bims-cliped Biomed News
on Clinical pediatrics
Issue of 2026–06–14
43 papers selected by
Alyssa M. Portwood, Akron’s Children
  1. Association Between Primary Care Access and Emergency Department Utilization.
  2. Institutional Variation in Cervical Spine Imaging Among Children with Blunt Trauma: A Multicenter Prospective Observational Cohort Study.
  3. Pediatric Trauma Center Utilization for Children Transported by Emergency Medical Services.
  4. Bundle implementation for reduction of central venous catheter associated bloodstream infections in pediatric intensive care unit - A systematic review.
  5. The Role of the Pediatric Pharmacist in Precision Medicine and Clinical Pharmacogenomics for Children.
  6. Adoption of a Pediatric Acute Care Cardiology Inpatient Model.
  7. The Feasibility and Acceptability of Mobilizing Community Paramedics to Provide the Standard of Care for Pediatric Concussion: Mobile Integrated Health Programing for Pediatric Patients.
  8. Supporting Safer Surgery: System-Level Interventions to Enhance Pediatric Perioperative Safety.
  9. Multidisciplinary Timely Debrief Sessions after Cardiac Arrests and Endotracheal Intubations in the Pediatric Emergency Department.
  10. Ethical Considerations When Referring Patients for a Higher Level of Care.
  11. Bedside Intussusception Diagnosis and Reduction: A Comprehensive Emergency Department Process for Bedside Intussusception Diagnosis and Reduction.
  12. Differences in Antibiotic Prescribing Patterns for Children with Acute Otitis Media Based on Patient, Clinician, and Clinic Characteristics.
  13. Issues navigating the healthcare delivery system among caregivers of children and youth with special healthcare needs: a qualitative study.
  14. A Framework for Building an Inclusive Quality Program in a Pediatric Heart Center.
  15. Reunification of displaced children in a disaster: Can children provide information necessary for reunification?
  16. Oncofertility in Pediatric and Adolescent Patients: Current Practice and Future Directions.
  17. Updates on drug-induced anaphylaxis in children.
  18. Racial and Ethnic Disparities in Care for Pediatric Sleep-Disordered Breathing.
  19. Caffeine treatment for apnea in infants and children: protocol for a systematic review and meta-analysis.
  20. Streamlining Kawasaki disease care: a quality improvement initiative to safely reduce length of stay.
  21. Clinical perspectives on pediatric weight-management programs: A nationwide look at models of care.
  22. Artificial intelligence in pediatric intensive care units: current applications in sepsis management.
  23. A Quality Improvement Project to Increase Pharmacist-Initiated Methicillin Resistant Staphylococcus Aureus Nasal Swab PCR for Vancomycin De-Escalation in Pediatric Patients With Respiratory Tract Infections.
  24. Novelties in the pragmatic management of anaphylaxis in pediatric age.
  25. Medical assistance in dying in pediatrics: a retrospective case study of clinical interactions and implications for team training.
  26. How Parent Caregivers of Children with Medical Complexity Respond to Patient Safety Events at Home.
  27. Food insecurity and hospital resource utilization.
  28. Environmental sustainability in palliative care: a narrative review.
  29. Context Matters: Variation in Pharmacologic Management of Pediatric Agitation Across Emergency and Inpatient Psychiatric Settings.
  30. Feasibility and implementation of a daily safety brief at a children's hospital-in-a-hospital.
  31. Pediatric concussion beyond sports: Falls, play, and everyday activities.
  32. Rotavirus Vaccine Coverage and Potential Barriers Among US Children Born From 2007 to 2024.
  33. Effect of Opt-Out HIV Testing for Adolescent Patients on a Pediatric Hospital Medicine Service.
  34. Pediatric ACL Injuries: A Current Concepts Review.
  35. Language Development in Bilingual Children: A Pediatrician's Guide.
  36. Are Pediatric Hospitalists Prepared to Supervise Fellows? A National Survey of Program Directors.
  37. Comparing non-operative management of abdominal solid organ injuries in pediatric and adult blunt trauma: A meta-analysis and systematic review.
  38. Supporting the health of unaccompanied immigrant children in a humanitarian crisis: An American Academy of Nursing consensus paper.
  39. Influenza Vaccination Trends Among Children and Adolescents, 2017-2023.
  40. Diagnostic Stewardship to Optimize Blood Culture in a Pediatric Cardiac Intensive Care Unit.
  41. Advancements in Respiratory Syncytial Virus (RSV) Prevention and Treatment in Pediatrics.
  42. Improving concussion recognition in youth sports: the role of parents, coaches, and community education.
  43. Inpatient Characteristics and Outcomes of Venous Thromboembolism Among Children and Adolescents.
  1. J Pediatr. 2026 Jun 07. pii: S0022-3476(26)00216-7. [Epub ahead of print] 115188
    Association Between Primary Care Access and Emergency Department Utilization.
    Lukas K Gaffney, Todd W Lyons, Michael C Monuteaux, Joel Hudgins.
       OBJECTIVES: To examine the association between primary care pediatrician (PCP) access and emergency department (ED) utilization and reliance for children, and to determine whether lack of PCP, limited after hour availability, and greater distance to care would be associated with higher ED utilization and reliance.
    STUDY DESIGN: We performed a retrospective, cross-sectional study of non-elective visits for children <18 years old in 2021-2022, utilizing the nationally representative Medical Expenditure Panel Survey. Primary outcomes were frequent ED utilization (>2 emergency visits annually) and high ED reliance (one-third or more of all medical visits occurring in the ED). We assessed the relationship between PCP access and the outcomes using logistic regression, adjusting for age, sex, race and ethnicity, and special healthcare need.
    RESULTS: We included 9,878 surveyed children, who were representative of 72,549,476 children nationally. 60,353,592 (83.2%) children had identified PCP. Lack of PCP was associated with high ED reliance (adjusted odds ratio 1.78, 95% confidence interval 1.26-2.50) but showed no significant association with frequent ED utilization (adjusted odds ratio 0.60, 95% confidence interval 0.34-1.08). Among children with identified PCP, neither travel time to PCP, ease of contact with phone or email, ease of contact after hours, nor nighttime and weekend availability was associated with either outcome.
    CONCLUSIONS: Lack of PCP is strongly associated with greater reliance on the ED as a source of medical care, but not with frequent ED utilization. Policymakers can use these data to tailor programs to the needs of specific groups that would most benefit from improved access to care.
    Keywords:  emergency care; emergency department reliance; health care utilization; primary care
    DOI:  https://doi.org/10.1016/j.jpeds.2026.115188
  2. J Pediatr. 2026 Jun 05. pii: S0022-3476(26)00217-9. [Epub ahead of print] 115189
    Institutional Variation in Cervical Spine Imaging Among Children with Blunt Trauma: A Multicenter Prospective Observational Cohort Study.
    PECARN C-Spine Study Team
       OBJECTIVE: To describe institutional variation in use of cervical spine radiographs (x-ray) and computed tomography (CT) among children evaluated following blunt trauma.
    STUDY DESIGN: We conducted a planned secondary analysis of a multicenter, observational cohort study of children 0-17 years old evaluated for possible cervical spine injury (CSI) in 18 emergency departments (EDs) from December 2018-October 2021. Our primary outcome was any ED cervical spine x-ray or CT, and our secondary outcome was use of CT only. We performed univariable logistic regression, reporting ED-level unadjusted and injury severity adjusted proportions of children with any cervical spine imaging and CT only, stratified by presenting ED type (referring general ED vs pediatric ED). Severity adjustment was based on Pediatric Emergency Care Applied Research Network high-risk predictors (GCS 3-8, unresponsiveness, abnormal airway/breathing/circulation, and focal neurologic deficits).
    RESULTS: We enrolled 22,430 eligible children, of whom 17.9% (n=4,008) were referred from a general ED. Cervical spine x-ray or CT was performed in 52.9% (n=11,865) and 1.9% (n=433) were diagnosed with a CSI. After adjusting for severity, imaging proportions were similar within each ED type (referring general EDs and pediatric EDs). Among children whose initial evaluation occurred in a referring general ED, 71.3% underwent any cervical spine imaging and 32.3% underwent CT as the sole modality. Among children presenting directly to a pediatric ED, the corresponding proportions were 48.9% and 7.9%.
    CONCLUSIONS: In this observational study of children with potential CSI, those managed in referring general EDs and transferred to pediatric EDs more frequently underwent cervical spine imaging, including CT as the sole modality, than those presenting directly to pediatric EDs. These data can inform future benchmarking to assess concordance after implementation of the PECARN CSI decision rule.
    Keywords:  Spinal Injuries; Tomography; Wounds and Injuries; X-Ray Computed
    DOI:  https://doi.org/10.1016/j.jpeds.2026.115189
  3. Prehosp Emerg Care. 2026 Jun 11. 1-14
    Pediatric Trauma Center Utilization for Children Transported by Emergency Medical Services.
    Kendall J Donohue, Lois K Lee, Michael Monuteaux, Eric W Fleegler, Caitlin Farrell.
       OBJECTIVES: Pediatric trauma remains a leading cause of morbidity and mortality in the United States, and care at pediatric trauma centers (PTCs) is associated with improved outcomes. However, national patterns of emergency medical services (EMS) transport to PTCs for injured children meeting trauma center criteria are not well described. We sought to evaluate EMS transport patterns among injured children meeting American College of Surgeons (ACS) trauma center criteria and to identify factors associated with transport to a PTC.
    METHODS: We conducted a retrospective cohort study using the National EMS Information System (NEMSIS) public-release database from 2019-2022. We included patients younger than 16 years who were transported by EMS for injury and met ACS trauma center field triage criteria. Patient-level EMS data were linked with geographic information system (GIS) road network analyses of trauma center locations to assess geographic access to pediatric and general trauma centers. Geographic access was defined as being within a 60-minute ground transport interval to a trauma center. The primary outcome was EMS transport to a designated PTC among children meeting trauma criteria and with geographic access to a PTC. Secondary measures included patient demographics, injury characteristics, urbanicity, region, and EMS scene and transport intervals. Multivariable logistic regression was used to identify factors independently associated with transport to a PTC.
    RESULTS: Of 793,459 injured children transported by EMS, 97,985 (12.3%) met trauma center criteria. Among those with access to a PTC (n = 54,923, 56%), only 40.6% were transported to one. Males and children with firearm injuries were more likely to reach a PTC, whereas adolescents, suburban, or rural patients were less likely. Median transport interval was 20 minutes for PTC transports versus 15 minutes for others.
    CONCLUSIONS: Despite meeting field triage criteria and having geographic access, less than half of injured children meeting trauma center criteria were transported to PTCs. Interventions to increase appropriate transport to PTCs and enhance pediatric readiness at non-PTCs are needed to optimize trauma care for children.
    Keywords:  Emergency medical services; Geographic access; Pediatric trauma; Pediatric trauma centers; Prehospital triage; Trauma systems
    DOI:  https://doi.org/10.1080/10903127.2026.2685690
  4. Infect Dis Health. 2026 Jun 12. pii: S2468-0451(26)00022-2. [Epub ahead of print]31(3): 100428
    Bundle implementation for reduction of central venous catheter associated bloodstream infections in pediatric intensive care unit - A systematic review.
    Hanna Clemente Rosenvald, Luiza Duarte de Barros, Hyan Bacelete, Maria Letícia Barbosa Braga Souza, Wanessa Trindade Clemente, Daniela Caldas Teixeira, Roberta Maia de Castro Romanelli.
       BACKGROUND: Catheter associated bloodstream infections (CLABSI) are the most frequently reported healthcare-associated infections in pediatric intensive care units (PICUs). Largely preventable, CLABSI have prompted the global implementation of care bundles aimed at reducing infection rates, healthcare costs, length of stay, and mortality. Objective - To evaluate and compare the effectiveness of various care bundles in reducing CLABSI rates per 1000 catheter-days in PICUs.
    METHODS: A systematic review of 23 original studies identified through PubMed, Embase, SciELO, BVS, and Scopus databases, selected in accordance with PRISMA guidelines. For each study, CLABSI rates before and after bundle implementation were extracted, and percentage reductions were calculated.
    RESULTS: Baseline CLABSI rates ranged from 2.0 to 25.2 per 1000 catheter-days. Intervention durations varied from 3 months to 9 years. Post-intervention rates ranged from 0.7 to 14.3 per 1000 catheter-days. No study achieved a zero CLABSI rate although positively, over half of the studies reported a reduction superior to 50%. Methodological weaknesses significantly limited the reliability of effect estimates.
    CONCLUSION: Care bundles are associated with meaningful reductions in CLABSI rates in PICUs. Although most studies lack rigorous design, the consistent improvements observed support their effectiveness. Randomized controlled trials would be needed to determine the effect size of individual bundle components.
    Keywords:  Catheter-related infections; Central venous catheters; Intensive care units; Patient care bundles; Pediatric; Prevention and control
    DOI:  https://doi.org/10.1016/j.idh.2026.100428
  5. J Pediatr Pharmacol Ther. 2026 Jun;31(3): 437-443
    The Role of the Pediatric Pharmacist in Precision Medicine and Clinical Pharmacogenomics for Children.
    Kelsey J Cook, Benjamin Q Duong, Hyun Kim, Nathan Lamb, Jenny Q Nguyen.
      For years, pharmacogenomics (PGx) has been transitioning from the laboratory to patient care. Utilization of PGx data in patient care is greater than ever, with over 80 institutions in the United States offering PGx services, including at least 12 in pediatric patient populations. There are over 300 drug products with PGx information in their labeling; many of which are commonly used in pediatric populations. Additionally, the increased use of next-generation sequencing (NGS) has led to increased availability of PGx data. Because PGx testing can provide patient-specific predictors for drug response, pharmacists are well positioned to assume a leadership role in PGx testing, clinical interpretation of results, and recommendations for individualization of drug therapy. Opportunities for pharmacists exist in both inpatient and outpatient settings, such as pharmacist-managed clinical PGx consultation services and educating patients about PGx testing. Given the potential for genetic and age-dependent factors to influence drug selection and dosing, pediatric pharmacists should be involved in the development of dosing recommendations and interprofessional practice guidelines regarding PGx testing in pediatric patients. Opportunities to become knowledgeable and competent in PGx extend from coursework as part of the pharmacy curriculum to postgraduate education (e.g., residencies, fellowship, continuing education). The Pediatric Pharmacy Association (PPA) acknowledges a need for pediatric pharmacists to have a working knowledge of PGx and recognizes the importance of PGx education for both students and practicing pharmacists with consideration for infants and children. This group also supports the need to have a subset of pharmacists specially trained in PGx with a pediatric focus.
    Keywords:  pediatrics; pharmacist; pharmacogenetics; pharmacogenomics; precision medicine
    DOI:  https://doi.org/10.5863/JPPT-25-00118
  6. JAMA Netw Open. 2026 Jun 01. 9(6): e2617553
    Adoption of a Pediatric Acute Care Cardiology Inpatient Model.
    Dana B Gal, Jessica K Georgis, Selin Alak-DeBergh, Ivo Pandjaitan, Aileen Yanga De Guzman, Cynthia Herrington, Nicolas L Madsen, Paul F Kantor.
       Importance: Despite widespread adoption and investment of resources nationally, the pediatric acute care cardiology (ACC) model of care has not been previously evaluated prospectively.
    Objective: To test the hypothesis that adoption of an ACC model will be associated with improved clinical outcomes.
    Design, Setting, and Participants: This single-center prospective quality improvement study was conducted in a 26-bed ACC unit of a high surgical volume, freestanding children's hospital. The baseline period was May 15 to October 31, 2023, and the intervention period was November 1, 2023, to November 30, 2024. All ACC unit encounters during the baseline and intervention periods were included. Data sources were hospital administrative data, local Pediatric Acute Care Cardiology Collaborative registry, and Patient and Family Experience (PFE) scores.
    Exposure: Full-scale change in the model of care: transitioned unit leadership from hospital pediatrics to cardiology, changed attending of record for medical patients to cardiologist, hired nurse practitioners as frontline clinicians, integrated residents into the team, implemented multidisciplinary family-centered rounding, updated communication processes, and transitioned cardiology fellows to in-house overnight call.
    Main Outcomes and Measures: Complication rate and back transfer to the intensive care unit (ICU) were outcome measures, discharge time was a process measure, 7-day unplanned readmissions and length of stay (LOS) were balancing measures. Standard rules for identifying special cause variation (SCV) were applied. The percentage of patients and families with positive PFE scores (defined as scores of 9 or 10) before and after the intervention were compared using an independent t test. Hypothesis was formulated prior to data collection.
    Results: There were 483 encounters (45.2% among children aged 1-18 years) in the baseline period and 973 (52.7% among children aged 1-18 years) in the intervention period. Outcome and process measures significantly improved showing SCV following adoption of the ACC model (mean complications: baseline, 23.6% vs intervention, 16.0%; mean back transfer to ICU: baseline, 11.4% vs intervention, 6.9%; mean patient discharge time: baseline, 15.37 hours vs intervention, 14.43 hours). LOS and 7-day unplanned readmissions were unchanged, suggesting no major inadvertent negative consequences of the ACC model. Mean LOS for medical patients decreased (7.83 vs 4.97 days). PFE improved after the intervention (median [SD], preintervention: 76.9% [3.7] vs postintervention: 82.9% [4.3]; P = .04).
    Conclusions and Relevance: In this quality improvement study of an ACC model, multiple outcomes improved without evidence of negative consequences. These clinical improvements may justify necessary investment of resources to support ACC models. Adaptation of this model for other subspecialties may help address pediatric resident workforce changes. Ongoing evaluation of resource utilization, sustainability of improvement, and newly embedded improvement efforts is underway.
    DOI:  https://doi.org/10.1001/jamanetworkopen.2026.17553
  7. Prehosp Emerg Care. 2026 Jun 08. 1-17
    The Feasibility and Acceptability of Mobilizing Community Paramedics to Provide the Standard of Care for Pediatric Concussion: Mobile Integrated Health Programing for Pediatric Patients.
    Rory A Marshall, Paige V Swanson, Benjamin L Michaels, Kelsy M Stenger, Daniel Corwin, Jonathan Lifshitz, James T Eckner, Nathaniel R Hunt, Betsy McDavid, Alexander Rogers, Mark X Cicero.
       OBJECTIVES: Community Paramedics (CPs) have not yet been engaged in pediatric concussion management. This study aimed to assess the feasibility and acceptability of building and delivering HeadStrong Community (a Mobile Integrated Health (MIH) program utilizing CPs) to provide pediatric concussion care in the community.
    METHODS: This was an experimental mixed-methods study. Physicians, CPs, and scientists used the Knowledge-to-Action cycle to co-develop the program in response to the knowledge-practice gap for CPs around recovery and rehabilitation for pediatric concussion. Patients 3-17 years who had sustained a concussion were eligible. Patients were recruited through the emergency department. The program consisted of a visiting clinician model where trained CPs assessed, helped manage, and provided anticipatory guidance and education for concussion. Feasibility was assessed by primary outcomes related to MIH agency uptake, CP uptake, patient enrollment, and modified Post-Concussion Symptoms Scale (PCSS) scores (0 = no symptoms, 48 = most severe symptoms). Description of uptake and enrollment and comparison of symptoms scores were conducted to analyze feasibility. Acceptability was assessed by primary outcomes of patient, parent, and CP satisfaction. Description of satisfaction scores (5-point Likert scale). Qualitative surveys of CPs were also conducted and thematically analyzed.
    RESULTS: Headstrong Community recruited and trained 15 CPs from 2 MIH agencies. Of 159 potentially eligible patients, 19% (30/159) patients enrolled and completed 28 home visits. PCSS scores improved pre- versus post- visit as reported by patients (pre-visit mean = 15.2 ± 10.4, post-visit mean = 8.8 ± 7.6, p < 0.001) and parents (pre-visit mean = 12.0 ± 8.1, post-visit mean = 7.8 ± 7.6, p < 0.001). High levels of program satisfaction were reported by patients (mean = 4.3 ± 1.2; median = 5(1-5); n = 23), parents (mean = 4.4 ± 0.8; median = 5(2-5); n = 23) and CPs (mean = 4.0 ± 0.7; median = 4(1-5); n = 28). The CPs reported success in learning and implementing new assessments as well as engaging with concerned families, but encountered challenges integrating with the broader health care system, particularly with other concussion specialized care.
    CONCLUSIONS: The expansion of MIH programming to pediatric concussion patients was feasible and acceptable. HeadStrong Community is a novel and innovative model for management of pediatric concussion and may serve as a template for adaptable MIH programming to address other health care needs. Further research is needed to validate clinical utility and continuously improve the program and model.
    Keywords:  Community Paramedic; Concussion; Mild Traumatic Brain Injury; Mobile Integrated Health; Paramedicine; Pediatric
    DOI:  https://doi.org/10.1080/10903127.2026.2680993
  8. Pediatrics. 2026 Jun 11. pii: e2025072662. [Epub ahead of print]
    Supporting Safer Surgery: System-Level Interventions to Enhance Pediatric Perioperative Safety.
    Michael E Natarus, Caitlin Naureckas Li, Abbey Studer, Allison Shaw, Mehul V Raval, Richard M Dsida, John Olmstead, Christine Pytel, Hannah Stuart, Thomas H Inge, Sangeeta Schroeder, Derek S Wheeler.
       BACKGROUND: Over a 21-month period, a cluster of 13 safety events was observed in a perioperative service area that met criteria as either serious safety events per the health care performance improvement safety event classification system or Joint Commission sentinel events. This cluster of events served as the impetus to deploy high reliability organization (HRO) interventions to reduce potential future harm.
    METHODS: To increase safety awareness and improve clinical safety across perioperative services, 3 interventions were iteratively implemented over a 6-month period: (1) surgical safety stand-downs; (2) error prevention training; and (3) establishment of a safety coach program. Simultaneously, analyses were conducted to address systemic causes leading to and preventing additional safety events from occurring. The impacts of these interventions were then monitored for over 2 years post-implementation to assess the outcome.
    RESULTS: Following the deployment of 3 interventions, we observed an increase in cases between events from a baseline mean of 2977 cases to a period of 39 654 cases (over 585 days) without a safety event triggering analysis. This occurred with a concurrent increased trend in safety reports. As a balancing metric, we did not observe decreased case volumes; in fact, cases increased throughout the observed period.
    CONCLUSION: Department-wide HRO-based interventions contributed to a significant decrease in serious safety and sentinel events and should be considered to improve patient care. Attention to departmental safety trends can drive systemic improvements leading to higher-quality perioperative care.
    DOI:  https://doi.org/10.1542/peds.2025-072662
  9. Pediatr Qual Saf. 2026 May-Jun;11(3):11(3): e891
    Multidisciplinary Timely Debrief Sessions after Cardiac Arrests and Endotracheal Intubations in the Pediatric Emergency Department.
    Jonathan A Hermel, Yvette Wang, Jamie M Klapp, Amy Bryl, Martha Pannepacker, Elise Zimmerman.
       Introduction: Multidisciplinary clinical debriefs are structured discussions following critical events to assess performance, identify improvement opportunities, and provide team support. Despite known benefits, debriefs are underused. We aimed to increase debrief completion following pediatric emergency department (ED) cardiac arrests and endotracheal intubations. The primary outcome was the percentage of critical events with a completed debrief form. To assess potential workflow disruptions, we assessed 2 balancing measures: room-to-provider and door-to-provider times among Emergency Severity Index level 1 and 2 patients.
    Methods: A key driver diagram guided targeted interventions. We implemented a standardized Research Electronic Data Capture (REDCap) debrief form using a plus-delta framework with scripted prompts, accessible via quick response codes throughout the ED. As part of the intervention design, debriefs were encouraged within 30 minutes of the event and were designed to last 7 minutes or less. Educational initiatives included staff meetings, email reminders, newsletters, signage, and designated nursing champions. We used statistical process control to assess changes over time.
    Results: Debrief completion increased from 4% to 52% during 15 months, showing special-cause variation. Median room-to-provider times remained unchanged. Median door-to-provider times decreased during the intervention period.
    Conclusions: Multiple interventions significantly increased the use of structured debriefing without adversely affecting patient flow. Structured debriefing is both feasible and sustainable in high-acuity ED settings, particularly when supported by ongoing education and active team engagement.
    DOI:  https://doi.org/10.1097/pq9.0000000000000891
  10. Hosp Pediatr. 2026 Jun 09. pii: e2025008755. [Epub ahead of print]
    Ethical Considerations When Referring Patients for a Higher Level of Care.
    Jenny Kingsley, Gitanjli Arora, Ian Wolfe, Catherine D Shubkin, Amy E Caruso Brown.
      Children and adolescents with serious illness or medical complexity are often referred to highly specialized children's hospitals that offer experimental interventions, novel management, or treatments that cannot be provided at local health care centers. Referral to a geographically distant, highly specialized health center presents new complexity, with a distinct set of ethical issues, for patients, families, and clinicians. We describe ethical considerations that occur at the initiation of referral, during the process of referral, and after a referral for pediatric patients receiving hospital-based care. Using illustrative cases, we highlight salient themes surrounding these challenges that span many tenets of pediatric bioethics, including beneficence (ie, weighing benefits against harms), imposing values to impact shared decision-making, and justice (ie, lack of standardization in processes creating risk for discrimination). Pediatric clinicians and ethicists must be aware of the potential challenges arising in referring and transferring patients for higher levels of specialized intervention and treatment. When referral is indicated, institutions should facilitate collaborative care as much as possible by sharing information early, frequently, transparently, and in a standardized manner.
    DOI:  https://doi.org/10.1542/hpeds.2025-008755
  11. J Am Coll Emerg Physicians Open. 2026 Jun;7(3): 100360
    Bedside Intussusception Diagnosis and Reduction: A Comprehensive Emergency Department Process for Bedside Intussusception Diagnosis and Reduction.
    Nitzan Atia, Jordanna H Koppel, Tami Brutman-Barazani, Michalle Soudack, Oren Feldman.
       Objectives: Ileocolic intussusception is a major cause of intestinal obstruction in children under 2 years of age. Diagnosis is typically confirmed using ultrasonography, and treatment often involves an air or hydrostatic enema performed by radiologists or surgeons outside of the pediatric emergency department (PED) without the provision of adequate sedation or analgesia. This study aimed to assess the efficacy and safety of a comprehensive bedside approach for the diagnosis and reduction of ileocolic intussusception within the PED of a tertiary care pediatric hospital.
    Methods: A retrospective cohort study conducted between January 2021 and July 2024. Key outcome variables included the reduction success rate, time to reduction, and adverse events.
    Results: During the study period, 28 children diagnosed with ileocolic intussusception via point-of-care ultrasound were treated bedside with ultrasound-guided hydrostatic reduction performed by a pediatric radiologist under sedation provided by pediatric emergency medicine physicians. There were 20 (86%) successful bedside reductions with an average time from admission to reduction of 126 minutes and an average length of stay of 407 minutes, respectively. No adverse events were recorded, although early recurrence of intussusception within 48 hours occurred in 2 patients (7%).
    Conclusion: This is the first study that detailed a comprehensive bedside approach for the diagnosis and reduction of ileocolic intussusception in the PED. This approach has a high success rate, minimizes the need for interdepartmental transfers, and facilitates the administration of appropriate sedation and analgesia without significant adverse events. Further prospective studies are needed to confirm the safety and efficacy of this bedside approach.
    Keywords:  emergency medicine; pediatric surgery; pediatrics; point of care ultrasound; sedation and analgesia
    DOI:  https://doi.org/10.1016/j.acepjo.2026.100360
  12. J Pediatric Infect Dis Soc. 2026 Jun 09. pii: piag042. [Epub ahead of print]
    Differences in Antibiotic Prescribing Patterns for Children with Acute Otitis Media Based on Patient, Clinician, and Clinic Characteristics.
    RELAX Study Group
       OBJECTIVES: Children with common infections receive varying care based on their backgrounds, however data for acute otitis media (AOM) management are limited. Our study aimed to evaluate differences in antibiotic prescribing rate and treatment duration for children (>2 years) with uncomplicated AOM based on patient, clinician, and clinic characteristics.
    METHODS: Retrospective study of health record data from two health systems (123 total sites) from 2019-2022. Primary outcomes included: 1) whether an antibiotic was prescribed, and 2) if so, the duration prescribed. Analyses were performed to assess whether differences in prescribing occurred among individual patients, clinicians, or clinics.
    RESULTS: Among 66,382 encounters for AOM, children who were races other than White, Hispanic, or had public insurance or self-pay were more likely to be prescribed an antibiotic than children who were White (87 vs 83% OR 1.43[1.12, 1.84]), non-Hispanic (88 vs 82% OR 1.54[1.06, 2.23]), or had commercial/private insurance (87 vs 83% OR 1.35[1.10, 1.67]). The mean treatment duration was approximately 9 days for all groups, however statistical significance was seen with shorter courses for children who were races other than White, Hispanic, had a primary language other than English, or had public insurance or self-pay. Duration differences were seen among clinicians, with those who prescribed the shortest durations seeing, on average, a greater proportion of children who were races other than White, Hispanic, spoke a non-English primary language, and had public insurance or self-pay.
    CONCLUSIONS: Children with AOM who were races other than White, Hispanic, or had public insurance or self-pay were more likely to be prescribed an antibiotic. However, shorter durations were more common among these children, primarily because clinicians serving this population tended to prescribe shorter durations to all patients, regardless of child sociodemographic characteristics.
    Keywords:  Acute otitis media; Antibiotic stewardship
    DOI:  https://doi.org/10.1093/jpids/piag042
  13. BMC Health Serv Res. 2026 Jun 11.
    Issues navigating the healthcare delivery system among caregivers of children and youth with special healthcare needs: a qualitative study.
    Caitlin M Meyer, Rebecca K Campbell, Maura R Kelleher, Ebonie Zielinski, Molly Hofmann, Jessica D Rothstein.
       INTRODUCTION: Caregivers of children and youth with special health care needs (CYSHCN), including those with disabilities, have numerous roles managing care for their children. While caregiver burden is well documented, less is known about how barriers within the healthcare delivery system contribute to this burden and how systems can be redesigned to better support families. This study explored Illinois caregivers' experiences navigating the healthcare delivery system for CYSHCN and sought their perspectives on resources needed to reduce caregiver burden.
    METHOD: We conducted a qualitative study as part of a statewide needs assessment in Illinois. Three focus group discussions were conducted with caregivers of CYSHCN recruited through partner organizations. Discussions included participatory activities to elicit priority health needs and concerns for families of CYSHCN in Illinois. Audio recordings were transcribed verbatim, coded, and analyzed by the research team using content analysis to identify themes related to systems-level drivers of caregiver burden and potential solutions.
    RESULTS: Caregivers (n = 22) described substantial emotional, logistical, and financial burden arising from fragmented healthcare delivery and insurance systems. Key challenges included poor communication and coordination across providers and health systems, inconsistent electronic health record integration, limited access to pediatric specialists, and inadequate availability and reliability of in-home nursing care. Insurance-related barriers, including instability in coverage, prior authorization requirements, and gaps in coverage for needed supplies, further exacerbated caregivers' strain. Despite these challenges, participants also identified approaches, resources, and supports they have utilized that mitigate caregiver burden, such as multidisciplinary care models, family-centered providers, and support networks. Caregivers emphasized the need for expanded care coordination and navigation, increased mental health supports for families, more flexible insurance and reimbursement policies, and greater investments in home-based care.
    DISCUSSION: The findings from this study underscore the need for improvements to the healthcare delivery system through coordinated efforts. Health systems and payers should prioritize the expansion of family-centered care coordination, strengthen communication across providers, and invest in a more stable home healthcare workforce. Advancing disability-inclusive, family centered systems through these strategies is essential to fostering better outcomes for both caregivers and CYSHCN.
    Keywords:  CYSHCN; Care coordination; Caregiver burden; Health services
    DOI:  https://doi.org/10.1186/s12913-026-14931-2
  14. Pediatr Qual Saf. 2026 May-Jun;11(3):11(3): e880
    A Framework for Building an Inclusive Quality Program in a Pediatric Heart Center.
    Judson A Moore, Jennifer Marietta, Adam L Ware, David K Bailly, Kevin Hummel, Aaron W Eckhauser, Chuck G Pribble, Melissa M Winder, Tina Wadhwa, Emilee T Glenn, Ashlee Gardner, Megan Wichser, Haley Francione, Carly Heyrend, Chelsea Buckalew, Bethany Marullo, Venu Amula, Adil Husain, Antonio G Cabrera.
       Introduction: Pediatric heart centers have advanced quality improvement (QI) work through registries and collaboratives, improving benchmarking and shared learning. However, institutions must also build internal, sustainable QI programs tailored to local needs. We outlined our experience in developing an inclusive QI program that provides a structured framework to drive continuous improvement.
    Methods: We implemented a 5-step approach: (1) cultivating an environment ready for change, (2) optimizing streams to identify improvement opportunities, (3) building systems to support initiatives, (4) promoting QI work and successes, and (5) sustaining and scaling improvements. This included engaging diverse stakeholders, streamlining data, reducing participation barriers, and applying structured project management. Proposals underwent rigorous review to ensure equitable support.
    Results: Between 2021 and 2025, the program supported 17 subgroups across cardiology, surgery, anesthesia, and critical care, with 60% of projects led by nonphysicians. It facilitated 21 QI consults (71% progressing to formal projects), 13 publications, more than 30 national presentations, and additional impactful unpublished work, while strengthening leadership and team expertise through QI education. System-level outcomes improved, including surgical mortality and US News & World Report rankings. Performance rounds generated 170 improvement actions to guide systematic change.
    Conclusions: An inclusive QI program enhances outcomes, and our structure underscores the value of both multidisciplinary collaboration and strategic resource use. By investing in leadership, promoting diversity, and aligning with institutional goals, heart centers can achieve sustained improvement. This framework offers a potential model for institutions seeking robust QI infrastructure.
    DOI:  https://doi.org/10.1097/pq9.0000000000000880
  15. Am J Disaster Med. 2026 Winter;21(1):pii: ajdm.0522. [Epub ahead of print]21(1): 7-20
    Reunification of displaced children in a disaster: Can children provide information necessary for reunification?
    Marcelo Lacayo, Andrew Pless, Jim Wilde, Robert Gibson, Natalie Lane.
       BACKGROUND: Natural and man-made disasters displace millions of people each year. Children are disproportionately at risk due to their physiology and dependent living needs. Familial separation, resulting from displacement, causes physical, emotional, and psychological distress. Reunification depends, in part, on the collection of personally identifiable information (personal data). Children who provide personal data leading to their identification can aid in the reunification process. Despite its importance, there is little data on whether children can provide their personal data and at what age. This study addressed these gaps.
    OBJECTIVE: To evaluate the capability of children to provide personal data necessary for identification.
    DESIGN: A convenience sample of children from 4 to 10 years of age, presenting to the pediatric emergency department, were enrolled to participate.
    SETTING: This single-site, cross-sectional study was conducted at a pediatric emergency department in an urban tertiary hospital.
    PARTICIPANTS: Study team members successfully enrolled 140 children and their caregivers into the study.
    INTERVENTIONS: Children were asked to provide their personal data. These data were then compared to data provided by the childs caregiver to study the team members.
    MAIN OUTCOME MEASURES: Data were analyzed using descriptive statistics and a TukeyKramar multiple comparison test.
    RESULTS: Data indicated a dependent relationship between age and knowledge of personal data, and -personal data recitation accuracy differed (statistically significant difference) between age groups.
    CONCLUSION: Children 5 years of age and older supplied personal data sufficient for identification.
    DOI:  https://doi.org/10.5055/ajdm.0522
  16. Hematol Oncol Clin North Am. 2026 Jun;pii: S0889-8588(26)00002-X. [Epub ahead of print]40(3): 379-391
    Oncofertility in Pediatric and Adolescent Patients: Current Practice and Future Directions.
    Rohini Chakravarthy, Monica M Laronda, Sara Zarnegar-Lumley.
      Childhood cancer survivors cite reproductive health and future fertility as important to their quality of life in survivorship. The discipline of oncofertility has made significant progress in recent decades. With the development of risk stratification guidelines and multidisciplinary teams to facilitate counseling and expanding options for fertility preservation, fertility considerations in patients are being increasingly prioritized. However, various barriers continue to exist, and long-term success rates of certain fertility preservation methods remain unknown. It is essential to continue research and advocacy efforts to ensure all patients have access to reproductive health care throughout the continuum from cancer diagnosis through survivorship.
    Keywords:  Adolescent infertility; Cancer survivorship; Fertility preservation; Oncofertility; Pediatric infertility
    DOI:  https://doi.org/10.1016/j.hoc.2026.02.001
  17. Curr Opin Allergy Clin Immunol. 2026 Jun 11.
    Updates on drug-induced anaphylaxis in children.
    Tiago Pereira, Maria Luís Marques, Eva Gomes.
       PURPOSE OF REVIEW: Data on pediatric drug-induced anaphylaxis (DIA) are scarce, as drugs are less common triggers of anaphylaxis in children; however, drugs are associated with more severe reactions and unusual presentations. This review summarizes evidence on pediatric DIA, covering epidemiology, clinical manifestations, triggers, and management focusing on pediatric specificities.
    RECENT FINDINGS: Available data shows that drugs are responsible for up to one-third of childhood anaphylaxis. Approximately half of DIA cases occur in healthcare facilities and triggers vary according to settings. In addition to beta-lactams and NSAIDs, other medications raise concerns in specific populations. Age-dependent and trigger-dependent differences regarding symptoms have been reported. Undertreatment remains a major problem.
    SUMMARY: The importance of DIA in children increases with age. Boys appear more frequently affected. Diagnosis is clinical but challenging especially in younger age groups and in perioperative settings. Elevated tryptase supports diagnosis but lacks sensitivity. Antibiotics and NSAIDs are major culprits, but in hospitalized patients, anesthetics and chemotherapeutic drugs are also relevant. Vaccines, biologicals, and immunotherapy extracts may be important in pediatric allergy practice. Immediate treatment is adrenaline, largely underused in children, even in hospital settings. All patients with DIA should undergo allergy evaluation to prevent recurrences and overlabeling of drug allergy.
    Keywords:  anaphylaxis; drug hypersensitivity; drug-induced anaphylaxis; pediatric anaphylaxis; pediatric drug-induced anaphylaxis
    DOI:  https://doi.org/10.1097/ACI.0000000000001180
  18. OTO Open. 2026 Apr-Jun;10(2):10(2): e70246
    Racial and Ethnic Disparities in Care for Pediatric Sleep-Disordered Breathing.
    Colleen C McLaughlin, Jesse L Hawke, Emily F Boss, Guy M Brock, Meredith M Lind, Tasleem J Padamsee, Prasanth Pattisapu, Deena J Chisolm, Laura J Chavez.
       Objective: Obstructive sleep disordered breathing is the most common indication for pediatric tonsillectomy in the United States, but there are barriers to specialty care that may contribute to disparities in tonsillectomy use. This study examined the association between race, ethnicity, urban/rural residence, and other factors in access to specialty care for children diagnosed with obstructive sleep disordered breathing.
    Study Design: Retrospective observational cohort study.
    Setting: Fifteen states participating in the United States Medicaid and Child Health Insurance Programs.
    Methods: Children ages 2 to 18 years from 2017 to 2018 with a diagnosis of obstructive sleep disordered breathing followed for 1 year to ascertain receipt of polysomnography, otolaryngology specialist visit, and tonsillectomy.
    Results: This study included 304,415 children with diagnosis of obstructive sleep disordered breathing. Care pathways differed by race and ethnicity; Black non-Hispanic and Hispanic children were more likely to undergo polysomnography, either alone or with other forms of care (adjusted rate ratios and 95% confidence intervals 1.06 [1.04-1.09] and 1.06 [1.04-1.08], respectively). White non-Hispanic children, on the other hand, were more likely to receive otolaryngology care and/or tonsillectomy without polysomnography (Black non-Hispanic: 0.97 [0.95-0.99], Hispanic: 0.93 [0.92-0.95]). Urban children were more likely to undergo polysomnography alone and polysomnography prior to otolaryngology care (Urban: 1.06 [1.03-1.09], relative to rural).
    Conclusion: Black non-Hispanic, Hispanic, and urban children were more likely to undergo polysomnography and less likely to have tonsillectomy in absence of polysomnography. These differences suggest potential unwarranted variation in diagnostic and surgical care across race/ethnic groups and urban/rural settings.
    Keywords:  ethnic and racial minorities; healthcare disparities; pediatrics; polysomnography; sleep‐disordered breathing; tonsillectomy
    DOI:  https://doi.org/10.1002/oto2.70246
  19. Syst Rev. 2026 Jun 08.
    Caffeine treatment for apnea in infants and children: protocol for a systematic review and meta-analysis.
    Michelle Yu, Hana Sharifi, Sofia Quon, Kaitryn Campbell, Bram Rochwerg, David J Zorko, Melissa J Parker.
       BACKGROUND: Caffeine citrate is recommended to treat apnea of prematurity in premature neonates based on high-quality evidence demonstrating improved outcomes. In contrast, the prescription of caffeine for mature neonates and infants hospitalized with apnea is based on a paucity of evidence. We present here our protocol for a systematic review to synthesize existing data on the safety and effectiveness of caffeine treatment for apnea in hospitalized pediatric patients, with findings expected to focus on mature neonates and infants.
    METHODS: We developed this systematic review protocol in accordance with the PRISMA guidelines and PRISMA-P checklist. The search strategy was developed with the assistance of an information specialist. Information sources will include MEDLINE, Embase, CINAHL, and CENTRAL databases, as well as unpublished literature sources. Eligible studies will include randomized controlled trials, non-randomized trials, and observational studies investigating caffeine (of any formulation, administered by any route, of any duration) versus placebo, usual care, or non-methylxanthine comparator. The population of interest is children aged 0-17 years with apnea presenting to emergency, critical care, or in-patient settings; studies of premature babies receiving treatment for apnea of prematurity will be excluded. Critical outcomes include total duration of respiratory support, ventilator-free days, duration of invasive mechanical ventilation, duration of non-invasive respiratory support, time to apnea cessation, and serious adverse events. Two authors will independently screen identified studies against prespecified eligibility criteria. Data from included studies will be abstracted in duplicate and entered into our data abstraction form. Risk of bias for each included study will be independently assessed by two reviewers using the appropriate risk of bias tool. If appropriate, we will perform a meta-analysis. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, with results presented in a summary of findings table.
    DISCUSSION: We will undertake the first rigorous evidence synthesis examining the safety and efficacy of caffeine treatment for apnea in hospitalized pediatric patients, where studies of premature babies with apnea of prematurity will be specifically excluded. We aim to fill the identified knowledge gap with this systematic review.
    SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251146484.
    Keywords:  Apnea; Caffeine; Critical care; Emergency treatment; Pediatrics
    DOI:  https://doi.org/10.1186/s13643-026-03222-w
  20. Paediatr Child Health. 2026 Jun;31(4): 319-325
    Streamlining Kawasaki disease care: a quality improvement initiative to safely reduce length of stay.
    Audrea Chen, Beth D Gamulka, Hanof Alkhdher, Macarena Palomer, Rae S M Yeung.
       Objectives: Kawasaki Disease is the most common cause of paediatric acquired heart disease and one of the most resource-intensive acute paediatric conditions to treat. Hospitalization for Kawasaki Disease is a stressful event for children and caregivers, leading to increased use of emergency resources after resolution of disease. A quality improvement clinical pathway was introduced to alleviate strain on inpatient resources and reduce length of stay by 33% over 12 months.
    Methods: All patients diagnosed and treated for Kawasaki Disease at this institution were included. The primary outcome measure was length of stay. Patients with complicated Kawasaki Disease (i.e., Admission to intensive care) were excluded from outcome measurement, however process and balancing measures were collected for all patients. Balancing measures included rate of urgent care access post-discharge and patient satisfaction.
    Results: Forty-nine patients were included in the study, with length of stay data collected for 19. The average length of stay was 46 hours (17% reduction from a pre-intervention baseline of 55 hours). Process measures showed >75% uptake in change ideas following two plan, do, study, act (PDSA) cycles. Patient satisfaction was high with no safety concerns after discharge. Approximately $25,402 was saved over 49 admissions through reductions in length of stay and laboratory investigations.
    Conclusion: While the primary objective was not met, a sustained 17% reduction in length of stay was achieved without compromising patient safety or satisfaction. This initiative successfully implemented a standardized clinical pathway through strong collaborator engagement and patient-driven change ideas.
    Keywords:  Clinical Pathways; Mucocutaneous Lymph Node Syndrome; Patient Care Management; Quality Improvement
    DOI:  https://doi.org/10.1093/pch/pxag001
  21. Obes Pillars. 2026 Sep;19 100276
    Clinical perspectives on pediatric weight-management programs: A nationwide look at models of care.
    Niharika Alla, Jacqueline Chan, Rushika Conroy.
       Background: Obesity is a common, complex, and often persistent chronic disease associated with serious health and social consequences. In the United States, recent data indicates that almost 20% of children and adolescents have obesity. Management of pediatric obesity involves multidisciplinary teams, including pediatricians, pediatric specialists, dietitians, behavioral health specialists, and exercise professionals, who deliver intensive health behavior and lifestyle treatment. Prior survey data from Pediatric Endocrine Society (PES) members indicate variability in practice patterns. There is an urgent need to assess current practices across groups and use these data to establish a standard of care across institutions.
    Methods: This is a cross-sectional survey of 38 providers who treat pediatric obesity. We report descriptive statistics (mean/median/IQR) only.
    Results: Of 168 potential respondents, 38 completed the survey. 61% of the clinics are run within the Pediatric Endocrine division. All clinics offer pharmacotherapy, while only some offer bariatric surgery treatment. There is a wide divergence in the structure, staffing, visit frequency, intake process, and operational workflow between programs. All programs are staffed with a physician or APP, 97% with dieticians, 60% with psychologists or behavioral health therapists, and 39% with bariatric surgeons. Ideal and actual follow up times were mismatched, with programs wanting to see patients for follow up more often than they were able to.
    Conclusion: The survey provides a detailed snapshot of current practices within pediatric weight management programs, highlighting the strengths and the substantial variability that characterize the field. While many clinics share core elements, there remains a divergence in others. These differences reflect the diverse environments in which programs operate and underscore the benefit of standardized models for delivering pediatric obesity care. This survey is an important foundation, but broader national efforts are essential to guide standardization, inform policy, and support the development of high-quality, accessible pediatric obesity care.
    Keywords:  Obesity program; Pediatric obesity; Weight management
    DOI:  https://doi.org/10.1016/j.obpill.2026.100276
  22. World J Pediatr. 2026 Jun 09.
    Artificial intelligence in pediatric intensive care units: current applications in sepsis management.
    Sheng Fu, Fei Li, Su-Yun Qian.
       BACKGROUND: Early detection of sepsis in pediatric intensive care units (PICUs) is critical, but challenging due to its nonspecific clinical presentation and marked physiological heterogeneity. Artificial intelligence (AI) offers transformative potential for precision sepsis management, but clinical translation remains complex due to methodological and implementation barriers.
    DATA SOURCES: A systematic review was conducted on the application of AI in sepsis management in PICUs. We included original research studies, meta-analyses, systematic reviews, clinical guidelines, and consensus statements. Databases searched included PubMed, Embase, Cochrane Library, Web of Science, Google Scholar, the China National Knowledge Infrastructure, and Wan Fang, covering records from inception to March 2026. Search terms included "artificial intelligence", "machine learning", "deep learning", "pediatric sepsis", "neonatal sepsis", "pediatric intensive care unit", and "Clinical Decision Support Systems".
    RESULTS: AI models consistently outperformed traditional pediatric scoring systems in both early prediction and risk stratification. Our comparative analysis indicates that while random forest models are more robust for discrete, cross-sectional data, long short-term memory networks excel at capturing the dynamic temporal patterns inherent in pediatric physiology. AI-driven clinical decision support systems were found to significantly improve adherence to standardized sepsis bundles; however, false-positive rates varied across healthcare tiers, exposing critical disparities in electronic health record infrastructure. Furthermore, multi-omics integration identified distinct biological endotypes, offering a path towards personalized therapy. Economic evaluations suggest these tools can reduce per-patient costs and optimize PICU resource allocation. Of note, recent global health policies now emphasize pediatric-specific validation and algorithmic fairness as prerequisites for equitable deployment of AI.
    CONCLUSIONS: Despite its technical superiority in the management of pediatric sepsis, the clinical utility of AI hinges on enhancing the transparency of "black-box" algorithms through explainable AI and narrowing the systemic infrastructure divide across healthcare tiers. Establishing robust quality controls and policy frameworks is paramount to evolving AI from a research-bound tool into a reliable diagnostic adjunct within standard pediatric care.
    Keywords:  Artificial intelligence; Early diagnosis; Machine learning; Pediatric intensive care unit; Precision medicine; Sepsis
    DOI:  https://doi.org/10.1007/s12519-026-01052-3
  23. J Pediatr Pharmacol Ther. 2026 Jun;31(3): 413-418
    A Quality Improvement Project to Increase Pharmacist-Initiated Methicillin Resistant Staphylococcus Aureus Nasal Swab PCR for Vancomycin De-Escalation in Pediatric Patients With Respiratory Tract Infections.
    Kimberly James, Trinkal Patel, Kelsey Jensen, Nipunie Rajapakse, Jamie Heyliger, Grace Lee, Ben Anderson, Laura Dinnes.
       OBJECTIVE: Overuse of broad-spectrum empiric antimicrobials remains common in children hospitalized with respiratory tract infections (RTI). A negative methicillin-resistant Staphylococcus aureus (MRSA) nasal swab (MNS) polymerase chain reaction (PCR) result has been shown to have a high negative predictive value for MRSA in RTI. In this quality improvement (QI) initiative, we developed a pharmacist-driven approach to reduce the duration of empiric vancomycin for RTI in children. The primary aim was the time to de-escalation of vancomycin, and the secondary aim was the reduction in vancomycin monitoring in patients hospitalized with RTI.
    METHODS: Baseline duration of vancomycin therapy was assessed by conducting a retrospective chart review. After root cause analysis and engaging key stakeholders, an electronic health record OurPractice Advisory (OPA) was implemented, prompting pharmacists to order an MNS PCR during order verification for vancomycin with an RTI indication.
    RESULTS: Preimplementation (01/01/2021 to 08/31/2023) included 89 patients, and 25 postimplementation (09/21/2023 to 05/31/2024). We found a 36% decrease in mean vancomycin duration from 53 to 34 hours after implementation of the pharmacist-driven OPA. Postimplementation, 24% of patients had a vancomycin concentration obtained, compared with 37% preimplementation. No patients were readmitted within 30 days postimplementation, compared with 1 patient preimplementation.
    CONCLUSIONS: This QI initiative provides preliminary data that empiric vancomycin duration in pediatric patients with RTI may be impacted by pharmacist-facing OPA implementation, prompting ordering of MNS PCR at the time of vancomycin verification. This initiative could be replicated at other institutions seeking to reduce empiric vancomycin usage.
    Keywords:  methicillin-resistant Staphylococcus aureus; nasal swab; pediatric; pharmacist; quality improvement; vancomycin
    DOI:  https://doi.org/10.5863/JPPT-25-00080
  24. Eur J Pediatr. 2026 Jun 09. pii: 480. [Epub ahead of print]185(7):
    Novelties in the pragmatic management of anaphylaxis in pediatric age.
    Gian Luigi Marseglia, Maria Angela Tosca, Michele Miraglia Del Giudice, Sara Manti, Giorgio Ciprandi, Amelia Licari.
      Anaphylaxis is a time-critical, potentially fatal systemic hypersensitivity reaction. This narrative review summarizes recent advances in the diagnosis and management of anaphylaxis in children and adolescents, with emphasis on new diagnostic frameworks, improved self-management strategies, intranasal adrenaline, and disease-modifying therapies. A narrative review was conducted using PubMed and MEDLINE, focusing on articles and guidelines published between January 2020 and March 2026. Search terms included "anaphylaxis", "pediatric anaphylaxis", "adrenaline", "epinephrine", "autoinjector", "intranasal adrenaline", "food anaphylaxis", "omalizumab", and "oral immunotherapy". International guidelines, consensus documents, systematic reviews, pharmacokinetic studies, and pediatric studies were prioritized. Food remains the leading trigger in children, but drug, Hymenoptera venom, cofactor-dependent, and non-IgE-mediated mechanisms must be systematically considered. Adrenaline is underused in community settings despite being the only life-saving drug. Intranasal adrenaline represents the most visible delivery innovation: it may reduce needle-related barriers and simplify administration, but current evidence is largely based on pharmacokinetic/pharmacodynamic studies and limited pediatric clinical data. Omalizumab and oral immunotherapy are reshaping long-term risk reduction in food allergy but do not remove the need for emergency adrenaline.
    CONCLUSION:  The pragmatic management of anaphylaxis in children and adolescents entails self-management and hospital-based care. Intramuscular adrenaline is the first-line treatment when anaphylaxis is ongoing or recurrent, whereas adjunctive therapies should be considered on clinical grounds. Discharge recommendations should be individualized and include structured education, risk assessment, emergency planning and specialist follow-up. Intranasal adrenaline is a promising innovation, but its introduction requires clinical positioning, pharmacovigilance, cost-effectiveness evaluation, and continued emphasis on early treatment.
    WHAT IS KNOWN: • Intramuscular adrenaline is the first-line treatment for anaphylaxis and should not be delayed. • Food is the leading trigger in children, while drugs, venom, and cofactors become more relevant with age.
    WHAT IS NEW: • Intranasal adrenaline is a promising needle-free option, but pediatric evidence remains limited. • Omalizumab and oral immunotherapy may reduce risk but do not replace emergency preparedness.
    Keywords:  Adrenaline; Anaphylaxis; Children; Food allergy; Intranasal adrenaline; Omalizumab
    DOI:  https://doi.org/10.1007/s00431-026-07147-3
  25. Paediatr Child Health. 2026 Jun;31(4): 367-376
    Medical assistance in dying in pediatrics: a retrospective case study of clinical interactions and implications for team training.
    Marta Martisella, Marc-Antoine Marquis, Audrey Stypulkowski, Antoine Payot, Claude Julie Bourque, Marie-Eve Bouthillier.
       Objectives: In Canada, medical assistance in dying (MAiD) has been a legal end-of-life (EOL) option since 2016. Although minors are not legally eligible, pediatric palliative care (PPC) teams can be involved in MAiD-related discussions initiated by patients or parents. However, little is known about how these discussions unfold in pediatrics. This study sought to describe the structure and content of these interactions, with the aim of developing a typology and clinical vignettes to support the preparation and training of pediatric healthcare professionals.
    Methods: We conducted a retrospective and descriptive case study within a single PPC service in a Canadian pediatric academic tertiary hospital. Data were collected from patient's charts (September 2013 to August 2023), including patient demographics, clinical characteristics, palliative care involvement, MAiD-related discussions and EOL details (N = 11). Descriptive statistics, as well as thematic and comprehensive analyses were used.
    Results: We identified 11 cases of documented MAiD-related interactions involving patients aged <1 to 18 years. Most interactions were initiated by patients' parents (73%; n = 8), and some by patients themselves (27%; n = 3). We identified three types of MAiD-related interactions: implicit (n = 2), explicit exploratory (n = 5) and explicit direct (n = 4). Based on this typology, we co-developed six clinical vignettes to illustrate these scenarios.
    Conclusion: Although rare, MAiD-related interactions in pediatric settings are complex and high-stakes, underscoring the need for enhanced training of pediatric healthcare professionals. The proposed typology and vignettes provide a framework to support reflective ethical practice and enhance pediatric teams' preparedness for EOL beyond the specific clinical and legal context of our study.
    Keywords:  Clinical Ethics; End-of-life; Euthanasia; Medical assistance in dying; Medical education; Paediatric palliative care
    DOI:  https://doi.org/10.1093/pch/pxag016
  26. Proc Hum Factors Ergon Soc Annu Meet. 2025 Sep;69(1): 137-140
    How Parent Caregivers of Children with Medical Complexity Respond to Patient Safety Events at Home.
    Anna Jolliff, Carolyn C Foster, Peter Walsh, Sofia Seewald, Carol Haywood, Mia Freeman, Nicole E Werner.
      The objective of this study was to use the critical decision method (CDM) to map the decision-making process of parent caregivers (PCGs) responding to patient safety events at home and to identify the work system factors that influence this process. PCGs (N = 13) were asked to share about a specific patient safety event that had occurred while caring for the CMC at home. PCGs were asked to describe the event in chronological order, after which their decision making at each timepoint was probed. The final process map included nine steps, the success of which were shaped by work system factors. This map of PCG decision making can be used to train policymakers, durable medical equipment companies, and clinical providers on the work that PCGs perform at home, and to evaluate whether a family has what they need to maintain home-based safety.
    Keywords:  children with medical complexity; cognitive task analysis; critical decision method; family caregiver; qualitative methods
    DOI:  https://doi.org/10.1177/10711813251367360
  27. J Hosp Med. 2026 Jun 10.
    Food insecurity and hospital resource utilization.
    Adolfo L Molina, Ariel Carpenter, Mary Orr, Samantha L Hanna, Dana Woodruff, Cynthia Deerman, Cassi Smola, Erin E Shaughnessy, Chang L Wu.
       BACKGROUND: Food insecurity (FI) is an important pediatric social risk factor associated with worse health outcomes. However, there is a paucity of data on FI's effects on hospitalized children and hospital-based reutilization.
    METHODS: This single-center, retrospective cohort study included children admitted between 2020 and 2023 to evaluate the effect of FI on hospital utilization (length of stay [LOS], emergency department [ED] revisits, and readmission). FI was identified using the two-question Hunger Vital SignTM at admission, with patients categorized as food secure, food insecure, or missed/refused screening. Multivariable generalized estimating equations, utilizing binomial and negative binomial distributions, were employed to calculated adjusted odds ratios (aOR) and incidence rate ratios (aIRR), respectively, while accounting for patient-level clustering. Models were adjusted for age, sex, race, ethnicity, language, and insurance type.
    RESULTS: We analyzed 31,553 pediatric hospitalizations in the analysis. Results demonstrated that patients in the missed/refused screening group had a significantly increased LOS, with a 73% increase in expected hospital duration (aIRR: 1.73; 95% confidence interval [CI]: (1.60-1.89) p < .0001) compared with the food-secure group. In contrast, no significant associations were found between documented FI and LOS, ED revisit, and 30-day readmission after adjusting for patient clustering.
    CONCLUSIONS: While the relationship between FI and utilization is multifactorial, these findings suggest that patients who are missed by or refuse screening represent a high-acuity cohort with significantly higher resource utilization. Addressing social risk during hospitalization remains an important opportunity for resource connection, and the high utilization among the unscreened population highlights a critical area for improving screening equity and clinical outreach.
    DOI:  https://doi.org/10.1002/jhm.70362
  28. Ann Palliat Med. 2026 May;15(3): 44
    Environmental sustainability in palliative care: a narrative review.
    Fermin S Hoq, Krista Clement, Rose Hatala, Caroline Mariano, Shilo Lefresne.
       BACKGROUND AND OBJECTIVE: Climate change represents an escalating threat to human health and disproportionately affects vulnerable populations. The healthcare sector contributes significantly to climate change, accounting for approximately 4.4% of greenhouse gas (GHG) emissions globally. While several medical specialties aim to improve sustainability of clinical practice, there is limited literature within palliative medicine. This narrative review aims to identify and evaluate existing work on the ecologic impact of palliative medicine and highlight climate conscious clinical recommendations within palliative care.
    METHODS: Scholarly databases including Medline, Embase, CINAHL, UBC Summon, Health Business Elite, and TRIP Medical and GreenLine were used for the literature search, and articles up to March 2026 were screened. Studies that described environmental sustainability efforts in palliative care were included. Articles underwent title and abstracts screening, followed by full text screening by two independent researchers. The extracted data was analysed thematically and summarized narratively.
    KEY CONTENT AND FINDINGS: A total of 176 articles were identified through database searches. After screening titles, abstracts, and full texts, eight peer-reviewed academic articles were included in the narrative review. Three major themes emerged regarding sustainability in palliative medicine: (I) conservative and goal-concordant prescribing, (II) minimization of low-value investigations and procedures, and (III) intensity of care and care setting optimization.
    CONCLUSIONS: The intersection of patient-centered care and planetary health considerations reveal that providing high quality palliative care has the co-benefit of reducing healthcare-associated GHG emissions and resource consumption. By aligning clinical practice with responsible resource stewardship, palliative care can simultaneously enhance patient outcomes and reduce the environmental footprint of healthcare.
    Keywords:  Palliative care; environmental sustainability; planetary health
    DOI:  https://doi.org/10.21037/apm-2025-1-146
  29. J Child Adolesc Psychopharmacol. 2026 Jun 09. 10445463261458604
    Context Matters: Variation in Pharmacologic Management of Pediatric Agitation Across Emergency and Inpatient Psychiatric Settings.
    Sean T Lynch, Angelo I Chaia, Ricky Burns, Chaden Noureddine, Timothy R Rice, Ashley N Sterchele.
       BACKGROUND: Management of acute agitation in youth frequently involves intramuscular (IM) antipsychotics; however, little is known about how treatment strategies vary across care settings. Differences between emergency and inpatient psychiatric environments may influence medication selection and dosing.
    METHODS: This retrospective secondary analysis included youth (<18 years) who received IM antipsychotics for agitation across multiple emergency departments and inpatient psychiatric units within a large urban health system (2019-2023). Comparisons between settings examined antipsychotic selection, coadministration of adjunctive medications, and dosing. To account for differences in medication selection, dosing comparisons were conducted within each antipsychotic agent. Secondary outcomes included repeat IM administration and restraint or seclusion within 24 hours.
    RESULTS: The sample included 158 youth (86 emergency, 72 inpatient). Antipsychotic selection differed significantly by setting, with greater use of haloperidol in emergency settings and chlorpromazine in inpatient settings (p < 0.001). Midazolam coadministration was more common in emergency settings (10.5% vs. 1.4%, p = 0.020). When examined within agents, chlorpromazine doses were higher in inpatient settings (36.7 mg vs. 30.4 mg, p = 0.035), while haloperidol and olanzapine dosing did not differ. Rates of additional IM administration were similar across settings (p = 0.295), although restraint or seclusion was more common in inpatient settings (p < 0.001).
    CONCLUSIONS: Pharmacologic management of pediatric agitation varies by care setting, particularly in antipsychotic selection and adjunctive medication use. Differences in dosing were limited to chlorpromazine, suggesting that variation reflects agent-specific prescribing patterns rather than overall treatment intensity. These findings highlight the influence of clinical context and provider practice patterns in shaping management strategies for pediatric agitation.
    Keywords:  emergency psychiatry; inpatient psychiatry; intramuscular antipsychotics; pediatric agitation; practice patterns
    DOI:  https://doi.org/10.1177/10445463261458604
  30. Front Pediatr. 2026 ;14 1752719
    Feasibility and implementation of a daily safety brief at a children's hospital-in-a-hospital.
    Weijen William Chang, Patricia Fontaine, Stephanie Adam, Joanna Beachy, Mark Heelon, Christine McKiernan, Deborah Naglieri-Prescod, Kristy Parker, Robert Rothstein, Charlotte Boney.
       Background: The daily safety brief (DSB) is a structured approach to enhancing patient safety and readiness, widely used in free-standing children's hospitals. This observational study examines the implementation and feasibility of a DSB within a children's hospital embedded in an adult healthcare system-a unique challenge requiring adaptation to an infrastructure primarily designed for adult care.
    Methods: Using a descriptive, observational design, we tracked safety concerns reported during DSBs over a 12-month period across inpatient units and the pediatric emergency department. Safety concerns were categorized using a predefined taxonomy and reviewed by the implementation team.
    Results: The implementation process confirmed the feasibility of integrating pediatric safety efforts within an adult system. While qualitative feedback suggested improved communication and situational awareness, this study did not measure direct improvements in patient safety outcomes, and the single-center design limits generalizability. The reduction in reported safety concerns over time should be interpreted cautiously, as changes in reporting may reflect cultural or behavioral factors rather than true safety improvements.
    Conclusions: This initiative highlights the potential for embedding pediatric safety practices within broader hospital operations, warranting further investigation using controlled designs with objective patient safety outcome measures.
    Keywords:  children's hospital; daily safety brief; feasibility; patient safety; quality assessement; situational awareness
    DOI:  https://doi.org/10.3389/fped.2026.1752719
  31. Semin Pediatr Neurol. 2026 Jul;pii: S1071-9091(26)00032-X. [Epub ahead of print]58 101288
    Pediatric concussion beyond sports: Falls, play, and everyday activities.
    Deena Godfrey.
      Though pediatric concussions from non-sports related mechanisms are associated with greater symptom burden and longer recovery times when compared to concussions from sport-related concussions, they remain less studied. Non-sport-recreation-related concussions tend to impact younger children and communities with greater health disparities, such as Black patients, people on public insurance, and those living in rural settings. In this chapter we will review non-sport mechanisms of pediatric concussion and review how they are distinguished from sport concussions with regards to demographics, symptomatology, and recovery times.
    DOI:  https://doi.org/10.1016/j.spen.2026.101288
  32. Pediatrics. 2026 Jun 08. pii: e2025074382. [Epub ahead of print]
    Rotavirus Vaccine Coverage and Potential Barriers Among US Children Born From 2007 to 2024.
    New Vaccine Surveillance Network Acute Gastroenteritis Working Group
      
    BACKGROUND/OBJECTIVES: The Advisory Committee on Immunization Practices recommends the first dose of rotavirus vaccine (RVV) be delivered by a maximum age of 14 weeks, 6 days and that the vaccine not be delivered until time of discharge from the neonatal intensive care unit (NICU). We hypothesized that these guidelines limit the number of children who can be vaccinated with RVV.
    METHODS: Children born on or after January 1, 2007, enrolled in the New Vaccine Surveillance Network from December 2014 to August 2024 aged at least 15 weeks with rotavirus-negative acute gastroenteritis or as a healthy control, and with known vaccination status were included. We identified factors associated with not initiating or completing the RVV series and missed opportunities for vaccination. Odds ratios (ORs) and 95% CIs were calculated using univariate logistic regression.
    RESULTS: A total of 24 755 children met the inclusion criteria. The risk factors most strongly associated with not initiating RVV were receiving the diphtheria, tetanus, and pertussis vaccine at greater than or equal to age 15 weeks (OR, 30.0; 95% CI, 26.8-33.7), extremely preterm birth (OR, 14.6; 95% CI, 11.2-20.0), being born soon after RVV introduction (2007-2009) (OR, 3.3; 95% CI, 2.9-3.8), and having no health insurance (OR, 2.2; 95% CI, 1.8-2.7). More than 50% of extremely preterm infants in the NICU were not discharged until greater than or equal to age 15 weeks.
    CONCLUSIONS: Re-evaluation of the vaccine guidelines to allow RVV administration in the NICU may remove barriers to vaccination and help improve RVV coverage.
    DOI:  https://doi.org/10.1542/peds.2025-074382
  33. Hosp Pediatr. 2026 Jun 12. pii: e2025008937. [Epub ahead of print]
    Effect of Opt-Out HIV Testing for Adolescent Patients on a Pediatric Hospital Medicine Service.
    Annie Sadler, Gargi Mukherjee, Jordan E Bryant, Melissa Cameron, Sandy Francois, Bridget A Wynn, Melissa Popkin, Sarah Thompson, Julia Yarahuan, Swaminathan Kandaswamy, Evan Orenstein, Andres Camacho-Gonzalez, Mark Griffiths, Lauren Middlebrooks, Claudia R Morris.
       BACKGROUND AND OBJECTIVE: In 2023, our emergency department, serving a region with one of the highest rates of new HIV infection, implemented Centers for Disease Control and Prevention-recommended universal, opt-out HIV screening for adolescents. However, few patients admitted to the pediatric hospital medicine service (PHM) were tested. To address this gap, we aimed to expand universal, opt-out HIV testing to PHM and evaluate screening implementation.
    METHODS: In this pre-postintervention study, we compared HIV testing rates for patients admitted to PHM aged 13 years or older during 5 months preimplementation and postimplementation (February to June 2024 and July to November 2024). Clinicians received regular education on HIV screening guidelines and opt-out language and were encouraged to incorporate screening in confidential psychosocial assessments. If the inpatient team did not offer testing, HIV navigators counseled adolescents, regardless of parental presence. Testing rates were compared with chi-square and Welch's t-test.
    RESULTS: There was a 38% increase in HIV screening from the preimplementation to postimplementation periods (preimplementation, 12.4%; postimplementation, 17.1%; P = .04). Postimplementation, 533 adolescents were eligible for HIV screening; 148 were approached, and 91 HIV tests were ordered (17.1% of eligible; 64% girls; mean age 16 ± 1.8 years), identifying one adolescent with HIV (>1% seroprevalence; 3% for boys). Adolescents were significantly more likely to be tested when approached by an HIV navigator than during a confidential interview (P = .004). Parental presence did not negatively impact adolescent participation.
    CONCLUSIONS: Adopting universal, opt-out HIV screening with HIV navigators in the inpatient setting significantly increased testing rates. Further studies on the most effective and sustainable approach to screening are needed.
    DOI:  https://doi.org/10.1542/hpeds.2025-008937
  34. J Clin Med. 2026 May 31. pii: 4253. [Epub ahead of print]15(11):
    Pediatric ACL Injuries: A Current Concepts Review.
    Caroline de Pesters, Tom Piscaer, Muhammad Deryl Ivansyah, Duncan Meuffels, Linda van den Berg, Franck Accadbled.
       BACKGROUND/OBJECTIVES: Anterior cruciate ligament (ACL) tears in children and adolescents are occurring at the intersection of skeletal growth and often early sports specialization, requiring a specialized approach, as pediatric ACL injury is not merely a scaled-down version of adult injury.
    METHODS: This review synthesizes the current understanding of diagnostic protocols, evolution of knee morphology and neuromechanical risk factors characteristic of the pediatric population. It further examines the spectrum of specific management strategies including conservative approaches, primary repair and various reconstruction techniques, alongside rehabilitation, prevention and follow-up procedures.
    RESULTS: In the diagnostic phase, pediatric-specific clinical and imaging findings must be carefully interpreted. Certain anatomical and neuromuscular characteristics seem to be linked to injury. Management remains complex, requiring a delicate balance between restoring stability and sparing bone growth. While conservative treatment may be attempted in specific cases, it must be promptly redirected toward surgical intervention if persistent instability occurs. Consensus on optimal surgical strategies remain impeded by the lack of robust evidence. Anterior cruciate ligament reconstruction (ACLR) still faces challenges such as growth disturbances, high graft failure, contralateral rupture rates and the biological process of graft remodeling. However, ACLR currently remains the gold standard compared to ACL repair. Tailored rehabilitation and robust prevention programs are needed.
    CONCLUSIONS: The management of ACL rupture in the pediatric population remains complex and constrained by important evidence gaps. Continued refinement of management strategies and future prospective, multicenter pediatric studies are needed.
    Keywords:  ACL reconstruction; ACL repair; conservative management; graft remodeling; growth disturbances; knee morphology; pediatric ACL; prevention; sports medicine
    DOI:  https://doi.org/10.3390/jcm15114253
  35. Pediatr Ann. 2026 Jun;55(6): e203-e206
    Language Development in Bilingual Children: A Pediatrician's Guide.
    Emma Office.
      Speech and language development are critical areas of a child's health and are monitored by primary care pediatricians at all routine visits. Given the prevalence of bilingual children and families in the United States, pediatric clinicians must be able to provide appropriate anticipatory guidance regarding bilingual language development in children. Pediatric clinicians must also be able to recognize signs of speech/language delays or disorders in bilingual children to provide appropriate evaluation and resources. This column aims to provide a foundation for pediatric clinicians in principles of bilingual language development and to address several common questions or misconceptions regarding bilingual language development that may be held by families, clinicians, and/or educators.
    DOI:  https://doi.org/10.3928/19382359-20260429-02
  36. Hosp Pediatr. 2026 Jun 08. pii: e2025008900. [Epub ahead of print]
    Are Pediatric Hospitalists Prepared to Supervise Fellows? A National Survey of Program Directors.
    Julianna Lau, Carolyn Marcus, Laura Chiel, Charlie Wickremasinghe, Sarah McBride.
       OBJECTIVE: Pediatric hospital medicine (PHM) fellowship programs have rapidly expanded since their official designation for subspeciality certification. In this new landscape, we explore how PHM fellowship programs select and prepare attendings to work with fellows on hospital medicine teams.
    METHODS: A national survey to explore current and ideal practices of PHM fellowship program directors (FPD) on attending preparation for fellow clinical supervision, including assessing interest for further faculty development.
    RESULTS: This survey was distributed to approximately 72 PHM FPD nationwide in February 2024. Fifty-one FPD responded to the entirety of the survey (71% response rate). Many fellowship programs reported providing training preparation materials to attendings who work with fellows (94%), and fewer programs consistently provided learner handoff (31%). FPD reported that the fewest faculty were perceived as being very capable of ensuring that fellows had an appropriate level of autonomy on clinical service. They perceived the most important topic to be included in attending preparation as promoting fellow autonomy. Almost half of the programs were interested in preparation materials to assist a faculty development curriculum for fellow clinical supervision.
    CONCLUSION: There is a wide range of practices in how PHM FPD prepare attendings to clinically supervise fellows. Many FPD reported interest in additional training materials to help prepare attendings in their program. Recognizing this national interest and understanding the most important topics for faculty development may help leaders in PHM fellowship programs further develop materials to ensure attendings are equipped with the skills to clinically supervise fellows.
    DOI:  https://doi.org/10.1542/hpeds.2025-008900
  37. Ir J Med Sci. 2026 Jun 08.
    Comparing non-operative management of abdominal solid organ injuries in pediatric and adult blunt trauma: A meta-analysis and systematic review.
    Amani N Al-Ansari, Mohammed Ajebli, Ibrahim Afifi, Ammar Al Hassani.
       BACKGROUND: Non-operative management (NOM) is the preferred approach for hemodynamically stable patients with blunt abdominal trauma (BAT) involving solid organ injuries. It is associated with shorter hospital stays (LOS) and favorable outcomes, particularly in pediatric patients, who have high rates of such injuries. This review assesses the efficacy of NOM in both pediatric and adult populations and compares outcomes between these groups.
    METHODS: A meta-analysis and systematic literature review was performed using databases such as PubMed, MEDLINE, Google Scholar, Springer, and ScienceDirect to identify English-language studies published from 1980 to 2025 on NOM of abdominal solid organ injuries (ASOI) from blunt trauma (BT) in pediatric and adult patients, adhering to PRISMA guidelines.
    RESULTS: The systematic review analyzed outcomes from 21 clinical studies that met the inclusion criteria, in contrast, nine studies only met the inclusion criteria for the meta-analysis assessment. This meta-analysis and systematic review validates that NOM of blunt ASOI is effective and safe in both children and adults.
    CONCLUSION: Although NOM in adults is generally limited to lower-grade injury, children are frequently managed non-operatively for higher-grade injury, reflecting perhaps differences in injury pattern and clinical management considerations, despite overall very similar protocols being applied. The data of this study displayed also no statistically significant differences between children and adults regarding the other clinical parameters LOS, blood transfusion requirement, hemodynamic instability and mortality.
    Keywords:  Abdominal; Blunt trauma (BT); Injury Severity Score (ISS); Non-operative management (NOM); Pediatric and adults; Solid organ injuries (SOI)
    DOI:  https://doi.org/10.1007/s11845-026-04461-5
  38. Nurs Outlook. 2026 Jun 11. pii: S0029-6554(26)00140-5. [Epub ahead of print]74(4): 102817
    Supporting the health of unaccompanied immigrant children in a humanitarian crisis: An American Academy of Nursing consensus paper.
    Mary Lou de Leon Siantz, Carmen Alvarez, Willa Doswell, Carol Howe, Mary Lynch, Anita Nirenberg, Karen Moore, Edilma Yearwood, Michele Upvall, Maya Zumstein-Shaha, Raquel Aldana, Chelsea Sachau.
      Unaccompanied immigrant children (UIC) are minors under 18 who arrive alone in the United States, often after experiencing cumulative trauma related to premigration adversity, family separation, and perilous journeys. These exposures increase risk for abuse, neglect, trafficking, and adverse physical and mental health outcomes. Trauma-informed care (TIC) offers an evidence-based, child-centered framework for nursing practice across the migration continuum by promoting safety, preventing retraumatization, and supporting continuity of care. Policies must prioritize children's best interests while equipping nurses, health professionals, and Customs and Border Protection personnel to deliver developmentally appropriate, compassionate care during screening, entry, release, and resettlement. An urgent, ethical, trauma-informed policy response is needed to safeguard UIC well-being. Providing TIC to UIC is both a moral imperative and a strategic investment in health equity and national well-being. The American Academy of Nursing supports integrating TIC across UIC services and minimizing detention to improve health outcomes.
    Keywords:  Child welfare; Health equity; Immigrants; Public policy; Trauma-informed care; Unaccompanied minors
    DOI:  https://doi.org/10.1016/j.outlook.2026.102817
  39. JAMA Netw Open. 2026 Jun 01. 9(6): e2617332
    Influenza Vaccination Trends Among Children and Adolescents, 2017-2023.
    Madhura S Rane, Geetha Gopalan, Joseph Nahmias, Michael L Rinke, Chloe A Teasdale.
      
    DOI:  https://doi.org/10.1001/jamanetworkopen.2026.17332
  40. Pediatr Qual Saf. 2026 May-Jun;11(3):11(3): e887
    Diagnostic Stewardship to Optimize Blood Culture in a Pediatric Cardiac Intensive Care Unit.
    Jun Sasaki, Angela Sorensen, Kristen Ferlisi, Lauren Shaw, Maryellen Horgan, Catherine Mareiro, Sarah A Teele.
       Introduction: The threshold for ordering blood cultures and initiating empiric broad-spectrum antibiotic therapy is often low in pediatric cardiac intensive care units (CICUs). However, excessive blood cultures carry risks, including anemia, false-positive results, and contamination related to vascular access. Overuse of broad-spectrum antibiotics can lead to the development of multidrug-resistant bacteria.
    Methods: In this quality improvement initiative focused on diagnostic stewardship, a blood culture algorithm was developed to reduce unnecessary blood culture sampling in patients with low sepsis probability. All patients admitted to the CICU were included in the study. The preimplementation observation period spanned from January 2022 to June 2023, and the postimplementation observation period lasted from July 2023 to December 2025.
    Results: There were 5,958 CICU admissions during the study period, with no statistically significant difference in the baseline clinical characteristics. The number of blood culture samples declined by 26% in the postimplementation period, from 111.9 to 82.8 per 1,000 patient-days (P < 0.001), and a centerline shift was observed after the 5-month mark in the statistical process control U-chart. No statistically significant change was observed in the central line-associated bloodstream infection rate per 1,000 line-days (1.7 versus 1.3, P = 0.26).
    Conclusions: A structured algorithm to support clinicians' decision-making for blood culture testing resulted in a statistically significant reduction in the number of blood cultures sent. The delayed centerline shift indicated that lasting change required complete practice adoption rather than mere intervention launch. This intervention was not associated with any safety concerns in clinical outcomes.
    DOI:  https://doi.org/10.1097/pq9.0000000000000887
  41. J Pediatr Pharmacol Ther. 2026 Jun;31(3): 322-338
    Advancements in Respiratory Syncytial Virus (RSV) Prevention and Treatment in Pediatrics.
    J Hunter Fly, Jeremy S Stultz, Lea S Eiland.
      Respiratory syncytial virus (RSV) is a major contributor to global morbidity and mortality, disproportionately affecting young children and infants. Annual worldwide estimates suggest more than 30 million cases of lower respiratory infection and 100,000 deaths are attributed to RSV in children younger than 5 years of age, making RSV prevention and treatment a global priority. Recently approved monoclonal antibodies and vaccines for the prevention of RSV in infants and children have the potential to significantly alter disease burden. Disease prevention is paramount as treatments with rigorously proven clinical efficacy are limited, and supportive care remains the primary management strategy for the majority of patients who contract RSV. However, new entities continue to be evaluated for the treatment of RSV in the pediatric population. This review aimed to synthesize and evaluate existing data on the approved RSV preventative therapies nirsevimab, RSVpreF, clesrovimab, and palivizumab. RSV disease, including its spread, virology, diagnosis, clinical presentation, and treatment, is also discussed.
    Keywords:  infant; monoclonal antibodies; neonate; pediatrics; respiratory syncytial virus infections; respiratory syncytial virus vaccine
    DOI:  https://doi.org/10.5863/JPPT-25-00075
  42. Semin Pediatr Neurol. 2026 Jul;pii: S1071-9091(26)00037-9. [Epub ahead of print]58 101293
    Improving concussion recognition in youth sports: the role of parents, coaches, and community education.
    Federico Baltar Yanes, Florencia Perez Vidarte, Alina Rivandeneira-Limongi, Pedro Piccardo, Alcy Torres.
      The lifelong benefits of youth sports include physical fitness and improved psychological and social skills. However, sports related risks, such as sport related concussion (SRC), must be continuously evaluated. The developing brain is uniquely vulnerable to SRC, with potential negative impacts across three fundamental domains: cognition, emotion, and learning. Surprisingly, SRC remains significantly underreported and clinically underestimated. This trend can be reversed through education focused on two critical pillars: early detection and timely reporting. However, the passive transfer of information, where athletes may feel pressured to suppress symptoms, is of limited value. SRC underreporting is heavily influenced by cultural and social factors, peer pressure, and coaching attitudes. While international legislation and guidelines vary, outcomes are optimized when legislative efforts are integrated with rigorous supervision, formal education, and medical infrastructure. The leadership of coaches and health professionals enhances team communication, athlete assertiveness, and reporting rates. In the absence of healthcare professionals, adults managing a suspected SRC should immediately remove the athlete from play and utilize the Concussion Recognition Tool 6 (CRT6) for assessment. Ultimately, effective pediatric SRC prevention requires a holistic strategy encompassing education, validated guidelines, medical support, and safety culture.
    Keywords:  Brain concussion; Healthcare education; Safety culture; Sports
    DOI:  https://doi.org/10.1016/j.spen.2026.101293
  43. JAMA Netw Open. 2026 Jun 01. 9(6): e2617459
    Inpatient Characteristics and Outcomes of Venous Thromboembolism Among Children and Adolescents.
    Sabrina Friebe, Dierk Scheinert, Esra Tokur Sonuvar, Toralf Kirsten, Eva Freisinger.
       Importance: Endogenous venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism (PE), is considered a rare event in pediatric patients, and its health care implications are largely unstudied. However, its burden on the health care system may be disproportionately higher owing to age-specific risk factors.
    Objective: To evaluate and characterize the inpatient cohort of children and adolescents with VTE and PE.
    Design, Setting, and Participants: This nationwide cohort study used data on inpatient cases of VTE in Germany (data source: Federal Bureau of Statistics DESTATIS) from 2020 to 2024. Cases younger than 20 years with VTE as the main or secondary diagnosis, as well as a subcohort with PE as the main diagnosis, were analyzed regarding risk profiles, inpatient care, and outcomes stratified by sex and age.
    Main Outcomes and Measures: Hospital-based incidence of VTE (VTE cases per 10 000 inpatient cases per year) and in-hospital mortality.
    Results: This study identified 14 108 pediatric inpatient cases of VTE (mean [SD] age, 9.0 [7.3] years; 7201 male [51.0%]), corresponding to a hospital-based incidence of 15.3 per 10 000 pediatric cases per year. A total of 3311 patients with VTE (23.5%), comprising 1361 of 6907 female patients (19.7%) and 1950 of 7201 male patients (27.1%), were infants younger than 1 year. Risk factors for VTE varied, as rates of infection, chronic organ failure, and congenital diseases decreased with increasing patient age, while cancer was most commonly diagnosed among cases aged 5 to 14 years, and thrombophilia remained a relatively constant risk factor across all age groups. PE occurred in 1564 VTE cases (11.1%); among cases whose main diagnosis was PE, 624 of 888 (70.3%) were female. The in-hospital mortality rate in the VTE cohort was 3.7% (522 of 14 108); mortality risk was significantly increased among infants aged 4 years or younger (OR, 3.52 [95% CI, 2.73-4.57]; P < .001).
    Conclusions and Relevance: This cohort study found a marked inpatient health care and economic burden for VTE among children and adolescents. Mortality risk was significantly increased among infants younger than 1 year. Studies are needed to provide evidence-based support for the safety and effectiveness of medical interventions for children and adolescents with VTE.
    DOI:  https://doi.org/10.1001/jamanetworkopen.2026.17459
This page is being maintained by Thomas Krichel. It was last updated on 2026‒06‒14 at 23:56.