bims-cliped Biomed News
on Clinical pediatrics
Issue of 2026–09–06
thirty-two papers selected by
Alyssa M. Portwood, Akron’s Children
  1. Recommendations for COVID-19 Vaccines in Infants, Children, and Adolescents, 2026-2027: Technical Report.
  2. Recommendations for COVID-19 Vaccines in Infants, Children, and Adolescents, 2026-2027: Policy Statement.
  3. Recommendations for the Prevention of RSV Disease in Infants and Children: Policy Statement.
  4. Recommendations for the Prevention of Respiratory Syncytial Virus Disease in Infants and Children: Technical Report.
  5. Caring for children with functional neurological disorders in the emergency department.
  6. Childhood Mental Health-Related Visits and Emergency Department Pediatric Volume in the United States, 2016 to 2022.
  7. A Real-World Evaluation of Large Language Model-Generated Hospital Courses in Pediatrics.
  8. Fertility Preservation for Children and Adolescents with Cancer.
  9. Housing and health: Evidence to act now to improve the health of children and families.
  10. Pediatric emergency department crowding during multiple resuscitation events.
  11. Strategies To Sustain the U.S. Pediatric Anesthesiology Workforce.
  12. Assessing Nurses' Knowledge and Attitudes Toward Pediatric Pain in a Free-Standing Emergency Department.
  13. Experiences and Perceptions of Crisis Text Services: Interview Study Among Young Adults With Suicidal Ideation.
  14. A Road Map for Addressing Incidental Findings in Pediatric Radiology.
  15. Pediatric Palliative Surgical Oncology: Principles, Practice, and Evolving Roles.
  16. Health equity and unintentional pediatric cannabis ingestion.
  17. Epidemiology and Mechanisms of Cervical Spine Injuries Caused by Non-Traditional Vehicles in the United States: An Analysis of National Emergency Department Data.
  18. Surgical rib fixation in pediatric patients: Following the adult trend or a different story?
  19. Communication Challenges and Strategies in Adolescent and Young Adult Cancer Survivorship Care: A Qualitative Study of Clinician Perspectives.
  20. Breaking Silos in Pediatric Nurse Practitioner Education: Virtual Case Collaboration Between Primary and Acute Care Pediatric Nurse Practitioner Students.
  21. Why Screening Matters in Pediatric Primary Care: Adolescent Suicide Risk from a 2023 Youth Risk Behavior Survey.
  22. Healthcare Encounters in the Week Preceding a Sepsis Hospitalization in Pediatric Patients.
  23. United States healthcare providers' views on pediatric meningococcal disease and vaccination.
  24. Patient and Public Involvement and Engagement in Pediatric Health Research: A Systematic Review.
  25. Preparing for Reduced Insurance Coverage of Children.
  26. RIGHTS principles for early intervention: right care at the right time for every infant, child and family in low and middle-income countries.
  27. The Impact of Pediatric Dermatologic Conditions on Mental Health in Underserved Communities in the United States: Barriers and Strategies for Their Mitigation.
  28. High-Flow Nasal Cannula Use for Respiratory Support Outside the Paediatric Intensive Care Unit in Children Over 1 Year: A Narrative Review.
  29. Efficiency Meets Safety: Transforming Operating Theatre-To-Paediatric Intensive Care Unit Transfers in a Paediatric Hospital.
  30. Red Blood Cell Transfusion for Preterm and Term Infants in the NICU.
  31. Missed Opportunities: The Importance of HIV Screening in Adolescent Populations.
  32. Prevalence and Characteristics of Mental Health Interventions Following Pediatric Hospitalization.
  1. Pediatrics. 2026 Sep 02.
    Recommendations for COVID-19 Vaccines in Infants, Children, and Adolescents, 2026-2027: Technical Report.
    Committee on Infectious Diseases
      This technical report accompanies the American Academy of Pediatrics policy statement recommendations for COVID-19 vaccination during the 2026-2027 respiratory virus season. The rationale is presented for recommending vaccination in all infants and children 6 through 23 months of age, children 6 months through 18 years of age who are moderately or severely immunocompromised, and children 2 through 18 years of age in certain additional risk groups, including those at high risk of severe COVID-19, residents of long-term care facilities or other congregate settings, children who have never been vaccinated against COVID-19, and children whose household contacts are at high risk for severe COVID-19. The report synthesizes currently available evidence on SARS-CoV-2 epidemiology, disease burden, COVID-19 vaccine effectiveness, vaccine safety, and vaccine cost-effectiveness in pediatric populations. Additionally, the report provides an overview of available COVID-19 vaccine products, formulations, storage and handling considerations, and coadministration with other immunizations.
    DOI:  https://doi.org/10.1542/peds.2026-079046
  2. Pediatrics. 2026 Sep 02.
    Recommendations for COVID-19 Vaccines in Infants, Children, and Adolescents, 2026-2027: Policy Statement.
    Committee on Infectious Diseases
      This policy statement updates the recommendations of the American Academy of Pediatrics (AAP) for the use of COVID-19 vaccines in the prevention of severe COVID-19 in children. A review of evidence supporting these recommendations is in the accompanying technical report (https://doi.org/10.1542/peds.2026-079046). These COVID-19 vaccine recommendations may change in future seasons or as additional variants emerge. The AAP recommends all infants and children 6 through 23 months of age who do not have contraindications receive 2026-2027 COVID-19 vaccine. The AAP also recommends a single dose of age-appropriate 2026-2027 COVID-19 vaccine for all children and adolescents 2 through 18 years of age at increased risk of severe COVID-19, regardless of prior COVID-19 vaccination status. Children 2 through 18 years of age not considered at increased risk of severe COVID-19 whose parent or guardian desires their protection from COVID-19 should be offered a single dose of age-appropriate 2026-2027 COVID-19 vaccine. Any available COVID-19 vaccine appropriate by age and health status can be administered and the most updated version of the COVID-19 vaccine that is available should be used.
    DOI:  https://doi.org/10.1542/peds.2026-079045
  3. Pediatrics. 2026 Sep 02.
    Recommendations for the Prevention of RSV Disease in Infants and Children: Policy Statement.
    Committee on Infectious Diseases
      This policy statement updates recommendations of the American Academy of Pediatrics (AAP) for the use of respiratory syncytial virus (RSV) immunization for the prevention of lower respiratory tract infection (LRTI) caused by RSV in infants and children. The AAP recommends RSV immunization for all infants under 8 months of age born during or entering their first RSV season, unless the infant has documented protection from vaccination of their pregnant parent; and for infants and children 8 through 19 months of age who are at high risk of severe RSV disease and entering their second RSV season. A review of evidence supports expanding the high-risk criteria for administration of RSV immunization in infants and children 8 through 19 months of age entering their second RSV season. A discussion of the evidence supporting the AAP recommendations and additional details on infants and children included in the expanded recommendations are in the accompanying technical report (https://doi.org/10.1542/peds.2026-079049).
    DOI:  https://doi.org/10.1542/peds.2026-079047
  4. Pediatrics. 2026 Sep 02.
    Recommendations for the Prevention of Respiratory Syncytial Virus Disease in Infants and Children: Technical Report.
    Committee on Infectious Diseases
      This technical report accompanies the American Academy of Pediatrics (AAP) policy statement (https://doi.org/10.1542/peds.2026-079047) and recommendations for respiratory syncytial virus (RSV) immunization during the 2026-2027 RSV season. The rationale is presented for recommending immunization of all infants younger than 8 months born during or entering their first RSV season, unless the infant has documented protection from vaccination of the pregnant parent; and infants and children 8 through 19 months of age who are at high risk of severe RSV disease and entering their second RSV season. The report synthesizes current evidence on RSV epidemiology, disease burden, immunization effectiveness, safety, and cost-effectiveness in pediatric populations; including evidence supporting expansion of high-risk groups for second season administration. Additionally, the report provides an overview of available RSV immunization products, formulations, and coadministration with other immunizations.
    DOI:  https://doi.org/10.1542/peds.2026-079049
  5. Arch Dis Child. 2026 Sep 01. pii: archdischild-2026-330914. [Epub ahead of print]
    Caring for children with functional neurological disorders in the emergency department.
    Jordan Garris, Aarti Gaglani, Michael Malley, Dara Albert.
      Functional neurological disorder is a common reason for children to present to the emergency department, but education gaps contribute to delays in diagnosis. This can result in unnecessary diagnostic testing and interventions, which lead to increased healthcare costs and, at times, patient harm. In this narrative review, we provide practical recommendations regarding emergency department management of paediatric functional neurological disorder. We recommend that emergency physicians use the described rule-in signs rather than negative medical tests to make a positive diagnosis of functional neurological disorder. We advocate for timely communication of this diagnosis to the patient and family in a clear and validating way. We also discuss considerations for patient triage, outpatient referrals and special scenarios that emergency physicians may frequently encounter.
    Keywords:  Adolescent Health; Emergency Care; Neurology; Paediatric Emergency Medicine; Psychology
    DOI:  https://doi.org/10.1136/archdischild-2026-330914
  6. Ann Emerg Med. 2026 Sep 03. pii: S0196-0644(26)00482-8. [Epub ahead of print]
    Childhood Mental Health-Related Visits and Emergency Department Pediatric Volume in the United States, 2016 to 2022.
    Audrey G Brewer, Kenneth A Michelson, Erick Masias, Taylor Walter, Kayla Robinson, Jennifer A Hoffmann.
       STUDY OBJECTIVES: Pediatric mental health emergency department (ED) visits are increasing, yet differences in presentations by ED type are not well described. Our objective was to examine characteristics of pediatric mental health-related ED visits by annual pediatric ED volume.
    METHODS: We conducted a retrospective cross-sectional study of ED visits among children 5 to 17 years with a primary mental health diagnosis, identified by International Classification of Diseases, Tenth Revision, Clinical Modification codes, using the 2016 to 2022 Nationwide Emergency Department sample. The outcome was presentation to an ED with high annual pediatric volume (≥10,000 visits). Using multivariable logistic regression modeling, we examined the association with patient- and hospital-level characteristics, reporting adjusted odds ratios and 95% confidence intervals (CIs).
    RESULTS: We identified 5,369,821 weighted mental health-related visits (4.7% low, 21.2% medium, 24.1% medium-high, and 50.1% high annual pediatric volume). The adjusted odds of presenting to a high compared with a low/medium/medium-high annual pediatric volume ED were higher among non-Hispanic Black (1.19, 95% CI 1.05, 1.35) and lower among Native American (0.54, 95% CI 0.35, 0.83) children compared with non-Hispanic White children. The adjusted odds were lower for individuals with substance-related diagnoses (0.79, 95% CI 0.71, 0.87) compared with those with suicide and self-injury.
    CONCLUSION: Pediatric mental health-related ED visits vary by patient characteristics and diagnoses across EDs with different annual pediatric volume categories. Findings may inform opportunities to develop and deploy ED-based interventions to improve pediatric mental health outcomes across diverse populations and settings.
    Keywords:  Emergency department utilization; Health disparities; Health equity; Pediatric mental health
    DOI:  https://doi.org/10.1016/j.annemergmed.2026.07.015
  7. Hosp Pediatr. 2026 Sep 03. pii: e2026009216. [Epub ahead of print]
    A Real-World Evaluation of Large Language Model-Generated Hospital Courses in Pediatrics.
    Jasmine E Kim, Jonathan D Hron, Daniel J Kats, Kara Wong, Lily Kutz, Chase R Parsons.
       BACKGROUND: Large language model (LLM)-generated hospital courses are increasingly integrated into electronic health records (EHRs), yet their accuracy and safety in pediatric populations remain poorly characterized.
    OBJECTIVE: To evaluate the accuracy, text quality, and perceived potential harm of EHR-integrated and LLM-generated hospital courses in pediatric inpatient care during early clinical implementation.
    METHODS: We conducted a descriptive evaluation from June 10 to August 8, 2025, at an academic freestanding children's hospital using an Epic EHR with an integrated LLM tool (GPT-4o and GPT-4.1). Clinicians across multiple roles, including attending physicians, residents, and advanced practice providers, reviewed LLM-generated hospital courses for their own patients. Clinicians identified and categorized errors (hallucinations, inaccuracies, or omissions). They also rated text quality (comprehensiveness, conciseness, coherence) on a 5-point scale and perceived harm on an 8-point scale.
    RESULTS: A total of 129 LLM-generated hospital courses were reviewed (median length of stay, 3 days; IQR, 2-7) by 50 involved clinicians. Hallucinations occurred in 21% (95% CI, 14%-29%) of the hospital courses, inaccuracies in 41% (53/129; 95% CI, 33%-50%), and omissions in 24% (31/129; 95% CI, 17%-32%). Overall, perceived harm ratings were low (median, 0; IQR, 0-1). Text quality ratings were high (median [IQR]: comprehensiveness, 4 [3-5]; conciseness, 4 [4-5]; coherence, 4 [4-5]) and comparable with prior literature.
    CONCLUSION: In this pediatric evaluation of LLM-generated hospital courses reviewed by frontline clinicians, errors were common, but perceived potential harm was low, even assuming use without clinician correction. These findings support the use of LLM-generated hospital courses as starting drafts when paired with clinician review and institutional safeguards.
    DOI:  https://doi.org/10.1542/hpeds.2026-009216
  8. Surg Oncol Clin N Am. 2026 Oct;pii: S1055-3207(26)00036-0. [Epub ahead of print]35(4): 885-897
    Fertility Preservation for Children and Adolescents with Cancer.
    Kristine S Corkum, Amanda Buchanan, Erin E Rowell.
      Survivors of pediatric cancer are at an increased risk for infertility and premature hormonal failure. Surgeons caring for children with cancer are important advocates for infertility risk assessment and can perform appropriate fertility preservation (FP) procedures. FP options in male individuals and female individuals vary by pubertal status and include nonexperimental (oocyte harvest, ovarian tissue cryopreservation, and sperm cryopreservation) and experimental (testicular tissue cryopreservation) options. This review summarizes infertility risk assessment and FP options, explores important factors in access to pediatric FP, and highlights the current status of FP research.
    Keywords:  Cancer; Fertility preservation; Infertility; Pediatric; Survivorship
    DOI:  https://doi.org/10.1016/j.soc.2026.04.011
  9. Acad Pediatr. 2026 Sep 04. pii: S1876-2859(26)00206-8. [Epub ahead of print] 103424
    Housing and health: Evidence to act now to improve the health of children and families.
    Kathryn M Leifheit, Taylor M Mobley, Daria Murosko, Noelia Lugo, Megan Sandel.
      Extensive, high-quality evidence has demonstrated the importance of housing as a fundamental determinant of child health and development. At the same time, housing has become more unaffordable in the US, such that one in three children lives in unaffordable housing, more children are at risk of eviction and homelessness, housing quality has not improved meaningfully, and wide disparities exist in neighborhood access to socioeconomic opportunity. This narrative review chronicles the impacts of housing on children's health via four pillars: affordability, stability, quality and safety, and neighborhood conditions. We 1) provide an overview of evidence linking each of these housing pillars to child health outcomes and 2) describe effective interventions to reinforce the housing pillar and promote health. Based on this evidence, we urge pediatricians to intervene and advocate at multiple levels in order to advance housing and health for children and families. This review aims to serve as a reference for pediatricians seeking to implement evidence-based housing interventions, across individual, clinical, systems, and policy levels.
    Keywords:  Pediatrics; Social Policy; homelessness; housing
    DOI:  https://doi.org/10.1016/j.acap.2026.103424
  10. Am J Emerg Med. 2026 Aug 31. pii: S0735-6757(26)00454-7. [Epub ahead of print]110 290-293
    Pediatric emergency department crowding during multiple resuscitation events.
    Elizabeth C Lendrum, Nathan Timm, Melissa Williams, Laura Kemp, Yin Zhang, Holly R Hanson.
       BACKGROUND: Multiple, simultaneous resuscitations in pediatric emergency departments (PEDs) strain resources and exacerbate crowding. In 2015, our pediatric institution implemented a Multiple Resuscitation Activation (MRA) to coordinate team response. The impact of MRAs on PED crowding remains unclear.
    OBJECTIVES: Evaluate whether MRAs are associated with changes in PED crowding and patient census.
    METHODS: A retrospective cohort study was conducted at a tertiary pediatric level one trauma center from January 2023 to December 2024. MRA events were matched 1:2 with non-activation control periods by time of day and calendar proximity. Crowding was measured using the Pediatric Emergency Department Overcrowding Scale (PEDOCS) at baseline and at 1 and 2 h after activation (or matched control time). Difference-in-differences analyses were used to compare changes in PEDOCS and patient census between activation and control periods.
    RESULTS: Thirteen MRAs involving 59 patients were identified, with a median activation duration of 73 min. Although PEDOCS scores and patient census increased following MRAs, these changes were not significantly different from those in matched control periods. The difference-in-differences estimate for PEDOCS was 6.0 points (95% CI, -15.4 to 27.4) at 1 h and 7.8 points (95% CI, -13.6 to 29.2) at 2 h. Corresponding estimates for patient census were 2 patients (95% CI, -17 to 21) and 6 patients (95% CI, -16 to 28).
    CONCLUSIONS: MRAs were not associated with significant increases in PED crowding or patient census compared with matched non-activation control periods. These findings suggest that coordinated response systems may help mitigate the operational impact of multiple simultaneous resuscitations.
    Keywords:  Crowding; Emergency; Operations; Pediatrics; Resuscitation
    DOI:  https://doi.org/10.1016/j.ajem.2026.08.056
  11. Anesthesiology. 2026 Sep 03.
    Strategies To Sustain the U.S. Pediatric Anesthesiology Workforce.
    Irim Salik, Jacques Scharoun, Philip Carullo.
      Pediatric anesthesiology is a deeply rewarding specialty, and the job market remains favorable for the trainees who choose it. However, the U.S. pediatric anesthesiology workforce is facing a convergence of challenges, including declining fellowship recruitment, increasing nonoperating room anesthesia (NORA) and complex surgical volume, expanding clinical demands, and migration of physicians from academic hospitals to ambulatory and contract-based practice models. These trends threaten access to specialized pediatric perioperative care, weaken educational and research missions, and strain the ability of children's hospitals to care for medically complex patients. This article examines the drivers of current U.S. workforce instability and proposes a framework for recruitment, retention, and long-term sustainability. Key recommendations include improving work-life integration through flexible scheduling, aligning compensation with clinical and academic contributions, investing in physician wellness, strengthening leadership engagement, leveraging technology to optimize staffing, and expanding mentorship and pipeline development initiatives. Sustaining the pediatric anesthesiology workforce will require deliberate institutional investment to ensure continued access to high-quality care for children.
    DOI:  https://doi.org/10.1097/ALN.0000000000006266
  12. J Dr Nurs Pract. 2026 Aug 31. pii: JDNP-2025-0079.R1. [Epub ahead of print]
    Assessing Nurses' Knowledge and Attitudes Toward Pediatric Pain in a Free-Standing Emergency Department.
    Randy Hamm.
      Background: Pediatric pain-related complaints remain a common reason for emergency department visits. Despite advances in pediatric care, barriers to effective pain assessment and management persist, including gaps in nurses' knowledge and attitudes regarding pediatric pain management. Objective: The purpose of this study was to assess free-standing emergency department (FSED) nurses' knowledge and attitudes regarding pediatric pain management in a rural North Carolina setting. Methods: A descriptive cross-sectional study was conducted among staff nurses employed at an FSED in rural North Carolina. Participants completed the Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain (PNKAS). Descriptive statistical analyses were performed using Statistical Package for the Social Sciences version 25. Results: The mean PNKAS score was 29.2 ± 11.1, with scores ranging from 18 (42.8%) to 37 (88.1%). Participants demonstrated strong knowledge in areas including appropriate pain assessment, benefits of nonopioid medications, and opioid administration practices. Lower performance was observed in understanding pediatric pain perception and accurate opioid dosage calculations. No statistically significant differences were identified among varying nursing experience groups. Conclusion: Knowledge gaps continue to exist in critical areas of pediatric pain management among FSED nurses, particularly related to pediatric pain perception and opioid dosage calculations. Implications for Nursing: Findings support the need for ongoing pediatric pain management education and competency-based training for emergency nurses. Strengthening knowledge in pain assessment and safe medication administration may improve the quality and safety of pediatric emergency care.
    Keywords:  PNKAS; emergency nursing; free-standing ED; nurse education; pain management; pediatric pain
    DOI:  https://doi.org/10.1891/JDNP-2025-0079
  13. JMIR Ment Health. 2026 Aug 26. 13 e89836
    Experiences and Perceptions of Crisis Text Services: Interview Study Among Young Adults With Suicidal Ideation.
    Kate LaForge, Alan R Teo, Lauren Denneson, Jennifer A Hoffmann, Peter C Britton, Ashley A Foster.
       Background: Suicide remains a leading cause of death among young adults aged 18 to 25 years. Young adults experiencing suicidal ideation (SI) are increasingly using crisis text services (CTSs), a free and accessible option for crisis intervention. Little is known about CTSs from the young adult perspective.
    Objective: This study aimed to characterize young adults' experiences with and perceptions of CTSs for SI.
    Methods: We conducted in-depth interviews, by phone, Zoom, or text, with young adults (n=39) in the United States who had a lifetime history of SI. Participants included those who had or had not engaged with CTSs for SI. Semistructured interviews were conducted from January to July 2024. The data were analyzed using a modified grounded theory approach.
    Results: We constructed 5 key themes to characterize young adults' perceptions of and experiences with CTSs for SI. Young adults perceived CTSs as a unique component of their mental health crisis management. They appreciated CTSs' technological features, particularly the privacy they provided and the ability to reflect on and edit responses. However, they expressed dissatisfaction with the nonspecific nature of many CTS interactions. The perceived anonymity of CTSs served multiple functions, both as a motivator for CTS use and as a potential point of vulnerability, should it be lost during a CTS interaction. Participants' perceptions of CTSs' impact varied; some viewed them as beneficial, whereas others reported neutral or inconsistent effects over time.
    Conclusions: Among young adults with SI, CTSs are a key yet imperfect resource. Quality improvement and evaluation efforts may be needed to understand how responders can better tailor responses to improve conversational quality and consistency for young adult texters.
    Keywords:  health care technology; mental health; mental health services; suicidal ideation; text messaging; young adult
    DOI:  https://doi.org/10.2196/89836
  14. J Am Coll Radiol. 2026 Sep 01. pii: S1546-1440(26)00337-6. [Epub ahead of print]
    A Road Map for Addressing Incidental Findings in Pediatric Radiology.
    Marla B K Sammer, Aparna Joshi, Angela J Beavers, Michael J Callahan, Sarah M Desoky, Jonathan R Dillman, Richard Jones, Viet T Le, Ezekiel Maloney, Cara Morin, Narendra S Shet, Jeffrey J Tutman, Steve J Stephen, Stella K Kang.
      Incidental findings on pediatric imaging studies can adversely impact patients and their families when inappropriately managed. However, there is limited literature on management of these findings in the pediatric population, and guidelines for similar findings in adult patients may not be suitable. Here, examples of incidental findings in children are illustrated to give readers a practical understanding of how pediatric incidental findings may differ from those in adults. The ACR's planned approach to developing pediatric-specific guidance for incidental findings is outlined, and a strategy for managing pediatric incidental findings in the absence of specific pediatric guidance is also provided.
    Keywords:  American College of Radiology; Incidental findings; guidelines; pediatric
    DOI:  https://doi.org/10.1016/j.jacr.2026.06.019
  15. Surg Oncol Clin N Am. 2026 Oct;pii: S1055-3207(26)00034-7. [Epub ahead of print]35(4): 899-912
    Pediatric Palliative Surgical Oncology: Principles, Practice, and Evolving Roles.
    Nelson Piché, Hau D Le.
      Pediatric cancer care has changed dramatically over the past several decades, with survival rates increasing to nearly 85% across many childhood malignancies. Yet, despite these advances, children with cancer and their families continue to confront significant physical, emotional, and psychosocial burdens. The expanding role of surgery in both curative and noncurative contexts demands proficiency in operative skill and also in communication, shared decision-making, prognostication, and the delivery of primary palliative care. This article presents a comprehensive, evidence-informed framework for pediatric palliative surgical oncology. We discuss the current literature, guiding principles, and communication models, and ethical complexities unique to pediatric patients.
    Keywords:  Cancer; Holistic care; Pediatric palliative care; Pediatric surgical oncology
    DOI:  https://doi.org/10.1016/j.soc.2026.04.009
  16. Inj Epidemiol. 2026 Sep 04. pii: 57. [Epub ahead of print]13(Suppl 1):
    Health equity and unintentional pediatric cannabis ingestion.
    Melissa P Blumberg, Amy D Thompson, Brandon George, Elizabeth Lendrum, Wendy J Pomerantz.
       BACKGROUND: Unintentional pediatric cannabis ingestion has been rising following medical and recreational legalization. In this study, we aimed to examine the epidemiology of pediatric cannabis ingestion following legalization and to assess the impact of demographic and socioeconomic factors on equity of social management.
    METHODS: A retrospective cohort study was conducted at two high-volume children's hospitals with level 1 trauma centers in the United States of America. Emergency department records from June 2016 to September 2024 were reviewed for children aged 0-6 years with a positive urine drug screen for tetrahydrocannabinol. Dates included were inclusive of medical (5/2011, 6/2016) and recreational legalization (4/2023, 11/2023) of cannabis products within both respective sites. Data collected included demographics, home zip code (used to assign a deprivation index), Emergency Severity Index triage level, and disposition. Manual chart review assessed ingestion type, location, suspected source owner, and involvement of social work, child protective services, and safe disposition planning. Descriptive statistics were used to characterize the population, and linear and logistic regression were used to determine the relationship between deprivation index, population characteristics, and social management.
    RESULTS: Among 266 cases, most children were under age 2 (58.3%), male (52.3%), non-Hispanic White (43.2%), English speaking (98.9%), and publicly insured (71.4%). Ingestions increased over time, with 51.8% occurring in the last two years (2023-2024). Edibles (51.1%) were the most common ingestion type, often belonging to a primary guardian (40.2%). Most cases were triaged as ESI 1or ESI 2 (83.5%), with 41.7% evaluated in a trauma bay. Hospital admission was common (82.0%), with 20.7% of admitted children requiring critical care. Social work (95.5%) and child protective services (80.1%) were involved in most cases. No relationship was found between deprivation index and social work consultation (p = 0.52), child protective service reporting (p = 0.41), discharge to a primary guardian (p = 0.26), or discharge to a primary residence (p = 0.144).
    CONCLUSIONS: The incidence of unintentional cannabis ingestion presenting to the pediatric emergency department is increasing. Findings suggest equitable management across demographic and socioeconomic strata, highlighting high acuity and significant toxicity at presentation.
    Keywords:  CPS; Cannabis; Equity; Ingestion; Social deprivation index; Social work
    DOI:  https://doi.org/10.1186/s40621-026-00710-4
  17. Spine J. 2026 Sep 01. pii: S1529-9430(26)00646-7. [Epub ahead of print]
    Epidemiology and Mechanisms of Cervical Spine Injuries Caused by Non-Traditional Vehicles in the United States: An Analysis of National Emergency Department Data.
    Hagop Klachian, Abhishek Srivastava, Rami Taha, Jenna Taha, Madison McDonald, Michael Megafu, Andrew Hecht, James Lin, Robert L Parisien.
       BACKGROUND CONTEXT: Cervical spine injuries related to non-traditional modes of transportation represent an emerging source of morbidity in the United States, particularly among younger populations. Although cervical spine trauma has been extensively studied in traditional motor vehicle crashes, epidemiologic data regarding injuries associated with non-traditional vehicles remain limited.
    PURPOSE: To characterize the epidemiology, mechanisms, demographics, and temporal trends of cervical spine injuries associated with non-traditional vehicles presenting to United States emergency departments.
    STUDY DESIGN/SETTING: Descriptive epidemiological study utilizing the National Electronic Injury Surveillance System (NEISS), a nationally representative database of emergency department visits in the United States.
    PATIENT SAMPLE: A total of 1,410 sampled NEISS records representing approximately 66,750 estimated emergency department visits for cervical spine injuries associated with non-traditional vehicles between January 1, 2015, and December 31, 2024.
    OUTCOME MEASURES: Primary outcomes included injury diagnosis, mechanism of injury, patient demographics, vehicle type, injury location, disposition, and temporal trends in annual injury estimates.
    METHODS: The NEISS database was queried for cervical spine injuries occurring between 2015 and 2024. Cases were identified using the neck body-part code and relevant diagnosis codes in combination with product codes for all-terrain vehicles (ATVs), dirt bikes, electric bicycles, go-carts, mopeds, minibikes, power-assisted cycles, and utility vehicles. Injury narratives were reviewed to confirm cervical spine involvement and classify mechanisms. National estimates and weighted percentages were calculated by summing the sampling weights provided for eligible NEISS records. No funds were received in support of this work ($0), and no study-specific conflicts of interest were identified.
    RESULTS: The 1,410 sampled NEISS records represented approximately 66,750 estimated emergency department visits nationally. Cervical strain or sprain was the most common diagnosis (45.7% of the weighted national estimate), followed by cervical fracture (21.4%). Males accounted for 62.4% of the weighted estimate. Four-wheel off-road ATVs were the most frequently involved vehicle type (30.6%), followed by two-wheeled powered off-road vehicles (17.7%). Patients aged 11-20 years represented the largest age group (25.7%). Weighted annual estimates increased significantly during the study period, with an average increase of 564 visits per year (P = 0.011). Non-contact mechanisms, including loss of control, rollover events, and falls from vehicles, predominated across age and sex groups. Most estimated visits resulted in treatment and release from the emergency department (76.0%).
    CONCLUSIONS: Non-traditional vehicles were associated with a substantial estimated burden of cervical spine injuries treated in United States emergency departments, particularly among adolescent and young adult males. ATVs and dirt bikes accounted for the largest shares of the weighted national estimate, and non-contact mechanisms predominated across demographic groups. These findings identify opportunities for targeted injury-prevention and safety interventions.
    Keywords:  Cervical spine injury; NEISS database; all-terrain vehicles (ATVs); emergency department; epidemiology; mechanism of injury
    DOI:  https://doi.org/10.1016/j.spinee.2026.08.007
  18. Injury. 2026 Aug 28. pii: S0020-1383(26)00632-7. [Epub ahead of print]57(10): 113645
    Surgical rib fixation in pediatric patients: Following the adult trend or a different story?
    Hadi S Hamdan, Mouhammad Halabi, Ahmad El Nouiri, Camden Gardner, Milosh Djuric, Lisa Hill, Jeffrey L Johnson.
       INTRODUCTION: For many years, non-operative management has been an established standard of care for rib fractures. In adults, surgical stabilization of rib fractures (SSRF) has become an increasingly accepted alternative, with growing evidence supporting its benefits. In contrast, the role of SSRF in pediatric trauma remains poorly defined. This study presents the largest known cohort of pediatric SSRF patients to describe their characteristics and assess whether pediatric practice mirrors adult trends.
    METHOD: A retrospective review of pediatric patients (<18 years) with rib fractures was conducted using the TQIP database (2017-2023). Patients were stratified by treatment (SSRF vs. non-operative). Demographic, injury, surgical, and outcome characteristics were compared. Adult SSRF patients during the same period were included for secondary analysis.
    RESULTS: Among 28,465 pediatric rib fractures, 87 (0.31%) underwent SSRF. Pediatric SSRF rates remained stable over time (0.16%-0.39%; p = 0.17), while adult SSRF use increased (1.5%-2.37%; p = 0.0027). Pediatric SSRF patients were older (14.6 vs. 13.0 years; p < 0.001), more likely to present with flail chest (25.3% vs. 1.2%, p < 0.001), and had higher ISS (25.9 vs. 20.3; p < 0.001) compared to non-SSRF pediatric patients. Compared to adults, pediatric SSRF patients underwent less extensive fixation but had more open thoracic injuries (14.9% vs. 2.3%; p < 0.001). Among pediatric SSRF patients, 50.6% had a same-day major thoracic/open-chest procedure. Pediatric SSRF patients had zero mortality, compared to 7.3% in non-operative pediatric patients (p = 0.009) and 2.7% in adults (p = 0.123).
    CONCLUSION: SSRF in pediatric patients remains rare, while adult SSRF is increasing in incidence. Our data suggest it is being used in highly selected pediatric cases, largely confined to older children and those presenting with severe or complex thoracic injuries such as flail chest or open fractures. Further research is needed to clarify pediatric-specific indications and determine which injury patterns may be appropriate for SSRF.
    Keywords:  Chest wall injury; Pediatric trauma; Rib fractures; SSRF; Surgical stabilization of rib fractures; Thoracic trauma; Trauma Quality Improvement Program (TQIP)
    DOI:  https://doi.org/10.1016/j.injury.2026.113645
  19. J Adolesc Young Adult Oncol. 2026 Sep 04. 21565333261483393
    Communication Challenges and Strategies in Adolescent and Young Adult Cancer Survivorship Care: A Qualitative Study of Clinician Perspectives.
    Mary Anne Kochenderfer, Briana Martin-Villa, Lidia Schapira, Stephanie M Smith.
       PURPOSE: Adolescent and young adult (AYA) cancer survivors treated in pediatric settings face long-term physical and psychosocial effects from cancer treatment, and lifelong specialized survivorship care is recommended. Prior research has focused on what survivors need to know about past cancer and future health, with less emphasis on how clinicians communicate with AYAs and families. This study evaluated effective communication strategies and challenges with survivorship-related communication according to experienced clinicians.
    METHODS: We conducted individual interviews with survivorship clinicians from diverse practice settings across the United States between November 2024 and February 2025. Interviews queried communication strategies, barriers, and recommendations for improving clinical interactions with AYA survivors. Qualitative analysis identified key themes and patterns.
    RESULTS: Clinicians (nine females and three males), in practice for 4-37 years, were physicians specializing in pediatric oncology (N = 7; two with med-peds training), primary care with a survivorship focus (N = 3), or nurse practitioners (N = 2). Barriers to effective communication included information complexity and volume, lack of time, and anxiety among AYA survivors and families. Effective communication strategies included building rapport, a mindset to "meet the patient where they're at," use of clear, accessible language with visual aids, and contextualizing information about health risks and associated uncertainty. Findings illustrated ways that clinician communication may promote or inhibit AYA engagement in survivorship care.
    CONCLUSION: Effective communication between clinicians and AYA cancer survivors may improve health outcomes by helping survivors understand health risks, managing associated uncertainty and anxiety, and promoting AYA engagement in survivorship care. This study will inform the development of communication interventions and training for clinicians.
    Keywords:  adolescent young adult; cancer survivorship; care delivery models for cancer survivors; patient–clinician communication; pediatric oncology; qualitative research
    DOI:  https://doi.org/10.1177/21565333261483393
  20. J Pediatr Health Care. 2026 Sep 02. pii: S0891-5245(26)00227-0. [Epub ahead of print]
    Breaking Silos in Pediatric Nurse Practitioner Education: Virtual Case Collaboration Between Primary and Acute Care Pediatric Nurse Practitioner Students.
    Sally Humphrey, Andrea Sebastian.
       INTRODUCTION: This article describes a virtual case study initiative to promote collaboration between Acute and Primary Care Pediatric Nurse Practitioner students. The program aimed to enhance clinical reasoning skills and clarify role differences within pediatric healthcare.
    METHODS: Students in both Acute and Primary Care PNP programs at UTHSC CON were assigned case studies on pediatric neurological and cardiovascular issues relevant to their settings. Each student prepared a 10-minute oral presentation covering: Chief Complaint, History of Present Illness, Review of Systems, Medical/Family/Social History (if applicable), Physical Examination Findings, Differential Diagnosis, Final Diagnosis, Medical Management Plan, and Family Education or Anticipatory Guidance. Presentations were delivered virtually via Zoom to peers, faculty, and clinical experts in neurology and cardiovascular care. After each presentation, students and faculty debriefed, provided feedback, and asked questions. Students then completed a 10-question survey about their experience.
    RESULTS: Student feedback from the post-activity survey was limited (n=4) but revealed consistent themes. Students valued examining the same diagnosis in different clinical contexts, especially comparing acute presentations in primary care and transitions to the emergency department. They appreciated exposure to diverse clinical perspectives, real-world cases, and involvement of specialty nurse practitioners.
    DISCUSSION: Through interactive case presentations, faculty-led discussions, and structured feedback, the initiative deepened students' understanding of care transitions across settings. It also fostered advanced diagnostic reasoning and collaborative skills essential for interdisciplinary practice. The project was well received, highlighting the value of case-based learning in competency-based education.
    Keywords:  Pediatric nurse practitioner; competency-based education; graduate nursing education; interprofessional education; problem-based learning
    DOI:  https://doi.org/10.1016/j.pedhc.2026.07.005
  21. J Pediatr Health Care. 2026 Sep 04. pii: S0891-5245(26)00294-4. [Epub ahead of print]
    Why Screening Matters in Pediatric Primary Care: Adolescent Suicide Risk from a 2023 Youth Risk Behavior Survey.
    Ashley E Barber, Yu Jin Kang, Regena Spratling.
       INTRODUCTION: Suicide is the second leading cause of death among the adolescent patient population with limited evidence supporting routine suicide screening. This study sought to assess adolescent suicidal ideation, suicide attempts, and mental wellbeing to inform evidence-based universal suicide screening practice.
    METHOD: A secondary data analysis of the 2023 Youth Risk Behavior Survey was conducted. Descriptive statistics and ordinal logistic regression were performed, using SPSS v.29, with a significance level of 0.05.
    RESULTS: The majority of participants were male (50.3%), over 16 years-old (61.3%), and White (49.2%). Compared with participants always reporting poor mental health without suicidal ideation, those with suicidal ideation and better mental health had significantly higher odds of more suicidal attempts (always good: OR = 19.14, 95% CI = 11.69-31.33; sometimes good: OR = 17.68, 95% CI = 13.53-23.09, p < .001).
    CONCLUSIONS: Consideration of universal suicide screening among adolescents may be warranted; however, the significance of the findings requires further examination.
    Keywords:  Suicide; adolescent health; primary health care; suicide prevention
    DOI:  https://doi.org/10.1016/j.pedhc.2026.08.001
  22. Crit Care Med. 2026 Sep 04.
    Healthcare Encounters in the Week Preceding a Sepsis Hospitalization in Pediatric Patients.
    Julia D Cartwright, Moshiur Rahman, Blythe Pollack, Stephen M Gorga, Kristen A Smith, Hallie C Prescott, Erin F Carlton.
       OBJECTIVES: Sepsis is a leading cause of morbidity and mortality for critically ill children, yet the pattern of healthcare use before admission for sepsis remains unknown. We measured the proportion and characteristics of healthcare encounters within 7 days before sepsis hospitalizations.
    DESIGN: Using the Merative MarketScan administrative claims database, we conducted a retrospective observational cohort study to quantify pre-admission healthcare encounters among children hospitalized with sepsis.
    SETTING: The Merative MarketScan database includes inpatient, outpatient, and emergency medical claims from employer-based insurance plans and Medicaid data from approximately 7 million healthcare consumers across multiple states.
    PATIENTS: Included patients were 0-18 years old and hospitalized with sepsis between January 1, 2016, and December 31, 2022. Children were required to have 30 days of continuous insurance enrollment before admission.
    INTERVENTIONS: None.
    MEASUREMENTS AND MAIN RESULTS: Our primary outcome was the occurrence of any healthcare encounter in the 7 days before sepsis hospitalization, including outpatient, emergency department, or inpatient visits. Of those encounters, we identified the proportion that were related to infection. We compared hospitalization characteristics, including mechanical ventilation, ICU use, and length of stay, among those with vs. without pre-sepsis healthcare utilization. We identified 6928 pediatric sepsis hospitalizations, of whom 64.3% (4452/6928) had a complex chronic condition with a median age of 10 years (interquartile range, 3-15 yr). Overall, 53.5% (3707/928) of sepsis hospitalizations had a healthcare encounter within 7 days of admission, including 33.7% (2338/6928) with an outpatient visit, 28.2% (1956/6928) with an emergency department visit, and 6.2% (431/6928) with an inpatient hospitalization. Among sepsis hospitalizations with any pre-admission encounter, 38.9% (1445/3707) had an infection-related diagnosis documented at the encounter. There was no difference in mechanical ventilation, ICU use, or length of stay between those with vs. without pre-sepsis healthcare encounters.
    CONCLUSIONS: Over half of children hospitalized with sepsis were evaluated in the outpatient or emergency department setting in the week preceding admission, with one in five evaluated for infection. Further understanding of these pre-admission encounters may allow for earlier sepsis identification and possibly intervention in the prehospital setting.
    Keywords:  bacteremia; hospitalization; pediatric; primary healthcare; sepsis
    DOI:  https://doi.org/10.1097/CCM.0000000000007336
  23. Expert Rev Vaccines. 2026 Dec;25(1): 2721744
    United States healthcare providers' views on pediatric meningococcal disease and vaccination.
    Oscar Herrera-Restrepo, Vasudha Gupta, Sophie Jacobovitz, Tosin Olaiya, Elise Kuylen, Karam Dahyaleh, Kristin K Johnson, Thatiana Pinto, Sofia B Pinto, Jana Shaw.
       BACKGROUND: Although meningococcal serogroup B (MenB) causes most invasive meningococcal disease (IMD) cases in United States (US) infants, MenB vaccination is not currently approved for this age group. This study sought to better understand US healthcare providers' (HCPs') views regarding IMD and a potential MenB vaccine for children ≤18 months old.
    RESEARCH DESIGN AND METHODS: An online survey was conducted in November 2024 among US board-certified HCPs who provided care to children ≤18 months old. Responses were analyzed descriptively.
    RESULTS: Among N = 506 HCPs, 97.8% responded that, if the Advisory Committee on Immunization Practices (ACIP) were to recommend MenB vaccination for children ≤18 months old, it should be recommended for all children in this age group (52.6%) or those at increased risk for IMD (45.3%). Less than one-fifth (17.6%) of HCPs correctly identified the ACIP MenB vaccination recommendation for children ≤18 months old; 84.4% indicated interest in learning more about a potential MenB vaccine if ACIP-recommended for this population. When considering recommending potential MenB vaccination, 68.6% of HCPs anticipated encountering vaccine hesitancy among parents/caregivers.
    CONCLUSIONS: Most HCPs viewed infant MenB vaccination favorably but demonstrated knowledge gaps regarding IMD epidemiology and vaccine recommendations, underscoring the need for targeted education to optimize future IMD prevention.
    Keywords:  Healthcare provider survey; invasive meningococcal disease; knowledge, attitudes, practices, and barriers; meningococcal serogroup B (MenB); vaccines
    DOI:  https://doi.org/10.1080/14760584.2026.2721744
  24. Health Expect. 2026 Oct;29(5): e70862
    Patient and Public Involvement and Engagement in Pediatric Health Research: A Systematic Review.
    Veronika Stadler, Rebeca Mozun, Jannik Strohm, SwissPedHealth Consortium, Chloé Caruso, Klara M Posfay-Barbe, Cornelia Hagmann.
       BACKGROUND: Patient and public involvement and engagement (PPIE) can increase the relevance and efficiency of research projects. An overview of PPIE approaches and implementation in pediatric research studies is needed to facilitate learning from others' experiences.
    OBJECTIVE: We aimed to systematically review practices in PPIE across all pediatric health research disciplines regarding characteristics and recruitment of PPIE participants, timepoints and methods used for PPIE, levels of involvement, benefits and barriers of PPIE.
    SEARCH STRATEGY: We searched Pubmed, EMBASE, Cochrane and PsycInfo using a comprehensive set of terms based on the concepts 'Patient and Public Involvement,' 'Health Research' and 'Pediatrics.'
    INCLUSION CRITERIA: We included original research articles describing PPIE implementation in pediatric health research published in English or German between 01/2003-10/2024.
    DATA EXTRACTION AND SYNTHESIS: Data was extracted using predefined categories and synthesized by narrative summary and thematic synthesis. PPIE reporting quality was assessed using the GRIPP2 short form checklist.
    MAIN RESULTS: Out of 1910 references, we included 37 original research articles, representing 35 studies. PPIE participants were mostly children, adolescents or caregivers involved in all research stages, especially in study design (89%) and recruitment (51%). Key positive impacts of PPIE on research included enhanced recruitment and retention rates and personal benefits for PPIE participants. Barriers to PPIE were financial and time resources required and challenges in recruiting representative PPIE participants. The level of involvement and PPIE reporting quality varied highly between studies.
    DISCUSSION: Common benefits and barriers of PPIE exist across pediatric research disciplines. Reporting quality varied highly between studies.
    CONCLUSIONS: PPIE is valuable in pediatric health research. Adherence to guidelines for conducting and reporting PPIE is important to enhance mutual learning.
    PATIENT OR PUBLIC CONTRIBUTION: PPIE input contributed to the understandability of the lay summary. The findings of this review, together with parent and public input, will inform guidelines for future PPIE activities at the authors' institutions.
    Keywords:  adolescent; biomedical research; child; community‐based participatory research; health services research; patient participation; pediatrics
    DOI:  https://doi.org/10.1111/hex.70862
  25. Pediatrics. 2026 Sep 01. pii: e2026077260. [Epub ahead of print]
    Preparing for Reduced Insurance Coverage of Children.
    David Keller, Keila N Lopez.
      
    DOI:  https://doi.org/10.1542/peds.2026-077260
  26. BMJ Paediatr Open. 2026 Sep 03. pii: e004467. [Epub ahead of print]10(1):
    RIGHTS principles for early intervention: right care at the right time for every infant, child and family in low and middle-income countries.
    Álvaro Hidalgo-Robles, Daniel Cid-Cofré, María Lucía Mesa-Rubio, Antonio Rizzoli-Córdoba, Anahí Venzor Strader, Helia Molina-Milman.
       BACKGROUND: Early intervention programmes for infants and young children at developmental risk are implemented inconsistently and inequitably worldwide. Variation in access, surveillance, referral, follow-up and service quality means that children and families may receive very different opportunities depending on where they live, system capacity and resources, laws, policy and local pathways. Practical, evidence-informed guidance is needed to translate 'what should be done' into 'how to implement it' across diverse settings.
    METHODS: This conceptual, practice-oriented article used a narrative review and an evidence-informed iterative framework-development process. Sources included global frameworks, clinical guidelines and evidence syntheses, randomised and longitudinal studies relevant to low and middle-income contexts and implementation science frameworks.
    RESULTS: We propose six Reach, Identify early, align Goals, Help families deliver, Track and improve and ensure Sustainability (RIGHTS) principles for early intervention programmes: (1) Reach underserved infants, children and families through proactive, equity-oriented and outreach-capable models; (2) Identify developmental risk early through standardised, feasible pathways with clear timepoints, tools, thresholds and referral circuits; (3) align Goals with family priorities, functioning and everyday routines through shared decision-making; (4) Help families deliver intervention using coaching, routines-based strategies and realistic doses of practice; (5) Track and improve systems through standards, service indicators, family experience measures and continuous learning cycles; and (6) ensure Sustainability by institutionalising governance, financing, workforce capacity and policy alignment for durable impact.
    CONCLUSIONS: Early intervention programmes should be designed to connect timely identification with family-centred, functionally meaningful and feasible support. Embedding standardisation, equity, caregiver partnership and data-informed improvement into service design may reduce unwarranted variation and strengthen continuity of care. Priority research areas include implementation-effectiveness studies, equity impacts, minimum data sets and the cost-effectiveness of scalable and sustainable early intervention programmes.
    Keywords:  Child Health; Children; Health Policy; Low and Middle Income Countries; Patient Rights
    DOI:  https://doi.org/10.1136/bmjpo-2026-004467
  27. Cureus. 2026 Aug;18(8): e113904
    The Impact of Pediatric Dermatologic Conditions on Mental Health in Underserved Communities in the United States: Barriers and Strategies for Their Mitigation.
    Claudia Pedreira, Harvey N Mayrovitz.
      Pediatric dermatologic conditions are associated with significant psychosocial burden and disparities in access to care, particularly among underserved populations in the United States. Chronic skin diseases such as atopic dermatitis, acne, psoriasis, and alopecia areata may negatively affect emotional well-being, sleep, self-esteem, quality of life, and social functioning in affected children and caregivers. Structural inequities related to race, ethnicity, socioeconomic status, insurance coverage, transportation, and healthcare accessibility further contribute to differences in disease burden and treatment access. This narrative review examined the relationship between pediatric dermatologic conditions, mental health outcomes, healthcare disparities, and barriers to care in underserved pediatric populations. A structured search of PubMed, Web of Science, and PsycINFO identified peer-reviewed studies published between 2015 and 2025 involving pediatric patients aged 0-18 years. The reviewed literature demonstrated that underserved pediatric populations experience delayed dermatologic evaluation, reduced access to specialty care and advanced therapies, and increased emergency department utilization. Chronic pediatric skin disease was consistently associated with anxiety, depression, stigma, sleep disturbance, and impaired quality of life affecting both patients and caregivers. Teledermatology as an alternative care model may help improve specialty access and reduce barriers to care, although disparities in telehealth utilization remain. These findings highlight the complex relationship between pediatric dermatologic disease, psychosocial burden, and structural inequities affecting underserved children. Multidisciplinary, family-centered, and culturally responsive approaches may help improve both psychosocial outcomes and equitable access to pediatric dermatologic care.
    Keywords:  access to care; atopic dermatitis; health equity; healthcare disparities; mental health; pediatric dermatology; pediatric skin disease; psychosocial burden; teledermatology; underserved populations
    DOI:  https://doi.org/10.7759/cureus.113904
  28. J Paediatr Child Health. 2026 Sep 05.
    High-Flow Nasal Cannula Use for Respiratory Support Outside the Paediatric Intensive Care Unit in Children Over 1 Year: A Narrative Review.
    Eimear O'Connell, Des W Cox.
       AIMS: High-flow nasal cannula (HFNC) therapy is increasingly used outside paediatric intensive care units (PICUs) for children with acute respiratory distress, despite limited evidence beyond bronchiolitis and neonatal populations. No existing review has synthesised evidence in children over 1 year without bronchiolitis managed in emergency department and ward settings. This narrative review aims to address this gap.
    METHODS: PubMed, Scopus and Medline (OVID) were searched to October 2025 for studies of HFNC in children aged over 12 months with acute respiratory distress, managed in emergency department or ward settings and compared with conventional oxygen therapy or non-invasive ventilation.
    RESULTS: Eight studies (six randomised trials, one pilot RCT, one observational cohort) were included, covering asthma, pneumonia and mixed hypoxaemic respiratory failure. Small trials showed early physiological improvement without consistent benefit in length of stay or PICU admission. Flow rates were highly variable, with several studies delivering flow below thresholds considered necessary for a true high-flow effect. The largest trial reported longer hospital stay and higher PICU admission with early HFNC use compared to conventional oxygen therapy.
    CONCLUSION: Overall, while HFNC appears safe and well tolerated, current evidence does not support routine first-line use outside the PICU in children over 1 year. More prospective research is urgently needed to identify which populations will benefit from HFNC use. Until such data is available, HFNC should be implemented with clear institutional guidelines, defined escalation criteria and close clinical monitoring.
    Keywords:  acute hypoxaemic respiratory failure; asthma; high‐flow nasal cannula; non‐invasive ventilation; pneumonia; respiratory distress
    DOI:  https://doi.org/10.1111/jpc.70572
  29. Nurs Crit Care. 2026 Sep;31(5): e70667
    Efficiency Meets Safety: Transforming Operating Theatre-To-Paediatric Intensive Care Unit Transfers in a Paediatric Hospital.
    Adel Sharadgah, Shabaan Osman, Rajnish Kumar, Iman Darwish, Victoria Shaward, Hisham Obeidat, Jihad Zahra, Reda Elsahy, Hisham Abdulla.
       BACKGROUND: Transfers from the Operating Theatre (OT) to the Paediatric Intensive Care Unit (PICU) represent a high-risk transition for critically ill children. At a Tertiary Paediatric Hospital, the absence of a standardised handover protocol resulted in prolonged recovery waits of up to 120 min, medication errors, haemodynamic instability, and reduced family and staff satisfaction.
    AIM: To enhance patient safety, reduce handover time, and improve family and staff satisfaction through a structured Operating Theatre-to-PICU handover process.
    STUDY DESIGN: Single-centre, pre-post quality improvement project in a 23-bed tertiary PICU. A multidisciplinary, co-designed intervention comprising a two-phase telephone checklist, a standardised shared drug library, preloaded infusion pumps delivered to OT, a dedicated receiving nurse and structured pre-arrival family orientation. Training was delivered by link nurses, using Kotter's change model.
    RESULTS: Handover duration decreased by approximately 50% (15-20 to 8-10 min) following implementation. No transfer-related medication errors occurred across the 77 protocol cases, versus six across 96 baseline transfers and haemodynamic instability attributable to infusion changes was virtually eliminated. Family satisfaction scores were higher in post-implementation cohorts (87% at 3 months; 90% at 6 months) than pre-intervention (72%), as were staff satisfaction scores (80% and 95% vs. 58%). Mean PICU length of stay decreased from 5.2 to 4.6 days.
    CONCLUSIONS: A structured, multi-component handover process improved patient safety, handover efficiency, and family and staff experience during OT-to-PICU transfers, sustained at 6 months.
    RELEVANCE TO CLINICAL PRACTICE: The intervention demonstrates that a multidisciplinary handover protocol can reduce transfer‑related risks and enhance family and staff experience during high‑risk transitions from the Operating Theatre-to-PICU.
    Keywords:  Kotter's change model; Operating Theatre to Paediatric Intensive Care Unit handover; family satisfaction; paediatric critical care; patient safety; quality improvement
    DOI:  https://doi.org/10.1111/nicc.70667
  30. Neoreviews. 2026 Sep 01. 27(9): e555-e570
    Red Blood Cell Transfusion for Preterm and Term Infants in the NICU.
    Sheema Gaffar, Molly Crimmins Easterlin.
      Red blood cell (RBC) transfusion practices in neonatal intensive care units are variable. Determining which patients should be transfused, and the specific hemoglobin or hematocrit thresholds, remains a recurring challenge in neonatal intensive care. Although some well-conducted randomized controlled trials and short-term follow-up studies exist for premature infants, data on term infants remain limited. Most information on term infants is derived from heterogeneous observational studies or expert consensus guidelines intended for a wider pediatric critical care population. In this review, we summarize the current literature on RBC transfusions in preterm and term infants, discuss unique characteristics of critically ill infants with varying comorbidities, and provide general strategies to guide the neonatologist in deciding when to transfuse RBCs. We also review specific considerations during RBC transfusion, such as volume, rate, and preparation as well as strategies to decrease the need for RBC transfusions.
    DOI:  https://doi.org/10.1542/neo.27-9-050
  31. Cureus. 2026 Jul;18(7): e113685
    Missed Opportunities: The Importance of HIV Screening in Adolescent Populations.
    Elizabeth C Bolton, Eric McGrath, Laura J Benajmins.
      Adolescents and young adults represent a substantial proportion of individuals newly diagnosed with HIV in the United States. Despite this, many youth living with HIV remain unaware of their status. HIV screening should be discussed and offered to adolescents; however, teens frequently report not being offered testing, and healthcare providers do not consistently adhere to screening practices. Detecting early HIV infection, including acute infection, is critical to initiating treatment, preventing transmission, and understanding patterns of disease. Acute HIV detection in adolescents and young adults is particularly challenging because early clinical manifestations are often nonspecific and may be misattributed to other common illnesses, such as influenza or mononucleosis. Maintaining a low threshold for testing, a high index of suspicion for HIV even in the presence of other diagnoses, and advocating for broad screening practices are essential to preventing missed diagnoses in this population. A 19-year-old male with a history of multiple sexually transmitted infections (STIs) was prescribed HIV pre-exposure prophylaxis (PrEP) but never initiated therapy. One year later, with a one-month prior negative fourth-generation HIV test, the patient developed a 103°F fever, back pain, myalgias, and a headache. Over the next several days, he presented to three emergency departments, but HIV testing was not performed. Subsequently, the patient presented to the clinic, and exam findings were consistent with streptococcal pharyngitis. Rapid strep testing was positive, and he was treated with intramuscular (IM) penicillin. However, serum testing from that visit showed HIV RNA PCR of 3,652,943 copies/mL (reference: undetectable, <20 copies/mL). The patient returned to the clinic two days later and was started on antiretroviral therapy. This case highlights the critical need for routine and timely HIV screening, specifically in the adolescent and young adult population, as acute HIV infection can present with non-specific symptoms as well as concurrent diagnoses such as strep throat. Clinicians must maintain a high index of suspicion and be knowledgeable about HIV testing modalities, particularly the fourth-generation antigen/antibody tests. Universal screening should not be based on self-reported risk behaviors, as they can be undisclosed. Barriers, including stigma, confidentiality concerns, and provider discomfort, hinder testing in primary care settings. Maintaining a high index of suspicion for HIV in adolescent and young adult patients is crucial, as missed or delayed diagnoses can accelerate disease progression and increase transmission. Integrating HIV testing into routine adolescent care helps normalize screening and reduce stigma.
    Keywords:  acute hiv infection; adolescent hiv screening; fourth-generation hiv testing; missed diagnosis; universal hiv testing
    DOI:  https://doi.org/10.7759/cureus.113685
  32. Hosp Pediatr. 2026 Sep 03. pii: e2026009345. [Epub ahead of print]
    Prevalence and Characteristics of Mental Health Interventions Following Pediatric Hospitalization.
    Mariah L DeSerisy, Julia A Heneghan, Matt Hall, Daniel H Choi, Leslie A Dervan, Daniel Garros, Denise M Goodman, Jason M Kane, Joseph G Kohne, Colin M Rogerson, Nadia Roumeliotis, Vanessa Toomey, Adam C Dziorny.
       BACKGROUND AND OBJECTIVES: As survival after pediatric critical illness improves, attention has shifted to post-intensive care syndrome and the long-term mental health of pediatric intensive care unit (PICU) survivors, who have high rates of posttraumatic stress, anxiety, and depression. The objective of this study is to examine the rates of new mental health follow-up and psychopharmacology use among publicly insured children following PICU hospitalization, compared with those hospitalized on acute care wards.
    METHODS: We performed a retrospective cohort study using 2016-2021 multistate Medicaid claims. The cohort comprised children aged 3 to 18 years discharged home after an index hospitalization. The primary exposure was PICU admission. The primary outcome was new mental health visits within 1 year after discharge. Secondary outcomes included visit clinician type, visit diagnoses category, and new psychiatric prescriptions.
    RESULTS: Among 144 763 Medicaid-insured pediatric hospitalizations (20.7% with PICU stays), only 5.2% initiated new mental health care. When compared with hospitalizations without PICU exposure, those with PICU exposure were more likely to complete new mental health visits (n = 1697 [6.1%] of PICU hospitalizations vs 5252 [4.9%] of non-PICU hospitalizations). PICU exposure was independently associated with a new mental health visit (odds ratio 1.07; 95% CI 1-1.14; P = .042). Older age, complex chronic conditions, and longer length of stay were associated with new mental health visits.
    CONCLUSIONS: New mental health follow-up after pediatric hospitalization is rare and independently associated with PICU exposure during hospitalization. Future studies should investigate barriers to care and identify effective methods for systematic screening and proactive referral.
    DOI:  https://doi.org/10.1542/hpeds.2026-009345
This page is being maintained by Thomas Krichel. It was last updated on 2026‒09‒08 at 17:30.