Palliative & supportive careKarina Castillo, Maria Clara Landivar, Kevin Zambrano, Michella Dirani, Diego Montenegro, Giselle Maldonado, Valeria Macias, Luis Noboa, Emilia Valdivieso, Jos…
OBJECTIVES: Grief and bereavement care (GBC) remains an underrecognized component of pediatric palliative care (PPC), contributing to the emotional and psychological burden experienced by patients, families, and healthcare professionals (HCPs). This perspective review examines gaps in GBC, defines key types of grief in pediatric settings, and proposes a framework to improve patient- and family-centered grief support. METHODS: We conducted a narrative perspective review using PubMed and Google Scholar to identify literature on GBC in PPC. Search terms included combinations of "grief," "bereavement," "pediatric palliative care," "children," "caregivers," "siblings," "healthcare professionals," "anticipatory grief," "complicated grief," and "prolonged grief disorder." Publications from 2020 onward were prioritized, with seminal earlier studies included when clinically or conceptually relevant. RESULTS: GBC in PPC differs from adult models because of developmental considerations, prolonged illness trajectories, and family-centered decision-making. Relevant forms of grief include anticipatory, disenfranchised, complicated, and prolonged grief, affecting patients, families, and HCPs. Effective approaches include early palliative care integration, legacy-making activities, structured communication, and interdisciplinary psychosocial support. However, global disparities persist, and HCPs frequently report inadequate training and institutional support. SIGNIFICANCE OF RESULTS: GBC should be viewed as a longitudinal, culturally sensitive, system-wide responsibility extending from diagnosis through bereavement. Integrated frameworks emphasizing early communication, patient- and family-centered care, and formal grief training for HCPs may strengthen bereavement support and reduce unmet psychosocial needs across the pediatric illness trajectory.
European journal of pediatricsCeleste Cagnazzo, Ivana Ferrero, Katia Mareschi, Franca Fagioli
UNLABELLED: Biobanks are increasingly central to precision medicine, particularly in rare diseases and paediatric oncology, where small and molecularly heterogeneous populations make access to high-quality, longitudinally annotated biological material essential. This narrative review examines the scientific value of paediatric biobanking and the ethical, regulatory, and organisational challenges that distinguish it from adult biobanking. Relevant scientific literature, European and Italian regulatory sources, international biobanking standards, and guidance on data protection and research governance were narratively reviewed, with particular attention to paediatric oncology, rare diseases, consent and assent, secondary use, interoperability, and emerging European frameworks. Paediatric biobanks can support biomarker discovery, molecular stratification, investigation of treatment resistance, and future analyses not foreseeable at the time of collection. Their governance is complicated by evolving child autonomy, the significance of dissent, transition to adulthood, future reuse of samples, and the distinction between consent to sample donation and the legal basis for processing associated personal data. Quality management, traceability, interoperable metadata, and controlled access are essential to preserve scientific utility. Emerging frameworks, including the European Health Data Space and EDPB guidance, favour a shift from one-time consent towards accountable life-cycle governance. CONCLUSION: Paediatric biobanking should be conceived as a longitudinal research infrastructure rather than a storage activity. Sustainable models must integrate evolving autonomy, robust ethical oversight, data protection, quality, interoperability, and responsible secondary use while preserving irreplaceable biological resources for future research. WHAT IS KNOWN: • Biobanks are essential to precision medicine and are particularly valuable in rare diseases and paediatric cancer. • Paediatric biobanking raises specific issues concerning parental consent, assent, future use, and transition to adulthood. WHAT IS NEW: • Emerging European frameworks support a shift from static consent towards accountable life-cycle governance of samples and data. • A European paediatric sample-data continuum could connect biospecimens, longitudinal clinical information, omics data, and evolving participant preferences across infrastructures.
Journal of robotic surgeryCiro Esposito, Anna Gargiulo, Claudia Di Mento, Marco Castagnetti, Vincenzo Coppola, Francesco Tedesco, Roberta Guglielmini, Maria Luisa Pirone, Chiara Caporal…
Robotic-assisted surgery offers significant technical advantages in pediatric procedures but presents complex, unresolved medico-legal challenges regarding liability. We retrospectively reviewed our ten-year experience comprising 205 pediatric robotic procedures. Technical issues related to the robot were encountered in 7 cases (3.4%). These included joystick latency (3/7), coagulation/cutting pedal malfunctions (2/7), and accidental power cable disconnections causing system shutdowns (2/7). A literature review was conducted to assess the current international state of the art regarding robotic medical liability. Although the technical events at our center did not result in clinical complications, they highlighted significant potential risks. The literature shows that specific guidelines governing human, product, and algorithm-related liability are still lacking. Robotic surgery shifts the focus from an exclusively fault-based liability of the surgeon to a network-based system involving multiple stakeholders: the surgeon, the healthcare institution, and the manufacturer. Determining whether an adverse event stems from human error, algorithmic malfunction, or a combination of both remains a critical challenge. Unlike open or laparoscopic surgery where liability is primarily attributed to the operator, robotic surgery involves a complex interaction between the surgeon's console inputs and the manufacturer's technology. Consequently, from a medico-legal standpoint, responsibility for complications should be shared among the surgeon, the hospital, and the device manufacturer.
European journal of pediatricsMaria Luisa Di Pietro, Daniele De Luca
A few months ago, the Lancet Commission on the Future of Neonatology laid the foundations for boosting research and development in this field, ensuring modern, effective neonatal medicine. Worried about curing neonates as it was done 20 years ago, the Commission document provides a long list of actions for the various stakeholders. Several ethical issues arise in the background, which may go unnoticed, particularly by clinicians busy with routine clinical care. This review highlights some issues, explains the ethical reasoning behind the Lancet Commission document, and promotes the adoption of "Value-Based Neonatology". The value-based approach is already being used in other medical specialties, and we set out the framework for its application in neonatal medicine here.Conclusion: We believe that the full introduction of VBN in neonatal clinical care and research will help changing practicing, because it would be hopefully useful to optimise resource allocation and eventually decrease the areas of uncertainties.
European journal of pediatricsA Ferri Perez, L Robijn, K Beernaert, E Michiels, A Lacerda, Y Aelvoet, E Vandecruys, K Poláková, J B Brandt, S Debulpaep, L Dombrecht
UNLABELLED: This study explores how physicians approach the initiation and management of paediatric palliative sedation therapy (PST) in two end-of-life scenarios. It aims to inform future practice, particularly given the current absence of comprehensive international and national guidelines in most countries. A quantitative dual-vignette study was conducted across five European countries, using an oncological and metabolic end-of-life scenario. The questionnaire examined participant characteristics, decisions and procedures related to initiating paediatric PST, consultation with parents and healthcare providers, and clinical responses following sedation initiation. Overall, 55.6% of respondents indicated they would initiate sedation in vignettes intentionally envisioned as candidates for palliative sedation. Morphine (66.0%) and midazolam (55.2%) were the most commonly selected drugs for initiating paediatric PST. Approximately one-third (31.2%) would start or continue intravenous fluids, while a majority would discontinue non-comfort medications (84.8%), monitoring (56.8%) and nutrition (56.0%). In the metabolic vignette, significant cross-country differences were observed in decisions regarding fluids, feeding and medication use (p < 0.05). Most respondents would involve parents in decision-making (83.2%) and would discuss the case in a multidisciplinary meeting (76.0%). Across clinical scenarios, physicians would adjust medication primarily in response to the child's assessed level of distress, escalating therapeutic measures as symptom severity increased. CONCLUSION: Substantial variability exists in physicians' approaches to paediatric PST across clinical scenarios and countries. These findings demonstrate that, while certain clinical principles such as first-line medications are commonly upheld, considerable heterogeneity in practice of paediatric PST remains, underscoring the need for paediatric-specific guidance and training to ensure consistent and evidence-based decisions. WHAT IS KNOWN: • PST aims to relieve intolerable, refractory end-of-life symptoms, and is used in 7-12% of paediatric deaths. • Opioids and benzodiazepines are most commonly used. However, limited paediatric guidelines and infrequent use of PST, results in considerable variability in medication choices, team involvement and overall practice. WHAT IS NEW: • This first international vignette study on paediatric PST shows major variation across countries and clinical scenarios, in medication adjustments, monitoring and artificial hydration. • The Netherlands, the only participating country with national guidelines, showed near-unanimity in responses, suggesting a potential role for national guidelines in promoting consistency in clinical practice?
Participation in neonatal randomized controlled trials (RCTs) is associated with improved or equivalent outcomes for infants and is widely viewed as a cornerstone of high-quality neonatal care. Equitable access to research participation is therefore essential to scientific validity, ethical integrity, and generalizability. Although substantial efforts have focused on improving the representation of racial and ethnic minority groups in neonatal research, the inclusion of families who speak languages other than English remains inadequately examined. In this perspective, we synthesize existing evidence on language-based exclusion in pediatric research and present findings from systematic reviews of neonatal RCT protocols and informed consent materials from the National Institute of Child Health and Human Development Neonatal Research Network (1991-2020) and ClinicalTrials.gov (2018-2025). We discuss regulatory, institutional, and structural factors contributing to language exclusion and highlight actionable strategies to promote language-inclusive research, including strengthened federal regulations, investment in equitable language access, language-inclusive study design, systematic documentation of participant language, and meaningful community engagement. Advancing language equity in neonatal research is critical to improving representation, strengthening scientific validity and ensuring that the benefits of research extend to all infants and families.
Human trafficking and exploitation of children are recognized pediatric public health concerns. Children and adolescents who experience trafficking may present to pediatric acute care settings with injuries, sexually transmitted infections, pregnancy concerns, malnutrition, substance use, chronic pain, behavioral health crises, delayed care, or non-specific somatic symptoms. Disclosure is uncommon, and clinical recognition depends on awareness of risk factors, careful observation, trauma-informed communication, and clear response pathways. Pediatric clinicians should avoid relying on stereotypes or expecting patients to self-identify as trafficked. Instead, clinicians can use developmentally appropriate and nonjudgmental questions, ensure privacy when safe, use professional interpreters, and involve multidisciplinary partners. This article provides a practical approach for pediatric clinicians in emergency department, urgent care, hospital, inpatient settings, and outpatient clinics to recognize possible trafficking, communicate safely, avoid common pitfalls, and connect children with appropriate protection and support.
Pediatric clinics of North AmericaJeffrey Goldhagen, Daniel Martinez-Garcia
Humanitarian pediatrics represents a transformative evolution of pediatrics that responds to global polycrises that disproportionately harm children. Grounded in child rights and humanitarian principles, it integrates clinical care, public and humanitarian health, research, policy, and advocacy to address both direct and indirect threats to children's survival, development, and wellbeing. Central to this approach is Témoignage, or bearing witness, through which pediatricians use ethical authority and evidence to expose injustice and advance accountability.
Global health actionHelena Hildenwall, Dorothy Akongo, Emmanuel Tenywa, Svante Norgren, Moses Kyangwa, Alfred Yayi, William Mugowa Waibi, Viveka Nordberg, Agnes Linnér, Eva Svenss…
Despite major global progress in child health, significant inequalities remain between low- and high-income countries. In Uganda's Busoga region, child mortality is still high, largely due to preventable conditions and limited healthcare resources. In response, a paediatric health partnership was established in 2021 between the Busoga region and Stockholm, Sweden. Following a quality-of-care assessment in two Ugandan hospitals, the collaboration identified four priority areas: paediatric emergency care, neonatology, child neurology with a focus on epilepsy, and child rights. Over 3 years, 63 staff exchanges have taken place, enabling joint reviews of clinical practices and identification of improvement needs. A key achievement is the implementation of the WHO Emergency Triage, Assessment and Treatment Plus (ETAT+), supported by training 14 national facilitators who now serve as focal persons in their facilities. Initiatives in neonatology have strengthened early interventions for premature and low birth weight infants such as improved nursing care, infection prevention, and nutrition practices. In neurology, the introduction of an epilepsy registry and education programmes has reduced stigma and improved management. The child rights initiative has trained more than 80 ambassadors and fostered child-friendly hospital environments that promote participation. The in-hospital mortality dropped over the project period (2020-2025) from 26.4% to 21.7% for neonates (p = 0.021) and from 3.8% to 2.8% (p = <0.01) for children less than five outside the neonatal period. Despite resource constraints, the partnership has benefited both regions. This twinning model highlights how equitable international collaborations can sustainably advance child health and reinforce healthcare systems in diverse settings.
Pediatric annalsJennifer L Fang, Mark W Kaczor, Whitney S Thompson, Christopher A Collura
Telemedicine, rapid genomic sequencing (rGS), artificial intelligence (AI), and emerging interventions at the limits of viability are reshaping neonatal critical care and transforming the future of neonatology. Telemedicine is expanding neonatal expertise beyond tertiary centers, improving access and continuity of care through prenatal consultation, tele-resuscitation, virtual rounds, and home monitoring. Advances in rGS are shifting neonatal diagnostics toward earlier, precision-based identification of genetic disease, enabling more individualized treatment and prognostication. AI applications in the neonatal intensive care unit are demonstrating promise in early disease detection, imaging interpretation, predictive analytics, and clinical decision support, with the potential to improve outcomes while reducing clinical burdens. Neonatology continues to consider ethical challenges at the limits of viability. The potential for artificial womb technology raises complex questions regarding fetal status, viability thresholds, and the future implications of ectogenesis prompting the urgent need for evolving ethical frameworks.
OBJECTIVE: To develop a national expert consensus on procedural sedation and analgesia practices in paediatric emergency departments in Spain and identify priority areas for standardisation, safety and implementation. METHODS: We conducted a modified two-round Delphi study with a panel of 28 clinicians with expertise in paediatric emergency care and procedural sedation from 23 centres in different regions of Spain. Participants rated key domains related to patient selection, fasting, monitoring, staffing, pharmacological strategies, training and safety standards. We used a predefined threshold of ≥ 70% agreement to establish consensus in both rounds. RESULTS: The panel reached strong consensus across core domains of paediatric procedural sedation practice, including minimum safety requirements, monitoring standards, staff competencies and organisational priorities. Strong agreement supported the standardisation of procedural sedation processes. Areas of residual disagreement highlighted persistent variation in implementation and resource availability across departments. Pharmacological preferences differed according to the clinical scenario; ketamine was preferred for more painful procedures, but drug preferences for less invasive procedures or imaging procedures varied. CONCLUSION: This national Delphi consensus provides a pragmatic framework to support safer and more consistent procedural sedation practice in paediatric emergency departments. Although the study included only centres in Spain, it addressed operational and clinical challenges common worldwide, and its findings are likely relevant for all emergency departments seeking to improve paediatric sedation.
Health expectations : an international journal of public participation in health care and health policyVeronika Stadler, Rebeca Mozun, Jannik Strohm, SwissPedHealth Consortium, Chloé Caruso, Klara M Posfay-Barbe, Cornelia Hagmann
BACKGROUND: Patient and public involvement and engagement (PPIE) can increase the relevance and efficiency of research projects. An overview of PPIE approaches and implementation in pediatric research studies is needed to facilitate learning from others' experiences. OBJECTIVE: We aimed to systematically review practices in PPIE across all pediatric health research disciplines regarding characteristics and recruitment of PPIE participants, timepoints and methods used for PPIE, levels of involvement, benefits and barriers of PPIE. SEARCH STRATEGY: We searched Pubmed, EMBASE, Cochrane and PsycInfo using a comprehensive set of terms based on the concepts 'Patient and Public Involvement,' 'Health Research' and 'Pediatrics.' INCLUSION CRITERIA: We included original research articles describing PPIE implementation in pediatric health research published in English or German between 01/2003-10/2024. DATA EXTRACTION AND SYNTHESIS: Data was extracted using predefined categories and synthesized by narrative summary and thematic synthesis. PPIE reporting quality was assessed using the GRIPP2 short form checklist. MAIN RESULTS: Out of 1910 references, we included 37 original research articles, representing 35 studies. PPIE participants were mostly children, adolescents or caregivers involved in all research stages, especially in study design (89%) and recruitment (51%). Key positive impacts of PPIE on research included enhanced recruitment and retention rates and personal benefits for PPIE participants. Barriers to PPIE were financial and time resources required and challenges in recruiting representative PPIE participants. The level of involvement and PPIE reporting quality varied highly between studies. DISCUSSION: Common benefits and barriers of PPIE exist across pediatric research disciplines. Reporting quality varied highly between studies. CONCLUSIONS: PPIE is valuable in pediatric health research. Adherence to guidelines for conducting and reporting PPIE is important to enhance mutual learning. PATIENT OR PUBLIC CONTRIBUTION: PPIE input contributed to the understandability of the lay summary. The findings of this review, together with parent and public input, will inform guidelines for future PPIE activities at the authors' institutions.
Pediatrics in reviewChetna K Pande, Sarah Risen, Jessica M LaRosa, Sapna R Kudchadkar
As mortality from pediatric critical illness has declined, post intensive care syndrome in pediatrics (PICS-p) has emerged as a framework to describe the broad and often long-lasting morbidities experienced by survivors of pediatric critical illness. PICS-p encompasses new or worsening impairment in physical, cognitive, emotional, and social health that affect both the child and their family. The term PICS-p also acknowledges and reinforces the traumatic impact of the critical care on the child and family dyad. Given the growing population of pediatric survivors of critical illness and the limited availability of newly emerging, specialized post-critical care clinics, it is imperative that general pediatricians, providing the child's medical home, are equipped to diagnose and manage PICS-p in the outpatient setting. In this review, we summarize the prevalence, pathophysiology, clinical course, and impact of PICS-p on children and families. We also review preventive strategies that can be implemented in the PICU and conclude with practical guidance for general pediatricians caring for children after critical illness.
Perspectives on medical educationLaura F Sartori, Bjorn K Watsjold, Katherine Wu, Lanelle Quzack, Jonathan S Ilgen, Joseph J Zorc, Lara Varpio
PURPOSE: Practice variation across physicians is commonly attributed to idiosyncratic tendencies. What factors contribute to physicians' practice variation in the disposition of children with asthma exacerbation? How do metrics demonstrating variation impact physicians and learners? METHODS: In this social constructivist qualitative study, we interviewed 11 Pediatric Emergency Medicine attendings, purposively sampling across a spectrum of acute asthma exacerbation admission rates. Participants reflected on their recent care of patients with asthma, how they assess patients, and how they determine disposition. They were shown a de-identified funnel plot demonstrating disposition rates across the physician group and reflected on the 1) quality of the metric and 2) impact on practice. We used reflexive thematic analysis to describe patterns across the data that addressed the study's research questions. RESULTS: Participants cited factors at the patient, caregiver, clinical care team, clinical environment, and personal practice levels that might result in variation. Participants framed the ability to weigh these sometimes competing factors as a reflection of patient-centered care. But when presented with a group-level data display, participants were surprised by the variation, valued seeing how they practiced compared to peers, and sometimes expressed a willingness to alter their practices to be "nearer the mean." CONCLUSIONS: Some variation in care may be driven by physician adaptive expertise, which is not fully captured through metric-driven nomothetic data. Though metrics are fundamental to understanding practice patterns, decontextualized aggregations of data may risk minimizing, or even framing as deviant, the expertise exercised by physicians when they weigh multiple factors in decision-making.
Revista brasileira de enfermagemRuana Luiz Ferreira da Silva, Ana Railka de Souza Oliveira-Kumakura
OBJECTIVES: to construct, assess, and test a simulated scenario using rapid-cycle deliberate practice for external ventricular drainage management in pediatric patients. METHODS: a methodological study, with the construction of a simulated scenario based on the concept of simulated scenario engineering and the NLN Jeffries Simulation Theory. The scenario was assessed by reviewers, who calculated the Modified Kappa Coefficient and Content Validity Index, and then tested it with nursing students. RESULTS: a scenario was constructed based on updated evidence. Two rounds were conducted with seven evaluators who assessed all elements of the scenario as appropriate, according to adopted references. In the test with the target audience, no adjustments were necessary. CONCLUSIONS: the evidence-based simulated scenario on external ventricular drainage management in pediatrics received an excellent assessment from the evaluators and the target audience during testing. The use of rapid-cycle deliberate practice proved promising for teaching and learning the subject.
Journal of medical Internet researchSeongwoo Yang, Ju Hyun Jin, Seng Chan You, Min Jung Kim, Kyung Won Kim
BACKGROUND: Pediatric health care requires distinct considerations, including caregiver involvement and developmental differences in cognition and communication as children gain autonomy, particularly as pediatric health care chatbots gradually emerge. Because childhood and adolescence are formative periods for health behaviors and self-management practices, pediatric chatbots also warrant evaluation against long-term rather than immediate outcomes. OBJECTIVE: This study aimed to characterize and synthesize the available evidence on pediatric health care chatbots evaluated for health-related outcomes. Furthermore, by identifying gaps in the existing literature, we sought to propose specific considerations for the design, evaluation, and implementation of pediatric health care chatbots. METHODS: PubMed, Embase, Scopus, PsycINFO, the Cochrane Library, and the Web of Science were systematically searched without publication year restrictions. Randomized controlled trials, mixed methods, and observational studies that evaluated health care chatbots for children (aged <19 y) or caregivers and assessed health-related outcomes were included. Nonoriginal papers, end-of-life or palliative care studies, and non-English publications were excluded. Study quality was assessed using the Mixed Methods Appraisal Tool and the Oxford Levels of Evidence 2. RESULTS: A total of 9 studies were included, with 5 (55.6%) involving pediatric participants only, while 4 (44.4%) involved caregivers. Six (66.7%) studies lacked a comparator, and only 3 (33.3%) chatbots were AI-based. Health and psychosocial outcomes were mixed, often showing null findings in objective clinical metrics despite some subjective improvements. Behavioral and cognitive outcomes generally showed favorable changes but relied heavily on subjective evaluations. Although chatbots demonstrated explicit developmental tailoring, with designs shifting from caregiver-mediated approaches in early childhood to autonomous, privacy-focused platforms for adolescents, definitive conclusions regarding their robust associations with health-related outcomes cannot be drawn. This is primarily due to pervasive methodological limitations, including the lack of active comparator groups, reliance on short-term metrics, and significant study heterogeneity. CONCLUSIONS: Pediatric health care chatbots are emerging across diverse health care contexts, but the current evidence remains limited and heterogeneous. This review identified developmentally relevant considerations, including caregiver involvement, age-appropriate communication, and developmental differences, that may warrant explicit attention in future chatbot design, evaluation, and implementation.
Journal of medical Internet researchColleen Stiles-Shields, Elyse Shenberger, Ann Bernica, Gabriella Bobadilla, Kandis Fletcher, Jasmine George, Sydney Gordon, Erika L Gustafson, Crystal S Hernan…
BACKGROUND: Digital health interventions (DHIs) offer scalable ways to reach youth. While DHI research often poses minimal risk, guardian permission is typically required for minors to participate. As a result, requiring guardian permission may unintentionally obstruct safe, high-quality research and delay its translation. OBJECTIVE: This review aims to explore practices related to guardian permission. This study systematically reviewed randomized controlled trials of DHIs with minors from the United States published between January 1, 2020, and June 17, 2026. METHODS: PubMed, Embase, PsycINFO, and ACM Digital Library were searched; Cochrane Library and Web of Science yielded only duplicates and were therefore excluded. Included studies had to be: conducted in the United States, randomized controlled trials evaluating DHIs for pediatric mental and/or behavioral health, written in English, and peer-reviewed. Studies were excluded if participation was decided at the school level, included caregivers or pregnant teens as participants, or had a mean sample age of more than 18 years. Two coders independently screened and extracted data, with a third, unique reviewer resolving discrepancies. Risk of bias was assessed using the revised Cochrane risk of bias tool for randomized trials (RoB 2). A narrative framework was used to identify themes. Inverse variance-weighted linear regressions and logistic regressions were conducted to compare studies with and without permission waivers. RESULTS: Of 7170 screened studies, 49 met inclusion criteria (21 used guardian permission waivers; 28 required permission). The most commonly reported rationale for waiver use was participant privacy. Logistic regressions showed that studies with waivers were more likely to assess gender beyond the binary of male-female (odds ratio [OR] 4.27, 95% CI 1.22-14.93; P=.02) and more likely to recruit online (OR 0.04, 95% CI 0.01-0.17; P<.001). Weighted study-level regression revealed significantly lower follow-up retention in studies with waivers (mean 77.03%, SD 12.32%) compared to those requiring guardian permission (mean 88.61%, SD 17.17%; P=.005). No significant differences emerged across age, race, ethnicity, assessment of suicidality, sensitive topic assessment, intervention focus, or treatment retention. CONCLUSIONS: Though several frameworks exist for evaluating ethics around waiving guardian permission for minors in research, this is the first review to systematically evaluate research in DHI, which often varies in terms of its level of risk. Although small sample sizes and variable reporting practices limited statistical power, the lack of differences in sample characteristics or study features between studies that used waivers and those that did not suggests that institutional review boards may be differentially interpreting regulations and guidance on waiving guardian permission. These findings likely indicate the need for more evidence to guide risk and benefit evaluations-or more education about the existing evidence base, as well as the risks and potential benefits of pediatric DHI research.
BMJ openAbid Ali Jamali, Shahan Waheed, Faisal W Ismail, Shiyam S Tikmani, Ahmed Raheem
INTRODUCTION: Up to 40% of major complications during airway management result from human factors. Through human factors such as planning, effective communication, strong leadership and clear role allocation within the team, smooth airway securement can be facilitated and the risk of complications reduced. Simulation-based teaching provides real-time situations and allows healthcare workers and learners to identify, refine and improve their technical and non-technical skills. This study aims to evaluate the effect of simulation-based human factors training on airway management among healthcare providers working in the emergency department of a tertiary healthcare setting in a low- and middle-income country. METHODS AND ANALYSIS: This will be a quasi-experimental study with a pre-post design to infer the impact of simulation-based human factors training among emergency medicine healthcare providers on paediatric airway management. The study will be conducted at the Centre of Innovation in Medical Education, Aga Khan University Hospital, Karachi. Participants will include emergency department healthcare providers who meet the inclusion criteria and are selected through purposive non-probability sampling. A total of 74 participants will be enrolled. Data will be analysed using Stata. Descriptive statistics will be presented as frequencies and percentages for categorical variables and as means with SD or medians with IQRs for continuous variables as appropriate. Changes in first-pass intubation success and time to secure the airway (≤30 vs >30 s) following the intervention will be assessed using McNemar's test. Changes in TEAM, CTS and NASA-TLX scores will be evaluated using a paired t-test. Generalised Estimating Equations will be used to identify factors associated with airway management outcomes, with results reported as adjusted ORs and 95% CIs. A p-value <0.05 will be considered statistically significant. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Aga Khan University Ethical Review Committee (ERC: 2026-12851-41186). Written informed consent will be obtained from all participants, and participation will be voluntary. Findings will be disseminated through thesis submission, conference presentations and peer-reviewed publications.
Italian journal of pediatricsFederico Marchetti, Maurizio Bonati, Antonio Clavenna
Despite important regulatory progress, evidence supporting the use of medicines in children remains limited, and off-label prescribing continues to be common in pediatric practice. Regulatory initiatives such as the United States Pediatric Research Equity Act (PREA) and the European Pediatric Regulation were designed to increase the labelling information relevant to paediatric use, yet important gaps persist because studies are often delayed, incomplete, or absent for many conditions and formulations. This article addresses the common misconception that off-label prescribing is always inappropriate or unsupported and argues that this interpretation is not supported by the current evidence. In reality, many off-label treatments in pediatrics are supported by scientific evidence, clinical guidelines, and consolidated experience, even when formal regulatory approval is lacking. Examples involving pediatric oncology, child psychiatric disorders, and supportive care illustrate how effective therapies may remain off-label despite becoming standards of care. The Italian experience reflects these broader challenges. Studies have shown that off-label prescribing is structural rather than exceptional in pediatrics, while national initiatives such as Law 648/96 and pediatric formularies have sought to support evidence-based prescribing beyond regulatory boundaries. It is necessary to overcome the simplistic distinction between prescriptions that comply with the indications and appropriate prescriptions. A more rational framework should distinguish unsupported off-label use from evidence-based off-label prescribing. Reducing the pediatric evidence gap therefore requires not only more pediatric research, but also recognition of rational off-label prescribing as an essential component of pediatric clinical practice.
JMIR research protocolsSophia Lau, Sophie Manami Orgler, Samiran Ray, Alexander Philip Yehuda Brown
BACKGROUND: Early warning systems are widely used to detect acute clinical deterioration, which may be defined as a significant worsening in health over a few hours that may lead to adverse outcomes such as code blue activation, unplanned intensive care unit admission, or death. These systems rely on the regular measurement of physiological parameters, such as heart rate and blood pressure, which are converted into warning scores using deterioration prediction algorithms (DPAs). A range of DPAs are currently in use, most commonly simple track-and-trigger tools or summative scoring systems. More complex machine learning approaches have been proposed that may improve prediction accuracy. However, heterogeneity in outcome definitions and reported model performance metrics hinders the evidence synthesis needed to support the deployment of proposed models in clinical contexts. OBJECTIVE: This scoping review aims to identify the range of DPAs developed for use in pediatric inpatient early warning systems, as well as operational definitions of deterioration and reported performance metrics. METHODS: The review will follow the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting guidelines. The population of interest is hospitalized children. The concept under review is DPAs, defined as decision-support tools that use routinely monitored physiological parameters to alert clinicians to worsening clinical status. The context will be inpatient ward settings, excluding emergency departments, neonatal units, and intensive care environments. Studies will be identified from searches of the MEDLINE, Embase, HMIC, Scopus, Web of Science, Cochrane, and ACM DL databases. Studies will be screened by 2 independent reviewers against the inclusion and exclusion criteria. A broad range of study types, including prospective and retrospective analyses, will be eligible for inclusion. Data on the choice of algorithmic approach, definition of deterioration, and reported performance metrics will be collated and presented descriptively in tabular and narrative formats. RESULTS: At the time of submission, the protocol has been registered and the search strategy finalized. A formal database search was carried out in May 2026. Screening and data extraction are expected to be completed by winter 2026, after which the findings will be published. CONCLUSIONS: This protocol describes the planned scoping review of DPAs for pediatric inpatient care. The completed review will summarize the types of algorithms evaluated, the outcomes used to define deterioration, and the performance metrics reported. These findings will support further evidence synthesis in this emerging field.
Pediatric surgery internationalYemi S Lawrence, Chisom R Udeigwe-Okeke, Nimanya A Stella, Kara L Faktor, Ramesh M Nataraja, Caroline Q Stephens, Doruk E Ozgediz, Emmanuel A Ameh, Global Init…
PURPOSE: Simulation-based education (SBE) is increasingly used in surgical training worldwide. With a shortage of specialized surgeons, SBE allows for skills acquisition in a safe environment, preserving patient safety and standardizing care. However, in global children's surgery, knowledge about SBE interest, use, and feasibility is limited. METHODS: A 17-item survey was developed to examine simulation in global children's surgery. The survey was piloted (Nov 2024) and distributed (Dec 2024-Feb 2025) through the Global Initiative for Children Surgery (GICS), an organization with 1100+ members across 60 countries. Descriptive statistics and free responses were reported. RESULTS: Of 85 respondents from 36 countries (approximately 7.7% response rate), over half used SBE in the past year, reaching about 1270 learners. The most common methods were low-cost models, mannequins, and bench trainers. Respondents identified several significant barriers to establishing SBE programs. Most (75%) simulation costs were under $300. CONCLUSION: Access to SBE resources remains a major barrier, highlighting the critical need for access to open-source education materials. The low cost suggests a need to evaluate cost-effectiveness. Despite a limited response rate and sampling from one organization, the use of low-cost simulation and interest in advanced technologies reflect a trend toward enhancing simulation in global children's surgical education.
NutrientsRoxana Maria Martin-Hadmaș, Rebeca Sovea, Diana Pol, George Mihăiță Gavra, Monica Tarcea, Adriana Neghirlă, Ștefan Adrian Martin
BACKGROUND/OBJECTIVES: Artificial intelligence (AI) tools are increasingly used for dietary assessment, but their reliability in pediatric nutrition remains uncertain. This study compared AI systems and human evaluators in pediatric menu assessment against expert-defined reference ratings. METHODS: This observational cross-sectional study used anonymized dietary and clinical information from three healthy pediatric cases. A multidisciplinary panel of pediatric nutrition specialists established standard evaluations. Assessments were completed by 84 AI evaluations, 116 nutrition specialists, 56 pediatric-focused physicians, and 88 physicians from other specialties. Outcomes included absolute error in total energy estimation, deviations in portion and qualitative ratings, standardized scores, and binary adequacy accuracy. Groups were compared using ANOVA or Kruskal-Wallis tests with post hoc analyses. RESULTS: A total of 344 assessments were included. Energy-estimation error differed between groups (Kruskal-Wallis = 12.85, p = 0.0016), but this analysis was based on a limited and highly unbalanced subset of 77 assessments. AI had the largest mean absolute error (260.3 ± 194.3 kcal), followed by nutrition specialists (148.4 ± 81.5 kcal); physicians with other specialties had the lowest error (60.4 ± 53.3 kcal); these subgroup comparisons should be interpreted cautiously because of the small and unequal numbers of available energy estimates. AI showed greater portion-rating deviation (0.488; 95% CI: 0.38-0.60) than nutrition specialists (0.310; 95% CI: 0.20-0.42; p = 0.0019, q = 0.0059) and pediatric-focused physicians (0.286; 95% CI: 0.16-0.41; p = 0.0181, q = 0.019). Conversely, AI showed the lowest deviations for variety (0.37 ± 0.49) and processing (0.33 ± 0.47), compared with 1.15-1.36 and 1.22-1.57, respectively, among human groups (both p = 0.0001). CONCLUSIONS: AI may support structured pediatric menu screening for descriptive qualitative features; however, lower precision for energy and portion assessment supports, under these specific conditions, its use as an adjunct, for qualified nutrition professionals.
Clinical photography can convey phenotypic, anatomical, and diagnostic information that may be difficult to replace with text. This also applies to highly sensitive pediatric clinical photographs when the scope of patient exposure is necessary to achieve a specific educational objective. This viewpoint addresses a more specific problem: "How should the educational function of a highly sensitive pediatric clinical photograph be evaluated when the condition identified with the photograph is substantively described elsewhere in the educational material?" The analysis is grounded in a documented longitudinal observation of 28 editions and reprints of a single academic textbook lineage published between 2005 and 2019, across which the same image-condition configuration persisted. At the point of image presentation, the depicted clinical conditions were explicitly identified, while the accompanying text stated that they were described elsewhere in the textbook, where their substantive clinical descriptions were located in accordance with the textbook's declared curricular structure. On this basis, I propose educational disconnection to describe a situation in which the image-specific educational contribution at the point of presentation is difficult to reconstruct from the observable relationship among image location, the clinical condition identified with the image, the condition's declared curricular location, the location of its substantive clinical description, and the destination indicated in the text accompanying the photograph. The central distinction is that identification of a clinical condition, identification of where that condition is substantively described, and identification of the educational contribution of its photograph are not the same. A separate question therefore remains: "What additional educational information does the image contribute here?" The longitudinal dimension extends this analysis through the concept of educational value decay, referring to the possibility that the relationship between an image and the context-specific justification for its presence may weaken over time, without assuming that educational value automatically declines with the age or repeated reproduction of the image. In response, I propose an Educational Reassessment Framework-a practical, event-triggered process that proceeds from identifying the image's educational function and its relationship to the curricular structure, through assessment of its image-specific educational contribution and exposure-function proportionality, to the consideration of equivalent alternatives, the continuing validity of its justification, and the conditions of responsible continued use. Reassessment is not intended to automatically remove historical, repeatedly used, or highly sensitive photographs. Responsible reuse of an educationally valuable image may remain justified and may reduce the need to photograph additional patients, but educational value does not substitute for appropriate authorization or other conditions of responsible use. Its purpose is to determine whether continued use is supported by an identifiable, current, and context-specific educational contribution, whether the scope of patient information disclosed is necessary and proportionate to that contribution, and whether the conditions supporting use remain appropriate.
Frontiers in public healthDongdong You, Weikun Zheng, Hailin Zhang, Xiaohong Cai, Feng Li
BACKGROUND: Pediatric workforce sustainability is an important public health concern in China. Pediatric residents enrolled in professional master's programs face simultaneous clinical training and academic demands, but longitudinal evidence on how their psychological burden changes during standardized residency training remains limited. This study aimed to characterize trajectories of burnout, perceived stress, and depressive symptoms across postgraduate year 1 (PGY1), postgraduate year 2 (PGY2), and postgraduate year 3 (PGY3). METHODS: This longitudinal repeated-measures cohort study included 50 pediatric residents enrolled in professional master's programs at a tertiary teaching hospital in China. Each resident was assessed once in PGY1, PGY2, and PGY3, yielding 150 repeated observations. Burnout was assessed using the Maslach Burnout Inventory-Human Services Survey, perceived stress using the 10-item Perceived Stress Scale, and depressive symptoms using the Patient Health Questionnaire-9. Generalized estimating equation models with robust standard errors were used to estimate stage-related mean differences while accounting for within-person clustering and adjusting for sex and cohort year. An exploratory participant-level analysis enumerated each participant's categorical burnout status across PGY1-PGY3 using the two previously defined burnout indicators. RESULTS: Across all repeated observations, mean scores were 27.65 ± 6.34 for emotional exhaustion, 15.80 ± 3.89 for depersonalization, 24.27 ± 5.48 for personal accomplishment, 67.19 ± 7.07 for the exploratory composite burnout index, 20.77 ± 5.87 for perceived stress, and 14.16 ± 4.72 for depressive symptoms. Descriptively, emotional exhaustion and the exploratory composite burnout index were higher at PGY3 than at PGY1. In adjusted GEE models, PGY3 was associated with higher emotional exhaustion compared with PGY1 (β = 2.740, 95% CI: 0.535-4.945, p = 0.0149) and a higher exploratory composite burnout index (β = 2.920, 95% CI: 0.417-5.423, p = 0.0222). No statistically significant PGY3-versus-PGY1 differences were observed for depersonalization, personal accomplishment, perceived stress, or depressive symptoms after adjustment. Participant-level transition analysis showed that 42 of 50 residents (84.0%) screened positive for burnout at all three stages, whereas 8 of 50 (16.0%) met the stricter three-dimension high-burnout definition at all three stages. CONCLUSION: Among pediatric residents enrolled in professional master's programs, the clearest stage-related difference was higher emotional exhaustion at PGY3, with a parallel increase in the exploratory composite burnout index. This pattern is consistent with greater occupational exhaustion in later training, but causal attribution to training stage is not possible. Repeated, stage-specific monitoring and targeted residency support may help protect trainee wellbeing and strengthen the sustainability of the pediatric workforce in China.
Medical sciences (Basel, Switzerland)Zenon Pogorelić, Andrea Cvitković Roić
BACKGROUND: Pediatric urology has traditionally relied on anatomical classifications, standardized diagnostic pathways, and disease-specific treatment algorithms. However, children with the same anatomical diagnosis may have substantially different risks of disease progression, renal injury, complications, and need for intervention. Personalized and precision medicine aim to integrate clinical, imaging, functional, biological, genomic, and longitudinal information to support individualized risk assessment and decision-making. METHODS: This narrative review was based on a targeted literature search of PubMed/MEDLINE, Scopus, Embase and Web of Science databases. Search terms included combinations of "personalized medicine," "precision medicine," "risk stratification," "pediatric urology," "biomarkers," "genomics," and "artificial intelligence," together with terms related to major pediatric urological conditions. Additional relevant publications were identified from reference lists of key articles. The literature was narratively synthesized according to its relevance to individualized risk assessment and clinical decision-making. RESULTS: Current evidence supports an evolving role for individualized risk assessment in vesicoureteral reflux, antenatal hydronephrosis and ureteropelvic junction obstruction, congenital anomalies of the kidney and urinary tract, hypospadias, undescended testes, and disorders of sex development. Biomarkers, genomic testing, advanced imaging, and artificial intelligence may provide additional information for phenotyping and outcome prediction. However, most predictive and AI-based models remain insufficiently validated, with limitations related to external validation, calibration, reproducibility, clinical utility, and generalizability. Longitudinal reassessment is particularly important because risk may change with growth, disease progression, and treatment response. CONCLUSIONS: Personalized pediatric urology should move beyond diagnosis-based algorithms toward dynamic, risk-adapted decision-making. The goal is not to increase the number of investigations or interventions, but to identify which child is most likely to benefit from additional testing, surveillance, or treatment. Future implementation will depend on robust validation of predictive models and demonstration that personalized approaches improve clinically meaningful outcomes.
The journal of extra-corporeal technologyMolly Elisabeth Oldeen, Carrie Whittaker Striker, Ronald Angona, Dafne Andrea Chianella, Chelsea Capone, Ashley B Walczak, Thomas Klein
BACKGROUND: In 2019, the American Society of ExtraCorporeal Technology (AmSECT) approved the inaugural Standards and Guidelines for Pediatric and Congenital Perfusion Practice. These standards and guidelines were created with the intent of periodic revision to ensure continued alignment with evolving best practices. In 2023, an AmSECT subcommittee initiated this review in consideration of current literature and contemporary clinical practices. METHODS: The subcommittee, consisting of pediatric and congenital perfusionists, conducted a systematic literature review assessing each standard and guideline to determine if current evidence supports elevation of guidelines to standards, incorporation of new guidelines or standards, or whether existing standards and guidelines should remain unchanged. AmSECT's adult Standards and Guidelines for Perfusion Practice (2023) updates were also considered. Proposed revisions were reviewed by the 2024 AmSECT International conference attendees, AmSECT Pediatric and Congenital Perfusion Committee, AmSECT Fellows of Pediatric Perfusion (FPP), and the AmSECT International Consortium for Evidence-Based Perfusion (ICEBP). RESULTS: Regarding pediatric and congenital specific changes, five guidelines were elevated to standards and three new guidelines and one standard were introduced. Additionally, five patient safety-related standards and one additional guideline were adopted from the Standards for Perfusion Practice (2023) document. CONCLUSION: Over the course of two years, consisting of an extensive literature review and feedback from multiple stakeholders, the 2025 update to the Standards and Guidelines for Pediatric and Congenital Perfusion Practice were approved by AmSECT leadership, ratified by an AmSECT membership vote, and subsequently endorsed by CHSS.
Disaster medicine and public health preparednessCarol Iddins, Cham E Dallas, Ziad Kazzi, Alla Shapiro, Tehnaz Boyle, Arthur Cooper
Acute pediatric radiation injury is fortunately rarely encountered in pediatric emergency medicine and trauma. Most reported experience with the condition has arisen from unanticipated, untoward events associated with radiation therapy for pediatric oncologic illness, as scientific study of pediatric outcomes following major radiation and nuclear events, such as Hiroshima, Nagasaki, Chernobyl, and Fukushima, has focused on long term morbidity, mostly with respect to thyroiditis and thyroid neoplasia, instead of acute care-for which data cannot be found in the English language scientific literature. As such, recent efforts have centered on development of medical countermeasures for pediatric patients based upon expert judgment, including but not limited to administration of antidotes and cytokines. The authors advocate for the creation of a multi-agency and multi-disciplinary working group to ensure the strategic mitigation of the critical gaps in preparedness and response to radiation injuries in children cited below.
PURPOSE: Laparoscopic appendectomy (LA) is the ideal initial laparoscopic procedure for surgical residents, but the comparative educational value of conventional three-port LA (CTPLA), transumbilical laparoscopy-assisted appendectomy (TULAA), and two-site LA (TSLA) remains unclear. METHODS: We retrospectively analyzed 372 pediatric patients who underwent LA at two institutions between 2016 and 2024. The cases were stratified by technique and appendicitis severity (simple, n = 217; complicated, n = 155). The physicians were classified into the junior residents/surgical residents' group (JR/SR group; n = 55) or the pediatric surgery fellow group (PSF group; n = 317). RESULTS: In simple appendicitis, TULAA demonstrated a shorter operative time (62.0 min) than TSLA (85.0 min; p < 0.001) and a shorter pneumoperitoneum time than both other approaches (p < 0.001). Similar advantages were observed in patients with complicated appendicitis. The postoperative hospital stay was shorter with TULAA and CTPLA than with TSLA in simple appendicitis (4.0 vs. 5.0days; p < 0.001). The perioperative complication rates were comparable. TULAA operative time was significantly influenced by surgeon experience (JR/SR group: 94.0 vs. PSF group: 59.5 min; p = 0.005), whereas TSLA was experience-independent (p = 0.983). CONCLUSION: TULAA offers optimal operative efficiency for early resident training. The sequential progression from TULAA to CTPLA to TSLA provides a data-driven framework for structured laparoscopic training in pediatric surgery.
European journal of pediatricsCharelity Adu-Gallant, Nora Karara, Julia Erdi, Sian Copley, Jaan Toelen, Kris Dierickx, J Peter de Winter
UNLABELLED: Despite guidance from the United Nations Convention on the Rights of the Child's (UNCRC) affirming that children have the right to be heard in all matters affecting them, European legal and clinical practices for paediatric healthcare decision-making remain variable. This study examines the perspectives of members of the Young European Academy of Paediatrics (yEAP), the network of national junior paediatric representatives within the European Academy of Paediatrics (EAP), on age limits, harmonisation of age limits across Europe, and their exposure to formal training in shared decision-making with children. Between 26 May and 1 August 2025, a survey was distributed among paediatricians in training and young specialists who are active delegates of the yEAP. The survey evaluated their preferred minimum age limits across different healthcare domains, their views on harmonisation of age limits across Europe, and their exposure to formal training in shared decision-making with children. Data were analysed using descriptive statistics. The findings reveal a variation in preferred minimum age limits for paediatric healthcare across different domains. The results are based on perspectives of 20 participants from different countries in Europe. Most participants (70%) favoured standardising age limits across Europe. Participants noted a substantial lack of formal training (85%) in shared decision-making with children. CONCLUSION: This study highlights both opportunities and challenges in translating child rights frameworks into practice. Given the small sample size, findings are exploratory, underscoring the need for broader research and context-specific policy and training initiatives. WHAT IS KNOWN: • Guidance from the United Nations Convention on the Rights of the Child's (UNCRC) affirms that children have the right to be heard in all matters affecting them. • Despite the guidance from frameworks like the UNCRC, variability persists in European legal and clinical practices regarding paediatric healthcare decision making. WHAT IS NEW: • The findings indicate that preferred minimum age thresholds for autonomous decision-making are not uniform but vary across healthcare domains. • Most participants favoured standardising age limits across Europe. • Participants noted a substantial lack of formal training in shared decision making with children.
Pediatric blood & cancerAmita Trehan, Emine A Rahiman, Jennifer Lowe, Maite Gorostegui, Scott Howard, Neil Ranasinghe, Julia Challinor, Nita Radhakrishnan
BACKGROUND: The International Society of Paediatric Oncology launched the Global Mapping Programme in 2018 to systematically map pediatric oncology services worldwide. Objectives were to document regional resources, maintain a publicly accessible stakeholder map, engage key stakeholders, and strengthen referral pathways. India, the world's most populous country (1.45 billion), has nearly 25% of its population under 15 years. The healthcare system, disparities in resources, access, and cost leave the true childhood cancer burden inadequately defined. Mapping pediatric cancer units (PCUs) is critical to identify the strengths and gaps and help policymakers, non-governmental organizations, funders, and clinicians. The data collection processes developed for mapping India are detailed in this report. PROCEDURE: The Pediatric Hematology Oncology Chapter of the Indian Academy of Pediatrics developed a 98-item survey to assess infrastructure, resources, and support systems. Designed to capture the heterogeneity of healthcare, it is the most extensive survey conducted within any Global Mapping Programme region. Launched in December 2023, it targeted approximately 150 PCUs, with responses limited to one per hospital. RESULTS: The survey closed in December 2024 with 133 responses, covering most centers, although some non-response remains a limitation. CONCLUSIONS: National cancer control policies in India have given limited attention to children. The mapping data can guide alignment with the World Health Organization Global Initiative for Childhood Cancer and support progress toward the CureAll framework goal of 60% survival. Achieving this goal requires coordinated central and state action to address gaps in workforce, resources, and family support, along with periodic reassessment of capacity in pediatric oncology.
European journal of pediatricsBogdana S Zoica, Manimaran Jayamurthy, Adam Briki, Neekash Agari, Dusan Raffaj, Patrick Davies, Maria Sellars, Avishay Sarfatti, Matteo Di Nardo, Tijana Radovi…
UNLABELLED: Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable bedside imaging modality in pediatric medicine, enabling rapid real-time patient assessment and procedural guidance. While its use is well established in pediatric emergency and critical care settings, its role in general pediatric practice is expanding. This narrative review summarizes the practical applications of POCUS relevant to general pediatricians, focusing on lung imaging, focused functional cardiac assessment, ultrasound-guided vascular access, and the image governance required for safe implementation. A narrative review of contemporary pediatric literature and relevant consensus guidance was undertaken, focusing on evidence applicable to general pediatric practice, including diagnostic performance, procedural utility, education, and governance. Evidence supports the use of POCUS in general pediatrics as a means to improve diagnostic confidence and procedural outcomes. Lung ultrasound demonstrates high diagnostic accuracy for common pediatric respiratory conditions, including consolidation and pleural effusion, and may reduce reliance on chest radiography. Focused cardiac ultrasound provides actionable insights into fluid responsiveness and ventricular function at the bedside, facilitating timely decision-making and early identification of cardiogenic shock. Ultrasound-guided vascular access improves cannulation success rates and reduces complication risks, especially in children with difficult access. Despite these benefits, the adoption of POCUS in general pediatrics remains uneven across Europe, primarily due to variability in training standards, credentialing processes, and institutional support. CONCLUSION: POCUS has the potential to enhance bedside pediatric assessment by improving diagnostic confidence, procedural safety, and responsiveness to clinical change. Safe and equitable integration into general pediatric practice will require structured training, clear governance, routine image archiving, and a coordinated approach to competency and implementation. WHAT IS KNOWN: • POCUS supports bedside assessment and procedural success in pediatric emergency and critical care. • Lung, focused cardiac and ultrasound-guided vascular access may also benefit general pediatric practice. WHAT IS NEW: • This review defines a pragmatic core POCUS scope for general pediatricians. • It links that scope to image governance and an author-proposed tiered competency framework for European implementation.
Journal of primary care & community healthJoy Friedman, Melissa A Alderfer, Kelsey Higgins, Aaron Carpenter, Jennifer Sciolla, Sarah E Wawrzynski
IntroductionStructural and social conditions influence pediatric health outcomes. Successful implementation of social needs screening and referral programs depends on community-based organizations (CBOs) to provide resources that address health-related social needs (HRSN). We explored current practices and perspectives of health care workers and CBO representatives on improving health system-CBO partnerships.MethodsParticipants were purposively recruited from a variety of health care settings involved in HRSN screening and CBOs delivering resources in the community. Participants completed semi-structured interviews. Qualitative thematic analysis was used to summarize data.ResultsTen key informants participated (six health care workers and four CBO representatives). Four themes were identified: 1) mismatches in demand, resources and eligibility challenge the provision of resources, 2) financial limitations threaten sustainability and need for vetting resources, 3) fostering relationships as a key facilitator in screening and resource delivery, and 4) barriers hamper follow-through and tracking referral outcomes. Recommendations for fostering partnership were also summarized.ConclusionsParticipants described systemic challenges in addressing HRSN. They recommended cultivating relationships between pediatric health systems and CBO partners who understand and advocate for their communities' needs and agendas. Shared goals include improving efficiency and cross-sector communication, defining and measuring outcomes, and demonstrating return on investment for non-medical interventions to enhance sustainability to programming addressing HRSN.
Pediatric blood & cancerAnshul Vagrecha, Adit L Tal, Kayleen A Bailey, Andrea D Orsey, Danielle Cohen, Jessica E Briggs, Jeremy Rosenblum, Farzana Pashankar, Katharine Offer, Alexande…
BACKGROUND: Starting a pediatric subspecialty fellowship presents numerous challenges to trainees. Virtual Symposium of Pediatric Hematology/Oncology of New York (v-SYMPHONY), an educational collaborative organized by 18 pediatric hematology-oncology (PHO) programs, initiated an annual bootcamp in 2022 aimed at easing the transition from pediatric residency to PHO fellowship. METHODS: The bootcamp consisted of virtual clinical lectures and fellow-led panels, which were created with input from diverse program leadership, educators, and past fellows using Kern's six-step module of curriculum development. It was offered to incoming fellows, first in the NY/NJ/CT region, and subsequently expanded nationally. RESULTS: Over 4 years (2022-2025), 147 pediatric residents completed this virtual bootcamp. The number of residents attending the live sessions increased from 19 in 2022 to 62 in 2025. Forty-four participants completed pre- and post-bootcamp surveys over this period, which showed significant improvement in both self-reported medical knowledge and preparedness and reported a decrease in transition to fellowship anxiety scores. CONCLUSION: These results highlight the need and benefits of a standardized orientation program that can be delivered virtually to ease the transition of PHO trainees from residency to fellowship. Such a standardized curriculum is feasible, adaptable, and potentially scalable to a national level.
BACKGROUND: WeChat group consultations extend pediatric advice into everyday messaging, but their interactional organization is not well described. OBJECTIVE: To identify recurring interactional stages, and clarification practices in asynchronous caregiver-physician exchanges. METHODS: We analyzed 5,938 messages nested within 347 manually identified complete consultation episodes from one private pediatric WeChat group in Chengdu, China, collected from January to December 2024. A qualitatively led mixed-methods design combined manual sequence segmentation, descriptive analysis of message distribution and length, and targeted qualitative analysis of clarification sequences. RESULTS: Four recurrent stages were identified: problem initiation, clinical data collection, diagnostic advice, and closure. Opening and illness presentation were combined in 69.45% of episodes (241/347), and diagnosis with treatment recommendation in 85.88% (298/347). Caregivers produced more messages overall than physicians (3,273 vs. 2,665), with substantially longer and more variable messages during problem initiation (median = 9 vs. 3; M = 17.91 vs. 3.50; IQR = 14.75 vs. 3) and clinical data collection (median = 10 vs. 7; M = 14.22 vs. 9.29; IQR = 11 vs. 7). Message-length distributions became more comparable during diagnostic advice (median = 10 for both; IQR = 12 vs. 13). Clarification sequences were identified in both directions: 293 physician-led sequences during clinical data collection and 686 caregiver-initiated sequences during diagnostic advice, progressively transforming underspecified symptom reports into more specified clinical accounts. CONCLUSION: The findings demonstrate how asynchronous messaging redistributes communicative activities between caregivers and physicians, with clarification as a recurrent mechanism for specifying clinically relevant information. Structured symptom prompts, clearer message threading, and explicit escalation guidance warrant testing in future intervention research. This study provides an empirical basis for understanding the sequential organization of asynchronous pediatric consultations and offers actionable directions for communication design in digital health services.
Medical careGabrielle Jutras, Andrea Huerta, Chetana Bisarya, Noelle Ebel, Joshua Gossett, George Mazariegos, Vicky L Ng, Emily R Perito, James E Squires, Sharad I Wadhwani
BACKGROUND: Social adversity contributes to poor health outcomes for children after liver transplantation (LT), including greater morbidity and mortality. Although social risk screening is standard practice in pediatric primary care, its adoption in pediatric LT (pLT) remains limited, despite the significant prevalence of social risks among these families. OBJECTIVES: To evaluate barriers and facilitators to social risk screening implementation in pLT settings across a multicenter learning health network. RESEARCH DESIGN: A mixed-methods study utilizing surveys and semistructured interviews. SUBJECTS: Health care practitioners involved in pLT care across North American centers in the Starzl Network for Excellence in Pediatric Transplantation (SNEPT) Network. Participants included multidisciplinary team members, notably transplant physicians, social workers, and research coordinators. MEASURES: We surveyed center leads to identify center-level implementation challenges. We conducted 1-on-1 interviews with transplant team members to identify barriers and facilitators. We analyzed qualitative data using the Capability, Opportunity, Motivation-Behavior model, an implementation science model for developing targeted interventions. RESULTS: We surveyed 10 centers, of which 40% of liver transplant clinics reported actively screening patients for Social Determinants of Health (SDoH). Most practitioners indicated reliance on social workers and cited limited resources as barriers to implementation. We also conducted interviews with 18 practitioners across 11 centers. Reported barriers included uncertainty about the tool's added value, time and space constraints during patient encounters, and challenges with data entry and sharing across a multicenter network. Facilitators included institutional support, interdisciplinary collaboration, and integration into electronic health records. CONCLUSION: Efforts to increase adoption should focus on improving practitioners' experiences with the tool as well as further assessing and disseminating its potential value in improving outcomes. Strategies for addressing logistical challenges to adapting workflows and simplifying network data management should be considered. This study establishes a foundation for improving screening rates and data capacity.
Acta oncologica (Stockholm, Sweden)Melissa Jakobsson, Helena Ventovaara, Eva Broström, Pernilla Pergert, Elisabet Tiselius, Johanna Granhagen Jungner
BACKGROUND AND PURPOSE: Tailored, language-appropriate information is fundamental for children and their families in paediatric oncology, influencing both the quality of care and clinical outcomes. Yet, for families who speak another language, interpreter services are not used to the extent necessary to ensure equitable and patient-safe communication. Knowledge about how healthcare professionals (HCPs) (registered nurses [RNs] and medical doctors [MDs]) experience and manage interpreter use is limited. To address this gap, this study aimed to explore the obstacles to interpreter use in Nordic paediatric oncology care and to examine the challenges HCPs experience during interpreter‑mediated conversations. Participants/materials and methods: A cross-sectional multicentre survey study involving 453 RNs and MDs from 20 paediatric oncology centres across the Nordic region. The Communication over Language Barriers Questionnaire was used in each country's majority language. Descriptive and non-parametric analyses were used to summarise and compare the data between countries and professions. Group differences were tested using Pearson's chi-square or Fisher-Freeman-Halton exact tests, with p < 0.05 considered significant. RESULTS: Time constraints in acute but also in planned care situations were identified as the most common obstacles to interpreter use. In addition, when using interpreters, the respondents sometimes or often experienced challenges such as uncertainty about the accuracy of the interpretation and about patients' understanding of the given information. INTERPRETATION: To ensure equitable, safe, and person‑centred care for children and their families, there is an emergent need for improved communication strategies and a need for better organisational support, easier interpreter access, and stronger systems for quality-assured interpreter services across the Nordic region.
European journal of pediatricsMarco Gabrielli, Giulia Zamagni, Sara Persello, Valeria Tozzi, Francesca Peri, Lucia De Zen
UNLABELLED: The purpose of this study was to describe real-world pediatric palliative care (PPC) utilization and care pathways within a regional Italian health system and to compare the observed specialist PPC caseload with the expected regional need. This retrospective observational study included pediatric patients formally taken in charge by the tertiary-level PPC Hub Center at IRCCS Burlo Garofolo, Trieste, between January 2022 and December 2025. Electronic clinical records were reviewed to reconstruct demographic and clinical characteristics, technological dependency, healthcare contacts, home-based activities, territorial mobility, and expected regional PPC need. Among 159 screened patients, 91 met the inclusion criteria. Most patients were non-oncologic (n = 80) and showed high clinical complexity and frequent technological dependency, with 29.7% requiring more than three medical devices. Median age was 6 years (IQR 1-12), foreign citizens accounted for 26.4% of the cohort, and overall mortality was 29.7%. Median healthcare utilization was 61 accesses per patient (IQR 35-97), with broad multidisciplinary involvement across hospital, outpatient, emergency, and home-based services. Care delivery was strongly centralized toward the tertiary PPC Hub Center. Observed specialist PPC coverage was 42.3% of the estimated regional specialist need, with lower coverage in more distant Local Health Authorities. CONCLUSION: Children receiving specialist PPC showed substantial clinical complexity, technological dependency, and intensive multidisciplinary healthcare use. Hub-centered pathways and the coverage gap support strengthening territorial capacity, proactive case identification, culturally sensitive family support, and integrated Hub-and-Spoke governance. WHAT IS KNOWN: • Children needing PPC have complex, long-term needs and high healthcare utilization. • Access to specialist PPC remains uneven across Italian regions and care settings. WHAT IS NEW: • This regional real-world study reconstructs longitudinal PPC pathways across hospital, home, and territorial services. • Specialist PPC coverage reached 42.3% of estimated need, with marked LHA variability and hub-centered care.
Acta orthopaedica et traumatologica turcicaYakup Kahve, Tahsin Aydın, Utku Gürhan
OBJECTIVE: Pediatric fractures are among the most common traumas in childhood and constitute an important public health issue. Although bibliometric studies in this field have recently appeared in the international literature, a comprehensive national-level evaluation is lacking in Türkiye. The aim of this study is to perform a bibliometric analysis of pediatric fracture research published in journals indexed in the ULAKBİM TR Index, and to examine publication characteristics, thematic trends, and interdisciplinary collaboration patterns within this indexing system. METHODS: A search was conducted in ULAKBİM TR Index database on August 15, 2025, using the keywords "çocuk" (child) "pediatrik" (pediatric), "kırık" (fracture), and "fracture." All publications containing these terms in their title or abstract were included. Bibliographic data such as year of publication, journal, authors, institutions, keywords, and citation counts were analyzed. In addition, keyword cooccurrence networks and interdisciplinary collaboration networks were generated. RESULTS: A total of 166 articles were evaluated. The highest number of publications appeared in Acta Orthopaedica et Traumatologica Turcica (17.5%) and Turkish Journal of Trauma and Emergency Surgery (10.2%). Institutional contributions predominantly originated from training and research hospitals affiliated with the Ministry of Health (59.6%). In keyword analysis, "child" (50), "surgery" (37), "method" (14), and "radiography" (11) were the most frequently used terms. In the interdisciplinary collaboration network, the strongest connections were observed between Orthopedics and Traumatology and Emergency Medicine, while contributions from fields such as Pediatrics, Radiology, and Public Health remained more limited. CONCLUSION: Pediatric fracture research published in journals indexed in the ULAKBİM TR Index suggests a gradual increase in publication activity over time, with a concentration in specific journals and institutions and a predominant focus on surgical approaches. Contributions related to rehabilitation, psychosocial effects, and long-term functional outcomes were relatively limited in the national literature. Cite this article as: Kahve Y, Aydın T, Gürhan U. A bibliometric analysis of pediatric fracture research published in journals indexed in the ULAKBİM TR index. Acta Orthop Traumatol Turc., 2026; 60(5), 0680, doi: 10.5152/j.aott.2026.25680.
Journal of robotic surgeryDonatella Di Fabrizio, Giovanni Cobellis, Edoardo Bindi
As robotic surgery expands beyond the da Vinci platform, the relevance of new-generation systems to pediatric patients remains uncertain. This review examined the technical characteristics, applications, and perioperative outcomes of alternative multiport robotic platforms in children. PubMed/MEDLINE, Web of Science, Scopus, and the Cochrane Library were searched through 28 February 2026 in accordance with PRISMA 2020. Owing to clinical heterogeneity, findings were synthesized narratively, with Wilson 95% confidence intervals for key binary outcomes. Six studies reported 166 patients across 27 procedure types. Senhance accounted for 164 patients, while Hugo RAS and Hinotori were each represented by one patient. Ages ranged from 15 days to 17 years and weights from 3.8 to more than 100 kg. Senhance was the only platform used with 3-mm robotic instruments. Conversion or planned escalation occurred in 19 patients (11.4%; 95% CI, 7.5-17.2%). Four intraoperative complications were reported (2.4%; 95% CI, 0.9-6.0%). Across all reports, 20 patients experienced postoperative complications (12.0%; 95% CI, 7.9-17.9%). In the largest cohort, seven patients required reintervention (4.6%; 95% CI, 2.2-9.2%) and seven were readmitted (4.6%; 95% CI, 2.2-9.2%). No deaths or comparative pediatric studies were reported. Published experience remains sparse and is almost entirely limited to Senhance. Current evidence describes early clinical use without establishing comparative safety, effectiveness, or platform superiority. Prospective multicenter studies with standardized reporting are needed.
Journal of wound careGuido Ciprandi, René Amaya, Joyce Barrantes Alfaro, Franco Bassetto, Dimitri Beeckman, Vitalya Boyar, Serena Crucianelli, Corrado Maria Durante, Pablo Garcia-M…
A call for global recognition from the International Society for Neonatal and Paediatric Wound Healing (ISPeW): Our purpose is to drive a global transformation in the prevention, assessment, treatment, education and research of neonatal and paediatric wounds. Through this document, ISPeW calls for the formal recognition of paediatric wound healing as a unique and vital discipline, deserving dedicated attention in clinical practice, scientific research and healthcare policy.