EEG-related deep tissue injuries in critically ill pediatric patients: A single institution quality improvement project.

Introduction: Neurologic complications, including seizures, are common in pediatric patients undergoing heart surgery, especially those requiring postoperative extracorporeal membrane oxygenation (ECMO), requiring prompt, vigilant postoperative monitoring. Prolonged EEG monitoring in critically ill children presents a risk of scalp/pressure injuries. The skin's sensitivity to microcirculatory changes can also provide valuable insights into the patient's overall tissue perfusion, making it a critical component in the management of these vulnerable patients.

The Community Health Workers and Mobile Health for Emerging Adults Transitioning Sickle Cell Disease Care (COMETS) Trial: Protocol for a Randomized Controlled Trial.

Background: Transitioning from pediatric to adult sickle cell disease (SCD) care is challenging for emerging adults (aged 17-25 years). This period is marked by a 7-fold increase in mortality rates and has the highest rates of hospitalizations, emergency room visits, and hospital readmissions compared with children living with SCD. These challenges are exacerbated by fragmented care coordination, difficulty navigating adult health care systems, and increased self-management responsibilities.

Characteristics of Transfusion and Association With Oncologic Outcomes in Hepatoblastoma Resection.

Introduction: Children with hepatoblastoma (HB) and other solid tumors frequently undergo intraoperative blood transfusion (IBT) with unknown impact on oncologic outcomes and scant data to guide transfusion in this population. This study tested the hypothesis that IBT is associated with poorer survival in children with HB.

Methods: A multicenter retrospective observational study of patients aged <18 years with HB who underwent primary tumor resection, including liver transplantation, from 2010 to 2019 was performed at 19 institutions.

2D Speckle Tracking Strain Echocardiography in Multisystem Inflammatory Syndrome in Children: A Multicenter Analysis From the MUSIC Study.

Background: 2D-speckle tracking echocardiography may help detect subclinical ventricular dysfunction, but data in multisystem inflammatory syndrome in children (MIS-C) are scarce. We investigated left ventricular (LV) strain parameters in MIS-C and their association with outcomes.

Methods: We performed an ambi-directional, 32-center cohort study on hospitalized MIS-C patients (March 2020-November 2021) with at least 1 echocardiogram read by the Core Lab.

Association of Fibrinogen and ROTEM parameters with age and race in a diverse pediatric population: a single center study.

Introduction: Rotational Thromboelastometry (ROTEM) is a whole blood viscoelastic analyzer providing a global assessment of coagulation. Reference Intervals (RIs) for ROTEM are limited in pediatrics, often not accounting for race. Moreover, discrete RIs may be misleading.

A Phase 4, Open-Label, Non-Randomized, Multicenter Study to Evaluate Efficacy (and Safety) of Intravenous Administration of Optison for Contrast-Enhanced Echocardiography in Pediatric Patients.

Contrast-enhanced echocardiography (CE-echo) is commonly used in adult patients to optimize endocardial border delineation (EBD) but there is limited experience in children. A prospective, open-label, non-randomized, multicenter study was performed to evaluate the efficacy of intravenous Optison for CE-echo in pediatric patients and determine the optimal dose of Optison. Subjects ≥ 9 and < 18 years with suboptimal echocardiograms (defined as ≥ 2 contiguous segments that could not be adequately visualized) were enrolled.

Site-Level Variation in Tracheal Intubation in the Pediatric Emergency Department: A Report From the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM).

Objectives: To describe site-level variation in the performance and outcomes of tracheal intubation (TI) in pediatric emergency departments (PEDs) using the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM).

Methods: A multicenter observational study of TI was performed between April 2018 and September 2023. TI data were obtained from the 16 PEDs contributing to the NEAR4PEM registry.

HABIT Efficacy Trial Intervention Improves Elements of General and Disease-Specific Quality of Life in Youth With Sickle Cell Disease.

Background: Whether interventions to improve hydroxyurea adherence in youth with sickle cell disease (SCD) also improve health-related quality of life (HRQoL) has not been determined. We prospectively examined changes in generic and disease-specific HRQoL over a 12-month period in youth who participated in "Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment (HABIT)" randomized controlled multi-site efficacy trial. The HABIT intervention was led by community health workers and augmented by tailored text message reminders.

Sustainable surgery: Merging health care and environmental impact.

Surgeons are uniquely positioned to implement sustainable practices and advocate for transparency in environmental impact reporting. Healthcare systems contribute significantly to greenhouse gas emissions, undermining their mission to promote well-being. Surgeons, as high-resource users and clinical decision-makers, are uniquely positioned to lead sustainability efforts.

Comparing Tolerability and Toxicity of Calaspargase-Pegol and Pegaspargase in Pediatric Leukemia Patients.

As of December 2022, calaspargase-pegol is the standard long-acting asparaginase formulation for patients younger than 22 years of age with acute leukemia. This 3-year retrospective evaluation compared real-world safety and efficacy of calaspargase-pegol versus pegaspargase in pediatric patients. Incidence and severity of hypersensitivity reactions, silent inactivation, and common asparaginase-associated adverse effects were collected.

Management of pediatric febrile seizures in the emergency department.

Febrile seizures are a common presentation to emergency departments. While established guidelines exist, variation in the management and treatment of febrile seizures persists across emergency departments. This issue reviews the definition of pediatric febrile seizure and discusses the presentation, differential diagnosis, management, and prognosis.

Risk factors for joint bleeding in severe hemophilia A and B: analysis of the Community Counts longitudinal surveillance cohort.

Joint bleeding is the primary determinant of end-stage arthropathy in hemophilia; joint bleeding has greatly decreased with the use of prophylaxis and introduction of highly effective therapies. This study aimed to determine current risk factors for joint bleeding in persons with severe hemophilia A or B. Demographic, treatment, and bleeding outcome data from Community Counts, a US national surveillance project, were analyzed.

Navigating nature's remedies: herbal and botanically derived complementary alternative medicine for children.

Purpose Of Review: The growing interest in complementary and alternative medicine (CAM) has sparked discussions about its role in modern pediatric healthcare. While some parents may turn to herbal supplements, essential oils, and other remedies for symptom management, questions remain regarding their safety, efficacy, and regulation for pediatric use. Pediatricians should understand the benefits and limitations of CAM to effectively inform families.

Recognition and Management of Iatrogenically Induced Opioid Dependence and Withdrawal in Children: Clinical Report.

Opioids are often prescribed to children for pain relief related to procedures, acute injuries, and chronic conditions. Around-the-clock dosing of opioids can produce physiologic opioid dependence within 5 days. According to a 2001 consensus paper from the American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine, dependence is defined as "a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, or administration of an antagonist.

Serum Syndecan-1 is Associated With Kidney and Cardiovascular Outcomes in Idiopathic Nephrotic Syndrome.

Introduction: Idiopathic nephrotic syndrome (INS) is associated with important kidney and cardiovascular morbidities. We tested the hypothesis that serum syndecan-1, a marker of endothelial glycocalyx injury, can help identify patients at risk for unfavorable kidney and cardiovascular outcomes.

Methods: We included 348 children and adults with INS ( = 35 unbiopsied, = 141 minimal change disease [MCD] and = 172 focal segmental glomerulosclerosis [FSGS]) from the Nephrotic Syndrome Study Network (NEPTUNE) cohort and 34 healthy participants ( = 22 adults, = 12 children).

Barriers and Opportunities for Diabetes Medical Management Plan (DMMP) Implementation in Schools: A National Survey of School Nurses and Diabetes Providers.

The American Diabetes Association (ADA) Diabetes Medical Management Plan (DMMP) was developed to serve as a gold standard. In preparation for planned revisions to address technology updates for school professionals, we surveyed diabetes health care providers (HCPs) and school nurses to understand barriers and facilitators to DMMP use. Respondents ( = 586) were predominantly school nurses ( = 509, 87%) and represented all US regions.

Surgical synergy: Assessing care coordination in pediatric surgical referral programs.

Background: Specialized pediatric surgical referral programs (PSPs) for complex conditions are increasing across the United States, resulting in care rendered geographically distant from patients' homes. We explored care coordination gaps across differing stakeholder perspectives to identify opportunities to optimize post-discharge practices in this evolving landscape.

Methods: We reviewed published literature for guidelines and consensus statements on ideal care coordination practices.

Line Insertion through a Long Umbilical Stump: A Concept Generating Laboratory Study.

Umbilical line insertion involves discomfort for preterm infants. We hypothesized that a 10- to 20-cm umbilical cord segment can be catheterized with an appropriate guide wire. This may facilitate line establishment with minimal baby discomfort.

Treatment outcomes in 63 cases of juvenile dermatomyositis-associated calcinosis.

Objectives: We performed a multi-institutional retrospective review of patients treated for juvenile dermatomyositis (JDM)-associated calcinosis to analyse the association between treatment outcomes and patient, disease, and treatment characteristics.

Methods: Childhood Arthritis and Rheumatology Research Alliance investigators searched their electronic health records for patients with JDM and calcinosis treated between 2003 and 2019 and analysed data at JDM diagnosis, calcinosis diagnosis, and calcinosis treatment. Statistical methods included univariable and multivariable analyses, Kaplan-Meier estimates, and multivariable Cox models.

Influenza-Associated Acute Necrotizing Encephalopathy in US Children.

Importance: Acute necrotizing encephalopathy (ANE) is a rare, but severe, neurologic condition for which epidemiologic and management data remain limited. During the 2024-2025 US influenza season, clinicians at large pediatric centers anecdotally reported an increased number of children with influenza-associated ANE, prompting this national investigation.

Objective: To understand the clinical presentation, interventions, and outcomes among US children diagnosed with influenza-associated ANE.

Integration of Adjunctive Therapy for Congenital Adrenal Hyperplasia.

CAH represents a prototypical enzyme deficiency disorder, most commonly affecting steroid 21-hydroxylase, in which the critical adrenal pathway from cholesterol to cortisol is blocked [...

Hypoglossal nerve stimulator for obstructive sleep apnea in children with down syndrome younger than 13.

Objective: Obstructive Sleep Apnea (OSA) is prevalent among children with Down syndrome (DS). While adenotonsillectomy is the first-line treatment for these patients, many do not achieve resolution of OSA. The U.

Transcatheter Structural Heart Interventions in Women.

Purpose Of Review: To provide a review of current transcatheter structural heart interventions in women, with a focus on sex-specific considerations in diagnosis, treatment and outcomes.

Recent Findings: Transcatheter interventions have transformed structural heart disease treatment, including valvular heart disease and left atrial appendage closure. Historically, low female enrollment in cardiovascular trials has limited sex-specific data integration into clinical guidelines.

Achieving meaningful reduction of HgbA1c in pediatric type 1 diabetes requires an individualized approach.

Objective: Individuals with diabetes often have difficulty attaining a goal hemoglobin A1c < 7.0 %. Diabetes care is multifactorial, including medications, education, and lifestyle intervention.