Adolescents with anorexia nervosa (AN) often present cognitive rigidity, impaired decision-making, and difficulties processing emotions, all of which can impede engagement in treatment. The marked rise in paediatric hospitalisations for AN during the COVID-19 pandemic highlights the urgent need for brief, targeted interventions in inpatient settings. This case series explored the feasibility and preliminary effects of combining Cognitive Remediation Therapy (CRT) and Cognitive Remediation and Emotion Skills Training (CREST) for eight female adolescents (12-16years) admitted to a paediatric ward with AN or atypical AN. Over the course of their hospitalisation, participants received 20 individual CRT+CREST sessions in addition to standard multidisciplinary care. Neuropsychological and self-report measures administered at admission (T0), post-intervention (T1), and 6-month follow-up (T2) revealed significant improvements in central coherence, cognitive flexibility, decision-making, theory of mind, and interoceptive awareness between T0 and T1 (all p<0.05). These gains were maintained at T2, with no further significant changes. All participants completed the intervention without dropout. Findings suggest that CRT combined with CREST is a feasible, developmentally sensitive approach that may enhance cognitive and emotional readiness for subsequent therapy in adolescents with AN during inpatient care. Larger controlled studies are needed to confirm these promising results.

Pakistan's neonatal and under-five mortality rates remain among the highest in South Asia. This challenge is exacerbated by a critical shortage of paediatric intensive care staff, with <30 trained specialists serving >80 million children. Recent national data indicate that only 70% of accredited paediatric hospitals have functional paediatric intensive care units, and nearly half lack adequate nurse-to-patient ratios. These shortages are most severe in rural regions, where delayed access to life-saving interventions contributes to preventable deaths. Emerging solutions such as telemedicine, neonatal care units within general hospitals, and public-private partnerships demonstrate potential for scalable reform. Strengthening paediatric critical care is essential to achieving Sustainable Development Goal 3.2 and ending preventable child deaths by 2030.

Sepsis is a common and clinically challenging life-threatening condition affecting children. Well-designed guidelines integrated into quality improvement initiatives reduce pediatric sepsis mortality and hospital length of stay. Our objective was to evaluate the quality of Canadian pediatric sepsis guidelines for children presenting to emergency departments (ED) and evaluate their consistency and concordance with the Surviving Sepsis guidelines (international reference standard). We contacted all 15 Canadian pediatric hospitals and national organizations to obtain guidelines. Guidelines were included if they contained at least one recommendation on detection or management of pediatric sepsis in the ED. Two independent reviewers applied the AGREE-II tool to evaluate guideline quality (methodologic rigor). Quality was classified as high, moderate, or low based on published definitions. For each of the 12 ED-relevant recommendations from the reference standard, we calculated the percentage of all Canadian guidelines that provided the same recommendation (consistency). For each individual Canadian guideline, we calculated the percentage of the 12 recommendations that were the same as the reference standard (concordance). Nine guidelines were included. Guidelines were presented as pathway/algorithm, order set, narrative, or a combination of formats. Most institutional guidelines were of low quality, and a single national guideline was classified as high quality. Overall, guidelines were highly consistent across most recommendations of the reference standard, except for fluid bolus content (balanced vs normal saline). Similarly, individual guidelines were highly concordant with the referencestandard, with only one low-quality guideline having a concordance of less than 80%. The quality of Canadian institutional guidelines is low in terms of methodological development; however, recommendations in these guidelines remain generally consistent with an international reference standard, though key areas of inconsistency exist. Future efforts should focus on regularly reviewing and updating the robust national guideline that can be adapted to local institutional needs.

Social Determinants of Health Screening and Pediatric Surgical Outcomes.

Peripheral intravenous infiltration and extravasation injuries (PIVIEs) in pediatric patients are a significant yet underrecognized source of preventable harm, often due to inconsistent detection and limited standardization. This study implemented a structured quality improvement initiative to enhance early detection, classification, and management of PIVIEs at C.S. Mott Children's Hospital, supporting the institution's goal of zero preventable harm. This single-center, prospective quality improvement study was conducted at a 347-bed academic pediatric hospital from January 2023 to December 2024. All patients with a documented PIVIE were included. Key interventions included creation of a multidisciplinary PIVIE Prevention Task Force, standardized event review, development of a pediatric infusion agent risk classification algorithm, and updated antidote protocols. Outcomes measured included PIVIE reporting volume, antidote timeliness, and classification documentation. Descriptive statistics were used to assess trends. Following intervention, 628 PIVIEs were reported-a 465.8% increase from 111 events reported during the 2021-2022 period. Implementation of an institutional standard of care form and a centralized database improved documentation and expedited antidote administration. A pediatric-specific classification system was developed and applied to over 90 high-use agents, enabling risk-based clinical decision-making. Interdisciplinary, structured interventions markedly improved reporting, documentation, and treatment of pediatric PIVIEs. Adoption of standardized classification tools and review processes may help hospitals reduce IV-related complications. Policymakers and accrediting bodies should consider incentivizing pediatric vascular safety metrics, supporting integration of pediatric-specific risk frameworks, and encouraging cross-institutional data sharing to drive broader improvements in care.

Mycoplasma pneumoniae (MP) is a common cause of lower respiratory tract infections in children. During the COVID-19 pandemic, a marked decline in MP infections was observed, with a delayed resurgence reported in some European countries. This study aimed to assess the epidemiologic trends and clinical features of MP infections in a pediatric tertiary care academic hospital in Italy from 2017 to 2024. We conducted a retrospective, single-center study including immunocompetent patients 30 days to 17 years of age, hospitalized with confirmed MP infection. Clinical, laboratory, and radiologic data were analyzed across 3 periods: prepandemic (2017-2019), pandemic (2020-2022) and postpandemic (2023-2024). Statistical analyses were performed to compare incidence and clinical characteristics over time. Of 303 included patients, 130 were hospitalized prepandemic and 148 postpandemics. The proportion of MP among acute respiratory infection hospitalizations nearly doubled, from 3.2% in 2019 to 6.1% in 2024. Despite the higher incidence, the need for respiratory support remained stable (25.7% overall; P = 0.3), the pediatric intensive care admissions were rare and unchanged (2.0% vs. 2.0%, P = 1.0) and median hospital stay was consistent across both periods (5 days, interquartile range 4-8; P = 0.803). MP incidence increased significantly postpandemic, and clinical severity remained comparable to prepandemic levels. Ongoing epidemiologic surveillance is essential to better understand infection dynamics and to guide effective clinical management strategies.

Parents' experiences of the time preceding infant admission to hospital within 4 weeks of birth: a qualitative interview study.

Fusobacterium has become increasingly recognized pediatric pathogen, responsible for a wide spectrum of infections, including otogenic, oropharyngeal, intra-abdominal and soft tissue infections. However, large-scale studies remain limited. This study aimed to assess the incidence, clinical features, complications and outcomes of pediatric Fusobacterium infections. Retrospective cohort study of children (0-18 years) diagnosed with Fusobacterium infections at a tertiary pediatric hospital between 2010 and 2023. A total of 195 cases were identified, with a 10-fold increase in incidence over 13 years. Linear regression demonstrated a significant annual rise in Fusobacterium isolations [β = 2.25, 95% confidence interval (CI): 1.99-2.60, P < 0.01], affecting both otologic (β = 0.65, 95% CI: 0.19-1.11, P < 0.01) and nonotologic sources (β = 1.58, 95% CI: 1.23-1.94, P < 0.001). Infections were primarily otogenic (50.2%), followed by skin and soft tissue, intra-abdominal and pharyngeal infections. Patients with otogenic infections were significantly younger (mean 2.6 vs. 10.3 years, P < 0.001). Hospitalization was required in 80.5%, and complications occurred in 37%. No mortality was observed. Pediatric Fusobacterium infections are rising, with significant clinical complexity and complications. While often otogenic, these infections affect multiple body systems. Awareness of their evolving epidemiology is crucial for optimizing diagnosis and management.

Serotype distribution and antimicrobial resistance in pediatric invasive pneumococcal pneumonia: A Laboratory Surveillance Study from Argentina, 2022-2024.

Stereo-EEG in an epilepsy surgery program: Initial experience in a tertiary pediatric hospital in Italy.

Between seizures and schooling: qualitative insights into the experiences of children with epilepsy.

To characterize the clinical features, management, and outcomes of paediatric patients with status epilepticus, and to explore whether distinct clinical subgroups can be identified from clinical descriptions. This was an exploratory retrospective single-centre cohort study of paediatric status epilepticus admissions to Switzerland's largest tertiary-level paediatric hospital. We analysed 642 status epilepticus admissions from 467 patients (230 females; median age at first 4 years 11 months [interquartile range 1 year 5 months-7 years 5 months]). We applied descriptive statistics and machine-learningapproaches. A k-means clustering algorithm was used to identify distinct clinical subgroups, while least absolute shrinkage and selection operator regression tested whether clinical metrics could predict mortality. Age-related differences in status epilepticus aetiology were observed: infants and younger children more often presented with acute symptomatic causes, whereas older children and adolescents were more likely to have pre-existing epilepsy. Out-of-hospital treatment was associated with faster treatment initiation and better treatment response. Shorter status epilepticus onset to treatment latency correlated with higher response rates and reduced need for intensive care. Cluster analysis identified three clinical subgroups: (1) younger patients with acute status epilepticus associated with an infection, including febrile status epilepticus ('febrile seizure' cluster); (2)younger patients with acute status epilepticus and a more severe in-hospital course ('para-infectious' cluster); and (3) older patients with an established epilepsy diagnosis ('known epilepsy' cluster). Across the cohort, progressive epilepsy aetiology and a previous diagnosis of epilepsy were associated with increased mortality risk. Paediatric status epilepticus comprises clinically distinct subgroups that are identifiable from routine clinical data. Such data-driven clinical clustering may help refine risk stratification and inform clinical decision making in paediatric status epilepticus.

To address crowding, our pediatric emergency department (ED) implemented a triage nurse-led protocol to redirect non-urgent patients to external pediatric clinics, other healthcare providers, family physicians, or home. This study aimed to identify the proportion of redirected children who returned to the ED and identify predictors of return. We conducted a health records review study of children under 18 years redirected from the ED of a tertiary pediatric hospital in Montreal, Canada. A random sample of 150 return visits and 300 controls was selected for a nested case-control study. The primary outcome was a return visit to the ED within 7 days. Potential predictors included demographic information, disease characteristics, triage level, and initial orientation. We calculated the proportion of return visits and performed univariate and multivariable analyses of identified predictors. Between September 2023 and August 2024, 80,221 children were triaged, of whom 6,556 (8.2%) were redirected. Within 7 days, 372 (5.7%) returned. Among the 150 reviewed return visits, 127 (85%) were related to the initial complaint: 64 (43%) were due to persistent symptoms, 49 (33%) to clinical deterioration, 6 (4%) were sent back by a physician, and 5 (3%) were for new symptoms. Seven patients (4.7%) required hospitalization on their return visit. Predictors associated with a lower probability of return included ear, nose, throat, and dental complaints, as well as redirection to specialized or pediatric clinics. Approximately, 6% of redirected children returned to the ED within 7 days, most often for persistent or worsening symptoms. Identifying predictors of return visits provides evidence to refine redirection guidelines and enhance the safety and effectiveness of triage nurse-led redirection strategies.

Undescended testis (UDT) is the most common congenital anomaly of the urogenital system in boys and is associated with long-term risks, including infertility in bilateral cases of UDT and testicular malignancy if not corrected promptly. International guidelines recommend referral by 6 months and surgical correction before 18 months of age. However, delays in diagnosis and management remain frequent worldwide. This study aimed to determine the age at diagnosis of UDT and to identify sociodemographic and perinatal factors associated with delayed diagnosis in a tertiary pediatric hospital in Iran. In this cross-sectional study, 70 patients with UDT who presented to the tertiary Children's hospital in one year were enrolled. Data were collected using a structured questionnaire completed by mothers, covering demographic, perinatal, and maternal variables. Statistical analyses were performed using SPSS software. The median age at diagnosis of UDT was 29 months, with nearly half of the cases identified at birth or during the neonatal period. Despite early recognition in many patients, a significant proportion were diagnosed later than recommended. Among the studied variables, higher maternal age was significantly associated with delayed diagnosis, whereas maternal education, birth order, prematurity, and place of residence showed no significant correlation. Although many children with UDT in our study were diagnosed early, delays beyond the recommended age for intervention remain common. Maternal age emerged as a significant predictor of delayed diagnosis, underscoring the need for targeted parental education and systematic screening during infancy.

Intraspinal anomalies (IA) are reported to occur in 7% to 19% of patients undergoing surgery for adolescent idiopathic scoliosis (AIS). However, these studies have not focused on IA that require neurosurgical intervention and have not assessed whether deformity characteristics predict their underlying presence. We hypothesized that specific radiographic deformity parameters would be associated with underlying IA in a population of presumed AIS patients undergoing posterior spinal fusion (PSF). A retrospective cohort study was performed over a 10-year period, identifying all patients with presumed AIS undergoing PSF who had a preoperative total spine MRI at a single, tertiary care pediatric hospital. The presence of an intraspinal anomaly was confirmed by MRI, and subsequent neurosurgical evaluation and intervention were recorded. Coronal and sagittal plane radiographic criteria were recorded, with a focus on previously identified predictive criteria. Radiographic criteria were compared against the whole population, as well as just those with thoracic deformities, seeking to identify factors associated with the presence of IA, as well as those associated with the need for neurosurgical intervention. A total of 427 patients met the inclusion criteria (mean 14.6±2.3y, 80.7% female). Of these, 33 patients (7.7%) were diagnosed with an IA: 23 syringomyelia, 14 Chiari I malformation, 4 tethered spinal cord, and 8 cerebellar tonsillar ectopia, with only 8 patients (1.9%) undergoing neurosurgical treatment. Thoracic deformities were predominant in 350 patients (81.7%), which was statistically similar for IA and AIS (84.9% vs. 83.3%). For the whole cohort, a left thoracic curve apex was significantly more likely in a patient with an underlying IA (IA: 21% vs. AIS: 6.2%; P<0.001) and was predictive on logistic regression analysis (odds ratio: 0.25, 95% CI: 0.1-0.67; P=0.003). Neurosurgical intervention was also associated with a left thoracic curve apex within the subset of thoracic-only deformities (IA: 38% vs. AIS: 6.5%, P=0.005) with a 37.5% sensitivity and 92.7% specificity. However, all patients requiring neurosurgical intervention also showed neurological symptoms, such as occipital headaches, sleep apnea, or extremity neurological symptoms. The presence of an intraspinal anomaly occurred in 33 patients (7.7%) of this presumed AIS cohort, but only 8 patients (24%) required neurosurgical intervention (1.9% of the total cohort). Only a left thoracic apex was associated with the need for neurosurgical intervention. However, all patients requiring neurosurgical intervention presented with concomitant neurological symptoms. Selective MRI screening protocols incorporating patient sex, radiographic criteria, and neurological indicators may prove sufficient in contrast to universal MRI screening in children with presumed AIS undergoing PSF while minimizing health care expenditures.

This study explored potential resilience factors that facilitate engagement in physical activity (PA) among adolescents with chronic musculoskeletal pain after completing intensive interdisciplinary pain treatment. Ten adolescents aged 13 to 17 years with a history of chronic musculoskeletal pain from a mid-western pediatric hospital in the United States participated in this qualitative study. Participants provided demographic information and completed semistructured virtual interviews. The interviews focused on their pain experiences, resilience, and engagement in PA. Transcripts were analyzed using primarily directed content analysis based on a pain resilience framework. Participants highlighted several key resilience factors that influenced their PA engagement, including positive affect, motivation, acceptance, and self-efficacy. Positive affect and mood affected their willingness and enjoyment of PA. Motivation was enhanced by focusing on short-term and long-term gains and setting smaller, manageable goals. Acceptance of pain allowed participants to engage in PA even on bad pain days, using psychological flexibility skills. Social support and the ability to pair PA with other valued activities, such as spending time with friends and family, were also crucial in maintaining PA engagement. The study identified resilience factors relevant to PA interventions for pediatric chronic pain. Incorporating strategies that enhance positive affect, motivation, acceptance, and self-efficacy, along with fostering social support, may improve PA engagement and could enhance the effectiveness of PA programs, promoting better outcomes for adolescents with pain. Future research should explore and further validate the importance of these resilience factors in larger, more diverse populations and across different stages of pain treatment.

Background : Most of children population was passive smoker it is caused by Family smoking habit at home. Cigarette smoke can leave chemicals or residue on clothing, ceilings, sofa curtains, and other places in the home. One of the effects that can occur as a result of smoking is respiratory tract infections (ISPA), which are the main cause of illness in children.Aims: This study aims to determine the relationship between smoking behavior and the incidence of acute respiratory infections in children at Jailolo Regional General Hospital, West Halmahera Regency. Methods : This study used a descriptive design with a cross-sectional approach. The study population consisted of all pediatric patients who visited the pediatric clinic at Jailolo Regional General Hospital whose parents had a history of smoking. A total of 107 respondents were selected using total sampling technique. The Brinkman Index was used to measure the degree of smoking behavior. Data analysis was performed using bivariate analysis with the Chi-Square test. Results : It is known that 77 children (72%) who visited the Jailolo Regional General Hospital Pediatric Clinic suffered from ARI, while only 30 children (28%) did not suffer from ARI. Furthermore, 27 respondents (25.2%) had parents who smoked lightly, while 40 respondents (37.4%) had parents who smoked moderately and heavily, respectively. The results of the Chi-Square test showed a significant relationship (p = 0.000). Conclusion : .This study found a significant association between smoking and the incidence of ARI in children

In paediatric patients with suspected osteomyelitis, magnetic resonance imaging (MRI) remains an essential diagnostic tool. Timely access to an MRI scanner remains a challenge in the Canadian system. For some paediatric patients, the need for sedation can introduce considerable time delays, particularly for those admitted to services who may rely heavily on radiology image interpretation. This study aimed to assess the current delivery of care for osteomyelitis by analyzing MRI wait times, the use of contrast and sedation, and associated patient outcomes. A single-centre retrospective cohort study from a level one paediatric children's hospital was performed. Data were collected from electronic medical records of paediatric patients with a diagnosis of osteomyelitis from December 1, 2018 to December 31, 2023. Records were reviewed to collect patient factors (e.g., age, sex, comorbidities), relevant MRI parameters (e.g., time of order, time of image acquisition, contrast, sedation), non-surgical and surgical management, involvement of infectious diseases, length of stay in the hospital, follow-up complications, and follow-up MRI. Patient data were compared based on time from the MRI order to image acquisition and interpretation. Continuous variables were assessed for normality using a Shapiro-Wilks test to determine the use of parametric or non-parametric tests. Regression analyses were performed to identify predictive indicators of delays in MRI image acquisition and treatment for osteomyelitis. A total of 60 pediatric patients with a definitive diagnosis of osteomyelitis had undergone an MRI at our center. The cohort consisted of 33 (55%) males with a mean age of 8.5 (+/- 4.5) years old. The average length of hospital stay for these patients was 9.4 (+/- 10.1) days. Patients with both osteomyelitis and a soft tissue abscess were more often admitted and underwent surgery more frequently, although these differences did not reach statistical significance. Contrast was indicated and administered in 95% of all MRI scans, with 19 (32%) of total scans performed with sedation. There were no differences in MRI acquisition time before, during, nor after the COVID-19 pandemic for these patients. The average time from MRI order to scan acquisition was 48.2 (+/- 41.8) hours for sedated patients, compared to 40.4 (+/- 30.6) hours for those not sedated, with no statistically significant difference between groups. The time from MRI order to interpretation followed similarly in the sedated scans, 53.3 (+/- 43.4) hours, and unsedated scans, 51.7 (+/−46.9) hours, with differences not found to be statistically significant. Based on our hospital's average hourly cost of pediatric inpatient care, the time from image request to formalized interpretation reached $3,405.87 for sedated scans and $3,303.63 for unsedated scans. Overall, the findings indicate delays in obtaining MRI scans, irrespective of need for sedation, which can contribute to prolonged hospital stays, increased costs and potentially delay in care. The substantial wait times for diagnostic MRIs highlight a critical area for quality improvement initiatives, suggesting that enhanced prioritization or further resource allocation for paediatric patients must be considered. Further, emphasis on incorporating rapid whole-body MRI scout protocols could significantly enhance patient care, image acquisition time and efficiency.

Spinal epidural abscess (SEA) is a rare pathology with potentially devastating consequences if not treated expeditiously. We retrospectively analyzed clinical and laboratory data retrieved from the medical records of children (age <18 years) admitted to a tertiary pediatric hospital with a diagnosis of SEA and available imaging findings of spinal dysraphism (SD) between 1/2010 and 8/2024. Eight children diagnosed with SD or other anatomical spinal anomaly prior or at the presentation of an SEA were included. The most common clinical presentation was fever (n = 8). Dermal sinus (n = 4) was the most common physical finding. The clinical diagnosis of SEA was made with a mean of 27 days after symptom onset. Escherichia coli and Enterococcus faecalis were the most cultured pathogens. The diagnosis of SEA was made by magnetic resonance imaging in all cases. All 8 children were treated with systemic antibiotics and all had undergone surgical interventions. Four patients remained with a neurologic sequelae, most commonly neurogenic bladder (n = 4). Our report is the first case series of SEA due to SD in a pediatric population described to date. Children with SD are at increased risk for SEA and usually develop this complication at a younger age compared to those with SEA without anatomical risk factors. They are also at increased risk for delayed diagnosis, concomitant meningeal involvement and long-term neurologic sequelae. The most significant variables influencing outcome are timely diagnosis and surgical intervention, followed by appropriate antibiotic administration.

Approximately 25% of the measurement variation made by community radiology can be attributed to error. Inaccuracies between community radiology and tertiary care may have a significant impact on the timely presentation of AIS patients. The study objective was to evaluate the effectiveness of a machine learning (ML) model to quantify curve magnitude on community-acquired spine radiographs and to subsequently identify AIS patients with moderate and severe deformity for triage. A retrospective review of AIS patients (n=116) at a tertiary-care pediatric hospital with community-acquired spine radiographs was conducted. Reference standard evaluations were obtained on community-acquired spine radiographs by independent measurements from two blinded raters (orthopaedic spine specialist; paediatric radiologist). The ML model was a two-step segmentation-based deep learning architecture, previously validated on 3-foot standing spine radiographs. Community radiology readings were retrieved from imaging reports. Cobb angle readings obtained by the ML model and by community radiologists were compared to the reference standard. The agreement was computed using intraclass correlation coefficient (ICC). Brace and surgical candidates were identified by reference standard and corresponding Scoliosis Research Society management categories (&gt;25°, &gt;50°). Figure 1 illustrates the two-step deep learning architecture. First, the model generates segmentation and a minimum bounding box for each vertebra. Second, landmarks are produced from the minimum bounding box, which are ultimately used by the model to calculate curve magnitude. On community-acquired spine radiographs, the agreement in Cobb angle readings between ML model and reference standard was excellent (ICC=0.93 95% CI 0.90–0.95; ICC=0.90 95% CI 0.86–0.93) with acceptable precision (SEM=3.97°; SEM=4.79°). Comparatively, the agreement between community radiologist and reference standard was fair (ICC=0.68 95% CI 0.51–0.79; ICC=0.67 95% CI 0.54–0.76) with a greater margin of error (SEM=8.28°; SEM=8.85°). The ML model correctly identified 85.4% of brace candidates (n=49) and 83.9% of surgical candidates (n=31), increased from 63.2% and 67.7% identified by community radiologist. Of those brace candidates that were missed, the ML model underestimated curve magnitude by 3.84°, on average. There was greater reliability of the Cobb angle readings obtained by the ML model compared to manual measurements obtained by community radiologists. There may be important clinical utility of an ML model to enhance measurements obtained in the community, which may expedite appropriate referrals to tertiary care. For any figures or tables, please contact the authors directly.