Improvements in outcomes for congenital heart disease (CHD) have resulted in a growing adolescent/adult CHD population. Subsequently, education on CHD causes and inheritance has been identified as important. This study aimed to determine population-specific understanding and preferences of CHD causes and inheritance education. CHD adolescents aged 13-18years, their parent, and clinicians involved in the care of patients with CHD completed a purpose-designed, online survey outlining their current understanding of CHD genetics and inheritance and their preferences for education content and delivery. Approximately 50% of participants were unsure if CHD was caused by genetic factors, and 25% believed CHD was not genetic. Many participants (63% (19/30) adolescents, 81% (26/32) parents) wanted to know more about CHD causes, with most considering this important. Over 60% of participants indicated that CHD causes had not been discussed with them, despite 74% of clinicians (17/23) indicating they discuss this. Information on genetic causes of CHD and recurrence risks, delivered in-person with parents present, was the preferred option for the content and delivery of this information. Most clinicians indicated genetics education should be introduced between 12 and 14years, whereas adolescents and parents preferred this to occur between 14 and 16years. Participants want to know more about CHD causes and inheritance, in an outpatient setting with parents in attendance. The findings of this study support the development of a specialized genetics education program about CHD causes and inheritance for adolescents with CHD. Further, it provides important insight into the content, timing, and delivery of this information.

Pediatric total intravenous anesthesia (TIVA) with propofol is well-established, safe, and offers advantages over volatile anesthesia. Nevertheless, its use remains limited because of inadequate training and knowledge, lack of confidence, perceived complexity, and uncertainty or limited awareness of its benefits. This error traps article explores key principles for the safe and effective use of pediatric TIVA, including pharmacological principles, the role of adjunct agents, practical aspects of drug delivery, electroencephalography-based monitoring, and the use of TIVA in specific populations.

Limited data exist on the long-term impact of invasive meningococcal disease (IMD) contracted during adolescence and early adulthood. This study aimed to determine the long-term outcomes on neurocognitive, psychological and quality of life (QoL) outcomes in adolescents and young adults. IMD survivors aged 15-25 years (2-10 years post-IMD hospitalization) and non-IMD age-matched control participants were recruited across mainland Australian states (2016-2023) and completed neurocognitive, psychological, QoL and physical assessments. A total of 41 IMD cases (93% serogroup B and 73% females) and 51 control participants (57% females) were enrolled in the study. There was no clinically significant difference in Full-Scale IQ between IMD cases (106, SD 11) and control participants [109, SD 14, adjusted difference -4, (95% confidence interval, -10 to 3), P = 0.2]. Mean QoL scores for IMD cases (0.80, SD 0.21) and control participants (0.90, SD 0.09) were similar [adjusted difference -0.06, (95% confidence interval, -0.13 to 0.02), P = 0.2]. Mathematical reasoning was poorer in cases than in controls (P = 0.02). IMD cases had significantly higher rates of psychological symptoms than controls (58% vs. 31%, P = 0.01), including posttraumatic stress disorder symptoms (10% vs. 0%, P = 0.03) and alcohol dependence (18% vs. 2%, P = 0.04). Physician-assessed physical sequelae were present in 15% of IMD survivors (50% severe). While long-term outcomes for adolescents and young adult IMD survivors show no significant impact on intellectual functioning or overall QoL, they experienced substantial psychological and physical sequelae. The impact on mental health underscores the need for comprehensive postdischarge psychological follow-up and care for IMD survivors, in addition to care for physical sequelae.

To investigate the birth prevalence, clinical manifestations, and management of congenital cytomegalovirus (CMV) infections in Australia, 1999-2023. Longitudinal observational study; analysis of prospectively collected Australian Paediatric Surveillance Unit (APSU) data. Australia, 1 January 1999 - 1 January 2024. Number of definite congenital CMV infections during study period and after the establishment of universal neonatal hearing screening (1 January 2004); clinical sequelae of definite infections; proportion of infants with symptomatic definite infections treated with antiviral medications. During 1 January 1999 - 1 January 2024, 586 cases of congenital CMV infection were reported to the APSU (8.15 [95% confidence interval, 7.50-8.83] infections per 100 000 births), including 479 definite infections (82%). The most frequent sequelae of definite infections were small for gestational age or intrauterine growth restriction (135 infants, 28.2%); neurological conditions (most frequently: deafness [183, 38.2%], microcephaly [89, 18.6%]); liver disease with jaundice (130, 27.1%), hepatomegaly (75, 15.7%), or hepatitis (85, 14.7%); and bone marrow conditions (most frequently: thrombocytopaenia [139, 29.0%], petechiae/purpura [89, 18.6%]). Of 168 Guthrie card tests (newborn blood spot screening), 154 (91.7%) were CMV-positive (polymerase chain reaction DNA detection), including 143 that provided the sole reason for classifying the cases as definite congenital CMV infections. During 1 January 2004 - 1January 2024, 447 of 506 cases (88.3%) were definite congenital CMV infections, of which 366 (81.9%) were symptomatic; 116 of these infants (32%) were treated with antiviral medications. The number of reported definite congenital CMV infections during 1 January 1999 - 1 January 2024 was only 1.0% of the number expected in Australia on the basis of their estimated prevalence in developed countries. The number of reported cases has continuously increased since 1999, as has the use of antiviral therapy. Surveillance of congenital CMV infections, the major infectious cause of congenital malformations, needs to be expanded to fully assess their prevalence and the associated disease burden, and to inform prevention strategies.

Background:Obesity was a risk factor for severe COVID-19 in children during early outbreaks of ancestral SARS-CoV-2 and the Delta variant. However, the relationship between obesity and COVID-19 severity during the Omicron wave remains unclear.Methods:This multicenter, observational study included polymerase chain r eaction-confirmed SARS-CoV-2-infected children and adolescents from Australia, Brazil, Italy, Portugal, Switzerland, Thailand, the United Kingdom and the United States hospitalized between January 1, 2020, and March 31, 2022. Data were collected across 3 time periods representing dominant SARS-CoV-2 variants: the ancestral strain (T1), pre-Omicron variants (Alpha and Delta; T2) and Omicron (T3). The primary outcome was the need for supplemental oxygen therapy and/or ventilatory support (respiratory support).Results:This study included 6176 hospitalized children and adolescents of 2 to <18 years of age. The median age was 11.0 (interquartile range, 6.0–14.0) years, and 2989 (48.4%) were female. Obesity status was available for 5460 (88.4%), of whom 213 (3.9%) met the criteria for having obesity. Obesity was positively associated with the need for respiratory support during T1 [risk ratio (RR), 3.45 (95% CI: 2.02–5.88)] and T2 [RR, 3.24 (95% CI: 1.57–6.67], but this association was lost during T3 [RR, 3.08 (95% CI: 0.85–11.15)]. These findings were similar for unvaccinated children.Conclusions:Obesity was associated with more severe COVID-19 during the ancestral and pre-Omicron waves but not during the Omicron wave. Importantly, the same phenomenon was observed in unvaccinated children, suggesting that differences in vaccination did not account for the observed changes in the need for respiratory support over time.

HighlightsWhat are the main findings?Skeletal maturity significantly influences surgical decision-making and outcomes in pediatric ACL reconstruction.A multimodal approach combining clinical, radiological, and MRI-based assessments enhances accuracy in determining skeletal maturity.What are the implications of the main findings?Tailoring ACL reconstruction techniques to skeletal maturity levels minimizes growth disturbances and improves functional outcomes.An integrated assessment strategy may standardize preoperative planning, particularly for patients with ambiguous maturity status or comorbidities.Anterior cruciate ligament (ACL) injuries in skeletally immature patients pose unique clinical and surgical challenges due to the presence of open physes and ongoing growth. In recent years, multiple surgical strategies have been developed to restore knee stability while minimizing the risk of growth disturbances. However, clinical decision-making remains complex due to the lack of consensus regarding the optimal timing, technique, and graft selection for this population. This narrative review outlines the current clinical and radiological tools used to assess skeletal maturity and explores how maturity status informs surgical approach, with particular emphasis on physeal-sparing, hybrid, and transphyseal techniques. We summarize postoperative complications—including growth disturbances and graft failure—while highlighting current guideline recommendations and ongoing controversies. Lastly, we propose a multimodal model for skeletal maturity assessment to support individualized treatment strategies and emphasize the need for standardized protocols and high-quality research to improve long-term outcomes in pediatric ACL reconstruction.

BackgroundPediatric to adult health service (AHS) transition is a challenging time for many adolescents and young adults with chronic illness. As the responsibility of illness management shifts from parents to the young person themselves, many young people fail to transition in a timely manner, which has important health consequences. Mobile apps show potential in assisting young people to self-manage their condition during this vulnerable time, but empirical data on app uptake as well as efficacy with respect to transition outcomes and illness control are lacking.ObjectiveThis study aimed to evaluate the usage of a mobile app called “TransitionMate” (TMApp) by adolescents and young adults, which was purpose-built to support chronic illness self-management for youth undergoing transition. Secondary aims were to assess AHS attendance and changes in illness control over the first 12 months post transition. Upon demonstration of TMApp feasibility (49/70, ≥70% of participants using TMApp at least once a month), a randomized controlled trial was planned to test app efficacy in relation to transition and illness control outcomes.MethodsYoung people aged 16‐19 years who were transitioning out of 2 major pediatric hospitals in Sydney, New South Wales, Australia, were recruited. Just before transition, participants’ demographic and clinical details were collected, and TMApp was installed on their mobile devices. Participants were contacted by telephone at 6 and 12 months for information on self-reported usage, app usefulness, and other feedback. Quantitative cohort-level usage data, including the number of times specific app features were accessed, were tracked via mobile analytics. At 12 months, electronic medical records from participants’ designated AHS were accessed for data on AHS attendances, measures of illness control, and unplanned hospitalizations.ResultsIn total, 73 adolescents and young adults (30 male; median age 18, IQR 17-18 y) were recruited, with 1 withdrawing participation in the first month. Participants were primarily from 3 chronic illness subgroups—diabetes mellitus (n=23), inflammatory bowel disease (n=19), and cystic fibrosis (n=9). Of the total, 50% (36/72) of participants reported using TMApp at 1 month post transition. Self-reported usage rates fell to 25% and 11% at 6 and 12 months, respectively. Mobile analytics data broadly corroborated self-reported usage. Furthermore, 8 participants who continued to use TMApp for 12 months gave a median usefulness rating of 8/10. Over two-thirds (48/72, 68%) of participants successfully transitioned to their designated AHS by 12 months. Among the successful transitioners who had illness control data available on electronic medical records, over 80% (24/30) maintained a stable or improved illness status at 12 months.ConclusionsTMApp was not used regularly enough by our young people to demonstrate feasibility and justify progression to a randomized controlled trial. Despite low app uptake, most participants successfully transitioned, suggesting that TMApp had minimal influence on transition outcomes.