bims-cliped 2026-10-04 papers

bims-cliped

Biomed News

on Clinical pediatrics

Issue of 2026–10–04
twenty-six papers selected by
Alyssa M. Portwood, Akron’s Children

Agitation Care Practices at US Children's Hospitals in a Multicenter Research Collaborative.
Enhancing Patient Throughput Through Front-end Redesign and Alternate Care Space Implementation in a Pediatric Emergency Department: A Quality Improvement Initiative.
Improving the Timeliness of Test Result Management After Hospital Discharge.
Predictors of Nurse Practitioners' Adherence to Menstrual Cycle-Related Practice Recommendations in Pediatric Primary Care.
Disparities in Reporting of Violent Events by Patients at a US Children's Hospital.
Outpatient interventions addressing the social determinants of health for children and their families: a scoping review.
The Pediatric Opioid Overdose and Addiction Crisis.
Truth, Reconciliation, and Transformation: Another Step Forward.
Pediatric Trauma Centers Are Associated With a Lower Frequency of Operative Intervention for Isolated Mandible Fractures: A National Analysis.
Examining Race-Based Puberty Information on Children's Hospital Websites.
Recommendations for the Development and Implementation of Generative Artificial Intelligence Tools in Pediatric Clinical Care: Policy Statement.
Increasing Interpreter Use for Pediatric Cardiology Units: A Quality Improvement Initiative.
Pediatric Institutions' Instagram Response to the 2025 Acetaminophen-Autism Controversy.
A Quality Improvement Project: Providing Music Therapy for Premature Infants in the Neonatal Intensive Care Unit.
Risk Factors for Undertriage of Children Presenting to a Pediatric Emergency Department With Abdominal Pain.
"At Some Point, You Have to Cut the Cord": Physician Perceptions of NICU-to-PICU Transfers.
Clinical Practice Guideline for the Diagnosis and Treatment of Urinary Tract Infection in Children From 8 Days to 5 Years of Age.
What Parents Need to Know About AI as a New Kind of Listener.
Post Intensive Care Syndrome in Pediatrics-What the General Pediatrician Needs to Know About Life After Critical Illness.
Improving Access to Transplant: A Quality Improvement Initiative to Reduce Time From Outpatient Dialysis Initiation to Deceased Donor Kidney Transplant Activation.
Youth and Parent Perspectives on Patient-Centered Outcomes for a Pediatric Hospital-Based Violence Intervention Program.
Selection of central venous access devices for neonates: an expert review.
A Systematic Review and Meta-Analysis of the Prevention and Management of Pediatric Urinary Tract Infection and Suspected Urinary Tract Infection: Technical Report.
Clearer Vision, Brighter Futures: Addressing Unmet Pediatric Eye Care Needs Through School-Based Vision Programs.
Assessing Pain in Children: A Narrative Review of Distraction-Based Interventions and Outcome Measurement Tools.
Diagnostic contribution of anaerobic bottles in pediatric blood cultures: experience at a tertiary children's hospital.

Hosp Pediatr. 2026 Sep 28. pii: e2026009703. [Epub ahead of print]

Agitation Care Practices at US Children's Hospitals in a Multicenter Research Collaborative.

Evan M Dalton, Jennifer A Hoffmann, Matt Hall, Sofia Chaudhary, Anna Cushing, Adrienne DePorre, Cori Grant, Meghan J Fennell, Alexandria G Georgadarellis, Ankita T Gupta, Holly R Hanson, Bijan Ketabchi, Divya Mirchandani, Paul C Mullan, Katherine A Nash, Andrew W Osten, Nicole Penwill, Raymond Pitetti, Samantha Severson, Gunjian Tiyyagura, Neil G Uspal, Wendi Wendt, Melissa Wood-Katz, Stephanie K Doupnik, Ashley A Foster.

DOI: https://doi.org/10.1542/hpeds.2026-009703
Pediatr Qual Saf. 2026 Sep-Oct;11(5):11(5): e923

Enhancing Patient Throughput Through Front-end Redesign and Alternate Care Space Implementation in a Pediatric Emergency Department: A Quality Improvement Initiative.

Cortney C Braund, Bernadette K Johnson, Shaela Moen, Sandra Spencer, Travis Justilian, Suzanne Sternberg, Kristin Vickrey, Matthew Cerchie, Candise Dunham, Nidhya Navanandan.

Introduction: Emergency department (ED) crowding remains a persistent national challenge, contributing to delays in care, increased length of stay (LOS), and higher rates of patients leaving without being seen (LWBS). Front-end strategies improve throughput and reduce LWBS by enabling earlier assessment and disposition. Building on prior efforts, this quality improvement initiative aimed to enhance patient flow for low-acuity pediatric patients by leveraging alternative care spaces to reduce roomed-to-disposition time, LOS, and LWBS while preserving capacity for higher acuity care.
Methods: This initiative occurred in a high-volume pediatric ED using a front-end, physician-driven "Intake" model. To improve efficiency and throughput, the team introduced an alternate care space. Additional interventions included role clarification, workflow standardization, and targeted education for physicians and staff to reduce roomed-to-disposition time for Intake patients by 10% within 4 months.
Results: Roomed-to-disposition time for all Intake patients decreased by 15% (from 88 to 75 min), whereas a specific group of low-intervention patients experienced a 49% reduction. LOS for all Intake patients decreased by 30%, and by 48% for low-intervention patients (from 286 to 148 min). Additional improvements included a 49% reduction in LWBS and a 37% decrease in arrival-to-provider time.
Conclusions: Our quality improvement initiative demonstrated that a thoughtful reorganization of existing ED Intake processes, without additional staffing or physical expansion, can meaningfully improve patient throughput, provider efficiency, and overall ED performance.

DOI: https://doi.org/10.1097/pq9.0000000000000923
Hosp Pediatr. 2026 Sep 28. pii: e2026009339. [Epub ahead of print]

Improving the Timeliness of Test Result Management After Hospital Discharge.

Meenu Krishnasamy, Rhiya Sharma, Lydia Nashed, Khoa Luong, Courtney Port.

BACKGROUND: Failure to follow up on test results pending at discharge (TPAD) is a well-documented patient safety issue, affecting 20% to 61% of hospitalized patients. At our institution, TPAD management practices varied, and no standardized process existed.
OBJECTIVE: To increase the percentage of TPAD managed within 36 hours of resulting for patients discharged by the pediatric hospital medicine (PHM) service from 53% to 95% in 3 months and sustain improvement over 9 additional months.
METHODS: We used the Model for Improvement methodology. All TPAD for PHM patients were routed to a shared electronic health record in-basket. We delegated daily result management to the admitting physician, with defined timing expectations and backup coverage. TPAD were categorized into 4 groups based on result type, urgency, and impact on care to help standardize management. Newly created documentation templates, instructional guides, and written agreements with subspecialists supported workflow implementation. Project measures were analyzed using statistical process control charts and differences between groups using appropriate statistical testing.
RESULTS: Of 5912 TPAD (1307 baseline; 4605 postintervention), results managed within 36 hours increased from a mean of 53% to 96%. Mean time to manage TPAD decreased from 195.4 hours to 11.6 hours. No disparities in timely result management were observed by race, ethnicity, language, or insurance. Per self-report, physicians spent an average of 10 minutes per shift on result management. Postintervention surveys showed high clarity, physician wellness, and high satisfaction.
CONCLUSIONS: This workflow successfully improved TPAD management, with high physician satisfaction. Next steps include improving documentation, quarterly audits, and involving trainees.

DOI: https://doi.org/10.1542/hpeds.2026-009339
J Adolesc Health. 2026 Sep 30. pii: S1054-139X(26)00342-3. [Epub ahead of print]

Predictors of Nurse Practitioners' Adherence to Menstrual Cycle-Related Practice Recommendations in Pediatric Primary Care.

Kristen L Sinay, Alexandra A García, Cara C Young, Marni Sommer, Karen Johnson.

   PURPOSE: The menstrual cycle is an important but often neglected indicator of the overall health of menstruating adolescents. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) offer menstrual cycle-related practice recommendations for providers caring for this population. About a quarter of primary care in the United States is provided by nurse practitioners (NPs); yet, factors influencing their adherence to these practice recommendations remain underexamined. We explored factors that predicted NPs' reported adherence to ACOG/AAP menstrual cycle-related recommendations when providing primary care to children and adolescents.
METHODS: A national cross-sectional sample of U.S. NPs was recruited for an online survey. We used hierarchical multiple linear regression to assess the ability of sociodemographic characteristics, knowledge, attitudes, subjective norms, and external barriers to predict practice adherence.
RESULTS: NPs from all 50 states (N = 886) participated (Mage = 46 years; 92% female; 80% White, non-Hispanic; 71% family NPs). Holding significant sociodemographic characteristics constant, NPs' attitudes, subjective norms, and external barriers collectively predicted nearly 40% of the variation in their reported adherence to the menstrual cycle-related recommendations of ACOG/AAP. NPs' attitudes had the most explanatory power for practice adherence.
DISCUSSION: Although NPs in this sample reported that they often adhered to ACOG/AAP menstrual cycle-related recommendations, strengthening NPs' positive attitudes and organizational norms may increase adherence to menstrual cycle-related recommendations. Stronger, more consistent messaging about best practices from professional societies and within NP curricula may improve NPs' attention to and support for adolescents' menstrual and overall health.

Keywords:  Adolescent; Child; Menstrual cycle; Nurse practitioners; Pediatrics; Primary health care

DOI:  https://doi.org/10.1016/j.jadohealth.2026.07.028
Hosp Pediatr. 2026 Sep 28. pii: e2026009351. [Epub ahead of print]

Disparities in Reporting of Violent Events by Patients at a US Children's Hospital.

Adrienne G DePorre, Emily Cramer, Shelby Chesbro, Christopher J Russell, Alec M Bernstein, Mallory Netz, Cy Nadler.

BACKGROUND: Violence toward health care workers is increasing, yet patient risk factors for having a reported violent event (VE) are unknown. Understanding patient risk factors associated with reported VEs is needed to inform equitable approaches to VE reporting and guide resource delivery.
OBJECTIVE: To identify patient and hospitalization characteristics associated with reported VEs at a US children's hospital.
METHODS: This case-control retrospective study included children aged 5 to 18 that were hospitalized between January 1, 2019 and December 31, 2023 at a 390-bed children's hospital. We identified reported VEs by querying a form in our electronic health record form, which documents violent behaviors by patients. Odds of a reported VE occurrence were modeled as a function of patient and hospitalization characteristics using a multivariable logistic regression model.
RESULTS: Among 28 052 youth with 43 991 hospitalizations, 199 youth (0.7%) and 242 hospitalizations (0.6%) had a reported VE. Higher rates of restraint use were observed among children with reported VEs (37.6%) compared with those without reported VEs (0.3%). Age, race, and mental or behavioral health (MBH) diagnosis were associated with adjusted odds of reported VEs. After controlling for other covariates, Black children were at increased adjusted odds ratio (aOR) of reported VEs (aOR 3.64; 95% CI, 2.51-5.27) compared with white children. Many MBH conditions were significantly associated with increased aORs for VEs, with disruptive, impulse control, and conduct disorders (aOR 6.25; 95% CI, 4.17-9.36) conveying the highest risk. We saw similar patterns of disparities when analyzing just those children with an MBH diagnosis.
CONCLUSION: Racial disparities in VE reporting highlight the need for applying an equity lens as institutions evaluate and improve reporting practices.

DOI: https://doi.org/10.1542/hpeds.2026-009351
Acad Pediatr. 2026 Sep 30. pii: S1876-2859(26)00262-7. [Epub ahead of print] 103480

Outpatient interventions addressing the social determinants of health for children and their families: a scoping review.

Justine Cohen-Silver, Iryna Artyukh, Giulia Puinean, Kimberly M Walker, Jose M Navarro, Elizabeth M Wooster, Andrew D Pinto.

   BACKGROUND: The social and economic environments in which children grow shape their immediate and long-term health. Many families navigate fragmented health and social care services, leaving critical needs unmet. Integrating social care within outpatient healthcare settings may improve continuity of care.
OBJECTIVES: This scoping review summarizes the evidence on outpatient social care interventions for children ages 0-13 and/or their families, focusing on support for at least one social determinant of health (SDOH), including housing, transportation, and food insecurity, low income, unemployment, education, early literacy, and social isolation.
DATA SOURCES AND ELIGIBILITY CRITERIA: We searched eight databases through July 2025, including Medline, Embase, and CINAHL. Eligible studies examined outpatient interventions addressing at least one SDOH and were published in English from 2013 onward.
SYNTHESIS METHODS: Dual screening and data extraction were performed, and findings were synthesized narratively.
RESULTS: 38 studies were included. Most were quantitative, non-randomized, conducted in the US, and based in pediatric clinics or federally qualified health centers. Interventions were organized using three models of health and social care integration: community partnerships (n=29), screening and intervening (n=21), and co-localization (n=9). Benefits included improved home literacy environments and parent-child interactions; higher program enrollment and adherence to well-visits and vaccinations; and better detection of social needs using universal screening.
LIMITATIONS: Evidence was mostly US-based and limited to children 13 years or younger, restricting generalizability.
CONCLUSIONS AND IMPLICATIONS: Outpatient social care interventions show promise in strengthening outcomes for children and families. Integrating multiple models may help bridge gaps across systems.

Keywords:  Children and families; Integrated care; Outpatient healthcare; Social care interventions; Social determinants of health

DOI:  https://doi.org/10.1016/j.acap.2026.103480
Pediatr Rev. 2026 Oct 01. 47(10): 568-580

The Pediatric Opioid Overdose and Addiction Crisis.

Adam Kronish, Scott E Hadland, Jessica B Calihan.

Adolescent and young adult (hereafter, "youth") experimentation with pills and powders is increasingly risky due to an unpredictable and hazardous drug supply characterized by fentanyl contamination. Youth opioid overdose deaths have more than doubled since 2019, and overdose is now the third leading cause of death among US children and adolescents. Pediatricians have an opportunity to improve outcomes for youth who use opioids by addressing risk factors for problematic opioid use, recognizing early use, providing evidence-based treatment, educating on strategies to reduce harm and overdose, and engaging family and communities to support recovery and well-being. Yet pediatricians with insufficient training and/or experience may feel unprepared to provide this care. This review provides a detailed overview of youth opioid use disorder prevention, screening, diagnosis, and management with an emphasis on pharmacotherapy and behavioral treatments, frameworks to support engagement in care, and emerging strategies to prevent opioid-related harms, including overdose.

DOI: https://doi.org/10.1542/pir.2025-006921
Pediatrics. 2026 Sep 28.

Truth, Reconciliation, and Transformation: Another Step Forward.

Joseph L Wright, Rachel H Kowalsky.

In the aftermath of the murder of George Floyd, the American Academy of Pediatrics (AAP) Board of Directors published a policy statement entitled "Truth, Reconciliation and Transformation: Continuing on the Path to Equity."1 The statement acknowledged historical transgressions and discriminatory actions in consideration of African-American pediatricians Roland B. Scott and Alonso DeGrate Smith for AAP membership. These truths resulted in public apologies to the families of Drs. Scott and DeGrate Smith, and an organizational referendum to amend Article I of the AAP bylaws to explicitly declare anti-discrimination and reconcile the AAP to "embrace equity for all children and families, as well as for the pediatricians who care for them, as central to the mission of the Academy."2 Simultaneous to these governance actions, a pivotal viewpoint article, "The Case for Removing Race from the American Academy of Pediatrics Clinical Practice Guideline for Urinary Tract Infection in Infants and Young Children with Fever," was published and brought to the AAP Board's attention.3 "Urinary Tract Infection: Clinical Practice Guideline (CPG) for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months," which was originally published in 2011 and reaffirmed in 2016,4 was noted in the viewpoint to inappropriately position the social construct of race as a clinical characteristic and to subsequently use race assignment as a dichotomizing variable to direct the clinical course of care, i.e., whether or not to obtain a catheterized urine specimen. This algorithmic approach stood to discriminate based on race and to potentially contribute to outcome disparities disproportionately impacting young Black girls experiencing missed urinary tract infections. The authors of the viewpoint article definitively noted that "race-based or ethnicity-based assessments about biologic vulnerabilities to disease can reify disproven concepts, which, when positioned within clinical guidelines, may contribute to implicit bias and structural racism." The AAP Board responsively acknowledged the need for systematic transformation in the organization's development of equitable clinical guidance and retired the CPG.5,6 The challenge at the time, however, was that there was not a definitive corrective action plan or policy platform from which to move forward. Building upon recommendations published in a 2022 policy statement, "Eliminating Race-Based Medicine,"7 the last four years have seen evidence-informed interrogation and incremental progress toward achieving equity in the development of pediatric clinical guidance.8,9.

DOI: https://doi.org/10.1542/peds.2026-078945
J Oral Maxillofac Surg. 2026 Sep 13. pii: S0278-2391(26)00918-3. [Epub ahead of print]

Pediatric Trauma Centers Are Associated With a Lower Frequency of Operative Intervention for Isolated Mandible Fractures: A National Analysis.

Lang Liang, Tim T Wang, Nicholas Wilken, Zachary S Peacock, Gary Warburton, John Caccamese, Cameron Lee.

BACKGROUND: Management of pediatric mandibular fractures varies across institutions and remains a subject of ongoing clinical debate. However, it remains unclear if treatment at a pediatric designated trauma center influences management.
PURPOSE: The purpose was to measure the association between pediatric trauma center designation and operative intervention for isolated mandibular fractures.
STUDY DESIGN, SETTING, SAMPLE: This retrospective cohort study used the American College of Surgeons National Trauma Data Bank, 2018 to 2023. Patients ≤16 years old with an isolated mandible fracture were included. Patients with multiple traumatic injuries and/or missing data were excluded.
PREDICTOR VARIABLE: The primary predictor was designation as a pediatric trauma center (yes/no).
MAIN OUTCOME VARIABLE: The primary outcome was operative intervention (yes/no). Operative intervention included open reduction internal fixation or closed reduction.
COVARIATES: Covariates were categorized as demographic (age, sex), injury-related (injury severity score), and hospital-level variables (teaching status, bed size).
ANALYSES: Descriptive, bivariate, and multivariable regression statistics were computed to measure the association between pediatric trauma center designation and operative intervention. An alpha threshold of P < .05 was considered statistically significant.
RESULTS: The cohort included 3,689 subjects with a mean age of 11.2 ± 4.6 years (70.4% male, n = 2,596). Within this cohort, 1,919 (52.0%) presented to a pediatric trauma center. A total of 2,123 subjects (57.5%) underwent operative intervention. In the bivariate analysis, treatment at a pediatric trauma center was associated with a lower frequency of operative intervention (relative risk 0.89; 95% CI 0.84 to 0.94, P < .001). After adjusting for study covariates, treatment at a pediatric trauma center remained associated with lower odds of operative intervention (odds ratio 0.86; 95% CI, 0.74 to 0.99, P = .04). Inbound interfacility transfer was also associated with nonoperative management (odds ratio 0.52; 95% CI, 0.45 to 0.60, P < .001). Treatment modality was generally consistent across centers, though pediatric centers utilized open reduction internal fixation more frequently in the youngest cohort (0 to 5 years, 72.7 vs 55.6%, P = .02).
CONCLUSION AND RELEVANCE: Patients presenting to pediatric trauma centers have lower odds of operative intervention for isolated mandibular fractures. In addition, transferred patients were less likely to undergo surgery, supporting further investigation of alternative triage and consultation pathways.

DOI: https://doi.org/10.1016/j.joms.2026.08.022
Acad Pediatr. 2026 Oct 01. pii: S1876-2859(26)00264-0. [Epub ahead of print] 103482

Examining Race-Based Puberty Information on Children's Hospital Websites.

Adeiyewunmi Ade Osinubi, J Reed Junkin, Sophia Austin, C Paula Lewis-de Los Angeles, Lisa Swartz Topor.

   BACKGROUND: In 2022, the American Academy of Pediatrics called for dismantling race-based medicine due to its harmful impact on patient care and education. Despite this, race-based guidance regarding pubertal timing persists in the literature and patient resources. Given the role of pediatric hospital websites as sources of information for families and as data for Artificial Intelligence, we examined the presence of race-based guidance on pubertal timing in girls across U.S. pediatric hospital websites.
METHODS: Pediatric hospitals in the United States were identified, and each website was queried using the terms "puberty" and "precocious puberty." Information provided on pubertal timing in girls was recorded, along with any inclusion of race-based guidance. Descriptive statistics and qualitative analysis of pediatric hospital puberty information were performed. An analysis of variance (ANOVA) test compared the prevalence of race-based information across seven U.S. regions.
RESULTS: Of 285 pediatric hospitals in the United States, 85 (29.8%) had patient-facing content on puberty, and 16 (18.8%) included race-based information. Half (8, 50%) of the pediatric hospitals that included race-based pubertal information included race as a "risk factor" for precocious puberty. Regional differences in the frequency of race-based pubertal information for patients on the hospital websites were not statistically significant (p=0.069).
CONCLUSION: This study demonstrates the ongoing presence of race-based information about puberty on pediatric hospital websites. Updating the patient-facing websites of pediatric hospital to avoid race-based pubertal guidance may foster a more inclusive and equitable environment for patients and their families.

Keywords:  medical education; precocious puberty; puberty

DOI:  https://doi.org/10.1016/j.acap.2026.103482
Pediatrics. 2026 Oct 03. pii: e2026079037. [Epub ahead of print]

Recommendations for the Development and Implementation of Generative Artificial Intelligence Tools in Pediatric Clinical Care: Policy Statement.

Council on Clinical Information Technology

The integration of generative artificial intelligence (GenAI) into pediatric health care offers exciting opportunities alongside critical challenges. GenAI tools, like large language models (LLMs), show promise in several health care applications, including but not limited to clinical decision support, documentation, and medical education across a wide range of pediatric subspecialties. However, real-world validation remains limited, and concerns persist around accuracy, bias, reliability, sustainability, and durability. Studies indicate that LLMs, when applied to pediatrics, often underperform compared with adult medical specialties, raising questions about their readiness for use in the care of children and adolescents. Moreover, the risk of exacerbating health disparities among patients of various races, ethnicities, genders, languages, abilities, and socioeconomic statuses because of biased or nonrepresentative training data underscores the need for rigorous oversight and accountability. This policy outlines recommendations for the safe, equitable, and effective use of GenAI in pediatric settings. Developers should prioritize diverse pediatric data sets, proactively address bias, and implement strong data privacy and security safeguards. Health care institutions must establish rigorous validation protocols, ensure compliance with privacy regulations, and maintain clear human oversight. Relevant regulatory and oversight bodies should enforce pediatric-specific evaluations and require postmarket surveillance. Governance frameworks must support interdisciplinary collaboration, transparency, and education initiatives to equip pediatricians with GenAI literacy. Reasonable disclosure of GenAI involvement in patient care is essential to establish and strengthen trust. GenAI policies pertaining to the care of children and adolescents must remain adaptive to ensure ethical, equitable, and evidence-based implementation. Despite these numerous challenges, GenAI holds transformative potential to improve pediatric health outcomes, and this policy seeks to empower developers, researchers, and clinicians to responsibly build and harness this technology.

DOI: https://doi.org/10.1542/peds.2026-079037
Pediatr Qual Saf. 2026 Sep-Oct;11(5):11(5): e933

Increasing Interpreter Use for Pediatric Cardiology Units: A Quality Improvement Initiative.

Dulce Maria E Ovalle Sanchez, Jennifer Gauntt, Ronna Porterfield, Robert J Gajarski.

Introduction: Effective communication between healthcare teams, patients, and families is critical to achieving high-quality care. Despite US regulations requiring language services, interpreters remain underutilized, and there is no standardized approach to communication in hospital settings. This quality improvement project aimed to increase interpreter use for families who speak a language other than English (LOE) from 94 to 122 occurrences/100 LOE-patient-days, the average interpreter interaction time/patient/month from 10 to 13 minutes, and the average interpreter use percentage during emergencies from 29% to 44% by December 31, 2025, in the acute care cardiology and cardiothoracic settings.
Methods: Baseline data from January 2022 to August 2024 were evaluated, and implemented interventions focused on 3 categories: increased interpreter accessibility, interpreter-use education, and the creation of translated documents. The number of interpreter occurrences and average interpreter minutes/patient/month, indexed to LOE-patient-days, were tracked monthly using statistical process control charts. A statistical process control p-chart was used to track the number of patients for whom an interpreter was used during emergencies as a function of total LOE patients who experienced an emergency with parents present.
Results: Interpreter use increased from 94 to 212 occurrences/100 LOE-patient-days whereas the average interpreter minutes/patient/month increased from 10 to 23 minutes following the interventions. The percentage of interpreter use during emergencies increased from 29% to 91%. Process and balancing measures tracked intervention utilization and unintended consequences.
Conclusions: Interventions that directly increased interpreter use helped standardize care for families who spoke an LOE, thereby enhancing healthcare communication, literacy, and family engagement.

DOI: https://doi.org/10.1097/pq9.0000000000000933
Hosp Pediatr. 2026 Oct 02.

Pediatric Institutions' Instagram Response to the 2025 Acetaminophen-Autism Controversy.

Katherine Poole, Jessica Visone, Shivani Srivastava, Kathryn Whitehill.

ABSTRACT: Objective: To describe the timing, frequency, and accessibility of Instagram posts from pediatric health institutions during the 2025 acetaminophen-autism controversy.Methods: Cross-sectional audit of public Instagram accounts of 62 pediatric health institutions from September 22 to November 15, 2025. The a priori sampling frame comprised the top 50 US children's hospitals for pediatric behavioral health, the top 10 Honor Roll children's hospitals (US News and World Report), 5 national medical societies, and health departments of the 10 states with the largest pediatric populations. Posts were extracted with a web-scraping tool and manually verified. Two reviewers independently coded relevant posts for prespecified content and accessibility features. Readability was assessed with two validated measures.Results: Twelve of 62 institutions (19%) posted relevant content. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists posted on day 0, while hospital time to first post ranged from 3 to 51 days. No state health department posted. Nonresponding institutions remained active: 1 hospital published 108 unrelated posts. The 26 relevant posts had a mean Flesch-Kincaid Grade Level of 11.4 and SMOG Index of 10.2. Among coded features, 88% included resource links, 73% directed audiences to a health care provider, 46% featured a named clinician, 42% discussed risks and benefits, and none were multilingual.Conclusions: Most sampled institutions published no relevant content during an active health controversy despite remaining active. Readability of relevant posts exceeded recommended targets, and none were multilingual. These gaps in institutional communication infrastructure could be addressed.

DOI: https://doi.org/10.1542/hpeds.2026-009767
Pediatr Qual Saf. 2025 Nov-Dec;10(6):10(6): e856

A Quality Improvement Project: Providing Music Therapy for Premature Infants in the Neonatal Intensive Care Unit.

Supriya Bisht, Lan Jiang, Melissa Frascone, Ellen Shatzkin, Kristen Buck, Katie R Forman.

Introduction: Preterm infants require adequate positive auditory stimulation for their development. Music therapy (MT) offers several benefits. Recorded music is recommended when live music is unavailable. This quality improvement project aimed to provide recorded MT to preterm infants.
Methods: The team led this quality improvement project in a level IV neonatal intensive care unit from December 2022 to April 2024, with the aim that within 6 months of starting it, 50% of preterm infants born at a gestational age of less than 32 weeks who met physiological stability criteria would receive MT sessions. The Plan-Do-Study-Act model included interventions such as educating neonatal intensive care unit staff and providers about MT, creating memory aids, and streamlining documentation. Recorded Mozart music was played through bedside speakers 3 times a week for 30-minute sessions. The outcome measure tracked the percentage of eligible infants who received MT. Process measures evaluated the percentage of MT sessions provided. Balancing measures included the termination of MT due to clinical instability.
Results: Eighty-seven infants received MT. The mean birth gestational age of the infants was 28.4 weeks. MT was initiated at a mean postmenstrual age of 33.4 weeks and continued until a mean age of 39.1 weeks. The percentage of infants receiving MT increased from 50% in the first month to 100% and stayed at a mean of 94.2%. The number of eligible MT sessions received per infant was 41.9% (average of 6.7 sessions). A total of 76.7% of nurses identified no barriers, and parents reported satisfaction with the MT program.
Conclusions: Recorded MT can be effectively provided. Multidisciplinary teamwork is required to sustain efforts in providing MT sessions.

DOI: https://doi.org/10.1097/pq9.0000000000000856
Pediatr Emerg Care. 2026 Sep 28.

Risk Factors for Undertriage of Children Presenting to a Pediatric Emergency Department With Abdominal Pain.

Sara Sandri, Ethan Gough, Siwei Xie, Joanna S Cohen.

   OBJECTIVES: To identify demographic and clinical risk factors associated with undertriage of pediatric patients presenting to the emergency department with abdominal pain.
METHODS: This retrospective cross-sectional study included pediatric patients who presented to the pediatric ED at an academic urban hospital between January 1, 2023, and December 31, 2023, with a chief complaint of abdominal pain and were triaged as Emergency Severity Index level 4. Undertriage was defined as a triage level 4 assignment followed by hospital admission or use of more than 1 resource category. Demographic and clinical data, including age, sex, race, ethnicity, insurance type, interpreter use, disposition, and resource utilization, were extracted from the electronic health record. Multivariable logistic regression was used to assess the association between interpreter use and undertriage, adjusting for potential confounders.
RESULTS: A total of 603 patients met the inclusion criteria, of which 198 (32.8%) were undertriaged. Undertriage was more likely among patients who required an interpreter and were 13 years or older. Undertriage was less likely among those identifying as Black or Hispanic. Presentations during overnight hours were also associated with lower odds of undertriage. No significant seasonal variation was observed. Among undertriaged patients, most patients underwent both laboratory testing (93.9%) and imaging (80.3%).
CONCLUSIONS: Nearly one-third of pediatric patients with abdominal pain triaged as level 4 were undertriaged. Patients 13 and older were more likely to be undertriaged compared with those aged 1 to 12. Interpreter use was associated with higher odds of undertriage, while Hispanic ethnicity and Black race were associated with lower odds of undertriage. These findings highlight the importance of addressing language-related barriers and other factors that influence equitable triage in the pediatric emergency department.

Keywords:  Emergency Severity Index; abdominal pain; emergency medicine; health disparity; interpreter use; language barriers; limited English proficiency; resource utilization; triage accuracy; undertriage

DOI:  https://doi.org/10.1097/PEC.0000000000003702
Hosp Pediatr. 2026 Sep 28. pii: e2026009518. [Epub ahead of print]

"At Some Point, You Have to Cut the Cord": Physician Perceptions of NICU-to-PICU Transfers.

Phillip D Cohen, Madonna Enwe, Jennifer K Fitzgerald, Sapna R Kudchadkar.

OBJECTIVE: Patients undergoing nonemergent neonatal intensive care unit (NICU) to pediatric ICU (PICU) transfer in the United States have complex medical needs and high relative mortality, but there are no best practices guiding these transfers. This qualitative study was designed to address this gap by characterizing facilitators and barriers to effective NICU-to-PICU transfer among physicians.
PATIENTS AND METHODS: Semistructured individual interviews were conducted with pediatric intensivists and neonatologists purposively sampled from previous national surveys on transfer processes. Interviews were recorded, transcribed, and qualitatively analyzed using an iterative process to elicit themes until thematic saturation was reached.
RESULTS: A total of 21 interviews were conducted among pediatric intensivists (n = 12) and neonatologists (n = 9). Three major themes emerged integral to effective transfer: ICU mutual trust, multidisciplinary presence, and clinician-family partnership. Subthemes of ICU mutual trust were (1) setting patient goals and caregiver expectations and (2) bridging inter-ICU clinical differences, both of which were tied to regular NICU-PICU touchpoints and early communication with families. Tied to the theme of multidisciplinary presence were (3) identifying continuity, in which care overlap was a facilitator and (4) leveraging collective expertise, in which nursing and allied health professionals' knowledge of long-stay patients are a major asset. Clinician-family partnership was linked to subthemes of (5) prioritizing patient needs and (6) addressing culture shock while not overstating the NICU-PICU differences.
CONCLUSIONS: In this qualitative study, pediatric intensivists and neonatologists have collectively identified actionable aspects of nonemergent NICU-to-PICU transfer that, if addressed, may benefit patients, families, and providers.

DOI: https://doi.org/10.1542/hpeds.2026-009518
Pediatrics. 2026 Oct 01. pii: e2026078565. [Epub ahead of print]158(4):

Clinical Practice Guideline for the Diagnosis and Treatment of Urinary Tract Infection in Children From 8 Days to 5 Years of Age.

Brian K Alverson, David S Hains, Stephen M Downs, Rana E El Feghaly, Catherine S Forster, Shabnam Jain, Andrea Johnston, Tej K Mattoo, Caleb P Nelson, Olusoji Olakanpo, Hansel J Otero, Craig A Peters, Nicole M Poppinga, Dipanwita Saha, Alan R Schroeder, Emily Senerth, Lauren Pilcher, Susan K Flinn, Rebecca L Morgan, Reem A Mustafa.

Urinary tract infection (UTI) is one of the most common bacterial infections in infants and young children, with a prevalence of 7% in infants with fever. This clinical practice guideline (CPG) provides an update of the literature and clinical recommendations of the 2011 American Academy of Pediatrics (AAP) CPG on diagnosing and managing UTI in infants and children. It is designed to provide guidance for pediatricians and other pediatric clinicians on the diagnosis and management of UTIs in infants and children 8 days to 5 years of age and is intended for use in children with low medical complexity across a variety of settings. The CPG is accompanied by 3 technical reports to further elucidate the data that guided the development of recommendations and to establish criteria for the diagnosis of UTI. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of the evidence and formulate recommendations and good practice statements, including GRADE evidence-to-decision frameworks, which were reviewed by internal and external contributors. The CPG provides 8 Key Action Statements (2 strong and 6 conditional clinical recommendations, ranging from low to very low certainty of evidence) and 4 Good Practice Statements regarding medical evaluation of suspected UTI, management of UTI specific to antibiotic treatment, and imaging modalities and prevention strategies for structural abnormalities, including vesicoureteral reflux, and bowel and bladder dysfunction evaluation and treatment.

DOI: https://doi.org/10.1542/peds.2026-078565
JAMA Pediatr. 2026 Sep 28.

What Parents Need to Know About AI as a New Kind of Listener.

François Modave, Mona Sayedul Huq, Lindsay A Thompson.

DOI: https://doi.org/10.1001/jamapediatrics.2026.4424
Pediatr Rev. 2026 Oct 01. 47(10): 557-567

Post Intensive Care Syndrome in Pediatrics-What the General Pediatrician Needs to Know About Life After Critical Illness.

Chetna K Pande, Sarah Risen, Jessica M LaRosa, Sapna R Kudchadkar.

As mortality from pediatric critical illness has declined, post intensive care syndrome in pediatrics (PICS-p) has emerged as a framework to describe the broad and often long-lasting morbidities experienced by survivors of pediatric critical illness. PICS-p encompasses new or worsening impairment in physical, cognitive, emotional, and social health that affect both the child and their family. The term PICS-p also acknowledges and reinforces the traumatic impact of the critical care on the child and family dyad. Given the growing population of pediatric survivors of critical illness and the limited availability of newly emerging, specialized post-critical care clinics, it is imperative that general pediatricians, providing the child's medical home, are equipped to diagnose and manage PICS-p in the outpatient setting. In this review, we summarize the prevalence, pathophysiology, clinical course, and impact of PICS-p on children and families. We also review preventive strategies that can be implemented in the PICU and conclude with practical guidance for general pediatricians caring for children after critical illness.

DOI: https://doi.org/10.1542/pir.2024-006723
Pediatr Transplant. 2026 Oct;30(10): e70473

Improving Access to Transplant: A Quality Improvement Initiative to Reduce Time From Outpatient Dialysis Initiation to Deceased Donor Kidney Transplant Activation.

Priyanka Chati, Jessica Whittington, Karissa Braden, Verghese Priya S, Kaitlyn White, Katrina Andracki, Cara McGarry, Stella Kilduff, Ricardo Superina, Mahima Keswani.

BACKGROUND: Pre-emptive kidney transplantation is the preferred treatment in patients with end-stage kidney disease (ESKD); however, many patients must unavoidably initiate dialysis prior to transplantation. Prolonged dialysis exposure is associated with increased morbidity and mortality, mandating prompt transition to transplant when possible. Delays in transplant readiness are unfortunately prevalent and are often driven by fragmented communication, limited education, and system-level barriers.
OBJECTIVE: To reduce time from dialysis initiation to deceased donor kidney transplant (DDKT) activation among pediatric patients through a single-center quality improvement initiative.
METHODS: This quality improvement (QI) project was conducted at a tertiary children's hospital affiliated with a pediatric outpatient dialysis unit. Baseline data from 2023 demonstrated a median dialysis-to-DDKT activation time of 211.5 days. Interventions were implemented in 2024 through three Plan-Do-Study-Act cycles (PDSA): (1) establishment of a multidisciplinary Guidance and Planning clinic for early transplant education; (2) implementation of biweekly transplant-dialysis coordination meetings supported by expanded transplant coordinator staffing; (3) distribution of a bilingual patient education booklet at dialysis initiation. The primary outcome measure was time to DDKT activation. Trends were evaluated using descriptive statistics and a run chart.
RESULTS: In 2024, 10 patients initiated dialysis during the intervention phase. Excluding 2 patients who were activated for transplantation prior to outpatient dialysis initiation, the median time from dialysis initiation to DDKT activation decreased by 38%, from 211.5 days in 2023 to 130.5 days in 2024. Sixty percent of patients initiating dialysis in 2024 underwent transplantation within the same calendar year. Process measures demonstrated successful implementation of interventions.
CONCLUSIONS: Implementation of a structured quality improvement approach was associated with reduced time to transplant activation in pediatric dialysis patients. Improved communication, education, and transplant coordination may represent modifiable factors that may enhance transplant readiness and outcomes.

DOI: https://doi.org/10.1111/petr.70473
Acad Pediatr. 2026 Sep 29. pii: S1876-2859(26)00255-X. [Epub ahead of print] 103473

Youth and Parent Perspectives on Patient-Centered Outcomes for a Pediatric Hospital-Based Violence Intervention Program.

Anthony Oddo, Kevin Rak, Leonardo Barrera, Leslie Helmcamp, Sheila Hickey, Britinia Johnson, Karen Sheehan, Samaa Kemal.

   BACKGROUND: Hospital-based violence intervention programs (HVIPs) aim to interrupt cycles of violence and support recovery among youth exposed to interpersonal violence. However, HVIP evaluations often rely on deficit-oriented outcomes (i.e., reinjury, mortality, criminal justice system involvement) that may not reflect priorities of youth and families.
OBJECTIVE: To determine youth and parent perspectives on patient-centered outcomes, needs, and priorities following violent injury.
METHODS: Focus groups were conducted with youth and parents connected to community-based organizations (CBOs) collaborating with a pediatric HVIP. Focus group participants were engaged as community proxies for HVIP participants given their affiliation with CBOs serving violence-affected communities and their relevant experiences with violence and/or service systems. Focus groups explored definitions of health and success, barriers to healing, and priorities for recovery. Transcripts were analyzed using thematic analysis and consensus-based coding.
RESULTS: Three focus groups were conducted with a total of 17 participants (12 youth, 5 parents). Five major themes emerged: (1) holistic definitions of health and success; (2) emotional communication and processing during recovery following violent injury; (3) systemic and structural barriers to recovery; (4) social circles as key determinants in healing; (5) the role of trust in recovery. Regarding patient-centered outcome priorities, youth emphasized goal-planning, mental health and social needs, while parents highlighted mental health, mentorship, and repeat injury.
CONCLUSIONS: Youth and parents prioritize outcomes that extend beyond traditional HVIP metrics. Incorporating patient-centered outcomes into program evaluation may better capture meaningful recovery and improve trauma-informed design of HVIPs.

Keywords:  Hospital-Based Violence Intervention Programs; Patient-Centered Outcomes; Youth Violence

DOI:  https://doi.org/10.1016/j.acap.2026.103473
Expert Rev Med Devices. 2026 Sep 29.

Selection of central venous access devices for neonates: an expert review.

Sabrina de Souza, Mari Takashima, Deanne August, Tricia M Kleidon, Alina G Bureke, Mary Beth Davis, Henrik Hjelmgren, Pranav Jani, Samantha Keogh, Amanda J Ullman.

   INTRODUCTION: Central venous access devices (CVADs) are essential for managing neonates requiring prolonged intravenous therapy. However, selecting the most appropriate CVAD remains complex due to population heterogeneity and variation in clinical practice, healthcare resources, and models of care.
AREAS COVERED: This expert review synthesizes current evidence and clinical guidance to support neonatal CVAD selection. It examines four major CVAD types - umbilical venous catheters, peripherally inserted central catheters, tunneled CVADs, and non-tunneled CVADs - focusing on their indications, contraindications, dwell times, and complication profiles. Device selection is discussed in relation to neonatal characteristics, therapy requirements, long-term vessel preservation, economic considerations, and healthcare context. This review integrates existing evidence to support individualized, context-informed decision-making across diverse models of care and identifies priorities for future research.
EXPERT OPINION: Optimal CVAD selection is not merely a technical decision but a strategic clinical process that integrates patient, therapy, device, and health-system factors. Existing frameworks provide valuable guidance and should be interpreted within the clinical context in which they are applied, acknowledging differences in expertise, available resources, and models of care. Continued advances in evidence generation, implementation, and neonatal-specific device innovation are essential to improving both immediate and lifelong vascular outcomes.

Keywords:  Central venous catheters; clinical decision-making; infant, newborn; intensive care, neonatal

DOI:  https://doi.org/10.1080/17434440.2026.2741518
Pediatrics. 2026 Oct 01. pii: e2026078568. [Epub ahead of print]158(4):

A Systematic Review and Meta-Analysis of the Prevention and Management of Pediatric Urinary Tract Infection and Suspected Urinary Tract Infection: Technical Report.

Leena AlShenaiber, Emily Senerth, Ifeoluwa Babatunde, Volf Gaby, Jamil Nazzal, Lauren Pilcher, Neha Tangri, Ahmad Sofi-Mahmudi, Alan Schroeder, Reem A Mustafa, Rebecca L Morgan.

BACKGROUND AND OBJECTIVE: Urinary tract infection (UTI) is a common bacterial infection during childhood. This article reports on a technical review investigating the management of UTI to inform the development of an updated clinical practice guideline (CPG) by the American Academy of Pediatrics (AAP).
METHODS: The authors performed 5 systematic reviews comparing different options for: 1) antibiotic duration in children without known anatomic anomalies; 2) antibiotic route in children without known anatomic anomalies; 3) use of continuous antibiotic prophylaxis (CAP) for children with vesicoureteral reflux (VUR); 4) use of CAP for children with bowel and bladder dysfunction (BBD); and 5) timing of evaluation of children with suspected UTI. We performed database searches of Medline via PubMed, Embase, and Cochrane library from January 1, 2008, through August 5, 2023. Eligible studies were published in English and compared management strategies in a population of children with UTI, suspected UTI, acute pyelonephritis, VUR, and/or BBD. Data on study characteristics and patient-important outcomes were extracted from studies and pooled using meta-analysis when appropriate. Risk of bias was assessed using the Prediction model of Risk Of Bias ASsessment Tool, the Risk of Bias in Nonrandomized Studies of Interventions, and version 2 of the Cochrane risk-of-bias tool for randomized trials. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.
RESULTS: Out of 6154 identified records, a total of 60 studies were included. Overall, there was low to very low certainty regarding the effects of any intervention on patient outcomes. These results suggest that a relatively shorter course of antibiotic therapy (7 days or fewer) may not increase the risk of recurrent UTI, although it is likely to reduce the adverse events associated with antibiotic therapy. Additionally, oral antibiotic therapy may be similarly effective to parenteral (or parenteral-to-oral) therapy while avoiding potential harms associated with hospitalization. Rates of breakthrough UTI and renal scarring may be similar among children who receive CAP compared with those who do not, but rates of antibiotic-resistant UTI may increase with administration of CAP. Prompt medical evaluation within 72 hours of symptom onset may be associated with less renal scarring compared with later evaluation and treatment.
CONCLUSION: These results informed the development of the updated AAP CPG on the management of pediatric UTI, including recommendations on the duration of antibiotic therapy, route of antibiotic administration, use of prophylaxis in children with VUR and BBD, and timing of medical evaluation when UTI is suspected. Specific areas of uncertainty identified through this review may be addressed with future research.

DOI: https://doi.org/10.1542/peds.2026-078568
J Sch Health. 2026 Oct;96(10): e70237

Clearer Vision, Brighter Futures: Addressing Unmet Pediatric Eye Care Needs Through School-Based Vision Programs.

YuQing Xu, Xinxing Guo, Megan Collins.

   BACKGROUND: Vision impairment affects approximately 1 in 4 school-aged children in the United States, and yet challenges in connecting to care exist. Poor vision has been linked to diminished academic performance, social development challenges, and poor mental health. School-based vision programs (SBVPs), which typically provide vision screenings, eye exams, and eyeglasses directly in schools, are one promising avenue to improve access to care, especially in underserved communities.
CONTRIBUTIONS TO THEORY: Vision is a foundational component of both health and educational equity, and SBVPs are interventions that address gaps in access to care for disadvantaged populations.
IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: SBVPs would benefit from better integration with school health services and more robust systems to coordinate referrals to eye care providers. States should monitor the impact of SBVPs on access to care. Implementation and expansion of SBVPs should prioritize under-resourced schools and students who face the greatest access barriers.
CONCLUSION: Evidence for the impact of SBVPs in addressing unmet eye care needs among our most vulnerable students is robust. Evidence-based policy, financing, data infrastructure, and community partnerships are needed to embed vision care in school health to advance both health and educational equity.

Keywords:  educational outcomes; health equity; pediatric vision; school‐based vision programs

DOI:  https://doi.org/10.1111/josh.70237
Paediatr Neonatal Pain. 2026 Dec;8(4): e70048

Assessing Pain in Children: A Narrative Review of Distraction-Based Interventions and Outcome Measurement Tools.

Meryem Akay Kuzey.

  Procedural pain and fear are common during pediatric immunizations and other needle-related procedures. This narrative review examined distraction-based, non-pharmacological interventions and the outcome measures used to assess pain and fear in children aged 6-12 years, with particular attention to AI-based interactive games and the Buzzy/Buzzle Bee cold-vibration device. A structured search of multiple databases identified 30 peer-reviewed studies published between 2015 and 2024. Studies were synthesized narratively according to intervention type, pain/fear outcomes, and measurement approach. Technology-based distraction, particularly virtual reality (VR), was associated with reduced pain, fear, or anxiety across multiple studies. Cold-vibration devices also reduced procedural pain and distress, while low-cost distraction methods provided practical alternatives. Outcome measures included self-report pain scales, fear scales, behavioral measures, proxy ratings, and physiological indicators. The findings support distraction-based approaches while highlighting substantial variation in outcome measurement and the need for consistent, developmentally appropriate assessment tools. Although these interventions show promise, the studies vary widely in how pain and fear are measured. The studies included used a variety of outcome measures, including self-report pain scales, fear scales, behavioral assessment tools, proxy ratings, and physiological indicators, making direct comparisons across studies more difficult. These inconsistencies highlight the need for more standardized and developmentally appropriate outcome measures. By summarizing current evidence and identifying gaps in assessment practices, this review underscores the importance of using reliable, child-centered tools to evaluate distraction-based interventions. Integrating these evidence-based distraction strategies into routine pediatric care may help reduce procedural trauma, improve children's experiences, and support more child-centered care.

Keywords:  AI‐based interactive games; distraction‐based interventions; non‐pharmacological methods; pediatric pain assessment

DOI:  https://doi.org/10.1002/pne2.70048
J Clin Microbiol. 2026 Sep 30. e0076426

Diagnostic contribution of anaerobic bottles in pediatric blood cultures: experience at a tertiary children's hospital.

Ju Hyeong Lee, Baek Sup Shin, Taek Soo Kim, Sue Shin, Ki Wook Yun, Eun Hwa Choi, Jae Hyeon Park.

  Routine use of anaerobic bottles in pediatric blood cultures remains controversial because diagnostic yield must be balanced against limited sampling volume. We retrospectively analyzed paired pediatric aerobic-anaerobic blood cultures collected from patients younger than 18 years at a tertiary children's hospital from January 2020 through December 2024. Accession-defined paired sets received within 15 min were grouped into culture episodes; episodes containing at least two paired sets comprised the primary cohort. Among 24,485 multi-set episodes from 8,658 patients, 999 (4.1%) were positive, and 387 (1.6%) were potential-contaminant episodes. Confirmed anaerobic-bottle contribution was observed in 208 positive episodes (20.8%), comprising additional organism recovery in 159 (15.9%) and detection more than 4 h earlier in 49 (4.9%); the absolute added yield was 8.5 per 1,000 episodes. Obligate anaerobes were identified in 11 positive episodes, whereas the majority of the contribution came from facultative organisms, particularly Staphylococcus aureus, Escherichia coli, and viridans group streptococci. Contribution was highest in the emergency room (28.2%) and neonatal intensive care unit (25.0%). Compared with the general ward, adjusted odds were higher in the emergency room (adjusted odds ratio, 1.83; 95% confidence interval, 1.23 to 2.73) and lower in the hemato-oncology ward (0.43; 0.21 to 0.85). Contribution was 21.8% among children younger than 4 years. The overall median within-accession time-to-positivity difference (anaerobic minus Peds Plus/F) was small (-0.17 h), although selected organisms showed earlier anaerobic detection. Anaerobic bottles provided complementary diagnostic information in approximately one-fifth of positive pediatric blood culture episodes, mainly through additional recovery rather than uniformly earlier detection.IMPORTANCEChildren often have only a small amount of blood available for culture, making the choice of culture bottles important. In this hospital-wide study, anaerobic bottles added diagnostic information in about one-fifth of positive pediatric blood culture episodes, mainly by recovering organisms that were not found in the paired pediatric aerobic bottle. Most of this benefit involved common bloodstream pathogens that can grow with or without oxygen, including Staphylococcus aureus and Escherichia coli, rather than rare obligate anaerobes. A similar overall contribution proportion was observed among children younger than 4 years. However, the pediatric aerobic bottle recovered more organisms overall in direct paired comparisons. These findings support viewing the two bottle types as complementary and emphasize that pediatric blood culture practice should balance adequate total blood volume with thoughtful allocation between bottle types.

Keywords:  Escherichia coli; Staphylococcus aureus; bacteremia; blood culture; child; infant

DOI:  https://doi.org/10.1128/jcm.00764-26