Non-Sedated Intrauterine Device Experiences Among Transgender and Cisgender Adolescents and Young Adults in the Outpatient Setting.

Study Objectives: This study compares the demographic characteristics and experiences of three different groups of adolescent and young adults (AYAs) seeking non-sedated intrauterine device (IUD) insertion in the outpatient setting: (1) cisgender individuals, (2) transgender and gender diverse (TGD) individuals receiving gender-affirming testosterone therapy, and (3) TGD individuals not receiving gender-affirming testosterone therapy.

Methods: This retrospective cohort study included AYAs age 13 to 21 years seeking IUD insertion. Data were obtained from the electronic health record via a pre-existing, multi-institutional shared quality improvement (QI) collaborative.

Refining Management of Pediatric First Rib Fractures Without Major Trauma.

Purpose: First rib fractures in children are typically associated with high-impact trauma; atraumatic etiologies remain understudied. The purpose of this study is to evaluate the presentation and management of pediatric first rib fractures in the absence of major trauma.

Methods: This is a retrospective study of pediatric patients diagnosed with first rib fractures between 2000-2023 at a quaternary, free-standing children's hospital.

Advancing preclinical biology for Ewing Sarcoma: an international effort.

Ewing sarcoma (EwS) is an aggressive bone and soft tissue cancer affecting adolescents and young adults. In vitro and in vivo models of EwS have been instrumental in advancing our understanding of EwS biology and essential in evaluating potential therapies, particularly for metastatic or relapsed disease where effective treatment options remain limited. Through an international collaborative effort between the Children's Oncology Group (COG) Bone Tumor Committee and the Euro Ewing Consortium (EEC), we review the current landscape of preclinical modeling used in EwS research encompassing both in vitro (cell lines and tumor organoids) and in vivo (mouse and non-mammalian xenografts) model systems.

Right Ventricular Outflow Tract Stenting in a Premature Infant With Tetralogy of Fallot.

Objective: To demonstrate a detailed procedural guide for right ventricular outflow tract (RVOT) stent placement for palliation of tetralogy of Fallot and pulmonary stenosis in a patient weighing <2 kg.

Key Steps: Obtain wire position with an 0.018-inch Hi-Torque floppy wire in a distal branch pulmonary artery.

Identifying Successful Pediatric Outpatient Antimicrobial Stewardship Strategies through Benchmarking: A Multi-Institutional Project.

Background: We evaluated the impact of benchmarking on antibiotic use and identified antibiotic stewardship (AS) strategies affecting pediatric outpatient antibiotic prescribing.

Methods: The Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS)-Outpatient Collaborative shared quarterly benchmarking reports with 22 institutions on antibiotic use metrics (percentage of acute and acute respiratory infection [ARI] encounters with antibiotic prescriptions, and among ARI, rates of amoxicillin and azithromycin use) for emergency departments, urgent care clinics, and primary care clinics. Data on antibiotic duration of ≤7 days were available from a subset of institutions.

Pediatric inguinal hernia: open versus laparoscopic approaches to surgical management.

Purpose Of Review: Inguinal hernia repair remains one of the most common pediatric surgical procedures. Advances in minimally invasive techniques have made laparoscopic herniorrhaphy a safe alternative to open surgery. This review summarizes clinical outcomes in open and laparoscopic pediatric inguinal hernia repair, discusses technical considerations including anesthetic choice, and reviews patient and surgical factors relevant to surgical approach and timing.

Sisyphus' Alert: The Uphill Struggle to Improve Venous Thromboembolism Prophylaxis Clinical Decision Support.

Chemoprophylaxis reduces the risk of hospital-acquired venous thromboembolism (VTE), but is not reliably ordered. Our institution created a clinical decision support (CDS) interruptive alert to remind clinicians to order VTE chemoprophylaxis when it is missing for qualifying inpatients. Unfortunately, this alert has required repeated modifications to ensure accurate logic, and continues to generate negative feedback from users.

2023 aerodigestive Society meeting: A multidisciplinary literature year in review.

The 2023 Aerodigestive Society meeting aimed to emphasize the importance of a multidisciplinary approach in managing aerodigestive disorders that affect the lungs, upper airway, and gastrointestinal tract in children. This approach necessitates the collaboration of multiple specialists and allied healthcare professionals. A collaborative approach to aerodigestive disorders is a young field with many opportunities for investigation of disease understanding and treatment approaches.

Site-Specific Adaptation of an Inpatient Patient Navigator Program at 2 Children's Hospitals.

Objective: The Family Bridge Program was developed at a single pediatric hospital to improve outcomes for hospitalized children from families of color, who are low income, or who speak a language other than English. The program uses a family navigator ("Guide") that supports families via 6 service domains: Language Access, Orientation to the Hospital, Communication Preferences and Coaching, Addressing Unmet Social Needs, Supportive Check-Ins, and Discharge Follow-Up. This study describes an analysis to translate the program to a second pediatric hospital.

HCN channels reveal conserved and divergent physiology in supragranular pyramidal neurons in primate species.

The physiological properties of human and rodent neurons differ, yet the extent to which these differences reflect human specializations is often unclear. Compared with their rodent counterparts, human supragranular pyramidal neurons possess enriched HCN-channel-dependent intrinsic membrane properties and a related sensitivity to synaptic inputs containing delta/theta band frequencies. We tested whether other primate species possess enriched HCN-channel dependent membrane properties.

The Role of Trusted Adults in Shaping Adolescent Health Information Access and Mental Wellbeing in Urban India.

Background: Adolescents in urban India face significant challenges in accessing healthcare and reliable health information, particularly during crises such as the COVID-19 pandemic. However, the role of trusted adults in shaping adolescent health remains underexplored.

Objectives: This study examined healthcare access, health information exposure, and the influence of trusted adults among urban Indian adolescents during the COVID-19 pandemic.

Reducing Routine Cardiology Evaluation Prior to Initiating Propranolol for Infantile Hemangiomas.

Objective: Determine if all patients with infantile hemangioma (IH) should undergo cardiology evaluation prior to initiating propranolol therapy or if only select patients should undergo cardiology evaluation, as indicated by a Propranolol Screening Checklist (PSC).

Methods: Retrospective review of 806 IH patients treated with propranolol between 2008 and 2018 at a single tertiary center. Statistical process control methods were used to compare the cardiology recommendations between the pre-PSC and post-PSC populations and there was special cause variation after implementation of the checklist.

Creating Data Systems to Promote Health Equity.

Health equity is an increasing focus for health services research as well as in ongoing refinements of health care delivery. However, the process of collecting and incorporating patient-level data into models and then translating these findings into the health care delivery processes is fraught with a multitude of potential mechanisms of compounding systematic disparities. Structural discrimination and human biases affect equity in collection of data, which ultimately impacts modeling and resultant findings.

Childhood Differences in Healthcare Utilization Between Extremely Preterm Infants and the General Population.

Post-discharge clinical needs of extremely preterm (EP) infants are not well defined. The aim of this study is to evaluate healthcare utilization after discharge in infants born EP and compare it to the general pediatric population. This study involved a post hoc analysis of infants born 24-0/7 to 27-6/7 weeks' gestation enrolled in the Preterm Erythropoietin Neuroprotection (PENUT) Trial who had at least one follow-up survey representing their course between 24 and 60 months of age.

Phase 1 and expanded imaging study of tozuleristide in patients with pediatric primary central nervous system tumors.

Objective: Fluorescence-guided surgery has been shown to increase the extent of resection in adult high-grade glioma. The peptide-dye conjugate tozuleristide is a fluorescence-guided surgical agent under development to aid in visualization of tumor tissue during CNS tumor resection. The goals of this study were to assess safety, pharmacokinetics, and the fluorescent signal of tozuleristide in primary CNS tumors in pediatric patients with CNS cancers and to determine a recommended dose for phase 2 studies.

Imatinib For Treatment of Multifocal Maxillofacial Giant Cell Lesions: A Case Series.

Maxillofacial giant cell lesions (MGCLs) can lead to disfigurement and functional impairments. Management often involves a combination of operative and nonoperative strategies. This case series presents the first reported use of imatinib for multifocal MGCLs in a patient with Noonan syndrome, alongside 2 patients with cherubism.

Survey of Well-being of Young Children: Implementation and Impact on Care Quality.

Introduction: Despite the American Academy of Pediatrics recommendations to use validated developmental screening tools, national adoption remains low. To address this, we launched a quality improvement project to implement the Survey of Well-being of Young Children (SWYC) in our residency clinic and assess its impact. Our primary aim was to achieve more than 50% screening coverage for early childhood well visits, with equitable implementation across both English-speaking and non-English primary speaking families.

The Evolving Pathophysiology of Bronchopulmonary Dysplasia.

Bronchopulmonary dysplasia (BPD) is the most common morbidity in very preterm infants, and is characterized by abnormal development of the lung. The pathophysiology of BPD is primarily due to effects of placental dysfunction, hyperoxia, ventilator-induced lung injury, poor nutrition, abnormal blood flow, and genomic/epigenomic factors on an immature lung. These adverse factors act on multiple cell types through many interacting signaling pathways.

Anatomical study of the superficial cervical plexus targeted for sensory nerve blocks in neonates.

Introduction: The superficial cervical plexus block can be used to provide perioperative analgesia in pediatric patients undergoing thyroid surgeries, brachial cleft cyst excision, tympano-mastoid surgery, as well as cochlear implantation. The cervical plexus is formed by the first four cervical spinal nerves, and the superficial cutaneous branches emerge from the posterior border of the sternocleidomastoid muscle, often referred to as the "nerve point of the neck." The aims of this study were to evaluate the location of this nerve point and formulate a standardized method of blocking the superficial cervical plexus in pediatric patients.

Dysfunctional Electron Transport Chain Assembly in COXPD8.

Combined oxidative phosphorylation deficiency type 8 (COXPD8) is an autosomal recessive mitochondrial disorder caused by a mutation of the nuclear encoded mitochondrial alanyl-tRNA synthetase gene (AARS2). Clinical manifestations of COXPD8 include lethal infantile hypertrophic cardiomyopathy, pulmonary hypoplasia, generalized muscle weakness, and neurological involvement. We report a patient with COXPD8 caused by two mutations in the AARS2 gene.

Heterozygous variants in affect hearing, vision, cardiac, and immune function.

Phospholipase C isozymes (PLCs) hydrolyze phosphatidylinositol 4,5-bisphosphate (PIP) into inositol 1,4,5-trisphosphate (IP) and diacylglycerol (DAG), important signaling molecules involved in many cellular processes including Ca release from the endoplasmic reticulum (ER). encodes the PLCγ1 isozyme that is broadly expressed. Hyperactive somatic mutations of are observed in multiple cancers, but only one germline variant has been reported.

Gender-Affirming Chest Surgery in Adults with Extreme BMI: A Multi-Center Retrospective Analysis of Clinical Outcomes.

Background: Transgender and gender-diverse (TGD) patients face multifactorial barriers to accessing medically-necessary interventions, including gender-affirming chest surgery (GACS). Surgeons may exacerbate this inequity by imposing preoperative body mass index (BMI) requirements on their patients. Recent studies present conflicting evidence regarding the association between BMI and postoperative complications following GACS; however, no studies have assessed these outcomes in cases of extremely high BMI (>40 kg/m).

Surveying Child and Adolescent Inpatient Psychiatric Units: Demographics, Policies, and Practice.

Background: The increasing demand for acute inpatient psychiatric unit (IPU) treatment for children and adolescents in recent years has put significant pressure on hospital systems to provide efficient and effective care. However, there is a gap in the literature regarding the characteristics of IPU care for children and adolescents in the US, making it difficult for institutions to benchmark their performance against nationwide standards or understand generalizability of existing research.

Objective: To address this gap in the literature by beginning to collect descriptive data on significant variables for youth care from a geographically and institutionally diverse group of on Child and Adolescent IPUs.