bims-cliped Biomed News
on Clinical pediatrics
Issue of 2026–09–13
thirty-six papers selected by
Alyssa M. Portwood, Akron’s Children
  1. Health Literacy in Pediatric Care: Evidence, Gaps, and Opportunities.
  2. AI at the Bedside: An Argument for a Training Wheels Approach.
  3. A Comparison of Pediatric Hospitalization Data in Cosmos and the Kids' Inpatient Database.
  4. Reducing Inpatient Pediatric Central Line-associated Bloodstream Infections by Proactive Risk Assessment and Escalation.
  5. Reducing Inequities in Restraint Use in the Pediatric Emergency Department.
  6. Caring Across Languages: Clinician Perceptions of Variability in US Pediatric Outpatient Epilepsy Care.
  7. Achieving Faster Bleeding Disorder Treatment in the Emergency Department: A Quality Improvement Initiative.
  8. Pediatric tele-behavioral health: history, evidence, barriers, and emerging directions.
  9. Improving peripheral arterial catheter placement in critically ill children: a pre-post quality improvement study.
  10. Making It Count: A Quality Improvement Project to Improve Pediatric Hospital Billing at a Community Hospital.
  11. Harnessing Cloud-Based Technology to Train School Nurses: A Type 1 Diabetes Exemplar.
  12. Parents' and caregivers' views on pediatric meningococcal disease and serogroup B vaccination.
  13. Clinicians' Experiences With Law Enforcement in a Pediatric Emergency Department.
  14. Variation in treatment and clinical outcome of rhabdomyolysis in children's hospitals.
  15. Pediatric Artificial Intelligence in Radiology: Unmet Needs and Next Steps-AJR Expert Panel Review.
  16. Triaging Benign Paroxysmal Movements in Infants and Young Children.
  17. Latin American Children of the US Immigration Crisis: The Essential Roles that All Pediatric Health Care Professionals Must Play.
  18. POCUS for the general pediatrician: a narrative review of practical applications, policy, and training.
  19. Infrastructure, Barriers, and Strategies for Pediatric Immunization Delivery in Hospital Settings.
  20. Continuous glucose monitoring devices in hospitalized pediatric patients.
  21. Discordance between early mobility protocol expectations and nurse-led mobilizations of critically ill children: A quality improvement initiative.
  22. Describing Pediatric Emergency Department Nurse Staffing Models and Unit Characteristics in Pediatric Hospitals in the United States.
  23. Acute, chronic, and non-fracture-related compartment syndrome in children. A current concepts review.
  24. Pediatric venous thromboembolism: an illustrated review.
  25. Using electronic health record audit logs to identify pediatric intensive care unit teams.
  26. Nurses' knowledge and attitudes toward pediatric pain assessment and management: a scoping systematic review from 2015 to 2025.
  27. Evolving landscape of paediatric sepsis: progress, gaps and the next generation of tools.
  28. Variation in blood culture testing in children hospitalized with three common infections.
  29. Quality Improvement Partnership to Improve Human Papillomavirus Vaccine Rates: Start at Age 9 Campaign.
  30. Ibuprofen versus acetaminophen for acute mild-to-moderate pain management in pediatric populations: a systematic review and meta-analysis of their efficacy.
  31. Early Mobilization in Critically Ill Patients with Cancer: A Scoping Review.
  32. Same-day discharge after pediatric neurosurgical procedures: a single-institution experience.
  33. Strengthening Health System-Community Partnerships to Address Pediatric Social Needs: A Qualitative Study.
  34. Practice variability of epinephrine administration in pediatric out-of-hospital cardiac arrest in the United States.
  35. Improving Guideline-concordant Antibiotic Use for Acute Otitis Media in a Pediatric Primary Care Network.
  36. Influenza vaccination in children with underlying conditions: affirming effectiveness and confronting gaps.
  1. Acad Pediatr. 2026 Sep 06. pii: S1876-2859(26)00214-7. [Epub ahead of print] 103432
    Health Literacy in Pediatric Care: Evidence, Gaps, and Opportunities.
    Alyssa Coffin, Alexander F Glick, H Shonna Yin.
      Health literacy is a foundational component of providing accessible pediatric care, influencing whether families can understand, access, and use health information. As families increasingly rely on online health resources, health literacy skills applied to digital information, or e-health literacy, has become an evolving dimension of pediatric health literacy. The concept of health literacy extends beyond an individual's abilities, intersecting with the demands placed on individuals by healthcare systems. There is a growing focus on organizational health literacy (OHL), which reflects how effectively systems support equitable communication, but this remains infrequently assessed or implemented. Limited parent, child, and adolescent health literacy is common and disproportionately affects families with lower income, minoritized racial/ethnic backgrounds, lower educational attainment, and who use languages other than English for care. Limited health literacy has been associated with decreased disease-specific knowledge, suboptimal health behaviors, and worse clinical outcomes. Although health literacy-informed strategies can improve comprehension and outcomes, best practices, such as teach-back, remain underutilized across pediatric care settings. The rapid expansion of digital tools offers new opportunities to enhance health literacy-informed communication but also introduces challenges related to equity, accuracy, and safety. Advancing pediatric health literacy requires coordinated efforts: embedding health literacy principles into institutional and national policies, integrating universal health literacy precautions into clinical workflows, expanding clinician and patient health literacy education, and advancing health literacy-focused research, including on digital interventions and artificial intelligence (AI)-supported communication. Prioritizing these efforts is essential to creating health literate-systems that enable all families to access, understand and use health information.
    Keywords:  communication; health disparities; health literacy
    DOI:  https://doi.org/10.1016/j.acap.2026.103432
  2. Pediatrics. 2026 Sep 08. pii: e2025074896. [Epub ahead of print]
    AI at the Bedside: An Argument for a Training Wheels Approach.
    Katherine E MacDuffie, Douglas S Diekema, Jennifer C Kett, Elliott M Weiss, Marlyse F Haward, Yoram Unguru.
      Bedside use of artificial intelligence (AI) platforms is increasingly common. Busy clinicians may welcome these generative AI (Gen AI) tools, which have the potential to streamline many time-consuming tasks and aid in patient care. Trainees may find them useful to quickly evaluate complex medical information. Acceptance of bedside Gen AI tools by patients and their families, however, is less clear, and a definitive standard surrounding informed consent has yet to be established. Omission of certain types of information by Gen AI tools, including "small talk," which comprises an essential element of many pediatric clinical interactions, demands attention alongside the tendency of Gen AI tools to fabricate content. Medical students and resident physicians may be early adopters of Gen AI tools and may accept AI-generated statements at face value before having fully developed adequate knowledge and critical skills to independently evaluate their veracity. Despite these challenges, Gen AI tools in the clinical space are here to stay. Safe and effective incorporation of these tools in patient care and medical education must balance a wide range of considerations. In the following Ethics Rounds, stemming from a 2024 Pediatric Academic Society Bioethics Club Meeting session on the use of AI, the commentators draw on their diverse background as pediatric clinicians, bioethicists, and educators to explore these issues.
    DOI:  https://doi.org/10.1542/peds.2025-074896
  3. Hosp Pediatr. 2026 Sep 07. pii: e2026009311. [Epub ahead of print]
    A Comparison of Pediatric Hospitalization Data in Cosmos and the Kids' Inpatient Database.
    Rohan Bhargava, Patrick Walsh, Julia Heneghan, Allan Wu, Brittany Marie Hunter, Nathan Money, Sriram Ramgopal.
       OBJECTIVE: To compare characteristics of pediatric hospitalizations in Epic Cosmos, an electronic health record-based database that aggregates voluntarily submitted data from across the United States, with nationally representative pediatric inpatient data in the Kids' Inpatient Database (KID).
    METHODS: We performed a retrospective cross-sectional study comparing hospitalizations for children (<18 years) in 2022 from KID and Cosmos. We compared proportions of key variables between these databases for demographics, primary diagnoses, and rates of medical complexity.
    RESULTS: We identified 1 878 764 hospitalizations in Cosmos and 5 140 395 hospitalizations in KID. Age and sex distribution aligned closely. Admissions from Cosmos had more missing race and ethnicity (31.4% vs 9.5%) and payor data (10.9% vs 0.0%) compared to KID. Cosmos hospitalizations more frequently exceeded 3 days in length (37.2% vs 32.2%) and had a higher proportion of admissions with medical complexity (14.3% vs 13.8%). Cosmos and KID demonstrated comparable distributions of primary diagnoses in each database, though Cosmos included a smaller proportion of liveborn admissions compared to KID (64.6% vs 68.6%). Cosmos had markedly fewer patients from the Western region than KID (14.1% vs 22.8%) but more from the South (43.9% vs 39.7%) and the Midwest (24.3% vs 21.0%).
    CONCLUSION: Cosmos showed core demographic similarities to KID, with some differences that may reflect its voluntary data submission model. We note differences to varying degrees in race and ethnicity, payor mix, regional representation, length of stay, medical complexity, and primary diagnoses. Future work should explore avenues to optimize the use of these databases in pediatric research.
    DOI:  https://doi.org/10.1542/hpeds.2026-009311
  4. Pediatr Qual Saf. 2026 Sep-Oct;11(5):11(5): e928
    Reducing Inpatient Pediatric Central Line-associated Bloodstream Infections by Proactive Risk Assessment and Escalation.
    Chris I Wong, Claudia Hoyen, Joyce Deptola, Theresa Smith, Josephine Rey, Charles G Macias.
       Introduction: Central line-associated bloodstream infections (CLABSIs), despite the application of best practices, are still prevalent and cause significant morbidity and mortality in pediatric patients. We describe a quality improvement project with an aim to reduce inpatient CLABSIs focused on standardization and proactive risk assessment.
    Methods: The aim was to reduce inpatient CLABSI rates by 30% within 3 years beginning in January 2021. An apparent cause analysis in 2018 suggested that the lack of escalation of concerns was a potential focus area. We used Plan-Do-Study-Act cycles starting with a pilot in 2019 to roll out a CLABSI Watcher Program. After a CLABSI prevention summit in 2020, a reorganization of drivers reidentified the need for a standardized escalation process for central line (CL) concerns. A CL nurse program was then scaled across the hospital, focusing on timely proactive huddling. Hospital-wide standardization of practices occurred from 2021 to 2023. We used statistical process control charts to assess changes in CLABSI rates.
    Results: Special cause variation, with a downward shift in the CLABSI rate process mean compared with baseline (0.97 per 1,000 CL days), was observed starting June 2021 (0.13 per 1,000 CL days). A second shift occurred from August 2023 through December 2024 (0.00 per 1,000 CL days). The CLABSI rate decreased by 65% (0.34 per 1,000 CL days) through December 2023.
    Conclusions: Significant reductions in hospital CLABSI rates can be achieved by using additional measures beyond focusing on CL maintenance and insertion bundles, and particularly through developing proactive risk assessment and escalation processes.
    DOI:  https://doi.org/10.1097/pq9.0000000000000928
  5. Pediatrics. 2026 Sep 10. pii: e2025073158. [Epub ahead of print]
    Reducing Inequities in Restraint Use in the Pediatric Emergency Department.
    Motunrayo R Adu, Max Rolison, Emily Powers, Alexandria Georgadarellis, Sarah Kandil, Pamela Hoffman, Jessica Vetter, Elizabeth Bartone, Kristen Campbell, Rachel Matz, Jennifer Grise, Lawrence Siew, Gunjan Tiyyagura.
       BACKGROUND AND OBJECTIVES: Restraints are used in emergency departments to treat acute agitation and prevent harm but can cause injury. Local data demonstrated racial and ethnic disparities in restraint use. Of non-Hispanic Black and Hispanic patients, 2.7% were physically restrained, compared with 1.1% of non-Hispanic White patients. Intramuscular chemical restraint rates were highest among non-Hispanic Black patients at 6.0%, compared with 3.7% in Hispanic patients and 2.6% in non-Hispanic White patients. We sought to reduce these differences to less than 1% within 12 months.
    METHODS: We identified drivers to managing agitation, including improved staffing, standardized care protocols, enhanced deescalation training, and early assessment. A multidisciplinary team implemented interventions through Plan-Do-Study-Act cycles, including a standardized pathway, 24/7 access to behavioral health counselors, care plans, deescalation training, and education on racial disparities. Statistical process control charts were used to track restraint use. Process measures included staff knowledge of racial disparities in restraint use. The balancing measure included the frequency of staff injuries.
    RESULTS: Physical restraint rates remained unchanged for non-Hispanic Black and non-Hispanic white but decreased to 1.3% for Hispanic patients. We observed reductions in intramuscular restraint disparities: rates decreased to 1.4% for non-Hispanic Black and 1.2% for Hispanic patients, with 8 consecutive points below the centerline, whereas rates for non-Hispanic white patients remained at 2.6%. Staff injuries did not increase.
    CONCLUSION: Targeted quality improvement interventions led to reduction in disparities in restraint use. Ongoing work includes simulation-based training and addressing structural drivers.
    DOI:  https://doi.org/10.1542/peds.2025-073158
  6. J Child Neurol. 2026 Sep 11. 8830738261484301
    Caring Across Languages: Clinician Perceptions of Variability in US Pediatric Outpatient Epilepsy Care.
    PERC Health Equity Special Interest Group
      Little is known about outpatient language access practices in the United States for children with epilepsy whose families use languages other than English (LOE) for medical care. The Pediatric Epilepsy Research Consortium (PERC) aimed to characterize clinician perceptions of institutional practices by developing and conducting a descriptive survey. We weighted statistical outcomes to equally represent clinician opinion from each center and conducted deductive thematic analysis of open-ended responses. One hundred clinicians from 40 institutions (53.3% institutional response rate) completed the survey. Access to both interpretation and translation services was uneven across PERC institutions. Seizure action plans in all common LOE were available at 15.2% of centers. Despite access to professional interpreters, 61.2% reported using nonprofessional interpretation at times. Qualitative themes included clinician burden, necessary resources, language certification practices, nonprofessional interpretation, translation delays, languages of lesser diffusion, technology use, trust in remote interpretation, language concordance, and perceptions of certification requirements. Findings highlight the need for interventions and guidelines to promote language-access for children with epilepsy whose families use LOE.
    Keywords:  disparities; language equity; pediatric epilepsy
    DOI:  https://doi.org/10.1177/08830738261484301
  7. Pediatr Qual Saf. 2026 Sep-Oct;11(5):11(5): e905
    Achieving Faster Bleeding Disorder Treatment in the Emergency Department: A Quality Improvement Initiative.
    Kristen Adams, Megan Caskey, Lindsey Neill, Daryl Moczygemba, Yingchao Yuan, Sheryl Yanger, Erin Munns, Jennifer Heineman, Arun Gurunathan.
       Introduction: People with bleeding disorders (PwBD) often rely on the emergency department (ED) for clotting factor concentrate (CFC) administration for apparent or suspected bleeding. Timely CFC administration reduces complications but is challenging due to high ED patient volumes and uncertainty about the treatment type, dose, and timing (especially in the pediatric population). Our project aimed to improve the time to CFC for PwBD presenting to the ED with bleeding concerns, with an initial SMART (specific, measurable, achievable, relevant, and time-bound) aim of decreasing the median time from 129 to 99 minutes within 6 months.
    Methods: Our interventions included educational initiatives, personalized management cards, improved hematology-to-ED communication, and the development of an evidence-based algorithm and guideline.
    Results: We exceeded our SMART aim, reducing the median time to CFC to82 minutes during the 6 months, and since then we have further improved treatment times, with a median time to CFC of 61 minutes since project initiation (53% reduction from baseline) and a median time to CFC of 41 minutes during the most recent 6 months of data collection (68% reduction from baseline).
    Conclusions: Our results highlight the successful and sustained application of quality improvement methodologies to improve CFC administration time in PwBD.
    DOI:  https://doi.org/10.1097/pq9.0000000000000905
  8. Curr Probl Pediatr Adolesc Health Care. 2026 Sep 08. pii: S1538-5442(26)00061-1. [Epub ahead of print] 101974
    Pediatric tele-behavioral health: history, evidence, barriers, and emerging directions.
    Elizabeth H Zeichner, Olivia O Familusi, Elizabeth Flook, Philip Scribano.
      There has been an increasing prevalence of mental and behavioral health conditions in children and adolescents in the United States, which has been exacerbated by the COVID-19 pandemic. However, many youth struggle to access behavioral health care. Tele-behavioral health, the delivery of mental health services through videoconferencing and other digital technologies, has emerged as a strategy to facilitate access. There is broad evidence supporting clinical effectiveness of tele-behavioral health across multiple psychiatric and behavioral health conditions. Multiple established care models exist for the delivery of tele-behavioral health. Here, we discuss key facilitators and barriers to implementation of tele-behavioral health, with important considerations including clinical appropriateness, provider training, and organizational support, in addition to essential safety and confidentiality considerations in care delivery with children and adolescents. There are also health equity implications in the use of tele-behavioral health, which can potentially reduce disparities in access to behavioral health care. However, important considerations remain to ensure that telehealth use is accessible and does not exacerbate inequities. Finally, there are emerging directions in the field of tele-behavioral health, particularly in the integration of artificial intelligence (AI).
    Keywords:  Artificial intelligence in healthcare; Health equity; Healthcare delivery; Pediatric behavioral health; Pediatric mental health; Tele-behavioral health
    DOI:  https://doi.org/10.1016/j.cppeds.2026.101974
  9. Front Pediatr. 2026 ;14 1931589
    Improving peripheral arterial catheter placement in critically ill children: a pre-post quality improvement study.
    Min Zhou, Kunhui Fu, Jiajia Li, Qiaoxia Wang, Na Yang, Liting Zeng, Linjuan Wang.
       Introduction and aims: Peripheral arterial catheter (PAC) assessment and insertion are essential but technically demanding procedures in pediatric intensive care. Practice varies widely, and inconsistent adherence to evidence-based standards contributes to preventable complications. This study aimed to improve the quality and safety of arterial catheterization in critically ill children through a structured quality improvement approach.
    Methods: A pre-post quality improvement study was conducted in a pediatric intensive care unit (PICU) across three phases: baseline (April-September 2024), implementation (October 2024-February 2025), and follow-up (March-September 2025). Phase-specific samples comprised 121, 76, and 63 patients and 170, 105, and 100 catheterizations, respectively; patients could contribute to more than one phase. A structured audit-and-feedback system measured adherence to 12 operational audit criteria derived from 10 retained evidence-based recommendations. Barriers to best practice were identified through stakeholder interviews, and a multi-component intervention bundle-incorporating standardized checklists, ultrasound-guided cannulation training, electronic decision support, and tiered competency assessment-was developed and implemented. Statistical process control charts were the primary longitudinal analysis, with phase comparisons as supportive analyses.
    Results: Overall nursing adherence increased from a baseline centerline of 57.0% to a post-implementation centerline of 74.3% (baseline-to-implementation p < 0.001). Assessment adherence increased from 69.4% to 88.9%, and insertion adherence increased from 36.6% to 53.6% (p < 0.01). First-attempt success changed only from 64.1% to 68.3%, without a sustained statistical process control shift or significant phase differences (all p > 0.20). Complication rates showed a significant downward trend (Kendall's Tau = -0.432, p = 0.017).
    Conclusions: The quality improvement bundle was associated with improved process adherence and lower observed complication rates in pediatric PAC management. However, the uncontrolled design limits causal attribution for the safety outcome. Assessment adherence responded rapidly, whereas insertion performance and first-attempt success remained operator-dependent, supporting continued competency-based training and routine ultrasound guidance.
    Keywords:  nursing adherence; pediatric intensive care unit; pediatric nursing; peripheral arterial catheter; quality improvement; statistical process control; ultrasound guidance
    DOI:  https://doi.org/10.3389/fped.2026.1931589
  10. Hosp Pediatr. 2026 Sep 07. pii: e2026009324. [Epub ahead of print]
    Making It Count: A Quality Improvement Project to Improve Pediatric Hospital Billing at a Community Hospital.
    Carrie Lind, James Gay, Mark Naguib, Anuj Patel, David P Johnson.
       BACKGROUND AND OBJECTIVES: Community pediatric hospital units are closing nationwide because of financial strain. Appropriate designation of hospitalized patients as inpatient (IP), rather than observation, increases hospital revenue. Clinicians often lack knowledge of bed status. Our aim was to improve the appropriate IP status designation of pediatric patients at a community hospital from a baseline of 18% to 60% by July 2022.
    METHODS: Our team of community Pediatric Hospitalists and Utilization Management (UM) specialists used the Model for Improvement. The most impactful interventions included identification of 8 diagnoses to admit in IP status and meetings with UM to automate IP conversions for certain diagnoses. Our primary measure was the percentage of patients with IP status at discharge. Our balancing measure was the number of IP denials by payers upheld after appeal. Statistical process control charts were used to analyze the primary measure.
    RESULTS: The mean percentage of pediatric patients with IP status at discharge increased from 18% to 59%. Denials by payers doubled over the study period, but 76% of the denials were reversed by peer-to-peer or written appeal. At this rate, the project could tolerate 4 denials for every additional IP admission.
    CONCLUSION: Our improvement process was associated with a meaningful increase in the percentage of pediatric patients with IP status at discharge without a significant increase in upheld payer denials. Improvement work focused on appropriate bed status of hospitalized patients may be one avenue to improving community hospital sustainability to serve patients closer to their homes.
    DOI:  https://doi.org/10.1542/hpeds.2026-009324
  11. NASN Sch Nurse. 2026 Sep 08. 1942602X261484934
    Harnessing Cloud-Based Technology to Train School Nurses: A Type 1 Diabetes Exemplar.
    Carly Tribbia, Mallory Bejster, TaShunda Green, Jenny Kasal, Maureen Murphy Rabbitte, Heide Cygan.
      In the United States, more than 40% of children and adolescents live with a chronic health condition, behavioral health need, or a specific learning disability that impacts their daily experience in the school setting. Among these conditions, type 1 diabetes (T1D) is one of the most prevalent chronic health conditions among youth. School nurses are essential in promoting student health and academic success by ensuring students have the support and resources needed to remain healthy and ready to learn. This exemplar describes an online back-to-school training for school nurses utilizing the school district's Google Workspace platform, providing school nurses with five evidence-based practice (EBP) resources and a recorded training on T1D management in a self-paced, online format. With the evolving landscape of technology, school districts should ascertain how to harness available technology in their district to create accessible and sustainable EBP resources and training materials for school nurses.
    Keywords:  chronic disease management; cloud-based; diabetes education; diabetes management; evidence-based practice; nurse education; online training; professional development; school nursing; students with type 1 diabetes; urban school district; youth with type 1 diabetes
    DOI:  https://doi.org/10.1177/1942602X261484934
  12. Hum Vaccin Immunother. 2026 Dec;22(1): 2720966
    Parents' and caregivers' views on pediatric meningococcal disease and serogroup B vaccination.
    Oscar Herrera-Restrepo, Vasudha Gupta, Sophie Jacobovitz, Tosin Olaiya, Elise Kuylen, Karam Dahyaleh, Lynn Kwock, Thatiana Pinto, Sofia B Pinto, Suzanne Staebler.
      In the United States (US), the highest incidence of invasive meningococcal disease (IMD) is among infants aged ≤ 1 year (y). While most IMD cases in US infants are caused by meningococcal serogroup B (MenB), there is no MenB vaccine approved or recommended for US children < 10 y. This study sought to understand general attitudes toward vaccination, knowledge of IMD, and MenB vaccine preferences among parents/caregivers of children ≤ 18 months. An online survey was conducted in November-December 2024 among US parents/caregivers of children ≤ 18 months. Survey responses were analyzed descriptively. Overall, 1,051 parents/caregivers participated in the study. Most parents'/caregivers' children had received all age-appropriate immunizations (73.4%). Of the 266 respondents (25.3%) whose children had received some or no immunizations, 59.8% reported concerns regarding potential vaccine side effects. Most parents/caregivers were familiar with IMD, but knowledge gaps exist regarding its risk and presentation in infants. Two-thirds of parents/caregivers (66.3%) would accept a MenB vaccine for their child if it were included in the Centers for Disease Control and Prevention immunization schedule as optional and recommended by a healthcare provider (HCP); acceptance increased to 72.1% following receipt of IMD information. Perceived barriers to uptake of a potential MenB vaccine focused on HCP-driven communication and guidance. Most US parents/caregivers understood the importance of vaccination and indicated acceptance of a potential MenB vaccine for their child ≤ 18 months. This study highlights the critical role of HCPs in addressing concerns and knowledge gaps to promote IMD prevention in US children ≤ 18 months.
    Keywords:  MenB; Vaccination/immunization; attitudes; children ≤18 months; infant; infectious diseases; knowledge; parent/caregiver; serogroup B
    DOI:  https://doi.org/10.1080/21645515.2026.2720966
  13. Pediatrics. 2026 Sep 10. pii: e2026076233. [Epub ahead of print]
    Clinicians' Experiences With Law Enforcement in a Pediatric Emergency Department.
    Anna H Abrams, Carly Ritger, James A Feinstein, Marian E Betz, Lalit Bajaj, Brooke Dorsey.
      
    BACKGROUND AND OBJECTIVES: Law enforcement officers (LEOs) are frequently present in emergency departments, where their roles may include accompanying patients, investigating injuries, or responding to safety concerns. Existing research on LEO presence in health care has focused on adult populations, with limited attention to pediatric settings. Pediatric emergency departments (PEDs) represent a distinct clinical environment in which developmental vulnerability, caregiver involvement, and legal considerations related to minors may shape interactions. Despite these differences, little is known about how LEO presence is experienced in pediatric care or how it may influence clinical interactions and care delivery. The objective of this study is to explore how PED clinicians and staff perceive and navigate interactions with LEOs during clinical care.
    METHODS: We sampled physicians, nurses, and bedside staff at a level 1 pediatric trauma center for 60-minute semistructured qualitative interviews virtually and in person. Interviews were audio recorded, professionally transcribed, and coded and analyzed using qualitative content analysis.
    RESULTS: Across 27 interviews (13 physicians, 11 nurses, 3 bedside staff) conducted April to August of 2024, 4 themes emerged: respectful collaboration supports effective encounters; communication breakdowns and role ambiguity undermine collaboration; concern that LEO presence could weaken patient trust and psychological safety; and gaps in policy and training leave clinicians unprepared. Across themes, clinicians emphasized developmental vulnerability, caregiver involvement, and ethical tensions unique to pediatric care.
    CONCLUSIONS: PED clinicians and staff described challenging interactions with LEOs involving communication, role clarity, and patient trust. Pediatric-specific dynamics, particularly patient vulnerability and caregiver involvement, were prominent. Participants also identified potential strategies to improve these interactions.
    DOI:  https://doi.org/10.1542/peds.2026-076233
  14. J Hosp Med. 2026 Sep 11.
    Variation in treatment and clinical outcome of rhabdomyolysis in children's hospitals.
    Darya Falamarzi, Matt Hall, Grace Tsaloff, Katie Peterson, Meghan Lemmen, David C Synhorst.
       BACKGROUND: Data in the last decade demonstrate an increase in pediatric hospitalizations for primary rhabdomyolysis. In 2020, the American Academy of Pediatrics released a general review article for the treatment of rhabdomyolysis, but it lacks standardization of care.
    OBJECTIVES: Our study aimed to describe the hospital-level variation in treatment of primary rhabdomyolysis and to determine how resource utilization relates to clinical outcomes.
    METHODS: This was a retrospective cross-sectional study from the Pediatric Health Information System database of patients aged 0-18 years with the primary discharge diagnosis of rhabdomyolysis admitted between January 2020 and December 2023.
    RESULTS: A total of 3779 cases across 36 children's hospitals met inclusion criteria. Fluids were received by a median of 86.4% across hospitals. A variety of intravenous (IV) fluids were used, with the most common being sodium chloride by a median of (67.1%), followed by dextrose and sodium chloride (45.1%), dextrose and sodium chloride with potassium chloride (14.2%), and dextrose in water (10.4%). Acetaminophen was the most used analgesic (47.8%), followed by nonsteroidal anti-inflammatory drugs (26.9%), and opioids (11.3%). Use of imaging studies was observed in all 36 hospitals and occurred in 31.1%; (interquartile range [IQR]: 26%-35.7%). When adjusted, there was no statistical difference in length of stay (LOS) (55.7 h), or emergency department return rate (1.5%) between the high, medium, and lower utilizer groups. There was a statistically significant decrease in the 7-day readmission rate in the medium compared with the high utilizer group (odds ratio [OR]: 0.57, 95% confidence interval [CI]: 0.33-0.96).
    CONCLUSIONS: There was wide variation across hospitals in all aspects of treatment for children hospitalized with rhabdomyolysis.
    DOI:  https://doi.org/10.1002/jhm.70467
  15. AJR Am J Roentgenol. 2026 Sep 09.
    Pediatric Artificial Intelligence in Radiology: Unmet Needs and Next Steps-AJR Expert Panel Review.
    Mario Sinti-Ycochea, Marla B K Sammer, Susan Sotardi, Jeannie K Kwon, Gary R Schooler, Andy Tsai, Hansel Otero.
      Artificial intelligence (AI) applications have transformed radiology, yet pediatric medical imaging remains substantially underrepresented in AI development, validation, regulation, and implementation. Unlike adults, children go through continuous physiologic and anatomic changes that require age-specific models trained on representative developmental data. However, pediatric AI is limited by scarce publicly available datasets, fragmented institutional data, rare diseases, heterogeneous reporting practices, and insufficient external validation. Ethical and regulatory challenges are also a concern in children, including consent for secondary data use, off-label use of adult-trained AI models, and the need for postdeployment surveillance. Additionally, reimbursement is misaligned and must be optimized to allow innovation. This AJR Expert Panel Narrative Review examines the current landscape of pediatric AI in radiology and proposes practical priorities to support its safe and equitable adoption. The panel gives key recommendations, emphasizing the importance of an implementation roadmap to establish a dedicated pediatric AI infrastructure and standards that are essential to ensure diagnostic accuracy, workflow efficiency, and optimal clinical outcomes for children while minimizing bias and protecting patient safety.
    DOI:  https://doi.org/10.2214/AJR.26.35523
  16. Clin Pediatr (Phila). 2026 Sep 07. 99228261481708
    Triaging Benign Paroxysmal Movements in Infants and Young Children.
    Matthew Chase Lustig.
      
    Keywords:  breath-holding spells; infantile gratification; paroxysmal nonepileptic events; pediatric emergency medicine; pediatric primary care; seizure mimics; shuddering attacks
    DOI:  https://doi.org/10.1177/00099228261481708
  17. Pediatr Clin North Am. 2026 Oct;pii: S0031-3955(26)00078-7. [Epub ahead of print]73(5): 1091-1116
    Latin American Children of the US Immigration Crisis: The Essential Roles that All Pediatric Health Care Professionals Must Play.
    Janine Young, Marsha Rae Griffin, Jose Ignacio Santos, Bruce Lesley, Eric A Russell, Fernando Sanchez Mendoza.
      Over 26% of US children live in immigrant families. Current immigration policy has disrupted children's access to health care and social/educational services that negatively affect their wellbeing. This article provides an overview of US immigration policy and examples of immigrant advocacy efforts including clinical advocacy-assuring that medical providers are taught evidence-based immigrant health care and that children receive this care; grass roots advocacy-working with border shelters and forming national networks of pediatric providers to link children to health care; and legal/policy advocacy-forming cross-border US/Mexican collaborative governance to provide binationally accepted health insurance and legal documentation.
    Keywords:  Advocacy; Deportation; Immigrant children; Latin America; Legal status; Pediatric health care; Unaccompanied immigrant children; Undocumented
    DOI:  https://doi.org/10.1016/j.pcl.2026.05.009
  18. Eur J Pediatr. 2026 Sep 10. pii: 735. [Epub ahead of print]185(10):
    POCUS for the general pediatrician: a narrative review of practical applications, policy, and training.
    Bogdana S Zoica, Manimaran Jayamurthy, Adam Briki, Neekash Agari, Dusan Raffaj, Patrick Davies, Maria Sellars, Avishay Sarfatti, Matteo Di Nardo, Tijana Radovic, David Garbera, Michael J Griksaitis.
      Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable bedside imaging modality in pediatric medicine, enabling rapid real-time patient assessment and procedural guidance. While its use is well established in pediatric emergency and critical care settings, its role in general pediatric practice is expanding. This narrative review summarizes the practical applications of POCUS relevant to general pediatricians, focusing on lung imaging, focused functional cardiac assessment, ultrasound-guided vascular access, and the image governance required for safe implementation. A narrative review of contemporary pediatric literature and relevant consensus guidance was undertaken, focusing on evidence applicable to general pediatric practice, including diagnostic performance, procedural utility, education, and governance. Evidence supports the use of POCUS in general pediatrics as a means to improve diagnostic confidence and procedural outcomes. Lung ultrasound demonstrates high diagnostic accuracy for common pediatric respiratory conditions, including consolidation and pleural effusion, and may reduce reliance on chest radiography. Focused cardiac ultrasound provides actionable insights into fluid responsiveness and ventricular function at the bedside, facilitating timely decision-making and early identification of cardiogenic shock. Ultrasound-guided vascular access improves cannulation success rates and reduces complication risks, especially in children with difficult access. Despite these benefits, the adoption of POCUS in general pediatrics remains uneven across Europe, primarily due to variability in training standards, credentialing processes, and institutional support.
    CONCLUSION: POCUS has the potential to enhance bedside pediatric assessment by improving diagnostic confidence, procedural safety, and responsiveness to clinical change. Safe and equitable integration into general pediatric practice will require structured training, clear governance, routine image archiving, and a coordinated approach to competency and implementation.
    WHAT IS KNOWN: • POCUS supports bedside assessment and procedural success in pediatric emergency and critical care. • Lung, focused cardiac and ultrasound-guided vascular access may also benefit general pediatric practice.
    WHAT IS NEW: • This review defines a pragmatic core POCUS scope for general pediatricians. • It links that scope to image governance and an author-proposed tiered competency framework for European implementation.
    Keywords:  Cardiac US; Lung US; POCUS; Pediatrics; Vascular access
    DOI:  https://doi.org/10.1007/s00431-026-07384-6
  19. Hosp Pediatr. 2026 Sep 07. pii: e2026009363. [Epub ahead of print]
    Infrastructure, Barriers, and Strategies for Pediatric Immunization Delivery in Hospital Settings.
    Vishal V Naik, Amanda L Adler, Danielle M Zerr, Doneen West, Douglas J Opel, Larry K Kociolek, Annika M Hofstetter.
      
    DOI:  https://doi.org/10.1542/hpeds.2026-009363
  20. Crit Rev Clin Lab Sci. 2026 Sep 05. 1-11
    Continuous glucose monitoring devices in hospitalized pediatric patients.
    Isaiah K Mensah, Christopher W Farnsworth.
      Continuous glucose monitoring (CGM) has revolutionized the landscape of diabetes management both in adults and pediatrics. CGM devices are now standard-of-care for pediatric diabetes management and are increasingly used in hospitalized patients. In the outpatient setting, studies show increasing analytical and clinical performance of CGM devices with improved diabetes outcomes. However, there are several inpatient factors that impact the accuracy of CGM devices relevant to hospitalized patients. The pediatric population is also the most vulnerable, and changes in management based on a false CGM reading can cause adverse events. Therefore, it is imperative to critically assess the accuracy and clinical performance of CGM devices in hospitalized pediatric patients. In this review, we assess the literature and summarize recent studies on the accuracy of CGM devices in pediatric inpatients, discuss regulatory requirements for their use, safety considerations, and procedures for confirmatory testing using standard-of-care glucose tests.
    Keywords:  CGM; glucose; pediatrics
    DOI:  https://doi.org/10.1080/10408363.2026.2722682
  21. World J Crit Care Med. 2026 Sep 09. 15(3): 122427
    Discordance between early mobility protocol expectations and nurse-led mobilizations of critically ill children: A quality improvement initiative.
    Divya Manikandan, Hallie Lenker, Colleen Mennie, Stephanie Morgenstern, Sukaina Furniturewala, Lisa Hwang, Krista Hajnik, Kristen M Brown, Nicole Shilkofski, Sapna R Kudchadkar, Jessica M LaRosa.
       BACKGROUND: Early mobility in the pediatric intensive care unit (PICU) is safe and associated with improved cognitive and functional outcomes while reducing complications and hospital length of stay. Protocolized early mobility programs guide activity based on physiologic criteria and increase mobilization rates. However, critically ill children remain under-mobilized. Nurses, key agents of mobility implementation, continue to report barriers even when protocols are in place, yet the extent to which these barriers contribute to deviations from early mobility protocols remains unknown.
    AIM: To evaluate discrepancies between nurse-reported mobility, electronic health record documentation, and early mobility protocol expectations in the PICU.
    METHODS: We conducted an observational study evaluating nursing-led mobility in 101 patients admitted ≥ 3 days to a large, academic PICU. Key variables included physiologic mobility level (1 = most restrictive to 3 = most liberal), the highest level of mobility (HLM) achieved, and the number of mobilizations. Data were obtained from the electronic health record, end-of-shift nurse interview [registered nurse report (RN-report)], and compared with protocol-expected mobility using Cohen's Kappa. Firth penalized logistic regression assessed age, pediatric risk of mortality score, and pediatric cerebral performance category as predictors of discordance.
    RESULTS: Agreement between protocol-expected and RN-reported mobility level was moderate (53.5%; κ = 0.32) and agreement between protocol-expected and RN-reported HLM was poor (40.6%; κ = 0.20). In univariate analysis, mechanical ventilation [odds ratio (OR) = 0.34, 95% confidence interval (CI): 0.19-0.97, P = 0.016], vascular access lines (OR = 0.43, 95%CI: 0.13-0.69, P = 0.043), and sedation > 30 minutes (OR = 0.30, 95%CI: 0.13-0.69, P = 0.005) were associated with reduced odds of HLM discordance. Conversely, severe disability at baseline was associated with higher odds of having a discordant mobility level (OR = 8.33, 95%CI: 2.50-27.76, P = 0.001), and a discordant HLM (OR = 3.71, 95%CI: 1.15-12.01, P = 0.029), even after adjusting for age and illness severity.
    CONCLUSION: In a longstanding PICU mobility program, discordance exists between protocol-expected and RN-reported mobility. Severe baseline disability increases this discordance, highlighting the need to evaluate the fidelity of early mobility programs.
    Keywords:  Documentation; Early mobility; Nursing-led mobility; Pediatric critical care; Post intensive care syndrome; Rehabilitation; Sedation
    DOI:  https://doi.org/10.5492/wjccm.122427
  22. J Emerg Nurs. 2026 Sep 09. pii: S0099-1767(26)00281-3. [Epub ahead of print]
    Describing Pediatric Emergency Department Nurse Staffing Models and Unit Characteristics in Pediatric Hospitals in the United States.
    Denise Downey, Shannon Engstrand, Debra Lajoie, Jean Anne Connor.
       INTRODUCTION: Hospitals across the United States experience critical nursing shortages and high turnover across all nursing roles. High nurse vacancy rates present ongoing challenges for emergency departments and may negatively affect patient care. Detrimental effects include overcrowding, longer waiting times, and delayed or missed nursing care. Amid a national nursing crisis, little is known regarding the staffing strategies employed by pediatric emergency departments. The purpose of this study was to provide a foundational description of the current staffing models and unit characteristics of pediatric emergency departments in the United States.
    METHODS: Nurse leaders were invited to participate in a 2-phase study using a descriptive qualitative inquiry and a cross-sectional survey methodology. Phase 1 included private, semistructured interviews via Zoom. The themes discovered during Phase 1 informed the development of Phase 2, an electronic survey distributed via email. Descriptive statistics and content analyses were used to summarize the results.
    RESULTS: Nurse leaders from 4 pediatric emergency departments participated in Phase 1 interviews. Three recurring themes regarding staffing challenges emerged: staffing nonemergency nurses to fill vacancies, retaining experienced nurses, and boarding patients that impeded patient flow. Nurse leaders from 9 pediatric emergency departments completed the Phase 2 electronic survey, describing their nursing and unit characteristics and available resources. Results indicated that most hospitals determined staffing decisions using census predictions and highlighted variability in nursing and unit characteristics across institutions.
    DISCUSSION: A foundational description of the nursing and unit characteristics of pediatric emergency departments demonstrates variation among institutions. Consensus regarding staffing models, resource standardization, and recruitment and retention strategies for experienced nurses requires continued investigation.
    Keywords:  Emergency department nursing; Job satisfaction; Pediatrics; Personnel staffing; Workload
    DOI:  https://doi.org/10.1016/j.jen.2026.07.021
  23. J Child Orthop. 2026 Sep 03. 18632521261485657
    Acute, chronic, and non-fracture-related compartment syndrome in children. A current concepts review.
    Francesco Candusso, Sara De Salvo, Camilla Cabrioli, Loris James Bari, Roberto Facchi, Emanuela Lanari, Marco Natale, Federico Canavese.
       Background: Pediatric acute compartment syndrome (PACS) is a rare limb-threatening emergency. Diagnosis is complicated by pediatric developmental physiology and communication barriers. Although traumatic fractures are the primary cause, non-fracture etiologies present unique diagnostic challenges. This review summarizes the latest evidence on the changing epidemiology, pathophysiology and diagnostic approaches to acute, chronic, and non-fracture compartment syndromes in children.
    Methods: A comprehensive literature search was conducted across the PubMed/MEDLINE, Embase, and the Cochrane Library databases. The review included English-language, peer-reviewed articles published between January 1966 and May 2026, utilizing Medical Subject Headings and keywords such as "compartment syndrome," "pediatric," "children," and "fasciotomy".
    Results: The diagnostic approach to PACS has shifted from the unreliable "5 Ps" at late stages to the early "3 As": increased anxiety, agitation, and analgesic requirements. Children naturally have higher baseline compartment pressures than adults, so pediatric-specific interpretations of pressure monitoring are required. While fracture-related PACS generally has an excellent prognosis if recognised and treated promptly, non-fracture acute compartment syndrome frequently suffers from critical diagnostic delays, leading to high rates of myonecrosis. The definitive standard of care remains an emergent decompressive fasciotomy. However, pediatric tissue demonstrates robust regenerative capacity, enabling conservative initial muscle debridement and achieving high success rates with delayed primary wound closure.
    Conclusions: Although pediatric patients have remarkable healing potential, even following delayed surgical interventions, early recognition is essential to preventing permanent disability. The ability to safeguard limbs depends entirely on clinician's ability to prioritize the behavioral "3 As" over late-stage neurovascular changes.
    Keywords:  Volkmann’s contracture; children; compartment syndrome; fasciotomy; intracompartimental pressure; pediatric
    DOI:  https://doi.org/10.1177/18632521261485657
  24. Res Pract Thromb Haemost. 2026 Aug;10(6): 106892
    Pediatric venous thromboembolism: an illustrated review.
    Maria G Espanol, Maissaa Janbain.
      Venous thromboembolism (VTE) in children has historically been considered uncommon; however, it is increasingly recognized in hospitalized pediatric populations, and its incidence has risen over the past few decades. This can be attributed to several factors, including greater awareness of the condition, improved survival rates for children with chronic and complex medical conditions, increased use of supportive care (such as central venous catheters), and advancements in diagnostic imaging. Acquired conditions, such as infections, malignancies, cardiovascular diseases, and inflammatory bowel disease, are recognized as risk factors for VTE. Among these, the presence of a central venous catheter remains the most significant and common risk factor for pediatric VTE. In this review, we present and illustrate the pathophysiology and current treatment options for VTE in the pediatric population.
    Keywords:  anticoagulation; deep vein thrombosis; pediatric thrombosis; pulmonary embolism; thromboprophylaxis; venous thromboemnolism
    DOI:  https://doi.org/10.1016/j.rpth.2026.106892
  25. JAMIA Open. 2026 Oct;9(5): ooag126
    Using electronic health record audit logs to identify pediatric intensive care unit teams.
    Liem M Nguyen, Stefanie S Sebok-Syer, Dane Jacobson, Karley Mariano, John Grunyk, Shelby Burk, Yasaman Nourkhalaj, Kimberley Kirk, Jochen Profit, Christian Rose, A Jay Holmgren, Thomas Kannampallil, Daniel Tawfik.
       Background: Teamwork influences patient outcomes, but electronic health records (EHRs) do not reliably capture patient care team members, limiting its study. EHR audit logs provide insights into healthcare workers' workflows and may help identify patients' care team members.
    Objective: To develop, validate, and compare algorithms utilizing EHR audit logs to identify patient-centric primary teams (bedside nurse, frontline clinician, and attending physician) in pediatric intensive care units (ICUs).
    Methods: We observed rounds for 1931 patient days (development = 678; validation = 1253) across pediatric (PICU), neonatal (NICU) and cardiovascular (CVICU) ICUs at a quaternary children's hospital and documented each patient's daytime care team. We developed 2 algorithms that leveraged EHR audit logs to identify team members: (1) clinically informed heuristics, and (2) a Longitudinal Contribution Score (LCS). Accuracy was computed for each role and algorithm. 95% confidence intervals (CIs) and algorithm comparisons (bootstrap P values) were computed via patient-day bootstrap resampling.
    Results: In the development cohort (PICU), the LCS demonstrated greater accuracy than the heuristics for all roles: nurse (LCS 92.9% [95% CI, 90.9-94.8]; heuristic 67.6% [64.0-71.1]), frontline (83.3% [80.5-86.1]; 77.9% [74.6-81.0]), and attending (66.5% [62.7-70.2]; 61.9% [58.3-65.6]); all P < .005. In the validation cohort (PICU, NICU, and CVICU), only the nurse advantage was statistically replicated (LCS 91.2% [89.5-92.8], heuristic 74.2% [71.7-76.4]; P < .001); with frontline (83.0% [80.9-85.1], 81.2% [79.1-83.4]; P = .110) and attending (69.0 [66.5-71.6] vs 70.0% [67.4-72.4]; P = .326) roles showing comparable accuracy.
    Conclusion: EHR audit log data can accurately identify patients' bedside nurses in pediatric ICUs. For frontline clinicians and attending physicians whose clinical coproduction and interdependence blurs individual EHR signals, identification is less accurate and supplementary data sources may be needed. Both algorithms provide a scalable foundation for team dynamics research, although the LCS offering greater generalizability than predefined heuristics.
    Keywords:  electronic health records; medical informatics; patient care team; pediatrics; validation study
    DOI:  https://doi.org/10.1093/jamiaopen/ooag126
  26. Front Health Serv. 2026 ;6 1918667
    Nurses' knowledge and attitudes toward pediatric pain assessment and management: a scoping systematic review from 2015 to 2025.
    Haytham Al-Oran, Yousef Rubbai.
       Introduction: Nurses play an essential role in providing care to patients, and having the necessary skills, knowledge, and attitudes for effective pain assessment and treatment is crucial for ensuring best patient outcomes. The purpose of this paper is to review recent research about current nurses' knowledge and attitude toward pediatric pain assessment and management in pediatric settings.
    Method: The methodological approach taken in this paper is a scoping review using Arksey and O'Malley's five-step framework (2005). Databases including EBSCO host, PubMed, CINAHL, Springer, Cochrane, Science Direct, Ovid, and Google Scholar were searched to collect full-text articles available in English between 2015 and 2026. 20 out of 235 full-text papers met the inclusion criteria in the current scoping review.
    Results: The synthesis of the results of the 20 included research studies revealed that nurses worldwide had poor knowledge and attitudes concerning pediatric pain assessment and management. Various tools were utilized to assess nurses' knowledge and attitudes. The majority of research adopted the use of true/false or multiple-choice questions, as well as Likert scales with acceptable validity and reliability. The most extensively utilized tool was the Knowledge and Attitudes Survey Regarding Pain.
    Conclusion: This review's findings imply that pain education programs should be refined to enhance nurses' knowledge and attitudes toward pediatric pain assessment and management. Studies in the future should focus on recognizing individual and environmental features that influence nurses' level of knowledge and attitudes to improve the development of educational programs and the quality of care provided.
    Keywords:  attitude; children; knowledge; nursing; pain assessment; pain management
    DOI:  https://doi.org/10.3389/frhs.2026.1918667
  27. Arch Dis Child. 2026 Sep 11. pii: archdischild-2026-331272. [Epub ahead of print]
    Evolving landscape of paediatric sepsis: progress, gaps and the next generation of tools.
    Pamela Jump Salcedo, Daniel R Owens.
      Paediatric sepsis remains a major cause of childhood mortality worldwide, despite substantial changes in its epidemiology, definitions and management over the past two decades. Progress has come from sharper criteria centred on organ dysfunction, prevention through vaccination and more nuanced bedside management. The Phoenix Sepsis Criteria have moved paediatric sepsis away from inflammation-based definitions towards life-threatening organ dysfunction, while conjugate vaccine programmes have reshaped the population of children presenting with invasive bacterial infection. Contemporary guidance also increasingly stratifies treatment by severity, reflecting a shift away from uniform bundles applied to all.Important gaps remain. Many paediatric sepsis deaths still occur within the first 24 hours of referral to intensive care, suggesting that outcomes are often determined before paediatric intensive care unit admission. Early recognition remains difficult: screening tools perform imperfectly in unselected febrile children, biomarkers remain adjuncts, and clinicians still rely on gestalt and parental concern. Sepsis is also heterogeneous, spanning children with different pathogens, host factors and immune responses.Future progress is likely to depend on risk stratification rather than universal screening. Machine learning may make early recognition more reproducible, while phenotype-informed approaches may support trials targeted to biologically meaningful subgroups. Both require prospective validation before routine use.
    Keywords:  Child Health; Paediatric Emergency Medicine; Sepsis
    DOI:  https://doi.org/10.1136/archdischild-2026-331272
  28. J Hosp Med. 2026 Sep 10.
    Variation in blood culture testing in children hospitalized with three common infections.
    Smit Shah, Jennifer L Goldman, Matt Hall, John R Stephens, Jillian M Cotter, Samantha A House, Matthew J Molloy, Michelle Polich, Michael J Steiner, Michael J Tchou, Ronald J Teufel, Irma T Ugalde, Andrew G Yu, Jessica L Markham.
       BACKGROUND: Routine blood culture (BCx) testing in uncomplicated community-acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) has demonstrated low clinical utility.
    OBJECTIVES: To evaluate hospital-level BCx testing trends and their association with clinical outcomes for children hospitalized with CAP, SSTI, and UTI.
    METHODS: This retrospective cohort study used the Pediatric Health Information System database to identify hospitalizations of children aged 3 months-18 years with CAP, SSTI, and UTI from 2016 to 2024. We excluded patients with complicated infections, complex chronic conditions, intensive care unit admission, or length of stay (LOS) > 7 days. Hospital-level BCx testing rates were calculated by infection type, and annual trends were examined. Hospitals were grouped into low, moderate, and high BCx testing groups. Outcomes including LOS, costs, readmissions, and emergency department revisits were compared across hospital groups, adjusting for infection type, age, and illness severity.
    RESULTS: Among 133,783 encounters across 37 hospitals, BCxs were obtained in 42% hospitalizations for CAP, 46% for SSTI, and 56% for UTI hospitalizations with substantial hospital-level variation (e.g., 14%-77% for CAP). Over time, four hospitals showed significant increases, eight showed decreases, and 25 showed no change in annual BCx testing. No clinically significant differences in outcomes were observed across low (n = 15), moderate (n = 14), or high (n = 8) hospital testing groups.
    CONCLUSIONS: BCx testing remains frequent for CAP, SSTI, and UTI with a minority of hospitals demonstrating testing reductions over time. The frequency of BCx testing and lack of significant differences in outcomes suggests opportunities for diagnostic stewardship.
    DOI:  https://doi.org/10.1002/jhm.70470
  29. Pediatr Qual Saf. 2026 Sep-Oct;11(5):11(5): e927
    Quality Improvement Partnership to Improve Human Papillomavirus Vaccine Rates: Start at Age 9 Campaign.
    Lauren E Ng, Jessica P Fenton, Linda Mermelstein, Lori Ellis, Randi Trope.
       Introduction: Human papillomavirus (HPV) infections and HPV-related cancers are preventable with vaccination. Initiating the HPV vaccine series at ages 9-10 years is associated with improved vaccination uptake and series completion. This quality improvement (QI) initiative aimed to increase first-dose HPV vaccination rates among 9- to 10-year-olds through the implementation of evidence-based interventions.
    Methods: Data were collected from electronic health records (EHRs) of established patients aged 9-10 years with at least 1 documented well-child visit annually from 2021 to 2024. Baseline data were obtained from January 2021 through May 2022. Interventions included provider education, adoption of a system-wide "Start at 9" policy, patient-facing educational materials, and EHR modifications to integrate HPV vaccine orders for patients aged 9 years and older. Monthly vaccination trends were evaluated using a P-chart.
    Results: A total of 9315 patients aged 9-10 years were included. The percentage of eligible patients receiving their first HPV vaccine increased from a baseline of 2% to 14% following the adoption of the "Start at 9" policy in conjunction with targeted educational interventions and EHR integration. A P-chart demonstrating special cause variation aligned with 2 QI interventions, indicating a sustained process shift. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination rates, used as balancing measures, remained stable throughout the study period.
    Conclusions: A coordinated, systems-level QI approach was associated with significant gains in early HPV vaccine initiation, supporting initiation of vaccination at age 9 years as an effective strategy to promote timely vaccination and strengthen preventive health outcomes.
    DOI:  https://doi.org/10.1097/pq9.0000000000000927
  30. Eur J Pediatr. 2026 Sep 07. pii: 723. [Epub ahead of print]185(9):
    Ibuprofen versus acetaminophen for acute mild-to-moderate pain management in pediatric populations: a systematic review and meta-analysis of their efficacy.
    Gian Luigi Marseglia, Paola Giovanna Marchisio, Gregorio Paolo Milani, Michele Miraglia Del Giudice, Irene Schiavetti, Giorgio Ciprandi.
      Ibuprofen and acetaminophen are the most widely used analgesics in pediatric practice for the management of acute mild-to-moderate pain. Despite their widespread use, the comparative analgesic efficacy of these two agents in children remains a subject of ongoing debate, with existing evidence largely derived from heterogeneous clinical settings and small individual trials. Therefore, this study aimed to systematically review and meta-analyze randomized controlled trials comparing the analgesic efficacy of ibuprofen versus acetaminophen in pediatric populations with acute mild-to-moderate pain. A systematic literature search was conducted up to May 2026 in PubMed, Scopus, and Web of Science. The review was conducted and reported in accordance with the PRISMA-Children and Adolescents (PRISMA-C) 2026 reporting guideline. Eligible studies were randomized controlled trials comparing ibuprofen with acetaminophen in children and adolescents (defined as individuals aged 0 to < 18 years) with acute pain, reporting at least one extractable efficacy outcome. Continuous outcomes were synthesized as standardized mean differences (Hedges' g) using random-effects models; dichotomous outcomes were pooled as risk ratios (RRs) with 95% confidence intervals. Risk of bias was assessed using the Cochrane RoB 2 tool and certainty of evidence was evaluated using the GRADE framework. Eight randomized controlled trials enrolling 1325 participants were included. Three pediatric trials contributed to the primary continuous pain outcome meta-analysis (n = 196 analyzable participants), yielding a pooled SMD of - 0.28 (95% CI - 0.57 to 0.00; p = 0.052; I2 = 0%), indicating a small effect favoring ibuprofen that did not reach conventional statistical significance. Given the small number of contributing studies (k = 3), the I2 statistic should be interpreted with caution as it has limited power to detect heterogeneity in this context. For the dichotomous pain freedom outcome (2 trials, n = 114), no significant difference was observed (pooled RR 1.03, 95% CI 0.53-1.99; p = 0.93; I2 = 0%). A prespecified sensitivity analysis including an adult soft-tissue injury trial attenuated the pooled effect toward the null (SMD - 0.15, 95% CI - 0.38 to 0.09; p = 0.23; I2 = 36.6%). Narrative synthesis of additional studies generally demonstrated comparable analgesic efficacy between the two agents across postoperative and outpatient pediatric settings. The overall certainty of evidence was rated as low for both primary outcomes, primarily due to imprecision and indirectness.
    CONCLUSION: Current evidence from randomized controlled trials does not demonstrate a superiority of ibuprofen over acetaminophen for acute mild-to-moderate pain management in children. Both agents appear to provide clinically meaningful analgesia across heterogeneous pediatric pain settings. The clinical choice between agents should be guided by individual patient factors, including contraindications to NSAIDs, the inflammatory nature of the pain etiology, and patient-specific characteristics. The low certainty of evidence underscores the need for adequately powered, methodologically rigorous trials to definitively establish the comparative efficacy of these two analgesics in the pediatric population.
    WHAT IS KNOWN: • Ibuprofen and acetaminophen are the two most widely used non-opioid analgesics for acute mild-to-moderate pain in children, and both are recommended as first-line agents by major international guidelines. • Prior meta-analyses in mixed pediatric-adult populations have suggested a modest analgesic advantage of ibuprofen over acetaminophen, but pediatric-specific evidence has remained limited and methodologically heterogeneous.
    WHAT IS NEW: • This systematic review and meta-analysis, restricted to randomized controlled trials in pediatric populations, found that ibuprofen showed a small effect favoring pain reduction compared with acetaminophen (SMD - 0.28, p = 0.052), although this did not reach conventional statistical significance. • The analgesic advantage of ibuprofen may be more pronounced in pain etiologies with a significant inflammatory component (e.g., fractures). At the same time, both agents appear broadly equivalent in most other acute pediatric pain settings, supporting individualized analgesic selection based on clinical context and patient-specific factors.
    Keywords:  Acetaminophen; Acute pain; Ibuprofen; Meta-analysis; Paracetamol; Pediatrics; Randomized controlled trial; Systematic review
    DOI:  https://doi.org/10.1007/s00431-026-07383-7
  31. J Intensive Care Med. 2026 Sep 08. 8850666261484866
    Early Mobilization in Critically Ill Patients with Cancer: A Scoping Review.
    Amanda Wheeler, Michaela Avallone, Christina A Watkins, Steven H Hsu.
      BackgroundCritically ill patients with active malignancy increasingly survive intensive care unit admissions but remain at risk of profound deconditioning and functional decline. Early mobilization has demonstrated benefits in general intensive care unit populations; however, oncology-specific evidence remains limited.ObjectiveTo map and synthesize the available evidence on early mobilization interventions in adult and pediatric oncology ICU patients, focusing on feasibility, safety, functional outcomes, quality of life, length of stay, and mortality.MethodFollowing PRISMA-ScR guidelines, a scoping review was conducted using PubMed, CINAHL Ultimate, OTseeker, and ProQuest Dissertations & Theses. Studies published between 2010 and 2025 were eligible if they included adult or pediatric intensive care patients with active malignancy who received early mobilization interventions during ICU admission.ResultsEight studies met inclusion criteria. Early mobilization was consistently reported as feasible and safe, with no serious mobilization related adverse events. Most studies described improvements in functional participation or mobility, although outcome measures were heterogeneous and frequently descriptive. Evidence regarding length of stay, quality of life, and mortality was limited and inconsistent. The literature was derived predominantly from adult oncology intensive care unit populations, with limited pediatric data, which focused primarily on feasibility and process-related outcomes.ConclusionEarly mobilization appears to be a feasible and safe practice in oncology ICU settings and is commonly reported alongside improvements in functional participation. However, evidence supporting benefits in length of stay, quality of life, or survival remains limited, highlighting the need for higher-quality comparative studies.
    Keywords:  ICU; early mobilization; oncology; rehabilitation
    DOI:  https://doi.org/10.1177/08850666261484866
  32. Childs Nerv Syst. 2026 09 07. pii: 354. [Epub ahead of print]42(1):
    Same-day discharge after pediatric neurosurgical procedures: a single-institution experience.
    Kishore Balasubramanian, Holden Husbands, Giancarlo Mignucci, Beste Gulsuna, Andrew Jea.
       BACKGROUND AND OBJECTIVES: Same-day discharge (SDD) after neurosurgical procedures in children remains underexplored. To our knowledge, this represents one of the first modern North American single-institution series to include SDD after major pediatric spinal instrumentation and procedures performed on children of elevated anesthetic risk.
    METHODS: A retrospective review of all neurosurgical procedures performed at an academic, tertiary referral center was conducted. Patients were identified as those who underwent surgery and were discharged on the same calendar day (length of stay [LOS] = 0 days). Patient demographics, procedural details, operative times, ASA classification, intraoperative complications, postoperative outcomes, and symptom status at follow-up were recorded.
    RESULTS: Of 976 neurosurgical encounters, 87 (8.9%) had a 0-day LOS, of which 75 were in patients younger than 18 years. Sixteen encounters in 16 unique pediatric patients met all inclusion criteria and were analyzed. Median age at surgery was 14.7 years (interquartile range [IQR] 7.1-16.1; range 0.1-17.4), with equal distribution by sex (8 males, 8 females). Procedures were classified as major in 14 encounters (87.5%) and minor in 2 (12.5%). Median operative time was 103 min (IQR 65-111; range 43-188). There were no intraoperative complications (0%), no surgical site infections (0%), no 7-day reoperations (0%), and no operative failures at first follow-up imaging (0%). No patient was readmitted within 30 days (0%), and 2 (12.5%) returned to the emergency department within 30 days, both managed without admission. At follow-up, symptoms were stable or improved in 14 of 16 encounters (87.5%). Fifteen patients were discharged on the operative calendar day; 1 was observed overnight and discharged the following morning.
    CONCLUSIONS: In this small, heterogeneous retrospective series, a diverse range of pediatric neurosurgical procedures, including major spinal and intracranial operations, were managed with SDD without serious complications. These preliminary observations are hypothesis-generating; careful patient selection remains paramount, and larger prospective studies are needed before broader adoption.
    Keywords:  Cost containment; Length of stay; Outpatient surgery; Pediatric neurosurgery; Same-day discharge
    DOI:  https://doi.org/10.1007/s00381-026-07450-2
  33. J Prim Care Community Health. 2026 Jan-Dec;17:17 21501319261470023
    Strengthening Health System-Community Partnerships to Address Pediatric Social Needs: A Qualitative Study.
    Joy Friedman, Melissa A Alderfer, Kelsey Higgins, Aaron Carpenter, Jennifer Sciolla, Sarah E Wawrzynski.
      IntroductionStructural and social conditions influence pediatric health outcomes. Successful implementation of social needs screening and referral programs depends on community-based organizations (CBOs) to provide resources that address health-related social needs (HRSN). We explored current practices and perspectives of health care workers and CBO representatives on improving health system-CBO partnerships.MethodsParticipants were purposively recruited from a variety of health care settings involved in HRSN screening and CBOs delivering resources in the community. Participants completed semi-structured interviews. Qualitative thematic analysis was used to summarize data.ResultsTen key informants participated (six health care workers and four CBO representatives). Four themes were identified: 1) mismatches in demand, resources and eligibility challenge the provision of resources, 2) financial limitations threaten sustainability and need for vetting resources, 3) fostering relationships as a key facilitator in screening and resource delivery, and 4) barriers hamper follow-through and tracking referral outcomes. Recommendations for fostering partnership were also summarized.ConclusionsParticipants described systemic challenges in addressing HRSN. They recommended cultivating relationships between pediatric health systems and CBO partners who understand and advocate for their communities' needs and agendas. Shared goals include improving efficiency and cross-sector communication, defining and measuring outcomes, and demonstrating return on investment for non-medical interventions to enhance sustainability to programming addressing HRSN.
    Keywords:  community-based organizations; pediatrics; screening; social determinants of health
    DOI:  https://doi.org/10.1177/21501319261470023
  34. Resusc Plus. 2026 Sep;31 101454
    Practice variability of epinephrine administration in pediatric out-of-hospital cardiac arrest in the United States.
    Chelsea B Kadish, Christopher B Gage, Jonathan R Powell, Alexander J Ulintz, Henry E Wang, Christopher E Gaw, Gregory Muller, Ashish R Panchal.
       Background: Pediatric out-of-hospital cardiac arrests (pOHCA) are low frequency, high acuity events for Emergency Medical Services (EMS). The survival rate is low, with only 10% of children surviving, and few survivors having favorable neurologic outcomes. Optimal prehospital management of pOHCA includes rapid epinephrine administration, yet factors contributing to its administration are not well understood.
    Objective: Our study objective was to evaluate the frequency of epinephrine administration in pOHCA. Our secondary objective was to characterize the demographic and clinical characteristics associated with epinephrine administration in pediatric OHCA in the United States.
    Methods: In this retrospective, observational study, we analyzed data from the National Emergency Medical Services Information System (NEMSIS) dataset for the year 2021. We identified pediatric patients ages ≥1 day-old to <18 years-old from "9-1-1" activations that were treated by advanced life support (ALS) clinicians. OHCA events were identified by performance of cardiopulmonary resuscitation (CPR) or defibrillation. We used descriptive statistics to evaluate the frequency of epinephrine administration and assess demographic and clinical characteristics in this population. Multivariable logistic regression model was utilized to find characteristics associated with epinephrine administration.
    Results: In 2021, 8495 pOHCA events (median [IQR] age: 3.0 [0.3-13.0] years; 58.5% males) were managed by an ALS unit in the United States. Two out of every five (40.2%) pOHCA events did not receive epinephrine. Epinephrine use was more common in younger age groups (1 day-1 year OR, 1.25 [95% CI, 1.07-1.46]; 1-5 years OR, 1.19 [95% CI, 1.00-1.38]; 6-12 years OR, 1.59 [95% CI, 1.24-1.79]; referent: 13-17 years), urban population settings (OR, 2.06 [95% CI: 1.79-2.38]), incidents with scene time >10 min (OR, 1.41, [95% CI, 1.25-1.60]), advanced airway attempt(OR 8.33, [95% CI, 7.33-9.47]), and in those receiving defibrillation (OR 1.95, [95% CI, 1.61-2.37]). Odds of epinephrine administration were lower in public settings (OR 0.55, [95% CI, 0.47-0.65]) and in females (OR 0.83, [95% CI, 0.73-0.93]).
    Conclusion: Epinephrine is not given in 2 of every 5 pOHCA events. Longer scene time and additional resuscitation interventions were associated with epinephrine administration. The low rate of administration has implications for further research and reforms in the prehospital care of critically ill children.
    Keywords:  Emergency medical services; Epinephrine; Out-of-hospital cardiac arrest; Pediatrics; Prehospital
    DOI:  https://doi.org/10.1016/j.resplu.2026.101454
  35. Pediatr Qual Saf. 2026 Sep-Oct;11(5):11(5): e913
    Improving Guideline-concordant Antibiotic Use for Acute Otitis Media in a Pediatric Primary Care Network.
    Sarah Sweeney, Anna Simon, Laura Morano, Jason Chang, Kari Goebel, Kenisha Campbell, Sheryl A Morelli, Matthew P Kronman.
       Introduction: Maintenance of Certification (MOC) projects have previously been shown to improve diagnostic accuracy and infection treatment in inpatient settings.
    Methods: We developed and delivered an MOC project in our ambulatory care network in 2023 to increase the use of American Academy of Pediatrics guideline-concordant antibiotic selection and duration for the treatment of acute otitis media (AOM), including amoxicillin for most patients, and the use of shorter (5-7 d) antibiotic durations in children over 2 years with nonsevere symptoms. We evaluated the use of guideline-concordant antibiotics across the network from January 2021 to September 2025, including periods before, during, and after the MOC intervention. We compared the use of guideline-concordant antibiotics between clinics that participated in the MOC intervention and those that did not.
    Results: The study period included 40,329 AOM episodes. By the end of the study period, 64.7% of children with AOM across the network received guideline-concordant antibiotic selection and duration, up from 46.6% at baseline. After the intervention, MOC-participating clinics had increased use of guideline-concordant antibiotic selection and duration compared to nonparticipating clinics (70.1% versus 54.5%). The frequency of patients returning within 7 days for a repeat AOM visit did not differ between the baseline period (124/12,735; 1.0%) and the postintervention period (303/27,594; 1.1%) (P = 0.3).
    Conclusions: An MOC program was effective in increasing guideline-concordant antibiotic prescriptions for pediatric AOM across an outpatient network. This effect persisted over time and was stronger in MOC-participating clinics. MOC participation has the potential to improve antibiotic stewardship in ambulatory settings.
    DOI:  https://doi.org/10.1097/pq9.0000000000000913
  36. Transl Pediatr. 2026 Aug 31. 15(8): 296
    Influenza vaccination in children with underlying conditions: affirming effectiveness and confronting gaps.
    Kimberley H Geissler, Elizabeth Peacock-Chambers.
      
    Keywords:  Influenza; asthma; pediatric; vaccine effectiveness (VE); vaccine hesitancy
    DOI:  https://doi.org/10.21037/tp-2026-0545
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