bims-cliped 2026-05-31 papers

bims-cliped

Biomed News

on Clinical pediatrics

Issue of 2026–05–31
twenty-six papers selected by
Alyssa M. Portwood, Akron’s Children

Gender Pay Equity in Pediatrics: Policy Statement.
Unplanned Extubation in PICU and Its Adverse Impact: A Case-Control Study.
Effect of an Institution-Specific Guideline on Adherence to the 2021 American Academy of Pediatrics Guidelines for Febrile Infants at a Community Emergency Department: A Quality Improvement Initiative.
Sometimes Kids Really Are Just Little Adults: Early Access to High-Efficacy Therapy Decreases Disability in Pediatric Multiple Sclerosis.
Is Short Therapy an Appropriate Regimen for Children and Young Adolescents with Drug-Susceptible Tuberculosis?
Update on pediatric allergic rhinitis: narrative review based on guideline updates.
Coordinated Care for Children in Foster Care: A Case Study From the Duke Foster Care Clinic.
The Role of Pediatric Hospital Systems in Addressing the Climate Crisis.
Pediatric Palliative Care: Communication, Decision-Making, Care, and Support Amid Complexity and Uncertainty.
Clinical Care Guideline Implementation of Nebulized Tranexamic Acid in Post-Tonsillectomy Hemorrhage.
Past, Present, and Future: The Legacy of the Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC).
Generic and Biosimilar Prescribing in Children and Adolescents: Policy Statement.
Treatment of pediatric flatfoot: a systematic review-based consensus and guidelines by CPAM-LRC.
Screen Time after Concussion: Still Searching for Just Right.
Cardioneuroablation for children with syncope.
Child and Adolescent Cancer Communication Preferences for Information Exchange: A Meta-Synthesis.
Early vs delayed opioid administration for pediatric sickle cell vaso-occlusive crisis: A systematic review and meta-analysis.
Impact of the 2025 Accreditation Council for Graduate Medical Education Pediatric Residency Changes on the Pediatric Hospital Medicine Workforce.
Care Pathway and Outcomes in Pediatric Septic Shock: A Narrative Review from Emergency Department Recognition to PICU Management.
Chronic Cancer-Related Pain in Children: A Narrative Review of Multimodal and Family-Centered Palliative Care Approach.
Farewell to PGY-6? Addressing the realities of pediatric fellowship training.
Managing pediatric pain during needle procedures: a narrative review of virtual reality and Buzzy as distraction-based interventions.
Protocolized Weaning From Mechanical Ventilation in the PICU: A Systematic Review and Meta-Analysis.
Safety Profile of Nebulized Ciprofloxacin-Dexamethasone After Pediatric Airway Surgery.
Nurses' perspectives on pain management in pediatric care: systematic review and meta-synthesis.
Comparing Neighborhood Deprivation Metrics in Pediatric Trauma: Is There a Better Predictor?

Pediatrics. 2026 May 26. pii: e2026077023. [Epub ahead of print]

Gender Pay Equity in Pediatrics: Policy Statement.

Committee on Pediatric Workforce

Gender-based pay inequities persist in pediatrics, affecting women at all career stages and across subspecialties, even after accounting for work hours, duties, and productivity. These inequities are further pronounced between pediatrics, a women-dominated field, and men-dominated adult medicine and surgery. Contributing factors include systemic bias; unequal access to mentorship, sponsorship, and coaching; unequal promotion to leadership roles; part-time work; and inadequate parental leave policies. The consequences are profound, not only for the financial well-being and career satisfaction of women physicians, but also for the pediatric workforce and access to health care for pediatric patients. Subspecialties with more women often face workforce shortages and lower salaries for all. This policy statement from the American Academy of Pediatrics summarizes evidence of gender pay inequities, their causes, and strategies to achieve compensation equity. It recommends transparent pay practices, supportive parental leave policies, equitable promotion policies, and regular compensation reviews to address these inequities. Achieving pay equity is critical to building a diverse, sustainable, and fairly compensated pediatric workforce capable of meeting the health care needs of all children. Equity in pay is both a professional and public health imperative.

DOI: https://doi.org/10.1542/peds.2026-077023
Nurs Crit Care. 2026 Jul;31(4): e70524

Unplanned Extubation in PICU and Its Adverse Impact: A Case-Control Study.

J M Ruiz-Ramírez, J M Garcia-Piñero, Alvaro León Campos, J M Morales-Asencio.

   BACKGROUND: Unplanned extubations are adverse events with multifactorial causes, involving both patient characteristics and organizational features in Paediatric Intensive Care Units (PICUs).
AIM: To identify the main clinical and contextual determinants associated with unplanned extubations in PICU patients.
STUDY DESIGN: We conducted a case-control retrospective observational study at a paediatric hospital in Eastern Andalucia (Spain). Cases were patients who experienced an unplanned extubation, and controls were those who did not during the same period.
RESULTS: A total of 121 active cases and 275 controls were included, yielding a rate of 5.07 events per 100 ventilated patients. For the 2902 invasively ventilated children, 147 unplanned extubations occurred in 121 children (4.17% of children experienced at least one event). Unplanned extubations occurred more frequently in patients receiving assisted ventilation (OR = 2.52; 95% CI: 1.56-4.07). The mean additional length of stay in the PICU for cases was 7.5 days. Independent predictors for unplanned extubations included male sex (OR = 0.87; 95% CI: 0.47-1.63), older age (OR = 1.01; 95% CI: 0.99-1.02), use of assisted-spontaneous ventilatory modes (OR = 2.47; 95% CI: 1.18-5.19), lower doses of midazolam (OR = 24.28; 95% CI: 1.57-11.62), and nurse overallocation (OR = 2.05; 95% CI: 1.19-3.53).
CONCLUSIONS: Unplanned extubations in PICU are influenced by both clinical factors and organizational aspects of care. Notably, most predictors identified (e.g., sedation practices, nurse staffing) are modifiable, indicating the potential for targeted interventions to reduce this adverse event.
RELEVANCE TO CLINICAL PRACTICE: Preventing unplanned extubations is critical for safeguarding paediatric patients. By optimizing nursing ratios, sedation regimens, and care protocols, PICUs can reduce the incidence of accidental extubations, thereby improving patient outcomes and minimizing prolonged lengths of stay. These findings should be used by healthcare managers to systematically evaluate the consequences of a severe adverse effect such as unplanned extubations (UE) and introduce quality improvement actions to minimize the consequences on patient safety and PICU outcomes.

Keywords:  children; intensive care; nurse ratios; paediatric critical care; patient safety; ventilation

DOI:  https://doi.org/10.1111/nicc.70524
Jt Comm J Qual Patient Saf. 2026 Apr 26. pii: S1553-7250(26)00100-5. [Epub ahead of print]

Effect of an Institution-Specific Guideline on Adherence to the 2021 American Academy of Pediatrics Guidelines for Febrile Infants at a Community Emergency Department: A Quality Improvement Initiative.

Alisha Ching, Allison Cator, Michele Carney, Ruoer Bei, Yaseen Rafee, Nesma Ghanim, Tim Tomy, Adenike Fatiregun, Mai Elhadi, Courtney W Mangus.

BACKGROUND: In a community hospital emergency department (ED), wide practice pattern variation in the management of febrile infants ≤60 days was noted following the release of the 2021 American Academy of Pediatrics (AAP) guidelines. The authors identified a need to standardize practice and improve adherence to AAP recommendations in the care of febrile infants. The aim of this study was to improve ED provider adherence to AAP febrile infant guidelines to > 80% within 18 months.
METHODS: In this quality improvement initiative, institution-specific febrile infant guidelines and corresponding order sets in the electronic health record based on the AAP recommendations were developed. Age-based, institution-specific algorithms for diagnosis and management of febrile infants were distributed to ED providers. The researchers engaged in multiple Plan-Do-Study-Act cycles of targeted interventions and tracked provider adherence to AAP recommendations over 18 months. ED length of stay (LOS) for all patients and rate of blood cultures for febrile infants > 60 days were tracked as balancing measures.
RESULTS: Despite an initial improvement in provider adherence to AAP recommendations from a baseline of 59.1% to 82.0% immediately following implementation of the institution-specific guidelines, there was a subsequent return to 64.3% over 18 months postimplementation. Adherence fluctuated with substantial variability over time. The small overall improvement in adherence postimplementation of the guideline was not statistically significant. There was no statistically significant change in ED LOS for all patients or rate of blood cultures in older infants as a result of the interventions.
CONCLUSION: This project's interventions resulted in statistically nonsignificant improvements in adherence to AAP guidelines for febrile infants ≤ 60 days old. Ongoing, high-reliability interventions may be required to consistently improve adherence to AAP guidelines.

DOI: https://doi.org/10.1016/j.jcjq.2026.04.007
Neurology. 2026 Jun 23. 106(12): e218168

Sometimes Kids Really Are Just Little Adults: Early Access to High-Efficacy Therapy Decreases Disability in Pediatric Multiple Sclerosis.

Grace Yoonheekim Gombolay, Jennifer P Rubin.

DOI: https://doi.org/10.1212/WNL.0000000000218168
Pharmaceuticals (Basel). 2026 May 01. pii: 721. [Epub ahead of print]19(5):

Is Short Therapy an Appropriate Regimen for Children and Young Adolescents with Drug-Susceptible Tuberculosis?

Susanna Esposito, Valentina Fainardi, Beatrice Rita Campana, Gaia Giorgia Arnesano, Nicola Principi.

  Background: Tuberculosis (TB) remains a major cause of morbidity and mortality among children worldwide, with approximately one million new pediatric cases annually. The conventional treatment for drug-susceptible TB has long relied on a 6-month multidrug regimen, which is highly effective but associated with challenges in adherence, toxicity, and healthcare burden. Objectives: To evaluate whether short-course therapy is an appropriate regimen for children and young adolescents with drug-susceptible TB, with particular focus on its efficacy, safety, and applicability in different clinical contexts. Methods: A structured narrative review of the literature was conducted, including randomized controlled trials, observational studies, and international guidelines addressing treatment duration in children and young adolescents with drug-susceptible TB. Evidence was synthesized focusing on children and young adolescents <16 years with drug-susceptible TB treated with short-course regimens compared to standard therapy. Results: A shorter treatment regimen, particularly 4-month courses, has been investigated as an alternative to standard therapy in the pediatric population with drug-susceptible TB. Children often present with paucibacillary and non-severe forms of TB, providing a biological rationale for treatment shortening. Evidence from a randomized controlled trial has demonstrated that a 4-month regimen is non-inferior to the standard 6-month therapy in children and young adolescents with non-severe, drug-susceptible TB. These findings have informed recent international guideline updates, which now recommend short therapy in carefully selected patients. However, a short regimen is not appropriate for infants younger than 3 months, children with severe or complicated TB, extrapulmonary disease such as central nervous system involvement, or those with drug-resistant TB. The overall quality of evidence remains moderate, and long-term relapse data are still emerging. Conclusions: Short-course therapy represents a promising but selective strategy in pediatric drug-susceptible TB management. It offers potential advantages, including improved adherence, reduced drug toxicity, and lower healthcare costs. However, its safe implementation requires accurate patient selection, access to appropriate diagnostic tools, and structured follow-up. Careful application within clearly defined clinical criteria is essential to ensure optimal outcomes.

Keywords:  antitubercular therapy; drug-susceptible tuberculosis; pediatric tuberculosis; short-course therapy; treatment adherence; treatment duration

DOI:  https://doi.org/10.3390/ph19050721
Clin Exp Pediatr. 2026 May 28.

Update on pediatric allergic rhinitis: narrative review based on guideline updates.

Jung Yeon Shim.

  Pediatric allergic rhinitis, among the most common chronic allergic diseases in children and adolescents, represents a significant public health burden in Korea and other countries. Allergic rhinitis in childhood is closely associated with asthma and should be considered a unified airway disease requiring integrated management. Recent Allergic Rhinitis and its Impact on Asthma and Korean Academy of Asthma, Allergy and Clinical Immunology guidelines advocate an evidence-based control-oriented stepwise treatment strategy that incorporates a patient-centered approach that is supported by both randomized trial data and real-world evidence. Intranasal corticosteroids (INCS) remain the first-line treatment for moderate to severe pediatric allergic rhinitis, whereas INCS plus intranasal antihistamine (INAH) combination therapy is recommended when symptom control is inadequate with INCS alone. Oral antihistamines (OAH) and INAH are recommended for children with mild disease or when rapid symptom relief is required. However, the addition of OAH to INCS therapy does not confer clinically meaningful additional benefits compared with INCS monotherapy in most patients with allergic rhinitis; therefore, routine combination therapy is not recommended. Leukotriene receptor antagonists are not recommended as first-line therapy for allergic rhinitis and are mainly used as add-on therapy in patients with concomitant asthma. In patients with predictable seasonal allergic rhinitis, INCS may be initiated 1-2 weeks before the anticipated pollen season to optimize symptom control. Pediatric management requires special consideration of age-specific clinical features, treatment adherence, safety, and caregiver education. The early diagnosis and guideline-based treatment of allergic rhinitis in children may improve their quality of life and reduce long-term respiratory morbidity.

Keywords:  Allergic rhinitis; Child; Glucocorticoids; Guideline; Intranasal

DOI:  https://doi.org/10.3345/cep.2026.00444
Clin Pediatr (Phila). 2026 Jul;65(7): 849-855

Coordinated Care for Children in Foster Care: A Case Study From the Duke Foster Care Clinic.

Lindsay Terrell, Katherine Ariano, Kevin Weinfurt, Bradley G Hammill.

  Foster children's unmet health needs have consequences that often lead to poor outcomes for children who age out of foster care. Information silos disrupt continuity of care resulting in inconsistent management of chronic conditions, medication lapses and missed signals of distress. The Duke Foster Care Program (FCP) and its affiliated Clinic (FCC) have found that delivering medical services to children in foster care requires a trauma-informed, unique approach. This model introduces care management tailored to the instability of foster care-addressing challenges such as system turnover and burnout. A key innovation is the use of a clinic-embedded Population Health Nurse (PHN), whose role focuses on coordination of care and the collection of actionable data to improve population outcomes. This health care-based solution bridges gaps in traditional medical case management. We posit that health care systems should consider this care management model to meet the needs of children in foster care.

Keywords:  care coordination; case management; foster care; population health; trauma informed care

DOI:  https://doi.org/10.1177/00099228251386693
Pediatr Clin North Am. 2026 Jun;pii: S0031-3955(26)00005-2. [Epub ahead of print]73(3): 623-635

The Role of Pediatric Hospital Systems in Addressing the Climate Crisis.

Hilary Ong, Elizabeth Cerceo.

  Health systems occupy a uniquely influential position in the global effort to address the climate crisis. As both major contributors to greenhouse gas emissions and critical institutions for protecting public health, hospitals and health care organizations have an ethical and operational imperative to lead climate action. In doing so, health systems also realize a range of ancillary benefits that reinforce their core missions: improved cost-effectiveness, measurable return on investment, enhanced staff recruitment and retention, deeper community engagement, and strengthened public trust. This article outlines how health systems can mitigate their environmental footprint while enhancing patient care, operational efficiency, and community resiliency.

Keywords:  Climate change; Climate health; Climate-smart healthcare; Planetary health; Sustainability; Sustainable health education

DOI:  https://doi.org/10.1016/j.pcl.2026.01.005
Children (Basel). 2026 May 19. pii: 693. [Epub ahead of print]13(5):

Pediatric Palliative Care: Communication, Decision-Making, Care, and Support Amid Complexity and Uncertainty.

DonnaMaria E Cortezzo.

Pediatric palliative care (PPC) is an essential, evolving component of care for children with serious, complex, life-threatening, or life-limiting conditions [...].

DOI: https://doi.org/10.3390/children13050693
Laryngoscope. 2026 May 29.

Clinical Care Guideline Implementation of Nebulized Tranexamic Acid in Post-Tonsillectomy Hemorrhage.

Jennifer Lavin, Kathleen Billings, Alyssa Smith, Krupa Patel, Jaqueline Corboy, Inbal Hazkani.

   OBJECTIVES: Nebulized tranexamic acid (TXA) can be utilized for non-operative management in post-tonsillectomy hemorrhage (PTH). Rapid adoption of new treatments in hospital settings is challenging due to personnel turnover, formulary restrictions, and inconsistent awareness. We investigated the utility of clinical care guideline (CCG) implementation on adherence to a TXA protocol and its association with operative control of hemorrhage.
METHODS: Model for Improvement methodology was utilized to develop CCG for TXA administration. An algorithm was created where patients presenting to the Emergency Department (ED) with active bleeding or blood clot received three nebulized TXA treatments. Exclusion criteria were severe bleeding, absence of active bleeding or clot, and inability to tolerate treatment or protect the airway. An order set was used to facilitate implementation. Data from 2 years pre- and post-initiation were compared. Measures included ED returns for PTH, TXA order set usage, TXA administration frequency, returns to the operating room, and secondary returns to the ED.
RESULTS: There were 2805 and 5382 tonsillectomies pre- and post- implementation periods respectively. There was no difference in patient age in the two groups. ED returns for bleeding were 70 (2.5%) and 155 (2.9%) respectively (p > 0.05). Post-implementation, 126 patients met inclusion criteria for TXA (81.3%). Order set utilization of patients receiving TXA in the ED was 95.7%. Operative PTH management pre- and post-intervention was 35/70 (50%) and 42/155 (27.1%) respectively (p = 0.001, ARR 0.320, 95% CI 0.116-0.500).
CONCLUSIONS: Implementation of a PTH clinical care guideline was associated with rapid adoption of TXA adherence. This was associated with reduced rates of OR returns.
LEVEL OF EVIDENCE: 3:

Keywords:  TXA; adenotonsillectomy; post‐tonsillectomy bleeding; post‐tonsillectomy hemorrhage; quality improvement; tranexamic acid

DOI:  https://doi.org/10.1002/lary.70641
Pediatr Emerg Care. 2026 May 25.

Past, Present, and Future: The Legacy of the Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC).

Sara M Touzinsky, Catherine Coughlin, Michael Harries, Lise E Nigrovic, Paul L Aronson.

  The Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC) is the research subcommittee of the American Academy of Pediatrics (AAP) Section on Emergency Medicine. Volunteer-led, the committee has a long history of supporting and facilitating high-impact multicenter pediatric emergency medicine research as well as nurturing future pediatric emergency medicine researchers. Currently, the 76 contributing sites across the United States, Canada, and Spain provide an avenue to investigate topics related to the emergency care of children with adequately powered, generalizable studies. We describe the history of PEM CRC, the impact on the field of pediatric emergency medicine, and future goals.

Keywords:  pediatric emergency medicine collaborative research committee

DOI:  https://doi.org/10.1097/PEC.0000000000003629
Pediatrics. 2026 May 26. pii: e2026077027. [Epub ahead of print]

Generic and Biosimilar Prescribing in Children and Adolescents: Policy Statement.

Committee on Drugs

Guidance from the American Academy of Pediatrics on generic drugs was last published in 1987. The regulatory process for development of a new generic product in place of the reference brand-name drug requires extensive US Food Drug and Administration (FDA) standards for similarity to ensure the same safety and effectiveness profiles as the reference drug. Since the last statement was published, the growth in biologic agents and the development of biosimilars as alternatives to the originator have become more common across the United States. Generic drugs are identical to the brand name drug and must meet the regulatory standard of bioequivalence, whereas biosimilars are "highly similar" but may differ in clinically inactive components and even molecular structure, as long as these differences are not "clinically meaningful." Confidence in the development and approval of generic and biosimilar medications should guide providers toward generic and biosimilar substitution. The recommendations included in this policy statement are intended to support generic substitution and substitutions with interchangeable biosimilars in accordance with the FDA while promoting interdisciplinary interaction between pediatric prescribers and pediatric pharmacists.

DOI: https://doi.org/10.1542/peds.2026-077027
Front Pediatr. 2026 ;14 1825355

Treatment of pediatric flatfoot: a systematic review-based consensus and guidelines by CPAM-LRC.

Sharula, Fei Zhao, Tianyi Wu, Qinglin Kang, Xiang Geng, Hui Qin, Yan Zhang, Jin He, Lihua Huang, Jia Xu, Shengdi Lu.

  The purpose of this clinical practice guideline is to provide evidence-based recommendations for the treatment of pediatric flexible flatfoot, developed in accordance with the Appraisal of Guidelines for Research and Evaluation II framework and with evidence certainty assessed using the GRADE framework and the Oxford Centre for Evidence-Based Medicine levels of evidence system. A multidisciplinary guideline development group under the Limb Reconstruction Committee of the Orthopedics Branch of China International Exchange and Promotion Association for Medical and Health Care systematically searched and reviewed evidence from primary studies including randomized controlled trials, cohort studies, and comparative studies, supplemented by existing systematic reviews and expert society surveys, to evaluate the effectiveness of conservative and surgical interventions and to guide clinicians and families on the content of an optimal treatment pathway. The guideline targets children and teenagers with flexible flatfoot and addresses interventions available to orthopedic surgeons, podiatrists, rehabilitation physicians, and orthotists, including observation, rehabilitative exercises, foot orthoses, subtalar arthroereisis, calcaneal osteotomy, and criterion-based progression to surgery. Structured conservative management should be considered the mainstay of care for all symptomatic children, with a minimum 6-month trial before surgical referral. However, there is limited evidence on the optimal type, dose, and duration of conservative treatment, and what constitutes an adequate trial of nonoperative care remains undefined. Foot orthoses can be helpful for symptomatic relief when pain or functional limitation is present, and rehabilitative exercise programs may allow superior normalization rates compared to orthoses alone. Pain-free ambulation and return to unrestricted sport are key milestones for both conservative and surgical pathways. However, no validated progression or discharge criteria exist to guide the transition from one treatment phase to the next. While the certainty of evidence was low to very low for most components of the treatment pathway, all 15 recommendation statements were formulated through two rounds of Delphi consensus polling, with 13 achieving the predefined ≥75% agreement threshold. This guideline also highlights the need for standardized diagnostic definitions, multicenter registry data, and age-stratified surgical indications not systematically addressed in previously published literature.

Keywords:  calcaneal osteotomy; clinical practice guideline; delphi consensus; flexible pes planus; foot orthoses; pediatric flatfoot; subtalar arthroereisis

DOI:  https://doi.org/10.3389/fped.2026.1825355
J Neurotrauma. 2026 May 27. 8977151261452924

Screen Time after Concussion: Still Searching for Just Right.

Theodore Macnow, Rebekah Mannix.

DOI: https://doi.org/10.1177/08977151261452924
Curr Opin Cardiol. 2026 May 20.

Cardioneuroablation for children with syncope.

Mitchell I Cohen, Jordan A Cohen.

   PURPOSE OF REVIEW: Children with recurrent syncope with prolonged pauses who have failed traditional therapies may be candidates for a cardioneuroablation as an alternative to pacemaker implantation. This article reviews cardioneuroablation in the pediatric population.
RECENT FINDINGS: Cardioneuroablation has been used in adults for cardioinhibitory syncope for more than 2 decades with promising results. Despite the heterogenous patient population and variation in technical approaches to the procedure, between 85 and 90% of patients have a significant reduction in syncope and improvement in quality of life. While the data in children is limited, reports have shown similar success. Catheter ablation of ganglionated plexuses can be performed by ablating in the right or left atrium or both. The long-term effects in disrupting the sympathovagal imbalance remains unknown.
SUMMARY: Cardioneuroablation may be an option for select children with cardioinhibitory syncope who have failed standard medical approaches. Early results of vagal ablation in children have been promising. Future long-term registries following cardioneuroablation is needed.

Keywords:  autonomic ablation; cardioneuroablation; syncope; vagal

DOI:  https://doi.org/10.1097/HCO.0000000000001305
Pediatr Blood Cancer. 2026 May 26. e70408

Child and Adolescent Cancer Communication Preferences for Information Exchange: A Meta-Synthesis.

Ginny L Schulz, Katherine Patterson Kelly, Kimberly A Pyke-Grimm.

  The communication needs of children and adolescents (C&A) with cancer are not being met. Understanding C&A communication experiences and preferences from their perspective is critical to patient-centered care and health outcomes. Our objective was to systematically review and synthesize qualitative data to describe C&A less than 18 years of age self-reported preferences for cancer communication specific to information exchange. We conducted a search in PubMed, PsycINFO, CINAHL, and SCOPUS databases and applied the Joanna Briggs Institute qualitative review methods. Studies with participants less than 18 years of age with childhood cancer were included in this synthesis. A total of 3241 articles were identified, with 69 articles included. In all, 365 findings related to preferences for exchanging information were extracted from 57 studies. The findings were aggregated into six synthesized findings: (i) How I receive information, (ii) When I want information, (iii) How my healthcare team shares information with me, (iv) How my parents share information with me, (v) How I get information, and (vi) When I do not want information. This meta-synthesis highlights that C&A with cancer have individual preferences for information exchange related to their treatment and can voice their preferences. Evidence-based practice recommendations were identified to meet their communication needs and preferences.

Keywords:  adolescents; cancer communication; children; information exchange; pediatric cancer

DOI:  https://doi.org/10.1002/1545-5017.70408
Am J Emerg Med. 2026 May 22. pii: S0735-6757(26)00245-7. [Epub ahead of print]107 94-100

Early vs delayed opioid administration for pediatric sickle cell vaso-occlusive crisis: A systematic review and meta-analysis.

Ayesha Khalid, Alexandra Salazar Riaño, Jonathan D Mohnkern, Marwa Ibrahim, Vedanti Dave, Joshua Hess, Paul T Finch, Thaís S Martins Shehan.

   IMPORTANCE: Sickle cell disease is frequently complicated by vaso-occlusive events, which represent one of the leading causes of acute pain and emergency care utilization in pediatric patients. However, there is limited and inconsistent data about the time to administer opioids in pediatric patients with sickle cell vaso-occlusive episodes (VOE).
OBJECTIVE: We aim to conduct a systematic review and meta-analysis to compare early and delayed opioid administration in pediatric patients with VOE.
DATA SOURCES: We systematically searched PubMed, Embase, and Cochrane Library from inception to November 2025.
STUDIES SELECTION: Randomized controlled trials or observational studies comparing early and delayed opioid administration in pediatric patients with sickle cell VOE. Five reviewers independently screened titles and abstracts, followed by full-text evaluation of potentially eligible articles. Disagreements were resolved through discussion and adjudication by a third reviewer.
DATA EXTRACTION AND SYNTHESIS: We followed PRISMA guidelines. Data were independently extracted by multiple reviewers.
MAIN OUTCOMES AND MEASURES: Our main endpoint was hospital admission from the index emergency department (ED) visit. Additional endpoints included ED discharge, ED length of stay, and pain reassessment. Risk ratios (RRs) were calculated for binary outcomes and mean differences (MDs) or standardized mean differences (SMD) for continuous outcomes with 95% confidence intervals (CIs). We performed a random-effect meta-analysis for all outcomes using R software (version 4.3.2).
RESULTS: Six studies comprising 3367 patients were included, of whom 67% received early and 32% delayed opioid. The mean age was 9-16 years, and males accounted for 50% of participants. There was no significant difference when comparing early vs delayed opioid administration for hospital admission (RR 0.96; 95% CI 0.85 to 1.10), ED discharge (RR 1.04, 95% CI 0.89 to 1.22), ED length of stay (MD -6.02 min; 95% CI -1.22,45 to 110.42) and pain reassessment (SMD 0.85; 95% CI -1.92 to 3.63). A subgroup analysis comparing ≤60 min with ≥60 min of opioids administration also showed no difference between intervention arms. Individual studies showed potential benefits with timely repeat opioid dosing and the use of intranasal fentanyl (INF).
CONCLUSIONS AND RELEVANCE: Our analysis showed no difference comparing early and delayed opioid administration in pediatric patients with sickle cell related VOE across hospital admission, ED discharge, ED length of stay, and pain reassessment.

Keywords:  Expert consensus; Opioid analgesia; Pediatric emergency medicine; Sickle cell disease; Vaso-occlusive crisis; meta-analysis

DOI:  https://doi.org/10.1016/j.ajem.2026.05.031
Hosp Pediatr. 2026 May 27. pii: e2025008480. [Epub ahead of print]

Impact of the 2025 Accreditation Council for Graduate Medical Education Pediatric Residency Changes on the Pediatric Hospital Medicine Workforce.

Rachel J Peterson, Kelsey Jackson, Danni Liang, Katherine A Auger, H Barrett Fromme, Anika Kumar.

OBJECTIVE: The 2025 Accreditation Council for Graduate Medical Education (ACGME) changes to the pediatric residency curriculum may impact the clinical workforce caring for hospitalized children. Prior to these changes, we sought to assess how pediatric hospital medicine (PHM) leaders anticipated the changes would impact staffing, clinical operations, and career satisfaction for their groups.
METHODS: In 2024, we developed and distributed a survey to Hospital Medicine division directors asking about their pre-ACGME changes to staffing models, any anticipated ACGME change-related staffing adjustments and accommodation plans. The survey included questions on perceived group career satisfaction and institutional support. Data were analyzed using descriptive statistics, and open-ended responses were categorized.
RESULTS: Of 165 distinct PHM programs, leaders from 101 PHM programs completed surveys. Regarding residency staffing related changes, 31% of leaders anticipated a decrease in pediatric resident presence on PHM services, and 23% were unsure about changes in resident presence. Most PHM leaders (70%) were contemplating, exploring, or implementing the hiring of hospitalists prior to the ACGME's execution of residency changes. Anticipated staffing changes, increased hiring of advanced practice providers, and increased current hospitalist shift coverage were all significantly correlated with leaders' concern for decreased hospitalist career satisfaction.
CONCLUSION: PHM group leaders anticipated additional staffing hires prior to the implementation of the 2025 ACGME pediatric residency changes. Increased workload and staffing concerns correlated with lower anticipated career satisfaction, highlighting the need for additional support for PHM groups.

DOI: https://doi.org/10.1542/hpeds.2025-008480
Children (Basel). 2026 Apr 30. pii: 622. [Epub ahead of print]13(5):

Care Pathway and Outcomes in Pediatric Septic Shock: A Narrative Review from Emergency Department Recognition to PICU Management.

Efrossini Briassouli, George Briassoulis.

   BACKGROUND: Pediatric septic shock remains a major cause of morbidity and mortality and requires timely recognition and management across multiple hospital settings. Although intensive care support is critical, outcomes are also influenced by earlier phases of care, including emergency department recognition, first-hour treatment, inpatient monitoring, and timely escalation to the pediatric intensive care unit (PICU).
OBJECTIVE: We aimed to review pediatric septic shock across the full hospital trajectory, from emergency department recognition to PICU management and outcomes, with emphasis on diagnostic challenges, early treatment, escalation of care, and prognostic assessment.
METHODS: This narrative review was based on a structured literature search of PubMed/MEDLINE, Scopus, and the Cochrane Library, with emphasis on international guidelines, consensus statements, systematic reviews, and clinically relevant pediatric studies addressing recognition, resuscitation, escalation, intensive care management, and outcomes in pediatric septic shock.
RESULTS: Pediatric septic shock is best approached as a dynamic continuum rather than a single event. Early recognition is complicated by age-dependent physiology, nonspecific presentation, and delayed hypotension. Timely antimicrobial therapy, individualized fluid resuscitation, early vasoactive support, and repeated reassessment during the first hours are central to management. Ward surveillance and prompt escalation to PICU are critical, as delayed recognition of deterioration may worsen organ dysfunction and resource use. In the PICU, phenotype-informed hemodynamic support, fluid stewardship, respiratory support, and organ support are essential. Outcomes should be evaluated beyond mortality to include organ dysfunction burden, duration of support, length of stay, and longer-term functional recovery.
CONCLUSIONS: Pediatric septic shock outcomes are shaped by the entire hospital care pathway rather than PICU treatment alone. A trajectory-based, continuum-of-care approach may improve timely diagnosis, escalation, and short- and longer-term outcomes.

Keywords:  PICU; care pathway; emergency recognition; pediatric; prognostic tools; septic shock

DOI:  https://doi.org/10.3390/children13050622
Children (Basel). 2026 Apr 29. pii: 618. [Epub ahead of print]13(5):

Chronic Cancer-Related Pain in Children: A Narrative Review of Multimodal and Family-Centered Palliative Care Approach.

Ada Maria Carstea, Alexandra Borda, Raluca Morosan, Adriana Elena Pittner, Estera Boeriu, Cristina Ionasiu Rebreanu, Stanciu-Lelcu Theia, Vulcanescu Dan Dumitru, Maria Mirabela Mihailescu Marin.

  Background: Chronic pain in children with cancer is a major challenge in pediatric palliative care. It results from the interaction of disease-related and treatment-related factors, psychological distress, and the child's family and social environment. When poorly controlled, it can impair quality of life, emotional development, social functioning, and family well-being. This narrative review examines the challenges and management strategies for chronic pain in children with cancer from a pediatric palliative care perspective, with attention to pain mechanisms, assessment difficulties, and psycho-emotional influences. Methods: This narrative review was based on a structured literature search conducted in PubMed/MEDLINE, Scopus, and Web of Science for English-language articles published between January 2000 and October 2025. Of 135 records identified, 15 studies judged most relevant to the thematic scope of the review were included in the final synthesis. A PRISMA-based flowchart was used to illustrate study identification and selection without implying a formal systematic review. Results: Chronic pain in children with cancer emerged as a multidimensional problem requiring an integrated approach to assessment and management, and some studies suggest that 20-26% of childhood cancer survivors experience persistent pain. Pharmacological strategies, including opioids and adjuvant medications, remain central, while psychological, supportive, and non-pharmacological interventions may complement multimodal care. Conclusions: Chronic pain in children with cancer should be managed through an integrated, individualized, and child-centered approach that addresses the physical, emotional, social, and relational dimensions of suffering and may improve quality of life for both children and their families.

Keywords:  children with cancer; chronic pain; family-centered care; pain management; pediatric oncology; pediatric palliative care; psychosocial support

DOI:  https://doi.org/10.3390/children13050618
J Perinatol. 2026 May 26.

Farewell to PGY-6? Addressing the realities of pediatric fellowship training.

Satyan Lakshminrusimha, Clara Song, Robin H Steinhorn.

The shortages in pediatric subspecialist workforce are threatening care of children in the US. A prolonged residency plus fellowship of 6 years and relatively low salaries may discourage medical students from choosing pediatric fellowship training. To address this "subspecialty shortage," the American Board of Pediatrics (ABP) recently announced a fundamental shift toward competency-based medical education (CBME). This proposal reduces fellowship training duration to a two-year clinical track option. This change is likely to start as early as 2028. We propose an alternate approach that is similar in length (5-years) but with a shorter residency (2-years) and a three-year fellowship for procedural-based subspecialties in pediatrics, cardiology and intensive care fields, such as neonatal-perinatal medicine (NPM), and pediatric critical care medicine (PCCM).

DOI: https://doi.org/10.1038/s41372-026-02737-3
Int J Nurs Stud Adv. 2026 Jun;10 100550

Managing pediatric pain during needle procedures: a narrative review of virtual reality and Buzzy as distraction-based interventions.

Maia Medland, Brian Greeley, Roi Jankelowitz, Sima Zakani, John Jacob.

   Background: : Needle-induced pain is common in children and can contribute to negative healthcare experiences. While pharmacological treatments can be effective, they may involve delayed onset and potential side effects. This narrative review explores two non-pharmacological alternatives, virtual reality and Buzzy (a device that combines cold therapy and vibration), as pain management tools during pediatric needle procedures. While there have been many studies using these methods, results have been mixed. The overall goal of this narrative review is to summarize higher quality studies on the use of virtual reality and Buzzy for managing needle-related pain in pediatric populations, with particular attention to how concurrent analgesic use, age, and study design may explain the variability observed in previous findings.
Methods: : Eligible articles included randomized controlled trials with a sample size ≥30 per group, typically developing children and youth, a control group, both a pre- and post-procedural self-reported measure of pain, published between 2015 and 2025, and available in English.
Results: : Ninety-nine articles were identified and 86 were excluded, of which 46 (53%) did not report pre-procedural pain. Thirteen articles met the inclusion criteria: ten on virtual reality and three on Buzzy. Results were mixed, however virtual reality and Buzzy were generally more effective in reducing needle-related pain when standard of care did not include analgesics. When examined by age, younger children showed more consistent benefits, particularly with virtual reality, whereas older children and adolescents demonstrated smaller or non-significant effects regardless of analgesic use.
Conclusion: : Virtual reality and Buzzy appear to be effective in managing needle-related pain in children; however, their effectiveness may be influenced by concurrent analgesic use, age, and intervention design. More research is needed to better understand when these interventions are most effective and for whom.

Keywords:  Buzzy; Children; Distraction; Needle-related procedures; Pain management; Pediatrics; Virtual reality

DOI:  https://doi.org/10.1016/j.ijnsa.2026.100550
Pediatr Pulmonol. 2026 May;61(5): e71678

Protocolized Weaning From Mechanical Ventilation in the PICU: A Systematic Review and Meta-Analysis.

Letícia Nascimento Machado, Humberto Magalhães Silva, Isabel de Siqueira Ferraz, Gregory Lui Duarte, Flávia Andrea Krepel Foronda, Toshio Matsumoto, Roberto José Negrão Nogueira, Tiago Henrique De Souza.

   BACKGROUND: The use of standardized weaning protocols for invasive mechanical ventilation (IMV) is well established in adult critical care, but evidence in pediatric populations remains limited and heterogeneous.
OBJECTIVE: To evaluate the impact of protocolized weaning compared to usual care on clinical outcomes in pediatric intensive care units (PICUs).
METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and non-randomized interventional studies comparing protocolized weaning with usual care in critically ill children. Databases searched included PubMed, Embase, Cochrane Library, and ClinicalTrials.gov, through July 2025, without language or date restrictions. Two reviewers independently extracted data and assessed risk of bias using RoB 2 and ROBINS-I tools.
RESULTS: Seventeen studies were included (seven RCTs and ten non-randomized studies), involving 16,805 pediatric patients. Among RCTs, protocolized weaning showed a non-significant trend toward reduced IMV duration (mean difference [MD]: -9.68 h; 95% CI: -19.62 to 0.26; p = 0.06). Non-randomized studies showed a significant reduction (MD: -30.30 h; 95% CI: -59.42 to -1.18; p = 0.04). In the combined analysis, protocolized weaning was associated with a statistically significant reduction in IMV duration (MD: -20.86 h; 95% CI: -33.31 to -8.40; p = 0.001). PICU length of stay was also reduced in the overall analysis, though not in RCTs alone. No significant differences were observed for hospital length of stay, extubation failure, or mortality. Trial Sequential Analysis showed that current RCT evidence remains inconclusive.
CONCLUSIONS: Protocolized weaning was associated with shorter mechanical ventilation duration in some analyses, although the certainty of this evidence is low due to high risk of bias and heterogeneity.

Keywords:  extubation readiness; mechanical ventilation; pediatric intensive care; spontaneous breathing trial; weaning protocols

DOI:  https://doi.org/10.1002/ppul.71678
Laryngoscope. 2026 May 27.

Safety Profile of Nebulized Ciprofloxacin-Dexamethasone After Pediatric Airway Surgery.

Abbey L Landini, Cyrus W Abrahamson, Maya Frost, David Spielberg, Inbal Hazkani, Dana M Thompson, Jonathan B Ida, Sarah Maurrasse, Taher Valika.

   OBJECTIVE: To evaluate the safety profile and patterns of use of nebulized ciprofloxacin-dexamethasone (CPD) in pediatric patients undergoing airway surgery.
METHODS: A retrospective chart review was performed of patients who underwent airway surgery at a tertiary pediatric center between 2019 and 2023 and received nebulized CPD 0.3%-0.1% postoperatively. Demographic, clinical, and procedural data were extracted. Exposure was defined as any postoperative nebulized administration. Adverse events were considered potentially CPD-related if they occurred during administration or within 30 days of discontinuation without a better explanation. Outcomes included endocrine, metabolic, infectious, pulmonary, and inflammatory complications.
RESULTS: A total of 399 patients received nebulized CPD. Mean age was 46.2 months (range: newborn-20.7 years). Indications included subglottic stenosis (92.5%), post-laryngotracheal reconstruction (5.3%), airway foreign body (2.0%), and supraglottoplasty (0.3%). Comorbidities were frequent, including neurologic conditions (47.6%), cardiac anomalies (41.6%), and bronchopulmonary dysplasia (25.1%). Most patients (93.4%) received CPD in the inpatient setting, for a mean duration of 11.7 days. No cases of adrenal suppression, glucose abnormalities, or bronchial hyperreactivity were identified. One patient had suspected airway fungal infection while receiving chemotherapy, though pathology was negative. Among the 85.7% of patients who underwent postoperative endoscopic evaluation, no significant inflammatory findings were observed.
CONCLUSION: Nebulized CPD Was Uniformly Incorporated Into Postoperative Airway Management in This Large Pediatric Cohort and Well Tolerated, With no Significant Adverse Events Observed. These Findings Support the Safety of CPD in Medically Complex Children and Highlight the Need for Multicenter Prospective Studies to Evaluate Efficacy and Optimize Dosing Protocols.
LEVEL OF EVIDENCE: 3:

Keywords:  adverse events; ciprofloxacin‐dexamethasone; nebulized therapy; pediatric airway surgery; safety; subglottic stenosis

DOI:  https://doi.org/10.1002/lary.70643
Front Pediatr. 2026 ;14 1814470

Nurses' perspectives on pain management in pediatric care: systematic review and meta-synthesis.

Majd Elmobasher, Hui Tao, Jing Guo, Issam AbuQeis, Abeer Teeti, Yu Wang, Ma Fang.

   Background: Pain remains one of the most frequently misinterpreted, underdiagnosed, and inadequately managed clinical conditions in pediatric populations. An estimated 50%-70% of pediatric patients experience undertreated pain, which can have serious negative effects on their overall health and well-being. Our study aims to identify, appraise, and synthesize qualitative studies exploring nurses' perspectives on pain management for pediatric patients to develop a conceptual understanding of facilitators and barriers from the nurses' perspective.
Methods: This review was registered with PROSPERO (CRD420251034205). A comprehensive literature search was conducted across CINAHL, PubMed, and Nursing journals for English-language studies. The SPIDER framework was used to guide the selection of qualitative studies. Inclusion and exclusion criteria were applied following the PRISMA 2020 guidelines, resulting in the inclusion of nine studies in the final synthesis. Confidence in the synthesized findings was assessed using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research) approach.
Results: Analysis of nine qualitative studies identified five interconnected themes shaping nurses' perceptions of pediatric pain management. Being Defeated by Pain reflected nurses' emotional and professional struggles with persistent or poorly managed pain. Family Participation is a Necessity emphasized the vital role of caregivers in assessment and decision-making. Evidence-Based vs. Experience-Based Pain Assessment revealed tension between adherence to clinical guidelines and reliance on personal judgment. Pharmacological vs. Non-Pharmacological Interventions highlighted challenges in selecting appropriate treatment strategies within practical constraints. Culture-Related Pain Management illustrated how cultural beliefs influence both pain assessment and intervention. Collectively, these themes underscore the complex, multifaceted nature of pediatric pain care from the nursing perspective. The GRADE-CERQual assessment indicated high confidence in the findings for "Being Defeated by Pain" and "Pharmacological vs. Non-Pharmacological Interventions," and moderate confidence for the remaining three themes.
Conclusions: Nurses face multifaceted challenges in pediatric pain management. Targeted, culturally sensitive strategies are needed to enhance nursing competence and quality of care.

Keywords:  barriers; meta-synthesis; nurses' perspectives; nursing practice; pain assessment; pediatric pain management; qualitative research

DOI:  https://doi.org/10.3389/fped.2026.1814470
J Pediatr Surg. 2026 May 25. pii: S0022-3468(26)00297-6. [Epub ahead of print] 163214

Comparing Neighborhood Deprivation Metrics in Pediatric Trauma: Is There a Better Predictor?

Emily K Myers, Kaci Pickett-Nairne, Keren Eyal, Kathleen Adelgais, Jose Diaz-Miron, Shannon N Acker.

   BACKGROUND: Neighborhood deprivation (ND) impacts pediatric trauma, the leading cause of mortality in children. The aim of this work was to compare the association of three common neighborhood deprivation metrics (NDMs) with pediatric trauma mechanisms and injury severity.
METHODS: This was a retrospective analysis of trauma patients ≤ 18-years-old presenting to a single level 1 pediatric trauma center from 1/2016 to 12/2021. NDMs utilized were the Area Deprivation Index (ADI), Childhood Opportunity Index (COI), and Social Vulnerability Index (SVI). Patients were divided into NDM quintiles. Descriptive statistics were used to compare the baseline characteristics of the study population. Univariable regression models were fit to examine the association with pediatric trauma mechanisms and severity. The area under the curve (AUC) was calculated and compared with a contrast test. The same analysis was performed for multivariable regressions.
RESULTS: Higher ND patients were younger, more often of Black race or Hispanic/Latinx ethnicity, and had government/Medicaid insurance. A higher percentage of auto-pedestrian, motor vehicle collisions (MVC), non-accidental trauma (NAT)/assault/neglect, and penetrating injuries occurred at high ND. Models incorporating COI had the highest predictive ability for MVC, sports, and ICU length-of-stay (LOS) ≥ 3 days. Models incorporating ADI had the highest predictive ability for Intensive Care Unit (ICU) admission, and Injury Severity Score (ISS) > 15. These differences in predictive ability persisted on multivariable analysis for sports, ISS > 15, and ICU LOS ≥ 3 days.
CONCLUSIONS: The NDMs were all associated with differences in injury mechanism/severity and can be used as ND markers in future pediatric trauma research.
TYPE OF STUDY: Retrospective cross-sectional analysis LEVEL OF EVIDENCE: Level IV.

Keywords:  Pediatric trauma; injury prevention; neighborhood deprivation

DOI:  https://doi.org/10.1016/j.jpedsurg.2026.163214