Pediatric Hospital Research Articles

Low Prevalence of Anaerobic Bacteria in Pediatric Septic Arthritis Makes Obtaining Anaerobic Cultures of Questionable Value.

Pediatric acute septic arthritis necessitates urgent identification and treatment to avoid irreversible joint damage if not recognized and treated in a timely manner. Many centers routinely obtain both aerobic and anaerobic cultures for the purpose of pathogen identification; however, the yield of anaerobic culture results has been called into question. The goal of this study was to determine the positivity rate of anaerobic cultures collected intraoperatively in pediatric patients with clinically diagnosed septic arthritis. Patients with a clinical diagnosis of septic arthritis were extracted from a search of musculoskeletal infections at a large tertiary care pediatric hospital from 2007 to 2021. Cultures obtained from the operating room or through arthrocentesis were examined. We identified 470 cases of pediatric septic arthritis of which only 3 cultures were positive (0.6%) for anaerobic organisms. All cases involved a single isolate. The anaerobic bacteria that were detected included 1 facultative anaerobe, 1 strict anaerobe, and 1 relatively aerotolerant anaerobe. Four aerobic organisms grew on the anaerobic cultures. Three of the false positives also grew on aerobic culture media, whereas 1 aerobic specimen grew explicitly on anaerobic media. Neither the facultative anaerobe nor the aerotolerant anaerobe grew on aerobic culture media. Over a 14-year period, only 0.6% (3 cases) of septic arthritis cases yielded positive anaerobic cultures that were not able to be cultured on aerobic media. As such, an anaerobic culture was more likely to culture a bacterium that would have also been cultured on aerobic media. In addition, a true positive anaerobic culture that would not have been diagnosed on aerobic cultures only occurs about once every 5 years at our institution. If one were to decide against obtaining anaerobic cultures, they would only miss 3 infections out of almost 500 (0.6%), and antibiotics would only have changed 0.6% of the time. These results suggest that routinely obtaining anaerobic cultures may be of limited value in pediatric septic arthritis. The false-positive rate of anaerobic labs exceeds that of true-positive cases. These results provide actionable opportunity to help guide clinician decision-making in a more cost-effective and efficient management of pediatric septic arthritis. IV.

Utilization of a Perioperative Care Pathway for Pediatric Alveolar Bone Grafting: A Quality Improvement Initiative.

To develop, implement, and evaluate a standardized perioperative care pathway for pediatric patients undergoing alveolar bone grafting from the anterior iliac crest. A historical control group of 40 patients was reviewed retrospectively and compared to a prospectively collected treatment group of 40 patients who were treated with the new pathway. Tertiary-level academic pediatric hospital between 2018 and 2021. Pediatric patients with nonsyndromic cleft lip and palate undergoing alveolar bone grafting. A perioperative clinical care pathway was specifically designed for patients undergoing alveolar bone grafting from the anterior iliac crest. The pathway involved standardization of perioperative care, ultrasound-guided regional anesthesia for both surgical sites, and scheduled postoperative analgesia. (1) Length of hospital stay; (2) opioid consumption postoperatively; and (3) volume of oral intake in the first 24 h postoperatively. Data was analyzed via comparison of means (Student's t-test for continuous data and Chi-square test for categorical data) and control chart analysis. Compared to the control group, patients in the treatment group had lower mean length of stay (26.8 vs 37.8 h, p < .001), lower mean morphine consumption postoperatively (8 vs 34 mcg/kg, p = .008), and a higher proportion of patients not requiring any postoperative opioid use (80% vs 50%, p = .005). Implementation of a standardized clinical care pathway for pediatric patients undergoing alveolar bone grafting from the anterior iliac crest is feasible and was associated with significant reductions in postoperative length of stay and postoperative opioid requirements.

Plasma exchange using peripheral arterial and venous access in the pediatric intensive care unit.

Therapeutic plasma exchange (TPE) is a vital therapeutic modality in pediatric intensive care units (PICU) for various indications. Traditionally, pediatric TPE is performed via a large bore, double lumen catheter, whose insertion necessitates deep sedation, and poses risk of hemorrhagic and thrombotic complications. Building on our previous success utilizing percutaneous radial artery catheters (ALs) for apheresis procedures, we present our experience with ALs for TPE procedures in the PICU. A retrospective cohort study, conducted in the PICU of a tertiary, university affiliated pediatric hospital, including all children aged 19 years and younger, who underwent TPE using an AL for vascular access, between 2018 and 2023. TPE procedures were evaluated for utility (the procedure was performed as planned) and safety. A total of 72 procedures were performed on 20 children, using ALs for inlet access and peripheral intra-venous catheters for blood return. Procedure success rate was 94%, with AL malfunction causing transient delays in 6%. All were successfully completed following AL replacement. ALs were mostly 20 and 22 gauge, predominantly located in the radial artery. AL gauge did not significantly affect flow rate or procedure duration. Our findings support AL use for vascular access, as a viable alternative to the traditional large bore, double lumen catheters most often used for TPE in children. Benefits of AL use may include a decrease in sedation requirements and a lower risk of vascular complications. Further investigation is warranted, for consideration as routine practice in PICUs.

Growing up in a larger body: youth- and parent-reported triggers for illness and barriers to recovery from anorexia nervosa

BackgroundA significant portion of youth with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) have history of ‘overweight/obesity’ (i.e., body mass index ≥ 85th percentile for age-and-sex) prior to the onset of the eating disorder (ED) diagnosis, but research on this population remains limited. The present study used semi-structured interviews to explore themes related to triggers of weight loss, treatment, and recovery among youth with AN/AAN and history of ‘overweight/obesity,’ and their parents.MethodThe sample included eleven youth and parent dyads (Median [IQR] age of youth = 16.0 (1.5) years, 90.9% female, 90.9% White, 27.3% Hispanic) who were evaluated for an ED in a multidisciplinary ED program at a pediatric hospital between November 2020 and April 2021. Nine youth and separately, nine parents of these 11 dyads completed semi-structured interviews with the research team. Seven matched pairs of patients and parents completed demographic surveys and study interviews. Interviews were recorded, transcribed, and coded by four research team members using a reflexive thematic approach.ResultsWeight stigma was the most frequently reported theme for a trigger for weight loss that led to the onset for developing AN/AAN by both youth and parents. Regarding barriers to recovery, themes from more than a half of youth included uncertainty of weight goals in treatment and feeling they are “not sick enough.” Notable themes for attitudes towards treatment from most parents included general agreement with clinician recommendations, but also an uncertainty of weight restoration goals and a belief that their child need to have a “normal” weight.ConclusionThese results highlighted how the majority of interviewed youth with history of ‘overweight/obesity’ reported weight stigma as both a trigger for the development of AN/AAN as well as a barrier to recovering. Internalized weight stigma among parents may influence their attitudes towards weight restoration as a treatment goal where these youth and parents may experience uncertainty of weight goals in treatment. This study demonstrated triggers and barriers to treatment that may be unique to youth with ED and history of ‘overweight/obesity’ and more research is needed to address weight stigma in multidisciplinary ED treatment for this understudied population.

Modeling the distribution and progression of motor ability among children with cerebral palsy: An analysis of three reference centile sets

BackgroundReference centiles describing gross motor function in children with cerebral palsy (CP) are used in clinical and research settings to guide treatments and evaluate interventions. However, it is unknown how existing references generalize to populations in novel settings. AimsThe aim of this study is to evaluate the cross-sectional and longitudinal performance of three reference centiles to describe the motor function of children with CP aged 2–12 years at a large urban US pediatric hospital through a retrospective observational study. Methodsand Procedures: We assessed cross-sectional performance by ranking our clinical population by quartile distributions described by the references. We assessed longitudinal performance by analyzing the distribution of prediction errors and correlations between predictions and observed scores. Outcomes and ResultsFor cross-sectional distribution, the reference centiles by Hanna more closely described our population than those by Duran. For longitudinal progression, prediction error was less than 6 GMFM points for most records at 24-, 12-, and 6-month time scales for all three sets of reference centiles, but higher at a 48-month time scale. Prediction errors increased at younger ages and higher motor ability. Conclusions and implicationsDespite differences in cross-sectional performance, all three reference centiles achieved similar longitudinal performance and are sufficient for most clinical and research uses. Caution should be used when applying these curves to locations with different standards of care.

A comparison of patients receiving vertebral body tethering for adolescent idiopathic scoliosis in the public and private hospital setting

PurposeVertebral body tethering (VBT) is a new growth-modulating surgery for adolescent idiopathic scoliosis (AIS) requiring a distinct skillset and intraoperative setup. We compared perioperative details and outcomes of VBTs performed in a public pediatric orthopedic hospital and a general private hospital setting.MethodsWe identified all patients receiving VBT for AIS from 1/2020 to 12/2023 with ≥ 6 months post-operative follow-up, with surgeries performed by the same senior surgeons. Clinical, radiological, and surgical details were retrieved.Results24 VBTs were performed in the private setting and 16 in the public setting. Average age at operation was 11.9 ± 1.1 at a Sanders staging of 3.8 ± 1.2 when the major curve Cobb angle was 50.5 ± 8.0°. Tethered curves were most often thoracic in location (23/40) followed by thoracolumbar/lumbar curves (10/40) and double curve tethers (7/40). Overall correction ratio of 68.0 ± 19.0% was achieved. Time from booking to operation (82.2 ± 39.2 vs 63.1 ± 34.4 days, p = 0.112) and operation time (310 ± 86.4 min vs. 289 ± 87.4 min, p = 0.054) were longer in the public and private setting respectively but failed to reach statistical significance. Time to chest drain removal (1.5 ± 0.8 vs. 3.5 ± 1.7 days, p < 0.001) and length of stay (4.3 ± 0.9 vs. 6.6 ± 1.8 days, p < 0.001) were significantly shorter in the private setting, whilst complication rates remained similar (7/24 vs. 3/16, p = 0.456).ConclusionExpertise, resource availability, and costs differ in the public and private healthcare setting. With regards to VBT, the conditions for referral and surgical outcomes remained similar. Earlier drain removal and discharge for patients managed in the private setting was not associated with an increase in complication rate.

Aleksander F. Tur — outstanding pediatrician, scientist, teacher (on the 130th anniversary of birth)

In 2024, the medical community will celebrate the 130th anniversary of the birth of the outstanding pediatrician, scientist, creator of scientific and practical schools of pediatrics — Alexander F. Tur. Alexander F. Tur was born on September 3 (15), 1894. In 1911 he was enrolled in the Imperial Military Medical Academy. From April 1915 he worked as a doctor in the active army; in August of the same year, A.F. Tur was captured and worked as a doctor in the infirmary for 3 years. In 1918, A.F. Tur resumed his studies at the Academy. From 1921 to 1930 — he worked part-time in the clinic of childhood diseases of the Military Medical Academy, under the guidance of Professor M.S. Maslov, in 1925 he was enrolled in the staff of the Leningrad Scientific and Practical Institute of Maternity and Infancy Protection named after Clara Zetkin. In 1939, the Department of Hospital Pediatrics was organized at the institute, headed by Alexander F. Tur and worked there until the end of his life. During the war years, A.F. Tur supervised the organization of clinic bomb shelters, advised children, conducted rounds, lectured students, and gave lectures to residents of the besieged city. A.F. Tur worked on a wide range of scientific problems in pediatrics, devoting his work to the most pressing issues of medicine: physiological characteristics and education of healthy children, physiology and pathology of newborns and premature babies, hematology of a healthy and sick child, dietetics of a healthy and sick child, rickets in children and its prevention, organization of children’s healthcare. A.F. Tur laid the foundations of preventive medicine at the outpatient stage, which are still followed today. The legacy of scientist is a fundamental pediatric school, a large number of scientific discoveries and works, thousands of trained do.

Provision of Adolescent Confidential Care in a Pediatric Tertiary Care Hospital

PurposeAdolescents are more likely to disclose sensitive health information if confidentiality is assured. We sought to evaluate the frequency, quality, and factors associated with provision of confidential care to adolescent patients at a pediatric teaching hospital. MethodsWe undertook a cross-sectional survey of adolescents presenting to a tertiary pediatric hospital from January 2019 to January 2020. A convenience sample of adolescents eligible for confidential care under Quebec legislation (aged 14–18 years) were surveyed either following their emergency department (ED) or inpatient care. Participants completed a self-administered electronic questionnaire regarding the confidential care provided at their initial ED or inpatient medical encounter. Multivariable logistic regression was used to identify factors associated with the provision of confidential care. ResultsOverall, 406 adolescents completed the survey (335 ED; 71 inpatient); 137 (33.7%) endorsed being offered and 95 (69%) accepted confidential time. Among adolescents receiving confidential care, 43% reported that the limits of confidentiality were reviewed and 23% reported that private issues were still discussed in front of family members. Multivariable analysis revealed inpatient setting (adjusted odds ratio [aOR] 2.28, 1.04–5.01), female gender (aOR 2.02, 1.21–3.38), age (aOR 1.67, 1.03–2.69), psychiatric diagnosis (aOR 8.10, 1.47–44.6), resident involvement (aOR 1.96, I.09–3.53) were all positively associated with the provision of confidential care. DiscussionSurvey results suggest inadequate provision of confidential care in an academic pediatric hospital. The limits of confidentiality were not consistently explained, and breaches in confidentiality were not infrequent. Confidentiality-specific education initiatives are necessary to improve the frequency and quality of confidential care for adolescents in tertiary care settings.

Successful Implementation of Nirsevimab and Factors Influencing Uptake in Neonatal Care.

Objective: To describe the implementation of nirsevimab for the prevention of respiratory syncytial virus (RSV)-associated lower respiratory tract disease in a pediatric hospital, focusing on strategies to ensure equitable access and address logistical challenges. Additionally, we aimed to identify predictors of nirsevimab deferral among eligible infants. Patients and Methods: Our hospital implemented a universal immunization campaign to all eligible infants, including those discharged from the newborn nursery, intermediate care nursery (ICN), and neonatal intensive care unit (NICU). We identified key drivers and barriers, formed a multidisciplinary team, and applied a systematic approach for integration of nirsevimab orders into existing workflows. We developed and disseminated educational resources for staff and caregivers. After the implementation, we conducted univariate and multivariate analyses to identify predictors of nirsevimab deferral to evaluate implementation success and possible gaps. Results: Despite challenges, we offered nirsevimab to 99% of eligible infants prior to discharge from the newborn nursery, ICN, and NICU with 71% receiving the immunization. On multivariate analysis, independent predictors of nirsevimab deferral included preferred language of English, deferral of hepatitis B vaccine, discharge from the newborn nursery, and public insurance. Conclusions: Our implementation strategy ensured equitable access to nirsevimab for newborns, with both our high uptake and acceptance rate underscoring the effectiveness of our approach. Key strategies for success included early stakeholder engagement, multidisciplinary collaboration, and proactive logistical planning. Our approach serves as a model for other institutions to offer nirsevimab prior to hospital discharge and highlights the importance of addressing both clinical and socioeconomic barriers.

Efficacy and tolerability of high-dose cefalexin 45 mg/kg/dose (maximum 1.5 g) three times daily in children with bone and joint infections.

Cefalexin, a first-generation cephalosporin, is commonly used as oral continuation therapy for paediatric bone and joint infections (BJIs). The standard four times daily cefalexin dose makes treatment adherence challenging. A pharmacokinetic modelling study found that a cefalexin dose of 45 mg/kg (maximum 1.5 g) three times daily achieves the same pharmacodynamic target. To evaluate the efficacy and tolerability of three times daily cefalexin dosing in children with BJIs. Retrospective audit of children aged 1-18 years who received cefalexin at a dose of 40-50 mg/kg (maximum 1.5 g) three times daily as oral continuation therapy for a haematogenous BJI at a quaternary paediatric hospital in Australia over a 4 year period (January 2019 to December 2022). Of 149 children with BJIs treated with three times daily cefalexin dosing, the majority (147/149; 99%) achieved cure, with two experiencing recurrence of their infection. Most children tolerated the higher cefalexin dose; 4 children experienced gastrointestinal symptoms and 13 developed neutropenia, which was mild in most cases with no associated complications. A reduced frequency dosing regimen using a high cefalexin dose of 45 mg/kg (maximum 1.5 g) three times daily is effective and well tolerated in most children with BJIs.

Direct medical costs of polyarthritis in a pediatric hospital in Mexico.

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. The polyarticular course (polyarthritis) represents 63-66% of patients with JIA. The aim was to determine the direct medical costs (DMC) of JIA of the polyarthritis type in pediatric patients of a tertiary hospital in Mexico. An analysis of the disease costs was developed from the perspective of the Instituto de Seguridad Social del Estado de México y Municipios Maternal and Child Hospital (HMI). The time horizon was 12 years. All patients diagnosed with JIA with polyarticular course treated by the pediatric rheumatology service of the HMI from January to September 2022 and with an active clinical record were included. Different costing techniques were used. The cost components were consultations, medications, hospitalization, and office and laboratory studies. The costs are reported in USD 2021. Twenty-six records of patients with polyarticular arthritis from the HMI were analyzed, with a mean of 4,555.2 USD (standard deviation [SD] = 1,456.7) and a median of 3,828 USD (SD = 1,492) in the first 10 years of treatment. The components of DMC were medications (82.7%), office and laboratory studies (8.4%), hospitalization (8.0%), and consultations (1.8%). Biological disease-modifying drugs (bDMARDs) accounted for 95.3% of the drug component cost. The cost of bDMARDs represented the most critical cost of polyarticular JIA, reflected in the 2nd year of treatment. Including generic bDMARDs and reviewing purchase prices by health institutions in Mexico is necessary.

Three-year outcome of a very young severe uncontrolled preschool wheezers cohort, a real-life study

Preschool wheeze is a public health issue. Disease control can be difficult to obtain in this population, in which no biologic therapy is indicated. We studied the evolution of severe preschool wheezers in real-life and identified the factors leading to no-control.We conducted a retrospective study at our tertiary asthma center. Each child under 3 years of age with severe, uncontrolled preschool wheeze was admitted to a pediatric day hospital for further investigations. We collected the results of clinical, biological and radiological exams, and follow-up data at 1 (Y+1), 2 (Y+2) and 3 years (Y+3).We included 135 patients; 63 (47 %) were still being followed at Y+3; 53 % were discontinued due to disease control. The median age at inclusion was 12 months. 29 % of patients followed up still had severe uncontrolled wheezing at Y+3. Eosinophils greater than 0.23G/L (p = 0.03) and a first case of bronchiolitis before the age of 2 months (p = 0.01) were factors in uncontrolled wheezing at Y1. Tobacco exposure was a factor associated with uncontrolled wheezing at Y+2 (p < 0.001). A first case of bronchiolitis before the age of 2 months (p = 0.007), male sex (p < 0.001) and a familial history of atopy (p = 0.05) were factors in uncontrolled disease at Y+3.We report a real-life study, with a very young population and very severe wheezing. Our therapeutic approach is original, enabling us to study the evolution of “therapeutic pressure” in the early years of this frequent disease, the pathophysiology of which is still poorly understood.

Classification of pediatric soft and bone sarcomas using DNA methylation-based profiling

Pediatric sarcomas present heterogeneous morphology, genetics and clinical behavior posing a challenge for an accurate diagnosis. DNA methylation is an epigenetic modification that coordinates chromatin structure and regulates gene expression, determining cell type and function. DNA methylation-based tumor profiling classifier for sarcomas (known as sarcoma classifier) from the German Cancer Research Center (Deutsches Krebsforschungszentrum) was applied to 122 pediatric sarcomas referred to a reference pediatric oncology hospital. The classifiers reported 88.5% of agreement between histopathological and molecular classification confirming the initial diagnosis of all osteosarcomas and Ewing sarcomas. The Ewing-like sarcomas were reclassified into sarcomas with BCOR or CIC alterations, later confirmed by orthogonal diagnostic techniques. Regarding the CNAs profile, osteosarcomas had several chromosomal gains and losses as well as chromothripsis, whereas Ewing sarcomas had few large events, such as amplifications of chromosomes 8 and 12. The molecular classification together with clinical and histopathological assessment could improve the diagnosis of pediatric sarcomas although there are limitations to deal with more rare classes. This study provides an increase in the number of sarcomas evaluated for DNA methylation profiling in the pediatric population.

Multidisciplinary management of third and fourth branchial remnants at a pediatric hospital

Multidisciplinary management of third and fourth branchial remnants at a pediatric hospital

Pediatric Scaphoid Nonunions: Does Insurance Status Play a Role?

Objective: There are no studies that evaluate the effects that insurance or socioeconomic status may have on treatment and outcomes of scaphoid nonunions in children. We evaluated whether there is an association between insurance status and (1) time from injury to hand surgeon evaluation, (2) time from specialist evaluation to surgery, and (3) postoperative outcomes of scaphoid fracture nonunions in children. Methods: A chart review was performed for patients who underwent surgical treatment of scaphoid fracture nonunion from January 2015 and April 2021 at a large tertiary care pediatric hospital. Underinsured patients were defined as those with no medical insurance or Medicaid/state-funded insurance. Results: There were 21 privately insured patients and 17 patients who were underinsured. There was no difference in age, race, or fracture characteristics between the two groups. The mean time between injury and hand surgeon evaluation was 192 SD 195 days for the privately insured group compared with 155 SD 205 days for the underinsured group (P = 0.57). The mean time between specialist evaluation and surgical treatment was 35 SD 54 days for the privately insured group and 31 SD 31 days for the underinsured group (P = 0.82). Union was achieved in 80% of patients with private insurance compared with 88% of underinsured patients after primary surgery (P = 0.67). There was no difference detected in the proportion of patients who had residual pain (15% vs 19%), range of motion deficits (38% vs 40%), strength deficit (6% vs 7%), and return to activity (94% vs 93%) between privately insured and underinsured patients, respectively (P = 1.00). Conclusions: There was no difference in time from injury to specialist evaluation, time from evaluation to surgery, or postoperative outcomes based on insurance status for pediatric patients with scaphoid fracture nonunions. Although insurance status was not associated with access to care for pediatric scaphoid fracture nonunions at our institution, this information may not be generalizable to other populations, including patients who sustain primary scaphoid fractures and who have not yet developed nonunions. Level of Evidence: Level III—retrospective cohort study.

Characteristics of hospital pediatricians and obstetricians/gynecologists working long hours in Tokushima, Japan: A cross-sectional study.

This study aimed to determine the actual working conditions, including working hours and desired future working styles of hospital pediatricians and obstetricians/gynecologists (OB/GYNs) in Tokushima Prefecture. This cross-sectional study used a self-administered questionnaire. Pediatricians and OB/GYNs (n = 96) working at 14 hospitals in Tokushima Prefecture were surveyed. The questionnaire included items related to working hours, working status, number of medical institutions, task-shifting/task-sharing status, and preferred work style. Factors associated with work hours were analyzed. Approximately 40% and 10% of pediatricians and OB/GYNs worked ≥60 h/week and ≥80 h/week, respectively. Their weekly working hours were significantly positively associated with the number of nights and holidays worked and concurrent medical facilities they worked at. Multiple regression models showed that weekly working hours were significantly associated with working at night and day-off duties and the number of working medical institutions being worked at concurrently. Pediatricians and OB/GYNs who worked ≥60 h/week were not implementing a "multiple attending physician system" or "on-call system," and task-shifting/task-sharing was inadequate. A significantly higher proportion of physicians who worked long hours (≥60 h/week or ≥80 h/week) wanted to reduce the number of night and day-off duties and work hours compared with those who did not. The results of this study suggest that many pediatricians and OB/GYNs work long hours, and it is essential to improve their work environment, including task-shifting/task-sharing. Further enhanced recruitment and retention of hospital pediatricians and OB/GYNs is required. A detailed and large-scale study of pediatricians and OB/GYNs' working environments is essential in the future.

Utility of acid citrate dextrose‐acidification for platelet volume reduction protocols in the transfusion service

AbstractBackgroundVolume‐reduced platelets can minimize circulatory overload, allergic transfusion reactions, or out‐of‐group plasma infusion. Our center adopted a volume reduction protocol that includes acidification with acid citrate dextrose solution A (ACD‐A) before centrifugation and without any rest period prior to resuspension allowing a better turnaround time for platelet issue.Study Design and MethodsThis report compares corrected count increments (CCIs) from full‐volume and ACD‐A acidified volume‐reduced human platelets in a retrospective study at a single hospital and in a mouse model.ResultsAt a pediatric tertiary care hospital, 530 patients received conventional apheresis platelets during the 20‐month study period. Among all patients, the expected 4‐h mean CCI was 9.8 (95% CI: 8.7, 10.9) for full‐volume platelets, and 8.8 (95% CI: 7.3, 10.6) for ACD‐acidified volume‐reduced platelets (p = .29). A statistically significant difference (p = .01) was identified in the expected 24‐h mean CCI: 6.3 (95% CI: 5.5–7.0) with full‐volume platelet, 4.7 (95% CI: 3.6–6.0) with ACD‐acidified volume‐reduced platelet. Limiting CCI calculations to patients with Hematology/Oncology/Hematopoietic Progenitor Cell Transplant diagnosis (n = 296, 56%) indicated a statistically significant difference in both 4‐ and 24‐h predicted CCIs, showing lower CCIs in ACD‐acidified volume‐reduced platelet, although these were still similar to the CCIs observed in all patients and considered to be clinically acceptable responses similar to other volume reduction protocols. The recovery of count‐adjusted, volume‐reduced platelets was significantly lower in mice, suggesting a procedure‐related defect.DiscussionACD‐A acidification of platelets before volume reduction decreases turnaround time for platelet issue and provides clinically allowable 4‐h and 24‐h platelet increments.

Unilateral Vestibular Hypofunction in an Adolescent: Case Report and Literature Review

Objective − The report presents a case of an adolescent girl with vertigo resulting from unilateral vestibular hypofunction, diagnosed after extensive pediatric and otorhinolaryngological evaluations.Case Report − A seventeen-year-old female adolescent sought medical assistance at the pediatric emergency hospital service on several occasions within one year due to feelings of weakness and darkened vision occurring during abrupt standing, exposure to heat, and stress. Symptoms were initially attributed to school obligations, low blood pressure, and the menstrual cycle. After an episode that also involved a brief loss of consciousness, an extensive neurological evaluation was conducted, excluding epileptogenic causes. Subsequent diagnostic procedures included evoked visual potential tests, psychological assessments, laboratory blood tests, thyroid hormone assays, and Borrelia burgdorferi serology, all yielding normal results. Finally, otorhinolaryngological examinations were performed, including pure tone audiometry, tympanometry, video head impulse tests, videonystagmography, and vestibular evoked myogenic potential tests. These tests indicated symptoms arising from unilateral labyrinthine hypofunction of the inner ear. The patient underwent vestibular rehabilitation, resulting in symptom resolution and confirmed functional recovery.Conclusion − Diagnosing vertigo in adolescence is challenging, as impaired balance can manifest as a symptom of various diseases. Presentation with atypical symptoms for peripherally caused balance disorders complicates diagnosis. Otorhinolaryngologists and audio-vestibular diagnosticians play pivotal roles in establishing accurate diagnoses.

The digital health landscape at children’s hospitals in Canada

ABSTRACT Objectives Canadian hospitals have historically lagged behind peer nations in terms of adoption of digital health tools. The aim of this study was to assess the current state of adoption of digital health tools at children’s hospitals in Canada. Methods We conducted an online survey of Canadian pediatric tertiary-care hospitals between January and July 2023. The 35-item questionnaire was administered in English and French. Hospital characteristics, informatics infrastructure data and electronic health record (EHR) functionality data were summarized using descriptive statistics. Results The survey was completed by 15 of the 17 (88.2%) pediatric hospitals in Canada. All institutions had an EHR with 10 (66.6%) being fully digitized and five (33.3%) being partially digitized. Funding and availability of clinicians with expertise in clinical informatics were cited as barriers to implementing digital health tools. The availability of core EHR functionalities ranged from 53.3% for medication to 100% for the presence of a laboratory and radiology information system. Only five (33.3%) institutions reported that they had a patient portal. Discussion While all hospitals in this study had an EHR, functionalities varied greatly between centers. Canada lags behind the United States in terms of adoption of digital health tools such as patient portals likely due to governmental mandates and incentives, and a focus on cultivating a physician informatics workforce. Conclusion Canadian pediatric hospitals lag behind peer institutions in digital maturity. This study highlights the perceived need from hospitals for policies, funding, and resources from the Canadian government to help increase the uptake of comprehensive EHRs.

Benefit-finding in children with advanced cancer and their parents.

Although pediatric cancer often causes significant stress for families, most childhood cancer survivors are resilient and do not exhibit severe or lasting psychopathology. Research demonstrates some survivors may report benefit-finding or positive outcomes following this stressful life event. However, considerably less research has included families of children who are unlikely to survive their illness. Thus, this study investigated benefit-finding among parents and their children with advanced cancer, as well as associated demographic and medical factors. Families (N = 72) of children with advanced cancer (ages 5-25) were recruited from a large pediatric hospital. Advanced cancer was defined as relapsed or refractory disease, an estimated prognosis of <60%, or referral to end-of-life care. Participants completed a demographic survey and the Benefit Finding Scale at enrollment. Children, mothers, and fathers reported moderate to high benefit-finding scores. Correlations between family members were weak and non-significant. Children reported significantly higher benefit-finding than fathers. Demographic and medical factors were not associated with benefit-finding in children, mothers, or fathers. Families of children with advanced cancer reported moderate to high benefit-finding regardless of background or medical factors. Children identified benefits of their cancer experience independent of the experiences of their mothers and fathers. Larger studies should continue to examine factors associated with positive and negative outcomes in the context of childhood cancer to inform interventions.