitals interpret metrics and make mitigation decisions. We analyzed qualitative data using thematic analysis and integrated findings with survey results.
    RESULTS: Forty-five of 47 eligible hospitals responded (96%), and 20 leaders completed interviews. Among metrics, occupancy indicators were most common (>98%). However, most hospitals lacked full alignment between metrics identified as important indicators of strain and those used to trigger mitigation. Early strategies included encouraging discharges, activating staff, and opening additional bedspace, whereas diversion or procedure cancellations were implemented later despite being perceived as relatively more effective. Qualitative analysis identified four themes: mismatch between measured capacity and experienced strain; adaptive capacity normalizing chronic strain; institutional commitments to access sustaining exposure to strain; and escalation of strain requiring institutional credibility thresholds.
    CONCLUSIONS: Pediatric hospitals track extensive operational metrics, yet strain recognition and mitigation are shaped by institutional priorities, professional norms, and measurement limitations. Improving strain management may require multidimensional measurement approaches and policy-level changes to strengthen pediatric care infrastructure.
    DOI:  https://doi.org/10.1542/peds.2026-076834
  5. J Hosp Med. 2026 Apr 20.
    National trends in pediatric sepsis hospitalizations, case mix, and mortality, 2016-2022.
    Sriram Ramgopal.
       INTRODUCTION: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. We evaluated changes in hospitalizations for children with sepsis between 2016 and 2022 and investigated factors associated with in-hospital mortality.
    METHODS: We performed a retrospective study using the 2016, 2019, and 2022 Kids' Inpatient Database. Our population of interest was non-newborn admissions for children (<18 years) admitted to US hospitals. We reported changes in admissions for sepsis over time, changes in population-adjusted sepsis admission rates. We identified factors associated with mortality among children with sepsis in nested models.
    RESULTS: Of 4,987,652 weighted non-newborn hospitalizations, 77,864 had sepsis. Sepsis-related admissions increased from 1.15% (95% confidence interval [CI]: 1.05%-1.25%) in 2016 to 1.90% (95% CI: 1.67%-2.11%) in 2022 (relative proportion 1.65; 95% CI: 1.41-1.89). Nationally, sepsis admissions increased from 0.28 per 1000 child-years in 2016 to 0.40 per 1000 child-years (rate ratio 1.46; 95% CI: 1.18-1.82). In-hospital mortality occurred in 2.8%. Factors positively associated with mortality included Asian or Pacific Islander (odds ratio [OR]: 1.55; 95% CI: 1.22-1.97) and Black (OR: 1.26; 95% CI: 1.08-1.48) race relative to White race, several types of medical complexity, transfer from an acute care hospital (OR: 2.12; 95% CI: 1.86-2.40) or another facility (OR 1.50; 95% CI: 1.11-2.03), and admission to an urban teaching hospital versus a rural hospital (OR: 2.08; 95% CI: 1.20-3.61).
    CONCLUSIONS: Sepsis accounts for an increasing proportion of admissions and accounts for a greater number of population-adjusted hospitalizations. Variation in mortality by race suggests modifiable drivers of outcomes.
    DOI:  https://doi.org/10.1002/jhm.70329
  6. Pediatr Emerg Care. 2026 Apr 20.
    Implementation of a Standardized Management Algorithm for Cannabis Hyperemesis Syndrome in a Pediatric Emergency Department.
    Carlton M Kelly, Megan Attridge, Yiannis L Katsogridakis, Lauren Mrozek, Kathryn Jackson, Jennifer A Hoffmann.
       OBJECTIVES: Cannabis hyperemesis syndrome (CHS) is an increasingly common cause of pediatric emergency department (ED) visits, yet management pathways remain understudied. We evaluated clinical outcomes following the implementation of a CHS management algorithm in a pediatric ED.
    METHODS: We conducted a retrospective study of encounters by adolescents before and after implementation of a CHS management algorithm in an academic pediatric ED from July 2020 to July 2024. We examined medications administered, length of stay, disposition, and return visits before and after implementation using chi-square, Fisher exact, or Mann-Whitney U tests as appropriate. We used mixed-effects models to examine the association of time period and admission rates, adjusting for age, sex, and emergency severity index level. A similar model examined the association of time period and ED length of stay that was also adjusted for total daily ED arrivals.
    RESULTS: Of 533 screened encounters, 128 met inclusion criteria, representing 44 unique patients. Following algorithm implementation, administration rates increased for capsaicin (2.7% vs. 22.2%, P<0.001) and metoclopramide (6.8% vs. 42.6%, P<0.001). Frequency of haloperidol administration did not change significantly (20.3% vs. 9.3%, P=0.138), but mean dose decreased (2.7 mg vs. 1.0 mg, P=0.014). The adjusted odds of hospital admission (adjusted OR: 0.57, 95% CI: 0.17, 1.86) and ED length of stay (adjusted beta: -0.01, 95% CI: -0.21, 0.20) did not significantly differ.
    CONCLUSIONS: Algorithm implementation was associated with increased capsaicin and metoclopramide use but no change in admission rates or length of stay. Prospective studies are needed to assess optimal CHS management in children.
    Keywords:  adolescent; cannabis; cannabis hyperemesis syndrome; cyclic vomiting; evidence-based medicine; marijuana; treatment algorithm
    DOI:  https://doi.org/10.1097/PEC.0000000000003588
  7. Acad Pediatr. 2026 Apr 20. pii: S1876-2859(26)00105-1. [Epub ahead of print] 103323
    Medical, social, and relational health risks and childhood asthma severity, National Survey of Children's Health, 2020-2024.
    Ikemefuna C Okwuwa, Timothy O Ihongbe.
       OBJECTIVE: Asthma is one of the most common chronic health conditions in children and is the number one cause of emergency department visits in young children. Various studies have examined medical, social, and relational determinants of childhood asthma; however, these factors are often examined in isolation despite evidence suggesting that they work in concert. This study aims to examine the cumulative and combined influence of medical, social, and relational health risks on childhood asthma severity.
    METHODS: Pooled data from the 2020-2024 National Survey of Children's Health (N=254,309) was analyzed. Medical, social, and relational health risks were measured using the Whole Child Risk Index. Asthma severity was categorized as no asthma, mild asthma, or moderate-to-severe asthma, and associations were examined using multinomial logistic regression, accounting for the complex nature of the data.
    RESULTS: Multinomial logistic regression revealed a dose-response relationship between cumulative health risk exposure and asthma severity. Compared to children with no health risk exposure, those exposed to one, two, or three health risk domains had progressively higher odds of both mild and moderate-to-severe asthma. Exposure to all combinations of health risk domains increased asthma severity risk, with the greatest odds observed among children exposed to all three health risk domains.
    CONCLUSIONS: This study demonstrates the cumulative and combined influence of medical, social, and relational health risks on asthma severity in children. Children exposed to multiple health risk domains experienced significantly greater asthma severity, highlighting the need for comprehensive, integrated approaches to pediatric asthma care.
    Keywords:  Childhood asthma; and relational health risks; medical health risks; social determinants of health; social health risks
    DOI:  https://doi.org/10.1016/j.acap.2026.103323
  8. Pediatr Clin North Am. 2026 Apr;pii: S0031-3955(25)00160-9. [Epub ahead of print]73(2): 445-469
    Surgical Site Infections and Perioperative Antibiotic Use in Children with Medical Complexity.
    Felicia A Scaggs Huang, Justin Markham, Tamara D Simon, Joshua K Schaffzin.
      Surgical site infection is an uncommon postoperative complication of surgery, occurring in 1% to 2% of all pediatric surgical patients. Rates vary widely between procedure types, but in general, children with medical complexity (CMC) tend to have more surgical site infections (SSIs) than their otherwise healthy peers. Reasons for this phenomenon are unclear and likely multifactorial. Optimal prevention efforts involve pediatric and surgical providers collaborating to balance all aspects of care of CMC during the perioperative period to prevent an SSI.
    Keywords:  Antimicrobial prophylaxis; Care bundles; Children with medical complexity; Infection prevention; Perioperative; Surgical site infection
    DOI:  https://doi.org/10.1016/j.pcl.2025.11.006
  9. JMIR Pediatr Parent. 2026 Apr 22. 9 e88204
    An Innovative Approach to Enhanced Care Management for High-Need Pediatric Medicaid Members: Retrospective Cohort Study.
    Jessie L Juusola, Shefali Kumar, Meghana S Iragavarapu, Luke Mueller, Neil Batlivala, Michael K Ong, Andrey Ostrovsky, Nathan Favini.
       Background: The California Advancing and Innovating Medi-Cal (CalAIM) initiative supports Enhanced Care Management (ECM) for high-need pediatric populations but published evidence of the impact of ECM in pediatric populations is lacking.
    Objective: We evaluated a novel multidisciplinary care model (Pair Team) for delivering ECM services, focusing on implementation and early outcomes for children and adolescents enrolled in California's Medicaid program (Medi-Cal).
    Methods: We conducted a retrospective, observational cohort study of Medi-Cal-enrolled children and adolescents who enrolled in Pair Team's program between July 2022 and November 2024. Program engagement, health care engagement, and depressive symptoms were assessed using program data, electronic health records, and prescription data.
    Results: The main cohort included 1294 enrollees with 12 months of follow-up data (mean age 8.9 years, 50.3% (651/1294) female, 81.8% (1058/1294) experiencing homelessness). Members averaged 2.8 interactions per month with care team members over the first 3 months and 57.1% (851/1491) were still enrolled at 12 months. In the year prior to enrollment compared to the year postenrollment, the prevalence of an asthma diagnosis increased from 7.8% to 10.0% (P=.005), outpatient visits increased 7% (rate ratio, RR=1.07, P<.001), emergency department visits decreased 9% (RR=0.91, P=.002), and antibiotic prescriptions increased 41% (RR=1.41, P=.001). For those with depressive symptoms at enrollment, mean PHQ-9 score decreased from 15.4 (SD 4.7) to 10.2 (SD 6.8) after 3 months (P<.001).
    Conclusions: An innovative ECM program successfully engaged with and retained high-need pediatric Medicaid patients. Program members had higher engagement with other health care in the year following enrollment, and depressive symptoms improved. These results highlight the potential for this model to improve outcomes for the highest-need pediatric Medicaid patients.
    Keywords:  CalAIM; California Advancing and Innovating Medi-Cal; ECM; Enhanced Care Management; HRSN; Pair Team; complex needs; health-related social needs
    DOI:  https://doi.org/10.2196/88204
  10. Pediatr Emerg Care. 2026 Apr 21.
    Performance of Open-Source LLMs in Identifying Pediatric Pneumonia From Free-Text Chest Radiograph Reports.
    Saki Amagai, Elizabeth C Powell, Elizabeth R Alpern, Todd A Florin, Yikuan Li, David Liebovitz, Yuan Luo, Juan Espinoza, Anthony F Wong, Sriram Ramgopal.
       OBJECTIVES: To develop and internally validate an automated system for classifying chest radiograph (CXR) reports for community-acquired pneumonia in children.
    METHODS: We performed a retrospective single-center study using 1000 pediatric emergency department encounters (2016 to 2022) with CXR. Reports were adjudicated by two physicians as positive, negative, or indeterminate for pneumonia. We evaluated five open-source LLMs (Gemma2 9B, Gemma2 27B, Falcon3 7B, DeepSeek R1 Distill Llama 8B, and Llama3.1 8B) on a 70/30 train-test split for an outcome of pneumonia. We reported performance metrics for both three-class and binary classification (pneumonia + indeterminate vs. no pneumonia).
    RESULTS: The median patient age was 4.2 years (IQR 1.7 to 10.5), and 54.4% were admitted from the ED. After clinician adjudication, 27.8% of reports were labeled pneumonia, 13.7% indeterminate, and 58.5% no pneumonia. Gemma2 9B achieved the best performance overall, with a pneumonia F1 score of 0.82 and no-pneumonia F1 score of 0.97 in three-class classification. Binary classification further improved performance (F1=0.97 for Gemma2 9B and 0.93 for 27B). Discrepancies between model and human labels often involved ambiguous language, highlighting interpretive subjectivity rather than model error. All LLMs substantially outperformed traditional NLP classifiers such as XGBoost, random forest, and logistic regression.
    CONCLUSIONS: Open-source LLMs accurately classified pediatric CXR reports for pneumonia. These findings support the feasibility of integrating LLMs into decision support and quality improvement pipelines to enhance radiographic interpretation and improve pediatric emergency care.
    Keywords:  clinical text classification; large language models; natural language processing; pediatric pneumonia; radiology reports
    DOI:  https://doi.org/10.1097/PEC.0000000000003616
  11. Pediatr Emerg Care. 2026 Apr 23.
    Managing and Communicating Diagnostic Uncertainty in Pediatric Emergency Care: National Insights and Opportunities for Intervention.
    Alexandra T Geanacopoulos, Molly S Totman, Kelsey A Miller, Mark I Neuman, Alon Peltz.
       BACKGROUND: Effective management and communication of diagnostic uncertainty are critical, yet understudied, drivers of patient safety in pediatric emergency care. We explored how clinicians manage and communicate diagnostic uncertainty and identified opportunities for intervention.
    METHODS: Four 1-hour-long focus groups were conducted with 19 geographically diverse emergency medicine physicians. Discussions focused on clinical vignettes with diagnostic uncertainty. Reflexive thematic analysis was used to generate themes.
    RESULTS: Participants described diagnostic uncertainty as a multidimensional experience involving complex interactions between the clinician, caregiver, and context. We identified 3 distinct themes: (1) Intersection of clinician's usual practice pattern with caregiver and contextual factors: Within the guardrails of safety and evidence-based care, clinicians adjust management and communication to caregiver expectations, health literacy, resources, acuity, and volume. (2) Synergies at the clinician, caregiver, and context interfaces: Shared decision-making, decision support tools, and primary care continuity facilitate clinician-caregiver alignment and safety. (3) Tensions at the interfaces: Perceived misaligned clinician-caregiver expectations, space constraints, and limited access to care promote additional work-up and hinder communication. Participants highlighted intervention opportunities to promote patient safety in uncertainty and reduce ED work-up: (1) standard tools to communicate uncertainty, (2) disease-specific risk prediction models with visual aids to effectively communicate risk, (3) improvements to the physical space, and (4) interventions to streamline access to primary care.
    CONCLUSION: Diagnostic uncertainty in pediatric emergency care is a multidimensional experience influenced by synergies and tensions between the clinician, caregiver, and context. Communication tools, decision-support strategies, and systems-level interventions can strengthen diagnostic safety in pediatric emergency care.
    Keywords:  diagnostic communication; management of uncertainty; pediatric emergency care
    DOI:  https://doi.org/10.1097/PEC.0000000000003614
  12. Pediatr Emerg Care. 2026 Apr 23.
    Enhancing Prehospital Care for Medically Complex Children: The Evolution of the STARS Program.
    Michelle Pintea, Joseph Finney, Nicholas Salzman, Lindsay Clukies, Mirela Miljkovic, Fahd A Ahmad, Steven Laffey.
       OBJECTIVES: The population of children and youth with special health care needs (CYSHCN) has grown significantly. This includes children with medical complexity (CMC), those with chronic conditions, functional limitations, or reliance on medical technology. Due to advances in medical care, these children are now able to live at home, making encounters with emergency medical services (EMS) more likely. EMS clinicians receive limited pediatric training and have infrequent encounters with this population, resulting in variable comfort and preparedness. Utilization of emergency care among CMC is further influenced by social determinants of health, with disadvantaged communities experiencing higher emergency department use and increased child mortality. To bridge these gaps, the Special Needs Tracking and Awareness Response System (STARS) was developed to enhance EMS readiness, promote health equity, and improve prehospital care for CMC.
    METHODS: Launched in 2014 as an EMS-driven initiative, STARS has evolved into a hospital-based, physician-led program with individualized emergency care plans stored in a secure electronic system. A major focus of STARS is to create and provide emergency care education to EMS and community EDs in their catchment area regarding STARS.
    RESULTS: As of 2025, STARS has enrolled 2424 patients. The program has reduced unnecessary transports, strengthened disaster response, and offered an opportunity to address health inequities in CMC.
    CONCLUSIONS: STARS provides a scalable and collaborative model that prioritizes medically complex, high-risk pediatric populations through targeted EMS training, interdisciplinary care coordination, and real-time access to patient-specific plans. This approach offers a unique opportunity to advance prehospital care and improve health outcomes for CMC.
    Keywords:  children with medical complexity; disabilities; disaster preparedness; emergency medicine; prehospital; transport medicine
    DOI:  https://doi.org/10.1097/PEC.0000000000003610
  13. Pediatr Clin North Am. 2026 Apr;pii: S0031-3955(25)00157-9. [Epub ahead of print]73(2): 327-344
    Intraoperative Care and Challenges in Children with Medical Complexity.
    Lisa R Lynch, Erica L Sivak, Cheryl K Gooden, Teeda Pinyavat.
      This article reviews the intraoperative processes that anesthesiologists manage when caring for children with medical complexity. Designed for a broad audience of health care providers, it covers fundamental considerations alongside the specialized knowledge, techniques, and modifications necessary for complex patients. Specific topics include preoperative anxiolysis, induction techniques, anesthetic medication selection, airway management, intraoperative ventilator management, vascular access, regional anesthesia, positioning, fluid and blood management, temperature management, extubation considerations, and special situations of intraoperative cardiac arrest management.
    Keywords:  Intraoperative management; Pediatric anesthesia; Pediatric subspecialty care; Perioperative care; Risk assessment
    DOI:  https://doi.org/10.1016/j.pcl.2025.11.003
  14. J Paediatr Child Health. 2026 Apr 23.
    Paediatric Central Venous Access Devices: An Evidence and Gap Map of Global Research.
    Tricia M Kleidon, Sabrina de Souza, Patrícia Kuerten Rocha, Elouise Comber, Jacqueline Cunninghame, Areum Hyun, Jefferson Wildes da Silva Moura, Amanda J Ullman, Mari Takashima.
       CONTEXT: Central venous access devices (CVADs) are essential in paediatric care but pose significant risks. Synthesising existing evidence is needed to guide safe, effective, and equitable practice amid evolving interventions and complex management needs.
    OBJECTIVE: To develop an evidence and gap map (EGM) to identify, categorise, and visualise paediatric evidence on interventions aimed at improving CVAD outcomes.
    DATA SOURCES: Following Campbell Collaboration guidance, systematic searches were conducted in PubMed, CINAHL, Scopus, and CENTRAL (date limits: 2014 to 30 June 2024).
    STUDY SELECTION: Eligible studies included patients (0-18 years) evaluating an intervention to improve CVAD outcomes, including randomised and non-randomised trials, implementation studies, and systematic reviews.
    DATA EXTRACTION: Two reviewers independently screened and extracted data on CVAD type, intervention, setting, outcomes, and study design. Data were descriptively analysed and visualised in Tableau.
    RESULTS: Of 952 studies in the broader EGM, 151 were paediatric-specific. Most were conducted in high-income countries (72%) and high-acuity settings, including critical care (41.9%) and oncology (38.5%). CVAD type was unspecified in 80.1% of studies. Systematic reviews (22.5%) and randomised controlled trials (28.5%) were available, though 40.4% of studies were before-and-after studies without controls. Common interventions addressed infection prevention, insertion technologies, and flushing. Clinical outcomes, particularly bloodstream infection (27.8%), dominated reporting, while patient-reported, economic, and device removal outcomes were rarely reported (< 2%).
    LIMITATIONS: Only studies from the last 10 years and English-language databases were included. No formal quality appraisal was conducted.
    CONCLUSIONS: Significant evidence gaps exist. Future research should prioritise rigorous, paediatric-specific studies across diverse settings and outcome domains.
    TRIAL REGISTRATION: Open Science Framework (OSF) q6gcr: https://osf.io/q6gcr/overview.
    Keywords:  catheterisation; central venous; evidence‐based nursing; paediatrics; systematic review; vascular access devices
    DOI:  https://doi.org/10.1111/jpc.70391
  15. Int J Pediatr Otorhinolaryngol. 2026 Apr 16. pii: S0165-5876(26)00122-9. [Epub ahead of print]205 112827
    Contemporary management of acute mastoiditis in children: Insights from a U.S. national database.
    Osama Hamdi, Laylaa Ramos, Taylor Jamil, Matthew Hill, Nicole Wershoven, Sarah A Gitomer, Brian Herrmann, Owen Darr.
       OBJECTIVE: Acute mastoiditis (AM) is a serious complication of acute otitis media. While historically managed with mastoidectomy, recent trends support conservative treatment, including intravenous (IV) antibiotics and pressure equalization tube (PET) placement. International studies demonstrate high success with these approaches, but U.S. pediatric data remains limited.
    METHODS: Pediatric patients diagnosed with AM identified via Current Procedural Terminology (CPT®) coding and International Classification of Diseases (ICD-10) between January 2010 and October 2021 were reviewed using PearlDiver, a private analytics database. Patient demographics, treatments, intervention timing, complication rates, and predictors of surgery were assessed using multivariate logistic regression.
    RESULTS: The mean patient age was 6.46 years, with 57.5% male. Surgical intervention occurred in 36.8%, including 1784 PETs, 347 subperiosteal abscess drainages, and 530 mastoidectomies. Median time to surgery was 1 day. Intracranial complications (e.g., abscess, meningitis, defined by ICD codes) occurred in 13.7%. Older age was linked to lower odds of surgery (p < 0.001), while under-immunization and complications of AM increased surgical likelihood (both p < 0.001). Intracranial complications were the strongest predictor of mastoidectomy (p < 0.0001). Higher family income correlated with fewer complications and lower mastoidectomy rates.
    CONCLUSION: In this national pediatric cohort, non-operative management was most common, with fewer than 40% of patients undergoing surgery. Complications of AM most strongly predicted surgical need. These findings are consistent with a growing trend toward conservative management of pediatric acute mastoiditis.
    Keywords:  Mastoidectomy; Mastoiditis; Otitis media; Pediatrics
    DOI:  https://doi.org/10.1016/j.ijporl.2026.112827
  16. Pediatr Clin North Am. 2026 Apr;pii: S0031-3955(25)00165-8. [Epub ahead of print]73(2): 513-524
    Perspectives on Interdisciplinary Perioperative Care for Children with Medical Complexity.
    Adriana Martin, Shannon Acker, Todd C Hankinson, Jason Zamkoff.
      Interdisciplinary peri-operative care for children with medical complexity involves in-depth coordination between surgical providers, peri-operative providers, and pediatric hospitalists. Patient selection and co-management mode are essential determinants for such a program, and these may vary from institution to institution. A successful co-management team can lead to enhanced multidisciplinary communication with improved care for this patient population. Appropriate funding for clinical staffing, a sustainable business model, and an established trust between medical and surgical providers are essential to this process.
    Keywords:  Complex chronic conditions; Interdisciplinary perioperative care; Medically complex pediatric patients; Pediatric surgical co-management; Surgical co-management
    DOI:  https://doi.org/10.1016/j.pcl.2025.12.003
  17. Clin Med Insights Pediatr. 2026 Apr 21. 11795565261432835
    Oral Health in Children With Congenital Heart Diseases: A Comprehensive Narrative Review.
    Wafaa Saleh, Ghada A Elhusseiny, Hamad Alharbi.
      Congenital heart disease (CHD) is the most common congenital anomaly among live births, and can present in different forms. Due to significant improvements in the surgical treatment of CHDs, the population of children with CHDs is increasing. Studies have shown that these children have worse oral health than their healthy counterparts. This is mainly due to a lack of oral hygiene measures, a lack of fluoride exposure, insufficient water intake, sugar intake, and the effect of cardiac medications. Due to poor oral health, they also have a prevalence of caries and gingival diseases, and need comprehensive dental treatment. This narrative review was motivated by a lack of clear guidelines for dentists, pediatric cardiologists, and parents on preventing poor oral health in children with CHDs. A comprehensive search strategy was employed, utilizing databases such as PubMed, Scopus, Web of Science, and Google Scholar, to identify relevant literature on oral manifestations and dental management of children with CHDs. We highlighted the necessity of the multidisciplinary team for optimal dental management of children with CHDs. In addition, we discussed optimal dental management strategies to improve their overall health outcomes and quality of life.
    Keywords:  children; congenital heart diseases; narrative review; oral health
    DOI:  https://doi.org/10.1177/11795565261432835
  18. Phys Sportsmed. 2026 Apr 18.
    Descriptive epidemiology of pediatric tennis injuries: insights from a decade of National data.
    Francesca Docters, Auston R Locke, Matthew D Ramey, Uma Balachandran, Sheena Ranade.
       OBJECTIVES: Tennis is a sport which can result in a range of injuries due to the extensive use of both the upper and lower extremities during play. Although tennis injuries are described in the literature, data specifically characterizing injury patterns in pediatric populations remain limited. This study aims to identify the epidemiology of pediatric tennis injuries presenting to US emergency departments (ED) over the past 10 years through both a sex and age specific analysis.
    METHODS: The National Electronic Injury Surveillance System (NEISS) was queried for pediatric (2-18) tennis injuries presenting to U.S. EDs from 1 January 2014-31 December 2023. Patient demographics, injury site, diagnosis, and disposition were recorded. National estimates (NE) were calculated using the NEISS statistical sample weight. Differences in injury distributions by age and sex were evaluated using Rao - Scott adjusted chi-square tests. Individual injury frequency differences across subgroups are presented descriptively.
    RESULTS: A total of 1,672 NEISS cases were identified, corresponding to an estimated 48,378 pediatric tennis-related injuries. Sprains/strains were the most commonly observed diagnosis among both sexes, followed by contusions/abrasions and fractures. Ankles were the predominant body part afflicted in sprains/strains and overall. Within contusions/abrasions, the face and eyeball were most commonly affected across sex and age subgroups. Children most commonly had lacerations and facial injuries, while adolescents most commonly had strains/sprains and ankle injuries. The distribution of injury types and locations significantly differed between males and females, and children and adolescents (p < 0.01). Fewer than 1% of injuries required hospitalization following ED presentation.
    CONCLUSION: Sprains/strains were the most common injuries, with distinct age-related patterns observed, including a higher proportion of facial injuries in children and ankle injuries in adolescents. Most injuries were minor, reflecting a relatively safe injury profile. These findings highlight potential targets for injury prevention strategies, such as protective eyewear and neuromuscular training.IRB approval was not required for this study because only publicly available, de-identified data were used in the analysis.
    Keywords:  Pediatrics; ankle sprains; emergency department; epidemiology; facial injuries; racquet sports; tennis injuries
    DOI:  https://doi.org/10.1080/00913847.2026.2662837
  19. Hosp Pediatr. 2026 Apr 23. pii: e2025008382. [Epub ahead of print]
    Children Hospitalized With Pneumonia Who Complete Oral Antibiotic Treatment Without Complications.
    Jillian M Cotter, Angela Dunn, Derek J Williams, Sriram Ramgopal, Cristin Q Fritz, Maia Taft, Matt Hall, Elizabeth Temte, Justine Stassun, Krishna Trivedi, Jack Kapes, Jack Lavey, Eric Coon, Allison Kempe, Lilliam Ambroggio.
       OBJECTIVE: While initial oral antibiotics are likely as effective as intravenous (IV) antibiotics for most children hospitalized with community-acquired pneumonia (CAP), most still receive IV therapy. We evaluated factors associated with doing well with initial oral antibiotics among children hospitalized with CAP.
    METHODS: We performed a multicenter retrospective cohort study of children hospitalized with CAP who were started on oral antibiotics at 4 children's hospitals between 2014 and 2020. We performed multivariable logistic regression to evaluate the association between hospital site and patient-level factors and doing well with oral antibiotics, defined as those who remained on oral antibiotics throughout the hospitalization, did not have escalation of care during the hospitalization, and did not have readmissions or emergency department revisits within 7 days of discharge.
    RESULTS: Among 419 children who received initial oral antibiotics, 76% (n = 317) did well with this regimen (ie, remained on orals and did not have escalation or revisits). Of those who did not do well (n = 102), 80% (n = 82) switched to IV antibiotics but had no escalation of care or revisits. In multivariable analyses, there were no patient-level factors associated with doing well with initial oral antibiotics, and only hospital site was statistically significant.
    CONCLUSIONS: Most children hospitalized with CAP given initial oral antibiotics continued oral therapy and did not have escalation of care or return visits. Switching from oral to IV antibiotics may be based more on nonpatient level factors (eg, clinician preference) than patient-level factors, although prospective studies are needed.
    DOI:  https://doi.org/10.1542/hpeds.2025-008382
  20. JPRAS Open. 2026 May;49 582-594
    A systematic review of the Wide Awake Local Anesthesia no Tourniquet (WALANT) approach in pediatric hand surgery.
    Aidan Shulkin, Daniel Borsuk, Emilie Bougie.
       Background and purpose: Wide Awake Local Anesthesia No Tourniquet (WALANT) for hand surgery in children and adolescents remains limited due to concerns regarding patient cooperation. This systematic review aims to synthesize the existing evidence on WALANT in the pediatric population to guide future directives.
    Methods: This systematic review was performed in accordance with PRISMA guidelines. In June 2025, a comprehensive search of MEDLINE, Embase, Web of Science, and CENTRAL was conducted. All studies reporting on WALANT in patients <18 years old were retrieved without date restrictions. For those meeting inclusion criteria, study and patient characteristics, interventions, and outcomes were extracted and analyzed. In addition, study quality was assessed based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence.
    Results: Eleven studies were identified, including 441 patients and 507 procedures. No major complications were documented, and conversion to sedation or general anesthesia was required in only 0.6% of patients. Overall, the procedures were successful, as shown by consistent improvements in hand function. Patient feedback suggested high levels of satisfaction and minimal perioperative pain. Additionally, certain studies observed marked reductions in operative time, room time, recovery time, hospital stay, and costs.
    Conclusions: Although the literature is limited, our findings demonstrate that WALANT is a safe, feasible and effective alternative to systemic anesthesia in children and adolescents. Key considerations include appropriate patient selection, child-centered communication strategies, distraction techniques, and supportive environments. This supports the broader integration of WALANT into pediatric practice. However, further research is warranted to optimize patient experience and assess institutional benefits.
    Keywords:  Hand surgery; Pediatrics; Systematic review; WALANT
    DOI:  https://doi.org/10.1016/j.jpra.2026.01.049
  21. Am J Transl Res. 2026 ;18(3): 2693-2706
    Development of a clinical indicator-based severity scoring system for pediatric atopic dermatitis and evaluation of dupilumab treatment outcomes.
    Peng Ding, Dongbo Zhang, Xi Deng, Hui Shi.
       OBJECTIVE: To develop and validate a pediatric atopic dermatitis (AD) severity scoring system based on routinely available clinical indicators and to evaluate the efficacy and safety of dupilumab in children with moderate-to-severe AD.
    METHODS: Clinical data from 236 children with AD treated between January 2023 and January 2025 were retrospectively analyzed and randomly split into training and internal validation cohorts (7:3). An external validation cohort included 42 patients treated between February and June 2025. AD severity was classified using the SCORAD index. Factors associated with disease severity were identified by logistic regression, and a scoring system was developed and evaluated using receiver operating characteristic (ROC) and calibration curves. In addition, children with moderate-to-severe AD treated with dupilumab were assessed for changes in clinical scores at baseline and weeks 4, 12, and 16, with adverse events recorded.
    RESULTS: The scoring system (0-9 points) included onset age ≤2 years, xerosis, spiny lichen, vitamin D insufficiency/deficiency, and eosinophil count ≥0.455×109/L. The areas under the ROC curve were 0.885 in the internal validation cohort and 0.824 in the external validation cohort, with good calibration. Dupilumab treatment significantly improved EASI, SCORAD, PP-NRS scores. At week 16, EASI50, EASI75, and EASI90 were achieved in 86.52%, 65.17%, and 33.71% of patients, respectively. Adverse events were mild and infrequent.
    CONCLUSIONS: A simple and practical severity scoring system for pediatric AD was developed and validated. Dupilumab demonstrated favorable efficacy and acceptable safety in children with moderate-to-severe AD.
    Keywords:  Atopic dermatitis; children; clinical efficacy; dupilumab; severity scoring system
    DOI:  https://doi.org/10.62347/QFBF1020
  22. J Pediatr Surg. 2026 Apr 22. pii: S0022-3468(26)00221-6. [Epub ahead of print] 163138
    Subclavian approach without ultrasound guidance is safe and effective for pediatric central venous access.
    Lauren Mayon, Yi-Ju Chiang, Alexander Lee, Kumail Mahesri, Kuojen Tsao, Allison L Speer, Kevin P Lally, Mary T Austin.
       BACKGROUND: The American College of Surgeons (ACS) recommends US guided internal jugular (IJ) approach for central venous access devices (CVADs); however, this is suboptimal in children. We use the subclavian without US guidance for access in children and adolescents and young adults (AYAs) at a high-volume oncology center.
    STUDY DESIGN: We undertook a prospective observational study of patients <=26 years undergoing CVAD placement between 1/1/15 - 9/30/23. US guidance was used in IJ but not in subclavian CVADs, and all procedures were performed by or under direct attending supervision following a standardized protocol. Adverse events (AEs) within 180 days were collected. Multivariate logistic regression model was applied to determine risk factors for predicting AEs.
    RESULTS: Seven hundred and thirteen patients were included. Overall AE rate was 25.7%. Ninety-nine patients had early AEs, and 84 had late AEs. Most common AEs included thrombosis (7.9%), migration (6.5%) and mechanical malfunction (6.9%). Central line-associated blood stream infection (CLABSI) rate was 4.1%. Most (83%, n=590) CVADs were subclavian without US guidance, and pneumothorax and bleeding rates were extremely low (0.3% and 0.7%). IJ CVADs had increased CLABSI and thrombosis rates compared to subclavian (8.4% vs 3.5% and 16.8% vs 8.9%, p<0.05). BMI >= 30 and steroid use were associated with all AEs (p<0.001 and p=0.003).
    CONCLUSION: Our results suggest utilizing the subclavian without US guidance is safe and effective for children and AYAs with cancer. This challenges the 2011 ACS recommendation for the use of US guidance in all CVAD placements.
    Keywords:  Access; Central; Pediatric; Subclavian; Ultrasound; Venous
    DOI:  https://doi.org/10.1016/j.jpedsurg.2026.163138
  23. J Pediatr. 2026 Apr 21. pii: S0022-3476(26)00141-1. [Epub ahead of print] 115113
    Pediatric Hemp-Derived Cannabinoid and Δ9-THC Exposures: A National Poison Data Study.
    Bernard Weigel, Michael Wahl.
       OBJECTIVE: To characterize unintentional pediatric exposures to hemp-derived cannabinoids (eg, Δ8-tetrahydrocannabinol [THC], Δ10-THC, THC-O) and evaluate how these exposures compare with those following Δ9-THC, the primary psychoactive component of cannabis.
    METHODS: We conducted a retrospective analysis of the National Poison Data System (NPDS) for single-substance exposures to cannabis edibles reported to contain either Δ9-THC or to hemp-derived cannabinoids in children ≤5 years from January 1, 2023, to December 31, 2024. Clinical effects, interventions, and outcomes were compared using chi-square tests.
    RESULTS: During the study period, 9,667 Δ9-THC and 2,169 hemp-derived cannabinoid cases were identified. In univariate analyses, hemp-derived cannabinoid ingestions were associated with higher rates of respiratory depression (5.9% vs 4.6%; p=0.01) and hypotension (3.87% vs 2.97%; p=0.03) compared with Δ9-THC exposures. Vasopressor use was more frequent in the hemp-derived cannabinoid group (0.37% vs 0.13%; p=0.02), yet rates of central nervous system depression, seizures, and intubation were similar. Children exposed to hemp-derived cannabinoids had higher critical care admission (11.3% vs 8.58%; p<0.001) and overall admission rates (28.35% vs 26.13%; p=0.03). No deaths were reported.
    CONCLUSIONS: Pediatric exposures to hemp-derived cannabinoids were associated with similar or greater clinical severity and healthcare utilization than Δ9-THC exposures. The lack of dose regulation for hemp-derived products may contribute to these findings. Prospective studies capturing dose data are needed to clarify risk and inform policy.
    DOI:  https://doi.org/10.1016/j.jpeds.2026.115113
  24. Saudi J Anaesth. 2026 Apr-Jun;20(2):20(2): 426-438
    Opioid stewardship program implementation in pediatric surgeries: A systematic review.
    Ahmed H Mahmoud, Rayan Muawad, Plino S Ruiz, Maha M Alkharisi, Hind Z Aljedani, Manar A Alhifzi, Sarah O Alobaidy, Maysoon A Abdelhamid, Raghad S Aloubili, Norah N Almutairi, Seham S Alshalahi, Abdullah AlDhuwaihy.
       Background: Postoperative opioid use in pediatric surgeries presents significant challenges due to associated risks such as dependence, oversedation, and misuse. Opioid stewardship programs (OSPs) aim to mitigate these risks by promoting appropriate opioid prescribing and multimodal pain strategies.
    Objectives: To evaluate the effectiveness of current OSPs and their impact on opioid prescribing practices in pediatric surgeries.
    Methods: We systematically searched PubMed, MEDLINE, Embase, Cochrane Library, CINAHL, and Web of Science for English language studies (2011-2024) that described opioid stewardship initiatives in pediatric surgery. Eighteen studies were included. We included randomized controlled trials, observational studies, and systematic reviews, excluding studies without a formal OSP, studies exclusively focusing on adults, and those without any specific outcomes. Data extraction and quality assessment were performed independently by multiple reviewers. Risk of bias was evaluated using Cochrane and ROBINS-I tools.
    Results: Eighteen studies were included with sample sizes ranging from 81 to more than 83,000 patients. The key interventions included opioid prescribing protocols, and guidelines, provider education about opioid use, and alternative pain management options to limit opioid dependence. All the studies reported reduction in opioid prescribing rates. There was reduction in discharge prescriptions from 68.4% to 10.7% after introducing consent (P < 0.001). There were no significant increases in emergency department visits related to reduced opioid prescribing. Pain scores remained stable, and oversedation events were reduced in some settings.
    Conclusion: Structured opioid stewardship interventions including protocols and guidelines, combined with targeted education and improved pain management techniques, effectively reduce opioid use while preserving adequate pain control. Future multicenter trials and studies will be required to further optimize opioid stewardship interventions and maximize patient outcomes.
    Keywords:  Analgesia; anesthesia; opioids; pain management; stewardship
    DOI:  https://doi.org/10.4103/sja.sja_749_25
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