bims-cliped Biomed News
on Clinical pediatrics
Issue of 2026–08–09
25 papers selected by
Alyssa M. Portwood, Akron’s Children
  1. Bridging Practice and Publication: Reexamining Quality Improvement in Pediatric Scholarship.
  2. Telemedicine in pediatrics: a critical narrative review of innovations, limitations, and future priorities.
  3. Environmental disinfection: Strategies to keep pediatric patients safe.
  4. Beyond Survival: Child and Parent Well-Being in Pediatric Heart Failure.
  5. Opportunities for Pediatricians to Address Racism and Bias to Reduce Racial Disparities in Breastfeeding and the Use of Human Milk: Policy Statement.
  6. Continuous Glucose Monitoring in Children and Adolescents With Type 2 Diabetes: A Narrative Review.
  7. Effectiveness of RSV Prevention Strategies in US Infants: 2024-2025.
  8. Practice Variation in Antibiotic Duration for Acute Otitis Media in Children Aged 2 to 5 Years: Five Versus 7 Days in a Multicenter Pediatric Cohort.
  9. Utilization of Postpartum Depression Screening in the Pediatric Emergency Department.
  10. Resident Perspectives on Post-Rounds Communication With Families Using Diverse Languages.
  11. Management and Outcomes of Pediatric Dog Bites at a Single Institution.
  12. Disproportionate pace of evidence-based care implementation in pediatric-onset multiple sclerosis: consequences and opportunities.
  13. Reducing Pediatric Medication Safety Risks Through Improved Dosing Weight Accuracy: A Hospital-Based Quality Improvement Initiative.
  14. Children With Complex Chronic Conditions in the Child Protective Services.
  15. Considerations in Transition of Pediatric Neurology Patients to Adult Care.
  16. Guides, algorithms and other support tools to improve neonatal and pediatric venous access care: A scoping review.
  17. Initial Specimen Diversion Devices for Emergency Department Blood Cultures May Reduce Contamination Rates and Costs: Structured Literature Review.
  18. Harnessing Artificial Intelligence to Strengthen Acute and Critical Care Nursing Practice: A Systematic Review.
  19. Characteristics of pediatric drowning out-of-hospital cardiac arrests in the United States.
  20. Interventional Procedures in Pediatric Musculoskeletal Diseases.
  21. Improving the Safety and Quality of Care for Children and Young People With Intellectual and Developmental Disability. The Motivated for Change Programme in a Paediatric Emergency Department Setting. A Mixed Methods Study.
  22. Implementation of Immersive Technologies in Pediatric Perioperative Care: A Multi-Institutional Survey Study.
  23. Complicated Acute Rhinosinusitis in Cystic Fibrosis: National Inpatient Pediatric Analysis.
  24. Evaluating Bright Futures Pediatric Handouts: Readability, Understandability, Actionability, and Clinical Implications.
  25. Molluscum Contagiosum in the Pediatric Population: Expert Consensus Guidance on Prevention and Treatment.
  1. Hosp Pediatr. 2026 Aug 07. pii: e2026009488. [Epub ahead of print]
    Bridging Practice and Publication: Reexamining Quality Improvement in Pediatric Scholarship.
    Preston Simmons, Brittany M Hunter, Alejandra Frauenfelder Sánchez, Patrick Brady, David P Johnson.
      Quality improvement (QI) publication rates in pediatrics surged through the early 21st century yet have noticeably plateaued since that time, a paradoxical shift given the volume of ongoing improvement work across pediatric health systems. We propose that the gap lies not in the quality of work being performed but in the disconnect between rigorous local improvement and publishable scholarship. Key deficits include inadequately specified aims, absent or implicit theories of change, analytic approaches that cannot distinguish intervention-related improvement from routine variation, and insufficient attention to sustainability. Closing this gap requires renewed commitment to 4 foundational components through clear operational definitions and specific, measurable, achievable, relevant, time-bound (SMART) aims that signal prospective planning to reviewers, an explicit theory of change operationalized through a well-constructed key driver diagram, time-series analytic methods capable of demonstrating special cause variation attributable to the intervention, and demonstrated sustainability evidenced by replicable change rather than temporary disruption. Rigorous single-center QI with well-described context and an explicit theory of change remains the foundation of the field. Protecting its integrity is a shared responsibility among authors, mentors, journals, and health systems and is essential to advancing evidence-based care for children.
    DOI:  https://doi.org/10.1542/hpeds.2026-009488
  2. Eur J Pediatr. 2026 Aug 01. pii: 631. [Epub ahead of print]185(8):
    Telemedicine in pediatrics: a critical narrative review of innovations, limitations, and future priorities.
    Gianvincenzo Zuccotti, Ilaria Anna Maria Scavone, Erika Cordaro, Virginia Rossi, Valeria Calcaterra.
      This narrative review synthesizes recent technological and organizational developments in pediatric telemedicine, maps their principal clinical applications, and critically discusses implementation, safety, equity, and future priorities. This narrative review used a transparent, non-systematic literature-search approach in PubMed/MEDLINE, Scopus, and Google Scholar, considering publications available through April 2026. Searches were intended to identify and contextualize relevant literature across pediatric settings rather than to provide an exhaustive, reproducible systematic evidence synthesis. No formal risk-of-bias assessment, meta-analysis, or certainty-of-evidence grading was undertaken; therefore, findings are interpreted cautiously and according to the maturity and consistency of the available evidence. Evidence suggests that telemedicine can support follow-up, access to specialist care, and family engagement in several pediatric chronic-care pathways, particularly diabetes and asthma. However, the evidence base is heterogeneous across specialties, frequently relies on observational or implementation studies, and is less mature for acute assessment, neonatal and rehabilitation uses, wearables, and AI-enabled tools.
    CONCLUSION: Telemedicine should be considered a complementary component of pediatric healthcare rather than a replacement for in-person assessment. Hybrid models may support accessibility, continuity, and sustainability when embedded in structured, patient-centered, equitable, and clinically appropriate pathways.
    WHAT IS KNOWN: • Telemedicine expanded rapidly in pediatrics during the COVID-19 pandemic and is now used across many specialties. • It can improve access, continuity of care, remote monitoring, and family engagement, especially in chronic and complex conditions.
    WHAT IS NEW: • This review summarizes recent technological and organizational innovations, including wearables, mHealth, EHR integration, AI, and hybrid care models. • It highlights current limits and future requirements for safe, equitable, and sustainable integration into routine pediatric care.
    Keywords:  Digital health; Pediatric chronic diseases; Pediatric telemedicine; Remote monitoring; Telehealth; Virtual care
    DOI:  https://doi.org/10.1007/s00431-026-07262-1
  3. Am J Infect Control. 2026 Sep;pii: S0196-6553(26)00360-3. [Epub ahead of print]54(9S): S147-S155
    Environmental disinfection: Strategies to keep pediatric patients safe.
    William A Rutala, David J Weber.
       BACKGROUND: Environmental contamination in children's hospitals contributes to the infection risk because microbes survive on surfaces and are easily transferred via staff/patients/visitors' hands to sick children via contaminated hands.
    METHODS: The published English literature was searched on environmental disinfection strategies to keep infant and pediatric patients safe from healthcare pathogens.
    RESULTS: This paper presents evidenced-based disinfection practices, using safe and effective disinfectants, to reduce the risk to children from toys, games, stuffed animals, and environmental surfaces.
    CONCLUSIONS: Maintaining a hygienic environment significantly reduces the risk of transmission of pathogens to pediatric patients and improves patient safety.
    Keywords:  Decontamination; Disinfection; Infection prevention; Pediatrics; Surfaces
    DOI:  https://doi.org/10.1016/j.ajic.2026.03.010
  4. Pediatr Cardiol. 2026 Aug 07.
    Beyond Survival: Child and Parent Well-Being in Pediatric Heart Failure.
    Lindsay J May, Josef Stehlik, Sharon Chen, Nelangi M Pinto, Heather T Keenan.
      Children with heart failure are at high risk of multiple hospitalizations, eventual need for heart transplant, and mortality. When at home, support and medical care are provided by parents. In this high-stakes situation, the quality of life of both the child and parents can be impacted. In recent years quality of life is increasingly relevant, as more medically complex children are now cared for at home and transplant waitlist times have lengthened. In this contemporary cohort, we conducted semi-structured interviews of dyads of children with HF and their parents, then used thematic analysis to identify quality of life themes. Among 13 dyads, 5 central themes emerged: (1) Both parents and children desire as much of a "normal" life as possible. (2) Parent responsibilities are extensive- they operate at maximum capacity in their medicalized parent role and face psychosocial challenges of their own. (3) Parents and children experience social isolation which is multifactorial and increases over time. (4) Coping methods are diverse- parents and children are resilient. (5) Specific supportive resources, in particular mental health resources, are lacking. We conclude that many opportunities exist to develop and improve program support for the pediatric HF population.
    Keywords:  Caregiver; Heart failure; Parent; Pediatrics; Quality of life; Well-being
    DOI:  https://doi.org/10.1007/s00246-026-04405-x
  5. Pediatrics. 2026 Aug 03. pii: e2026078282. [Epub ahead of print]
    Opportunities for Pediatricians to Address Racism and Bias to Reduce Racial Disparities in Breastfeeding and the Use of Human Milk: Policy Statement.
    Section on Breastfeeding
      Pediatricians play an essential role in breastfeeding care and are uniquely positioned to help reduce racial disparities in breastfeeding. Evidence-based solutions include partnerships between pediatricians and community health workers, implementation of culturally centered hospital practices, securing fair payment for lactation services and supplies, practices that discourage commercial milk formula marketing in clinical settings, and ongoing learning about breastfeeding in different cultures. Pediatricians can avail themselves of resources that may elevate their role in achieving equitable breastfeeding care throughout the US.
    DOI:  https://doi.org/10.1542/peds.2026-078282
  6. J Paediatr Child Health. 2026 Aug 04.
    Continuous Glucose Monitoring in Children and Adolescents With Type 2 Diabetes: A Narrative Review.
    Cate O'Brien, Kairavi Sethi, Alexia Peña.
       AIM: Continuous glucose monitoring (CGM) has well-established benefits in Type 1 diabetes; however, evidence in paediatric Type 2 diabetes (T2D) remains limited, and CGM is not currently publicly funded for this group in Australia. This review aimed to evaluate the impact of CGM use in adolescents with T2D.
    METHODS: A systematic search of Ovid Medline, Embase, CINAHL and Emcare was conducted for studies published from database inception to 18 November 2025 that evaluated CGM use in children and adolescents with T2D. Outcomes included glycaemic measures (HbA1c and time in range [TIR]), patient-reported benefits and barriers and psychological outcomes.
    RESULTS: Of 1019 manuscripts identified, eight studies met inclusion criteria. Study designs were longitudinal or cross-sectional, with relatively small sample sizes (7-41 participants). Five studies assessed HbA1c and TIR, two demonstrating short-term improvements that were not consistently sustained over time. Reported benefits included improved lifestyle behaviours, greater ease of diabetes management and increased frequency of glucose monitoring. Common barriers were sensor adhesion issues, connectivity challenges and concerns regarding wearability. Psychological outcomes were variable across studies.
    CONCLUSIONS: CGM use in children and adolescents with T2D is associated with transient improvements in glycaemic control and perceived benefits in daily diabetes management; however, technical and usability barriers limit sustained effectiveness. Structured education for children and families is essential to overcome these barriers and optimise long-term outcomes. Current evidence supports consideration of CGM funding for children and adolescents with T2D in Australia, alongside implementation of education programs to maximise benefit.
    Keywords:  adolescents; children; continuous glucose monitoring; type 2 diabetes
    DOI:  https://doi.org/10.1111/jpc.70525
  7. Pediatrics. 2026 Aug 04. pii: e2026076089. [Epub ahead of print]
    Effectiveness of RSV Prevention Strategies in US Infants: 2024-2025.
    Amanda B Payne, Steph Battan-Wraith, Sarah E Reese, Cassandra A Hathaway, Sara Y Tartof, Karthik Natarajan, Stephanie A Irving, Shaun Grannis, Sean Chickery, Gabriela Vazquez-Benitez, Kristin Dascomb, S Bianca Salas, Cassandra Bezi, Lina S Sy, Bruno Lewin, Melissa S Stockwell, Ashley B Stephens, Jungmi Han, Allison L Naleway, Brian E Dixon, Colin Rogerson, Thomas Duszynski, William F Fadel, Sarah W Ball, Jingran Cao, Charlene McEvoy, Tamara Sheffield, Daniel Bride, Julie Arndorfer, Joshua Van Otterloo, Monica Godfrey, Amber Kautz, Allison Avrich Ciesla, Morgan Najdowski, Josephine Mak, Jennifer DeCuir, Ryan E Wiegand, Ruth Link-Gelles.
       OBJECTIVE: In 2023, 2 products, a long-acting monoclonal antibody (nirsevimab) and maternal respiratory syncytial virus (RSV) vaccination, were recommended in the United States to prevent severe RSV disease among infants in their first RSV season. Low uptake during the 2023 to 2024 RSV season limited effectiveness estimates. We estimated nirsevimab and maternal RSV vaccine effectiveness against RSV-associated emergency department (ED) encounters and hospitalization among US infants during the 2024 to 2025 RSV season, when uptake was higher.
    METHODS: We used electronic health record data from 5 health care systems in test-negative analyses of ED encounters and hospitalizations with RSV-like illness during October 1, 2024 to March 31, 2025, among infants in their first RSV season. Nirsevimab and maternal RSV vaccine effectiveness were estimated by comparing RSV-positive with RSV-negative encounters with respect to immunization status in separate logistic regression models adjusted for age, race and ethnicity, sex, calendar day, and geographic region.
    RESULTS: Among 3531 ED encounters and 470 hospitalizations included in the nirsevimab analyses, nirsevimab effectiveness against RSV-associated ED encounters and hospitalization was 62% (95% CI: 54-68) and 77% (95% CI: 61-87), respectively. Among 810 ED encounters and 187 hospitalizations included in the maternal RSV vaccine analyses, vaccine effectiveness against RSV-associated ED encounters and hospitalization was 49% (95% CI: 26-65) and 82% (95% CI: 54-93), respectively.
    CONCLUSION: Nirsevimab and maternal RSV vaccination were effective against RSV-associated ED encounters and hospitalization among infants in their first RSV season. As uptake increases and additional products are recommended, monitoring infant RSV immunization effectiveness remains important.
    DOI:  https://doi.org/10.1542/peds.2026-076089
  8. Pediatr Emerg Care. 2026 Aug 05.
    Practice Variation in Antibiotic Duration for Acute Otitis Media in Children Aged 2 to 5 Years: Five Versus 7 Days in a Multicenter Pediatric Cohort.
    Andrea Rivera-Sepulveda, Nabeel Mohammad, Adaobi Okocha, Zhuo Li, Sophia Blumenfeld, Arezoo Zomorrodi.
       BACKGROUND: Acute otitis media (AOM) is among the most common pediatric infections and a leading indication for antibiotic prescribing. Although current guidelines recommend 5 to 7 days of therapy for children 2 to 5 years of age with uncomplicated AOM, variation in antibiotic duration remains common. We evaluated whether a 5-day antibiotic course was associated with similar short-term outcomes compared with a 7-day course.
    METHODS: We conducted a retrospective multicenter cohort study using electronic health record data from 44 pediatric emergency departments, urgent care centers, and primary care practices within an integrated health care system. Children 2 to 5 years of age with uncomplicated AOM treated with a single oral antibiotic during 2022 were included. The primary analysis compared children prescribed 5 versus 7 days of therapy. Treatment failure was defined as an AOM-related return encounter requiring a new systemic antibiotic prescription within 7 days after completion of therapy (EOT+7). Secondary analyses evaluated outcomes by antibiotic class and prespecified sensitivity analyses.
    RESULTS: The final analytic cohort included 7528 children; 906 received 5-day therapy, and 1799 received 7-day therapy. Treatment failure occurred in 0.44% and 0.61%, respectively (absolute risk difference: -0.17%; 95% CI: -0.73 to 0.39; risk ratio: 0.72; 95% CI: 0.23-2.26). Findings were consistent across antibiotic-specific and sensitivity analyses.
    CONCLUSIONS: Among children 2 to 5 years of age with uncomplicated AOM, a 5-day antibiotic course was not associated with an increased risk of short-term treatment failure compared with a 7-day course, supporting guideline-concordant prescribing and outpatient antimicrobial stewardship.
    Keywords:  acute otitis media; antibiotics; short course; stewardship
    DOI:  https://doi.org/10.1097/PEC.0000000000003670
  9. Pediatr Emerg Care. 2026 Aug 03.
    Utilization of Postpartum Depression Screening in the Pediatric Emergency Department.
    Marissa S Cantu, Whitney Schwarz, Janine Perkins, Julyssa Gallegos, John Arbo.
       BACKGROUND: Postpartum depression (PPD) is a common complication of childbirth with significant implications for maternal and child health. Standard screening practices may miss mothers with later-onset symptoms. The pediatric emergency department (PED) may provide an opportunity to extend PPD screening beyond routine outpatient care.
    OBJECTIVES: To evaluate the feasibility and utilization of Edinburgh Postnatal Depression Scale (EPDS) screening for PPD among mothers of children 12 months or younger presenting to a PED and to describe the demographics of screened patients.
    METHODS: We conducted a retrospective descriptive study of EPDS screening implemented as a quality improvement initiative in an urban academic PED between May 15, 2023 and November 30, 2023. Biological mothers of children 12 months or younger were screened at triage using the EPDS in English or Spanish. Positive screens were defined as a score ≥9 or endorsement of suicidal ideation. Demographic data, Emergency Severity Index (ESI), insurance status, EPDS results, and documented interventions were abstracted from the electronic medical record.
    RESULTS: A total of 734 EPDS screens were completed. Forty-one mothers (5.6%) screened at risk or positive. Of these, 17 (41%) had infants aged 6 to 12 months. Maternal mental health resources were offered to 37 (90.2%) mothers with positive screens. All mothers with positive screens had public insurance. The screened population was predominantly white (41.1%) and Hispanic (41.1%).
    CONCLUSIONS: PPD screening in the PED for mothers of children up to 12 months of age is feasible and may identify at-risk mothers. PED-based screening may help address gaps in maternal mental health care for underserved populations.
    Keywords:  edinburgh postnatal depression scale (EPDS); emergency department utilization; maternal mental health; mental health screening; pediatric emergency department; postpartum depression; quality improvement
    DOI:  https://doi.org/10.1097/PEC.0000000000003671
  10. Hosp Pediatr. 2026 Aug 06. pii: e2025008845. [Epub ahead of print]
    Resident Perspectives on Post-Rounds Communication With Families Using Diverse Languages.
    Alexandra Lieberman, Christopher J Russell, Lynne Huffman, Angela Castellanos.
       OBJECTIVE: To explore pediatric residents' experiences communicating with families after rounds and identify barriers and facilitators to communication with families using languages other than English (LOE).
    METHODS: We conducted a qualitative study using semi-structured interviews with pediatric residents at a freestanding children's hospital. We used purposive sampling to recruit residents who recently worked on inpatient general pediatrics or subspecialty medical teams. Interviews were audio recorded, transcribed, and coded via inductive thematic analysis to develop codes and themes. Two investigators independently reviewed transcripts before reconciling codes. Interviews continued until thematic sufficiency was achieved.
    RESULTS: We interviewed 17 participants and identified 3 themes: (1) post-rounds communication is meaningful for residents, fostering connection, professional fulfillment, and family-centered care; (2) communication is inconsistently prioritized given competing clinical demands and shaped by unclear expectations and prior experiences with families; (3) communication challenges are heightened for families using LOE as reliance on language services, availability constraints, and variable interpreter modalities amplify time pressures and compromise quality. These barriers contribute to post-rounds communication disparities for families using LOE, including delayed updates and less rapport-building. Residents suggested improving communication through increased interpreter access, enhanced training, and improved interpreter request processes.
    CONCLUSION: Residents value post-rounds communication, but competing clinical priorities without explicit expectations make it difficult to get back to the bedside. Challenges are amplified for families using LOE due to the need for interpretation and contribute to communication disparities. Next steps involve better understanding other team and caregiver perspectives and developing system-wide strategies to support equitable communication practices.
    DOI:  https://doi.org/10.1542/hpeds.2025-008845
  11. J Pediatr Health Care. 2026 Jul 31. pii: S0891-5245(26)00221-X. [Epub ahead of print]
    Management and Outcomes of Pediatric Dog Bites at a Single Institution.
    Cody Dalton, Eli Isenberg, Brock Crockett-Beck, Zoona Sarwar, Jeremy Johnson, Catherine J Hunter.
       OBJECTIVES: Pediatric dog bite injuries are a common cause of emergency department. This study aimed to characterize management, and outcomes of pediatric dog bite injuries at a tertiary care center and identify implications for pediatric emergency practitioners.
    METHODS: A retrospective chart review was conducted of patients with dog bite injuries over two-years at a single pediatric tertiary care center. Descriptive statistical analysis was performed on injury characteristics, management, and outcomes.
    RESULTS: Most injuries occurred in familiar environments. Facial injuries were most common (83%). Nearly all patients (98.9%) required laceration repair mostly in the emergency department. Most patients had antibiotics. Minimal complications were observed and were primarily cosmetic.
    CONCLUSIONS: Pediatric dog bite injuries most frequently involve the face and are typically managed nonoperatively. Multidisciplinary consultation is often required, particularly for complex facial injuries. This supports prompt assessment, appropriate wound management, and targeted antibiotic use in pediatric emergency care.
    Keywords:  Pediatric trauma; animal-associated trauma; antimicrobial prophylaxis; injury prevention; multidisciplinary trauma care
    DOI:  https://doi.org/10.1016/j.pedhc.2026.06.016
  12. Implement Sci Commun. 2026 Aug 06. pii: 143. [Epub ahead of print]7(1):
    Disproportionate pace of evidence-based care implementation in pediatric-onset multiple sclerosis: consequences and opportunities.
    Claudia Gambrah-Lyles, Jordan J Cole, Alex T Ramsey.
       BACKGROUND: Pediatric-onset multiple sclerosis (POMS) is a chronic autoimmune disease of the central nervous system that requires lifelong care. Long-term outcomes in POMS depend on both early therapeutic intervention and sustained continuity of specialty care into adulthood. However, there is a discrepancy between the speed and consistency at which pharmaceutical disease-modifying therapies and best practices for transition-to-adult care are incorporated into clinical practice. While pharmaceutical disease-modifying therapies have been rapidly incorporated into routine practice, uptake of best practices for transition-to-adult care has been inconsistent and slow, despite evidence-based guidelines and models.
    MAIN BODY: There is an urgent need for the implementation of transition-to-adult care interventions to "catch up" to that of disease-modifying therapies for POMS. Closing this gap is important because without a system of continuous care, patients lose access to disease-modifying therapies, negating the benefits of early and rapid uptake and jeopardizing long-term neurologic stability and outcomes as youth with multiple sclerosis (MS) grow into adulthood. This paper applies the Framework to Assess Speed of Translation (FAST) to examine this contrast in implementation pace and understand why pharmaceutical disease-modifying therapies have diffused rapidly, whereas innovations to support transitioning to adult care have not. We examine how innovation, adopter and contextual factors affect the diffusion and uptake of innovations in POMS, illustrating how interventions with observable relative advantage, strong champions, and compatibility with existing medical paradigms are propelled through the system, whereas interventions that are perceived as more complex, diffuse in ownership, and less visibly linked to outcomes are hindered. We argue that future efforts to improve transition-to-adult care in POMS must systematically identify and address determinants of pace that have slowed progress to date. Guided by the Designing for Accelerated Translation (DART) framework, we propose strategies for developing and mapping transition-to-adult care interventions that emphasize rapid translation.
    CONCLUSION: Our objective is to facilitate the acceleration of translation of evidence-based transition-to-adult care practices in POMS so that continuity of care keeps pace with therapeutic innovation, maximizing long-term outcomes for this population.
    Keywords:  Adolescent health; Implementation pace; Implementation speed; Pediatric multiple sclerosis; Transition-to-adult care
    DOI:  https://doi.org/10.1186/s43058-026-01069-9
  13. J Nurs Care Qual. 2026 Aug 04.
    Reducing Pediatric Medication Safety Risks Through Improved Dosing Weight Accuracy: A Hospital-Based Quality Improvement Initiative.
    Katelyn Brant, Judith Ascenzi, Meghan Rowcliffe, Scott Burkett, Ann Kane.
       BACKGROUND: Avoidable medication errors involving inaccurate weight-based dosing in pediatric patients are a well-documented patient safety concern.
    LOCAL PROBLEM: Select patients receiving medications and fluids based on nonmeasured weights contributed to medication errors.
    METHODS: Using several Plan-Do-Study-Act (PDSA) intervention cycles, we aimed to increase the percentage of patients with a measured dosing weight within 12 hours of admission from a baseline of 18.5 % to greater than 75% within 6 months.
    INTERVENTIONS: PDSA cycles included awareness campaigns, education, and electronic health record enhancements to improve documentation and visualization of weight methods.
    RESULTS: Patients with documented measured weights used for dosing improved from 18.5% to 66.2%, demonstrating statistically significant improvements.
    CONCLUSIONS: Interventions are adaptable to other pediatric institutions and potentially to adult populations as well.
    Keywords:  adverse drug events; medication safety; quality improvement
    DOI:  https://doi.org/10.1097/NCQ.0000000000001006
  14. Pediatrics. 2026 Aug 07. pii: e2025075190. [Epub ahead of print]
    Children With Complex Chronic Conditions in the Child Protective Services.
    Ross W Cleveland, Hiu-Fai Fong, Jessica Liu, Jay G Berry, Edie Weller, Henry T Puls.
      
    OBJECTIVES: Little is known about the prevalence and outcomes for children with complex chronic conditions (CCCs) in the Child Protective Services (CPS) system. We aimed to determine the prevalence and associations of CCC designation across CPS outcomes and years among a group of children reported in CPS.
    METHODS: This was a retrospective, cross-sectional study using CPS and Medicaid data among children enrolled in Medicaid in Kentucky and Florida who were reported to CPS January 1, 2017, to December 31, 2020. The primary outcome was a CCC, distinguished with diagnosis codes in Medicaid claims. We derived logistic regression models to assess the aOR of a child having a CCC by type of maltreatment, report substantiation, and foster care placement, after adjusting for covariates.
    RESULTS: Among 610 886 children reported to CPS, 8.7% had a CCC. The percentage of children with a CCC increased from 6.2% to 10.7% from 2017 to 2020. A higher percentage of children in foster care vs those who were not had a CCC (18.1% vs 8.3%). Children reported for medical neglect were more likely to have a CCC (aOR, 4.53 [95% CI, 4.32-4.76]) compared with those reported for basic needs neglect. Report substantiation (aOR, 1.21 [95% CI, 1.18-1.24]) and foster care placement (aOR, 1.43 [95% CI, 1.37-1.49]) were both associated with CCC diagnoses.
    CONCLUSIONS: Children with CCCs represent a distinct and prevalent group of children reported to CPS and placed into foster care. Multisectoral systems of support are needed for these children and their families prior to and throughout CPS involvement.
    DOI:  https://doi.org/10.1542/peds.2025-075190
  15. Ann Child Neurol Soc. 2025 Sep;3(3): 145-151
    Considerations in Transition of Pediatric Neurology Patients to Adult Care.
    Asif Doja, Katherine Muir, Megan E Harrison, Sarah Healy, Ashley Vandermorris, Alene Toulany.
       Background: Transition refers to the planned, coordinated movement of adolescents from the child- and family-centered environment of pediatric care to the adult healthcare system. A well-structured transition process is essential for ensuring adolescents with chronic health conditions continue to thrive in young adulthood. Poor transitions can lead to negative health outcomes, worsening of comorbidities such as anxiety and depression, and poorer psychosocial well-being.
    Methods: This topical review combines literature from general pediatrics, adolescent medicine, general child neurology, and child neurology subspecialities to provide holistic recommendations for the transition of pediatric patients to adulthood.
    Conclusions: Core principles of transition include starting transition planning early, creating individualized transition plans, providing support before transition, and ensuring ongoing support after transition to adult care. For adolescents with neurological conditions, additional considerations include recognizing that many childhood neurological disorders are now lifelong conditions, addressing the impact of varying levels of intellectual disability, reevaluating the diagnosis at the time of transfer, and establishing emergency care planning.
    Keywords:  adult neurology; child neurology; transition
    DOI:  https://doi.org/10.1002/cns3.70019
  16. J Hosp Med. 2026 Aug 02.
    Guides, algorithms and other support tools to improve neonatal and pediatric venous access care: A scoping review.
    Alina G Burek, Katie Butler, Tracey Liljestrom, Erin Weber, Grayce Endres, Libby Stutzman, Kelsey Porada, Ahmed Mohammed, Hayley E Severson, Kathryn E Flynn, Amanda Ullman, Mary Beth Hovda Davis.
       BACKGROUND/OBJECTIVE: Despite the ubiquitous need of venous access in children, care is often highly variable, lacking standardization. Our objective was to review current venous access guides, algorithms, and other tools available for clinical implementation; map out their focus (device type, population); and identify quality gaps.
    METHODS: A scoping review with a systematic search of Ovid MEDLINE and other databases was completed on January 24, 2025. All study designs describing the development of venous access guides/algorithms/tools for patients aged <18 years in the emergency department or inpatient units published after 2013 in English were included. Descriptive analysis was used to summarize the results. Quality of studies was assessed using the Appraisal of Guidelines for Research Evaluation (AGREE II) tool.
    RESULTS: Of the 105 studies included, 18% (n = 19) involved peripheral access, 66% (n = 69) involved central access, and 16% (n = 17) involved both. Neonates were the population of focus in half the publications (n = 52), and reduction in central line-associated bloodstream infections (CLABSI) was the primary aim of 56% (n = 59) of publications. Device selection and removal were two components of care with the lowest representation, particularly for peripheral access. Based on AGREE II scoring, 50% (n = 53) of identified guides/algorithms/tools were recommended for use. The lowest scoring quality domains were rigor of development and applicability, with 25% (n = 26) and 28% (n = 29) of studies, respectively, scoring in the lowest quintile.
    CONCLUSIONS: Most venous access guides/algorithms/tools focus on CLABSI reduction and neonates, leaving gaps in guidance for other components of the care process and other populations.
    DOI:  https://doi.org/10.1002/jhm.70407
  17. West J Emerg Med. 2026 Jul 16. 27(4): 913-919
    Initial Specimen Diversion Devices for Emergency Department Blood Cultures May Reduce Contamination Rates and Costs: Structured Literature Review.
    Makayla D Ayres, Maria C Johnson, Megan E Andersen, Alyson P Lewis, Lucas S Farrow, Amelia M Vopat, Kathleen M Spears.
       INTRODUCTION: Emergency departments (ED) are a primary site of blood culture collection in the United States. High rates of blood culture contamination, commonly seen in EDs, are associated with diagnostic inaccuracy, unnecessary antibiotic use, and increased costs. In this structured literature review, we evaluated the effectiveness of initial specimen diversion devices (ISSDs), which are attached to the needle tip and discard the initial 0.15-1.5 mL of blood. We paid particular attention to their applicability in reducing blood culture contamination in adult ED patients in rural healthcare settings. The average cost of an ISDD is $15-$30, and this upfront cost creates a significant barrier in rural EDs, which face resource scarcity.
    METHODS: In this review of primary literature from 2021-2025, we evaluated the efficacy of ISDD in lowering blood culture contamination rates in adult patients in the ED. Our primary outcome was the change in contamination rates after introduction of the ISDD. Secondary outcomes included changes in vancomycin duration of therapy, hospital length of stay, and total hospital costs.
    RESULTS: We screened 460 records across PubMed, EBSCO, and Embase. Eight papers were selected for full review, from 10 hospital systems. All studies demonstrated a decrease in the rates of blood culture contamination with the ISDD. Contamination rates were reduced by an average of 2.89% across all 10 study locations. Only three of 10 hospitals (30%) achieved a blood culture contamination rate below 1%. One rural community hospital saw an absolute reduction of BCCs from 3.94% to 1.05%. Another study reported a decrease in total yearly hospital costs from $1,120,000 to $383,690, and another reported a 31.4% reduction in mean duration of vancomycin therapy.
    CONCLUSION: This review shows the clinical value of ISDDs to reduce blood culture contamination, and highlights the need for further research into scalable implementation strategies, especially in resource-constrained systems, like rural hospitals.
    DOI:  https://doi.org/10.5811/westjem.50723
  18. Nurs Crit Care. 2026 Sep;31(5): e70606
    Harnessing Artificial Intelligence to Strengthen Acute and Critical Care Nursing Practice: A Systematic Review.
    Wesam Taher Almagharbeh, Sameer A Alkubati, Amal Ali Alasmari, Amal Ali Alharbi, Hazem AbdulKareem Alfanash, Fuad H Abuadas, Rabie Adel El Arab, Abdullah Alkhawaldeh, Ayman Ateq Alamri, Haia Mahdi Albalawi, Abeer Alatawi.
       BACKGROUND: Artificial intelligence (AI) is reshaping clinical decision support systems (CDSSs). In acute and critical care, nurses provide continuous surveillance, recognise deterioration, coordinate escalation and translate protocols into bedside action. AI-CDSS may be particularly relevant when they support rather than replace clinical judgement.
    AIM: To examine whether nurse-used AI-CDSS improve patient-important outcomes in acute and critical care contexts and summarise effects on care processes and nurse-reported outcomes.
    STUDY DESIGN: Following PRISMA 2020 and a preregistered protocol, we searched eight databases and major trial registries for English-language studies from 1 January 2010 to 1 January 2026. Searches were conducted on 1 January 2026. We included randomised, quasi-experimental and adjusted cohort studies in which registered nurses or nursing teams were primary users of AI-CDSS generating patient-specific predictions or recommendations. Mortality was pooled using a random effects model; other outcomes were synthesised narratively.
    RESULTS: Seven studies involving about 75 000 patients were included. Most evidence came from acute wards, intensive care units, sepsis, deterioration and delirium-prevention contexts, with additional home and palliative care evidence. Three mortality studies were pooled. Nurse-facing AI-CDSS were associated with lower hospital mortality (RR 0.68, 95% CI 0.53-0.87; I2 = 24%), although the prediction interval included possible no effect. Length of stay and protocol adherence generally improved when tools were embedded in nursing workflows. Nurse-reported outcomes were sparse.
    CONCLUSION: Nurse-facing AI-CDSS may strengthen acute and critical care nursing by improving surveillance, escalation and protocol delivery for patients at risk of deterioration. Evidence is promising but limited by small study numbers, heterogeneous interventions and sparse nurse-reported outcomes. Critical care implementation should prioritise nurse-centred design, alert burden, equity, safety monitoring and rigorous evaluation before scale-up.
    RELEVANCE TO CLINICAL PRACTICE: Nurse-used AI-CDSS show potential to improve patient outcomes and care processes, but evidence remains limited and context dependent.
    Keywords:  artificial intelligence; clinical decision support systems; critical care nursing; machine learning; nursing; patient outcomes
    DOI:  https://doi.org/10.1111/nicc.70606
  19. Resusc Plus. 2026 Jul;30 101413
    Characteristics of pediatric drowning out-of-hospital cardiac arrests in the United States.
    Christopher E Gaw, Chelsea B Kadish, Christopher B Gage, Sara Helwig, Jacob C Kamholz, Shea L van den Bergh, Kayla M Riel, Ashish R Panchal.
       Aims: Drowning is a leading cause of pediatric death in the United States, yet data characterizing these arrests is limited. Our study aimed to describe demographic and emergency medical services (EMS) response characteristics for drowning-related pediatric out-of-hospital cardiac arrests (pOHCAs).
    Methods: Using the 2023 National Emergency Medical Services Information System dataset, we conducted a cross-sectional study of EMS-attended 9-1-1 responses involving children 1 day-17 years old who experienced a drowning-related pOHCA. We used descriptive statistics and multivariable logistic regression (adjusted odds ratio; 95% confidence intervals) to identify factors associated with return of spontaneous circulation (ROSC).
    Results: Our study included 753 drowning-related pOHCAs. Most arrests were toddlers aged 1-4 years (57.8%), males (64.5%), at private residences (72.5%), and in urban settings (83.7%). EMS clinicians were commonly dispatched during the summer (46.7%) and between 12:00 and 17:59 (47.4%). Arrests were often unwitnessed (73.7%) and received bystander cardiopulmonary resuscitation (CPR) (81.3%). Fifty-four percent of adolescent arrests were unwitnessed compared to 80.5% among toddlers (P < 0.001). Most arrests (81.3%) received bystander CPR. Shockable rhythms were uncommon (4.6%). EMS-witnessed ROSC was obtained in 42.0% of arrests. In multivariable regression, adolescent age (3.25; 1.25-8.79), witnessed arrests (1.59; 1.03-2.45), and bystander CPR (2.83; 1.67-4.96) were associated with higher odds of ROSC.
    Conclusions: Most drowning-related pOHCAs involved young children, with age-based differences in scene characteristics and pre-EMS arrival factors. Adolescent arrests were more frequently witnessed and more likely to obtain ROSC. Opportunities exist to improve drowning prevention among children and enhance the chain of survival.
    Keywords:  Cardiac arrest; Drowning; Emergency medical services; Pediatrics; Prevention and control; Resuscitation
    DOI:  https://doi.org/10.1016/j.resplu.2026.101413
  20. Radiol Clin North Am. 2026 Sep;pii: S0033-8389(26)00064-3. [Epub ahead of print]64(5): 865-876
    Interventional Procedures in Pediatric Musculoskeletal Diseases.
    Silvia Gazzotti, Maria Pilar Aparisi Gómez, Riccardo Guglielmi, Giuseppe Guglielmi, Alberto Bazzocchi.
      Interventional radiology (IR) procedures are becoming increasingly relevant in the management of musculoskeletal disorders due to their high precision and low invasiveness. However, specific considerations need to be made when applied to children and adolescents, especially in terms of anesthetic care and radioprotection. The aim of this article is to provide a description of the main IR procedures available for the treatment of benign and malignant bone tumors, septic arthritis, and rheumatic diseases in the pediatric population (including radiofrequency ablation, high-intensity focused ultrasound, intralesional injection of sclerosing agents or steroids, biopsies, and embolization), summarizing available evidence and outlining distinctive aspects.
    Keywords:  Ablation; Arthritis; Biopsy; Children; Focused ultrasound; Interventional radiology; Pediatric; Tumors
    DOI:  https://doi.org/10.1016/j.rcl.2026.05.006
  21. Health Expect. 2026 Aug;29(4): e70776
    Improving the Safety and Quality of Care for Children and Young People With Intellectual and Developmental Disability. The Motivated for Change Programme in a Paediatric Emergency Department Setting. A Mixed Methods Study.
    Natalie Ong, Sarah Ghasem Zadeh, Jerzy Zieba, Karl Pobre, Gail Tomsic, Jacqueline Milne, Shefali Jani, Natalie Silove.
       BACKGROUND: Children and young people with intellectual and developmental disability have long been known to suffer from inequities in accessing safe and quality health care. These challenges are most felt within the emergency department due to its busy, crowded, and overstimulating environments with staff that are not trained to provide reasonably adjusted care.
    AIMS: The study is an evaluation using qualitative and quantitative methods of a continuing education and quality improvement programme designed to increase the knowledge, skills, and confidence of healthcare staff in providing reasonable adjustments to children and young people with intellectual disability in hospitals.
    METHODS: This study evaluated the Motivated for Change programme, which uses Behavioural change, Adult Learning, and Quality Improvement strategies to drive practice change and service improvement. A hundred and thirty-one and 89 staff participated in a pre- and post-intervention survey. Interviews were conducted with parents of children and young people with intellectual and developmental disability attending the emergency department. Observational studies were also conducted in the pre- and post-intervention phase. These were transcribed, categorised, and coded with themes derived. Consensus was reached through meetings with the research team.
    RESULTS: The Motivated for Change programme has demonstrated significant increases in staff knowledge, skills, and experience in providing safe and quality care for these children and young people. Evidence of change is reflected in the parent and staff interview and observational study themes. In addition, staff were further motivated to undertake quality improvement projects, develop an in-house training programme to provide ongoing training for new staff, and make further improvements in the department.
    CONCLUSIONS: The Motivated for Change programme has demonstrated its efficacy in enabling changes in the practice of reasonable adjustments and the emergence of local champions for sustained efforts for ongoing improvements in safety and quality of care.
    PATIENT AND PUBLIC INVOLVEMENT: The development of the research question and outcome measures was informed by data from previous research publications involving parents and staff. We sought input from a parent advisory committee in the design of the study. Parents were not involved in the recruitment and conduct of the study. Results were presented to the parent advisory at the end of the study.
    Keywords:  children and young people; continuing professional development; developmental disability; intellectual disability; quality improvement
    DOI:  https://doi.org/10.1111/hex.70776
  22. J Med Ext Real. 2026 Jan-Dec;3:3 29941520261451587
    Implementation of Immersive Technologies in Pediatric Perioperative Care: A Multi-Institutional Survey Study.
    Kathryn S Handlogten, Allison Fernandez, Galaxy Li, Kesavan Sadacharam.
       Background: Immersive technologies (ImTs), including virtual, augmented, or mixed reality, are increasingly used to support periprocedural pediatric patients, but clinical adoption varies widely across children's hospitals and specialties. Multiple determinants for the adoption of ImT in health care have been identified; however, these have not been well characterized in pediatric perioperative settings.
    Aims: Among Society for Pediatric Anesthesia Improvement Network (SPAIN) member institutions, we describe the current state of pediatric perioperative ImT use, identify barriers and facilitators to ImT adoption, and report perceived implementation-related factors.
    Methods: We conducted a multi-institutional cross-sectional survey of pediatric perioperative practices via key contacts from SPAIN. Survey responses underwent mixed-methods analyses informed by the Consolidated Framework for Implementation Research.
    Results: Among 27 eligible institutions, 24 (89%) provided responses, 13 of which reported ImT use. Of these, 8 (62%) reported existing institutional infrastructure or governance to support ImT. Use patterns were highly heterogeneous, but use was commonly paired with the presence of champions, technology expertise, and available resource support. Use cases included anxiety reduction, distraction, and procedural support. Barriers, facilitators, and potential strategies for successful implementation were highlighted.
    Conclusions: ImT is used variably across pediatric anesthesia practices affiliated with SPAIN. These findings provide a descriptive snapshot of current practice and highlight factors commonly associated with adoption. Further work is needed to more rigorously characterize the implementation processes and evaluate strategies that may support integration of ImT into routine care in diverse clinical settings.
    Keywords:  extended reality; immersive technology (ImT); implementation science; pediatric anesthesia; perioperative
    DOI:  https://doi.org/10.1177/29941520261451587
  23. Am J Rhinol Allergy. 2026 Aug 05. 19458924261473981
    Complicated Acute Rhinosinusitis in Cystic Fibrosis: National Inpatient Pediatric Analysis.
    Emily S Kwon, Saharsh Talwar, Annie Xu, Sudeepti Vedula, Rachel Kaye, Evelyne Kalyoussef, Wayne Daniel Hsueh.
      BackgroundNo prior national-level hospital admission analysis has compared acute rhinosinusitis (ARS) outcomes between cystic fibrosis (CF) and non-CF pediatric patients, leaving clinicians without population-level data to contextualize hospitalization burden and complication rates in this group.ObjectiveWe aimed to compare the complication risks and healthcare utilization between patients with CF versus without CF in children hospitalized with ARS.MethodsThe study examined inpatient admissions for pediatric ARS patients with or without CF in 2003-2019 using the Kids' Inpatient Database (KID), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Outcomes included orbital complications, intracranial complications, sinus involvement, sinus procedure rates, length of stay, and hospital charges.ResultsOf the weighted 41,148 patients with ARS, 1.5% had CF (n = 632). CF patients had lower odds of orbital complications (aOR 0.09, 95% CI 0.04-0.20, P < .001) but higher odds of sinus procedures (aOR 1.59, 95% CI 1.14-2.20, P = .006) compared to non-CF patients. CF patients also had longer hospital stays (8 vs 3 days, P < .001) and higher hospital charges ($43,918 vs $11,129, P < .001) compared to non-CF patients.ConclusionChildren with concurrent CF and ARS experience greater overall disease burden, reflected in prolonged hospitalization, higher healthcare costs, and higher rates of sinus surgeries. However, CF patients appear less prone to orbital complications.
    Keywords:  Kids’ Inpatient Database; acute rhinosinusitis; cystic fibrosis; database; inpatient; orbital complications; pediatric; sinusitis
    DOI:  https://doi.org/10.1177/19458924261473981
  24. Clin Pediatr (Phila). 2026 Aug 06. 99228261475551
    Evaluating Bright Futures Pediatric Handouts: Readability, Understandability, Actionability, and Clinical Implications.
    Yusuke Matsuura, Emily Myers.
      Bright Futures Parent and Patient Handouts from the American Academy of Pediatrics are widely used after pediatric well-child visits, yet their content has not been systematically evaluated. We assessed all fourth-edition handouts using standard readability formulas for readability and the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) for understandability and actionability. Patient Handouts averaged a 4th-grade level (ages 7-8), 5th-grade level (ages 9-10), and 6th- to 7th-grade level (age 11+). Parent Handouts ranged from about 5th to nearly 7th grade. The PEMAT-P scores across all 23 handouts showed high understandability (92.3%) but lower actionability (60%). Overall, Bright Futures Handouts appear readable and understandable, supporting their use in pediatric practice, although opportunities remain to improve actionability. When clinicians create or evaluate patient education materials, attention to plain language, straightforward delivery, visual aids, and checklists helps improve readability, understandability, and actionability. These strategies may support more effective patient education and promote pediatric health outcomes.
    Keywords:  Bright Futures; PEMAT-P; generative AI; health literacy; patient education; patient education material; readability
    DOI:  https://doi.org/10.1177/00099228261475551
  25. J Drugs Dermatol. 2026 Aug 01. 25(8): 717-725
    Molluscum Contagiosum in the Pediatric Population: Expert Consensus Guidance on Prevention and Treatment.
    Nanette B Silverberg, Latanya Benjamin, Mercedes E Gonzalez, Adelaide A Hebert, Pearl C Kwong, Peter Lio, Anthony Mancini, Vanja Adzovic, Anneke Andriessen, Lawrence A Schachner.
       BACKGROUND: Molluscum contagiosum (MC), caused by the molluscum contagiosum virus, is a common viral skin infection in children. MC may persist for months to years and can substantially impair the quality of life for affected children and their families through discomfort, pruritus, cosmetic concerns, social stigma, and household transmission. Newer US Food and Drug Administration (FDA)-approved therapies have demonstrated patient-acceptable clearance rates, providing clinicians with additional options to treat pediatric MC. The paper summarized literature on MC in childhood and provided evidence-based guidance to help clinicians manage pediatric MC.
    METHODS: A panel of dermatologists developed a consensus paper to address the challenges of treating pediatric MC. The modified Delphi process comprised a two-pronged literature review, development of evidence-supported statements, physician review and modification, and a face-to-face panel meeting to discuss the systematic literature search results and draw on clinical experience and opinion to create six consensus statements, followed by voting.
    RESULTS: Consensus was achieved for 6 statements. Self-limiting, prolonged infection is common, particularly in children with impaired skin barrier conditions and immune deficiencies. Families may seek treatment to reduce patient discomfort from inflammatory symptoms, limit transmission, and reduce disease burden. Physicians should focus on patient and family quality of life through education and shared decision-making. Berdazimer gel 10.3% and cantharidin 0.7% are FDA-approved therapies that achieve meaningful lesion clearance (&gt;50%) within 6 weeks to 3 months.
    CONCLUSIONS: The use of FDA-approved therapies with clinically meaningful clearance rates, combined with supportive management, provides an opportunity to improve outcomes and quality of life for children with MC. &nbsp.
    DOI:  https://doi.org/10.36849/JDD.10025
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