Undernutrition significantly increases the risk of severe infections and mortality in children under five, particularly in low- and middle-income countries. Pneumonia, a leading cause of childhood death, is especially dangerous in undernourished children, yet prognostic measures to identify those at highest risk are lacking. To identify algorithms of poor prognosis in undernourished children with clinical pneumonia for early identification of children at risk for poor outcomes. This study analyzed a subset of children enrolled in a cohort designed to identify biomarkers of bacterial pneumonia. Children aged 2–59 months with clinical pneumonia were recruited from two rural Gambian hospitals. Clinical and anthropometric data were collected at baseline, during hospitalization, and at 30-day follow-up. Nutritional status was classified using WHO definitions for stunting (height-for-age Z-scores) and wasting (weight-for-height Z-scores) as severe (Z-scores ≤ -3), moderate (-2 ≥ Z-scores > -3), and mild (-1 ≥ Z-scores > -2). Prognostic outcomes were classified into good and poor. Poor prognosis included death, prolonged hospital stay (≥ 7 days), post-discharge care-seeking, and difficult to feed during admission. Good prognosis was based on a hospital stay < 3 days, with good outcomes within 30 days of the initial visit. Classification tree models and penalized logistic regression models (fit through elastic net) were used to identify combinations of predictors of poor prognosis (prognostic signatures). A total of 246 children with clinical pneumonia and undernutrition (wasting or stunting) were included. Children with poor prognosis presented more frequently with respiratory distress, hypoxemia, reduced capacity oforal feeding difficulty, and anemia. As expected, undernutrition was associated with adverse outcomes. The final prognostic algorithms were accurate to identify undernourished children at risk of poor prognosis: with sensitivity and specificity > 80% and area under the receiver operating characteristic curve ≥ 0.80. Furthermore, we identified accurate prognostic signatures among children with both wasting and stunting. Measures collected at admission in undernourished children with clinical pneumonia can identify those at risk of poor outcomes. The prognostic signatures developed in this study may inform early risk stratification and guide timely intervention, particularly in resource-limited settings.

Abstract Pediatric gliomas are the most common form of malignant brain tumors in children, representing ∼50% of all pediatric brain tumor cases and being the leading cause of cancer-related deaths in children under the age of 15. Aggressive standard treatments offer limited benefit in high-grade gliomas, with low survival rates (25%; 5-year survival rate) and significant long-term cognitive consequences diminishing life quality due to the harsh impact of these interventions on the developing brain. These limitations underscore the urgent necessity of novel therapeutic approaches and a more comprehensive understanding of the disease’s molecular drivers and tumor behavior. To explore the molecular underpinnings of pediatric gliomagenesis, we utilized an advanced non-invasive postnatal electroporation approach (MADR) to create an inducible mouse model and derived organoids in combination with extensive genomic, transcriptomic, and proteomic analyses. Through this platform, we identified several ETS transcription factors as key contributors to tumor development. These factors, including the Pea3 subfamily (ETV1, ETV4, ETV5) and ETV6 (also known as Tel), are known for regulating key cellular functions such as proliferation and cell differentiation which could shape the tumor heterogeneity. We observed significant and overexpression of ETV5 and other ETS factors in pediatric gliomas and in a cell-population dependent manner, where they interact directly and dynamically with glial-specific transcriptional regulators (e.g.: OLIG2) to drive tumor formation. Furthermore, our single-cell analyses of Ets inducible MADR-derived organoids were further unraveling the common and different roles of ETV1, ETV4, ETV5, and ETV6 in determining the different tumor progression, cell identity, and how they regulate transcriptional programs during gliomagenesis showing they importance of its regulations in the heterogeneity shaping for the tumor success. Interestingly, among them, ETV4 showed an exclusive potential to force the glioma cell phenotype to fate them to a unique cell cluster. In addition, our data reveal the central role of ETV5 in glial fate decisions by promoting the differentiation of neural precursor cells toward an oligodendrocyte progenitor cell (OPC)-like phenotype. OPCs are highly proliferative and migratory cells considered potential origins of glioma. Thus, targeted in vivo suppression of ETV5 resulted in substantial reductions in tumor growth, delayed disease progression, and improved survival outcomes, affirming its functional importance in the tumor behaviour. These findings emphasize the central involvement of ETS transcription factors in promoting glioma diversity and illustrate how the distinct activation of individual Ets family members can differentially direct the lineage and functional state of tumor subpopulations. Altogether, this study position ETS factors as key regulators of tumor biology and promising therapeutic targets in high-grade pediatric gliomas. Citation Format: Antonio C. Fuentes-Fayos, Hannah Park, Naomi Kobritz, Moise Danielpour, Joshua J. Breunig. ETS transcription factors as key modulators of heterogeneity in pediatric high-grade gliomas [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Brain Cancer; 2026 Mar 23-25; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2026;86(6_Suppl):Abstract nr B046.

The Society of Critical Care Medicine Pediatric Sepsis Definition Task Force recommends the use of the Phoenix Sepsis Score (PSS) to diagnose pediatric sepsis among children with suspected infection. However, the performance of the PSS in different healthcare settings remains unclear. The present study aimed to validate and modify the ability of the PSS to predict in-hospital death in children with suspected infection admitted to the intensive care unit (ICU) in China. This multicenter retrospective cohort study included children aged ≤18 years with suspected infection admitted to the ICU from five hospitals in China between January 2012 and December 2023. Two children's specialized hospitals and three tertiary general hospitals participated. The primary evaluation of PSS prediction performance was based on in-hospital mortality discrimination through the area under the receiver operating characteristic curve (AUROC). The secondary evaluation was conducted using the area under the precision-recall curve (AUPRC). Given the moderate discriminative performance of the PSS in this cohort, we employed extreme gradient boosting (XGBoost) with SHapley Additive exPlanations (SHAP) to identify key predictors of in-hospital mortality. Predictors selected through this process were incorporated into the original PSS framework while prioritizing clinical feasibility, resulting in a modified score, PSS+, for mortality prediction. Among 9221 ICU admissions for children with suspected infections (13.4% mortality), the PSS showed moderate discrimination, with an AUROC of 0.60 (95% CI: 0.59-0.62). The modified PSS (PSS+), which selectively incorporated comorbidities, vital signs, and demographic variables identified through model development, outperformed the original PSS-4, PSS-8, and pediatric sequential organ failure assessment (pSOFA) in terms of both internal validation (AUROC of 0.75, 95% confidence interval [CI]: 0.70-0.78) and external validation (AUROC of 0.71, 95% CI: 0.69-0.73). The PSS demonstrated only moderate ability to predict in-hospital mortality among pediatric ICU patients in the present cohort, indicating that its application in other healthcare settings should be approached with caution. The modified PSS+ scoring system significantly improved mortality prediction performance and may serve as a more reliable and clinically applicable tool for risk assessment in critically ill children.

A Dried Platelet-Derived Biologic for Blood-Brain Barrier Repair and Hemorrhage Control Following TBI in Mice.

Background: Acute respiratory infections (ARI) are a significant cause of illness and death in infants and children under five. Infants' nutritional status and feeding patterns are factors that affect their vulnerability to ARI. This literature review aimed to summarize the incidence of ARI, the risk factors, and the evaluation of nutritional strategies. Methods: The literature review was conducted using articles published between January 2020 and December 2025. A search was conducted in PubMed and Scopus using keywords related to ARI. Results: ARI is very common among children under 5 years old. Malnutrition and low birth weight correlate with heightened risk and severity of ARI. Insufficient exclusive breastfeeding practices are associated with an increased risk of ARI, while exclusive breastfeeding has a protective effect. Environmental factors affect the likelihood of ARI. Evidence on micronutrient supplementation is varied and not ideal. Conclusion: Interventions for ARI in children require an integrated strategy that focuses on exclusive breastfeeding, improved nutritional status, and a healthier household environment.

Despite extensive literature on suicide prevention and experiences of bereaved individuals in the context of adult suicide, a significant gap remains in research examining the impact of suicidal deaths of children and adolescents. This systematic review aims to understand the experiences and impact among parents and mental health professionals (MHPs) following the loss of a child/adolescent to suicide and identify ways in which insights from bereaved individuals can inform strengthening systemic responses. The meta-synthesis included qualitative, quantitative and mixed-methods studies. The coding principles were based on thematic synthesis and interpretative phenomenological analysis to allow the participants' voices to emerge. The findings from quantitative studies were interpreted qualitatively and incorporated into higher-order themes. The final conceptual framework was developed through triangulation across diverse study methodologies and participant groups. Twenty-five studies were included. Superordinate themes illuminating experiences of parents include-'pervasive experiences of bereaved parents', 'making sense of the child and the suicide', 'moving on vs moving forward' and 'when support falls short'. Experiences of MHPs were captured through the following preliminary superordinate themes-'navigating grief as therapists', 'client suicide-is realistic estimate a fallacy', 'surviving client's suicide' and 'holding space for healers'. This review uniquely speaks of the shared grief experiences of parents and MHPs on a continuum while also highlighting the distinct contexts and meanings that shape their experiences. Integrated postvention support should prioritize systemic continuity of care for bereaved parents and families while simultaneously ensuring individualized support for bereaved MHPs through sensitive institutional structures.

Introduction Maternity units are supposed to be places that welcome new life, but sometimes things do not go as hoped. Many mistakenly believe that the death of a baby, known for only a few hours or days, has less impact than the death of an older child. However, the sense of loss experienced by parents is equally profound. Purpose The objective of this study was to assess the opinions of caregivers on supporting couples in perinatal bereavement at the Kintambo Maternity Hospital in Kinshasa, Democratic Republic of the Congo. Methods This descriptive study was conducted at the Kintambo Maternity Ward in Kinshasa, focusing on caregivers' opinions regarding the support of couples during perinatal bereavement. A survey was used to explore the issue and collect data, aiming to describe and understand the phenomenon from the perspective of those involved. Additionally, face-to-face interviews were employed as a data collection technique, allowing caregivers to express their views. Results The results show that 56% of the caregivers interviewed were men and 46% were women. However, 41% of caregivers expressed a favourable opinion regarding the support of couples during perinatal bereavement, while 59% expressed an unfavourable opinion. Furthermore, 25.4% of caregivers believed that emotional involvement is an obstacle to supporting couples, 20.3% lacked in-depth knowledge about perinatal bereavement support, 35.5% showed a lack of empathy, and 18.6% of caregivers displayed a lack of psychological stability. Conclusion Supporting a couple during perinatal bereavement is challenging and requires a range of personal skills and significant self-awareness. A caregiver, dealing with both their own emotions and those of the couple, can be a custodian of suffering. It is essential for caregivers to harness their emotions positively, using them as a strength rather than fearing them, in order to better understand and care for those in mourning.

BackgroundHigh mortality in children awaiting liver transplantation is a significant concern. At Cipto Mangunkusumo Hospital, the only active and established pediatric living-donor liver transplantation (LDLT) center in Indonesia, similar challenges persist. This study aims to determine the mortality rate, time to death or transplantation and causes of death in children listed for LDLT at our center.MethodsThis prospective single-center cohort study was conducted from January 2023 to December 2024. Consecutive sampling included all eligible children age 0–18 listed for LDLT. Participants were monitored from listing until pretransplant death, transplantation, loss to follow-up or study completion. The primary outcome was all-cause mortality on the LDLT waiting list.ResultsSixty-two children were enrolled; 64.51% (n=40) were female with biliary atresia accounting for 72.58% of diagnoses. Malnutrition was identified in 70.97% (n=44) and 35.48% (n=22) had a history of cytomegalovirus (CMV) infection. Median duration from listing to death was 87.5 days. Median time to transplantation was 263.5 days. During follow-up, 22 children died with sepsis as the leading cause, 22 underwent LDLT, 13 were lost to follow-up and 5 remained on the waiting list. Donor scarcity contributed substantially to prolonged listing and loss to follow-up.ConclusionsChildren listed for liver transplantation experience a high waiting list mortality at our center. This is primarily due to infection, malnutrition and socioeconomic factors. Sepsis persists as the principal cause of death. LDLT remains the only feasible option for children requiring liver transplantation in Indonesia.

Background: Diarrhea is a leading cause of childhood death in the world, account ing for 5-10 million deaths per year. Worldwide, rotavirus is estimated to cause more than 111 million cases of diarrhea annually in children younger than 5 year of age. It is considered as a major cause of childhood morbidity and mortality particu larly in developing countries like Bangladesh. Considering the high morbidity and significant mortality, this study was designed to determine the incidence of rotavirus and adenovirus associated diarrhea among under 2 years. Materials and methods: This cross-sectional study was conducted in the Department of Pediatric Gastroenterology, Chattogram Maa-O-Shishu Hospital Medical College from 1st September 2022 to 28th February 2023. Total of 150 patients were enrolled in this study who were admit with acute watery diarrhoea. Stool samples were obtained and assayed for rotavirus antigen by Immunochromatography Test (ICT) – ICT Quick Rotavirus kits (Arco Biotech, Germany) were used to detect rotavirus antigen in stool samples. Results: Viral antigens were detected in 116 (77.33%) out of 150 samples analysed during the study period. Of the antigen-positive samples,70(60.3%) belonged to boys and 46 (39.65%) belonged to girls. Of the total antigen-positive samples the Rotavirus antigen was identified in 101 (87.06%) specimens, the Adenovirus antigen was identified in 11 (9.48%) and Rota adeno was identified in 4 (3.44%) specimens. The high prevalence of rotavirus and adenovirus between the ages of 7 and 12 was found 47 (40.51%) and 6 (5.17%) respectively which is to be statistically significant (p &lt; 0.05). High incidence rate of rotavirus infections in winter months was determined. This was found to be statistically significant (p &lt; 0.05). Conclusion: This study showed a high prevalence of Rotavirus (67.33%) infection in patients under 2 years of age. Peak age incidence under 12 months and in January . Using the rotavirus vaccine in this population can reduce diarrhoea prevalence and eliminate unnecessary antibiotic use. Chatt Maa Shi Hosp Med Coll J; Vol.24 (2); July 2025; Page 97-101

Paediatric traumatic brain injury (pTBI) remains a leading cause of death and disability in children around the world. The evidence to support pTBI management in children notably lags that in adult populations, with a lack of data available to inform management. Injury mechanisms and physiological responses vary considerably across the developmental spectrum of childhood, bringing unique challenges to the management of pTBI. This is compounded further by complexity of neurodevelopmental changes influencing long-term outcomes. The foundation of current understanding of pTBI is laid on the innovative work done over the turn of the century. Incremental progress in the past few years has furthered our understanding of mechanisms, disease pathophysiology, recovery pathways and consequences of pTBI. There are developments in identification of biomarkers that can help in diagnosis and predict outcomes more accurately to guide clinical decision-making and track long-term outcomes. However, this progress has been slow, and more work is required to translate the large body of observational work into interventions to help improve outcomes of pTBI. This review aims to synthesize recent findings, evaluate existing evidence and propose future research directions. Structured initially to address key epidemiological and pathophysiological differences in the paediatric population with associated clinical challenges, followed by the potential role of physiological, blood and imaging biomarkers, this review seeks to provide a comprehensive update. Additionally, it addresses current evidence gaps in therapeutic strategies, rehabilitation needs and comprehensive systems of care, integrating insights from high- and low-resource settings. Finally, it reviews current research with a view to offering recommendations to reduce the evidence gaps in pTBI.

Vaccination provides lifelong protection, preventing an estimated 600,000 adult deaths and 2.5 million childhood deaths globally each year. Although Ghana has made significant progress in routine vaccination, disparities persist across regions and districts. National statistics often mask these local-level gaps. This study aimed to identify the factors influencing incomplete vaccination among children aged 0–23 months at Tetteh Quashie Memorial Hospital in Akuapem North. A cross-sectional study was conducted among 214 caregivers of children aged 0–23 months. Kobo Collect was used as the data collection tool and the data were exported to STATA v17.0 for analysis. Vaccination status was assessed against Ghana’s Expanded Programme on Immunization (EPI) schedule. Descriptive statistics, Fisher’s exact test, and logistic regression analyses were performed to identify factors associated with incomplete vaccination, with p-values < 0.05 considered statistically significant at 95% confidence level. Results were presented in tables and graphs. The prevalence of incomplete childhood vaccination was 27.1% (95% CI [21.3%–33.6%]). Muslim mothers (aOR = 12.9; 95% CI: 4.11–18.22; p = < 0.01) and single-parent households (aOR = 13.9; 95% CI: 4.35–44.97; p < 0.01) were more likely to have incomplete vaccination, while awareness of vaccine-preventable diseases (aOR = 0.01; 95% CI: 0.00-0.02; p < 0.01) was less likely to be associated with incomplete vaccination. Children aged 5–6 months were less likely to be incompletely vaccinated (aOR = 0.29; 95% CI: 0.11–0.74; p = 0.010). Children aged 9 months and above were more likely to be incompletely vaccinated (aOR = 2.7; 95% CI: 1.24–5.99; p = 0.012). Fourth-born children were less likely to be incompletely vaccinated compared to firstborns (aOR = 0.16; 95% CI: 0.03–0.74; p = 0.020). Health-related factors, including the time from home to the vaccination facility (< 0.01) and the average waiting time at the facility (p < 0.01), were significantly associated with vaccination status. This study found that vaccination coverage declined across successive doses, with incomplete vaccination associated with caregiver religion, family setting, low awareness, and the child’s age. Targeted education and improved access are needed to increase completion rates and achieve universal vaccination goals.

Background/Objectives: Hand, foot and mouth disease (HFMD) caused by enterovirus 71 (EV71) may cause severe complications and death in children. It is also a common cause of outbreaks in the Asia-Pacific Region. Incidence among children 1 to <2 years was over 3000/100,000 population in China. A systematic review and meta-analysis was performed to review evidence on vaccine efficacy (VE), immunogenicity, and safety of two doses of EV71 vaccine in children. Methods: Randomized controlled trials (RCTs) comparing EV71 vaccine with placebo or with another EV71 vaccine in children and adolescents aged ≤18 years were searched on PubMed, Medline, Embase, CENTRAL, and CNKI (Chinese) in week 5 November 2024. The reference list of each study and the websites of vaccine manufacturers were also searched. The Cochrane Risk of Bias 2 tool (RoB2) was used to assess the risk of bias. VE, immunogenicity (including seropositive rate, seroconversion rate, geometric mean titer (GMT), Geometric Mean Fold Increase (GMFI)), and rate of adverse events were analyzed. Results: A total of 4199 articles were identified, and 25 studies were finally included. VE (%) against EV71 HFMD in children aged ≤5 years at 12 months was 94.8% (95%CI 87.2-97.9) for Sinovac and 90.9% (95%CI 70.4-97.2) for Wuhan Institute of Biological Products (WIBP), while the Chinese Academy of Medical Sciences (CAMS) reported 97.4% (95%CI 92.9-99.0) at 11 months. At 1 month after the second dose, 99.19% (95%CI 98.15-99.65) of children aged ≤5 years in the vaccine group were seropositive, and 96.30% (95%CI 92.71-98.17) achieved seroconversion. GMT at 1 month after the second dose in the vaccine group was 46.78 (95%CI 26.18-83.61) times that in the placebo group. GMFI at 1 month after the second dose in the vaccine group was 28.41 (95%CI 22.18-36.39) times that of the placebo group. The rate of serious adverse events (AEs) was lower in the vaccine group than the placebo group (1.23% (95%CI 0.58-2.69) vs. 1.34% (95%CI 0.58-3.07)) at 1 month after the second dose. There was no significant difference in other adverse events between the vaccine and placebo groups. Conclusions: EV71 vaccines were effective, immunogenic and safe. Areas with a high incidence of EV71 may consider introducing EV71 vaccines.

The examination of the atrio-ventricular node region should be a routine practice in all cases of sudden unexpected death in infancy (SUDI) and childhood (SUDC).

Pertussis-related hyperleukocytosis is a major driver of pediatric mortality. While exchange transfusion (ET) improves survival, predictors of death in ET-treated children remain poorly defined. We sought to identify independent predictors of death to refine treatment strategies. A single-center retrospective cohort study analysis of 44 children with pertussis-related hyperleukocytosis treated with ET was conducted. Patients were stratified into survival (n = 27) and mortality (n = 17) groups. Univariate comparisons of clinical, laboratory, and ET-related parameters were performed. Multivariate logistic regression identified independent mortality risk factors. The mortality group exhibited a younger median age at onset (55 vs. 103 days, p = 0.006), higher peak white blood cell (WBC) count (82.19 ± 21.95 vs. 68.10 ± 18.78 × 10⁹/L, p = 0.023), and greater incidence of pre-ET cardiovascular failure (94.1% vs. 22.2%, p < 0.001). In multivariable analysis using Firth's penalized logistic regression, pre-ET cardiovascular failure (OR 53.69, 95% CI 3.63-795.10), higher peak WBC count (OR 1.09 per 1 × 10⁹/L increase, 95% CI 1.02-1.17), and younger age at onset (OR 0.97 per day increase, 95% CI 0.95-0.99) showed significant associations with mortality. Younger age at onset, marked leukocytosis, and pre-ET cardiovascular failure were associated with increased mortality in children with pertussis complicated by hyperleukocytosis. These factors may help identify patients at higher risk and highlight the importance of early recognition, close monitoring, and timely supportive management. Further prospective studies with larger sample sizes are warranted to validate these findings and to inform optimized management strategies in this vulnerable population.

Pediatric trauma: Where are we and where are we heading? A narrative review of recent evidence.

Adulterated cough syrup caused acute kidney failure deaths in children: lessons have still not been learnt.

Valuing pediatric health-related quality of life (HRQOL) is essential for economic evaluations in child healthcare. Instruments like EQ-5D-Y were developed for this purpose. A key methodological innovation-though controversial-has been the use of the child perspective for valuation of EQ-5D-Y health states, where adults value health states imagining a 10-year-old child. This paper critically reviews empirical findings on this approach, examines potential biases, assesses alignment with stakeholder views, and explores alternatives. We relied on a targeted review of empirical literature, including studies comparing adults valuing their own health (adult perspective) and using child perspectives, as well as stakeholder opinion studies. Findings were synthesized into ten key learnings: (1) Child-perspective valuations are typically higher than adult ones for the same health states. (2) Adults prioritize pain/discomfort and being sad/unhappy differently for children. (3) Child age has minimal impact. Mechanisms contributing to differences between adult and child perspectives include (4) discomfort with child death, (5) different valuations of life duration, (6) psychological distance, (7) emotional difficulty deciding for others, and (8) external goals influencing results. Stakeholder engagement shows that (9) the effects of using child perspectives do not align well with societal preferences, and (10) stakeholders express a preference for approaches that directly involve children and adolescents in valuation tasks. We conclude that relying on child perspectives may introduce systematic biases, potentially undermining the validity of pediatric health utilities. A re-evaluation of current valuation methods for EQ-5D-Y may be warranted, with greater consideration for direct child involvement, mapping techniques, and group-based deliberative approaches.

Introduction: Traumatic brain injury (TBI) is the leading cause of injury-related death and disability in children within the United States. Direct mechanical trauma from primary injury can disrupt the blood brain barrier and subsequent biochemical and cellular cascades can impact vascular tone. As endothelial nitric oxide production is diminished, cerebral vasodilation is impaired. Flow-mediated dilation (FMD) is an ultrasound-derived measure that serves as a surrogate for endothelial function in both pediatric and adult studies; however, there are no studies to date that investigate the use of FMD as a marker of endovascular function in children with brain injury. We hypothesize that patients with TBI will have a lower FMD than healthy patients due to the endothelial dysfunction that is sustained at the level of their blood brain barrier in TBI. Methods: A single-center, prospective, observational study used ultrasound to obtain FMD measurements in children with acute TBI in a pediatric trauma center versus healthy age-matched controls. Measurements were obtained within 24 hours of injury. Edge detection software was used to detect changes in the diameter of the brachial artery in response to shear stress, as captured by ultrasound. Reactive hyperemia after vascular occlusion by distal cuff inflation served as the stimulus for FMD. Demographic and clinical data included severity of TBI, mechanism of injury, and functional outcomes. Results: 15 children from 1-18 years of age with mild, moderate, or severe TBI, and 21 healthy age-matched controls were enrolled in this study. The mean age was 9.9 years (SD  3.6). There was a significant decrease in FMD in patients with TBI compared to healthy controls (6.02% vs 7.82%, p = 0.02), and TBI was associated with a 1.76 reduction in FMD adjusting for age (F(2,33) = 3.86, p = 0.03). There was no significant difference in FMD between mild TBI versus moderate/severe TBI (5.66% vs 6.16%, p = 0.65). Conclusions: This study showed a reduction in FMD in children with acute TBI, highlighting the endovascular changes that occur with acute TBI at the blood-brain barrier. Further studies to evaluate the use of ultrasound-derived FMD measurement to predict outcomes may serve as a valuable tool to guide therapeutic decisions.

Introduction: According to the CDC, the leading cause of death in both children and young adults in the United States is trauma. Extracorporeal membrane oxygenation (ECMO) has been used in patients with severe trauma since the 1970’s. We sought to characterize the use of this form of advanced life support in trauma patients and better describe current practice patterns given its increased use for respiratory failure during the COVID19 pandemic. Methods: Utilizing data from the Trauma Quality Improvement Program database from 2017-2023, procedure codes were used to identify in which patients ECMO was used. We included both adult and pediatric patients and evaluated practice patterns and outcomes both overall and in these distinct populations. Pediatric patients were defined as less than 18 years of age. Descriptive and inferential statistical methods were used to analyze the data. Results: The use of ECMO was identified in 1,919 patients out of 8,014,737 encounters (0.02%). Within this group, 224 (11.7%) were < 18 years of age. The median time from hospital arrival to ECMO cannulation was 44 hours (IQR 5-147). The most common adult comorbidities among those cannulated were tobacco use, hypertension and diabetes. Survival ranged from 59-68% annually in all patients and 61-90% in pediatric patients. The number of facilities at which cannulation was performed annually ranged from 103-158 and steadily increased throughout the study period. Conclusions: ECMO use in trauma was infrequent but the number of performing facilities increased during the study period. Survival among these patients was similar to previous reports. Our findings will help inform future clinical guidelines and practice regarding the use of ECMO in this population.

Inflammation is a major driver of preterm birth, a common pregnancy disorder and the leading cause of childhood death. T regulatory (Treg) cells are essential mediators of maternal fetal tolerance and are critical for constraining uterine inflammation. In some tissue settings, loss of Foxp3 expression can cause instability in Treg cell lineage commitment, elevated production of proinflammatory cytokines and compromised suppressive function. Whether preterm birth susceptibility is associated with loss of lineage fidelity and adoption of proinflammatory phenotypes in Treg cells is unknown. In this study, we investigated the lineage stability of Treg cells in vivo in pregnant mice using a Foxp3 fate-mapping system and models of preterm birth induced by late-gestation inflammatory challenge with lipopolysaccharide (LPS) or interleukin-1β (IL-1β). Ex-Foxp3-expressing (ex-Foxp3) cells were observed in the uterus-draining lymph nodes (udLNs) in non-pregnant mice and in similar abundance across normal gestation, and a proportion expressed proinflammatory cytokines IFNγ and/or IL-17A. Bulk RNA-sequencing of sorted Treg and ex-Foxp3 cells from late-gestation udLNs revealed substantial loss of the Treg cell lineage program in ex-Foxp3 cells, characterized by reversal in expression of canonical Treg cell genes and pathways. Late gestation LPS or IL-1β administration to induce preterm birth did not expand the ex-Foxp3 cell population in the uDLNs or uterine decidua. We conclude that uterine Treg cells exhibit a high level of lineage stability in pregnancy regardless of proinflammatory challenge. Whether there is any biological or pathophysiological significance of ex-Foxp3 cells in gestational tissues remains to be defined.