bims-cliped Biomed News
on Clinical pediatrics
Issue of 2026–05–24
thirty-two papers selected by
Alyssa M. Portwood, Akron’s Children
  1. Prevention of Drowning: Policy Statement.
  2. Prevention of Drowning: Technical Report.
  3. Achievable Benchmarks of Care in Pediatric Emergency Departments.
  4. Dealing with Death: Health Care Professional Perspectives after Pediatric Patient Death.
  5. Pediatric healthcare worker perspectives on implementation of a secure firearm storage program: a qualitative study.
  6. Reducing Behavioral and Mental Health Emergency Department Visits and Admissions.
  7. Factors Associated With Use of Procedural Sedation in Pediatric Facial Laceration Repair in the Emergency Department: A Retrospective Cross-Sectional Study.
  8. Medical home access in children with asthma: Association with asthma severity and sociodemographic factors.
  9. Pediatric Quality Measures in Hearing Screening and Follow-Up.
  10. Scabies Cases in Children are Still on the Rise After the COVID-19 Pandemic.
  11. Pediatric Quality Measures in Developmental Screening and Follow-Up.
  12. Integrated CPR Coach and Compressor Training Improves CPR Quality in a Pediatric Emergency Department.
  13. Hypothermia and Mortality Among Children in the Emergency Department.
  14. Azithromycin for Preschoolers with Wheezing in the Emergency Department.
  15. Hospital and Emergency Department Pediatric Capability, Patient Characteristics, and Radiology Imaging for Children.
  16. Nonemergency Acute Care Delivered Outside of the Medical Home: Policy Statement.
  17. Temporomandibular disorders in children and adolescents: an underexplored condition in need of developmentally informed diagnostic guidance.
  18. Patterns and Disparities in Caregiver Access to Hospitalized Children's Clinical Notes.
  19. Development of a Keyword-Based Search Strategy to Identify Gender Diverse Youth in Electronic Medical Records.
  20. Contemporary management of pediatric venous thrombosis: how does it differ from adult care?
  21. Breaking the seizure cycle: Belgian expert consensus on the diagnostics and treatment of acute convulsive seizures in children.
  22. Characteristics of children and adolescents with fibromuscular dysplasia: a systematic review and meta-analysis.
  23. Prefabricated Functional Bracing Versus Spica for Pediatric Femur Fractures Reduces Cost.
  24. Challenges encountered by diagnostic radiography students and radiographers in paediatric general radiography: A narrative review.
  25. Assessing Caregivers' Pre-visit Information-Seeking Behaviors for Pediatric Emergency Care: A Pilot Questionnaire Study in a University Hospital.
  26. Quality improvement interventions in surgical oncology: systematic review of international studies.
  27. Gastrostomy plus fundoplication or gastro-jejunal tube or gastrostomy alone for treating or preventing gastro-esophageal reflux in children and adolescents with neurological impairment.
  28. Nursing management of deep vein thrombosis in children: a narrative review of challenges, evidence-based strategies, and systematic pathways.
  29. The environmental impact of diagnostic imaging: opportunities for pediatric radiologists.
  30. Effectiveness and Safety of Contemporary Drug Regimens for Multidrug- and Extensively Drug-resistant Tuberculosis in Children and Adolescents: A Global Systematic Review and Meta-analysis.
  31. Pediatric home-based hospice and palliative care: a scoping review.
  32. Urban-rural differences in healthcare access among children with epilepsy: identifying factors associated with adequate care using the National Survey of Children's health.
  1. Pediatrics. 2026 May 18.
    Prevention of Drowning: Policy Statement.
    Council on Injury, Violence, and Poison Prevention
      Drowning is a leading cause of unintentional injury death in children. Multiple layers of prevention are necessary, because no single method is effective in preventing drowning. This policy statement guides clinicians, families, community partners, injury-prevention professionals, and policy makers regarding evidence-based best practices for reducing pediatric drowning.
    DOI:  https://doi.org/10.1542/peds.2026-077410
  2. Pediatrics. 2026 May 18.
    Prevention of Drowning: Technical Report.
    Council on Injury, Violence, and Poison Prevention
      Drowning is a leading cause of unintentional injury death in children. In 2023, there were 981 US children under age 20 years who died from drowning. There are persisting and widening disparities in pediatric drowning death rates based on race and ethnicity. Multiple layers of prevention are necessary, because no single method is effective in preventing drowning. Proven drowning prevention strategies include 4-sided isolation pool fencing with functioning self-closing and self-latching gates; close, constant, attentive, and competent supervision; swimming competency; life jacket use when boating; and early rescue and resuscitation of persons who drowned. Clinicians have an important role in preventing drowning by providing age- and content-specific anticipatory guidance to their patients and by involving families, community partners, and public health officials when advocating for the implementation of evidence-based drowning countermeasures and culturally-affirming aquatic policies in their community.
    DOI:  https://doi.org/10.1542/peds.2026-077412
  3. JAMA Netw Open. 2026 May 01. 9(5): e2613391
    Achievable Benchmarks of Care in Pediatric Emergency Departments.
    PECARN Registry Study Group
       Importance: Achievable benchmarks of care (ABCs) are a process by which performance is anchored on a select high-achieving group. ABCs can motivate systemic quality improvement toward realistically achievable goals. The establishment of multisite ABCs in pediatric emergency medicine has been limited.
    Objective: To report ABCs for pediatric emergency care management (encounters with asthma, infections, or pain), readiness (vital measurement, timeliness, and throughput), and quality (return visits).
    Design, Setting, and Participants: This cross-sectional study analyzed visits at 12 emergency department (9 pediatric emergency departments [EDs] and 3 affiliate community sites) from January 1, 2017, to December 31, 2024, in the Pediatric Emergency Care Applied Research Network (PECARN) Registry. Data were analyzed from August 2025 to March 2026.
    Main Outcomes and Measures: An ABC was calculated for each performance measure and derived from the 10% of visits attended to by the highest-performing clinicians both within individual sites and in the database overall using the pared mean method. ABCs for each performance measure are described at the network and site level by year and overall.
    Results: A total of 5 302 587 visits (median [IQR] patient age, 5.1 [1.8-11.0] years; 52.6% male patients) were included, of which 4 364 658 were quaternary pediatric ED visits and 937 929 were to affiliate community sites. Quality metrics varied across network sites and settings, with ranges of 56.8% to 99.3% for vital sign documentation, 61.4% to 92.6% for 2-point pain reduction for encounters with long bone fractures, and 93.1% to 99.2% for systemic corticosteroids given for visits with asthma exacerbation. Return visit with admission rate and antibiotic stewardship metrics had minimal variability across sites and care settings. There was significant ABC variability in throughput metrics (time-to-clinician and length of stay) across sites and pediatric ED vs affiliate setting. Overall, throughput metrics worsened over the study period. Performance measures more within clinicians' locus of control (care of encounters with asthma, pain reduction in encounters for long bone fractures) had wider variation between the site's mean performance and ABC, indicating practice variation within the sites.
    Conclusions and Relevance: This cross-sectional study from 12 EDs established ABCs for pediatric care management using electronic health record data. These can be used to compare quality outcomes of pediatric emergency care and provide benchmarking relevant to settings that care for children.
    DOI:  https://doi.org/10.1001/jamanetworkopen.2026.13391
  4. J Palliat Med. 2026 May 23. 10966218261449442
    Dealing with Death: Health Care Professional Perspectives after Pediatric Patient Death.
    Maria Z Huang, Michael Henne, Rene Roth, Ami Doshi.
       BACKGROUND: Many pediatric health care professionals (HCPs) experience patient death and continue to carry out their clinical roles, including caring for the child's family immediately after being impacted by a child's death. Yet, HCPs are often overlooked as those who experience grief and require support in the coping process themselves.
    OBJECTIVES: To identify the variety of ways HCPs cope and the resources they utilize when dealing with a patient death.
    DESIGN: Qualitative study with one-on-one semistructured interviews.
    SETTING/SUBJECTS: HCPs at a U.S. tertiary children's hospital across different professional disciplines (medical decision makers, treatment implementers, and psychosocial support providers), different clinical environments (critical care units, medical units, emergency room, and outpatient), and a range of health care experience (from <1 year to >20 years).
    MEASUREMENTS: Data were analyzed using grounded theory and in an inductive manner. Factors and themes were identified in an iterative process.
    RESULTS: Briefly, 22 HCPs completed an interview. A multitude of factors influence HCPs' experience after pediatric patient death. Three major themes were identified: (1) HCPs rely on their professional community for processing and coping after patient death, (2) HCPs have a deep sense of duty toward each other and toward patients/families, which may drive their desire for knowledge and practice improvement, and (3) HCPs seek to make meaning following patient death.
    CONCLUSIONS: Health care institutions and their leaders have many opportunities to support HCPs after patient death.
    Keywords:  bereavement; end-of-life; health care professionals; patient death
    DOI:  https://doi.org/10.1177/10966218261449442
  5. BMC Pediatr. 2026 May 20.
    Pediatric healthcare worker perspectives on implementation of a secure firearm storage program: a qualitative study.
    Claire R Waller, Mallika Pandey, Jennifer M Boggs, Arne Beck, Ruth P Bedoy, Alison M Buttenheim, Marisa E Elias, Katelin Hoskins, Shari Jager-Hyman, Christina Johnson, Melissa Maye, Bridget McArdle, Celeste Pappas, Dylan S Small, LeeAnn M Quintana, Courtney Benjamin Wolk, Leslie A Wright, Nathaniel J Williams, Brian K Ahmedani, Rinad S Beidas.
       OBJECTIVE: Primary care-based secure firearm storage programs are well-positioned to prevent firearm-related injury, the leading cause of death for young people in the United States. While recommended by the American Academy of Pediatrics and US Surgeon General, these programs have yet to become routine practice. Our cluster randomized hybrid effectiveness-implementation trial studied implementation of a universal evidence-based secure firearm storage program, S.A.F.E. Firearm (Suicide and Accident Prevention through Family Education) across 30 clinics in two large health systems. S.A.F.E. Firearm includes a brief discussion between a clinician and parent on secure firearm storage and an offer of free cable locks at pediatric well-child visits for youth ages 5-17. The ASPIRE trial demonstrated meaningful clinician behavior change, with S.A.F.E. Firearm delivered to 49% of patient families in the clinics that received both trial implementation strategies. The present study qualitatively explores factors broadly influencing the successful implementation of S.A.F.E. Firearm, centering healthcare worker (HCW) perspectives.
    METHODS: Semi-structured qualitative interviews were conducted with leaders, clinic change agents, and clinicians involved in implementation from 2023 to 2024 (N = 38). The interview guide was informed by the original and updated Consolidated Framework for Implementation Research. Interviews were coded and analyzed using an abductive, integrated (i.e., deductive and inductive) approach. Inter-rater reliability (Kappa = 0.87) was strong.
    RESULTS: Interviews elucidated four interconnecting themes. HCWs unanimously expressed pediatric HCWs' responsibility to promote firearm safety (role of pediatrics in firearm safety) across heterogeneous community and healthcare firearm cultures. By preserving families' autonomy and privacy around firearms, S.A.F.E. Firearm's nonjudgemental and universal approach promoted program acceptability and delivery. Consequently, HCWs' understanding versus confusion around this universal, privacy-focused harm reduction approach was foundational to implementation.
    CONCLUSION: Health systems can harness HCWs' shared commitment to firearm safety by deploying brief programs that preserve recipient autonomy and privacy. To scale these evidence-based approaches, we recommend offering clear, simple trainings and collaboratively adapting programs to meet the needs of HCWs and recipients.
    TRIAL REGISTRATION: Registry https://clinicaltrials.gov/study/NCT04844021, TRN NCT04844021, first registered on April 14, 2021.
    Keywords:  Firearms; Implementation science; Injury prevention; Pediatric primary care; Suicide prevention; Well-child care
    DOI:  https://doi.org/10.1186/s12887-026-06985-2
  6. Pediatrics. 2026 May 19. pii: e2024069267. [Epub ahead of print]
    Reducing Behavioral and Mental Health Emergency Department Visits and Admissions.
    Alex C Nyquist, Melissa Young, Andrew F Beck, La Donna Morales, Jessica A Kahn, Emmanuel Chandler.
       BACKGROUND AND OBJECTIVES: Pediatric emergency department (ED) visits and admissions for behavioral and mental health (BMH) concerns are rising nationally. Such encounters can be traumatic, with adverse clinical and financial consequences for patients and their families. We aimed to reduce excess ED visits and hospital admissions for patients at an urban primary care clinic exclusively serving adolescents. Specifically, we sought to decrease the BMH ED visit rate from 7.9 to 6.0 per 1000 patients per month and the BMH admission rate from 4.5 to 3.0 per 1000 per month.
    METHODS: We pursued this quality improvement (QI) initiative between 2019 and 2025. The population included patients aged 12 to 19 years within our Teen Health Center's clinical registry. Interventions addressing 7 key drivers (appropriate staff and space, knowledge and awareness of BMH resources, effective patient triage, reliable and standardized screening and assessment, optimal care coordination, optimal follow-up, and community outreach) were designed, tested, and implemented. The BMH ED visit and BMH admission rates (per 1000 patients per month) among the primary care population were tracked via statistical process control charts.
    RESULTS: Over the improvement period, BMH ED visits decreased from 7.9 per 1000 per month to 5.9 (25% reduction). Admissions decreased from 4.5 per 1000 per month to 1.9 (58% reduction). This equates to around 10 fewer ED visits and around 11 fewer admissions per month for BMH concerns for patients in our primary care practice.
    CONCLUSIONS: Implementing collaborative primary care with QI may improve BMH care for adolescents by reducing ED visits and admissions.
    DOI:  https://doi.org/10.1542/peds.2024-069267
  7. Pediatr Emerg Care. 2026 May 18.
    Factors Associated With Use of Procedural Sedation in Pediatric Facial Laceration Repair in the Emergency Department: A Retrospective Cross-Sectional Study.
    Isabella G Steidley, David Mills, Elizabeth Waltman, Michael C Monuteaux, Todd Lyons, Andrew Miller, Chris A Rees, Assaf Landschaft, Amanda Stewart, Eric W Fleegler, Amir Kimia.
       OBJECTIVE: To identify factors associated with the utilization of procedural sedation during pediatric facial laceration repair.
    METHODS: We performed a retrospective cross-sectional study at a tertiary care pediatric ED from 2016 to 2020 of patients aged 0 to 18 with facial lacerations repaired with sutures. Our primary outcome was utilization of procedural sedation (ketamine, propofol alone or plus fentanyl or ketamine, midazolam plus fentanyl), with a secondary outcome of utilization of anxiolysis (intranasal midazolam). We measured the association of covariates, including provider subspecialty and patient age, sex, race and ethnicity, insurance status, time and day, laceration characteristics, mechanism, and layers of repair in a multivariate analysis and multinomial logistic regression.
    RESULTS: We identified 4943 patient visits, with 3859 (78.8%) laceration repairs performed by emergency medicine providers and 1084 (21.9%) performed by plastic surgery. Procedural sedation was used in 373 (7.6%) visits. Lacerations repaired by plastic surgery were 25 times more likely to involve procedural sedation compared with those repaired by emergency medicine providers [adjusted odds ratio (aOR): 25.0, 95% CI: 17.1-36.5]. Additional factors included: laceration length (≥5 vs. <2.5 cm, aOR: 3.87, 95% CI: 1.88, 7.94), laceration complexity (complex vs. simple aOR: 2.50, 95% CI: 1.75, 3.57), and time of presentation (overnight vs. day, aOR: 2.58, 95% CI: 1.36, 4.91).
    CONCLUSION: Provider specialty was the strongest independent predictor of procedural sedation use, even after adjustment for wound characteristics. These findings highlight substantial practice variation and suggest an opportunity to develop standardized, clinically driven approaches to sedation decision-making for pediatric facial lacerations.
    Keywords:  clinical practice variation; facial laceration; procedural sedation; sedation utilization
    DOI:  https://doi.org/10.1097/PEC.0000000000003628
  8. Pediatr Allergy Immunol. 2026 May;37(5): e70350
    Medical home access in children with asthma: Association with asthma severity and sociodemographic factors.
    Alexandria Murry Newton, Kylie Handa, Molly Bloom, Amy Hendrix-Dicken, Susan Studebaker, Micah Hartwell.
       BACKGROUND: Access to patient-centered medical homes (PCMH)-defined as having a primary care provider who provides comprehensive, family-centered care-is critical for children with asthma, which affects nearly 5 million children in the US. Management can be complex, and uncontrolled disease increases morbidity among children. Therefore, we examined rates and associations of PCMH status, asthma severity, and sociodemographic factors.
    METHODS: This cross-sectional study used the 2022 National Survey of Children's Health, a nationally representative dataset, to assess PCMH status among children with asthma and conducted design-based X2 tests to measure differences between groups based on asthma severity, parental factors, and other social determinants of health.
    RESULTS: Among a sample of 3636 children with asthma, 41.5% met criteria for a PCMH. Significant associations were observed between PCMH access, asthma severity, and several sociodemographic variables (p < .001), except the child's age. Only 19.0% of children with severe asthma ratings met PCMH criteria. In contrast, 45.1% of children with mild asthma met PCMH criteria. Parental education and PCMH access were positively correlated, and the highest rates of PCMH access were among children with two biological parents.
    CONCLUSION: Our results showed that having access to a PCMH was associated with a decreased likelihood of severe asthma symptoms. Additionally, there are sociodemographic factors that significantly impact the likelihood of children with asthma meeting criteria for a PCMH. Given the scale of children with asthma not having comprehensive medical care, national and state policies are needed to enhance access to services.
    Keywords:  asthma; healthcare disparities; medical home; patient‐centered medical home; pediatrics; social determinants of health; sociodemographic factors
    DOI:  https://doi.org/10.1111/pai.70350
  9. Pediatrics. 2026 May 21. pii: e2025075232. [Epub ahead of print]
    Pediatric Quality Measures in Hearing Screening and Follow-Up.
    Renée F Wilson, Genie Han, Jennifer O Lambert, Erica M S Sibinga, Katherine A Connor, Alaa A Ahmed, Troy Gharibani, Eric B Bass, Julia M Kim.
       CONTEXT: Quality measures are needed to ensure that children receive timely screening and follow-up for hearing problems.
    OBJECTIVE: To summarize pediatric quality measures for hearing screening and follow-up.
    DATA SOURCES: We searched PubMed, Embase, CINAHL, Cochrane Library, and PsycINFO from 2009 to December 7, 2024, including gray literature from governmental and nongovernmental entities.
    STUDY SELECTION: Systematic reviews, original articles.
    DATA EXTRACTION: Measure definitions, study characteristics, barriers, and research gaps.
    RESULTS: We identified 27 hearing screening and 97 follow-up measures, mostly applied to newborns. In total, 9 systematic reviews identified 5 screening and 10 follow-up measures, 13 studies identified 13 screening and 47 follow-up measures, and 12 gray literature sources identified 11 screening and 42 follow-up measures. We found evidence for reliability, validity, usability, and feasibility in 8, 11, 3, and 4 screening measures, respectively, and for 22, 44, 17, and 13 follow-up measures, respectively. Of the follow-up measures, 14 had evidence against feasibility. Additionally, 8 screening and 8 follow-up measures demonstrated improvement in quality-of-care outcomes. Use of measures differed by state, targeted population, and clinician type. Barriers to measure implementation were related to data infrastructure, integration, collection, reporting, and lack of standardization.
    LIMITATIONS: Searches focused on identifying measures used in the United States. Studies were not designed to assess measure characteristics.
    CONCLUSIONS: Many pediatric hearing screening and follow-up measures have evidence of reliability, validity, and usability, although feasibility of follow-up measures is a concern. Future research should evaluate data infrastructure and systems for implementing follow-up and standardizing and stratifying screening and follow-up measures.
    DOI:  https://doi.org/10.1542/peds.2025-075232
  10. Actas Dermosifiliogr. 2026 May 19. pii: S0001-7310(26)00092-X. [Epub ahead of print] 104682
    Scabies Cases in Children are Still on the Rise After the COVID-19 Pandemic.
    D Andina-Martínez, C J García-García, E Fernández-Mozo, R Trincado-Lamuño, S Clavero-Sánchez, L Morera Noguel.
      As a significant increase in the incidence of scabies in adults has been described since 2020, a cross-sectional, single-center, retrospective study was conducted in patients younger than 18 years presenting to the Pediatric Emergency Department (PED) of a tertiary referral center during a 6-year period (from January 1st, 2018 through December 31st, 2023) with a diagnosis of scabies. Results showed that incidence followed a similar trend in the pediatric population, with 5 times more episodes attended during 2022-2023 compared with the prepandemic period. Incorrect prescriptions of scabicidal drugs were frequent, as was inadequate management of cohabitants and fomites, especially in facilities other than the PED. In conclusion, the increase in pediatric cases of scabies, possibly exacerbated by the COVID-19 pandemic, requires clinicians to remain alert to this condition, and combined efforts by dermatologists, primary care physicians, and pediatricians are needed for early recognition and appropriate management of scabies.
    Keywords:  COVID-19; exanthem; parasitic diseases; scabies; skin
    DOI:  https://doi.org/10.1016/j.ad.2026.104682
  11. Pediatrics. 2026 May 21. pii: e2025075334. [Epub ahead of print]
    Pediatric Quality Measures in Developmental Screening and Follow-Up.
    Genie Han, Jennifer O Lambert, Christina D Bethell, Mary L Leppert, Renée F Wilson, Erica M S Sibinga, Katherine A Connor, Alaa Ahmed, Troy Gharibani, Eric B Bass, Julia M Kim.
       CONTEXT: Timely identification and management of developmental problems are essential for children.
    OBJECTIVE: To summarize quality measures for developmental screening and follow-up among children in the United States.
    DATA SOURCES: PubMed, Embase, CINAHL, Cochrane Library, and PsychINFO from 2009 to December 7, 2024. Gray literature sources recommended by experts.
    STUDY SELECTION: Systematic reviews, primary studies, and gray literature sources.
    DATA EXTRACTION: Two reviewers extracted information on measure definitions, study characteristics, barriers, and research gaps.
    RESULTS: We included 11 systematic reviews, 36 studies, and 11 gray literature sources and identified 67 developmental screening measures and 61 follow-up measures. Measures focused on early childhood in clinic settings. We found evidence for reliability, validity, and usability in 29, 25, and 30 screening measures, respectively, and 34, 39, and 36 follow-up measures, respectively, with evidence both for and against feasibility of measures. Eighteen studies showed improvement in measures with use of specific tools or implementation practices for developmental screening and follow-up. Differences in use of measures by state, population, institution, or clinician type were infrequently described. Barriers to measure implementation related to electronic health record data extraction, resource limitations, and burden of data collection and reporting. We found little evidence on reduced disparities associated with measure implementation.
    LIMITATIONS: We excluded information from other countries, from before 2009, or about measures for behavioral, social, or emotional screening.
    CONCLUSION: Many pediatric developmental screening and follow-up measures have evidence of reliability, validity, and usability, but feasibility is a concern. Future research should focus on feasibility, standardization, and stratification.
    DOI:  https://doi.org/10.1542/peds.2025-075334
  12. Resuscitation. 2026 May 20. pii: S0300-9572(26)00188-7. [Epub ahead of print] 111141
    Integrated CPR Coach and Compressor Training Improves CPR Quality in a Pediatric Emergency Department.
    Archit Sahai, Kelsey Feldmann, Gina Klein, Amanda Fronk, Alexandra Nicholson, Mary Frey, Adam A Vukovic, Benjamin Kerrey, James Gray.
       OBJECTIVE: Care teams frequently struggle to meet CPR quality metrics during pediatric cardiac arrest. In a pediatric emergency department (PED), we aimed to increase our chest compression compliance with American Heart Association's (AHA) recommendations for depth (baseline 14%) and rate (baseline 69%) to >80% and to maintain chest compression fraction (CCF) at 89%.
    METHODS: We completed a quality improvement study, leveraging an existing CPR quality assurance program. Our primary intervention was designing a simulation-based CPR coach curriculum for existing coaches supplemented with compressor training and metronome guided feedback. We collected data from video review and an accelerometer equipped defibrillator. Run charts at the patient level assessed chest compression compliance for depth, rate, and CCF. Statistical control charts evaluated mean depth and mean rate compliance.
    RESULTS: Between October 2022 and December 2025, 140 total patients presented in cardiac arrest. One hundred and six patients, consisting of 54 infants, 24 children, and 28 adolescents, were included. Median percent depth compliance for all ages increased from 14% to 61%. For infants, mean depth increased from 3.1 to 4.4 cm. Mean depth did not increase for children and adolescents, though special cause variation was observed in children. Median percent rate compliance increased from 69% to 80%. Consecutive encounters meeting AHA mean rate target increased. CCF remained at 89%.
    CONCLUSIONS: In a PED, a multimodal intervention incorporating CPR coach training, compressor training, and metronome guided feedback improved chest compression depth and rate compliance while maintaining CCF. Improvement was enhanced by an existing quality assurance program and required supplementary education and resources.
    Keywords:  CPR Coach; CPR quality; Pediatric cardiac arrest; cardiac arrest
    DOI:  https://doi.org/10.1016/j.resuscitation.2026.111141
  13. Pediatrics. 2026 May 20. pii: e2025075725. [Epub ahead of print]
    Hypothermia and Mortality Among Children in the Emergency Department.
    Lucy Campbell, Aarthi Kottapalli, Leslie Hueschen, Jonathan R Higgins, Erin J Meyer, Laura F Sartori, Paria M Wilson, Naghma S Khan, Alexander Rogers, Sriram Ramgopal.
       OBJECTIVES: Hypothermia is a risk factor for poor outcomes in infants and children with sepsis or trauma, but its overall association with mortality among all children in the emergency department (ED) is unknown. We investigated the association between hypothermia and in-hospital mortality among children presenting to the ED.
    METHODS: We performed a retrospective multicenter cohort study of pediatric (<18 years) ED encounters using the 2012-2021 Pediatric Emergency Care Applied Research Network registry. We evaluated the association between first-recorded temperature (as hypothermia [≤36 °C], euthermia, or fever [≥38 °C]) and in-hospital mortality in multivariable logistic regression models adjusted for demographics, vital signs, trauma, and medical complexity.
    RESULTS: Among 5 308 892 encounters (median age 4.92 years, IQR 1.68-10.7; 52.5% male), hypothermia and fever were present in 161 111 (3.0%) and 715 366 (13.5%), respectively. In-hospital mortality occurred in 1918 (0.04%) encounters (39.2% hypothermic, 13.3% febrile). Hypothermia at presentation was associated with in-hospital mortality overall (odds ratio [OR] 20.15, 95% CI 18.00-22.55). This association was present in all subgroup analyses, with greater effects in patients without medical complexity (OR 104.40, 95% CI 84.40-129.14) compared with those with medical complexity (OR 8.81, 95% CI 7.68-10.11), and similar effects among patients with trauma (OR 25.33, 95% CI 15.82-40.53) and without trauma (OR 19.53, 95% CI 17.36-21.98).
    CONCLUSION: Hypothermia is an independent risk factor for mortality among children presenting to the ED, overall and within subgroups. Hypothermia may be an important measure to identify children at highest risk of poor outcomes.
    DOI:  https://doi.org/10.1542/peds.2025-075725
  14. N Engl J Med. 2026 May 18.
    Azithromycin for Preschoolers with Wheezing in the Emergency Department.
    PECARN AZ-SWED Trial Study Group
       BACKGROUND: Wheezing illnesses are a leading cause of hospitalization for preschool-age children and are frequently treated with antibiotics. Observational studies have shown more frequent isolation of three pathogenic bacteria (Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae) from nasopharyngeal samples from children with recurrent episodes of wheezing than from those without such illnesses.
    METHODS: In this multicenter trial, we randomly assigned patients 18 to 59 months of age who presented to an emergency department with a moderate-to-severe episode of wheezing to receive azithromycin once daily at a dose of 12 mg per kilogram of body weight or matching placebo for 5 days. The primary outcome was the sum of scores on the Asthma Flare-up Diary for Young Children (ADYC) over 5 days. Primary-outcome scores could range from 5 to 35, with higher scores indicating more severe wheezing-related symptoms. Efficacy was assessed separately in patients who tested positive for pathogenic bacteria (the positive cohort) and in those who tested negative (the negative cohort). Secondary outcomes were length of stay in the emergency department, length of hospital stay, and return emergency department visits or hospitalizations within 72 hours. Bacterial clearance and antimicrobial resistance were measured at follow-up visits 1 to 3 weeks after randomization.
    RESULTS: Among 840 patients who underwent randomization, 521 tested positive for pathogenic bacteria. The trial was stopped for futility by the data and safety monitoring board after a planned interim analysis. ADYC scores did not differ significantly between the azithromycin and placebo groups in either the positive cohort (median, 9.59 [interquartile range, 7.29 to 12.60] vs. 9.72 [interquartile range, 7.66 to 12.17]; P = 0.70) or the negative cohort (median, 9.30 [interquartile range, 6.97 to 11.62] vs. 9.10 [interquartile range, 7.19 to 11.45]; P = 0.69). In the positive cohort, bacterial clearance was 58.7% in the azithromycin group and 11.4% in the placebo group. Secondary outcomes appeared to be similar in the two groups for both cohorts, as did the development of bacterial resistance and the incidence of adverse events.
    CONCLUSIONS: Azithromycin did not lead to a greater reduction in the severity of wheezing-related symptoms than placebo in preschool-age children who presented to the emergency department with moderate-to-severe acute wheezing. (Funded by the National Heart, Lung, and Blood Institute and others; AZ-SWED ClinicalTrials.gov number, NCT04669288.).
    DOI:  https://doi.org/10.1056/NEJMoa2516505
  15. JAMA Netw Open. 2026 May 01. 9(5): e2613689
    Hospital and Emergency Department Pediatric Capability, Patient Characteristics, and Radiology Imaging for Children.
    Margaret E Samuels-Kalow, Rebecca E Cash, Kenneth A Michelson, Courtney B Wolk, Maeve F Swanton, Krislyn M Boggs, Carlos A Camargo, Elizabeth R Alpern.
       Importance: Judicious use of radiology imaging is an important quality measure in emergency care for children. Prior studies have shown differences in imaging utilization by insurance status and race and ethnicity.
    Objective: To examine if measures of hospital and emergency department (ED) pediatric capabilities modify the association between insurance, race and ethnicity, and imaging utilization.
    Design, Setting, and Participants: This retrospective cohort study combined data from the 2019 State Emergency Department and State Inpatient Databases of 8 states with the 2019 National Emergency Department Inventory-USA and the 2021 National Pediatric Readiness Project (NPRP) Survey on patients 18 years of age or younger. There were 857 034 total ED visits across 3 cohorts, encompassing patients with asthma, head trauma, or abdominal trauma. Statistical analysis was performed from May 2024 to January 2026.
    Exposure: Pediatric capability, as measured by presence of a pediatric emergency care coordinator, readiness according to NPRP data, and hospital functional capability (inpatient and intensive care unit bed status).
    Main Outcomes and Measures: The association of insurance and race and ethnicity (separate models) with imaging utilization was examined across the 3 cohorts. Chest radiography was evaluated for patients with asthma, head computed tomography (CT) was evaluated for patients with head trauma, and abdominal CT was evaluated for patients with abdominal trauma. Separate mixed-effects logistic regression models were constructed, adjusting for age, sex, presence of a complex chronic condition, diagnostic grouping system severity score, hospital pediatric ED visit volume, and complexity of the hospital patient mix (percentage of patients with complex chronic conditions and mean severity clinical score) with random intercept for hospital. As a sensitivity analysis, these associations were examined separately for discharged patients.
    Results: There were 857 034 total ED visits in the 3 cohorts, encompassing patients with asthma (380 719 ED visits; mean [SD] age, 9.6 [5.0] years; 210 598 male [55%]), head trauma (435 644 ED visits; mean [SD] age, 7.2 [5.7] years; 264 004 male [61%]), and abdominal trauma (40 671 ED visits; mean [SD] age, 11.0 [5.4] years; 21 632 male [53%]). Children with public insurance were less likely to have undergone imaging across all measures compared with those with private insurance (asthma: adjusted odds ratio [AOR], 0.85 [95% CI, 0.83-0.86]; head trauma: AOR, 0.77 [95% CI, 0.75-0.78]; abdominal trauma: AOR, 0.59 [95% CI, 0.55-0.63]). In the adjusted model, compared with non-Hispanic White patients, non-Hispanic Black and Hispanic patients were less likely to have undergone imaging across all measures (non-Hispanic Black, asthma: AOR, 0.83 [95% CI, 0.81-0.85]; non-Hispanic Black, head trauma: AOR, 0.77 [95% CI, 0.74-0.79]; non-Hispanic Black, abdominal trauma: AOR, 0.60 [95% CI, 0.55-0.65]; Hispanic, asthma: AOR, 0.91 [95% CI, 0.89-0.93]; Hispanic, head trauma: AOR, 0.85 [95% CI, 0.82-0.87]; Hispanic, abdominal trauma: AOR, 0.72 [95% CI, 0.66-0.80]). The presence of pediatric capability was associated with differences in imaging utilization, but not with changes in the pattern of association between either insurance or race and ethnicity and imaging utilization. Similar results were observed among those who were discharged.
    Conclusions and Relevance: In this cohort study of pediatric ED visits, increased pediatric capability was not associated with differences in the patterns of imaging utilization by insurance status or race and ethnicity. Additional efforts are needed to ensure that pediatric capability improves quality and equity of care.
    DOI:  https://doi.org/10.1001/jamanetworkopen.2026.13689
  16. Pediatrics. 2026 May 18. pii: e2026077003. [Epub ahead of print]
    Nonemergency Acute Care Delivered Outside of the Medical Home: Policy Statement.
    Committee on Practice and Ambulatory Medicine
      The American Academy of Pediatrics (AAP) affirms the medical home is the preferred location for children and adolescents to receive care for acute, nonemergency health concerns. However, some children and families use acute care services outside the medical home because of real or perceived benefits such as accessibility, convenience, additional services offered, or cost of care. Examples of acute care entities include urgent care centers, retail-based clinics, direct-to-consumer telemedicine platforms, mental health crisis services, school-based health centers, hospital care, and emergency medical services (EMS). To maintain safe, high-quality, coordinated care, pediatricians and other pediatric clinicians should understand the services available, as well as the potential benefits and limitations of different services offered in the local medical neighborhood. To align with these principles, acute care entities should adhere to core standards of continuity of care and best practices in pediatric-specific diagnosis and treatment.
    DOI:  https://doi.org/10.1542/peds.2026-077003
  17. Pain Manag. 2026 May 22. 1-18
    Temporomandibular disorders in children and adolescents: an underexplored condition in need of developmentally informed diagnostic guidance.
    Caroline M Sawicki, Linda Sangalli.
       INTRODUCTION: Temporomandibular disorders (TMD) are increasingly recognized in children and adolescents, yet their diagnosis and clinical management remain less clearly defined than in adult populations. Despite evidence that TMD symptoms often emerge during critical periods of craniofacial growth and that TMD-related pain in adolescence substantially increases the risk of persistence into adulthood, pediatric TMD remains underrepresented in research, clinical guidelines, and professional education.
    AREAS COVERED: The review synthesizes emerging consensus on age-appropriate screening tools and diagnostic frameworks based on adaptations of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for children and adolescents; highlights the importance of interdisciplinary, biopsychosocial approaches for early identification, prognosis, and management of pediatric TMD; and identifies key gaps in epidemiology, diagnostic validation, and longitudinal outcomes. When pediatric-specific evidence is available, this review summarizes practical approaches to screening, clinical examination, and psychosocial assessment that are feasible in primary care and pediatric dental settings. Gaps in the validation of diagnostic tools and thresholds across developmental stages are identified as pressing research priorities, as they directly influence epidemiological estimates, clinical decision-making, and care pathways.
    Keywords:  DC/TMD; Temporomandibular disorders; adolescents; children; screening
    DOI:  https://doi.org/10.1080/17581869.2026.2676726
  18. Hosp Pediatr. 2026 May 18. pii: e2025008651. [Epub ahead of print]
    Patterns and Disparities in Caregiver Access to Hospitalized Children's Clinical Notes.
    Amanda Walker, Sahar Barfchin, Gift Kopsombut, David W West, Sara Slovin, Jobayer Hossain, Zhaoying Lu, David I Rappaport.
       OBJECTIVE: Despite evidence that parental access to pediatric hospitalization notes improves communication and parental understanding, no studies, to our knowledge, have examined which caregivers access hospitalization notes. We aim to identify demographic and clinical factors associated with caregivers viewing notes and describe notes that are most likely to be viewed to promote equitable caregiver engagement and understanding during hospitalizations.
    METHODS: We retrospectively analyzed data from all hospitalized children at 2 academic children's hospitals from April 2021 to April 2022 following implementation of immediate note availability. We analyzed demographic and clinical data of patients whose caregivers activated the patient portal and viewed clinical notes.
    RESULTS: We included 767 642 notes from 22 580 hospitalizations for 17 148 unique patients. Overall, 34 186 notes (4.5%) were viewed. Most (60%) patients had their portal activated, but only 15% of those had 1 or more notes read. Decreased odds of viewing notes occurred for Black patients (odds ratio [OR] 0.48, 95% CI: 0.42-0.54), Hispanic/Latino patients (OR 0.67, 95% CI: 0.61-0.74), Spanish-speaking patients (OR 0.50, 95% CI 0.42-0.60), patients with a primary language other than English or Spanish (OR 0.35, 95% CI: 0.21-0.54), and patients with Medicaid compared with private insurance (OR 0.60, 95% CI: 0.55-0.65). Emergency department notes, History and Physical notes, and discharge summaries were most-frequently viewed. Most (67%) notes were viewed after discharge.
    CONCLUSIONS: Despite high portal activation rates, few hospitalization notes were viewed. Significant disparities exist in portal access and viewing notes. Further work is needed to overcome barriers to accessing pediatric medical information.
    DOI:  https://doi.org/10.1542/hpeds.2025-008651
  19. Transgend Health. 2026 Jun;11(3): 220-223
    Development of a Keyword-Based Search Strategy to Identify Gender Diverse Youth in Electronic Medical Records.
    Amanda N Burnside, Jennifer A Hoffmann, Douglas Lorenz, Jessica Walter, Johnny Berona, Aron Janssen.
      A retrospective cross-sectional study of nearly 3 years of emergency department (ED) encounters was performed with the goal of developing an electronic medical record (EMR) search strategy to identify transgender and gender diverse (TGD) youth. A search of nine keywords to identify TGD youth was conducted in the EMR, and text from clinician notes was extracted and reviewed. Among 15,413 ED encounters, 1126 keywords were identified, and 91.2% were classified as TGD. The final dataset classified 605 ED encounters (428 unique youth) as TGD. The study offers a feasible technique to identify and prioritize TGD youth in health research using EMR data.
    Keywords:  electronic medical record; gender diverse; health care; keyword search; transgender
    DOI:  https://doi.org/10.1089/trgh.2023.0182
  20. J Thromb Haemost. 2026 May 19. pii: S1538-7836(26)00331-4. [Epub ahead of print]
    Contemporary management of pediatric venous thrombosis: how does it differ from adult care?
    Alexandra Zabeida, Hui Yin Lim, Amy L Kiskaddon, Hollie Gilmore, Paul Monagle, Marie-Claude Pelland-Marcotte.
      Pediatric venous thromboembolism (VTE) is increasingly recognized in clinical practice, yet its management differs substantially from adult care due to age-specific risk factors, developmental hemostasis, and distinct clinical contexts. Although pediatric treatment strategies were long extrapolated from adult data, the updated American Society of Hematology and International Society on Thrombosis and Haemostasis pediatric VTE guidelines now provide more tailored, evidence-based recommendations. In children, VTE is most often provoked-typically by central venous catheters or postoperative states-whereas adults more commonly present with unprovoked or cancer-associated thrombosis. While the use of direct oral anticoagulants is expanding in pediatrics with increasing safety and efficacy data, parenteral anticoagulation with low-molecular-weight heparin and unfractionated heparin remains widely used, particularly in certain clinical situations. Treatment duration also differs: pediatric guidelines support shorter courses for provoked events and emphasize imaging-guided reassessment. This JTH in Clinic article reviews contemporary pediatric VTE management and highlights key differences from adult practice. The article also emphasizes the importance of dedicated pediatric anticoagulation stewardship programs to improve safety, ensure optimal dosing, support transitions to oral agents, and guide treatment duration. Across all age groups, shared decision-making remains essential to delivering high-quality thrombosis care.
    Keywords:  Anticoagulation; Children; Thrombosis
    DOI:  https://doi.org/10.1016/j.jtha.2026.04.039
  21. Acta Neurol Belg. 2026 May 22.
    Breaking the seizure cycle: Belgian expert consensus on the diagnostics and treatment of acute convulsive seizures in children.
    A Aeby, B Ceulemans, K Jansen, A Jansen, L Lagae, P Leroy, A-S Schoonjans, H Verhelst, M R Cilio.
       INTRODUCTION: Seizures are the most common neurological emergency in children. Heterogeneous causes, subtypes, and varying treatment responses make seizures a complex and often unpredictable challenge for clinicians. The management of acute seizures in children, particularly in the outpatient setting, received relatively limited attention in international treatment guidelines. Prompt and proper management in the acute setting, may prevent hospitalization as well as long-term neurological and developmental consequences.
    METHODS: An expert consensus panel was convened to develop comprehensive and practical guidance for the early recognition, diagnostic evaluation, and management of acute convulsive seizures in children and adolescents. Recommendations were formulated through a structured review of the most recent scientific literature, current clinical guidelines, and expert opinion. Emphasis was placed on generating clear, actionable recommendations to support healthcare professionals in the rapid identification and effective treatment of acute convulsive seizures in pediatric populations.
    RESULTS: This report specifically focuses on the first 5-10 min from seizure onset, which usually corresponds to the outpatient setting, including the initial steps of the inpatient treatment pathway for acute convulsive seizures in children and adolescents.
    CONCLUSIONS: This expert review provides actionable insights for healthcare professionals managing pediatric seizures, emphasizing the importance of a rapid and effective treatment for acute convulsive seizures.
    Keywords:  Benzodiazepine; Febrile seizure; Levetiracetam; Outpatient; Recommendations
    DOI:  https://doi.org/10.1007/s13760-026-03045-5
  22. J Hypertens. 2026 Apr 15.
    Characteristics of children and adolescents with fibromuscular dysplasia: a systematic review and meta-analysis.
    Weiwei Wang, Małgorzata Podymniak-Grzeszykowska, Tom Robberechts, Nadejda Ranguelov, Sophie Pierard, Mieczysław Litwin, Maria Simona Stoenoiu, Alexandre Persu.
      Based on data from large international registries, the clinical presentation of fibromuscular dysplasia (FMD) in adult patients is now well established. By contrast, characteristics of FMD in children and adolescents remain poorly described. We present the first systematic review and meta-analysis focused on pediatric FMD. Seven databases were searched for studies published since 2000. Data were pooled using random-effects models. Subsequently, the characteristics of pediatric FMD patients were compared with those of adult patients included in the US and FEIRI registries. Nine retrospective studies totalizing 218 children/adolescents with FMD were identified. All had renal FMD and 93.7% were revascularized. The mean age at diagnosis was 11.7 years. Fifty-two % were females (U.S. Registry 94.7%; FEIRI 81.5%). Most patients (66.6%) had focal FMD (U.S. Registry 24.0%; FEIRI 28%). Despite incomplete screening, multivessel FMD was identified in 19.1% (U.S. Registry 55.1%; FEIRI 57.4%), and aneurysms and dissections in 15.3% and 1.7%, respectively (U.S. Registry 22.7%, 28.1%; FEIRI 21.6%, 5.6%). The proportion of mid-aortic syndrome (MAS) was 6.3%. In ethnicity-stratified analyses, the female proportion was 43.5% in Asian vs. 58.2% in Caucasian children, and the prevalence of multifocal FMD was 21.8% vs. 37.9%. In conclusion, compared with adult patients, children/adolescents with FMD are characterized by a lower proportion of females and a higher proportion of focal FMD, both in Asians and Caucasians. While associated MAS appears less frequent than previously thought, multivessel involvement and aneurysms were frequently reported, suggesting the interest of a systematic arterial exploration in children with FMD, as recommended in adults.
    Keywords:  CIconfidence interval; FEIRIthe European/International Fibromuscular Dysplasia Registry and Initiative; FMDfibromuscular dysplasia; MASmid-aortic syndrome; MOOSEmeta-analysis of observational studies in epidemiology; PRISMAPreferred Reporting Items for Systematic Reviews and Meta-analyses; aneurysm; children and adolescents; dissection; fibromuscular dysplasia; meta-analysis; mid-aortic syndrome; secondary hypertension; systematic review
    DOI:  https://doi.org/10.1097/HJH.0000000000004318
  23. J Pediatr Orthop. 2026 May 18.
    Prefabricated Functional Bracing Versus Spica for Pediatric Femur Fractures Reduces Cost.
    Nicholas J Stamatos, Matthew Frederickson, Patrick M Wise, Megan R Terle, Brian Haus, Holly B Leshikar, Amanda T Whitaker.
       BACKGROUND: Hip spica casting under general anesthesia is standard treatment for femoral shaft fractures in children aged 6 months to 5 years. Prefabricated functional braces (PFBs) can be applied in the emergency department without general anesthesia. We compared hospital utilization, charges, reimbursement, and short-term outcomes between treatments.
    METHODS: We reviewed children aged 6 months to 5 years with isolated unilateral femoral shaft fractures treated at a single level I trauma center. Spica patients were identified retrospectively (2021 to 2024; n=38), and PFB patients were identified (2024 to 2025; n=22). We compared length of stay (LOS), hospital-based (HB) and professional-based (PB) charges, reimbursement proportion, sedation requirements, and complications. Insurance was categorized as public versus private, and reimbursement was analyzed overall and within insurance strata.
    RESULTS: PFB treatment reduced LOS (16.4±8.2 vs. 26.2±15.9 h, P=0.003) and total charges ($56,372±$15,212 vs. $78,892±$14,780, P<0.001), a mean reduction of $22,520 per patient (~$20,000 net after device cost). Public insurance was more common in the spica group (71% vs. 41%, P=0.030). Overall reimbursement proportion was higher for PFB (47.8%±37.4% vs. 26.2%±30.2%, P=0.027); however, within insurance strata, reimbursement did not differ significantly by treatment, suggesting the unadjusted difference was attributable to payer mix. No brace patient required general anesthesia; 77% required no sedation. Total charges did not differ by sedation status within the brace group ($55,594 vs. $55,640). Complication rates were similar (27% vs. 37%, P=0.57).
    CONCLUSIONS: In appropriately selected young children with femoral shaft fractures, PFB management avoids general anesthesia, shortens LOS, and substantially reduces charges while maintaining comparable short-term clinical outcomes.
    LEVELS OF EVIDENCE: Level III-therapeutic.
    Keywords:  cost; functional brace; hospital charges; length of stay; pediatric femur fracture; spica cast
    DOI:  https://doi.org/10.1097/BPO.0000000000003328
  24. J Med Imaging Radiat Sci. 2026 May 16. pii: S1939-8654(26)00253-5. [Epub ahead of print]57(4): 102439
    Challenges encountered by diagnostic radiography students and radiographers in paediatric general radiography: A narrative review.
    Osward Bwanga, Bornface Chinene, Chikumbutso Khomba.
       INTRODUCTION: Paediatric radiography is a specialised area of imaging focused on children, requiring unique knowledge, skills, and approaches distinct from those of adult imaging. Diagnostic radiography students and radiographers face challenges, including managing patient anxiety, ensuring cooperation, communicating effectively, managing children with special needs, and handling cases of non-accidental injury (NAI). Therefore, the aim of this review was to explore the challenges diagnostic radiography students and radiographers encounter in paediatric general radiography, with the intention of identifying key areas for improvement in education, resources, and clinical practice.
    METHODS: A literature search was conducted between July and September 2025 using PubMed/MEDLINE, CINAHL, ScienceDirect, and hand searches of key radiography journals and cited references using Google. Inclusion criteria comprised primary research studies published in English after 2000 that focused on or included paediatric general radiography. Twenty research studies were identified from diverse healthcare contexts. Data were extracted using a standardised form and thematically analysed.
    RESULTS: Analysis identified five major themes of challenges: (1) education and training deficits, including insufficient undergraduate preparation and limited continuing professional development (CPDs); (2) inadequate dedicated imaging equipment and resources, particularly in resource-limited settings; (3) difficulties in communication and interaction with children and carers, especially with children with special needs and in NAI cases; (4) workload pressures and limited peer or institutional support; and (5) stress and emotional demands associated with paediatric practice. These challenges were interrelated and affected the quality and efficiency of paediatric general radiography services.
    CONCLUSION: This review underscores that the challenges in paediatric general radiography are multifaceted and systemic. Addressing educational gaps and students' clinical exposure to paediatric patients, improving access to dedicated equipment, strengthening communication strategies, and implementing support systems are critical to optimising practice. Given that the reviewed studies were limited to single-country contexts, future research should investigate paediatric radiography practices across multiple international settings.
    PLAIN LANGUAGE SUMMARY: Imaging children needs different skills than imaging adults, and it can be challenging for students and staff. This review looked at published studies to understand the main difficulties faced by radiography students and radiographers when taking X-ray images of children. This study found gaps in training, limited child-specific equipment, communication difficulties with children and carers, heavy workloads, and emotional stress that can affect care. This matters because addressing these challenges can help improve education, working conditions, and the quality of imaging care for children and families.
    Keywords:  Challenge; Children; Diagnostic radiographer; Paediatric general radiography; Radiography student
    DOI:  https://doi.org/10.1016/j.jmir.2026.102439
  25. Cureus. 2026 Apr;18(4): e107171
    Assessing Caregivers' Pre-visit Information-Seeking Behaviors for Pediatric Emergency Care: A Pilot Questionnaire Study in a University Hospital.
    Kei Narita, Naho Hirai, Rie Sato, Yoshiaki Iwashita.
      Background and objectives Multiple informational resources - including online tools and the pediatric telephone consultation service (#8000) - are available in Japan to assist caregivers in determining whether to seek emergency care for their child. However, the utilization of these resources prior to pediatric emergency department (ED) visits remains unclear. This study aimed to examine whether caregivers sought information before visiting a pediatric ED and to identify which resources they utilized. Materials and methods We conducted a descriptive, questionnaire-based study involving caregivers who brought their child to the ED at a tertiary care center in a regional city in Japan between May and August 2022. Both paper-based and online questionnaires were used, consisting of 17 items that addressed patient demographics, pre-visit information searches, search methods, and clinical outcomes. Results Of the 42 distributed questionnaires, 36 valid responses were analyzed, resulting in a response rate of 85.7%. Among the 36 respondents, 21 caregivers reported seeking information prior to visiting the ED. The internet was the most frequently utilized resource, with 15 respondents indicating its use. Awareness of the #8000 hotline was high; however, only a minority utilized it, with just two respondents indicating usage. The perceived appropriateness of the visit did not differ significantly between caregivers who sought information and those who did not, with a p-value of 0.8. Conclusions These preliminary findings indicate that, although caregivers are aware of public information resources, many primarily rely on online searches before seeking emergency care. Further research, involving larger studies across more diverse settings, is necessary to elucidate how caregivers utilize these resources and how they can be better supported in their decision-making processes.
    Keywords:  consultation services; emergency department; health education; information seeking; non-severe illness; parental perception; pediatric
    DOI:  https://doi.org/10.7759/cureus.107171
  26. BJS Open. 2026 May 12. pii: zrag053. [Epub ahead of print]10(3):
    Quality improvement interventions in surgical oncology: systematic review of international studies.
    Adil Rashid, Sugeeta Sukumar, Joanna Dodkins, Georgia Zachou, Nicola S Fearnhead, Kate Walker, Ajay Aggarwal.
       BACKGROUND: Substantial variation in surgical care and outcomes has been identified by quality assurance initiatives. Quality improvement (QI) interventions have the potential to address these disparities. This paper aimed to assess the types of QI interventions that have been designed, implemented, and evaluated in surgical oncology.
    METHODS: A systematic search of MEDLINE and EMBASE was conducted to identify studies on QI interventions published between January 2000 and September 2025. Studies reporting the impact of the QI intervention on predefined quality deficits in clinical outcomes or care and process measures were selected. Data on study design, QI methodology, quality deficits, intervention types, and outcomes were extracted. Results were summarized using narrative synthesis and appraised using the Cochrane Effective Practice and Organization of Care risk of bias tool.
    RESULTS: Of 11 373 studies, 109 were included. The majority were in the USA (48 (44.0%)), followed by Canada (20 (18.3%)), and the UK (11 (10.1%)). The commonest tumour types were gynaecological (22 (20.2%)) and colorectal (20 (18.3%)). The commonest quality deficits addressed were postoperative complications (22 (20.2%)) and prolonged length of stay (12 (11.0%)). One study was conducted globally, 6 nationally, 20 regionally, and 82 locally. Among randomized clinical trials, only 2 of 12 (16%) demonstrated a positive effect compared with 86 of 97 (89%) non-randomized studies. Only 28 (25.7%) studies referenced specific QI methodologies, most commonly the Plan-Do-Study-Act cycle (10 (9.2%)). QI interventions encompassed care pathway standardization, perioperative care bundles, audit, and feedback, combined with surgical skills workshops and digital tools, including checklists, and care coordination initiatives. Most studies were uncontrolled before-and-after studies (74 (67.9%)) and were classified as low quality.
    CONCLUSIONS: There are limited high-quality evaluations of QI interventions in the literature. Key gaps include interventions to improve equitable access to surgical care. Comprehensive QI studies leveraging large-scale, multidisciplinary collaborations and robust methodologies are needed to realize potential gains in surgical oncology care.
    Keywords:  healthcare disparity; practice variation; quality assurance; surgical outcome
    DOI:  https://doi.org/10.1093/bjsopen/zrag053
  27. Cochrane Database Syst Rev. 2026 May 20. 5 CD015007
    Gastrostomy plus fundoplication or gastro-jejunal tube or gastrostomy alone for treating or preventing gastro-esophageal reflux in children and adolescents with neurological impairment.
    Juan Carlos Flores, José Manuel Campos, Juan Cristóbal Gana, Catalina Arredondo, Romina Torres-Robles, Macarena Jofré, Emily Ana Butler, Eyal Cohen.
       RATIONALE: Children with neurological impairment (NI) represent a vulnerable pediatric population who often experience multiple co-occurring chronic conditions and may develop worsening comorbidities over time due to primary dysfunctions of the nervous system. Among the most significant of these are gastro-esophageal reflux (GER) and dysphagia, which likely account for much of the associated morbidity and mortality. There is substantial variation in the management of GER, and few studies have been conducted to evaluate the effects of antireflux procedures in preventing and improving outcomes in this population.
    OBJECTIVES: To assess the benefits and harms of the two most common enteral feeding tubes and associated antireflux procedures. We aimed to compare: 1) gastrostomy tube (GT) plus fundoplication, 2) gastrostomy plus insertion of a gastro-jejunal (GJ) tube, and 3) GT alone for treating or preventing GER in children and adolescents with NI.
    SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, six other databases, and two trials registers, together with reference checking and contact with two experts in the field, to identify studies for inclusion in the review. There were no restrictions on language. The latest search date was 17 September 2024.
    ELIGIBILITY CRITERIA: Randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) in children with NI, with or without GER, comparing the three interventions. We excluded studies of neurologically normal children.
    OUTCOMES: Our critical outcomes were symptoms of GER and mortality. Important outcomes included major surgical complications (perforation or peritonitis), length of stay (LOS), number of hospitalizations for respiratory morbidity (pneumonia), number of emergency department (ED) visits, and child's quality of life (QoL).
    RISK OF BIAS: We used the ROBINS-I tool to assess bias in NRSIs. We did not find any RCTs.
    SYNTHESIS METHODS: We meta-analyzed the results for each outcome where possible (inverse-variance, random-effects). Where this was precluded by the nature of the data, we synthesized results according to Synthesis Without Meta-analysis (SWiM) guidelines. We used GRADE to assess the certainty of evidence.
    INCLUDED STUDIES: We included 11 NRSIs with a total of 3122 children with NI. Among these, seven cohort studies compared GT plus fundoplication versus GT alone (2654 participants); one cohort study compared GJ tubes versus GT alone (50 participants); and three cohort studies compared GT plus fundoplication versus GJ tubes (418 participants).
    SYNTHESIS OF RESULTS: GT plus fundoplication compared to GT alone for GER in children with NI The evidence is very uncertain about the effect of GT plus fundoplication on symptoms of GER (odds ratio [OR] 2.02, 95% confidence interval [CI] 0.64 to 6.44; 3 NRSIs, 180 participants; very low-certainty evidence); mortality (OR 2.62, 95% CI 0.41 to 16.80; 3 NRSIs, 415 participants; very low-certainty evidence); major surgical complications (OR 2.61, 95% CI 0.46 to 14.87; 3 NRSIs, 412 participants; very low-certainty evidence); and LOS (1 NRSI with no comparison, 130 participants; very low-certainty evidence). GT plus fundoplication may result in little to no difference in the number of hospitalizations for pneumonia (mean difference [MD] 0.04 higher, 95% CI 0.01 lower to 0.09 higher; 1 NRSI, 2054 participants; low-certainty evidence). The evidence is very uncertain about the effect of GT plus fundoplication on the number of ED visits (OR 1.82, 95% CI 0.78 to 4.27; 1 NRSI, 130 participants; very low-certainty evidence). Child's QoL was not reported. GJ tubes compared to GT alone for GER in children with NI The evidence is very uncertain about the effect of GJ tubes on mortality (OR 5.38, 95% CI 0.40 to 73.09; 1 NRSI, 50 participants; very low-certainty evidence) and child's QoL (effect estimate not reported; no effect of the type of tube on quality of life; 1 prospective NRSI, 50 participants; very low-certainty evidence). Symptoms of GER, major surgical complications, LOS, number of hospitalizations for respiratory morbidity (pneumonia), and number of ED visits were not reported. GT plus fundoplication compared to GJ tubes for GER in children with NI The evidence is very uncertain about the effect of GT plus fundoplication on symptoms of GER (3 NRSIs with conflicting results, including 1 unmatched cohort, 1531 participants; very low-certainty evidence); mortality (OR 1.12, 95% CI 0.52 to 2.41; 3 NRSIs, 418 participants; very low-certainty evidence); major surgical complications (OR 2.84, 95% CI 0.45 to 17.82; 2 NRSIs, 190 participants; very low-certainty evidence); and LOS (1 NRSI with no comparison, 79 participants; very low-certainty evidence). GT plus fundoplication may result in little to no difference in the number of hospitalizations for pneumonia (MD 0.05 lower, 95% CI 0.21 lower to 0.11 higher; 1 NRSI, 228 participants; low-certainty evidence). Number of ED visits and child's QoL were not reported. We downgraded the certainty of evidence for risk of bias and imprecision. Most studies were at serious risk of bias due to confounding, except for hospitalizations for pneumonia for the comparisons of GT plus fundoplication versus GT alone and versus GJ tubes.
    AUTHORS' CONCLUSIONS: In children with NI, the evidence is very uncertain about the effect of GT plus fundoplication on symptoms of GER, mortality, major surgical complications, and LOS, when compared to GT alone or GJ tubes (very low-certainty evidence). GT plus fundoplication may result in little to no difference in the number of hospitalizations for pneumonia when compared to GT alone or GJ tubes (low-certainty evidence). The evidence is very uncertain about the effect of GT plus fundoplication on the number of ED visits when compared to GT alone (very low-certainty evidence). The evidence is very uncertain about the effect of GJ tubes on mortality and child's QoL when compared to GT alone (very low-certainty evidence). We found no RCTs, and our results should be interpreted with caution due to the limited number of studies and the limitations of NRSIs. Additional research is necessary. It is likely that RCTs will be difficult to conduct; however, better-designed NRSIs could improve the quality of evidence in this area.
    FUNDING: This review was funded by Foundation Fresno, Universidad Católica de Chile, for librarian support only. The foundation had no role in the design or conduct of this review.
    REGISTRATION: Protocol available via DOI: 10.1002/14651858.CD015007.
    DOI:  https://doi.org/10.1002/14651858.CD015007.pub2
  28. Transl Pediatr. 2026 Apr 30. 15(4): 157
    Nursing management of deep vein thrombosis in children: a narrative review of challenges, evidence-based strategies, and systematic pathways.
    Yufen Huang, Yangchen Hu, Caina Gao, Yiyao Bao.
       Background and Objective: Pediatric deep vein thrombosis (DVT) is an increasingly recognized vascular condition with potentially life-threatening consequences. Despite growing clinical awareness, nursing care remains challenging due to the lack of standardized, age-appropriate protocols-often defaulting to adult-oriented approaches. This review aims to synthesize current evidence on the multifactorial etiology, diagnostic challenges, and optimal nursing strategies for pediatric DVT, with a focus on improving early detection, individualized management, and long-term outcomes.
    Methods: A narrative review was conducted to analyze peer-reviewed studies and clinical guidelines on pediatric DVT published in recent years, focusing on etiology, risk factors, diagnostic difficulties, and nursing interventions.
    Key Content and Findings: Pediatric DVT arises from a complex interplay of genetic thrombophilias, acquired triggers [e.g., central venous catheters (CVCs), infection], and immune-inflammatory mechanisms. Clinical presentation is highly variable and age-dependent, complicating early diagnosis. Effective nursing strategies include: (I) validated pediatric risk assessment; (II) individualized anticoagulation monitoring; (III) meticulous catheter care; (IV) early mobilization; and (V) nutritional support. Multidisciplinary collaboration, family-centered education, and psychological support are crucial for preventing post-thrombotic syndrome (PTS) and promoting recovery.
    Conclusions: A tailored, evidence-based nursing framework-grounded in pediatric physiology and centered on family engagement-is essential for optimizing DVT care in children. This review provides a practical foundation for developing standardized, high-quality nursing protocols to enhance safety, efficacy, and long-term outcomes in pediatric DVT management.
    Keywords:  Children; deep vein thrombosis (DVT); evidence-based strategies; nursing management; risk factors
    DOI:  https://doi.org/10.21037/tp-2026-1-0096
  29. Pediatr Radiol. 2026 May 22.
    The environmental impact of diagnostic imaging: opportunities for pediatric radiologists.
    Jonathan Gross, Sumit Pruthi, Reed A Omary, Elizabeth J Snyder.
      Healthcare operations are a major contributor to human-produced greenhouse gas emissions worldwide and in the USA in particular. Medical imaging, largely due to its high energy use requirements, disproportionately contributes to healthcare's negative environmental impacts. Although there has been growing concern about radiology's role in climate change, most existing knowledge of radiology's impact derives from adult radiology departments. Pediatric radiologists, however, have compelling reasons to consider and work to reduce our specialty's contributions to climate change: our pediatric patients are uniquely vulnerable to the negative effects of climate change and face wide-ranging impacts to their overall health and well-being. The aim of this manuscript is to review the major environmental impacts from radiology and to highlight potential areas for improvement.
    Keywords:  Child; Climate change; Diagnostic imaging; Environment; Radiologists
    DOI:  https://doi.org/10.1007/s00247-026-06656-5
  30. Pediatr Infect Dis J. 2026 May 21.
    Effectiveness and Safety of Contemporary Drug Regimens for Multidrug- and Extensively Drug-resistant Tuberculosis in Children and Adolescents: A Global Systematic Review and Meta-analysis.
    Wamaka Kaminyoge, Reuben Simfukwe, Mwiza Singini, Norman Sitali, Felix P Chilunga.
       BACKGROUND: Children and adolescents with multidrug-resistant (MDR) or extensively drug-resistant (XDR) tuberculosis (TB) face major treatment challenges. Although newer all-oral regimens have transformed adult TB care, their use in younger populations has largely been extrapolated from adult studies, despite important biologic and clinical differences. Systematic and up-to-date evidence on the effectiveness and safety of contemporary regimens in children and adolescents is lacking. We conducted a global systematic review and meta-analysis to address this gap.
    METHODS: We systematically searched PubMed, EMBASE, Web of Science, Cochrane Library and Google Scholar for studies published between January 1, 2015, and September 1, 2025. Eligible studies included children 0-19 years old with confirmed or presumed MDR/XDR-TB or rifampicin-TB receiving pharmacologic treatment. Outcomes were pooled using a random-effects meta-analysis. The primary outcome was treatment success (cure or completion); severe (grade 3/4) adverse events were assessed as secondary outcomes.
    RESULTS: We included 14 studies comprising 490 children across 13 countries. Overall pooled treatment success was 89% (95% confidence interval: 84%-93%; I2 = 51.9%). Newer all-oral regimens achieved slightly higher success (91%) than injectable-containing regimens (83%). Severe grade 3/4 adverse event were sparse (7 of 14 studies); events occurred in 21% (95% confidence interval: 13%-33%), most commonly QT prolongation and anemia, with limited specific drug attribution.
    CONCLUSIONS: Newer, all-oral bedaquiline- and delamanid-based regimens for pediatric MDR/XDR-TB are effective and generally well tolerated, though the full safety profile remains incompletely characterized. In pediatric MDR/XDR-TB, where studies are rare, our findings provide the best available evidence and a foundation for improved treatment guidelines and future research.
    Keywords:  contemporary regimens; extensively drug-resistant tuberculosis; meta-analysis; multidrug-resistant tuberculosis; pediatric
    DOI:  https://doi.org/10.1097/INF.0000000000005269
  31. BMC Palliat Care. 2026 May 16.
    Pediatric home-based hospice and palliative care: a scoping review.
    Ellen Davis, Daniel H Grossoehme, Toluwalase Ajayi, Justin N Baker, Pamela S Hinds, Lisa Humphrey, Jill Ann Jarrell, Rachel Thienprayoon, Sarah Friebert.
      Pediatric palliative and/or hospice care is provided across a broad spectrum of settings, ranging from inpatient to outpatient to a child's home. Pediatric home-based hospice and/or palliative care teams offer a specialized, interdisciplinary approach to care, allowing children to stay in the home while offering comprehensive support. This scoping review seeks to summarize what is known about pediatric home-based hospice and/or palliative care and to identify gaps in the current research. Following Arskey and O'Malley's scoping review framework, we searched four databases for studies focused on pediatric home-based hospice and/or palliative care programs. Studies were included if they were published between 2000 and 2024, available in English, and focused on children and young adults receiving palliative or hospice care at home, including via telehealth, in the pediatric system. Of 2,552 results initially identified, 96 met our inclusion criteria and were included in this review. Common themes emerged including studies analyzing models of care, characterizing the population, end-of-life decision making, clinical outcomes of home-based hospice and/or palliative care, costs and economic impact, family experiences, quality domains, specific treatment modalities, and the use of telehealth. Overall, the available literature supported home-based hospice and/or palliative care as an effective model of care, reducing the burden on families, improving quality of life, and allowing families to stay in their preferred setting for care without sacrificing clinical outcomes. Key research gaps included small sample sizes, limited use of control groups and scarcity of randomized clinical trials, difficulties including the perspective of the ill child in research, and a need for longitudinal studies on the effects of home-based hospice and/or palliative care on children and families. Given the compelling evidence for the benefits of pediatric home-based hospice and/or palliative care, further research into disparities in care access, best models of care, and novel payment models are critical.
    Keywords:  Home-based care; Hospice; Palliative; Pediatrics; Scoping review
    DOI:  https://doi.org/10.1186/s12904-026-02146-5
  32. Epilepsy Behav. 2026 May 19. pii: S1525-5050(26)00240-4. [Epub ahead of print]182 111119
    Urban-rural differences in healthcare access among children with epilepsy: identifying factors associated with adequate care using the National Survey of Children's health.
    Carrson French, Ashleigh Buzzell, Madison Reese, Cherie Herren, Douglas Nolan, Micah Hartwell.
       BACKGROUND: Epilepsy, affecting approximately 470,000 U.S. children, is associated with higher comorbidities, increased mortality, and limited access to specialized care. This study identifies gaps in access and quality of care between rural and urban children with epilepsy (CWE) using the National Survey of Children's Health. We evaluated differences in care between children with and without epilepsy, and between rural and urban CWE, aiming to clarify the factors linked to adequate care.
    METHODS: We conducted a cross-sectional analysis of 2021-2023 National Survey of Children's Health (NSCH) data, representative of U.S. children aged 0-17 years. Children were classified by parental report of an epilepsy diagnosis. Outcomes included healthcare access (insurance, personal doctor, specialist visits, referral difficulty) and patient- and family-centered care (PFCC) measures. Survey weights and design-based χ2 tests compared children with and without epilepsy, and rural-urban differences among CWE.
    RESULTS: Of 145,720 children, 888 (0.6%) had epilepsy; 11.6% resided in rural areas. CWE were more likely to have a personal doctor, but parents more often reported frustration accessing services. PFCC ratings were lower for CWE, including statements of 'providers who always listened carefully', 'showed sensitivity to family values', and 'provided needed information'. No significant rural-urban differences were found among CWE.
    CONCLUSION: Caregivers of CWE reported lower PFCC in listening, cultural sensitivity, and provision of information, alongside greater frustration accessing services. Improving provider-caregiver communication and streamlining service access may enhance satisfaction and continuity of care. Limitations include a lack of epilepsy severity data and a small epilepsy subsample. Future research should incorporate standardized satisfaction measures and detailed clinical data to guide interventions.
    Keywords:  Epilepsy; Patient- and family-centered care; Pediatric; Rural
    DOI:  https://doi.org/10.1016/j.yebeh.2026.111119
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