Pediatric Conditions Research Articles

Barriers and supports for Indigenous youth and young adults with childhood- onset chronic health conditions transitioning from pediatric to adult healthcare: a qualitative study

BackgroundThis study examined the experiences of Indigenous youth and young adults with pediatric onset chronic health conditions who had or were about to transition from pediatric to adult healthcare services. Transition is the process by which youth develop the knowledge and self-management skills needed to manage their health condition, ideally beginning around age 12–13 and continuing until the mid-20s. There is a growing body of literature on healthcare transition, but there is an absence of literature on Indigenous youth, who face additional barriers to accessing healthcare relative to non-Indigenous Canadians. The primary objective of this study was to identify the supports and barriers for Indigenous youth with childhood-onset chronic health conditions transitioning from pediatric to adult healthcare services.MethodsThe research was done in the province of Alberta, Canada, in collaboration with a Community Advisory Committee comprised of Indigenous healthcare providers, Elders and Knowledge Keepers and guided by a community-based participatory research approach. Semi-structured qualitative interviews (n = 46) were conducted with Indigenous youth, caregivers, and healthcare providers. There were three Talking Circles, two for youth (9 participants) and one for caregivers (6 participants). Three research assistants coded the transcripts thematically using NVivo. The key findings were presented to the Community Advisory Committee for feedback to validate the interpretation of the qualitative data.ResultsThe thematic findings include: (1) systemic inequalities exacerbate gaps in healthcare; (2) intergenerational trauma created unique barriers for Indigenous youth; (3) long-term relationships with care providers as a protective factor; (4) the incorporation of Indigenous worldviews into healthcare services to aid transition; and (5) assuming new responsibilities as an adult. The participants provided recommendations to improve healthcare service delivery including the need for Indigenous transition supports in community and improving education for healthcare practitioners about transition and Indigenous worldviews.ConclusionThis study demonstrates the complexity of the transition experience for Indigenous youth with pediatric onset chronic health conditions. The identified barriers to successful transition could be addressed through systems level changes and the development of Indigenous specific transition support services. Such approaches need to be Indigenous-led and incorporate Indigenous culture, language, and teachings.

Reduced kidney size and renal function of high-grade vesicoureteral reflux and intrarenal reflux in contrast-enhanced voiding urosonography

BackgroundVesicoureteral reflux (VUR) is a common pediatric urological condition associated with renal scarring, hypertension, and chronic kidney disease. Contrast-enhanced voiding urosonography (ceVUS) has emerged as a promising technique for diagnosing and evaluating VUR, with intrarenal reflux (IRR) often detected using this method. This study aimed to explore the relationship between different VUR grades and IRR on ceVUS, and assess the impact of VUR and IRR on kidney size and function.MethodsWe reviewed all ceVUS studies from January 2019 to December 2023 conducted at West China Hospital, Sichuan University. Both video clips and digital images of the ceVUS examinations were recorded. A total of 220 uretero-renal units (URUs) of 110 children (67 males and 43 females) were included in this study.ResultsAmong the 220 URUs assessed, 134 were diagnosed with VUR, and 25 exhibited IRR, with IRR exclusively observed in patients with grade II VUR or higher. Upon age and sex matching, the severity of IRR showed a significant positive correlation with high-grade VUR (P < 0.001). Notably, patients with high-grade VUR and IRR displayed reduced kidney size compared to those without VUR or IRR (P < 0.05). Furthermore, patients with high-grade VUR and IRR had reduced DMSA renal function (P = 0.015, P = 0.012, respectively), and patients with high-grade VUR had more DMSA scars (P = 0.027), compared with those without VUR or IRR.ConclusionOur study highlights that on ceVUS, the IRR degree was associated with the high-grade VUR, along with reductions in kidney size and renal function in patients with high-grade VUR and IRR.

Efficacy of piracetam in children with breath-holding spells: a systematic review and meta-analysis.

A number of randomized-controlled trials (RCTs) have been conducted comparing the efficacy of piracetam with placebo and other medications in children with breath-holding spells (BHS). However, no systematic review has yet collated all this evidence. All RCTs comparing the efficacy and/or safety of piracetam with placebo or other medications in children with BHS were included. The pooled estimates were compared for the number of participants with a favorable response, the change in monthly frequency of BHS, compliance, and adverse effects in both groups. The ROB 2.0 tool was used to assess the risk of bias, and the GRADE system was used to determine the certainty of the collated evidence. We included 5 RCTs (437 participants) in the review. Piracetam group had significantly more participants with favorable responses at 1, 2 and 3months after randomization, as compared to placebo group (RR: 6.5 (95% CI-1.8-23.2), I2 = 75%, p = 0.004, RR: 4.7 (95% CI-3.3-6.7), I2 = 49%, p < 0.0001, RR: 5.4 (95% CI-3.4-8.5), I2 = 0%, p < 0.0001 respectively). Number of participants with complete response or total cessation of attacks was more in thepiracetam group compared to placebo (RR: 5.7 (95% CI-1.4-23.2), I2 = 88%, p = 0.01). Change in theaverage number of BHS was significantly more in thepiracetam group, as compared to theplacebo group (mean difference-4.9 (95% CI-0.7-9.0), I2 = 99%, p = 0.02). Number of participants with treatment-emergent adverse effects were comparable in both piracetam and placebo groups (RR: 1.9 (95% CI-0.5-7.6), I2 = 0%, p = 0.33). Conclusion: Oral piracetam is efficacious and safe in children with BHS, and its efficacy may further increase by co-administration of oral docosahexaenoic acid. What is known? • Breath-holding spells (BHS) are a common pediatric condition, affecting 0.1% to 4.6% of otherwise healthy children. • Several studies have investigated the efficacy of piracetam in reducing the frequency and severity of BHS, with mixed results. What is new? • Oral piracetam is efficacious and safe in children with BHS. • Its efficacy is further increased by co-administration of oral docosahexaenoic acid.

Angiopoietin-2: A Therapeutic Target for Vascular Protection in Hutchinson–Gilford Progeria Syndrome

Hutchinson–Gilford progeria syndrome (HGPS) is a pediatric condition characterized by clinical features that resemble accelerated aging. The abnormal accumulation of a toxic form of the lamin A protein known as progerin disrupts cellular functions, leading to various complications, including growth retardation, loss of subcutaneous fat, abnormal skin, alopecia, osteoporosis, and progressive joint contractures. Death primarily occurs as the result of complications from progressive atherosclerosis, especially from cardiac disease, such as myocardial infarction or heart failure, or cerebrovascular disease like stroke. Despite the availability of lonafarnib, the only US Food and Drug Administration-approved treatment for HGPS, cardiovascular complications remain the leading cause of morbidity and mortality in affected patients. Defective angiogenesis—the process of forming new blood vessels from existing ones—plays a crucial role in the development of cardiovascular disease. A recent study suggests that Angiopoietin-2 (Ang2), a pro-angiogenic growth factor that regulates angiogenesis and vascular stability, may offer therapeutic potential for the treatment of HGPS. In this review, we describe the clinical features and key cellular processes impacted by progerin and discuss the therapeutic potential of Ang2 in addressing these challenges.

Spinal cord-spinal canal disproportion following treatment for syringomyelia associated with Chiari malformation type I: illustrative case.

Chiari malformation type I (CM-I) is a common pediatric neurosurgical condition that is often associated with syringomyelia (SM) and spine deformity. The association of these three conditions is well recognized, but the pathophysiology linking them has yet to be fully elucidated. This case report describes the unusual course of a 13-year-old male with CM-I, a large holocord syrinx, and progressive scoliosis who developed an angiography-negative subarachnoid hemorrhage (SAH) 4 months after successful posterior fossa decompression with duraplasty (PFDD). Notably, his cervical spinal canal diameter was increased relative to normative data. After presenting with SAH, he was treated with a course of lumbar cerebrospinal fluid drainage, which relieved his symptoms, and he had no further incidents. His syrinx responded to PFDD with a dramatic decrease in spinal cord diameter, in contradistinction to his dilated bony spinal canal. He is presently 4 years out from his SAH and doing well clinically. This report describes the first case of nonaneurysmal SAH following PFDD for CM-I and SM and explores a possible link between SM and bony spinal canal diameter. https://thejns.org/doi/10.3171/CASE24272.

Pulmonary MRI in Newborns and Children.

Lung MRI is an important tool in the assessment and monitoring of pediatric and neonatal lung disorders. MRI can provide both similar and complementary image contrast to computed tomography for imaging the lung macrostructure, and beyond this, a number of techniques have been developed for imaging the key functions of the lungs, namely ventilation, perfusion, and gas exchange, through the use of free-breathing proton and hyperpolarized gas MRI. Here, we review the state-of-the-art in MRI methods that have found utility in pediatric and neonatal lung imaging, the structural and physiological information that can be gleaned from such images, and strategies that have been developed to deal with respiratory (and cardiac) motion, and other technological challenges. The application of lung MRI in neonatal and pediatric lung conditions, in particular bronchopulmonary dysplasia, cystic fibrosis, and asthma, is reviewed, highlighting our collective experiences in the clinical translation of these methods and technology, and the key current and future potential avenues for clinical utility of this methodology. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

Age- and sex-specific reference percentile curves for accelerometry-measured physical activity in healthy European children and adolescents.

This study provides age- and sex-specific percentile curves for PA-accelerometry in European children and adolescents, addressing a current gap in the availability of full-age range reference data. These curves based on healthy children and adolescents can be used by clinicians, researchers, and policymakers to interpret PA-accelerometry measurements, track physical activity trends, and evaluate treatment responses and health interventions. • Daily physical activity (PA) is considered an important measure in various paediatric conditions. Existing reference data for PA in European children based on hip-worn accelerometers are limited to specific age ranges, and comprehensive data covering the full age range are lacking. • The study provides age- and sex-specific reference curves for PA derived by hip-worn accelerometers in European children and adolescents. These curves aid clinicians, researchers, and policymakers in interpreting PA measurements and tracking trends over time in European children.

The utility of Chat Generative Pre-trained Transformer as a patient resource in paediatric otolaryngology.

This study aimed to determine the feasibility of using Chat Generative Pre-trained Transformer (ChatGPT) (https://chatgpt.com) as a patient resource for paediatric otolaryngology conditions and assess the quality of responses generated by ChatGPT when compared with information available on the internet. ChatGPT responses to common paediatric otolaryngology conditions were compared with top internet pages for readability (Flesch Reading Ease score, word count), expediency (time taken to generate response), validity (comparison of recommendations to the American Academy of Otolaryngology Head and Neck Surgery guidelines) and consistency (changes in recommendations based on question variation). ChatGPT was more expeditious in generating responses with fewer words, albeit with higher reading scores. When compared with accredited guidelines, there was no difference in validity between these sources (internet sources and ChatGPT). Consistent responses were obtained with question variation. ChatGPT may be a valuable source for patients and families in providing valid information comparable to internet materials.

Cryptorchidism: A 20-Year Journey of Patient Outcomes and Family Concerns – A Cohort Study at a Single Center

Background: Undescended testis (UDT), or cryptorchidism, is a prevalent pediatric condition with significant implications for fertility and malignancy risk if untreated. Affecting 1–5% of male infants, UDT is influenced by genetic, hormonal, and environmental factors. Methods: This retrospective cohort study examines 470 pediatric UDT cases treated at a single center over two decades (2004–2024) at a single pediatric surgery center - The Maternity and Child Teaching Hospital, Al Qadisiya, Iraq, focusing on surgical outcomes, fertility, long-term testicular health, and family concerns. Inclusion criteria; Patients were identified from hospital records and outpatient clinic registries confirmed diagnosis of UDT (unilateral or bilateral), availability of complete medical records, patients who underwent chromosomal analysis as part of their diagnostic workup, and underwent surgical intervention within the study timeframe at our center with at least three years of follow-up. Results: The mean age at diagnosis was 18 months, with 45% diagnosed within the first year. Unilateral UDT predominated (60%), and testicular position influenced size and outcomes. Surgical success was achieved in 90% of cases, with minor complications including wound infections (5%) and reoperations (5%). Earlier diagnosis correlated with improved fertility outcomes, with normal spermatogenesis observed in 75% of early cases but declining significantly with delayed treatment (P &lt; 0.05). Chromosomal abnormalities, present in 9% of patients, heightened family concerns, particularly regarding fertility and psychosocial impacts. Conclusion: Family concerns evolved through stages of care, initially focusing on fertility and malignancy risks, then shifting to surgical safety and postoperative recovery. Tailored counseling and psychosocial support were integral to family satisfaction. This study underscores the importance of early diagnosis, multidisciplinary care, and culturally sensitive family engagement to optimize outcomes and enhance the quality of life for patients with UDT. Future recommendations include routine genetic screening and targeted educational initiatives to address community-specific challenges.

Identifying opportunities to reduce imaging overuse in hospitalized children.

Radiologic imaging is routinely performed to aid in diagnosis for hospitalized children. Identifying and reducing variability in imaging practices can improve care while reducing harms and costs. To identify common inpatient pediatric conditions with high prevalence of imaging and variation in imaging practices and imaging-related costs across hospitals. We conducted a cross-sectional study of children 0-18 years old admitted to 50 children's hospitals in the Pediatric Health Information Systems database between 2017 and 2019. We excluded patients with complex chronic conditions, pregnancy, newborn, or neonatal intensive care charges, and those who died or who were discharged to hospice or rehabilitation facilities. Conditions with at least 2500 discharges and in which ≥30% of patients received imaging were included. Outcomes included imaging frequency, standardized imaging-related costs (including all modalities across all encounters), and hospital-level variation in imaging costs using the intraclass correlation coefficient (ICC). Of the 56 included conditions, imaging was most frequently conducted in patients with pectus excavatum (97.8%), scoliosis (96.2%), and intestinal obstruction (96%). Fracture ($21.4 million), trauma ($15.7 million), and appendicitis ($8.6 million) had the highest total imaging-related costs. Conditions with the highest geometric mean standardized imaging costs were nervous system disorders ($507), osteomyelitis ($494), vesicoureteral reflux/hydronephrosis ($468). Scoliosis (ICC = 0.49) and preseptal cellulitis (ICC = 0.48) had the highest variation in imaging-related costs. To reduce imaging overuse in hospitalized children, conditions with frequent imaging, high imaging-related costs, and high hospital-level variation in imaging practices should serve as priorities for future evidence generation, guideline development, and/or improvement initiatives.

The eACT study design and methods: A sequential, multiple assignment, randomized trial of A novel adherence intervention for youth with epilepsy

BackgroundEpilepsy is a common, chronic pediatric neurological condition predominately treated with anti-seizure medications (ASMs) to control or reduce seizures. Approximately 60 % of youth with epilepsy demonstrate suboptimal adherence to their ASM. This paper describes the methodology, recruitment, design, and baseline participant characteristics of a sequential, multiple assignment, randomized trial (SMART) designed to test the effectiveness of a behavioral health intervention to improve adherence in families of young children with epilepsy. MethodsUsing a two-stage SMART, youth ages 2–12 years old with newly diagnosed epilepsy and their families were enrolled. Following an 8-week run-in phase, families with ≤95 % adherence were randomized to control (education + automated digital reminders) or intervention (education + automated digital reminders + individualized feedback) arms. After three months, families in the intervention group who remained non-adherent (i.e., ≤ 95 %) were re-randomized to 1) continue with same intervention or 2) receive two telehealth problem-solving sessions with an interventionist over the next two months. Study measures were completed at baseline, 8-, 14-, and 20-months post-baseline. ResultsOf the n = 466 ethnically and racially diverse study participants, n = 268 participants were non-adherent and were randomized. The primary outcome was electronically monitored ASM adherence at post-intervention, while secondary outcomes included seizure freedom, health care utilization, and epilepsy-specific health-related quality of life. ConclusionsNovel aspects of the trial design (e.g., sequential, recruitment of racial and ethnic diverse youth), modifications to the protocol related to the COVID-19 pandemic and evolving socio-political and medical climate, as well as recruitment and retention challenges are discussed.ClinicalTrials.gov Number: NCT03817229

Clinical experience and treatment considerations with vesicular monoamine transport 2 inhibitors

Abstract Vesicular monoamine transporter 2 inhibitors (VMAT2i) are currently Food and Drug Administration–approved for the treatment of Huntington disease chorea and tardive dyskinesia. Additionally, they are often used for other hyperkinetic movement disorders in clinical practice. Due to a lack of head-to-head clinical trials, management of VMAT2i in the clinical setting may be unclear and rely on the clinical experience of the practitioner. Due to the limited distribution model, which typically requires VMAT2i to be dispensed by specialty pharmacies, access and initiation of treatment may present as barriers. Patient cases allow for the exploration of switching between VMAT2i, alternative routes of administration, utilization in pediatric and off-label conditions, and how to successfully initiate and monitor a patient on VMAT2i therapy.

Transcatheter closure of patent ductus arteriosus with mitral regurgitation in children: Clinical outcome and improvement of mitral regurgitation after procedure with echocardiogram follow-up

Background: Patent ductus arteriosus (PDA) is a prevalent pediatric heart condition, often causing heart failure and pulmonary hypertension. Mitral regurgitation, a common occurrence, may be improved by CMRI after PDA closure, suggesting improved follow-up. Objectives: The purpose of this retrospective study is to evaluate the clinical outcomes and follow-up echocardiogram results following transcatheter PDA closure in these patients, with the view of proposing an effective treatment strategy. On other words, the goal is to improve the follow-up of children with PDA and mitral regurgitation five years after PDA closure in which the issue of long-term follow-up of these children still needs to be assessed. Methods: The Queen Alia Heart Institute conducted retrospective study that examined the outcomes and follow-up of children with open PDA with only mitral regurgitation (MR) who underwent closure, outcomes, and follow-up by echocardiography from January 2018 to March 2022. The patient cohort included 46 children who were discussed in heart team meetings and were candidates for catheterization for device closure due to no resolution of the shunts proposed for transcatheter closure of PDA with color Doppler echocardiography. Transcatheter closure was performed with general anesthesia or conscious sedation, and continuous hemodynamic monitoring was performed for at least 30 minutes to ensure stabilization. The study also reviewed the management and outcomes of children with isolated MR and no intervention for PDA. Current intervention techniques for transcatheter closure in patients diagnosed with PDA and MR are divided into four main strategies: Lesson-Severn wire-controlled occlusion, Sideris muscular device implantation, inter-procedural MR availability assessment before device deployment, and secondary transcatheter or interventional strategy due to remaining MR. Advances in treatment have allowed patients to receive intervention at younger ages and benefit from a reduced dose of radiation. Results: A study comparing children with and without PDA and MDI showed significant improvements in post-intervention EROA, RV volume, RVEF, LVEDVi, and LVFS compared to pre-intervention values. The subgroup analysis revealed that after PDA closure, MR drainage volume decreased, while ventricular volume and function were compensated. The study also found that the improvement and EROA reduction might be related to sex rather than age. The results showed no statistical difference in hospitalization rates between the two groups, but the DuctAngio group had a higher proportion of patients with symptoms and poor health. The study also found that patients with MR showed better patient experience, highlighting the potential improvements in pediatric cardiology. Conclusions: The study found that transcatheter closure of significant PDA with MR improved MR in most patients rapidly and at midterm follow-up, with immediate symptomatic improvement and cardiac remodeling, without long-term MR progression.

IgG4-related disease: A systematic review of a rare pediatric condition

IgG4-related disease: A systematic review of a rare pediatric condition

Experiences of siblings of children with chronic pediatric conditions: a qualitative systematic review.

This review emphasizes the necessity for healthcare professionals to attend to the emotional and psychosocial needs of well siblings, and educate parents on how to better address well siblings' needs. Future research could look into the experiences of siblings of children with less common CPCs. • The specific needs of well siblings of children with chronic pediatric conditions are unexplored. • Well siblings have difficulty comprehending and adapting to their sibling's chronic condition upon diagnosis. • Interactions between family members and healthcare professionals play a crucial role in shaping how well siblings understand their siblings' chronic conditions. • Well siblings adopt various ways to help them cope with these challenging circumstances. •Well siblings are at risk for psychological distress upon learning about their sibling's chronic conditions.

Neuroendoscopic Lavage in Hydrocephalus with Ventricular Empyema: A Case Report

Introduction: Ventricular empyema, or pyogenic ventriculitis, is a severe condition characterized by pus accumulation in the cerebral ventricles due to intracranial infection, often caused by Gram-negative bacteria. Early diagnosis and treatment are crucial to prevent fatal neurological damage. Case Report: A 3-month-old infant with severe hydrocephalus and ventricular empyema was admitted with symptoms of seizures, fever, and diarrhea. Initial examination showed decreased consciousness and significant leukocytosis. CT scans confirmed severe hydrocephalus and ventricular empyema. Despite resistance to standard antibiotics, neuroendoscopic lavage (NEL) and bilateral external ventricular drainage (EVD) were performed, leading to substantial improvement. Discussion: The patient’s condition improved significantly post-surgery, with a decrease in leukocyte count and resolution of empyema as shown in follow-up imaging. This case demonstrates the efficacy of NEL in treating complex pediatric neurosurgical conditions. Conclusion: NEL proves to be an effective treatment for intraventricular empyema in pediatric patients, improving clinical outcomes and reducing hospital stays. The success of this approach emphasizes the need for tailored neurosurgical interventions and regular follow-ups to ensure patient recovery and prevent recurrence.

Analgesia in paediatric acute pancreatitis: A scoping systematic review.

Acute pancreatitis (AP) is a common paediatric condition, yet there is little data to support optimal analgesic practice. The aim of this scoping review was to report analgesic practice, investigate trends in analgesic strategy and evaluate the impact of analgesic modality on outcomes. A systematic search of Medline, Embase, CENTRAL, Pubmed Central and Google Scholar was performed by two independent investigators. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Three retrospective cohort studies, all conducted in North America, reported on analgesic practice in paediatric AP. The studies included 658 patients (median age, 12 years; female sex, 57%; non-biliary aetiology, 85.9%). Overall, analgesia was administered in 67% of patients, including opioids in 59.5% (43.8%-71.4%). Rates of acetaminophen (17.9% and 77.7%) and non-steroidal anti-inflammatory drugs (7.7% and 40.2%) were reported in two studies. Two studies reported reducing rates of opioid administration or reduced duration of opioid administration since 2017 and 2014, respectively. One study did not find any correlation between opioid administration and sociodemographic factors, length of stay or admission to intensive care units. No studies reported on complications or quality of life. No studies investigated non-medical modalities. There were no long-term data on analgesic use post-discharge. Opioids are the mainstay of pain treatment in paediatric AP in North America. However, factors that influence the analgesic type, the impact of analgesic modality on the post-pancreatitis outcome and long-term analgesic use constitute a knowledge gap. Future studies are needed to inform analgesic use in paediatric AP.

Using Artificial Intelligence to Identify Three Presenting Phenotypes of Chiari Type-1 Malformation and Syringomyelia

BACKGROUND AND OBJECTIVES: Chiari type-1 malformation (CM1) and syringomyelia (SM) are common related pediatric neurosurgical conditions with heterogeneous clinical and radiological presentations that offer challenges related to diagnosis and management. Artificial intelligence (AI) techniques have been used in other fields of medicine to identify different phenotypic clusters that guide clinical care. In this study, we use a novel, combined data-driven and clinician input feature selection process and AI clustering to differentiate presenting phenotypes of CM1 + SM. METHODS: A total of 1340 patients with CM1 + SM in the Park Reeves Syringomyelia Research Consortium registry were split a priori into internal and external cohorts by site of enrollment. The internal cohort was used for feature selection and clustering. Features with high Laplacian scores were identified from preselected groups of clinically relevant variables. An expert clinician survey further identified features for inclusion that were not selected by the data-driven process. RESULTS: The feature selection process identified 33 features (28 from the data-driven process and 5 from the clinician survey) from an initial pool of 582 variables that were incorporated into the final model. A K-modes clustering algorithm was used to identify an optimum of 3 clusters in the internal cohort. An identical process was performed independently in the external cohort with similar results. Cluster 1 was defined by older CM1 diagnosis age, small syringes, lower tonsil position, more headaches, and fewer other comorbidities. Cluster 2 was defined by younger CM1 diagnosis age, more bulbar symptoms and hydrocephalus, small syringes, more congenital medical issues, and more previous neurosurgical procedures. Cluster 3 was defined by largest syringes, highest prevalence of spine deformity, fewer headaches, less tonsillar ectopia, and more motor deficits. CONCLUSION: This is the first study that uses an AI clustering algorithm combining a data-driven feature selection process with clinical expertise to identify different presenting phenotypes of CM1 + SM.

Surgery and the first 8000 days of life: a review

Abstract The first 8000 days of life, from birth to adulthood, encompasses critical phases that shape a child's health and development. While global health efforts have focused on the first 1000 days, the next 7000 days (ages 2–21) are equally vital, especially concerning the unmet burden of surgical conditions in low- and middle-income countries (LMICs). Approximately 1.7 billion children globally lack access to essential surgical care, with LMICs accounting for 85% of these unmet needs. Common surgical conditions, including congenital anomalies, injuries, infections, and pediatric cancers, often go untreated, contributing to significant mortality and disability. Despite the substantial need, LMICs face severe workforce and infrastructure shortages, with most pediatric surgical conditions requiring specialized skills, equipment, and tailored healthcare systems. Economic analyses have shown that pediatric surgical interventions are cost-effective, with substantial societal benefits. Expanding surgical care for children in LMICs demands investments in workforce training, infrastructure, and health systems integration, complemented by innovative funding and equitable global partnerships. Prioritizing surgical care within national health policies and scaling up children's surgery through initiatives like the Optimal Resources for Children's Surgical Care can improve health outcomes, align with Sustainable Development Goals, and foster equity in global health. Addressing the surgical care gap in LMICs will reduce preventable mortality, enhance quality of life, and drive sustainable growth, emphasizing surgery as an essential component of universal health coverage for children.

Food insecurity in a diverse community pediatric gastroenterology clinic: Screening strategies and insights.

We aimed to evaluate the prevalence of food insecurity (FI) in the community pediatric gastroenterology(GI) subspecialty clinic at Texas Children's Hospital (TCH) West Campus and to assess the utilization of services through our partnership with a local food bank. From July 1, 2023, to February 29, 2024, all patients seen in the pediatric GI clinic at TCH West Campus were screened for FI using the validated Hunger Vital Sign tool and given the opportunity to consult with a local food bank representative. A retrospective chart review was then performed on patients who completed the implemented FI screening process. 13.4% of the total patients screened positive for FI. Hispanic patients (p < 0.0001), patients with the preferred language of Spanish (p < 0.0001), those enrolled in Medicaid or Children's Health Insurance Program (p < 0.0001), and patients with obesity (body mass index ≥ 30.0, p = 0.0003) were more likely to screen positive for FI. Poor weight gain/failure to thrive and steatotic liver disease were significantly more common in those with FI (p < 0.0001 and p = 0.0003, respectively), while celiac disease, abdominal pain, and blood in stool were more common in those without FI (p = 0.0003, 0.0475, and 0.0404, respectively). As a result of our implemented FI screening process, 68.4% of those screening positive opted for resource referral, with 50.7% successfully receiving assistance in combating FI. Identifying the potential impact of FI in common pediatric GI conditions calls for proactive screening and more holistic, patient-centered approaches in clinical practice.