Pediatric Guidelines Research Articles

Abstract P507: Adherence to Pediatric Screening Guidelines for Cardiovascular Risk Factors in a Diverse Cohort of Children in Chicago

Background: Preventive screenings in children and adolescents encourage maintenance of optimal cardiovascular health (CVH) early in life, but there may be a gap between recommendations and clinical practice. We evaluated adherence to pediatric guidelines for universal age-based and risk-based screening for body mass index (BMI), blood pressure (BP), lipids, and blood glucose. Methods: We used 2010-2018 ambulatory visit data from children aged 2-12y within CAPriCORN, an electronic health record network from major healthcare systems in Chicago. For each child who attended a well-child visit and met age and/or risk-based criteria, receipt of BMI, BP, lipids, and/or HbA1c or fasting blood glucose measurements were assessed. For each metric, proportion adherence was calculated via generalized estimating equations with an exchangeable correlation structure and was stratified by age, sex, race/ethnicity, and insurance status. Results: This study included 87,549 children who attended 197,559 well-child encounters. Across all encounters, children were 51.5% male and mean (SD) age 6.4 (3.3) years. Universal age-based screening prevalence (95% CI) per 100 eligible children was 77.1 (76.8, 77.3) for BMI, 33.4 (33.1, 33.7) for BP, and 9.6 (9.3, 9.9) for lipids. Risk-based screening prevalence (95% CI) per 100 eligible children was 13.9 (12.2, 15.9) for BP, 6.9 (6.4, 7.5) for lipids, and 13.3 (12.6, 14.1) for blood glucose. Conclusions: Early screening of CVH risk factors could lead to earlier interventions, which could alter CVH trajectories across the lifetime. Low levels of adherence to universal age-based and risk-based CVH screening highlight the gap between recommendations and clinical practice, emphasizing the need to understand and address barriers to screening in pediatric populations.

Assessment of Adherence to Standard Operating Procedure in Blood Pressure Measurement of Children Above Three Years of Age Among Nurses Working in Paediatric Unit at Pondicherry Institute of Medical Sciences

Blood Pressure (BP) is the pressure of the blood flow which exerted against the wall of arteries when the ventricles contract. BP measurement based on guidelines is quality care and safe nursing practice. Adherence to guidelines reduces inaccuracies that may expose the patient to misdiagnosis and inappropriate care An infant may have a pretty common blood pressure of 80/45 mm of Hg, while that evaluation in an adult is considered low. A teenager may have a satisfactory blood pressure of 110/70 mm of Hg, but that value would be of apprehension in a toddler. Measurement of BP in children is more difficult than in adults because readings are likely to be falsely high in crying children, and an appropriately sized cuff may not be available. According to Paediatric resuscitation guidelines 2012, it is important to measure Blood Pressure while assessing a sick child to determine the circulatory and neurological status. Therefore, BP measurement based on guidelines becomes truly a valuable tool in screening for high-risk patients, early detection and control of hypertension, and prevention of complications. STATEMENT OF THE PROBLEM: “A Descriptive Study to assess adherence to the standard operating procedure in blood pressure measurement of children above three years of age among nurses working in the paediatric unit at Pondicherry institute of medical sciences” OBJECTIVES: 1. To determine the level of adherence among the staff nurses in following the standard operating procedure in blood pressure measurement in pediatric patients admitted to the Pondicherry Institute of Medical Sciences. 2. To identify the barriers in adhering to the standard operating procedure in blood pressure measurement. 3. To associate the demographic variables of staff Nurses with their level of adherence in following standard operating procedures for BPM. METHODOLOGY A descriptive non-experimental method was used to assess the level of adherence of standard operating procedures in blood pressure measurement of children above three years of age. The study was conducted in the pediatric ward, Pondicherry Institute of Medical Sciences, Pondicherry, in September 2019. Purposive sample method was used and the sample included 33 nurses. Each sample was observed three times using the observational checklist, which consists of twelve steps. Descriptive statistics were used to analyze the data. Frequency and percentage were used to assess the adherence level in following the standard operating procedure in blood pressure measurement. RESULT The result of the analysis of data shows that the majority of 32 (97 %) were female nurses, 31(94%) had B.Sc. Nursing degree and the majority of 27 (81.8 %) had work experience less than 4 years. Out of 33 participants, 6 (18.2 %) had adhered to the standard operating procedure in blood pressure measurement, 27 (81.8 %) were not able had adhered at all times while checking blood pressure with Aneroid BP Apparatus. Barriers related to adherence to SOP were related to lack of time, less manpower, workflow constraints, and some assumed that it is not necessary to follow each step every time, the cooperation of the child. CONCLUSION The result of the study showed that very few nurses adhered to each step in the SOP of blood pressure measurement. The study concludes that there is a need to conduct in-service education between regular intervals on the importance of SOP and skills and the importance of blood pressure measurement among nurses of PIMS Keywords: Standard Operating Procedure, Blood Pressure, Adherence, Nurses, Pediatric Unit

A Dutch paediatric palliative care guideline: a systematic review and evidence-based recommendations for symptom treatment

BackgroundChildren with life-threatening and life-limiting conditions can experience high levels of suffering due to multiple distressing symptoms that result in poor quality of life and increase risk of long-term distress in their family members. High quality symptom treatment is needed for all these children and their families, even more so at the end-of-life. In this paper, we provide evidence-based recommendations for symptom treatment in paediatric palliative patients to optimize care.MethodsA multidisciplinary panel of 56 experts in paediatric palliative care and nine (bereaved) parents was established to develop recommendations on symptom treatment in paediatric palliative care including anxiety and depression, delirium, dyspnoea, haematological symptoms, coughing, skin complaints, nausea and vomiting, neurological symptoms, pain, death rattle, fatigue, paediatric palliative sedation and forgoing hydration and nutrition. Recommendations were based on evidence from a systematic literature search, additional literature sources (such as guidelines), clinical expertise, and patient and family values. We used the GRADE methodology for appraisal of evidence. Parents were included in the guideline panel to ensure the representation of patient and family values.ResultsWe included a total of 18 studies that reported on the effects of specific (non) pharmacological interventions to treat symptoms in paediatric palliative care. A few of these interventions showed significant improvement in symptom relief. This evidence could only (partly) answer eight out of 27 clinical questions. We included 29 guidelines and two textbooks as additional literature to deal with lack of evidence. In total, we formulated 221 recommendations on symptom treatment in paediatric palliative care based on evidence, additional literature, clinical expertise, and patient and family values.ConclusionEven though available evidence on symptom-related paediatric palliative care interventions has increased, there still is a paucity of evidence in paediatric palliative care. We urge for international multidisciplinary multi-institutional collaboration to perform high-quality research and contribute to the optimization of symptom relief in palliative care for all children worldwide.

The role of sex on the prevalence of cardiovascular risk factors in children and adolescents with Type 1 diabetes: The SWEET international database

ObjectiveTo assess the prevalence of cardiovascular risk factors (CVRFs) in children and adolescents with type 1 diabetes (T1D) in the International SWEET registry and the possible role of clinical variables in modifying the risk of having single or multiple CVRFs. Study designThe study is a cross-sectional study. Cut-off points for CVRFs were fixed according to International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines and WHO parameters: LDL cholesterol (LDL-C) > 100 mg/dL; Systolic Blood Pressure (BP-SDS) > 90th percentile for sex, age, and height; BMI-SDS > 2SD for sex and age. Logistic regression models were applied to evaluate variables associated with at least 1 or 2 CVRFs among registry children and adolescents. Results29,649 individuals with T1D (6–18 years, T1D ≥ 2 years) participating in the SWEET prospective multicenter diabetes registry were included. In the cohort, 41 % had one or more CVRFs, and 10 % had two or more CVRFs. Thirty-five percent of enrolled individuals had LDL-C > 100 mg/dL, 26 % had BMI-SDS > 2SD, and 17 % had Systolic BP-SDS > 90th percentile. Females had higher frequency than males of having 1 or 2 CVRFs (45.1 % vs 37.4 %, 11.8 % vs 7.8 %; p < 0.001). Multivariable logistic regression models showed that sex (female), HbA1c category (>7.0 %), and age (>10 years) were associated with a higher chance of having at least 1 or 2 CVRFs (p < 0.001). ConclusionsIn children and adolescents with T1D, female sex, in addition to HbA1c above 7 %, and older age (>10 years) was associated with a higher risk of having at least a CVRF (LDL-C, BMI-SDS, BP) according to internationally defined cut-offs.

Point-of-care ultrasound in pediatric anesthesiology: considerations for training and credentialing.

To discuss considerations surrounding the use of point-of-care ultrasound (POCUS) in pediatric anesthesiology. POCUS is an indispensable tool in various medical specialties, including pediatric anesthesiology. Credentialing for POCUS should be considered to ensure that practitioners are able to acquire images, interpret them correctly, and use ultrasound to guide procedures safely and effectively. In the absence of formal guidelines for anesthesiology, current practice and oversight varies by institution. In this review, we will explore the significance of POCUS in pediatric anesthesiology, discuss credentialing, and compare the specific requirements and challenges currently associated with using POCUS in pediatric anesthesia. Point-of-care ultrasound is being utilized by the pediatric anesthesiologist and has the potential to improve patient assessment, procedure guidance, and decision-making. Guidelines increase standardization and quality assurance procedures help maintain high-quality data. Credentialing standards for POCUS in pediatric anesthesiology are essential to ensure that practitioners have the necessary skills and knowledge to use this technology effectively and safely. Currently, there are no national pediatric POCUS guidelines to base credentialing processes on for pediatric anesthesia practices. Further work directed at establishing pediatric-specific curriculum goals and competency standards are needed to train current and future pediatric anesthesia providers and increase overall acceptance of POCUS use.

The Outcomes of Emergency Admissions and Associated Factors Among Children Admitted to the Pediatric Emergency Unit at Selected Public Hospitals in Addis Ababa, Ethiopia — A Retrospective Cross-Sectional Study

BACKGROUND: A pediatric emergency condition is a life-threatening process that, without timely and standard clinical intervention, may lead to death. Therefore, this study aimed to assess the outcomes of emergency admissions and associated factors among children admitted to the pediatric emergency of selected public hospitals. METHODS: An institutional-based retrospective cross-sectional study design was conducted on children admitted to the emergency unit/ward from January 02, 2020, to January 08, 2022, in the emergency units of randomly selected public hospitals. Data were extracted with prepared checklists from February 1 to March 1, 2022. RESULT: A total of 303 admitted children’s charts were reviewed with 100% coverage. The mean age of children was 37.47 months, and the male-to-female ratio was 1.16:1. The study revealed that the most common causes of emergency admission were pneumonia (22.4%), surgical emergencies (14.5%), and late-onset sepsis (9.2%), respectively. More than half (53.8%) of children were admitted to the Pediatric Emergency Department for less than 24 hours, and the mean length of stay was 2 days. 39.6% of children were discharged with clinical improvement. Known comorbidity (AOR=4.65, 95% CI (1.23-17.64)) and length of stay less than 24 hours (AOR=4.2, 95% CI (1.2-14.7)) were strongly associated with the outcome. CONCLUSION: Pneumonia is still the most common cause of pediatric emergency admission, and the mortality rate of children at the Pediatric Emergency Department is high, with known comorbidity showing a significant association with mortality. FMOH recommended developing national pediatric emergency care guidelines and providing skill gap training for healthcare workers.

Prevalence of Systemic Hypertension and the Effects of Cerebral Revascularization in Patients With Moyamoya Disease

Background Hypertension is often codiagnosed in patients with moyamoya disease (MMD), a progressive intracranial steno‐occlusive vasculopathy; this has principally been attributed to renal artery stenosis (up to 10%). Susceptibility MMD genes, including ring finger protein 213/mysterin and GUCY1A3 , have also been linked to extracranial vascular disease and increased systolic blood pressure. We aimed to define the prevalence of systemic hypertension in MMD patients and characterize its evolution after cerebral revascularization. Methods Patients with MMD treated with extracranial‐intracranial bypass from 2014 to 2018 were retrospectively enrolled. Blood pressure measurements and antihypertensive agent use were recorded pre‐ and postoperatively. Hypertension was defined according to the 2020 International Society of Hypertension Guidelines (adults) and 2017 American Academy of Pediatrics Guidelines (children). Multivariate logistic regression was performed for clinical and radiographic predictors of hypertension. Results A total of 242 adult and 51 pediatric patients underwent revascularization. Preoperatively, 146 adult and 20 pediatric patients met the diagnostic criteria for hypertension resulting in prevalences of 60.3% and 39.2% respectively. In adults, this was significantly associated with age (odds ratio [OR] 1.05 [95% CI, 1.02–1.09]), body mass index (OR, 1.08 [95% CI, 1.03–1.13]), hyperlipidemia (OR, 2.57 [95% CI, 1.09–6.04]), kidney disease (OR, 18.98 [95% CI, 1.80–200.47]), and symptomatic presentation (OR, 8.88 [95% CI, 1.16–68.06]). After a mean follow‐up of 34.3±18.1 months in adults (33.8±14.9 months – children), patients with hypertension decreased by 15.3% (1.9% – pediatrics) and 31.8% (17.7% – children) experienced improvement in hypertensive status with normalization of blood pressure or reduced need for antihypertensive agents. Posterior circulation involvement was a negative predictor for response of hypertensive status to revascularization (OR, 0.10 [95% CI, 0.01–0.79]). Conclusion Hypertension is prevalent among adult and pediatric patients with MMD with contributions from known vascular risk factors. Its association with symptomatic presentation and observed improvement following revascularization suggests blood pressure changes, in part, are a compensatory physiological response to increased intracranial vascular resistance.

Systematic identification and quality appraisal of guidelines developed for the pediatric population in India

BackgroundWell-developed clinical practice guidelines are the cornerstone of evidence-based healthcare practice and policy. ObjectiveThis study was undertaken to systematically identify clinical practice guidelines developed in India for the pediatric age group, and appraise their methodological quality. MethodsWe conducted a systematic review to identify all Indian guidelines designed for implementation in the pediatric age group. We searched databases of published literature, and websites of national agencies, and used a step-wise approach to screen titles, abstracts and full-texts of eligible publications. We appraised the methodological quality of the included guidelines using the standard AGREE II (Appraisal of Guidelines Research and Evaluation) checklist, scoring each guideline across six domains. ResultsThe literature search identified 10,959 citations. Step-wise screening resulted in the inclusion of 138 Indian guideline documents, pertaining to pediatric care. The overall AGREE II score of the included guidelines ranged from 12 to 72.5%, the median (IQR) being 30% (24.6, 37). Only 2 (1.4%) guidelines scored above 60%. There was wide variation in the scores across quality appraisal domains. The domain-wise median (IQR) scores were as follows. Scope and purpose: 50% (43, 66.7), Stakeholder involvement: 44.5% (39, 50), Rigor of development: 12.5% (8, 23.4), Clarity of presentation: 50% (39, 61), Applicability: 0% (0, 12.5), and Editorial independence: 66.7% (0, 67). Although guidelines published during 2011–2020 had higher quality scores (compared to previous decades), there was no significant further improvement from 2021 onwards. ConclusionThis study identified overall low methodological quality of Indian pediatric guidelines, and suggests urgent need for improvement.

Prevalence and correlates of paediatric guideline non-adherence for initial empirical care in six low and middle-income settings: a hospital-based cross-sectional study

ObjectivesThis study evaluated the prevalence and correlates of guideline non-adherence for common childhood illnesses in low-resource settings.Design and settingWe used secondary cross-sectional data from eight healthcare facilities in six Asian...

A protocol for adapting a clinical practice guideline for the treatment of paediatric asthma for the Egyptian Pediatric Clinical Practice Guidelines Committee

AbstractIntroductionPaediatric asthma is a prevalent and chronic respiratory condition affecting children worldwide. This protocol outlines the methodology for developing a clinical practice guideline (CPG) for the management of paediatric asthma. The goal of this guideline is to provide evidence‐based recommendations for healthcare professionals, improving the quality of care and health outcomes for paediatric patients with asthma.MethodsWe will use the ‘Adapted ADAPTE’ adaption method, a systematic approach to adapt existing guidelines, which consists of three phases (setup, adaptation and finalisation phases), nine modules and 24 steps, with adaptations to the process and tools to suit the Egypt healthcare context and resources.QuestionsClinical questions were prepared using the patient population, interventions, professionals, outcomes and healthcare context (PIPOH) model. This CPG protocol addresses critical clinical questions at the heart of effective asthma management in children. It focuses on the diagnosis of paediatric asthma, considering age‐specific clinical presentations and diagnostic tests, assessment of asthma severity, control medications like inhaled corticosteroids, long‐acting β‐agonists and others, with an emphasis on appropriate tools and criteria. The CPG also delves into the realm of long‐term control treatment, exploring the effectiveness and safety of pharmacological and nonpharmacological interventions, while considering individualised needs. Furthermore, it examines strategies for monitoring and adjusting treatment plans over time, ensuring optimal care. These clinical questions form the foundation of the CPG, facilitating evidence‐based care delivery and enhancing health outcomes for paediatric asthma patients.

International recommendations for screening and preventative practices for long-term survivors of transplantation and cellular therapy: a 2023 update.

As hematopoietic cell transplantation (HCT) and cellular therapy expand to new indications and international access improves, the volume of HCT performed annually continues to rise. Parallel improvements in HCT techniques and supportive care entails more patients surviving long-term, creating further emphasis on survivorship needs. Survivors are at risk for developing late complications secondary to pre-, peri- and post-transplant exposures and other underlying risk-factors. Guidelines for screening and preventive practices for HCT survivors were originally published in 2006 and updated in 2012. To review contemporary literature and update the recommendations while considering the changing practice of HCT and cellular therapy, an international group of experts was again convened. This review provides updated pediatric and adult survivorship guidelines for HCT and cellular therapy. The contributory role of chronic graft-versus-host disease (cGVHD) to the development of late effects is discussed but cGVHD management is not covered in detail. These guidelines emphasize special needs of patients with distinct underlying HCT indications or comorbidities (e.g., hemoglobinopathies, older adults) but do not replace more detailed group, disease, or condition specific guidelines. Although these recommendations should be applicable to the vast majority of HCT recipients, resource constraints may limit their implementation in some settings.

Prevalence of Adolescents Meeting Criteria for Metabolic and Bariatric Surgery.

The American Academy of Pediatrics endorses metabolic and bariatric surgery (MBS) as a safe and effective treatment of severe obesity in children with class 3 obesity or with class 2 obesity and qualifying comorbidities. The study objective was to determine eligibility and characteristics of adolescents who qualify for MBS based on American Academy of Pediatrics guidelines. This retrospective cohort study analyzed electronic health record data of 603 051 adolescents aged 13 to 17 years between January 1, 2018, and December 31, 2021. Centers for Disease Control and Prevention criteria were used to define obesity classes 2 and 3. Multivariable logistic regression was used to evaluate the factors associated with meeting MBS eligibility criteria. Of the 603 041 adolescents evaluated, 22.2% had obesity (12.9% class 1, 5.4% class 2, and 3.9% class 3). The most frequently diagnosed comorbid conditions were gastroesophageal reflux disease (3.2%), hypertension (0.5%), and nonalcoholic fatty liver disease (0.5%). Among adolescents with class 2 obesity, 9.1% had 1 or more comorbidities qualifying for MBS, and 4.4% of all adolescents met the eligibility criteria for MBS. In multivariable modeling, males, Black and Hispanic adolescents, and those living in more deprived neighborhoods were more likely to meet MBS eligibility criteria. Overall, 1 in 23 adolescents met the eligibility criteria for MBS. Demographic and social determinants were associated with a higher risk for meeting these criteria. The study suggests that the health care system may face challenges in accommodating the demand for MBS among eligible adolescents.

Increasing trend in hypertension prevalence among Korean adolescents from 2007 to 2020

BackgroundThe purpose of this study was to examine the prevalence of hypertension in Korean adolescents, its long-term trends, and factors associated with the development of hypertension.MethodsData of the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2020 were combined into three time periods (2007–2011, 2012–2016, and 2017–2020). A total of 11,146 Korean adolescents aged 10–18 were included in the analysis. The definition of hypertension was based on the 2017 American Academy of Pediatrics guidelines for hypertension.ResultsThe age-adjusted prevalence of hypertension was 5.47%, 7.85%, and 9.92% in 2007–2011, 2012–2016, and 2017–2020, respectively. Long-term trend analysis using Joinpoint analysis over the observation period showed a significantly increasing trend in hypertension prevalence with a mean annual percentage change of 6.4%. Boys, those aged 13–15, those aged 16–18, overweight/obese, and those living in urban areas were more likely to develop hypertension (OR 1.980, 1.492, 3.180, 2.943, and 1.330, respectively).ConclusionThe prevalence of hypertension in Korean adolescents was higher than the global prevalence of hypertension and showed an increase over a 13–year period. Targeted strategies for prevention and early detection of hypertension are needed in this population.

Appraisal of Australian and New Zealand paediatric sepsis guidelines.

Clinical practice guidelines (CPGs) are an important tool for the management of children with sepsis. The quality, consistency and concordance of Australian and New Zealand (ANZ) childhood sepsis CPGs with the Australian Commission on Safety and Quality in Healthcare (ACSQHC) sepsis clinical care standards and international sepsis guidelines is unclear. We accessed childhood sepsis CPGs for all ANZ states and territories through Paediatric Research in Emergency Departments International Collaborative members. The guidelines were assessed for quality using the AGREE-II instrument. Consistency between CPG treatment recommendations was assessed, as was concordance with the ACSQHC sepsis clinical care standards and international sepsis guidelines. Overall, eight CPGs were identified and assessed. CPGs used a narrative and pathway format, with those using both having the highest quality overall. CPG quality was highest for description of scope and clarity of presentation, and lowest for editorial independence. Consistency between guidelines for initial treatment recommendations was poor, with substantial variation in the choice and urgency of empiric antimicrobial administration; the choice, volume and urgency of fluid resuscitation; and the choice of first-line vasoactive agent. Most CPGs were concordant with time-critical components of the ACSQHC sepsis clinical care standard, although few addressed post-acute care. Concordance with international sepsis guidelines was poor. Childhood sepsis CPGs in current use in ANZ are of variable quality and lack consistency with key treatment recommendations. CPGs are concordant with the ACSQHC care standard, but not with international sepsis guidelines. A bi-national sepsis CPG may reduce unnecessary variation in care.

Comparative Effectiveness of Perioperative Antibiotic Regimens to Prevent Surgical Site Infections in Pediatric Liver Transplant Recipients.

Surgical site infections (SSIs) are a common complication in liver transplant (LT) recipients. Lack of pediatric prophylaxis guidelines results in variation in preventative antibiotic regimens. We performed a retrospective observational study of LT recipients <18 years old using a merged data set that included data from the Pediatric Health Information System and the United Network for Organ Sharing between 2006 and 2017. The exposure was defined as the antibiotic(s) received within 24 hours of LT, with 6 categories, ranging from narrow (category 1: cefazolin), to broad). The primary outcome was presence or absence of SSI in the index admission. Mixed-effects logistic regression compared the effectiveness of each category in preventing SSI, relative to category 1. Of the 2586 LT, 284 (11%) met SSI criteria. The SSI rate was higher in the younger subcohort (16.2%) than in the older (8.6%), necessitating a stratified analysis. Antibiotics from category 5 were most commonly used. In the younger subcohort, the adjusted risk was increased in all categories compared with the reference, most notably in category 3 (odds ratio [OR], 2.58 [95% confidence interval: .69-9.59]) and category 6 (2.76 [.66-11.56]). In the older subcohort, estimated ORs were also increased for each category, most notably in category 4 (2.49 [95% confidence interval: .99-6.27]). None of the ORs suggested benefit from broader-spectrum prophylaxis. Our E-value assessment suggests that it's unlikely there is unmeasured confounding by indication to the degree necessary to revert ORs to protective. There was wide variation in antibiotic prophylaxis. Adjusted analyses did not reveal a protective benefit of broader-spectrum prophylaxis in either subcohort, suggesting that narrower regimens may be adequate.

Echogenomics: Echocardiography in Heritable Aortopathies.

The aim of this article is to review the current echocardiographic considerations in the diagnosis and monitoring of patients with inherited aortopathies. Aortic dilation is a key feature in heritable aortopathies, and dissection is a leading cause of morbidity and mortality. New genetic and histopathologic findings are helpful in better understanding these conditions. Non-invasive imaging modalities, including echocardiogram, computerized tomography, and magnetic resonance imaging, are essential in monitoring these patients, as well as providing new prognostic factors of arterial stiffness that may help with risk stratification in the future. Diagnosis of heritable aortopathies should be considered with identification of aortic root dilation, particularly in children and young adults, or when there is a family history of aortic disease. Recent adult consensus guidelines highlight the importance of underlying genotype and phenotypic features when considering prophylactic surgical intervention. There are currently no consensus pediatric guidelines.

Renal Trauma in an Adolescent of a Tertiary Care Hospital; Is Ultrasound Adequate?

Children are at high risk of renal injury from blunt trauma than adults. Renal trauma can be from direct, blunt, penetrating and iotrogenic injury. Renal injuries are accounting for 10% of abdominal trauma. In our cases, renal injury caused to patient after falling from bicycle in September 2023. Depending upon the pre-existing congenital or acquired renal pathology, its incidence increases. Blunt trauma comprises more than 95% of traumatic renal injury. Patient with renal trauma present with flank &amp;/or abdominal pain and with hematuria. Computed tomography (CT) is the investigation of choice in evaluation of blunt renal injury. Ultrasound is helpful in detecting hemoperitonum in patients with suspected intraperitoneal injury. FAST (Fast Abdominal Sonography for Trauma), thus is important. Sonography was conducted to precisely diagnose and detect renal injuries caused by blunt abdominal trauma. Ultrasonography is also useful in detecting injuries and it is less value in evaluating those with suspected extraperitoneal injury. In some cases, MRI, Renal angiogram and scintigraphy may be useful. In our case, an adolescent boy with fall from bicycle sustaining blunt abdominal trauma in September 2023 with Gr-IV injury to right kidney is under observation as hemodynamically stable. No Pediatric renal trauma guidelines have been established though children are at higher risk of renal injury from blunt trauma than adults.

Screening for obstructive sleep apnea (OSA) in children and adolescents with obesity: A scoping review of national and international pediatric obesity and pediatric OSA management guidelines.

Obstructive sleep apnea (OSA) is a prevalent complication that affects up to 60% of children and adolescents with obesity. It is associated with poorer cardiometabolic outcomes and neurocognitive deficits. Appropriate screening and intervention for OSA are crucial in the management of children with obesity. We performed a scoping review of international and national pediatric obesity (n = 30) and pediatric OSA (n = 10) management guidelines to evaluate the recommendations on OSA screening in pediatric obesity. Sixteen (53%) of the pediatric obesity guidelines had incorporated OSA screening to varying extents, with no consistent recommendations on when and how to screen for OSA, and subsequent management of OSA in children with obesity. We provide our recommendations that are based on the strength and certainty of evidence presented. These include a clinical-based screening for OSA in all children with body mass index (BMI) ≥ 85th percentile or those with rapid BMI gain (upward crossing of 2 BMI percentiles) and the use of overnight polysomnography to confirm the diagnosis of OSA in those with high clinical suspicion. We discuss further management of OSA unique to children with obesity. An appropriate screening strategy for OSA would facilitate timely intervention that has been shown to improve cardiometabolic and neurocognitive outcomes.

Implementing the Pediatric Ventilator Liberation Guidelines Using the Most Current Evidence.

Invasive mechanical ventilation is prevalent and associated with considerable morbidity. Pediatric critical care teams must identify the best timing and approach to liberating (extubating) children from this supportive care modality. Unsurprisingly, practice variation varies widely. As a first step to minimizing that variation, the first evidence-based pediatric ventilator liberation guidelines were published in 2023 and included 15 recommendations. Unfortunately, there is often a substantial delay before clinical guidelines reach widespread clinical practice. As such, it is important to consider barriers and facilitators using a systematic approach during implementation planning and design. In this narrative review, we will (1) summarize guideline recommendations, (2) discuss recent evidence and identify practice gaps relating to those recommendations, and (3) hypothesize about potential barriers and facilitators to their implementation in clinical practice.

Current practice of intracranial pressure monitoring in children with severe traumatic brain injury-a nationwide prospective surveillance study in Germany.

For management of severe traumatic brain injuries (sTBI) in children, the overall level of evidence to guide diagnostic and therapeutic procedures is low. Since 2016, international guidelines have subsequently suggested invasive intracranial pressure (ICP) monitoring in patients with initial Glasgow Coma Scale (GCS) ≤8. In Germany, ICP monitoring was an individual case decision from 2011 until the 2022 update of the German pediatric TBI guideline. The aim of this study was to evaluate current clinical practice of invasive ICP monitoring in Germany in children <10 years with respect to guideline recommendations. Anonymized clinical data on sTBI cases <10 years of age were collected in a nationwide prospective surveillance study via the German Pediatric Surveillance Unit ESPED from July 2019 until June 2022. Inclusion criteria for the surveillance study were sTBI (initial GCS ≤8) or neurosurgery following TBI. For this analysis, only cases with GCS ≤8 were subject to the present analysis. Descriptive analyses were performed to assess the proportion of ICP monitored patients and describe the cohort. Out of 217 reported cases, 102 cases met the inclusion criteria and thus qualified for ICP monitoring. Of these, 37 (36%) received ICP monitoring. Monitored patients were older, had lower median GCS values at presentation (4 vs. 5), higher mortality (32% vs. 22%), and were more frequently diagnosed with cerebral edema (68% vs. 37%). In children <10 years with sTBI, the present clinical management regarding ICP monitoring deviates from the current German national and international guidelines. The reasons remain unclear, with the low level of evidence in the field of ICP monitoring and the recency of changes in guideline recommendations as potential contributors. Prospective interventional studies should elucidate the benefit of ICP monitoring and ICP directed therapies to provide evidence-based recommendations on ICP monitoring.