bims-cliped Biomed News
on Clinical pediatrics
Issue of 2026–05–03
28 papers selected by
Alyssa M. Portwood, Akron’s Children
  1. Child Restraint System Use and Injury Severity in Pediatric Motor Vehicle Collisions: Insights From the NTDB.
  2. Health-Related School Absenteeism Among US School-Age Children With Chronic Health and Social Needs.
  3. Not Like in the Textbook - Neonatal and Infant Appendicitis is a Challenging Diagnosis.
  4. Safety and Effectiveness of Fast-Track Systems in Pediatric Urgent Care Units: A Systematic Review.
  5. Pediatric Firearm Survivors as a Medically Complex Population.
  6. Management of a First Non-febrile Convulsive Seizure in the Pediatric Emergency Department: A Retrospective Study From 2015 to 2021 at the University Hospital of Reims.
  7. Bridging the Gap: Addressing Geographic Inequities in Pediatric Care.
  8. Boarding Pass to Better Medication Delivery for Boarded Pediatric Emergency Patients.
  9. Acute Drug-Induced Dystonia in Children: Risk Factors, Clinical Characteristics, and Emergency Management.
  10. Current Management of Uncomplicated Acute Appendicitis: A Narrative Review of Nonoperative and Surgical Strategies.
  11. Patient-Provided Video Footage of Injuries in the Pediatric Emergency Department: A Novel Adjunct to Patient History.
  12. Care Variation Among Sites Participating in a National Quality Improvement Initiative for Croup.
  13. Implementation of central venous access device care bundles using a plan-do-study-act approach to reduce central line-associated bloodstream infection in children at a tertiary hospital in Indonesia.
  14. Ecological sustainability in pediatric anesthesia: current evidence and future directions.
  15. Emerging Sedation Strategies in Pediatric Emergency Care: Pharmacological Advances and Clinical Applications.
  16. Strategic recruitment and retention for pediatric research: a systematic review and meta-analysis.
  17. Management of Pediatric Hand Injuries in the Acute Setting Part 1: Principles of Pediatric Hand Surgery Management.
  18. Management of Pediatric Hand Injuries in the Acute Setting Part 2: Fractures and Dislocations.
  19. Management of Pediatric Hand Injuries in the Acute Setting Part 3: Lacerations and Fingertip Injuries.
  20. Recent advances in pediatric pulmonology and allergy: Articles of interest to fellows. Subclinical small airway dysfunction, anti-inflammatory reliever therapy, and biologic treatment in pediatric asthma.
  21. Language Equity in Pediatrics: Caring for Children From Families Who Speak a Language Other Than English.
  22. Complexity of care among pediatric patients in acute care settings: A systematic integrative review.
  23. Evaluating the impact of simulation on patient outcomes in pediatric and neonatal critical care: a systematic review and critical appraisal of the evidence.
  24. Medication Overuse Headache in Children and Adolescents: A Narrative Review.
  25. Implementing Evidence-based Opioid Prescribing in Pediatric Orthopaedics.
  26. Updates in paediatric advanced life support (PALS) 2025: Implications for clinical practice.
  27. Evidence-Based Strategies to Promote Diversity and Equity for Medical Education Programs.
  28. Epidemiology of Pediatric Transfusion Reactions.
  1. Am Surg. 2026 Apr 28. 31348261448884
    Child Restraint System Use and Injury Severity in Pediatric Motor Vehicle Collisions: Insights From the NTDB.
    Zoe Flyer, Andriena Giron, John Schomberg, Laura F Goodman, Emily Gray Robillard, Michael Valente, Shelby K Shelton, Rishi Bhargava, Theodore Heyming.
      BackgroundMotor vehicle collisions (MVCs) are the second leading cause of childhood mortality in the US, and child restraint systems (CRS) remain underutilized. We examine differences in demographics and clinical characteristics in pediatric patients presenting to the emergency department (ED) after MVCs with or without CRS.MethodsWe identified MVC trauma patients reported within the National Trauma Data Bank (NTDB) < 8 years of age and height/weight CRS-eligible. Bivariate descriptive analyses, interquartile range for continuous variables and a chi-square test of proportions tested differences of categorical variables of CRS strata. Sensitivity analysis was used in patients that were age appropriate for car and booster seats.ResultsIn all patients, median age for those without CRS was older (6 years, IQR 4-7) than those with CRS (4 years, IQR 2-5, P < 0.0001). A lower proportion of Black patients had CRS compared to White (24.0% vs 32.6%, P < 0.0001). For those with CRS, the highest proportion were boosters (38.7%). Injury severity score (ISS) was higher in the non-CRS group (8, IQR 4-14) than CRS (5, IQR 2-11, P < 0.0001). A larger proportion of CRS patients were discharged home from ED (26.8% vs 18.5%). Racial disparities persisted in older patients, with fewer booster-eligible Black children in CRS (30.0% vs 17.9%, P < 0.001).ConclusionsThis study demonstrates that older and Black children were less likely to be in a CRS, and that those who were not in CRS were more severely injured. Our study serves as the foundation for research to mitigate disparities, and outreach related to CRS improvements.
    Keywords:  pediatric surgery; trauma
    DOI:  https://doi.org/10.1177/00031348261448884
  2. JAMA Pediatr. 2026 Apr 27.
    Health-Related School Absenteeism Among US School-Age Children With Chronic Health and Social Needs.
    Michelle Shankar, Samantha R Levano, Miya Lemberg, Jonathan M Gabbay, Marina Reznik, Michael L Rinke, Kevin Fiori, Rebecca Dudovitz.
       Importance: In the 2022-2023 school year, more than 1 in 4 children in the US were chronically absent from school, doubling prepandemic rates. As a potential signal of underlying health and social challenges and a predictor of long-term health, this surge in absenteeism presents a pressing public health concern.
    Objective: To examine associations between chronic health needs, health-related social needs, and health-related school absenteeism among US school-aged children.
    Design, Setting, and Participants: This cross-sectional study was conducted using the 2022-2023 National Survey of Children's Health among US children aged 6 to 17 years with available data on school absenteeism. Data were analyzed from April to December 2025.
    Exposures: Chronic health needs, including children with special health care needs status or 1 of 27 chronic health conditions, and household-level health-related social needs (HRSNs), including housing instability, food insecurity, parent health needs, or exposure to adverse childhood experiences. Covariates included age, sex, race and ethnicity, and income.
    Main Outcome and Measures: The primary outcome was elevated health-related school absenteeism, defined as missing 11 days or more due to illness or injury in the past year. Survey weights were used to generate national estimates.
    Results: The weighted sample represented 49.3 million children (mean age, 11.6 years; 24 100 000 female children [48.9%]; 30 700 000 [62.2%] at ≥201% of the federal poverty level). More than half of the sample (35 012 of 66 752 [52.5%]) reported having combined chronic health need(s) and HRSN(s), representing an estimated 25.9 million children. Prevalence of elevated health-related school absenteeism in the study sample was 6.8% (n = 5117), representing an estimated 3.4 million children. Compared to children with neither chronic health needs nor HRSNs (1.8%; 95% CI, 1.3%-2.2%), the estimated probability of elevated health-related school absenteeism was higher among those with either chronic health needs (4.4%; 95% CI, 3.6%-5.3%) or HRSNs (3.7%; 95% CI, 3.0%-4.4%) and was highest among those with both (9.4%; 95% CI, 8.8%-9.9%).
    Conclusions and Relevance: In this cross-sectional study, children with chronic health needs and HRSNs were more likely to experience elevated health-related school absenteeism compared to children without these needs; these associations were greatest among children with both chronic health needs and HRSNs. These findings highlight potential opportunities to improve health and educational outcomes through targeted interventions focused on these groups.
    DOI:  https://doi.org/10.1001/jamapediatrics.2026.1138
  3. J Surg Res. 2026 Apr 24. pii: S0022-4804(26)00209-X. [Epub ahead of print]322 471-475
    Not Like in the Textbook - Neonatal and Infant Appendicitis is a Challenging Diagnosis.
    Claire Wunker, Anne Sung, Ninette Musili, Stuart Bradin, Erin E Perrone.
       INTRODUCTION: Appendicitis is the most common condition requiring emergency surgery in pediatric patients. Despite this, appendicitis is exceedingly rare in neonatal and infant age groups. Neonatal appendicitis is difficult to diagnose as it mimics other more common abdominal pathologies.
    METHODS: A retrospective review from 2004 to 2024 of a quaternary pediatric hospital was conducted and included all infants under 1 y of age who underwent appendectomy and were found to have appendicitis on pathology. Patients were excluded if they had an appendectomy without pathology confirming appendicitis or no documentation of appendicitis. Data extracted included demographics, symptoms, labs, imaging, surgical, and pathological outcomes.
    RESULTS: Seven patients presented with appendicitis with a median age of 14 d (interquartile range 8.5-45d). Five had comorbidities. The most common presentations were abdominal distension, pain, fever, and diarrhea. The average white blood cell count was 12.95 ± 6.42x103 cells/μL. C-reactive protein and procalcitonin were elevated in both patients in which they were completed. Five of the patients had blood cultures, with two of the five positive for Escherichia coli. Most patients had an abdominal x-ray (n = 6) and two had free air. Two underwent abdominal ultrasound and one demonstrated an enlarged appendix. Three of the patients required more than one visit for definitive treatment. Two patients had laparoscopic procedures. Four of the patients had perforations. There was no mortality or complications related to surgery.
    CONCLUSIONS: Neonatal and infant appendicitis at our institution was rare. There was no unifying presentation or symptomatology that was consistent across the patient cohort, which makes diagnosis challenging in this patient population.
    Keywords:  Appendicitis; Infant; Neonate
    DOI:  https://doi.org/10.1016/j.jss.2026.03.098
  4. Cureus. 2026 Mar;18(3): e105890
    Safety and Effectiveness of Fast-Track Systems in Pediatric Urgent Care Units: A Systematic Review.
    Mohammad Alahmadi.
      Emergency department (ED) overcrowding and prolonged waiting times remain major challenges in pediatric emergency care. This systematic review evaluated the effectiveness and safety of fast-track systems implemented in pediatric urgent care and emergency department settings. A systematic search of PubMed/MEDLINE, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials was conducted for studies published between 2014 and 2024. Screening and selection followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A total of 1,038 records were identified, of which 251 were screened after duplicate removal, and 14 studies met the inclusion criteria. The included studies were conducted primarily in North America, Europe, Asia, and Australia and consisted mainly of before-and-after quality improvement (QI) studies and retrospective cohort designs. Across the included studies, fast-track implementation was associated with improvements in operational efficiency. Reported reductions in length of stay (LOS) ranged from 8.9% to 36%, while waiting times decreased in several studies, including reductions in arrival-to-provider time from 62 to 39 minutes in redesigned triage systems. Improvements in patient flow metrics, including reduced left-without-being-seen (LWBS) rates and decreased short-stay admissions, were also observed. Safety outcomes were reported in a subset of studies and generally included 72-hour return visits or 30-day readmissions, with no statistically significant increases observed following fast-track implementation. Four studies also reported improvements in caregiver satisfaction. Fast-track systems in pediatric emergency settings are associated with improved operational performance, particularly reductions in length of stay and waiting times, while maintaining stable safety outcomes. The effectiveness of these systems appears to depend on implementation characteristics such as dedicated clinical space, appropriate staffing models, and standardized clinical protocols. Further research is needed to evaluate long-term safety outcomes, sustainability, and applicability in diverse healthcare settings.
    Keywords:  efficiency; emergency service; hospital; length of stay; organizational; patient safety; pediatrics; triage; waiting times
    DOI:  https://doi.org/10.7759/cureus.105890
  5. J Hosp Palliat Nurs. 2026 Apr 28.
    Pediatric Firearm Survivors as a Medically Complex Population.
    Lisa C Lindley, Meaghann S Weaver.
      Firearm injury is now the leading cause of death among children and adolescents in the United States, yet far more children survive gunshot wounds and encounter substantial long-term consequences. This article argues that pediatric firearm survivors constitute a population of children with medical complexity, a group defined by severe chronic health conditions, significant functional limitations, substantial service needs, and high health care utilization. Survivors often experience multisystem trauma, neurological impairment, chronic pain, organ dysfunction, and enduring functional deficits requiring long-term rehabilitation, medical technology, and educational and psychosocial support. Families frequently manage intensive caregiving responsibilities and navigate fragmented systems of care. Survivors also demonstrate elevated mental health needs and high rates of readmissions, subspecialty care, and emergency visits, reflecting chronic and resource-intensive trajectories. By applying established frameworks for children with medical complexity, this article reframes firearm survivorship as a chronic condition rather than a discrete traumatic event.Recognizing pediatric firearm survivors as medically complex has important implications for hospice and palliative care nursing practice. Such recognition supports trauma-informed, longitudinal models of palliative care and highlights the need for targeted interventions that address the persistent medical, functional, and psychosocial burdens of this growing population.
    Keywords:  children with medical complexity; firearm injury; firearm survivors; gunshot; palliative care
    DOI:  https://doi.org/10.1097/NJH.0000000000001234
  6. Cureus. 2026 Mar;18(3): e106050
    Management of a First Non-febrile Convulsive Seizure in the Pediatric Emergency Department: A Retrospective Study From 2015 to 2021 at the University Hospital of Reims.
    Amine Kaake, Mélanie Jennesson-Lyver.
       INTRODUCTION: The onset of epileptic manifestations frequently occurs during childhood and often leads to initial management in pediatric emergency departments. The diagnostic approach is challenging, as epileptic seizures must be distinguished from non-epileptic paroxysmal events and acute symptomatic seizures. Although several national and international recommendations exist, real-world data on the management of first seizures in pediatric emergency settings remain limited.
    OBJECTIVE: The primary objective of this study was to analyze patient characteristics and management of children presenting to a pediatric emergency department with a first non-febrile convulsive seizure. The secondary objective was to develop a practical management algorithm tailored to pediatric emergency settings.
    METHODS: We conducted a retrospective, single-center observational study in a tertiary pediatric hospital in Reims, France. All patients under 18 years of age presenting to the pediatric emergency department with a first non-febrile convulsive seizure between January 1, 2015, and June 30, 2021, were included.
    RESULTS: Data from 167 children were analyzed and categorized into three groups: epileptic seizure (99, 59.3%), non-epileptic paroxysmal event (64, 38.3%), and acute symptomatic seizure (4, 2.4%). Clinical examination was normal in the majority of cases and did not reliably discriminate between groups. Semiological features such as eye deviation, eye rolling, generalized or focal hypertonia, and postictal confusion were significantly associated with epileptic seizures, whereas stressful or vasovagal situations were more frequent in non-epileptic events. All patients in the epileptic group underwent neuropediatric consultation, and 55 (55.5%) were discharged with antiepileptic treatment. Laboratory investigations were performed in 52 (52.5%) patients, with abnormalities identified in only 4% of cases. Electroencephalography (EEG) was performed in 96 (96.7%) patients and showed abnormalities in 64 (69.8%). In non-epileptic events, the EEG was normal in all cases where it was performed. Brain imaging was selectively performed and identified structural abnormalities in 21 (26.6%) patients who underwent MRI.
    CONCLUSIONS: In children presenting with a first non-febrile convulsive event, epileptic seizures accounted for a substantial proportion of cases, while non-epileptic events remained frequent. Clinical history and witness description were the most informative elements for diagnosis, whereas routine laboratory testing had limited utility. EEG and neuroimaging were valuable in selected cases. The proposed management algorithm provides a pragmatic, emergency-oriented framework to support clinical decision-making and help standardize the evaluation of these patients.
    Keywords:  childhood epilepsy; epilepsy in children; epileptic seizure; first seizure; pediatric emergency department; pediatric seizure
    DOI:  https://doi.org/10.7759/cureus.106050
  7. Pediatr Ann. 2026 May;55(5): e177-e181
    Bridging the Gap: Addressing Geographic Inequities in Pediatric Care.
    Amanda R Holloway, Christine E Maloney.
      Across the United States, access to pediatric inpatient units, specialists, and intensive care units is becoming more concentrated in tertiary children's hospitals. Although this shift enables consolidation of resources and expertise, it also results in a significant access gap for millions of children living in rural communities nationwide. Children in regions lacking local pediatric services face disparities in identification of critical illness, delays in transport to definitive care, and an increased risk of adverse outcomes. These discrepancies raise an important question: How can the pediatric community ensure that every child receives excellent care, regardless of their location?
    DOI:  https://doi.org/10.3928/19382359-20260209-03
  8. Hosp Pediatr. 2026 Apr 27.
    Boarding Pass to Better Medication Delivery for Boarded Pediatric Emergency Patients.
    Jessica Hayes, Christine Moore Smith, Megan Malik, Alexandria Lawrence, Morgan Crum, S Barron Frazier.
       ABSTRACT: Background: Prolonged boarding of patients in the pediatric emergency department (PED) is associated with increased risk of missed or delayed administration of essential home medications. Children with chronic medical or psychiatric conditions requiring time-sensitive medications may experience preventable clinical deterioration during extended PED stays. The aim was to increase the percentage of encounters in which all high-risk home medications were ordered for pediatric patients roomed in the PED >4 hours from 38% to over 70% between August 2024 and June 2026.Methods: We conducted a quality improvement initiative at a large, academic PED. Eligible patients were ≤18 years, remained in the PED for >4 hours after rooming, and were anticipated to require admission. Using Model for Improvement and Lean methodology, we implemented workflow-integrated interventions, including division-wide education, caregiver-integrated medication identification via electronic triage, time-based electronic reminders, and workflow-embedded ordering tools. The primary outcome was the proportion of encounters in which all high-risk home medications were ordered. Data were analyzed using statistical process control charts.Results: In association with our improvement interventions, the average percent of encounters for boarding patients in which all high-risk home medications were ordered increased from a baseline of 38% to 87% with special cause variation observed on a statistical process control p-chart.Conclusions: A multifaceted, workflow-integrated quality improvement initiative was associated with improved reliable ordering of high-risk home medications for boarded pediatric patients. Embedding medication identification and ordering supports within clinical workflows represents a scalable strategy to improve medication safety during prolonged PED stays.
    DOI:  https://doi.org/10.1542/hpeds.2026-009298
  9. Pediatr Emerg Care. 2026 Apr 30.
    Acute Drug-Induced Dystonia in Children: Risk Factors, Clinical Characteristics, and Emergency Management.
    Bilge Akkaya, Fatma Şule Erdem, Betül Öztürk, Raziye Merve Yaradilmiş, Ahmet Serkan Özcan, Orkun Aydin, Ali Güngör, Nilden Tuygun.
       BACKGROUND: Drug-induced acute dystonia is an adverse drug reaction that is concerning in pediatric patients but resolves rapidly with appropriate treatment. In children, data on risky drugs, clinical patterns, and the management of dystonia in the emergency department are limited. This study aimed to evaluate the demographic and clinical findings and treatment outcomes of children presenting to the pediatric emergency department with drug-induced acute dystonia.
    METHODS: This retrospective observational study includes children aged 1 month to 18 years who were diagnosed with acute dystonia in a tertiary pediatric emergency department between October 2022 and March 2025. The diagnosis was made by a pediatric emergency subspecialist based on clinical findings. Patients were classified according to clinical phenotype as focal/segmental dystonia (group I) and multifocal/generalized dystonia (group II). Demographic data, drug exposures, clinical characteristics, and treatment responses were analyzed.
    RESULTS: A total of 79 patients were included in the study. The median age was 11 years (IQR: 7 to 16) in group I and 10 years (IQR: 6 to 16) in group II. The most commonly associated drug groups were antipsychotics (55.6%), antiemetics (26.6%), and psychostimulants (20.3%). Focal dystonia is the most common clinical pattern, affecting the head and neck muscles in 61% of cases. The use of metoclopramide was significantly higher in group I (OR: 0.21; 95% CI: 0.04-0.99). All patients were treated with parenteral biperiden.
    CONCLUSIONS: Antipsychotics and antiemetics are the main triggers of drug-induced acute dystonia in children. Dystonia usually appears within the first 72 hours after starting the drug. It can develop even at therapeutic doses. Dystonias associated with antiemetic drugs often show focal or segmental distribution. Parenteral biperiden is a fast and effective treatment option. Acute dystonia can mimic serious etiologies in the emergency department. Obtaining a detailed drug history can facilitate the diagnostic process.
    Keywords:  acute dystonia; adverse drug reaction; biperiden; drug-induced dystonia; emergency management; pediatrics
    DOI:  https://doi.org/10.1097/PEC.0000000000003624
  10. Cureus. 2026 Mar;18(3): e106086
    Current Management of Uncomplicated Acute Appendicitis: A Narrative Review of Nonoperative and Surgical Strategies.
    Sol Angie Rincon Mora.
      Acute appendicitis remains one of the most common surgical emergencies worldwide and has traditionally been treated with appendectomy. However, growing evidence from randomized trials and international guidelines has challenged this paradigm, suggesting that nonoperative management with antibiotics may be a safe alternative for selected patients with uncomplicated disease. This narrative review aims to examine the current evidence on the management of uncomplicated acute appendicitis, with particular focus on the role of antibiotic therapy compared with surgical appendectomy, patient selection, and clinical outcomes. A narrative review of the literature was conducted using major medical databases, including PubMed, Scopus, and Google Scholar. Randomized clinical trials, systematic reviews, meta-analyses, and international guidelines published in recent years were analyzed to summarize current diagnostic strategies and treatment approaches for uncomplicated acute appendicitis. Recent studies demonstrate that antibiotic therapy can successfully treat a substantial proportion of patients with uncomplicated appendicitis, potentially avoiding immediate surgery. Nevertheless, nonoperative management is associated with higher rates of recurrence and subsequent appendectomy. The presence of an appendicolith has been consistently identified as a significant predictor of treatment failure. Laparoscopic appendectomy remains a safe and definitive treatment with low complication rates and minimal risk of recurrence. The management of uncomplicated acute appendicitis is evolving from a strictly surgical disease to a condition with multiple evidence-based treatment options. While appendectomy remains the definitive therapy, antibiotic treatment represents a feasible alternative in carefully selected patients. A patient-centered approach that incorporates imaging findings, clinical risk factors, and shared decision-making is essential for optimal outcomes.
    Keywords:  acute appendicitis; antibiotic therapy; appendectomy; laparoscopic appendectomy; nonoperative management
    DOI:  https://doi.org/10.7759/cureus.106086
  11. Pediatr Emerg Care. 2026 Apr 27.
    Patient-Provided Video Footage of Injuries in the Pediatric Emergency Department: A Novel Adjunct to Patient History.
    Lyndsay Lee, Patrick Yoo, Francesca Bullaro, Jonathan Golden, Jane Cerise, Kristy Williamson.
       OBJECTIVE: To evaluate the impact of viewing video footage during a pediatric emergency department (ED) encounter on the medical assessment of children with traumatic injuries, specifically its influence on clinical decision-making and management.
    METHODS: Data was collected over 35 months at a pediatric level 1 trauma center. Pediatric emergency medicine (PEM) providers completed a survey after evaluating patients presenting with an injury and reviewing video footage shown to them depicting what happened to the child. The survey included basic video information and whether video footage influenced the providers' approach to patient care.
    RESULTS: Fifty-one surveys were completed after families voluntarily showed PEM providers video footage of the patient's mechanism of injury. In 27 cases (53%), ED providers reported that observing the video influenced management. Review of footage influenced providers' decision regarding radiologic imaging in 18 cases (35%); providers performed imaging in 11 cases where they would not have otherwise, and did not perform imaging in 7 cases where they would have otherwise. Review of footage influenced providers' decision regarding laboratory studies in 5 cases (10%). Six (12%) providers indicated they consulted specialists after viewing the video footage when they otherwise would not have.
    CONCLUSION: The study findings indicate that viewing video footage related to the mechanism of injury affected the clinical decision-making processes of PEM providers in more than half of the observed instances (53%). This suggests that video surveillance footage has potential utility as an adjunct to traditional history-taking in the trauma evaluation of patients presenting to the ED.
    Keywords:  injury; mechanism; pediatric; trauma; video
    DOI:  https://doi.org/10.1097/PEC.0000000000003620
  12. Hosp Pediatr. 2026 Apr 26.
    Care Variation Among Sites Participating in a National Quality Improvement Initiative for Croup.
    Kelly R Bergmann, Vivian Lee, Gabrielle Z Hester, Ellen Kerns, Makayla Schissel, Kendall Arslanian, Sloane Magee, Brittany Jennings, Bolanle Akinsola, Beth Condley, Amy M DeLaroche, Daniela Hochreiter, Adolfo L Molina, Adolfo L Molina, Amanda Nedved, Lisa L Schroeder, Ryan Sewell, Randi Trope, Amy Tyler, Irina Topoz, On Behalf Of The Better Assessment And Response To Croup In Kids Barck Collaborative.
       ABSTRACT: Background: There is substantial care variation for children with croup. Our primary aim was to describe variation in croup pathways by acute care setting and hospital type among sites participating in a national quality improvement (QI) collaborative: Better Assessment and Response to Croup in Kids (BARCK).Methods: We conducted a cross-sectional study, consisting of site surveys to identify site characteristics and independent review of croup clinical pathways by study physicians. Site application surveys were distributed via the Pediatric Acute and Critical Care and Quality Network listserv in September 2024, and a pre-project survey was distributed between January and February 2025. Data were reported using frequencies and percentages.Results: Of 107 participating sites, 96 (89.7%) completed surveys. Forty-eight (50.0%) sites indicated having a croup pathway, of which 30 (28.0% of participating sites, 62.5% with a croup pathway) were submitted and reviewed. Of 30 sites with croup pathways, 17 (56.7%) were classified as emergency departments (EDs) and 13 (43.3%) as mixed ED and urgent care (UC). Nine (52.9%) pathways from ED sites recommended ≥3 racemic epinephrine (RE) treatments prior to admission compared to 4 (30.8%) pathways from ED/UC sites. Few pathways from ED sites provided guidance on when to obtain a neck (23.5%) or chest radiograph (17.6%) compared to pathways from ED/UC sites (53.8% and 46.2%, respectively). Findings were similar when comparing by hospital type.Conclusions: There is considerable variation in croup pathways. The BARCK collaborative will provide an opportunity to standardize care practices across care settings.
    DOI:  https://doi.org/10.1542/hpeds.2025-009086
  13. Front Pediatr. 2026 ;14 1718071
    Implementation of central venous access device care bundles using a plan-do-study-act approach to reduce central line-associated bloodstream infection in children at a tertiary hospital in Indonesia.
    Yogi Prawira, Nina Dwi Putri, Dwi Putri Lestari, Pramita Gayatri Dwipoerwantoro, Irene Yuniar, Aryono Hendarto, Idham Jaya Ganda.
       Background: Sepsis is a major cause of morbidity and mortality worldwide, especially in low- and middle-income countries. Central line-associated bloodstream infection (CLABSI) contributes significantly to hospital-onset sepsis. However, data on CLABSI rates related to central venous catheter placement and bundle non-compliance in our hospital are limited.
    Aim: To evaluate a Plan-Do-Study-Act (PDSA) based CLABSI bundle in reducing CLABSI rates in children at Dr. Cipto Mangunkusumo Hospital.
    Methods: A quality improvement study using three sequential PDSA cycles was conducted between September and November 2022. Children aged 1 month to 18 years who underwent central venous access device (CVAD) insertion by the Pediatric Emergency and Intensive Care team between June and November 2022 were included. Interventions comprised education on the CLABSI bundle and CVAD insertion practices, increased nursing involvement through standardized bedside training, and reinforced documentation and monitoring of CVAD care.
    Results: A total of 280 patients were included, with 143 in the pre-intervention period and 137 during the intervention period. The mean CLABSI rate decreased from 12.7 to 8.6 per 1,000 central-line days within three months of PDSA implementation. The lowest CLABSI rate, 3.4 per 1,000 central-line days, was observed in November 2022. Process evaluation PDSA Cycle 3 identified persistent system-level barriers, including limited availability of essential supplies and suboptimal adherence to recommended insertion and dressing practices.
    Conclusion: PDSA-based CLABSI bundle implementation was feasible and associated with an early reduction in CLABSI rates; however, system-level and resource constraints limited sustained improvement.
    Keywords:  Plan-Do-Study-Act (PDSA); critical care; infection control; pediatrics; quality improvement
    DOI:  https://doi.org/10.3389/fped.2026.1718071
  14. Curr Opin Anaesthesiol. 2026 Jun 01. 39(3): 280-287
    Ecological sustainability in pediatric anesthesia: current evidence and future directions.
    Patricio Gonzalez-Pizarro, Nicola Groes Clausen, Alexander Fuchs.
       PURPOSE OF REVIEW: Climate change is already disrupting healthcare delivery with perioperative medicine, particularly pediatric anesthesia, being both highly exposed to climate-related shocks and a major contributor to healthcare-related greenhouse gas emissions (GHG). This review examines how mitigation and resilience strategies can be integrated into pediatric anesthetic practice.
    RECENT FINDINGS: Sustainability measures in pediatric anesthesia are currently actionable and clinically beneficial. Reducing the use of volatile anesthetics through low-flow techniques, avoiding N2O or desflurane, and increasing the adoption of total intravenous anesthesia lead to substantial reductions in GHG and are associated with better clinical outcomes. EEG-guided anesthesia further reduces unnecessary exposure to anesthetics and improves recovery profiles. The use of reusable warming drapes or the implementation of 10R policies can markedly reduce our footprint without compromising the quality of care.
    SUMMARY: Sustainable pediatric anesthesia is achievable today and aligns with improved clinical outcomes. Translating evidence into routine practice remains a challenge. Patient safety primacy or entrenched clinical habits continue to slow the adoption of sustainable practices, even when supported by robust data. Success will depend on reframing sustainability as a core component of quality and safety, embedding it within guidelines and audit structures, and supporting clinicians, thereby enabling durable behavior change.
    Keywords:  EEG; behavior change; inhalational anesthesia; pediatric anesthesia; sustainability
    DOI:  https://doi.org/10.1097/ACO.0000000000001627
  15. Cureus. 2026 Mar;18(3): e105779
    Emerging Sedation Strategies in Pediatric Emergency Care: Pharmacological Advances and Clinical Applications.
    Sabrina Montoya, Diego Alvarez Ramirez, Ronald Chavarría, Elia L Zamora, Christian Andrés Soto Cordero.
      Emerging sedative agents are increasingly being explored to improve the safety and effectiveness of procedural sedation in pediatric emergency care. Traditional agents such as propofol and ketamine remain widely used because of their rapid onset and clinical effectiveness; however, they may be associated with adverse effects, including hypotension, respiratory depression, and emergence reactions, which require careful monitoring during pediatric procedural sedation. In this context, newer pharmacologic approaches have been investigated to optimize safety and procedural control. Remimazolam, a benzodiazepine metabolized by tissue esterases, demonstrates rapid clearance, minimal drug accumulation, and stable hemodynamic profiles. Clinical studies suggest comparable efficacy to propofol in procedural sedation, with potential advantages including reduced respiratory depression and a lower incidence of emergence delirium. Its reversibility with flumazenil may further enhance safety in selected clinical scenarios. Dexmedetomidine, a selective α₂-adrenergic receptor agonist, provides sedation that resembles natural sleep and offers intrinsic analgesic properties with minimal respiratory depression. Although its onset of action may be slower than that of agents such as propofol, dexmedetomidine is associated with favorable respiratory stability and may be particularly useful in pediatric patients requiring cooperative or prolonged sedation. Intranasal administration represents a noninvasive alternative in situations where intravenous access has not yet been established, although its pharmacokinetic profile may result in delayed onset. These agents have been applied in a variety of pediatric procedures, including painful interventions, imaging studies, and short diagnostic procedures. Their use may be particularly valuable in children with developmental disorders or complex comorbidities, where stable hemodynamic and respiratory profiles are essential. Contemporary safety frameworks emphasize structured risk assessment, airway preparedness, weight-based dosing strategies, and continuous monitoring techniques such as capnography and pulse oximetry. Current evidence from randomized and observational studies suggests that emerging sedative strategies may provide effective procedural sedation while maintaining favorable safety profiles when appropriately integrated into multimodal sedation approaches. Nevertheless, important knowledge gaps remain, including limited pediatric data for certain agents, the need for standardized protocols, and the evaluation of long-term outcomes in younger patient populations.
    Keywords:  airway safety; dexmedetomidine; emergency medicine; pediatric procedural sedation; remimazolam; ultra-short-acting agents
    DOI:  https://doi.org/10.7759/cureus.105779
  16. Front Pediatr. 2026 ;14 1786388
    Strategic recruitment and retention for pediatric research: a systematic review and meta-analysis.
    Sergio Monares, Madeleine Godfrey, Ava Heinegg, Faith Taliaferro, Peter P Moschovis, Wanda I Gonzalez, Lael M Yonker.
       Objective: To evaluate the effectiveness of recruitment and retention strategies in pediatric clinical studies, focusing on achieving adequate representation across a range of demographic considerations.
    Study design: A systematic review was conducted using PubMed, PsycNET, and Cochrane databases to identify articles published between January 1, 1993, and September 1, 2024. Inclusion criteria targeted general pediatric studies emphasizing recruitment diversity. We compared success rates of these strategies across different races and ethnicities, targeted age groups, and community location, to current published national recruitment rates in pediatric research.
    Results: Of the 2,272 studies identified, 23 studies were included that detailed specific recruitment and retention strategies specifically targeting diverse pediatric populations for general pediatric health topics. These studies enrolled a total of 5,482 participants with ages ranging from 0.55-19.8 years of age for child and adolescent populations, and a mean parental age of 35.5 years for studies targeting parents of children. Community-based recruitment strategies were most effective for engaging underrepresented populations. Family services and flexible scheduling were particularly effective for parents and young children, while monetary compensation and group-oriented efforts resonated more with adolescents. Retention strategies, including flexible scheduling, family services, and compensation, were successful across populations.
    Conclusion: Tailored recruitment and retention strategies addressing cultural, social, and logistical needs are essential for ensuring diversity of age, race, ethnicity and geographic location in pediatric research. Community-based strategies enhanced recruitment, while compensation and logistical incentives, such as follow-up reminders and family services improved retention. Addressing data gaps on recruitment and retention efforts are critical for future research to achieve adequate representation and improve health outcomes in pediatrics.
    Keywords:  participant engagement; pediatric research; recruitment strategies; retention strategies; study design
    DOI:  https://doi.org/10.3389/fped.2026.1786388
  17. J Pediatr Soc North Am. 2026 May;15 100363
    Management of Pediatric Hand Injuries in the Acute Setting Part 1: Principles of Pediatric Hand Surgery Management.
    Micah K Sinclair, Daniel Santana, M Claire Manske.
      Injury to the pediatric hand is common, yet acute management techniques are variable due to limited evidence-based guidance. The initial evaluation and treatment often falls to emergency department physicians, on-call orthopaedic surgeons, or primary care providers, who may lack specialized training or experience in pediatric hand injuries. The purpose of this three-part series is to provide education about the differences in management of pediatric hand patients, as compared to adult hand care. Additionally, it provides recommendations for the initial management of traumatic hand injuries in skeletally immature patients, guided by the literature where possible. This includes the management of urgent and emergent traumatic pathologies, including digital amputations and joint dislocations, in addition to common pediatric pathology.
    Key Concepts: (1)Pediatric-specific anatomy and physiology require different management strategies for hand injuries compared to adults.(2)Not all pediatric hand injuries will be okay without active management; early detection and referral can be crucial.(3)System-wide coordination among primary care, the emergency department, on-call orthopaedic surgeons, and hand specialists is essential for optimal management of pediatric hand trauma.
    Keywords:  Finger fracture; Hand trauma; Laceration; Open physis; Pediatric hand; Splinting
    DOI:  https://doi.org/10.1016/j.jposna.2026.100363
  18. J Pediatr Soc North Am. 2026 May;15 100364
    Management of Pediatric Hand Injuries in the Acute Setting Part 2: Fractures and Dislocations.
    Micah K Sinclair, Daniel Santana, M Claire Manske.
      This is the second article in a three-part series on the acute care of pediatric hand injuries. The first article covered what defines a pediatric hand injury, general principles, when to refer a child to a pediatric hand surgeon, and an overview of immobilizing the pediatric hand and upper extremity. For a detailed collection on the technical aspects of pediatric splint and cast application, the reader is referred to the JPOSNA Primer on Cast and Splint Application. https://www.jposna.com/content/jposna_ae_primer_on_cast_and_splint_application. This section will discuss the principles of diagnosis and immediate management for specific fractures and dislocations. Expert opinions were consulted to supplement this review.
    Key Concepts: (1)Phalanx fractures are among the most common upper extremity fractures in children. Treatment varies based on the fracture's location within the phalanx.(2)Radiographs of the finger (including thumb) and clinical functional exam, including evaluation of the involved finger in flexion, are necessary to determine appropriate treatment.(3)Immediate management at time of injury can often be definitive treatment of the presenting injury.(4)Detailed management is described for the most common finger, hand, and carpal fractures.(5)Follow-up with a hand specialist within 1 week of injury will ensure proper treatment of pediatric hand fractures.
    Keywords:  Finger dislocation; Finger fracture; Hand trauma; Pediatric hand; Scaphoid; Seymour fracture
    DOI:  https://doi.org/10.1016/j.jposna.2026.100364
  19. J Pediatr Soc North Am. 2026 May;15 100365
    Management of Pediatric Hand Injuries in the Acute Setting Part 3: Lacerations and Fingertip Injuries.
    Micah K Sinclair, Daniel Santana, M Claire Manske.
      This is the third article in a series on the assessment and management of pediatric hand trauma. Building on the foundational principles established in the previous articles, this segment focuses on lacerations and fingertip injuries-frequently encountered open pediatric hand injuries in emergency departments. Prompt recognition and appropriate initial treatment are essential to optimize functional outcomes and prevent complications.
    Key Concepts: (1)Examination of arm and hand function in children with a laceration can be difficult.(2)Recommendations are made for examination of children to identify tendon, nerve and arterial injury.(3)Fingertip injuries can often be treated in the emergency department.(4)Hand lacerations and amputations at all levels should include a consultation with a hand surgeon.
    Keywords:  Amputation; Finger fracture; Hand trauma; Laceration; Nail bed injury; Pediatric hand; Subungual hematoma
    DOI:  https://doi.org/10.1016/j.jposna.2026.100365
  20. Paediatr Respir Rev. 2026 Apr 25. pii: S1526-0542(26)00033-3. [Epub ahead of print]
    Recent advances in pediatric pulmonology and allergy: Articles of interest to fellows. Subclinical small airway dysfunction, anti-inflammatory reliever therapy, and biologic treatment in pediatric asthma.
    Irlanda Alvarado-Amador, Seda Tunca, Chiara Astori.
      Recent advances in pediatric asthma continue to refine the understanding of disease mechanisms and to reshape therapeutic strategies. In this brief review, we discuss three recent articles of particular interest to fellows and early-career clinicians. First, we examine evidence showing that subclinical small airway dysfunction may be present in children with well-controlled asthma despite normal FEV1, highlighting the potential role of oscillometry as a complementary tool in functional assessment. Second, we review the CARE trial, which demonstrated that as-needed budesonide-formoterol was superior to SABA-only reliever therapy in reducing asthma attacks in children with mild asthma. Third, we summarize recent data on dupilumab in children with uncontrolled moderate-to-severe type 2 asthma, showing sustained benefits across disease severity strata. Together, these studies illustrate how physiological assessment and targeted anti-inflammatory therapies are advancing personalized care in pediatric asthma.
    Keywords:  Budesonide–formoterol; Dupilumab; Oscillometry; Pediatric asthma; Small airway dysfunction
    DOI:  https://doi.org/10.1016/j.prrv.2026.04.004
  21. Pediatr Ann. 2026 May;55(5): e164-e168
    Language Equity in Pediatrics: Caring for Children From Families Who Speak a Language Other Than English.
    Mary S Pilarz, Stephanie Granada, Hannah L Harp, Adrian D Zurca, Kshama Shah, Victoria A Rodriguez.
      Families who speak a language other than English (LOE) are a growing population in the United States. Children of these families are at risk of disparities in clinical settings. This narrative review synthesizes evidence from outpatient and inpatient settings and outlines pragmatic strategies to improve communication and outcomes. Speaking a LOE is linked to low rates of preventive care, underinsurance, long hospitalizations, delayed escalation of care, undertreatment of pain, and adverse events. Although working with professional interpreters improves outcomes, services remain underutilized; families prefer in-person interpretation when available. Emerging modalities, such as equipment-assisted simultaneous interpretation and artificial intelligence-based translation, show promise for mitigating disparities but still demonstrate uneven performance across languages. Advancing equity will require best-practice interpretation use, investment in interpreter services and clinician language proficiency, inclusive research, and education that equips clinicians and health systems to partner effectively with families who speak an LOE.
    DOI:  https://doi.org/10.3928/19382359-20260209-04
  22. J Pediatr Nurs. 2026 Apr 28. pii: S0882-5963(26)00185-5. [Epub ahead of print]89 192-210
    Complexity of care among pediatric patients in acute care settings: A systematic integrative review.
    Rocío García-Ruiz, Jordi Adamuz-Tomás, María Ruiz-Montaño, Sergio Barrientos-Trigo.
       BACKGROUND: The concept of complexity of care is well established in scientific literature; however, in pediatric populations, research has primarily focused on medical aspects, lacking a comprehensive approach that includes additional influencing factors.
    PURPOSE: This study aimed to identify the evidence on complexity of care among pediatric patients attending pediatric acute care settings.
    METHODS: An integrative review was conducted the PRISMA guidelines (PROSPERO registration: CRD42023469426). The search included articles published up to July 2025 in PubMed, CINHAL, Scopus, and WOS. Both the quality and internal validity of the studies included were independently assessed by two reviewers.
    RESULTS: Twenty-two articles were analysed, identifying 48 complexity-related factors and 39 assessment scales. Findings were grouped into four thematic categories, within each of which the following key complexity factors were identified: A) Clinical aspects of pediatric patients, such as diagnosis, patient type, and clinical stability; B) Environmental factors, particularly family involvement; C) Care provider aspects, such as direct/indirect nursing activities and workload; D) Organisational elements, especially nursing staff experience.
    CONCLUSIONS AND IMPLICATIONS: This review expands the understanding of complexity beyond patient pathology. It underscores the need for further research to explore healthcare professionals' perceptions of complexity and examine how the identified factors influence health outcomes. Developing integrated assessment tools may enhance care planning and resource allocation in pediatric settings.
    Keywords:  Child care; Hospitals; Nursing care and Review [publication type]
    DOI:  https://doi.org/10.1016/j.pedn.2026.04.015
  23. Eur J Pediatr. 2026 Apr 26. pii: 302. [Epub ahead of print]185(5):
    Evaluating the impact of simulation on patient outcomes in pediatric and neonatal critical care: a systematic review and critical appraisal of the evidence.
    Anna Zanin, Elisa Poletto, Santiago Mencia, Orsola Gawronski, Gilles Jourdain.
      While the literature widely supports a positive relationship between simulation-based education (SBE) and learning outcomes, its impact on patient outcomes remains less clearly understood. Our aim was to comprehensively survey the landscape of simulation-based research (SBR) that evaluates patient outcomes (Kirkpatrick Level 4) in the context of pediatric and neonatal critical care. A systematic search of MEDLINE, Cochrane Library, CINAHL, and ERIC was conducted through December 2024. We included RCTs, non-RCTs, and before-after studies focusing on Kirkpatrick Level 4 outcomes. Quality was appraised using the RoB 2 and ROBINS-I tools. A total of 2481 articles were screened. Sixteen studies met the inclusion criteria. Most were prospective (63%) and single-center (69%), with only three RCTs (19%). All included studies (100%) reported Level 4 outcomes; however, a critical distinction emerged between system-level and patient-level results. While 75% (12/16) of studies reported positive impacts on Level 4a (system processes), such as protocol adherence or response times, only 50% (8/16) demonstrated significant improvements in Level 4b (direct patient outcomes), such as mortality or complication rates. In addition, all included studies were judged to have a high or critical risk of bias.
    CONCLUSIONS:  Although SBE effectively optimizes clinical processes (Level 4a), a significant evidence gap remains regarding its direct impact on patient health (Level 4b). Current SBR often lacks the methodological rigor-specifically the use of randomized designs-needed to isolate SBE as the primary driver of clinical improvement. Future research must prioritize high-quality, multicenter trials targeting patient-oriented metrics to bridge this translational gap.
    WHAT IS KNOWN: • SBE has been extensively developed in pediatric and neonatal critical care settings; however, its impact on healthcare professional training and on patient outcomes remains less well understood.
    WHAT IS NEW: • There is a scarcity of rigorous Level 4 evidence linking SBE to patient outcomes in pediatric and neonatal critical care. • We provide a methodological roadmap advocating for mixed-methods and multicenter designs to bridge this clinical evidence gap.
    Keywords:  Pediatric Kirkpatrick model; Pediatric intensive care unit; Resuscitation; Simulation
    DOI:  https://doi.org/10.1007/s00431-026-06925-3
  24. Curr Pain Headache Rep. 2026 Apr 27. pii: 57. [Epub ahead of print]30(1):
    Medication Overuse Headache in Children and Adolescents: A Narrative Review.
    Joshua Ransick, Juliana VanderPluym.
      
    Keywords:  Headache disorders; Headache epidemiology; Medication overuse headache; Pediatric headache
    DOI:  https://doi.org/10.1007/s11916-026-01497-1
  25. J Am Acad Orthop Surg. 2026 Apr 24.
    Implementing Evidence-based Opioid Prescribing in Pediatric Orthopaedics.
    Monica Kogan, Kyleen Jan, Amelia Hummel.
      Effective pain management is essential in pediatric orthopaedic procedures to ensure optimal patient outcomes and recovery. Although opioids are an important component of pain control, their misuse remains a notable public health concern. Pediatric patients often encounter opioids for the first time after orthopaedic procedures, underscoring the need for stringent prescribing protocols. The Pediatric Orthopaedic Society of North America guidelines provide a comprehensive framework for tailoring pain management to procedure intensity. Despite their potential, implementation challenges and variability persist. This review examines the Pediatric Orthopaedic Society of North America guidelines, barriers to adoption, and opportunities to optimize postoperative pain management while mitigating risks. Future research and guideline evolution are necessary to uphold patient safety and combat the opioid crisis.
    DOI:  https://doi.org/10.5435/JAAOS-D-25-00176
  26. Trop Doct. 2026 Apr 30. 494755261445181
    Updates in paediatric advanced life support (PALS) 2025: Implications for clinical practice.
    Saroj Kumar Tripathy, Sarthak Das, Ehtesham Ansari.
      The 2025 pediatric advanced life support guidelines, developed by the American Heart Association and the American Academy of Pediatrics, are a resource for healthcare professionals caring for infants and children under 18 years of age in peri-arrest and other emergency care situations. The new guidelines address evolving pediatric cardiac arrest patterns, characterized predominantly by respiratory failure or shock, with persistent disparities in out-of-hospital survival and neurological outcomes. Major revisions include setting a blood pressure target above the 10th centile post-cardiac arrest, administering epinephrine after two attempts of defibrillation in a shockable rhythm, and administering early epinephrine in non-shockable cardiac arrest, as well as preventing hyperthermia. It also emphasizes evidence-based strategies such as early high-quality cardiopulmonary resuscitation (CPR), targeted post-arrest care, continuous electroencephalogram for neurological monitoring, and IV sotalol as an option for refractory supraventricular tachycardia. Long-term survivor support and family presence during resuscitation are integrated as vital aspects of care. While core recommendations-such as CPR technique, ventilation strategies, and shock management-are reaffirmed, the update provides a robust framework for multicentric harmonization. The adoption of these updated protocols in promises enhanced resuscitation outcomes, consistent neurological recovery, and the development of context-specific best practices in pediatric emergency care.
    Keywords:  American Academy of Pediatrics (AAP); American Heart Association (AHA); advanced life support; cardiac arrest; paediatric resuscitation
    DOI:  https://doi.org/10.1177/00494755261445181
  27. Pediatr Ann. 2026 May;55(5): e188-e194
    Evidence-Based Strategies to Promote Diversity and Equity for Medical Education Programs.
    Megan Schmalz, Joyce Tong, Zoe Listernick, Audrea M Burns, Michelle A Lopez, Adam Cohen.
      A growing body of research demonstrates that equity and diversity in pediatric medical education programs are imperative to strengthen the pediatric workforce and improve pediatric health outcomes. Despite this, there is limited actionable guidance for clinicians and educators on methods to mitigate inequities within the recruitment process. This narrative review summarizes evidence-based strategies to reduce disparities in the undergraduate and graduate medical education applicant selection process, including holistic review, data-driven selection, implicit bias training, reduction of structural barriers, and showcasing existing diversity within programs. The review concludes with calls to action for leaders of programs and professional societies to pursue recruitment practices that are fair and evidence-based, as well as to create a more representative workforce. Additionally, recruitment improvements are only part of the puzzle, and programs must ensure an equitable and inclusive learning environment for diverse learners to have the best opportunity for success.
    DOI:  https://doi.org/10.3928/19382359-20260209-05
  28. JAMA Netw Open. 2026 Apr 01. 9(4): e269274
    Epidemiology of Pediatric Transfusion Reactions.
    NHLBI Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P)
       Importance: Pediatric hemovigilance is a nascent field in transfusion medicine. The lack of standardized hemovigilance reporting in the US makes it difficult to determine age-specific transfusion reaction rates and risks.
    Objective: To evaluate the rates and epidemiology of transfusion reactions reported to transfusion services in neonatal and pediatric populations.
    Design, Setting, and Participants: This cohort study analyzed transfusion reactions occurring in children younger than 18 years reported to 8 hospitals' transfusion services during April 1, 2019, through December 31, 2023. Data were evaluated from March 2024 to June 2025 using standardized data collection forms and associated electronic health records.
    Exposure: Patients who received transfused blood products (red blood cells [RBCs], platelets, plasma, or cryoprecipitate) with at least 1 transfusion reaction reported to the transfusion service.
    Main Outcomes and Measures: Reaction rates per 100 000 products transfused were calculated. Pediatric transfusion reactions were characterized in detail, including reported severity and imputability; product type; patient age, sex, race, and ethnicity; and reported symptoms, premedication, and clinical management.
    Results: The sample included 228 886 products transfused to 22 628 patients (median [IQR] age, 4.2 [0.3-12.4] years; 127 903 males [55.9%]). The products were transfused to patients of Asian (18 649 [8.2%]), Black (37 673 [16.5%]), White (93 824 [41.0%]), multiracial (3680 [1.6%]), other (68 857 [30.1%]), or unknown race (6203 [2.7%]) and Hispanic or Latinx (52 398 [22.9%]), non-Hispanic and non-Latinx (144 017 [62.9%]), and unknown ethnicity (32 471 [14.2%]). A total of 1165 imputable transfusion reactions were reported, with an overall reaction rate of 0.52% (95% CI, 0.49%-0.55%). Patients aged 5 to 11 years had the highest reported transfusion reaction rate (891.11 [95% CI, 799.81-989.11] per 100 000 products transfused). Platelet transfusions had the highest transfusion reaction rates (821.75 [95% CI, 754.14-893.80] per 100 000 products transfused), with allergic reactions being most common (506.04 [95% CI 453.30, 563.24] per 100 000 products transfused), whereas RBC transfusions had more reported febrile nonhemolytic transfusion reactions (FNHTRs; 296.20 [267.06, 327.67] per 100 000 products transfused) than other types of reactions. The most common symptoms were urticaria (69.6% [368 of 529 patients]) in allergic reactions, fever (96.5% [559 of 579 patients]) in FNHTRs, and acute respiratory distress (87.5% [21 of 24 patients]) in transfusion-associated circulatory overload (TACO); the most common treatments were antihistamines (80.3% [425 of 529 patients]) for allergic reactions, antipyretics (67.9% [393 of 579 patients]) for FNHTRs, and diuretics (83.3% [20 of 24 patients]) for TACO. Many patients (35.8% [107 of 299]) did not receive premedication after the first reaction in subsequent transfusions, regardless of reaction type. When transfusion reactions recurred, they were often of the same type (77.9% of reactions [120 of 154] after allergic reactions were allergic; 72.1% of reactions [98 of 136] after FNHTRs were FNHTRs).
    Conclusions and Relevance: In this cohort study of pediatric transfusion reactions, reactions appeared to be age dependent, and rates of allergic reactions and FNHTRs were higher than rates from previously published, possibly underreported, predominantly adult data. These findings underscore the importance of pediatric-specific hemovigilance to improve recognition, reporting, and safety monitoring of transfusion reactions.
    DOI:  https://doi.org/10.1001/jamanetworkopen.2026.9274
This page is being maintained by Thomas Krichel. It was last updated on 2026‒05‒04 at 16:05.