bims-cliped Biomed News
on Clinical pediatrics
Issue of 2026–07–19
28 papers selected by
Alyssa M. Portwood, Akron’s Children
  1. Interventions to Reduce Monitor Alarms Across Pediatric Inpatient Settings: A Systematic Review.
  2. Pediatric Measles Resurgence: Implications for Acute and Critical Care Nursing Practice.
  3. Continuous Aerosolized Albuterol Treatment for Status Asthmaticus on the General Care Floor: A Quality Improvement Initiative.
  4. The New Vaccine Surveillance Network: 25 years of active, population-based surveillance for pediatric infectious diseases in the United States.
  5. Statewide Variation in Social Needs Screening and Referral Practices Across Pediatric Primary Care Practices in Maryland.
  6. A quality improvement project to optimize the neonatology research experience for families.
  7. A Qualitative Evaluation of Infant Safe Sleep Following Free Crib Provision.
  8. Improving Pediatric Nurse Practitioner Students' Knowledge, Comfort, and Skill in Firearm Safe Storage Counseling Through Simulation.
  9. Racial and Ethnic Disparities in Length of Stay for Pediatric Bacterial Tracheostomy-Associated Infections.
  10. Trampoline Fractures in Children.
  11. Preparing Pediatric Hospital Medicine Physicians to Care for Transgender Youth: A Call to Action.
  12. Current Practices and Variations Among Pediatric Severe Asthma Programs in the United States-The North American Severe Pediatric Asthma Consortium.
  13. Death and Cardiac Disease in Pediatric Hospitals and the Role of Subspecialty Palliative Care.
  14. New Technology Dependence Among Children Hospitalized for Traumatic Injury.
  15. Adolescent Hospital Visits for Sexual and Reproductive Health Outcomes After the Dobbs Decision.
  16. Quality Improvement Initiative to Reduce Inappropriate Viral Testing within the Pediatric Emergency Department.
  17. The Value of a Medical Home for Children with Medical Complexity from the Perspective of Their Families.
  18. Noticing and responding to end-of-life suffering in the PICU: A co-designed conceptual framework for nursing practice.
  19. Epidemiology of Potential Missed Diagnosis of Pediatric Central Nervous System Infections in the Emergency Department.
  20. Surgeon Perceptions on Fertility Counseling and Preservation in Children with Cancer: A Multicenter Survey of North American Hospitals.
  21. Parental involvement in patient safety events in paediatric emergency care: a multi-method analysis.
  22. Nursing Interventions to Promote Health Literacy in Children and Adolescents: A Scoping Review.
  23. Minimally Invasive Spinal Interventions for Back and Neck Pain in the Pediatric Population: a Systematic Review.
  24. Patient risk factors for 30-day unplanned readmission after pediatric neurosurgery: are we improving?
  25. Evaluation of virtual reality-based meditation as a tool to mitigate stress among parents and providers in the neonatal intensive care unit.
  26. Artificial Intelligence and Clinician Burnout in the United States: A Narrative Review.
  27. Implementation of a Nebulized Tranexamic Acid Protocol for Pediatric Post-Tonsillectomy Hemorrhage: A Quality Improvement Initiative.
  28. Coping Strategies and Social Support for Transition Readiness Among Youth With Sickle Cell Disease.
  1. Hosp Pediatr. 2026 Jul 14. pii: e2025009079. [Epub ahead of print]
    Interventions to Reduce Monitor Alarms Across Pediatric Inpatient Settings: A Systematic Review.
    Kathleen J Berg, Kori Hess, Megan Gripka, Andrea Melanson, Kelli Ott, Todd Glenski, Jarrod Dusin, Nicholas A Clark.
       CONTEXT: In pediatric inpatient settings, excess alarms from physiologic monitors lead to alarm fatigue, which can jeopardize patient safety.
    OBJECTIVE: To systematically review interventions to reduce alarms from pulse oximeters and cardiorespiratory monitors in neonatal intensive care units (NICUs), pediatric intensive care units (PICUs), and medical/surgical units (MSUs).
    DATA SOURCES: PubMed, Embase, CINAHL, and citations of selected articles were searched from January 2010 to August 2025.
    STUDY SELECTION: Two reviewers independently screened studies. Included studies were conducted in the NICU, PICU, or MSU; implemented at least 1 intervention intended to reduce alarms; and reported alarm frequency from pulse oximeters and/or cardiorespiratory monitors.
    DATA EXTRACTION: At least 2 reviewers independently appraised study quality and extracted data, including setting, design, population, interventions, alarm type, alarm frequency, and balancing measures.
    RESULTS: Twenty-three studies were included: 12 NICU, 2 PICU, 8 MSU, and 1 that was both PICU and MSU. There were 16 quality improvement (QI) studies, 5 nonrandomized studies, and 2 randomized controlled trials. Common interventions included educating staff, widening alarm parameters for all patients, customizing alarm parameters for specific ages or conditions, lengthening alarm time delays, and standardizing communication about patients' monitoring plans. Because of significant heterogeneity among studies, the impacts of individual interventions could not be compared.
    LIMITATIONS: Balancing measures were inconsistently reported. There is a lack of standardized methodology for systematically reviewing QI studies.
    CONCLUSIONS: Most studies reported decreased alarm frequency. All studies measuring nonactionable alarms reported decreases. This systematic review can inform local improvement work to decrease excess alarms from physiologic monitors.
    DOI:  https://doi.org/10.1542/hpeds.2025-009079
  2. Crit Care Nurse. 2026 Jul 17. e1-e11
    Pediatric Measles Resurgence: Implications for Acute and Critical Care Nursing Practice.
    Janakiram Rameswaran, Jessica Strohm Farber, Kristin Atlas, Kerry Shields.
       BACKGROUND: The United States declared endemic measles eliminated in 2000. However, outbreaks continued, with resurgences in 2019 and 2025. In 2025, more than 2200 cases across 48 outbreaks, the most since 1992, were reported. In the first half of 2026, 2073 cases were reported. Declining measles, mumps, and rubella vaccination rates have increased susceptibility among children. Acute and critical care nurses are central to early recognition and management of measles for optimal outcomes.
    OBJECTIVE: To summarize current evidence on measles epidemiology, pathophysiology, clinical presentation, complications, treatment strategies, and acute and critical care nursing implications, emphasizing preparedness amid rising case numbers.
    METHODS: A literature review was conducted using PubMed and CINAHL databases and websites of Centers for Disease Control and Prevention, World Health Organization, professional organizations, and pediatric hospitals. English-language sources published from 2015 to August 2025 were prioritized; relevant earlier studies were included. Reference lists were searched for additional articles.
    DATA SYNTHESIS: Measles is among the most contagious human diseases. Typical features include fever, cough, coryza, conjunctivitis, and morbilliform rash. Severe respiratory and neurological complications may require critical care hospitalization. Complications like encephalitis may present weeks to years after acute infection. Management remains supportive, with vitamin A supplementation recommended. Acute and critical care nursing priorities include early recognition, isolation precautions, specimen collection, respiratory and hemodynamic support, neurological monitoring, serial assessments, hydration, nutrition, and caregiver education.
    CONCLUSION: Measles is resurging in the United States despite being vaccine preventable. Nurse preparedness, including knowledge of clinical features, complications, and infection control, is essential to mitigate morbidity and mortality and to support outbreak prevention. (Critical Care Nurse. Published online ahead of print July 17, 2026).
    DOI:  https://doi.org/10.4037/ccn2026877
  3. Pediatr Qual Saf. 2026 Jul-Aug;11(4):11(4): e896
    Continuous Aerosolized Albuterol Treatment for Status Asthmaticus on the General Care Floor: A Quality Improvement Initiative.
    Kailey A Remien, Charles Hardy, Karen Allen, Matthew Wysong, Morgan Zlotolow, Gerd McGwire, Courtney Whitacre, Renae Forsythe, Tara Dinh, Lisa Ulrich, Adjoa A Andoh, Samantha W Gee, Shauna Schord.
       Introduction: Asthma, a leading cause of pediatric hospitalization, affects more than 6 million US children and costs more than $5 billion annually. Continuous aerosolized albuterol (CAA) effectively treats severe exacerbations but is typically reserved for intensive care or emergency settings. This quality improvement project aimed to safely expand CAA use on the general care floor (GCF) by monitoring treatment uptake, protocol adherence, and safety outcomes.
    Methods: This single-center quality improvement project, led by a multidisciplinary team, included children aged 2-18 years with status asthmaticus on CAA who met the inclusion criteria. Interventions involved protocol development, staff education, electronic health record updates, and a resident-led handoff huddle. Primary outcomes were non-pediatric intensive care unit (PICU) CAA hours and the proportion of patients treated on the GCF. Process measures included protocol use and handoff huddles. Balancing metrics included PICU and emergency transfers, fluid-refractory hypotension, and ED length of stay.
    Results: From June 2024 to October 2025, GCF CAA accounted for 17% of total hospital CAA, surpassing the 10% target. ED length of stay remained unchanged, indicating no disruption to workflow. We safely treated 72 patients on the GCF (average CAA duration of 21.6 h); 22 (31%) required PICU transfer; none were emergent transfer. This intervention saved 1,017 PICU hours (42.4 PICU bed-days), equivalent to $275,600 in room-and-board costs. These savings represent a substantial reduction in PICU resource use; however, we did not conduct a formal cost-effectiveness analysis.
    Conclusions: CAA can be safely administered in the GCF following a structured protocol, reducing the need for PICU resources without adversely affecting ED care efficiency.
    DOI:  https://doi.org/10.1097/pq9.0000000000000896
  4. Clin Infect Dis. 2026 Jul 13. pii: ciag434. [Epub ahead of print]
    The New Vaccine Surveillance Network: 25 years of active, population-based surveillance for pediatric infectious diseases in the United States.
    NVSN Collaborators
       BACKGROUND: In 1999, the Centers for Disease Control and Prevention (CDC) established the New Vaccine Surveillance Network (NVSN) as a multi-site pediatric infectious diseases active surveillance system.
    METHODS: NVSN prospectively collects population-based clinical, epidemiologic, and laboratory information on children who seek medical care at hospitals, emergency departments, urgent care centers, and outpatient clinics with symptoms of acute respiratory infections (ARI) and acute gastroenteritis (AGE) in the United States.
    RESULTS: These efforts have clearly established the significant burden of both ARI and AGE in US children, demonstrated the effectiveness of licensed pediatric vaccines, and helped guide their use. The surveillance platform also measures the real-world impact of preventive measures intended to avoid or ameliorate adverse child health outcomes within the US healthcare system. Furthermore, NVSN provides a platform for detecting and evaluating emerging infections (e.g. enterovirus D-68, SARS-CoV-2) and unexpected sequelae in children.
    CONCLUSIONS: For 25 years NVSN has provided an evidence-based foundation for pediatric infectious disease policy decision-making through objective, empirical data. Sustained investment in disease surveillance guides the scientific principles and public health practices that prevent suffering and premature death, prepares us for new and existent pathogen threats, and enables wise economic decisions that improve the health of Americans.
    Keywords:  EV-D68; New Vaccine Surveillance Network; PREVAIL Cohort; RSV; SARS-CoV-2; disease burden; emerging infectious diseases; health policy; influenza; norovirus; pediatric infections; population-based surveillance; rotavirus; vaccine effectiveness
    DOI:  https://doi.org/10.1093/cid/ciag434
  5. Acad Pediatr. 2026 Jul 17. pii: S1876-2859(26)00191-9. [Epub ahead of print] 103409
    Statewide Variation in Social Needs Screening and Referral Practices Across Pediatric Primary Care Practices in Maryland.
    Hanae Fujii-Rios, Melissa R Lutz, Kristin Topel, Cameron Lee, Arenal Haut, Morgan Cook, Barry S Solomon.
       BACKGROUND: There has been an increased focus on addressing health-related social needs (HRSN), with recent regulatory bodies requiring screening in adult populations. Though not yet included in the new requirements, pediatric primary care has been at the forefront. Assessing statewide practices is important to understand if HRSN screening and resource provision occur equitably for patients and families.
    OBJECTIVE: To characterize HRSN screening and referral processes amongst a representative sample of pediatric primary care practices in Maryland.
    METHODS: In this cross-sectional study (June-August 2023), Maryland pediatric primary care practices were sampled proportionally by county pediatric population density and surveyed regarding practice characteristics, HRSN screening, and referral mechanisms. Results were summarized descriptively.
    RESULTS: Surveys were completed by 54 practices from 22 of the 24 Maryland counties approximately proportional to pediatric population density in each county. Of the 85% of practices reporting screening for at least one HRSN, all screen during well child visits. Screening processes varied across clinics, with most occurring in the exam room (52%), verbally (57%), and by a physician or nurse practitioner (54%). Most practices document HRSN in the electronic medical record (84%). Clinics have various cascading interventions including referrals to community resources, social workers, and community health workers.
    CONCLUSION: In a geographically representative sample of pediatric primary care practices in Maryland, most screen for at least one HRSN though variability exists in the method and timing of screening and subsequent referral processes. Our findings underscore the need for practice-level support to ensure HRSN are optimally and equitably addressed.
    Keywords:  Health-related social needs; pediatric primary care; screening
    DOI:  https://doi.org/10.1016/j.acap.2026.103409
  6. J Perinatol. 2026 Jul 15.
    A quality improvement project to optimize the neonatology research experience for families.
    Marianna B Castellanos, Adrian Baca-Arzaga, Maria Laura Mourão, Rhys Johnstone, Denisse Moncada, John A F Zupancic, Helen Healy.
       BACKGROUND: Enrollment in neonatal research is challenging due to time-limited decisions and consent complexity, contributing to biased samples.
    LOCAL PROBLEM: In our NICU, research consent approaches were inconsistent, participation data were limited, and multiple studies occurred concurrently.
    METHODS: We conducted a quality improvement initiative (January 2022-December 2023) with secondary analysis of sociodemographic factors. Primary measures were the percent of eligible families approached and consenting; subgroup analyses examined language, gestational age, and insurance.
    INTERVENTIONS: Seven PDSA cycles targeted staffing, language-concordant and antenatal approaches, team coordination, and standardized training.
    RESULTS: The approach rate increased from 52% to 66% with special cause variation. Overall, 65% of families consented. Observational studies enrollment showed special cause variation; interventional enrollment remained stable. Antenatal approaches yielded a 91% consent. Language-concordant approaches were associated with higher consent among Spanish- (88%) and Portuguese-speaking (83%) families (p = 0.047).
    CONCLUSIONS: Structured team processes and language-concordant, antenatal approaches improved rates and supported more equitable participation.
    DOI:  https://doi.org/10.1038/s41372-026-02809-4
  7. Kans J Med. 2026 May-Jun;19(3):19(3): 49-54
    A Qualitative Evaluation of Infant Safe Sleep Following Free Crib Provision.
    Kourtney Bettinger, Maheen Bangash, Danica Dodd, Carolyn R Ahlers-Schmidt, Christy Schunn, Ann Davis.
       Introduction: Unsafe sleep practices are a leading cause of infant mortality in the United States. Authors of this qualitative study examined parental perceptions and reported practices related to infant safe sleep among families who received a free portable crib after their infant's birth. Specifically, authors explored whether families used the portable crib to provide a safe sleep environment for their infants.
    Methods: Parents of infants aged 2 to 11 months who received a free portable crib were invited to participate in a structured 11-question interview assessing safe sleep perceptions and practices, including crib use. Eleven families participated in the study.
    Results: Six themes emerged from the interviews: (1) parents recalled receiving safe sleep counseling, often in considerable detail; (2) many parents initially planned to bed-share before receiving the crib; (3) reported sleep practices frequently differed from established safe sleep recommendations; (4) parents described multiple reasons for not consistently following recommendations; (5) participants supported the continued provision of free cribs and safe sleep counseling; and (6) parents generally found the crib helpful, although it often was used alongside other sleep arrangements.
    Conclusion: Although parents recalled receiving safe sleep counseling, reported sleep practices frequently did not align with recommended guidelines. Further research is needed to better understand this gap and to identify strategies that improve adherence to safe sleep recommendations.
    Keywords:  infant, sudden infant death; physiology; prevention and control, sleep
    DOI:  https://doi.org/10.17161/kjm.vol19.25004
  8. J Pediatr Health Care. 2026 Jul 11. pii: S0891-5245(26)00216-6. [Epub ahead of print]
    Improving Pediatric Nurse Practitioner Students' Knowledge, Comfort, and Skill in Firearm Safe Storage Counseling Through Simulation.
    Christine A Schindler, Theresa G Schnable, Emily Knurek.
       INTRODUCTION: Firearm injury is the leading cause of death among children and adolescents in the United States. Pediatric nurse practitioners are positioned to counsel families regarding safe firearm storage; however, many reports inadequate preparation for these conversations.
    METHODS: The intervention included two standardized patient simulations, structured debriefing, and a faculty-led educational session on firearm safe storage and counseling strategies. Outcome measures included a knowledge quiz, Likert scale self-efficacy survey, simulation performance rubric, and reflective writing assignments.
    RESULTS: Significant improvements were observed in perceived knowledge, comfort, and skill. Qualitative analysis revealed increased confidence, improved communication strategies, and greater clarity regarding the pediatric nurse practitioner role in firearm injury prevention.
    DISCUSSION: This model offers a feasible and scalable framework for integrating firearm injury prevention into graduate pediatric nursing curricula.
    Keywords:  Risk reduction; counseling; firearm injury prevention; safety; simulation
    DOI:  https://doi.org/10.1016/j.pedhc.2026.06.010
  9. Hosp Pediatr. 2026 Jul 16. pii: e2025009114. [Epub ahead of print]
    Racial and Ethnic Disparities in Length of Stay for Pediatric Bacterial Tracheostomy-Associated Infections.
    Pediatric Research in Inpatient Setting Network
       BACKGROUND AND OBJECTIVES: Racial and ethnic disparities disproportionately impact children with medical complexity (CMC), including children with tracheostomies. Children hospitalized for bacterial tracheostomy-associated infections (bTRAINs) experience care variations that may exacerbate disparities. Our study aimed to quantify disparities in length of stay (LOS) for children hospitalized with bTRAINs.
    METHODS: We conducted a multicenter observational study of children aged 0 to 21 years who were hospitalized and treated for a bTRAIN at 6 children's hospitals between August 2020 and August 2024, excluding children with outlier LOS (>30 days). Our primary predictor was race and ethnicity, as documented in the electronic medical record. Our primary outcome was LOS (days). We used mixed-effects regression modeling to account for repeated encounters, nesting of patients within hospitals, and adjusting for confounders (socioeconomic factors, comorbidities and illness severity).
    RESULTS: We included 662 children (39% white, 35% Hispanic, 22% Black, and 4% Asian) representing 1349 unique encounters. The median age at hospitalization was 6 years (IQR 2-13) and 72% of children had public insurance. Median LOS was 8 days (IQR 5-12). When adjusting for confounders, all other racial groups had longer LOS compared with white children with ratio of means of 1.14 (95% CI: 1.03-1.28) for Black; 1.12 (95% CI: 1.01-1.25) for Hispanic; and 1.29 (95% CI: 1.07-1.54) for Asian children.
    CONCLUSIONS: Black, Hispanic, and Asian children hospitalized for a bTRAIN experience longer LOS than white children. Understanding is needed on how implicit bias, systemic racism, and care-team preferences lead to disparities and if standardized care can improve outcomes.
    DOI:  https://doi.org/10.1542/hpeds.2025-009114
  10. J Pediatr Orthop. 2026 Jul 14.
    Trampoline Fractures in Children.
    Roope Parviainen, Topi Laaksonen, Petra Grahn, Juha-Jaakko Sinikumpu, Ilkka Helenius, Matti Ahonen.
       BACKGROUND: Trampoline use has become increasingly common among children and adolescents, paralleled by a rise in trampoline-related injuries. Nevertheless, current age-based recommendations for trampoline use are supported by limited evidence. This study aimed to determine whether the frequency and severity of trampoline-related fractures differ among specific pediatric age groups.
    METHODS: We identified all pediatric trampoline-related fractures treated in the Helsinki area, Finland, between 2014 and 2022. Cases were extracted from the institutional fracture registry, the KIDS Fracture Tool, which contained 18,279 fractures as of December 2022. The distribution, fracture severity, and frequency of surgical treatment were compared with the other sports-related fractures recorded in the registry. Trampoline-related fractures were analyzed across 3 age groups: 0 to 5 years, 6 to 10 years, and 11 to 15 years.
    RESULTS: A total of 1153 trampoline-related fractures were identified (592 in girls and 561 in boys), representing 6.3% of all pediatric fractures. The annual incidence of trampoline-related fractures was 9.3 per 10,000 children. In the youngest age group, the lower leg was the most commonly fractured site, whereas forearm fractures predominated in the older groups. Well-aligned fracture was the most frequent fracture pattern in younger children, while more severe fracture types increased in prevalence with age. The proportion of open fractures was higher in the trampoline cohort than in the overall sport-related fracture cohort (relative risk, 2.02; 95% CI: 1.22-3.34).
    CONCLUSIONS: Trampoline-related fractures show age-dependent variation, with younger children sustaining predominantly low-energy injuries and older children experiencing more severe fracture patterns. Trampoline injuries were associated with a higher risk of displaced fractures requiring internal fixation and open fractures. Due to the lack of exposure data, definitive conclusions cannot be made regarding age-specific injury risk or age-based restrictions.
    LEVEL OF EVIDENCE: Level IV-case series.
    Keywords:  Injury; fracture; pediatric; trampolining
    DOI:  https://doi.org/10.1097/BPO.0000000000003410
  11. Hosp Pediatr. 2026 Jul 17. pii: e2026009295. [Epub ahead of print]
    Preparing Pediatric Hospital Medicine Physicians to Care for Transgender Youth: A Call to Action.
    Sophie Lieberman, Olivia O Familusi, Aditi Vasan, Nicole Washington, Morgan Congdon.
      
    DOI:  https://doi.org/10.1542/hpeds.2026-009295
  12. Pediatr Pulmonol. 2026 Jul;61(7): e71738
    Current Practices and Variations Among Pediatric Severe Asthma Programs in the United States-The North American Severe Pediatric Asthma Consortium.
    Kristina Gaietto, Nadia Krupp, Avani V Shah, Erhan Ararat, Samantha H Averill, Sachin Baxi, Matejka Cernelc-Kohan, Jeffrey M Chambliss, Heather De Keyser, Monica Federico, Bob Geng, Akilah A Jefferson, Parisa Kaviany, Lila C Kertz, Kirsten Kloepfer, Allyson Larkin, Sydney Leibel, Tanya Martinez-Fernandez, Samira Naime, Robert D Pesek, Dinesh K Pillai, Deepa Rastogi, Katherine Rivera-Spoljaric, Kristie R Ross, Franziska J Rosser, Tregony C Simoneau, Jade Tam-Williams, Kelan G Tantisira, William Anderson, Jonathan M Gaffin, Theresa W Guilbert, Erick Forno.
       BACKGROUND: Severe and difficult to treat asthma in children is a complex condition causing significant morbidity and associated healthcare costs. While treatment guidelines exist for severe asthma, optimal treatment approaches for the pediatric population are less well established. Furthermore, best practices regarding real world management and implementation of guidelines for the severe pediatric asthma population are lacking. In order to provide care for this population, institutions around the United States have developed multidisciplinary severe pediatric asthma programs (SPAPs). In recent years, the North American Severe Pediatric Asthma Consortium (NASPAC) was established as a mechanism for SPAPs to collaborate and share expertise in pediatric severe asthma. We describe the structure of the individual programs within NASPAC, as well as similarities and differences between them.
    METHODS: Study design consisted of a cross-sectional observational framework model, utilizing a Redcap survey that was distributed to sixteen SPAPs in 2024. Survey questions included total and new patient volume, type of staff, frequency of SPAP sessions, eligibility criteria for enrollment in the SPAP, and typical initial evaluation once enrolled. Twelve centers had completed prior surveys regarding patient volume in 2018 and 2021, and this data was used for comparison.
    RESULTS: Fourteen centers responded to the 2024 survey. The centers were most similar in their incorporation of core personnel (pulmonologists, allergists, social workers, asthma educators), and the morbidity measures used for their clinic inclusion criteria. Almost all SPAPs had a basic initial evaluation including medication and technique review, adherence evaluation/discussion and spirometry. Significant variability was seen in presence of additional staff (psychologists, endocrinologists, nutritionists), and additional radiologic and laboratory testing at initial evaluation.
    DISCUSSION: Significant similarities exist among fourteen independent severe pediatric asthma programs throughout the United States. However, practice variability was evident between centers. The formation of NASPAC provides opportunities for research and collaborative initiatives, as well as to establish best practices for real world management of the severe and difficult to treat pediatric asthma population.
    DOI:  https://doi.org/10.1002/ppul.71738
  13. Pediatrics. 2026 Jul 17. pii: e2025074622. [Epub ahead of print]
    Death and Cardiac Disease in Pediatric Hospitals and the Role of Subspecialty Palliative Care.
    Collaborative Research from the Pediatric Cardiac Intensive Care Society (CoRe-PCICS) Investigators
      
    OBJECTIVES: To characterize end-of-life (EOL) experiences of children and adults with heart disease who die in pediatric hospitals.
    METHODS: This multicenter retrospective study included patients with heart disease who died within 31 US pediatric referral centers from July 1, 2021, to June 30, 2023. Data from terminal admissions were collected. Outcomes included high medical intensity EOL care, which was defined based on therapies used on day of death and active resuscitation (CPR) as the mode of death. Multivariable analyses, accounting for clustering by center, were performed to identify factors associated with outcomes, with adjusted odds ratios (aOR) and 95% CIs presented.
    RESULTS: We reviewed 1044 decedents. Median age at admission was 67 days (25%, 75%: 0 d, 3.2 y). Subspecialty palliative care (SPC) followed 696 (68%) patients, with initial consultation a median 20 days before death (25%, 75%: 5, 69). High medical intensity care and CPR occurred at EOL in 654 (63%) and 172 (17%) patients, respectively. In multivariable analyses, greater odds of high medical intensity EOL care were observed for patients with cardiomyopathy or transplant diagnoses (aOR 1.70; 95% CI 1.06, 2.73) or cardiac surgery (aOR 3.33; 95% CI 2.39, 4.63), and lower odds were observed in patients with genetic abnormalities (aOR 0.68; 95% CI 0.51, 0.90) or SPC involvement (aOR 0.44; 95% CI 0.32, 0.60). Odds of CPR at EOL were lower with SPC involvement (aOR 0.34; 95% CI 0.24, 0.50), inversely associated with Child Opportunity Index (per 10-point increase: aOR 0.91; 95% CI 0.85, 0.97), and higher for patients of Black race (aOR 1.94; 95% CI 1.23, 3.06).
    CONCLUSION: Patients with heart disease who die in US pediatric hospitals frequently experience high medical intensity care and CPR at EOL. Odds of these clinical outcomes were significantly lower if SPC is involved.
    DOI:  https://doi.org/10.1542/peds.2025-074622
  14. Pediatrics. 2026 Jul 15. pii: e2025075515. [Epub ahead of print]
    New Technology Dependence Among Children Hospitalized for Traumatic Injury.
    Jillian K Gorski, Ryan J Coller, Adam S Brinkman, Christian D Pulcini.
       OBJECTIVE: We aimed to determine the frequency of, and factors associated with, new technology dependence among hospitalized pediatric trauma survivors.
    METHODS: We performed a retrospective cross-sectional study of encounters from over 800 US hospitals using the 2021 and 2022 American College of Surgeons National Trauma Data Bank Trauma Quality Improvement Program files. We included children younger than 18 years hospitalized for trauma who survived to discharge. We performed multivariable logistic regression to determine the effect of exposures including injury mechanism and serious injuries on our primary outcome of interest, the performance of a procedure conferring technology dependence as defined by the Pediatric Complex Chronic Condition System Version 3. Secondary outcomes included hospital length of stay, complications, and discharge disposition.
    RESULTS: Among 183 848 hospitalized pediatric trauma survivors (median age: 10 years, 64.1% male), 2.0% underwent a procedure conferring new technology dependence. Firearm (odds ratio [OR] 3.8) and traffic injuries (OR 2.4) were associated with new technology dependence, and serious injuries to all but 1 body system (extremities) were associated with new technology dependence, particularly head and neck injuries (OR 9.2). The most common procedure types were spinal fusion (41.0%), cerebrospinal fluid drainage (27.6%), and feeding device placement (27.6%). Children with new technology dependence experienced longer hospital stays, more complications, and were less frequently discharged home without services.
    CONCLUSIONS: One in 50 hospitalized pediatric trauma survivors underwent procedures conferring new technology dependence. These findings underscore the need for trauma-informed survivorship care and prevention strategies that address the chronic health consequences of childhood injury.
    DOI:  https://doi.org/10.1542/peds.2025-075515
  15. Hosp Pediatr. 2026 Jul 17. pii: e2025009017. [Epub ahead of print]
    Adolescent Hospital Visits for Sexual and Reproductive Health Outcomes After the Dobbs Decision.
    Christina Bonaparte, Matt Hall, Cheryl L Errichetti, Monika K Goyal, Lauren S Chernick, Elizabeth Hovel, Vanessa McFadden, Melissa K Miller, Stephani Stancil, Abbey R Masonbrink.
       OBJECTIVE: To evaluate changes in adolescent sexual and reproductive health (SRH)-related hospital encounters post-Dobbs and compare by state abortion policies.
    METHODS: We conducted a retrospective cohort study of adolescent pediatric hospital encounters from June 2021 to December 2024 and used an interrupted time series analysis to measure the impact of Dobbs on SRH outcomes. Encounters included any hospital encounter of patients aged 11 to 18 years from 42 children's hospitals nationwide. SRH outcomes included pregnancy diagnosis, sexually transmitted infection (STI) testing and diagnosis, emergency contraception (EC) provision, or abortion, based on billing codes.
    RESULTS: Of 3 448 158 pediatric hospital encounters, 1 584 397 (45.9%) occurred in abortion-restricted states. In abortion-restricted states, there was an increase in pregnancy diagnosis during encounters at the time of Dobbs (June 2022) (odds ratio [OR], 1.26; 95% CI, 1.02-1.55; P = .029). Encounters with STI testing (OR, 0.99; 95% CI, 0.99-1.00; P = 0.027), STI diagnoses (OR, 0.98; 95% CI, 0.97-1.00; P = .017), and EC (OR, 0.98; 95% CI, 0.96-1.00; P = .028) decreased post-Dobbs compared with pre-Dobbs in restricted states. Of 1 863 761 (54.1%) pediatric hospital encounters in permissive states, pregnancy encounters decreased pre-Dobbs (OR, 0.98; 95% CI, 0.96-1.00; P = .021) and then slightly increased post-Dobbs (OR, 1.03; 95% CI, 1.01-1.05; P = .006), whereas STI trends in testing and diagnosis remained stable across all 3 time periods.
    CONCLUSION: In abortion-restricted states post-Dobbs, we found a 26% increase in the odds of pregnancy-related encounters, as well as a decrease in STI testing, diagnosis, and EC administration. Further efforts are needed to offset the disparate risk for outcomes for youth living in abortion-restricted states.
    DOI:  https://doi.org/10.1542/hpeds.2025-009017
  16. Pediatr Qual Saf. 2026 Jul-Aug;11(4):11(4): e898
    Quality Improvement Initiative to Reduce Inappropriate Viral Testing within the Pediatric Emergency Department.
    Cherisse Mecham, Rachel Kortman, Emma Albrecht, Sam Dowell, Cecilia Monteilh.
       Introduction: The American Academy of Pediatrics Section on Emergency Medicine's Choosing Wisely Campaign includes recommendations discouraging comprehensive viral panel testing in children with suspected respiratory viral illness. In the year preceding project implementation, our free-standing pediatric emergency department (PED) ordered comprehensive respiratory pathogen panels (RPPs) in 11.9% of all visits, and 50% of those lacked a clinical indication. This project aimed to reduce the percentage of PED visits with RPP orders from 11.9% to 9% over a 6-month viral respiratory season.
    Methods: We conducted four major interventions over 2 plan-do-study-act cycles. Interventions included developing a clinical guideline for viral testing, performing provider education, introducing a narrower-spectrum Quad (influenza A/B, COVID-19, and respiratory syncytial virus) polymerase chain reaction (PCR) test, and adding an order-entry indication requirement for RPPs, which also served as a just-in-time educational tool for providers. We tracked data via a clinical dashboard and through periodic chart reviews.
    Results: Of the 43,283 patient visits during the project period, the percentage of PED RPP orders decreased from 11.9% at baseline to 6.8% during the intervention period and remained at 6.8% in the following respiratory season. The project had sustained cost savings of over $300,000 in RPP testing each year. The decrease in RPP orders did not lead to an increase in the cumulative use of other viral tests.
    Conclusions: This quality improvement initiative significantly improved and sustained comprehensive viral PCR testing practices in the PED without increasing the use of alternative respiratory viral testing.
    DOI:  https://doi.org/10.1097/pq9.0000000000000898
  17. Acad Pediatr. 2026 Jul 14. pii: S1876-2859(26)00186-5. [Epub ahead of print] 103404
    The Value of a Medical Home for Children with Medical Complexity from the Perspective of Their Families.
    Kristina E Malik, Ashley Dafoe, Kate Holler, Brooke Dorsey, Christopher J Stille.
       OBJECTIVE: To identify what families value in a medical home for children with medical complexity (CMC).
    METHODS: This was a qualitative study using semi-structured interviews with caregivers of CMC recruited from a single complex care program. Participants identified their child's medical home during the interview and described experiences which made it a medical home. Transcripts were coded and themes were developed through iterative team discussions using thematic analysis; a parent partner was on the team from grant development through publication.
    RESULTS: During semi-structured interviews with 17 caregivers of CMC, 94% identified a medical home. Caregivers identified it was valuable for a medical home to provide comprehensive whole child care through curiosity to learn, a willingness to problem solve, and bi-directional trusting relationships that reduced the mental load on families. Caregivers gave specific examples where the synergy of these components improved CMC and family outcomes.
    CONCLUSION: These results support the current definition of a pediatric medical home for CMC and also introduce the novel idea that having a medical home has a positive outcome of reducing the mental load on families. This study suggests ensuring delivery of care concordant with the medical home principles can support the needs of CMC.
    Keywords:  CMC; CYSHCN; children and youth with special health care needs; children with medical complexity; medical home; pediatrics; primary care
    DOI:  https://doi.org/10.1016/j.acap.2026.103404
  18. Intensive Crit Care Nurs. 2026 Jul 16. pii: S0964-3397(26)00166-7. [Epub ahead of print]96 104498
    Noticing and responding to end-of-life suffering in the PICU: A co-designed conceptual framework for nursing practice.
    Elizabeth G Broden Arciprete, Kelly N Michelson, Shelli L Feder, Jerris W Marr, Nora Al-Roub, Suzanne R Gouda, Aubrey Mckenzie Jones, Ashleigh B Schopen, Alexandra K Tapper, Tracy A Pasek, Reena J Kelly, Liz R Morris, Aleksandra E Olszewski, Christine Gallagher, J Allen Taylor, Sarah Brand McCarthy, Jennifer M Snaman, Prasanna Ananth.
       OBJECTIVES: Pediatric intensive care unit (PICU) nurses spend the most time with patients and families during a critical illness. However, nurses, families, and other clinicians conceptualize suffering differently, leaving some types of suffering when a child is nearing the end-of-life (EOL) unaddressed. PICU nurses are thus well-positioned but underequipped to address suffering during EOL. We aimed to 1) characterize distinctive features that indicate the presence and/or absence of suffering; and 2) identify nursing care responses that help attend to EOL suffering.
    METHODS: Using qualitative interpretive description, we collaborated with a purposive sample of bereaved parents and interdisciplinary health professionals, including nurses, to develop a conceptual model to better equip nurses to notice and respond to EOL suffering. The sample participated in 3 focus group discussions. Two coders generated descriptive codes from each focus group, which were revised with participants at subsequent sessions and then arranged into overarching categories. Categories and sub-categories were then co-designed into a conceptual model that was iteratively refined by participants and the research team.
    RESULTS: Participants (N = 25) included 8 parents, 6 PICU nurses, 3 PICU physicians/advanced practice providers (APPs), 3 palliative care physicians/APPs, and 5 allied health professionals. Together with the research team, participants co-designed A Conceptual Framework to Guide Bedside Nursing Care to Address EOL Suffering, which relates four overlapping categories: 1) Noticeable Indicators for Acknowledgement and Validation, 2) Responsive Indicators for In-the-Moment Interventions, 3) Collaborative Responses, and 4) Dynamic Contextual Factors. Participants described that some indicators of suffering may be acknowledged and/or validated (such as shattered assumptive world) but not always eased. Whereas other indicators (such as physical and emotional expressions) may be responsive to in-the-moment interventions (such as facilitating opportunities for connection). Collaborative Responses included nurse strategies to address suffering such as partnering with parents, promoting connection and comfort, and connecting with resources. Dynamic Contextual Factors included external influences beyond the patient, family, and nurse, that shaped how nurses notice and respond to suffering, such as uncertainty.
    CONCLUSIONS: This study helped operationalize indicators of and nurse-led responses to EOL suffering using a parent and clinician collaborative approach. The conceptual model can inform nurse-led, parent-partnered interventions to acknowledge and ease suffering among children nearing EOL and their families.
    IMPLICATIONS FOR CLINICAL PRACTICE: Some manifestations of suffering during EOL in the PICU may be readily addressable through nursing care while others may be witnessed and validated by nurses. Partnership between parents and nurses is a cornerstone of holistically addressing suffering.
    Keywords:  Community-based participatory research; Family-centered care; Palliative care; Pediatrics; Terminal/end-of-life care; User centered design
    DOI:  https://doi.org/10.1016/j.iccn.2026.104498
  19. Pediatr Emerg Care. 2026 Jul 16.
    Epidemiology of Potential Missed Diagnosis of Pediatric Central Nervous System Infections in the Emergency Department.
    Kaileen Jafari, Yasaman Fatemi, Apeksha Gupta, Eileen J Klein, Prashant Mahajan.
       BACKGROUND: Pediatric CNS infections (CNSi)-meningitis, encephalitis, and craniospinal abscess-are uncommon, high-morbidity conditions in which timely emergency department (ED) diagnosis is critical and challenging. This study aimed to characterize the epidemiology of potential missed diagnosis (PMD) of CNSi and assess its association with acute neurological complications.
    METHODS: Cross-sectional analysis of 2018 to 2019 Healthcare Cost and Utilization Project State ED and Inpatient datasets from California, Florida, Maryland, New York, and Wisconsin. Children aged 0 to 17 years with an admission for CNSi were included; those missing the linkage variable, birth hospitalizations, and with pre-existing intracranial devices were excluded. PMD was defined as a prior 7-day ED visit with a high-risk diagnosis, defined using Symptom-Disease Pair Analysis of Diagnostic Error methodology. Descriptive statistics and multivariable logistic regression were used to assess predictors of PMD and neurological complications.
    RESULTS: Among 2686 CNSi cases, 284 (10.6%) had PMD with a median revisit interval of 2 days (IQR 1 to 3). In children >90 days with PMD, over 75% had isolated ED diagnoses of flu-like symptoms (fever, headache, vomiting, or fatigue), while 6% had CNSi "red flags" of altered mental status or neck pain. Potential missed diagnosis was more common in all age groups >90 days of age (aOR range: 4.19 to 4.78) and patients who were Asian (aOR 1.83, 95% CI: 1.06-3.16), Black (aOR 1.87, 95% CI: 1.30-2.70), and Hispanic (aOR 1.53, 95% CI: 1.1-2.13) relative to White children. In addition, patients initially presenting to lower annual pediatric volume quartile EDs (aOR 3.7, 95% CI: 2.6-5.3) and minor (aOR 1.49, 95% CI: 1.11-1.98) or nonteaching hospitals (aOR 2.08, 95% CI: 1.27-3.41) had higher risk of PMD. Among the subset of bacterial CNSi cases, PMD was associated with increased risk of neurological complications (aOR 2.49, 95% CI: 1.41-4.39).
    CONCLUSIONS: One in 10 children with CNSi had a potential missed diagnosis, most often after an initial ED visit for nonspecific flu-like symptoms. Risk of PMD was greater in children >90 days of age and those seen at lower-pediatric volume and nonacademic EDs. In addition, PMD in bacterial CNSi was associated with increased risk of severe neurological complications. These findings highlight the need for targeted diagnostic support tools to improve timely recognition of pediatric CNS infections, particularly in older infants and children.
    Keywords:  diagnostic error; health services; infectious disease; neurology
    DOI:  https://doi.org/10.1097/PEC.0000000000003648
  20. J Pediatr Surg. 2026 Jul 16. pii: S0022-3468(26)00394-5. [Epub ahead of print] 163312
    Surgeon Perceptions on Fertility Counseling and Preservation in Children with Cancer: A Multicenter Survey of North American Hospitals.
    Annie Talbot, Jonathan P Roach, Samantha Bothwell, Lindsay Talbot, Rodrigo Romao, Joseph Murphy, Donald Lucas, Roshni Dasgupta, Barrett Cromeens, Timothy Lautz, Erika Newman, Marcus Malek, Brian Craig, Jennifer Aldrink, Kimberley Riehle, Laura Stafman, Maren Shipe, Stephanie Polites, Elisabeth Tracy, Daniel Rhee, Aodhnait Fahy, Hau Le, Jonathan Walker, Elizabeth Fialkowski, Daniel Robertson, Erin Brown, Amanda Buchanan, Laura Boomer, Melissa Suh, Christa Grant, Shahab Shaffiey, Emily Christison-Lagay, Tamer Ahmed, Henry Rice, Kristen Calabro, Danielle Cameron, Chloé Boehmer, Madeline Peters, Kristine S Corkum.
       PURPOSE: Treatment of pediatric cancers often requires gonadotoxic therapies, making fertility preservation (FP) an essential component of comprehensive oncologic care. However, surgeon exposure to oncofertility care varies. This study evaluated pediatric surgeon knowledge, comfort, and perceptions regarding FP counseling and care.
    METHODS: A cross-sectional survey was administered to lead surgeon investigators from 52 sites across North America participating in the Pediatric Surgical Oncology Research Collaborative (PSORC) to evaluate surgeon perceptions on FP. Surgeon knowledge and comfort levels providing FP services to patients with cancer diagnoses were ascertained.
    RESULTS: Ninety-three percent of invited PSORC surgeons completed the survey. Most respondents desired further educational opportunities in pediatric oncofertility (92%) and supported incorporation of FP training into fellowship education (83%). Among surgeons without a dedicated FP program, 96% were interested in establishing one, and 43% reported active program development. A minority (10.4%) of respondents reported no fertility preservation counseling at all at their institutions. Surgeons at institutions with dedicated FP programs were significantly more comfortable performing FP procedures (p=0.003) and risk stratifying patients (p=0.042). They were also more knowledgeable about FP options (p=0.003), outcomes of ovarian tissue cryopreservation (OTC) and testicular tissue cryopreservation (TTC) for fertility and hormone restoration (p=0.005), and options for future hormone and fertility restoration (p=0.002).
    DISCUSSION: Significant opportunities exist to expand surgeon education, institutional resources, and multidisciplinary FP infrastructure. Respondents were highly motivated to increase educational opportunities and resources to improve fertility care for pediatric oncology patients.
    Keywords:  Oncofertility; fertility loss; fertility preservation; infertility; survivorship
    DOI:  https://doi.org/10.1016/j.jpedsurg.2026.163312
  21. BMJ Paediatr Open. 2026 Jul 13. pii: e004794. [Epub ahead of print]10(1):
    Parental involvement in patient safety events in paediatric emergency care: a multi-method analysis.
    Isobel Joy McFadzean, Lauren Donovan, Thomas Purchase, Emily Ball, Philippa Robb, Philippa Rees, Andrew Carson-Stevens.
       INTRODUCTION: Parents are central to keeping children safe when receiving healthcare. National scrutiny of failures to recognise and respond to clinical deterioration in children led to the introduction of Martha's Rule by National Health Service (NHS) England, which formalises families' rights to request an urgent clinical review for children. Given rising paediatric emergency department (ED) attendances and evidence of healthcare-associated harm within EDs, we examined how parents contribute to and mitigate unsafe care in this care context.
    METHODS: This was an exploratory multi-method analysis of anonymised paediatric safety incidents from EDs. We sought reports reported by EDs between 2014 and 2020. 4000 reports were reviewed to identify whether a patient safety incident had occurred and whether there was parental involvement to mitigate or contribute to the harm. Reports were categorised by incident type (what happened), contributory (why it happened), mitigatory factors (actions taken to reduce or prevent harm), outcome (patient impact) and harm severity.
    RESULTS: Of 658 reports that met the definition of a patient safety incident and included parental involvement, 591 (90.0%) described parents mitigating harm and 67 (10.0%) described inadvertent contribution to incidents. Parents most commonly mitigated harms by advocating for their children, prompting reassessments where necessary and supporting care. However, poor communication involving clinical information, particularly allergies or pertinent medical history, contributed to harm, leading to multiple safety incidents, including the administration of contraindicated medication within EDs.
    CONCLUSION: Parents are important participants in paediatric safety within EDs, and we have identified diverse ways in which they prevent harm. As policy initiatives formalise escalation pathways, healthcare systems must strengthen mechanisms to support partnership working with families across healthcare settings, while addressing paediatric vulnerabilities that contribute to harm.
    Keywords:  Caregivers; Health services research; Qualitative research
    DOI:  https://doi.org/10.1136/bmjpo-2026-004794
  22. Healthcare (Basel). 2026 Jun 24. pii: 1829. [Epub ahead of print]14(13):
    Nursing Interventions to Promote Health Literacy in Children and Adolescents: A Scoping Review.
    Catarina Fragoso, Marina Sousa, Fernanda Loureiro, Zaida Charepe.
      Background/Objectives: Health literacy (HL) is recognized as an important social determinant of health. It supports healthy behaviors and effective health management throughout one's life. For children and adolescents, developing HL influences their well-being, development, and ability to make informed health decisions. Nurses are strategically positioned to promote HL from an early age. To our knowledge, no prior synthesis has specifically examined nurse-led HL interventions targeting pediatric populations, highlighting the originality and relevance of this scoping review. The purpose of this review was to map and characterize nursing interventions aimed at improving HL outcomes in children and adolescents. Methods: A scoping review was conducted according to the Joanna Briggs Institute methodology, using a three-step search strategy, and reported in accordance with the PRISMA-ScR guidelines. Searches were conducted in MEDLINE, CINAHL, Scopus, Web of Science, and ProQuest with no date restriction, including studies published in Portuguese, English, or Spanish. Studies involving children and adolescents (ages 0-18) in any healthcare or community setting were eligible. Data on intervention characteristics and HL outcomes were extracted and analyzed descriptively, and no critical appraisal of the included sources was conducted. Results: A total of 44 studies were included. Interventions were predominantly school-based and focused on adolescents (n = 26), with a clear gap in early childhood (n = 2). Studies of early childhood primarily used storytelling and reading activities, whereas interventions targeting older children and adolescents more often employed participatory educational strategies, group-based approaches and digital platforms. The most frequently addressed topics were chronic disease management (n = 12), mental health (n = 7), and nutrition (n = 5). HL domains mainly focused on healthcare and health promotion, with fewer studies addressing disease prevention. Most interventions were conducted in school settings (n = 24), highlighting this context over those in primary care, community, and hospital settings. Conclusions: The results revealed nursing interventions used to promote HL, particularly in the management of chronic diseases, mental health and nutrition. However, the existing body of research is still limited. Key gaps include the absence of standardized measurement tools and the scarcity of longitudinal studies evaluating long-term outcomes. These limitations constrain the comparability and generalizability of findings, highlighting the necessity of more rigorous, methodologically robust research to support evidence-based practices. This scoping review comprehensively maps nurse-led interventions that promote HL among children and adolescents, identifying key priorities to guide future research in this area.
    Keywords:  adolescent; child; health literacy; nursing; scoping review
    DOI:  https://doi.org/10.3390/healthcare14131829
  23. Curr Pain Headache Rep. 2026 Jul 16. pii: 87. [Epub ahead of print]30(1):
    Minimally Invasive Spinal Interventions for Back and Neck Pain in the Pediatric Population: a Systematic Review.
    David Jevotovsky, Ruben Dovlatyan, Sara Mermelstein, Dylan Banks, Roi Medina, Austin Dukat, Christopher Lee, Salman Hirani, Salvador Portugal, Tracy Espiritu McKay.
       OBJECTIVE: To evaluate the effectiveness and safety of spinal interventions for pediatric patients with chronic back and neck pain who failed conservative management.
    DESIGN: Systematic review.
    METHODS: Following PRISMA 2020 guidelines, a comprehensive search of PubMed, Embase, Web of Science, and Cochrane Central was performed through August 2024. Eligible studies included clinical reports of interventional procedures for pediatric spine related pain. Primary outcomes were pain reduction measured by subjective scales or validated instruments; secondary outcomes included safety and adverse events. Risk of bias and certainty of evidence were assessed using the MASTER and GRADE scales.
    RESULTS: Of 578 identified studies, 8 met inclusion criteria, encompassing 258 pediatric patients. Interventions included epidural steroid injections (n = 227), sacroiliac joint injections (n = 13), facet injections (n = 2), ozone discolysis (n = 2), medial branch blocks (n = 1), interspinous ligament injections (n = 1), and microdiscectomy (n = 1). Across all studies, some degree of pain relief was reported, with functional improvement noted when measured. Adverse events were rare, mild, and transient, including a post-procedural headache and a transient sciatic motor block. No major long-term complications were reported. Evidence certainty was graded as 'very low' due to small sample sizes, observational designs, and heterogeneous methodologies.
    CONCLUSIONS: Preliminary evidence suggests spinal interventions may provide pain relief and functional improvement for carefully selected pediatric patients refractory to conservative measures, with a safety profile comparable to adults. However, evidence remains limited and heterogeneous. Larger, controlled studies are needed to guide clinical practice and inform future guidelines.
    DOI:  https://doi.org/10.1007/s11916-026-01521-4
  24. J Neurosurg Pediatr. 2026 Jul 17. 1-9
    Patient risk factors for 30-day unplanned readmission after pediatric neurosurgery: are we improving?
    Sina Sadeghzadeh, Shaila D Ghanekar, Paul Serrato, Ethan D L Brown, Apratim Maity, Michael DiLuna, Aladine A Elsamadicy.
       OBJECTIVE: Thirty-day unplanned readmission is a key quality metric in pediatric neurosurgery, yet contemporary drivers of readmission in pediatric neurosurgery and whether outcomes are improving remain unknown. Thus, the authors assessed temporal readmission trends and evaluated patient- and hospital-level predictors of 30-day unplanned readmissions across major pediatric neurosurgical procedures.
    METHODS: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program Pediatric data (2012-2023). Children who underwent CSF shunt placement or revision, craniosynostosis repair, tumor surgery, Chiari decompression, spine procedures, or myelomeningocele closure were included. The primary outcome was 30-day unplanned readmission; secondary endpoints were unplanned reoperation, length of hospital stay (LOS), and mortality. Multivariable logistic regression was used to identify independent predictors, including era of treatment (2012-2017 vs 2018-2023).
    RESULTS: Among 95,104 procedures, readmissions decreased from 10.8% in 2012-2017 to 9.1% in 2018-2023 (p < 0.001), and the later era independently lowered the readmission risk (adjusted OR [aOR] 0.80, 95% CI 0.76-0.84). Unplanned reoperations decreased (from 10.4% to 9.6%, respectively, p < 0.001), LOSs shortened (from 6.89 to 5.92 days, respectively, p < 0.001), and mortality was unchanged (0.5%). Relative to those for shunt placement, readmission odds were higher after shunt revision or removal (aOR 1.28, 95% CI 1.19-1.37) and lower after craniosynostosis repair (aOR 0.26, 95% CI 0.22-0.30), Chiari decompression (aOR 0.62, 95% CI 0.56-0.69), and spine procedures (aOR 0.51, 95% CI 0.46-0.56). The readmission risk increased with a higher American Association of Anesthesiologists class (1 vs 3: aOR 1.77, 95% CI 1.48-2.12; 1 vs ≥ 4: aOR 1.76, 95% CI 1.44-2.15), nonelective case status (emergency: aOR 1.36, 95% CI 1.27-1.45), and longer anesthesia time (aOR 1.08, 95% CI 1.06-1.09). Early postoperative complications were the strongest correlates for readmission risk: organ/space surgical site infection (SSI; aOR 19.01, 95% CI 16.77-21.55) and superficial SSI (aOR 8.68, 95% CI 7.69-9.80).
    CONCLUSIONS: Pediatric neurosurgical readmissions have improved over the past decade, but risk remains concentrated after shunt revision or removal and among nonelective, high complexity cases, highlighting targets for quality improvement and perioperative efficiency.
    Keywords:  NSQIP-Pediatric; pediatric neurosurgery; quality improvement; readmission trends; risk factors; unplanned readmission
    DOI:  https://doi.org/10.3171/2026.2.PEDS25600
  25. J Perinatol. 2026 Jul 15.
    Evaluation of virtual reality-based meditation as a tool to mitigate stress among parents and providers in the neonatal intensive care unit.
    Tierney M Morrison, Jeffrey Jacobson, Henry A Feldman, Anne Hansen.
       OBJECTIVE: To evaluate the effect of virtual reality (VR) meditation on stress among parents of infants in the neonatal intensive care unit (NICU) and NICU provider stress and burnout.
    STUDY DESIGN: Parents and providers were randomized to VR meditation, eyeshade relaxation or control group. All participants completed the Perceived Stress Scale (PSS) at the start and end of the study and self-rated mood before and after meditation or relaxation. Providers also completed the Maslach Burnout Inventory (MBI) at start and end of study. Changes in scores were compared among groups.
    RESULTS: Self-rated mood increased in VR group parents and providers. Subgroup analysis showed fathers had greater improvement in self-reported mood following VR meditation. There was a significant decrease in VR group provider PSS scores.
    CONCLUSION: VR meditation may furnish an immediate benefit, which may be sustained in NICU providers, and is a novel, accessible stress mitigation tool in the NICU.
    DOI:  https://doi.org/10.1038/s41372-026-02800-z
  26. Cureus. 2026 Jul;18(7): e112814
    Artificial Intelligence and Clinician Burnout in the United States: A Narrative Review.
    Crissinee Sucharitrak.
      Burnout remains one of the defining occupational hazards of healthcare in the United States, and it spares no one on the care team: physicians, nurses, trainees, and assistants all report it at high rates. When generative AI entered healthcare around 2023, it arrived quickly and carried a promise of relief from the administrative burden that so many clinicians identify as a reason for their exhaustion. This review asks one question about that promise: Does the current evidence from the United States indicate that AI alleviates or worsens clinician burnout, and under what implementation conditions? We approached this question through a structured thematic narrative synthesis, weighting evidence by study design. Randomized controlled trials carried the greatest interpretive weight, while non-randomized studies were considered lower-certainty supporting evidence. The first randomized trials of AI-assisted scribing, published in 2025-2026, are encouraging with respect to documentation time and, in some trials, well-being. Yet most of what has been published so far is non-randomized, single-center, and short-term. The more troubling pattern is that AI tends to displace work rather than reduce it. Tasks are not eliminated but moved: from production to oversight, and potentially from physicians to nurses and assistants. Where earlier commentaries offered the metaphors of a "double-edged scalpel" and a "productivity paradox," this review proposes "displacement of burden" as a framework that can actually be tested.
    Keywords:  ambient artificial intelligence scribe; artificial intelligence; clinical decision support; clinician burnout; documentation burden; electronic health record; healthcare workforce; large language models; nursing burnout; physician burnout
    DOI:  https://doi.org/10.7759/cureus.112814
  27. Otolaryngol Head Neck Surg. 2026 Jul 17.
    Implementation of a Nebulized Tranexamic Acid Protocol for Pediatric Post-Tonsillectomy Hemorrhage: A Quality Improvement Initiative.
    Kyle W Singerman, Andrea Nguyen, Blake Welker, Dovan Khalifee, John P Dahl, Janelle R Noel-MacDonnell, Meghan Tracy, Elie Khalifee.
       OBJECTIVE: We hypothesized that initiation of a standardized nebulized TXA protocol for posttonsillectomy hemorrhage (PTH) would reduce the need for surgical control of bleeding without increasing adverse clinical outcomes.
    METHODS: This quality improvement project included patients under 18 years of age who presented with PTH. Preintervention data were collected between January 1, 2020, and June 30, 2022. Plan-Do-Study-Act (PDSA) cycle 1, between July 1, 2022, and December 31, 2023, included patients who received nebulized TXA without a standardized protocol, based on emerging evidence supporting its use in PTH. PDSA cycle 2, between January 1, 2024, and July 13, 2025, followed the implementation of a standardized TXA protocol. Data included need for surgical control of bleeding, length of stay, transfusions, readmissions, and TXA-related complications.
    RESULTS: A total of 501 patients were included, with a median age of 7.2 years, distributed across the preintervention group (n = 171), PDSA 1 (n = 205), and PDSA 2 (n = 125). The proportion of patients requiring surgical control of bleeding decreased with each intervention (43.9% vs 29.8% vs 15.2%, P < .0001). There were no changes in the length of stay, transfusion rates, readmissions, or TXA-related complications.
    DISCUSSION: Across 2 PDSA cycles, we achieved a 65.4% reduction in the need for surgical control of bleeding for PTH without an increase in balancing measures, used as surrogates for unintended consequences of the interventions.
    IMPLICATIONS FOR PRACTICE: Implementation of a nebulized TXA protocol may be a safe and effective management option for PTH.
    Keywords:  PS/QI; pediatric otolaryngology; post‐tonsillectomy hemorrhage; tonsillectomy; tranexamic acid
    DOI:  https://doi.org/10.1002/ohn.70341
  28. JAMA Netw Open. 2026 Jul 01. 9(7): e2622753
    Coping Strategies and Social Support for Transition Readiness Among Youth With Sickle Cell Disease.
    Apoorva S Iyengar, Tanisha Belton, Jack Chen, Tisheya Ward, Olivia Teng, Banu Aygun, Abena Appiah-Kubi, Nataly Apollonsky, Donna Boruchov, Biree Andemariam, Omar Niss, Lori E Crosby, Lisa Schwartz, Lamia Barakat, Kim Smith-Whitley, Sophia Jan, Caren Steinway.
       Importance: Suboptimal transitions from pediatric to adult health care can negatively impact disease outcomes, medication regimen adherence, and disease self-management in adulthood. Little is known about whether the presence of coping strategies in young adults (YAs) with sickle cell disease (SCD) is associated with higher transition readiness scores.
    Objective: To evaluate whether coping strategies and social support are associated with higher transition readiness scores in YAs with SCD.
    Design, Setting, and Participants: This cross-sectional study was a subanalysis of baseline data from a prospective randomized clinical trial of YAs aged 17 to 25 years with SCD planning to transition to an adult sickle cell clinic within the next 12 months at 5 institutions across Connecticut, New York, Ohio, and Pennsylvania. The recruitment period was from January 15, 2019, to December 31, 2022. Analysis used data from this time period and was conducted from September 30, 2024, to June 30, 2025.
    Main Outcomes and Measures: Measures included the Transition Readiness Assessment Questionnaire (TRAQ) to assess transition readiness, the Medical Outcomes Study-Social Support Survey (MOS-SSS) emotional/informational subscale to assess social support, and the Brief-COPE (problem-focused, emotion-focused, and avoidant subscales) to assess coping strategies. Bivariate and multivariable linear regression analyses were used to assess differences of transition readiness. Covariates included worry (PedsQL Sickle Cell Disease Module worry I), age, gender, SCD disease severity, and social support.
    Results: The final cohort included 373 YAs (mean [SD] age, 18.9 [1.9] years; 190 female [51.5%]), with 335 of 367 reporting race as Black (91.3%) and 335 of 365 reporting ethnicity as non-Hispanic/Latino (91.8%). Unadjusted analysis found that overall coping (mean difference, 0.14; 95% CI, 0.01-0.27; P = .03), problem-focused coping (mean difference, 0.18; 95% CI, 0.09-0.27; P < .001), and the emotional/informational subscale of the MOS-SSS (mean difference, 0.13; 95% CI, 0.07-0.19; P < .001) were associated with higher transition readiness scores. Adjusted linear regression analysis showed that problem-focused coping (mean difference, 0.10; 95% CI, 0.003-0.19; P = .04) was associated with transition readiness even after adjusting for age, gender, disease severity, worry, recruitment site, and social support.
    Conclusions and Relevance: In this cross-sectional study in a national cohort of adolescents and YAs with SCD, problem-focused coping strategies were associated with higher levels of transition readiness. These findings suggest important intervention targets for supporting transitioning adolescents with SCD.
    DOI:  https://doi.org/10.1001/jamanetworkopen.2026.22753
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