bims-cliped 2026-10-25 papers

bims-cliped

Biomed News

on Clinical pediatrics

Issue of 2026–10–25
28 papers selected by
Alyssa M. Portwood, Akron’s Children

Practical Guide to Dissemination and Implementation Science for Pediatric Hospitalists.
Driving Legislative Change for Access to Medications.
Extreme Heat in Children and Adolescents-Practical Strategies for Action, Advocacy, and Understanding in Nursing Practice.
Exploring Perspectives and Barriers in Implementing Home Monitoring for Pediatric Pulmonary Diseases: Mixed Methods Study.
Optimal Resources for Children's Surgery 2: Essential Human Resources for Optimal Children's Surgery.
Frontline Staff Vaccine Communication During Pediatric Well-Child Encounters: A Mixed-Methods Study.
Child-specific bioethics: Review of pediatric palliative care ethics guidelines.
Clinical applications of remote patient monitoring.
Use of Intranasal Analgesia for Acute Pain in Pediatric Emergency Departments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Ableism is a Crisis in American Pediatric Health Care.
Experiences of Ableism in Pediatric Healthcare.
Receipt of needed care coordination and emergency department utilization among US children with chronic physical pain: a pooled analysis of the 2022-2024 National Survey of Children's Health.
Reducing surgical site infections among paediatric patients undergoing cardiac surgery: a multi-disciplinary quality improvement initiative.
Understanding partial hospitalization programs (PHPs): Intermediate mental health care between clinic and hospital.
Impact of a VLBW feeding guideline on central line usage and enteral feeding practices: A quality improvement project.
Routine Screening Demonstrates Pediatric Delirium Hospital-Wide.
Shoulder Instability Pediatric Management of Shoulder Instability in the Pediatric Athlete: A Contemporary Review of Current Evidence.
Transition from pediatric to adult care for patients with type 1 diabetes mellitus: more than just a handover.
Pediatric abusive head trauma: A nursing call to action.
Mental health experiences and barriers: Black adolescents presenting for suicide risk and their caregivers.
Association Between Childhood Opportunity Index and Pediatric Emergency Department Utilization of Youth With Experiences of Trafficking: A National Multicenter Retrospective Cohort Study.
Improving Pediatric Primary Care Providers' Knowledge of Developmental Behavioral Pediatrics Through a Phone Consultation Line.
Implementation of Diabetes Care Coordination in Schools Across Pediatric Centers in the T1D Exchange Quality Improvement Collaborative.
The impact of standardized meal plans for patients hospitalized for anorexia nervosa.
Real-world effectiveness and safety of cenobamate in children and adolescents with drug-resistant epilepsy: a systematic review, meta-analysis, and meta-regression.
Emergency Department Diagnosis of Concussion in Very Young Children with Head Injury.
Asynchronous pediatric specialty care: eConsults and eVisits as tools to improve access, demand management, and care coordination.
Scaling and Spreading Implementation Strategies for Prevention of Necrotizing Enterocolitis.

Hosp Pediatr. 2026 Oct 19. pii: e2026009550. [Epub ahead of print]

Practical Guide to Dissemination and Implementation Science for Pediatric Hospitalists.

Jillian M Cotter, Christina Studts, Leigh Anne Bakel, Justin M Lockwood, Suchitra Rao.

In pediatric hospital medicine (PHM), effective interventions often fail to reach the bedside or are significantly delayed, contributing to gaps in quality, outcomes, and value. Dissemination and implementation (D&I) science addresses this evidence-to-practice gap by studying methods to promote the uptake, integration, and sustainment of evidence-based interventions in real-world settings. In this methodology article, we apply a PHM lens to D&I science, outlining when D&I is most useful and how it differs from quality improvement and traditional efficacy and effectiveness research. We introduce core D&I terminology and commonly used theories, models, and frameworks and describe key steps in conducting D&I studies, including identifying contextual barriers, selecting theory-informed implementation strategies, assessing appropriate implementation outcomes, applying rigorous study designs, and planning for dissemination and sustainment. We highlight practical tools and examples from PHM literature to support application in inpatient pediatric settings. We also discuss key limitations, including methodological complexity and challenges with measurement and reproducibility. By providing a pragmatic overview, this article aims to equip pediatric hospitalists and researchers with foundational D&I knowledge to accelerate translation of evidence into practice and improve care for hospitalized children.

DOI: https://doi.org/10.1542/hpeds.2026-009550
Pediatrics. 2026 Oct 20. pii: e2026076816. [Epub ahead of print]

Driving Legislative Change for Access to Medications.

Ala Aldabbas, Matthew J Giefer, John C Carlson.

An insurance company denied coverage for an inflammatory bowel disease medication, stating that the lack of a pediatric Food and Drug Administration indication made that treatment experimental. This was legally permissible. The patient's pediatric gastroenterologist partnered with others to create a new state law that mandated insurance coverage for medications in children when the treatment was covered for adult patients and there were data to support pediatric efficacy and safety. Coalition building included support from a hospital system, community petitions, and interactions with legislators. Family and physician testimony supported passage of the law, in effect since 2023. The patient was able to obtain the necessary treatment, and the law has been used to help other children gain access to prescribed treatments. This process can serve as a model for similar advocacy in other states.

DOI: https://doi.org/10.1542/peds.2026-076816
Nurs Clin North Am. 2026 Dec;pii: S0029-6465(26)00033-2. [Epub ahead of print]61(4): 571-583

Extreme Heat in Children and Adolescents-Practical Strategies for Action, Advocacy, and Understanding in Nursing Practice.

Gina Friel, Mitzie Rains Meyers, Michelle DePhillips, Karen G Duderstadt.

  Warming temperatures, air pollution, and extreme weather events are some of the environmental changes currently impacting the pediatric population. Children and adolescents are at high risk, susceptible to extreme weather events at every stage of development. Pediatric nurses and nurse practitioners are responsible for providing holistic care to children and their families. The interplay between the earth's changing climate and the impact on human health directly affects nursing practice. Pediatric nurses working with children and adolescents are key in providing specific strategies to identify heat related illnesses, encourage prevention and adaptation strategies, and community engagement to improve child health outcomes.

Keywords:  Adolescent; Children; Climate change; Extreme heat; Impact

DOI:  https://doi.org/10.1016/j.cnur.2026.06.005
JMIR Pediatr Parent. 2026 Oct 20. 9 e101452

Exploring Perspectives and Barriers in Implementing Home Monitoring for Pediatric Pulmonary Diseases: Mixed Methods Study.

Mees Hp Stoop, Romy Krul, Badies Han Manai, Iris Groothuis, Arwen J Sprij, Marianne Nuijsink, Hettie M Janssens, Matthijs D Kruizinga.

   BACKGROUND: Home monitoring has the potential to enable early detection of disease progression in pediatric lung diseases such as asthma and cystic fibrosis (CF). There is minimal evidence regarding the opinions of caregivers and children on home monitoring.
OBJECTIVE: This study aimed to explore children's and caregivers' perspectives on home monitoring.
METHODS: This multicenter, mixed methods study included children aged 6 to 18 years with asthma or CF and their caregivers. Participants were recruited from Juliana Children's Hospital and Erasmus MC Sophia Children's Hospital between September 2023 and June 2025. Participants completed a structured questionnaire assessing experiences, attitudes, and potential barriers and facilitators to home monitoring. Fourteen children and their caregivers took part in in-depth interviews. Conventional content analysis was applied to both open-text and interview data.
RESULTS: A total of 113 caregiver-child dyads (62 [54.9%] asthma and 51 [45.1%] CF) participated in this study. Willingness to use home monitoring was high among both children (asthma: n=47, 83.9%; CF: n=30, 62.5%) and caregivers (asthma: n=54, 87.1%; CF: n=44, 86.3%). Children with asthma and their caregivers showed significantly greater willingness to use the proposed types of home monitoring than children with CF and their caregivers. Caregivers who expressed difficulty with symptom interpretation were significantly more motivated to use home monitoring. Key barriers included time demands, usability, device size, and concerns about maintaining personal contact with health care providers. Facilitators included compact, user-friendly devices, clear instructions, and improved disease understanding.
CONCLUSIONS: High willingness to adopt home monitoring was observed among children with asthma and children with CF, but preferences and perceived barriers differ. Tailoring device choice and implementation strategies to patient needs, minimizing burden, and integrating medical oversight are important for successful uptake.

Keywords:  asthma; caregiver perspectives; child; cystic fibrosis; digital health; patient acceptance of health care; patient perspectives; telemedicine

DOI:  https://doi.org/10.2196/101452
World J Surg. 2026 Oct 20.

Optimal Resources for Children's Surgery 2: Essential Human Resources for Optimal Children's Surgery.

GICS Membership

   BACKGROUND: Following its inaugural meeting at the Royal College of Surgeons of England, London, United Kingdom, in 2016, the Global Initiative for Children's Surgery (GICS) published the Optimal Resources for Children's Surgery 1 (OReCS) consensus document detailing the facilities and resources required at each level of care. In addition to physical resources needed to provide care for children, the Lancet Commission on Global Surgery (LCoGS) identified the density of surgical providers as a marker of sufficient workforce in capacity. To meet the needs of patients, OReCS 2 details the varying types of providers needed at each level of care to meet the minimum expected capacity to care for children with surgical needs.
METHODS: We performed a review of the literature and reviewed LCoGS recommendations that applied solutions in low resource settings. We then used an iterative Delphi-like approach to determine the types of providers needed for each of 13 sub-specialties in children's surgical care at the different hospital levels. Participation was open to all GICS V conference attendees that were held from 24 to 26 February 2024 in Manila Philippines. This represents 441 participants from 50 countries (79% low to middle income countries). Final recommendations were made based on a greater than 75% agreement by respondents and reviewed by the 20 GICS board of directors.
RESULTS: In the current literature, there is considerable variability in the provider types described for each facility level with an emphasis on the use of non-physician health workers such as clinical officers, nurse anesthetists, and community health workers to improve access. Using the modified Delphi from GICS V, it is recommended to have a generalist medical practitioner, followed by non-physician surgical providers at the health center level. First level hospitals should have generalist medical practitioner, non-physician surgical provider, and generalist medical practitioner with pediatric-specific training. At the referring hospital level, which includes 2nd level hospital, third level hospital, and children's hospital, recommendations are generalist medical practitioner (GMP), non-physician surgical providers (NPSP), pediatric general and specialty surgeons, and some medical specialists such as cardiologist, gastroenterologist, and others, for maximum care coverage.
CONCLUSIONS: To improve access to high-quality care and perform the procedures considered essential, different types of providers are needed at different facility levels. Ranging from community health workers to surgical subspecialists to nurses with expertise in pediatric intensive care units to physiotherapists. OReCS 2 provides detailed examples of the optimal human resources and workforce needed at each facility level.

Keywords:  children’s surgery; global health; human resources; optimal care

DOI:  https://doi.org/10.1002/wjs.70631
Pediatrics. 2026 Oct 23. pii: e2026077450. [Epub ahead of print]

Frontline Staff Vaccine Communication During Pediatric Well-Child Encounters: A Mixed-Methods Study.

David M Higgins, Dennis Gurfinkel, Brooke Dorsey, Sean T O'Leary.

BACKGROUND AND OBJECTIVES: Evidence-based vaccine communication from clinicians is associated with improved parental vaccine acceptance. However, vaccine communication practices of frontline staff, including medical assistants (MAs) and receptionists, remain largely unknown. We aimed to characterize these practices during well-child encounters in pediatric primary care.
METHODS: We conducted a mixed-methods study with direct observations of frontline staff in 2 pediatric practices in Denver, CO, during well-child encounters in the summer (no influenza vaccine available) and fall (influenza vaccine available) of 2024, recording the frequency and format of vaccine communication. Following the observations, we conducted semi-structured interviews with MAs to explore their vaccine communication practices, perceived roles, comfort, and training.
RESULTS: We observed 174 encounters (127 MA-parent, 47 receptionist-parent interactions). Vaccine communication occurred in at least 51% (95% CI, 43%-60%) of MA interactions vs 6% of receptionist interactions (P < .001). When vaccines were recommended, MAs used a presumptive format in 46% (95% CI, 34%-59%) of encounters overall, but far less during influenza season (21% vs 76%; P < .001). Interviews revealed that MA communication styles evolved through on-the-job experience and peer-to-peer learning rather than formal training, with influenza vaccines treated as optional rather than routinely recommended.
CONCLUSIONS: MAs frequently communicate with parents about vaccines during well-child encounters but underutilize evidence-based presumptive communication, particularly for influenza vaccines. Communication practices are learned informally through peer-to-peer learning, highlighting a significant opportunity for targeted training to support team-based vaccine communication in pediatric primary care.

DOI: https://doi.org/10.1542/peds.2026-077450
Nurs Ethics. 2026 Oct 17. 9697330261493468

Child-specific bioethics: Review of pediatric palliative care ethics guidelines.

Christina Lamb, Dimitra V Pouliopoulou.

  Pediatric palliative care is increasingly recognized as an established practice yet less than ten percent of children who need it access it worldwide. Contributing to this gap is an absence of pediatric-specific bioethics frameworks to guide the care of dying children. Because philosophies influence cohesive care provision, the purpose of this review was to critically examine the international, scholarly literature on the ethical content of pediatric end-of-life care guidelines to ascertain what pediatric ethics approaches are used to guide the care of dying children. A Rapid Review of the international, scholarly literature was undertaken from September 2024 to April 2025. Of the 12,215 reviewed documents, 19 were retained for inclusion. Documents were mapped for the presence of pediatric-specific bioethics frameworks, care guidelines, ethical approaches, principles and values. Records were identified according to country, population, holistic care, child-centricity and pediatric, family, and ethicist involvement in ethical decision-making. Nineteen documents were included. Findings were synthesized through tabulation and narrative analysis. No pediatric-specific bioethics framework explicitly originating in pediatric theory and research was identified. Although most ethical approaches focused on children, they relied on prevailing adapted adult frameworks or adultist iterations of principlism, care and relational ethics and single or matrix-based principal accounts. Care for dying children needs to be consistently grounded in child philosophies. Recommendation: Expanding access to pediatric palliative care requires ethics education research toward pediatric-specific pedagogies and bioethics frameworks to support consistent, ethically robust, holistic, and child-centered care to improve access across clinical, international and interdisciplinary settings.

Keywords:  death; ethics; palliative care; pediatrics; population health; review

DOI:  https://doi.org/10.1177/09697330261493468
Curr Probl Pediatr Adolesc Health Care. 2026 Oct 22. pii: S1538-5442(26)00070-2. [Epub ahead of print] 101983

Clinical applications of remote patient monitoring.

Rosalie Sleppy, Sarah Hadley, Emily Stevenson, John Chuo, Tamar J Preminger.

  Remote patient monitoring (RPM) utilizes a variety of technologies that enable rapid transmission of health data, allowing healthcare providers to manage medical conditions outside the hospital setting. As an increasingly important component of pediatric telehealth and healthcare delivery, RPM has been successfully implemented across multiple specialties. This review highlights RPM programs at the Children's Hospital of Philadelphia (CHOP), including initiatives in cardiology, neonatology, primary care, gastrostomy tube care, and neurology. These programs have demonstrated success in reducing unnecessary hospitalizations and emergency department visits, increasing access to care and subspecialty follow-up, and lowering mortality among children with chronic diseases. The review also examines the digital health technologies that support these programs. In addition, artificial intelligence is playing an expanding role in RPM through predictive alerts, risk stratification, and agentic monitoring tools that enable more personalized and proactive care. Despite these benefits, important challenges remain, including disparities in digital literacy, language barriers, and licensing restrictions. We propose that a hybrid care model integrating RPM, digital health technologies, and in-person visits provides a comprehensive framework for pediatric healthcare delivery. As RPM continues to expand across pediatric subspecialties, the development of telehealth "neighborhoods" may help strengthen medical homes for children with complex chronic conditions. Such models have the potential to improve clinical outcomes, enhance care coordination, and reduce healthcare disparities among vulnerable pediatric populations.

Keywords:  Artificial intelligence; Digital health technologies; Remote patient monitoring; Telehealth; Telemedicine

DOI:  https://doi.org/10.1016/j.cppeds.2026.101983
Pain Res Manag. 2026 ;2026(1): e1894053

Use of Intranasal Analgesia for Acute Pain in Pediatric Emergency Departments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Mohammed Alsabri, Yahya A Mahmoud, Shree Rath, Eslam Abady, Mohamed Ashraf Shehab, Raseel Sleem, Luis L Gamboa, Mohammed Hamzah, Michael Gillman.

   BACKGROUND: Pain is one of the most common reasons for presentation to pediatric emergency departments, yet timely and effective analgesia remains inconsistently delivered. Intranasal (IN) analgesics offer a noninvasive alternative to injectable routes, but their comparative effectiveness, safety, and acceptability across agents and routes remain incompletely defined.
METHODS: We conducted a systematic review and network meta-analysis of randomized controlled trials evaluating IN analgesics for acute pain management in children aged 0-18 years presenting to emergency or prehospital settings. Eligible trials compared IN agents with alternative IN formulations, intravenous, intramuscular, oral analgesics, or placebo. Pain reduction measured using validated pediatric pain scales at predefined timepoints was the primary outcome. Secondary outcomes included need for rescue analgesia, adverse events, acceptability, and emergency department length of stay.
FINDINGS: Fifteen randomized controlled trials involving 1388 pediatric patients were included. Across all evaluated timepoints, including the primary outcome and assessments at 10, 15, 20, 30, and 60 min, no IN or intravenous analgesic demonstrated statistically superior pain reduction compared with IN fentanyl. Requirements for rescue analgesia were similarly comparable across treatments. IN ketamine was associated with a significantly higher risk of adverse events compared with standard-dose IN fentanyl, although events were predominantly mild and transient. Acceptability among patients, caregivers, and providers was high across IN agents, and available data indicated no clinically meaningful differences in emergency department length of stay.

Keywords:  acute pain; emergency department; fentanyl; intranasal analgesia; ketamine; meta-analysis; pain management; pediatric emergency medicine; randomized controlled trials; systematic review

DOI:  https://doi.org/10.1155/prm/1894053
Pediatrics. 2026 Oct 21. pii: e2026077456. [Epub ahead of print]

Ableism is a Crisis in American Pediatric Health Care.

Richard C Antonelli, Allysa Ware, Nikki Montgomery.

DOI: https://doi.org/10.1542/peds.2026-077456
Pediatrics. 2026 Oct 21. pii: e2025074093. [Epub ahead of print]

Experiences of Ableism in Pediatric Healthcare.

Stefanie G Ames, Christina K Zigler, Melissa Wardrop, Danielle Gerber, Dori Ortman, Kristyn Felman, Amanda Gatewood, Kendall Armstrong, Sophie Kooiman, Ryan J Coller, Amy J Houtrow.

BACKGROUND: There is growing evidence of ableism in pediatric health care, but our limited understanding of the experiences of ableism inhibits further evaluation and intervention. The study objective was to describe community perspectives of the experiences of ableism in pediatric health care for children with disabilities.
METHODS: Participants completed a group concept mapping study using web-based software to input experiences of ableism in health care. Following a formal statement reduction, participants sorted unique experiences into conceptual clusters. Data were mapped to generate a similarity matrix. A multidimensional scaling algorithm generated a point map, and a hierarchical cluster analysis grouped statements into clusters. Focus groups validated and labeled clusters.
RESULTS: Participants (n = 132) generated 658 statements about ableism experiences. After reduction, 145 experiences were categorized in 11 conceptually distinct clusters: 1) substandard care including withholding care, 2) dehumanizing language and behaviors, 3) negative assumptions, 4) inflexible organizational policies and practices, 5) inaccessible built environment and lack of accommodations, 6) lack of access to resources, 7) unfair standards and normalized inequity in health systems, 8) dismissal of the lived experience and caregiver expertise, 9) intersectional identities and judgements of worthiness to receive care, 10) restrictions driven by insurance coverage and policy, and 11) complexity in community and health services navigation.
CONCLUSIONS: Wide-ranging experiences of ableism occur in pediatric health care interactions. The lived experiences of ableism identified in this study provide insight for future research in pediatric health care.

DOI: https://doi.org/10.1542/peds.2025-074093
Front Pain Res (Lausanne). 2026 ;7 1994046

Receipt of needed care coordination and emergency department utilization among US children with chronic physical pain: a pooled analysis of the 2022-2024 National Survey of Children's Health.

Tongming Cheng, Ziming Cai, Xiaonan Zhou, Ciai Lai, Lizhen Huang, Wei He.

   Background: Children with chronic physical pain often require complex, multidisciplinary services across medical, behavioral, and community systems. However, whether receipt of needed care coordination is associated with acute healthcare utilization and care access in this population remains poorly characterized.
Methods: We conducted a pooled cross-sectional analysis of the 2022-2024 National Survey of Children's Health (NSCH). The analytic cohort included US children aged 6-17 years with caregiver-reported chronic physical pain who had an identified need for care coordination. The exposure was receipt of needed care coordination. The primary outcome was all-cause emergency department (ED) utilization (≥1 visit) in the prior 12 months. Survey-weighted multivariable logistic regression was used, with a minimally adjusted model (sociodemographic factors) and a fully adjusted model (additionally including insurance status, anxiety, depression, and functional difficulties) reported side by side.
Results: Among 6,326 eligible children (representing an average of 878,491 children annually), weighted 12-month ED visit rates were 29.0% (95% CI, 25.4%-32.5%) for those who received needed care coordination versus 40.0% (95% CI, 36.4%-43.7%) for those who did not. In the minimally adjusted model, receipt of needed care coordination was associated with lower odds of ED utilization (adjusted OR [aOR] 0.61; 95% CI, 0.48-0.76; P < .001; n = 6,310). This association persisted in the fully adjusted model (aOR 0.69; 95% CI, 0.54-0.87; P = .0019; n = 6,145) and was consistent for recurrent ED visits (≥2 visits: aOR 0.54; 95% CI, 0.36-0.79; P = .0015). Receipt of care coordination was also associated with substantially lower odds of unmet healthcare needs (aOR 0.32; 95% CI, 0.23-0.45) and forgone mental health care (aOR 0.21; 95% CI, 0.13-0.33). The estimate for hospital stay was imprecise and included the null (aOR 0.61; 95% CI, 0.37-1.01; P = .053).
Conclusion: Among US children with chronic physical pain who needed care coordination, receipt of needed care coordination was associated with lower odds of all-cause ED use and reported healthcare access gaps. These cross-sectional findings do not establish temporal ordering or causal effects and should be evaluated in prospective studies.

Keywords:  National Survey of Children's Health (NSCH); care coordination; child health; chronic pain; emergency department utilization; healthcare access; pediatric health services

DOI:  https://doi.org/10.3389/fpain.2026.1994046
Infect Prev Pract. 2026 Dec;8(4): 100581

Reducing surgical site infections among paediatric patients undergoing cardiac surgery: a multi-disciplinary quality improvement initiative.

Faizah Amer Alnahdi, Sahar Abdullah Alamro, Tareq Jamal Alanezi, Mohammed Alaklabi, Lubna Abdulrahman Elshaib, Eman Abdullah Alabuod, Najla Najim Albishi, Abdulmohsen Ali Althomairi, Fadwa Fahad Alkhuraisi.

   Introduction: Sternal wound surgical site infections (SSIs) in paediatric cardiac surgery are associated with significant morbidity, prolonged hospitalization, and elevated healthcare burden. In response to baseline surveillance at our cardiac centre, between July and December 2024 13 SSIs were identified among 128 open-heart paediatric cardiac surgeries (10.2%), exceeding national and international benchmarks; a structured quality-improvement initiative was implemented to reduce SSI rates and enhance SSI prevention practices.
Methods: An evidence-based SSI-prevention bundle that included preoperative chlorhexidine gluconate (CHG) preparation, optimal antibiotic selection, dosing, timing, and redosing, standard wound care, sterile delayed sternal closure protocols, and improved environmental cleaning was implemented from January to December 2025 a by a multi-disciplinary team. Plan-Do-Study-Act (PDSA) cycles, statistical process control charts, compliance audits, and mixed qualitative feedback were used to measure impacts. The measures were the SSI rate and bundle adherence reliability. Essential elements include strengthening adherence to perioperative bundle components across all phases; a sterile delayed sternal closure setup; and intensified environmental cleaning consistent with national guidelines, supported by staff education, real-time process and outcome monitoring with feedback, electronic health record prompts, daily audits, and ongoing staff and leadership engagement.
Results: During the baseline period (July-December 2024), 13 SSIs occurred among 128 paediatric cardiac surgeries (10.2%). After bundle implementation (January-December 2025), eight SSIs were identified among 357 procedures (2.2%); representing a relative reduction of more than 75% in the overall SSI rate with considerable improvements seen in superficial, deep, and delayed-sternal-closure-related infections. Bundle adherence increased from a baseline mean of 37% to 77%, with sustained compliance above 80% from June 2025 onwards.
Conclusion: A comprehensive, multi-disciplinary SSI-prevention care bundle was associated with reduced paediatric cardiac SSIs and improved care reliability. The approach is sustainable, adaptable to other contexts with appropriate modifications, and provides a practical model for enhancing surgical safety in high-risk paediatric groups.

Keywords:  Paediatric cardiac surgery; Quality improvement; Surgical site infection

DOI:  https://doi.org/10.1016/j.infpip.2026.100581
Curr Probl Pediatr Adolesc Health Care. 2026 Oct 22. pii: S1538-5442(26)00074-X. [Epub ahead of print] 101987

Understanding partial hospitalization programs (PHPs): Intermediate mental health care between clinic and hospital.

Jennifer M Moran, Samuel D Scott.

  Pediatric partial hospitalization programs (PHPs), often called day treatment programs, provide intensive behavioral health treatment for children and adolescents who need more support than traditional outpatient services but do not require inpatient psychiatric hospitalization. As PHPs become increasingly common, pediatricians are more likely to encounter patients who may benefit from this level of care, yet many providers remain unfamiliar with how these programs operate and when referral is appropriate. This article provides a practical overview of pediatric PHPs, including program structure, treatment goals, and core services such as psychiatric care, individual and group therapy, family involvement, safety monitoring, and school support. Common referral concerns are reviewed, including depression, anxiety, suicidal ideation without imminent risk, self-harm, emotional dysregulation, trauma-related disorders, and school refusal. The article also offers guidance on level-of-care decision-making, highlighting clinical situations in which outpatient treatment, PHP, or inpatient psychiatric care may be most appropriate. Particular attention is given to the pediatrician's role in identifying youth who may benefit from referral, collaborating with behavioral health teams, and supporting patients and families throughout treatment and discharge. A better understanding of pediatric PHPs can help pediatricians make informed referral decisions, improve care coordination, and connect youth with timely, appropriate behavioral health services.

Keywords:  Adolescent psychiatry; Behavioral health continuum; Day treatment; Level of care; Mental health referral; Partial hospitalization program; Pediatric mental health

DOI:  https://doi.org/10.1016/j.cppeds.2026.101987
Nutr Clin Pract. 2026 Oct 20.

Impact of a VLBW feeding guideline on central line usage and enteral feeding practices: A quality improvement project.

Megan Mataga, Kaitlyn Chang, Rissa Landman, Alyssa Schmitt, Priyanka Tiwari.

   BACKGROUND: Feeding guidelines (FGs) reduce the incidence of necrotizing enterocolitis (NEC) and improve growth and enteral nutrition (EN) practices in very low birth weight (VLBW) infants. Our unit's baseline data revealed delayed initiation of EN, prolonged time to full EN, prolonged days on parenteral nutrition (PN), and frequent use of peripherally inserted central catheters (PICC). After introduction of this FG, our specific, measurable, attainable, realistic, and time-bound (SMART) aims were to reduce PICC placements in infants 1000-1500 g by 30% and to reduce the time to achieve full EN in VLBW infants by 20% without adversely impacting NEC rate, growth, and mom's own milk (MOM) provision.
METHODS: We conducted a time-series quality improvement initiative over 48 months. Outcome and process measures included the percentage of PICC placements, nutrition-related central line days, day of life (DOL) EN initiated, and DOL on full EN. Balancing measures included NEC, growth, and MOM provision. Two-tailed t-tests, Mann-Whitney U tests, and chi-square tests were used to analyze demographic data, numerical variables, and categorical variables, respectively. Statistical process control charts and established rules for special cause variation were applied.
RESULTS: Our results demonstrate a 54% reduction in PICC placements and a 38% reduction in time to achieving full EN. We saw no increase in NEC rate but observed a decrease in growth and MOM provision.
CONCLUSION: The use of a standardized FG resulted in fewer PICC placements and decreased time to full EN without increasing the NEC rate. Future initiatives will focus on improving growth and MOM provision in VLBW infants.

Keywords:  central line; enteral nutrition; feeding guideline; parenteral nutrition; quality improvement; very low birth weight

DOI:  https://doi.org/10.1002/ncp.70195
Pediatr Phys Ther. 2026 Oct 16.

Routine Screening Demonstrates Pediatric Delirium Hospital-Wide.

Margaret Scholl, L David Wittkower, Caroline Andy, Chani Traube.

   PURPOSE: To identify the rate of positive delirium screens in children within a pediatric hospital setting.
METHODS: All Physical, Occupational, and Speech Therapists in our acute-care pediatric medical center were trained to use the Cornell Assessment of Pediatric Delirium (CAPD), an observational delirium screening tool validated for use in children of all ages and developmental stages. Delirium screening was then performed during all therapy sessions, hospital-wide.
RESULTS: During the 15-week study period, 1259 delirium screens were completed on 791 unique patients. Delirium was diagnosed in every pediatric unit, with the highest rates noted in the intensive care units (34.3%), but was also found in noncritically ill pediatric patients at a rate of nearly 14%.
CONCLUSION: Delirium occurred in 20.5% of our cohort, which included children hospital-wide. There is a need to implement delirium screening in all pediatric units, not just in the critical care space.

Keywords:  delirium; developmental; infant; pediatric intensive care; rehabilitation; toddler

DOI:  https://doi.org/10.1097/PEP.0000000000001312
Curr Rev Musculoskelet Med. 2026 Oct 21. pii: 68. [Epub ahead of print]19(1):

Shoulder Instability Pediatric Management of Shoulder Instability in the Pediatric Athlete: A Contemporary Review of Current Evidence.

Liam H Wong, Hannah M Chi, Erick M Marigi, Nirav K Pandya, Michael R Davies.

   PURPOSE OF REVIEW: Shoulder instability in pediatric and adolescent athletes is increasingly common and clinically complex due to early sport specialization and high-demand participation. This review aims to inform clinical decision-making by synthesizing contemporary evidence on injury patterns, diagnostic techniques, treatment options, and associated outcomes when faced with treating pediatric athletes.
RECENT FINDINGS: Unique anatomic and developmental features specific to the pediatric population including capsular elasticity, collagen composition, open physes, and evolving glenoid and humeral morphology contribute to age-specific injury patterns and influence treatment outcomes. Younger children more frequently sustain atypical soft-tissue lesions, while adolescents experience markedly higher recurrence risk with rates of 44-77% following nonoperative management. Adolescents also develop off-track Hill-Sachs lesions more frequently than adults (24.4% vs. 3.3%), reflecting differences in immature bone mechanics. Diagnosis requires thorough history, physical examination, assessment of social and socioeconomic factors, and advanced imaging. Arthroscopic Bankart repair remains the most common surgical intervention and yields high return to sport rates (75-90%), though recurrence in pediatric patients (15-50%) substantially exceeds adult rates. Remplissage reduces recurrence in adolescents with off-track lesions, and bone augmentation procedures such as the Latarjet demonstrate lower recurrence (3-8%) in patients with significant glenoid bone loss or failed prior stabilization. Long-term outcomes in skeletally immature patients and alternative bone block procedures remain incompletely studied. Management requires individualized risk stratification based on adherence, skeletal maturity, sport demands, bone loss, lesion morphology and patient history and adherence. Although surgical stabilization provides favorable functional outcomes and high return to sport rates, recurrence remains a significant concern in younger and collision-sport athletes.

Keywords:  Pediatric Shoulder; Pediatric Shoulder Dislocation; Shoulder Instability; Shoulder Instability Management

DOI:  https://doi.org/10.1007/s12178-026-10062-7
Endocr Pract. 2026 Oct 17. pii: S1530-891X(26)01289-9. [Epub ahead of print]

Transition from pediatric to adult care for patients with type 1 diabetes mellitus: more than just a handover.

Panagiota Georgia Maltezou, Ioannis-Anargyros Vasilakis, Eleni Angelopoulou, Christina Kanaka-Gantenbein.

  Type 1 diabetes (T1D) is a chronic autoimmune disease that commonly presents during childhood or adolescence and requires lifelong multidisciplinary care. The transition from pediatric to adult diabetes services is a pivotal stage often accompanied by poorer glycemic control, reduced clinic attendance, and increased risk of disengagement from healthcare. This review summarizes current evidence on the principles, challenges, and effective strategies for transitioning adolescents and young adults with T1D from pediatric to adult care. A review of the literature was conducted, focusing on transition models, clinical and psychosocial outcomes, and recommendations from the International Society for Pediatric and Adolescent Diabetes (ISPAD) and other relevant studies. Evidence supports transition as a structured, individualized, and developmentally appropriate process rather than a single transfer of care. Successful transition programs incorporate early preparation, multidisciplinary collaboration, joint pediatric-adult care, transition coordinators, psychosocial support, and progressive patient autonomy. These approaches improve continuity of care, self-management, clinic attendance, and glycemic outcomes while reducing loss to follow-up. Although transition care is increasingly recognized as a key component of T1D management, its implementation remains inconsistent. Wider adoption of standardized, evidence-based transition pathways is needed to optimize long-term health outcomes for young adults with T1D.

Keywords:  T1D; Type 1 Diabetes; adolescents; children; transition

DOI:  https://doi.org/10.1016/j.eprac.2026.10.006
Nursing. 2026 Nov 01. 56(11): 16-20

Pediatric abusive head trauma: A nursing call to action.

Candice V Laboy, Paula Barbel.

   ABSTRACT: Pediatric abusive head trauma (AHT) is the leading cause of death from physical child abuse in the United States. The term "pediatric AHT" replaced the former descriptor, "shaken baby syndrome," to include all nonaccidental head injuries. AHT can present with a wide range of symptoms that are often vague, including lethargy, vomiting, and irritability, leading to missed diagnoses. Various clinical decision tools assist in the efficient and accurate detection of AHT. Nurses play a pivotal and opportune role in the prevention, screening, and education. This article discusses the risk factors, clinical presentation, key assessment findings, diagnostic criteria, screening tools, and educational approaches for nurses to better care for patients and families with this suspected diagnosis. Additionally, nurses can follow the Concern for AHT Guide, which initiates the outsourcing of resources through Child Protective Services and social work. Another tool discussed is the Period of PURPLE Crying, which is implemented in postpartum discharge teachings, well-baby appointments, and baby immunization appointments to decrease AHT.

Keywords:  identification; nonaccidental head injury; nursing; pediatric abusive head trauma; prevention; screening; shaken baby syndrome

DOI:  https://doi.org/10.1097/NSG.0000000000000481
Child Adolesc Ment Health. 2026 Oct 20.

Mental health experiences and barriers: Black adolescents presenting for suicide risk and their caregivers.

Rhonda C Boyd, Makiya Lloyd, Danielle Mowery, Simone Imani Boyd, Ciarah St Paul, Luis Viegas de Moraes Leme, Jason D Jones, Jeremy Esposito, Tami D Benton, Gregory K Brown, Maria A Oquendo.

   BACKGROUND: Health disparities in suicidal behaviors exist for Black youth. There are many barriers that Black adolescents and their caregivers encounter when attempting to access mental health (MH) care. However, there is limited information available concerning their experiences, barriers, and facilitators of MH services.
METHODS: Qualitative interviews were conducted with Black adolescents (ages 10-18) presenting in a pediatric emergency department with past-year suicidal ideation and/or behaviors and/or their caregivers. The sample consisted of 9 adolescents and 11 caregivers. Qualitative analysis was conducted by structured annotation and thematic analysis.
RESULTS: Adolescent and caregiver interviews identified seven themes: (1) emotional and behavioral experiences; (2) impact of previous MH treatment; (3) MH barriers; (4) facilitators for future treatment; (5) MH communication; (6) support; and (7) community resources.
CONCLUSION: Themes highlighted by both adolescents and caregivers were the impact of previous treatment, MH barriers, facilitators for future treatment, MH communication, and support. Although the interviews are consistent with research literature documenting the negative experiences and barriers to care for Black adolescents, MH experiences can be positive and helpful if provided in a culturally responsive manner.

Keywords:  Qualitative methods; ethnicity; mental health; suicidal behavior

DOI:  https://doi.org/10.1111/camh.70137
Pediatr Emerg Care. 2026 Oct 19.

Association Between Childhood Opportunity Index and Pediatric Emergency Department Utilization of Youth With Experiences of Trafficking: A National Multicenter Retrospective Cohort Study.

Preeti Panda, Yaowei Deng, Anastasia Lynge, Andy Forest, Bella Triolo, Andrea Fang, Victoria Ward, Ewen Wang, Jennifer Newberry, Maya Mathur, Anisha Patel.

   OBJECTIVE: To understand associations between the Child Opportunity Index (COI), a neighborhood-based measure of resources that influence child health and development, and pediatric ED utilization among youth with experiences of trafficking in the United States, as well as to describe their range of COI, sociodemographic characteristics, and pediatric ED utilization.
METHODS: This was a retrospective, observational, cohort study. We identified (by ICD-10 code) youth with experiences of trafficking who presented to pediatric EDs across 50 US children's hospitals between January 2018 and February 2023 within the Pediatric Health Information System database. Descriptive analyses and multivariate regression were performed.
RESULTS: We identified 908 youth with experiences of trafficking who presented to pediatric EDs. Among them, 55% (n=499) were from neighborhoods with Very Low and Low COI, while 45% (n=409) were from neighborhoods with Moderate to Very High COI. Mental health diagnoses were common (n=584, 65.3%), and mental health, child abuse, and physical trauma were the top diagnosis categories for ED visits. Low-resource intensity visits were uncommon (12.8%). One-third of patients had an ED visit in the year prior. We did not find major statistically significant associations between COI and hospital utilization.
CONCLUSIONS: In this cohort of youth with experiences of trafficking, all levels of COI and a wide range of visit acuity levels were represented. Further study is needed to better understand the prevalence and health needs of youth with experiences of trafficking who receive ED care, to develop effective screening and intervention programs to support these youth.

Keywords:  Childhood Opportunity Index; child trafficking; emergency department

DOI:  https://doi.org/10.1097/PEC.0000000000003737
J Dev Behav Pediatr. 2026 Oct 22.

Improving Pediatric Primary Care Providers' Knowledge of Developmental Behavioral Pediatrics Through a Phone Consultation Line.

Duygu Unkaracalar, Rhonda Eppelsheimer, Randall A Phelps.

   OBJECTIVES: Developmental behavioral concerns comprise a large proportion of referrals in primary care. Access to Developmental Behavioral Pediatrics' (DBP) expertise is limited, with long wait-times to access care. We describe usage of a new DBP phone consult line, regarding diagnostic questions, recommended resources, and to assess contribution to pediatric primary care providers' (PCPs) knowledge and confidence in managing developmental and behavioral issues.
METHODS: This study has 2 components: (1) A retrospective review of consultation call-records between July 2023 to December 2025, describing utilization of DBP call line, including demographics, diagnostic questions, types of recommendations, and contribution to expediting appropriate interventions. (2) A prospective PCP survey to determine PCP satisfaction with recommendations and perceived learning of new information and skills for the management of DBP concerns.
RESULTS: A total of 362 consultations were completed. The average wait time for consultation was 10.7 days, significantly shorter than typical in-person DBP assessment wait times (averaging a year or more). Consultations addressed a broad range of developmental and behavioral concerns, and provided guidance on diagnosis, management, and care coordination. Most patients (85.7%) accessed appropriate interventions without or before referral. PCPs reported high satisfaction (89.7%) and learning new information applicable to future patients (79.3%).
CONCLUSION: A new DBP phone consultation line improves timely access to DBP expertise. It facilitates collaborations between PCPs and DBPs to support PCP clinical decision-making. In addition to decreasing delays in accessing interventions, this model aligns with adult learning principles, to yield high provider satisfaction, enabling PCPs to apply newly acquired knowledge to future patient care.

Keywords:  access to developmental behavioral pediatrics; adult learning; expedited DBP care; phone consultation line

DOI:  https://doi.org/10.1097/DBP.0000000000001520
Diabetes Obes Cardiometab CARE. 2026 Sep-Oct;1(5):1(5): 953-962

Implementation of Diabetes Care Coordination in Schools Across Pediatric Centers in the T1D Exchange Quality Improvement Collaborative.

Christine A March, Alissa Guarneri, Dhruvi Vora, Elissa Naame, Sarah Orris, Fran Cogen, Kajal Gandhi, Sarah K Lyons, Linda Siminerio, Risa M Wolf, Crystal Woodward, Ingrid Libman, Nicole Rioles.

OBJECTIVE: To characterize barriers and facilitators in implementing evidence-based care coordination for type 1 diabetes in K-12 schools among diabetes centers in the U.S.
RESEARCH DESIGN AND METHODS: We conducted a mixed-methods study with diabetes centers in the T1D Exchange Quality Improvement Collaborative who deliver pediatric care. A representative from each center participated in a survey and optional semistructured interview. Questions were situated within an implementation science framework and asked about processes for communication, education, and clinical care related to in-school diabetes support; the interview probed deeper on barriers and solutions. Surveys were analyzed descriptively. Interviews were transcribed and coded by two reviewers using a thematic analysis.
RESULTS: Surveys were returned by 38 predominantly academic pediatric centers representing different U.S. regions and patient volumes (range 600 to >3,000, 93% response rate). Most respondents (58%) were somewhat satisfied with current processes for communicating with schools and providing medical orders, with <25% being extremely satisfied. Centers identified problematic barriers: insufficient clinician time (74% of respondents), school call volume (78%), and inefficient communication methods (71%). Less than 5% of centers billed for care coordination activities. Qualitative themes expanded upon center and school-level barriers. Desired solutions focused on technology or intermediary roles (e.g., nurse navigators) for coordination. Although school-partnered interventions were viewed favorably, scalability and sustainability were concerns.
CONCLUSIONS: Diabetes care coordination between K-12 schools and diabetes centers is variably implemented because of challenges within both institutions. Further research is needed to test implementation strategies that can overcome barriers and augment evidence-based care.

DOI: https://doi.org/10.2337/doc26-0110
J Eat Disord. 2026 Jul 22. pii: 243. [Epub ahead of print]14(1):

The impact of standardized meal plans for patients hospitalized for anorexia nervosa.

Joshua Borus, Rachel Lockwood, Gabriela Vargas, Lisa Mancini, Ramy Yim, Sara Forman, Tracy Richmond.

INTRODUCTION: Patients hospitalized with Restrictive Eating Disorders (REDs) often face heightened anxiety and challenges around meals. Inconsistent meal delivery and food choice complexity further complicate care. The study evaluated the tolerability of a standardized, no-choice meal plan by assessing nutritional supplement use via oral and nasogastric (NG) tube as proxies for meal completion.
METHODS: A quality improvement initiative at a pediatric hospital replaced patient-selected meals with a 7-day rotating standardized meal plan. Adolescent patients could exclude up to five "dislike" foods. Electronic medical record (EMR) data from 10 months pre- and 6 months post-implementation (n = 302) were analyzed for rates of supplement via oral and NG tube in the first week of hospitalization.
RESULTS: NG tube use decreased from 22% to 17% of patients and 11% to 6% of patient-days. Oral supplementation increased from 33% to 36% of patients and 18% to 19% patient-days. Changes were not statistically significant.
CONCLUSION: The standardized meal plan was well tolerated. Future studies should assess psychological impacts and long-term outcomes of removing choice in meals.
IMPLICATIONS AND CONTRIBUTION: This brief provides initial evidence that a standardized meal plan in a hospital setting is well-tolerated and may provide benefits of reducing the psychological burden of choices for adolescents with REDs.

DOI: https://doi.org/10.1186/s40337-026-01583-0
Epilepsy Behav. 2026 Oct 20. pii: S1525-5050(26)00469-5. [Epub ahead of print]186 111348

Real-world effectiveness and safety of cenobamate in children and adolescents with drug-resistant epilepsy: a systematic review, meta-analysis, and meta-regression.

Debopam Samanta, Praveen Kumar Ramani, Puneet Jain.

   BACKGROUND AND OBJECTIVES: Cenobamate is a third-generation antiseizure medication (ASM) approved for focal-onset seizures in adults; pediatric use remains off-label and supported primarily by retrospective studies. We conducted a systematic review, meta-analysis, and meta-regression to evaluate the real-world effectiveness and safety of adjunctive cenobamate in pediatric drug-resistant epilepsy (DRE).
METHODS: We conducted a PRISMA 2020-compliant systematic review and meta-analysis (PROSPERO: CRD420261475361) of real-world studies including patients ≤18 years with DRE. Single-arm proportions were pooled using random-effects generalized linear mixed models. Heterogeneity was assessed using I2 and τ2. Pre-specified random-effects meta-regression explored study-level moderators of ≥50 % seizure reduction. Risk of bias was assessed using the JBI Critical Appraisal Checklist for Case Series.
RESULTS: Sixteen retrospective cohorts comprising 720 pediatric patients from 10 countries were included. The pooled proportion achieving ≥50 % seizure reduction was 59.9 % (95 % CI, 51.4 %-67.9 %; 95 % prediction interval, 30.2 %-83.8 %; I2 = 68.2 %). Pooled estimates were 41.9 % (95 % CI, 26.4-59.2 %) for >75 % seizure reduction, 18.6 % (95 % CI, 12.3-27.1 %) for seizure freedom, and 49.9 % (95 % CI, 44.1-55.7 %) for any adverse effect. Leave-one-out analysis showed that no individual study disproportionately influenced the pooled ≥50 % seizure-response proportion (58.3-61.9 %). Visual and regression-based assessments did not detect marked funnel-plot asymmetry or an association between study size and effect estimates. No pre-specified moderator, including age, prior ASM burden, cenobamate dose, follow-up duration, focal epilepsy, clobazam exposure, or etiology, was significantly associated with response.
CONCLUSIONS: Approximately six in ten pediatric patients with DRE achieved ≥50 % seizure reduction with cenobamate. However, persistent unexplained heterogeneity and exclusively retrospective evidence limit subgroup-level inference. Prospective individual-patient-data registries with standardized outcome and dosing measures are needed to better define effectiveness, safety, and predictors of response in pediatric populations.

Keywords:  Adolescents; Cenobamate; Children; Drug-resistant epilepsy; Meta-analysis; Meta-regression; Real-world evidence

DOI:  https://doi.org/10.1016/j.yebeh.2026.111348
J Pediatr. 2026 Oct 22. pii: S0022-3476(26)00406-3. [Epub ahead of print] 115378

Emergency Department Diagnosis of Concussion in Very Young Children with Head Injury.

Jack Christian, Evin Rothschild, Oluwakemi Badaki-Makun, Jessica Gill, Isam Nasr, Elise Omaki, Eva Seligman, Leticia Manning Ryan.

Although very young children ages 1-4 years accounted for the largest proportion of head injury encounters across a pediatric emergency department network, they had the lowest proportion of concussion diagnoses compared with older groups. These findings highlight the need for age-appropriate concussion assessment and may suggest underrecognition in young patients.

DOI: https://doi.org/10.1016/j.jpeds.2026.115378
Curr Probl Pediatr Adolesc Health Care. 2026 Oct 23. pii: S1538-5442(26)00065-9. [Epub ahead of print] 101978

Asynchronous pediatric specialty care: eConsults and eVisits as tools to improve access, demand management, and care coordination.

Jillian L McKee, Gregory Lawton, Audrey Vitello, Kate Fuller.

  Timely access to pediatric subspecialty care remains a persistent challenge for health systems, families, primary care providers (PCPs), and specialists. Traditional referral pathways often require in-person visits for low acuity questions that can often be addressed through structured review of existing clinical information. Provider-to-provider electronic consults (eConsults) offer an asynchronous, electronic medical record-based model that enables PCPs to obtain pediatric specialty guidance without requiring an in-person subspecialty visit. Related asynchronous models, including patient-to-provider electronic visits (eVisits), may further expand low-acuity care capacity for low-acuity care. This article reviews eConsults and eVisits as demand-management strategies that improve access, reduce unnecessary referrals, support PCPs, preserve specialty capacity for higher-acuity patients, and promote more equitable specialty access. Drawing on published literature and implementation experience at Children's Hospital of Philadelphia (CHOP), this manuscript describes clinical applications, operational requirements, outcomes, implementation challenges, and future directions, including artificial intelligence-augmented guidance and evaluation of clinical outcomes beyond healthcare utilization.

Keywords:  Asynchronous care; Digital health; Pediatrics; Telehealth; Telemedicine; eConsult; eVisit

DOI:  https://doi.org/10.1016/j.cppeds.2026.101978
Clin Perinatol. 2026 Dec;pii: S0095-5108(26)00079-5. [Epub ahead of print]53(4): 861-875

Scaling and Spreading Implementation Strategies for Prevention of Necrotizing Enterocolitis.

Jae H Kim, Katie Huff, Heather C Kaplan, Amy T Nathan.

  The primary focus in advancing necrotizing enterocolitis (NEC) has been on prevention as there have not been major breakthroughs in novel biomarkers or therapeutics, likely due to the multiple etiologies that lead to NEC and its rapidity of onset. Many opportunities to prevent NEC exist in tested standardization of practices based on varying strengths of medical evidence. Learning methods of scaling and spreading these approaches require a sound foundational knowledge of the principles of expanding successful improvement work. This paper provides a primer on these principles, and how they may be applied to reducing NEC in your own clinical context.

Keywords:  Implementation science; Learning health network; Necrotizing enterocolitis; Quality improvement

DOI:  https://doi.org/10.1016/j.clp.2026.07.005