Pediatric Procedures Research Articles

Exploring Amico H impact: A promising tool to promote children's knowledge and adherence to medical procedures

mHealth (e.g., the use of mobile devices such as smartphones and tablets for delivering healthcare services) has become a crucial resource in pediatric healthcare, providing children with psychoeducation and distraction, and enhancing treatment compliance. Amico H, a newly developed application, is targeted at ameliorating children's and parents' experience of pediat-ric medical procedures and communication with healthcare professionals. With the virtual en-vironment of a castle, Amico H is a mHealth app for children, offering interactive games and psychoeducational support during medical treatments. The present experience explores the im-pact of the Amico H prototype on children, teens, and parents in terms of pleasantness, usabil-ity, and usefulness. Method: A total of 99 children and teens aged 4-19 years (10.53 ± 3.69 years; 73% female), both hospitalized (28%) or not and N=32 caregivers (72% mothers) re-sponded to an ad-hoc survey on the app's user experience. Descriptive analyses and group comparisons have been computed. Results: Findings highlight that children and caregivers were highly amused and satisfied by Amico H. Compared to teens, children needed more help from adults in the use of the app. Conclusion: All the results indicate that Amico H is a pow-erful tool to ameliorate pediatric hospitalization experience and to promote children's knowledge about health and medical procedures. The need for age-specific versions of Amico H emerged. Future directions and limits are discussed.

Creation of Three-dimensional Anatomic Models in Pediatric Surgical Patients Using Cross-sectional Imaging: A Demonstration of Low-cost Methods and Applications

BackgroundPediatric surgery patients often present with complex congenital anomalies or other conditions requiring deep understanding of their intricate anatomy. Commercial applications and services exist for the conversion of cross-sectional imaging data into three-dimensional (3D) models for education and preoperative planning. However, the associated costs and lack of familiarity may discourage their use in centers with limited resources. The purpose of this report is to present a low-cost, reproducible method for generating 3D images to visualize patient anatomy. MethodsDe-identified DICOM files were obtained from the hospital PACS system in preparation for assorted pediatric surgical procedures. Using open-source visualization software, variations in anatomic structures were examined using volume rendering and segmentation techniques. Images were further refined using available editing tools or artificial intelligence-assisted software extensions. ResultsUsing the described techniques we were able to obtain excellent visualization of desired structures and associated anatomic variations. Once structures were selected and modeled in 3D (segmentation), they could be exported as one of several 3D object file formats. These could then be retained for 3D printing, visualization in virtual reality, or as an anatomic reference during the perioperative period. Models may also be imported into commercial gaming engines for rendering under optimal lighting conditions and with enhanced detail. ConclusionPediatric surgeons are frequently tasked with the treatment of patients with complex and rare anomalies. Visualization and preoperative planning can be assisted by advanced imaging software at minimal to no cost, thereby facilitating enhanced understanding of these conditions in resource-limited environments. Level of EvidenceV, Case Series, Description of Technique.

Are we Getting It Right First Time? An exploration of clinical coding practices within a UK paediatric dental hospital department.

Introduction Issues arising from the current coding system in dentistry have been highlighted. Available codes are considered to lack clarity and fail to reflect all dental specialties. There are no paediatric-specific codes, which means codes from other specialties are used, which may not accurately reflect the work carried out.Aim This paper aims to explore the range of codes and the consistency and accuracy of current coding practices within the paediatric dentistry department at Newcastle Dental Hospital, and explore the potential impact of introducing new speciality-specific codes for the aforementioned procedures.Method Data were retrospectively collected to determine whether the following treatments had been undertaken, and if so, which procedure code had been used for the treatment: inhalation sedation; dietary advice; acclimatisation; preformed metal crowns, silver diamine fluoride application; and apexification. All codes used within the department for a six-month period were also reviewed retrospectively and the frequency in which procedures relating to the potential new codes would be undertaken within the department was estimated to facilitate consideration of potential financial impact of the introduction of new codes.Results Codes utilised for the aforementioned procedures did not accurately reflect work carried out despite being relatively consistent. The potential new codes corresponded to procedures that were commonly undertaken within the department.Discussion This study highlights shortcomings in the coding system relating to a lack of applicable codes for paediatric dentistry procedures. Introduction of new speciality-specific codes should help to address this deficit to ensure a more accurate representation of the needs of the community to help commissioning and workforce planning.

Implementation of Standardized Educational Material in Outpatient Pediatric Surgery: A Pilot Study

IntroductionCaregiver health literacy is affected by both personal knowledge and education provided by clinicians. Literature on implementation of educational materials into pediatric surgical clinical practice is scarce. We developed plain-language picture-based educational material and implemented it in a pediatric surgery clinic. We assessed both caregiver and clinician satisfaction before and after implementation. MethodsPicture-based educational material was developed for epigastric/umbilical/inguinal hernias/hydroceles, gastrostomy/gastrojejunostomy tube creation, and soft tissue masses and implemented in an academic pediatric surgery clinic. Pediatric surgeons (n = 12), clinic nurses (n = 4), and physician extenders (n = 2) were surveyed before and after a 4-week pilot implementation period. In parallel, parents of children (0-18 y) completed a 19-item postpre electronic survey capturing demographics, self-professed level of prior knowledge, and opinions regarding the material. Descriptive statistics were performed. ResultsClinician response rate was 88% (pre) and 72% (post). Preimplementation, clinicians overwhelmingly reported repetitive parental counseling, need to redraw diagrams, and anticipation of improvement in workflow with standardized materials. Postimplementation, most clinicians felt the material was easy to use (76%), beneficial (77%), and perceived satisfaction in parents they were counseling (77%). Caregiver response rate was 100%. The majority reported their understanding improved after reviewing the material, found the material easy to understand and helpful, were more comfortable managing their child's condition, and recommended continued use of the material during visits. ConclusionsResults indicate clinician satisfaction and willingness to use standardized educational material during outpatient visits, as well as caregiver satisfaction and self-reported improved understanding. These findings support further development and use of standardized educational material for pediatric surgical conditions and procedures.

Current management of symptomatic vesicoureteral reflux in pediatric kidney transplantation-A European survey among surgical transplant professionals.

Vesicoureteral reflux (VUR) is common in children and adolescents undergoing kidney transplantation (KTx) and may adversely affect allograft kidney function. To explore the current management of symptomatic native and allograft VUR in pediatric KTx recipients, an online survey was distributed to European surgical transplant professionals. Surgeons from 40 pediatric KTx centers in 18 countries participated in this survey. Symptomatic native kidney VUR was treated before or during KTx by 68% of the centers (all/selected patients: 33%/67%; before/during KTx: 89%/11%), with a preference for endoscopic treatment (59%). At KTx, 90% favored an anti-reflux ureteral reimplantation procedure (extravesical/transvesical approach: 92%/8%; preferred extravesical technique: Lich-Gregoir [85%]). Management strategies for symptomatic allograft VUR included surgical repair (90%), continuous antibiotic prophylaxis (51%), bladder training (49%), or noninterventional surveillance (21%). Redo ureteral implantation and endoscopic intervention for allograft VUR were equally reported (51%/49%). This survey shows uniformity in some surgical aspects of the pediatric KTx procedure. However, with regard to VUR, there is a significant variation in practice patterns that need to be addressed by future well-designed and prospective studies. In this way, more robust data could be translated into consensus guidelines for a more standardized and evidence-based management of this common condition in pediatric KTx.

Pediatric Brain Tissue Segmentation Using a Snapshot Hyperspectral Imaging (sHSI) Camera and Machine Learning Classifier.

Pediatric brain tumors are the second most common type of cancer, accounting for one in four childhood cancer types. Brain tumor resection surgery remains the most common treatment option for brain cancer. While assessing tumor margins intraoperatively, surgeons must send tissue samples for biopsy, which can be time-consuming and not always accurate or helpful. Snapshot hyperspectral imaging (sHSI) cameras can capture scenes beyond the human visual spectrum and provide real-time guidance where we aim to segment healthy brain tissues from lesions on pediatric patients undergoing brain tumor resection. With the institutional research board approval, Pro00011028, 139 red-green-blue (RGB), 279 visible, and 85 infrared sHSI data were collected from four subjects with the system integrated into an operating microscope. A random forest classifier was used for data analysis. The RGB, infrared sHSI, and visible sHSI models achieved average intersection of unions (IoUs) of 0.76, 0.59, and 0.57, respectively, while the tumor segmentation achieved a specificity of 0.996, followed by the infrared HSI and visible HSI models at 0.93 and 0.91, respectively. Despite the small dataset considering pediatric cases, our research leveraged sHSI technology and successfully segmented healthy brain tissues from lesions with a high specificity during pediatric brain tumor resection procedures.

Posterior pericardial window: a simple and reproducible technique in order to prevent pericardial tamponade in paediatric cardiac surgery.

Pericardial tamponade, which increases postoperative mortality and morbidity, is still not uncommon after paediatric cardiac surgery. We considered that posterior pericardiotomy may be a useful and safe technique in order to reduce the incidence of early and late pericardial tamponade. Herein, we present our experience with creation of posterior pericardial window following congenital cardiac surgical procedures. This retrospective study evaluated 229 patients who underwent paediatric cardiac surgical procedures between June 2021 and January 2023. A posterior pericardial window was created in all of the patients. In neonates and infants, pericardial window was performed at a size of 2x2 cm, whereas a 3x3 cm connection was established in elder children and young adults. A curved chest tube was placed and positioned at the posterolateral pericardiophrenic sinus. An additional straight anterior mediastinal chest tube was also inserted in every patient. Transthoracic echocardiographic evaluations were performed daily to assess postoperative pericardial effusion. A total of 229 (135 male, 94 female) patients were operated. Mean age and body weight were 24.2 ± 26.7 months and 10.2 ± 6.7 kg, respectively. Eight (3.5%) of the patients were neonates where 109 (47.6%) were infants and 112 (48.9%) were in childhood. Fifty-two (22.7%) re-do operations were performed. Six (2.6%) patients underwent postoperative surgical re-exploration due to surgical site bleeding. Any early or late pericardial tamponade was not encountered in the study group. Posterior pericardial window is an effective and safe technique in order to prevent both the early and late pericardial tamponade after congenital cardiac surgery.

Virtual reality and noise canceling headphone distraction during pediatric dermatologic procedures.

Pain and anxiety related to medical procedures have long been recognized as a significant healthcare concern. If a patient's procedural pain and anxiety are not addressed, long-term physical and psychological sequelae including increased perceived pain, anxiety, disruptive behavior, trauma reactions, or refusal of future procedures can occur. The objective of our study was to assess the utility of a virtual reality (VR) headset or noise-canceling headphones (HP) compared to treatment as usual (TAU) in reducing pain and anxiety during pediatric dermatology procedures. Results indicated a significant difference between pre- versus post-procedure anxiety in the VR and HP groups but not the TAU group suggesting non-pharmacologic technology-based interventions such as VR and headphones may reduce patients' anxiety during pediatric dermatology procedures.

Risks and benefits of anesthesia for combined pediatric procedures in the NIH undiagnosed diseases program

PurposeThe NIH Undiagnosed Diseases Program (UDP) aims to provide diagnoses to patients who have previously received exhaustive evaluations yet remain undiagnosed. Patients undergo procedural anesthesia for deep phenotyping for analysis with genomic testing. MethodsA retrospective chart review was performed to determine the safety and benefit of procedural anesthesia in pediatric patients in the UDP. Adverse perioperative events were classified as anesthesia-related complications or peri-procedural complications. The contribution of procedures performed under anesthesia to arriving at a diagnosis was also determined. ResultsFrom 2008 to 2020, 249 pediatric patients in the UDP underwent anesthesia for diagnostic procedures. The majority had a severe systemic disease (American Society for Anesthesiology status III, 79%) and/or a neurologic condition (91%). Perioperative events occurred in 45 patients; six of these were attributed to anesthesia. All patients recovered fully without sequelae. Nearly half of the 249 patients (49%) received a diagnosis, and almost all these diagnoses (88%) took advantage of information gleaned from procedures performed under anesthesia. ConclusionsThe benefits of anesthesia involving multiple diagnostic procedures in a well-coordinated, multidisciplinary, research setting, such as in the pediatric UDP, outweigh the risks.

CONVERSION OF LAPAROSCOPIC APPENDECTOMY TO OPEN APPENDECTOMY IN CHILDREN REASONS AND CLINICAL OUTCOMES

This study was carried out To assess the impact of this conversion on clinical outcomes to better understand the reasons for pediatric patients' open appendectomy procedures as opposed to laparoscopic ones. This medical research study is retrospective. We conducted a retrospective study of pediatric patients (ages 1 to 18) who had appendicectomies at MMC Mardan's Department of Pediatric Surgery between January 2010 and December 2020. Patient demographics, preoperative presentation, surgical technique (open or laparoscopic), conversion reasons, intraoperative findings, postoperative problems, duration of hospital stay, and follow-up results were all recorded. The statistical analysis included logistic regression analyses, t-tests, and chi-square tests when appropriate. The research included 462 pediatric patients, of whom 268 had a laparoscopic appendectomy, and 194 underwent open appendectomy. In 56 patients (20.9%), laparoscopic Conversion to open appendectomy was necessary. The most frequent causes of Conversion were adhesion-related vision difficulties (33.9%) and complex appendicitis (46.4%). Compared to patients who had a successful laparoscopic operation, those who had laparoscopic-to-open Conversion had a substantially greater risk of postoperative problems (24.1% vs. 8.2%, p < 0.001) and longer hospital admissions (mean 4.7 vs. 2.9 days, p < 0.001). The results of a logistic regression study showed that older age (OR 1.22, 95% CI 1.06-1.41) and complex appendicitis (OR 3.14, 95% CI 1.56-6.33) were independent predictors of Conversion. In children, complex appendicitis and intraoperative complications often need Conversion from laparoscopic to open appendectomy. Extended hospital stays and a greater incidence of postoperative complications are linked to these patients. Optimizing results and reducing the need for Conversion need a surgeon with extensive training and expertise in patient selection.

Clinical and Economic Impact of Proximal Junctional Kyphosis on Pediatric and Adult Spinal Deformity Patients.

The common goal of pediatric and adult spinal reconstructive procedures is to minimize long-term risk of disability, pain, and mortality. A common complication that has proved particularly problematic in the adult spinal deformity population and that has been an area of increased research and clinical focus is proximal junctional kyphosis (PJK). The incidence of PJK ranges from 10%-40% based on criteria used to define the condition. Clinically, PJK complication is associated with increased pain, decreased self-image and Scoliosis Research Society scores, and severe neurological injuries affecting the patient's quality of life. Economically, direct costs of PJK complication-associated revision surgery ranges from $20,000 to $120,000, which places an enormous burden on patients, providers, and payers. To mitigate the risk of PJK occurrence postoperatively, it is paramount to develop consistent guidelines in defining and classifying PJK in addition to extensive preoperative planning and risk stratification that is patient specific. This article will provide an overview on the clinical and economic impact of PJK in pediatric and adult spine deformity patients with an emphasis on the role of patient factors and predictive analytics, challenges in developing a consistent PJK classification, and current treatment and prevention strategies.

Analyzing efficacy of indocyanine green in pediatric thoracoscopic procedures based on a non-systematic review

Analyzing efficacy of indocyanine green in pediatric thoracoscopic procedures based on a non-systematic review

Pediatric Therapeutic Endoscopic Procedures Performed by Adult Trained Advanced Endoscopists Are Safe and Effective

Pediatric Therapeutic Endoscopic Procedures Performed by Adult Trained Advanced Endoscopists Are Safe and Effective

Reaching a crossroads in the management of pink pulseless hand in pediatric supracondylar humerus fracture: exploration Versus conservation

Introduction Supracondylar fracture of the humerus (SFH) is the most common fracture of the elbow in the pediatric population (60%) (1, 2). Displaced SFH in children is commonly associated with vascular insult in the form of absent distal pulses. In such cases, the limb can be cold and cyanotic or warm and pink despite the loss of pulse. Immediate exploration of the cold cyanotic limb is the current recommendation (3). The treatment of pink, warm pulseless limbs is still under debate (4). Aim The aim of this study is to evaluate the role of intraoperative in situ conventional angiography in the same setting of fracture fixation in cases of SFH with pink pulseless hands. Patients and methods This is a comparative study between two groups of pediatric patients admitted to Tanta University Hospitals, who suffered from SFH associated with a pink pulseless hand, and who underwent reduction and closed fixation of the fracture. Group (A) includes prospective data from 30 pediatric patients recruited from January 2021 to January 2023, who were managed by same-session conventional in situ brachial artery angiography. Group (B) includes retrospective data records from December 2016 to December 2019, composed of 50 similar age-group patients who were managed conservatively for 6–12 h after fracture fixation. Then after failure to regain distal pulse, CTA was performed to disclose the underlying arterial condition. Results The mean age of patients was 6.4 years ±2.73. The main mode of trauma was falling to the ground on outstretched hand (47% in group A, and 54% in group B). The types of arterial injury were as follows: brachial artery entrapment (27% in group A, 18% in group B), complete transection (7% in group A, 6% in group B), intimal contusion and thrombosis (43% in group A, 56% in group B), arterial spasm (23% in group A, 20% in group B). The mortality rate was 0% and the limb salvage rate was 100% in both groups, however, the number of anesthesia sessions, the mean total operative time, and the duration of hospital stay were significantly lower and in favor of group (A). Conclusion We believe that in situ conventional angiography is the most appropriate, accurate, and rapid diagnostic tool to define the lesion and plan the procedure in pediatrics with a pink, warm, well-perfused pulseless hand associated with SFH.

Caring for the Pediatric Patient Post-Nuss Procedure

Background Surgical correction for pectus excavatum (PE) is often performed during adolescence for patients exhibiting cardiac and respiratory problems. The surgery to correct PE is a thoracoscopic-assisted minimally invasive repair of PE or Nuss procedure. The postoperative clinical management is largely related to addressing pain from the constant pressure from the bar(s) on the sternum. A quality improvement project was developed to improve nurses' knowledge of appropriate postoperative care for the pediatric patient undergoing a Nuss procedure. Method A literature search was conducted using CINAHL and MEDLINE (ProQuest) to identify research studies that have evaluated nurses' knowledge of postoperative care for patients undergoing surgical correction for PE. Six studies were identified that investigated nurses' knowledge and attitudes of postoperative pain management in the pediatric patient and the effectiveness of enhanced recovery pathways to improve patient outcomes. A pretest and posttest were developed from the findings of the literature review along with an educational intervention. The educational presentation focused on the postoperative care of the pediatric patient who undergoes a Nuss procedure. A complete supplemental care plan is provided, which includes an enhanced recovery after surgery pathway, recommended pain treatment plan, exercises, medication recording sheet, home management tips for pain control, and patient discharge information. Results Implementation of a targeted educational program for the care of the pediatric patient who undergoes a Nuss procedure improved the clinician's knowledge and attitudes, resulting in a positive impact on pain management practice and patient outcomes. Conclusion Targeted educational interventions to improve pain management knowledge in nurses can result in increased understanding of appropriate postoperative pain management. This increased knowledge has the possibility to improve pain management and significantly improve the nurse and patient experience.

The Advantages of Combined Regional and General Anesthesia in Ophthalmic Surgery in Children

Background: Regional anesthesia is a common procedure in an adult patient undergoing ophthalmic surgery, but it cannot be done alone in the pediatric age group. General anesthesia is accompanied by complications intra- and post-operatively. Objectives: to determine whether or not using regional anesthesia in combination with general anesthesia in pediatric eye procedures improves patient outcomes. Methods: Forty children, with an age range of 6 - 12 years were included in the study that was conducted at Ghazi Al-Hariri Hospital / Department of Ophthalmology and Ibn Al-Haytham (Ophthalmology Hospital), both teaching hospitals, from December 2018 to October 2019. These children were allocated into one of two groups: GA (general anesthesia) and GA-R (general anesthesia-regional anesthesia). Heart rates, mean arterial blood pressure, oculo-cardiac reaction, and postoperative nausea and vomiting were measured. All required approvals were obtained from the scientific committee of the Iraqi Board for Medical Specializations. Statistical analysis was done using SPSS V26, with a P value of <0.05 considered significant. Results: None of the patients developed oculo-cardiac reactions or needed additives to the anesthesia given during surgery in the GA-R compared to the GA group. Intra-operative measurements of heart rates and mean arterial blood pressure were lower in the GA group than in the GA-R group (p<0.05). Compared to the GA group, the GA-R group had a lower incidence of postoperative nausea and vomiting (p<0.05). More patients in the GA group needed analgesia than in the GA-R group. Conclusion: Using regional anesthesia as a peribulbar block with general anesthesia is a safe and successful procedure in pediatric ocular surgeries. Received:Feb. 2023 Accepted: Sept. 2023 Published: Oct. 2023

Can ChatGPT Guide Parents on Tympanostomy Tube Insertion?

The emergence of ChatGPT, a state-of-the-art language model developed by OpenAI, has introduced a novel avenue for patients to seek medically related information. This technology holds significant promise in terms of accessibility and convenience. However, the use of ChatGPT as a source of accurate information enhancing patient education and engagement requires careful consideration. The objective of this study was to assess the accuracy and reliability of ChatGPT in providing information on the indications and management of complications post-tympanostomy, the most common pediatric procedure in otolaryngology. We prompted ChatGPT-3.5 with questions and compared its generated responses with the recommendations provided by the latest American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) "Clinical Practice Guideline: Tympanostomy Tubes in Children (Update)". A total of 23 responses were generated by ChatGPT against the AAO-HNSF guidelines. Following a thorough review, it was determined that 22/23 (95.7%) responses exhibited a high level of reliability and accuracy, closely aligning with the gold standard. Our research study indicates that ChatGPT may be of assistance to parents in search of information regarding tympanostomy tube insertion and its clinical implications.

Diagnostic Reference Levels in Interventional Pediatric Cardiology: Two-Year Experience in a Tertiary Referral Hospital in Latin America.

The goal of the present study was to propose the first local diagnostic reference levels (DRLs) for interventional pediatric cardiology procedures in a large hospital in Colombia. The data collection period was from April 2020 to July 2022. The local DRLs were calculated as the 3rd quartile of patient-dose distributions for the kerma-area product (Pka) values. The sample of collected clinical procedures (255) was divided into diagnostic and therapeutic procedures and grouped into five weight and five age bands. The Pka differences found between diagnostic and therapeutic procedures were statistically significant in all weight and age bands, except for the 1-5-year age group. The local DRLs for weight bands were 3.82 Gy·cm2 (<5 kg), 7.39 Gy·cm2 (5-<15 kg), 19.72 Gy·cm2 (15-<30 kg), 28.99 Gy·cm2 (30-<50 kg), and 81.71 Gy·cm2 (50-<80 kg), respectively. For age bands, the DRLs were 3.97 Gy·cm2 (<1 y), 9.94 Gy·cm2 (1-<5 y), 20.82 Gy·cm2 (5-<10 y), 58.00 Gy·cm2 (10-<16 y), and 31.56 Gy·cm2 (<16 y), respectively. In conclusion, when comparing our results with other existing DRL values, we found that they are similar to other centers and thus there is scope to continue optimizing the radiation dose values. This will contribute to establishing national DRLs for Colombia in the near future.

Diagnostic Accuracy of Laryngeal Ultrasound for Evaluating Vocal Fold Movement Impairment in Children

PurposeVocal fold movement impairment (VFMI) secondary to recurrent laryngeal nerve (RLN) injury is a common source of morbidity after pediatric cervical, thoracic, and cardiac procedures. Flexible laryngoscopy (FL) is the gold standard to diagnose VFMI yet can be challenging to perform and/or risks possible clinical decompensation in some children and is an aerosolizing procedure. Laryngeal ultrasound (LUS) is a potential non-invasive alternative, but limited data exists in the pediatric surgical population regarding its efficacy. We aimed to investigate the diagnostic accuracy of LUS compared to FL in evaluating VFMI. MethodsA prospective, single-center, single-blinded (rater) cohort study was undertaken on perioperative pediatric patients at risk for RLN injury. Patients underwent FL and LUS. Cohen's kappa was used to determine chance-corrected agreement. ResultsBetween 2021 and 2023, 85 paired evaluations were performed with patients having a median (IQR) age of 10 (4, 42) months and weight of 7.5 (5.4, 13.4) kilograms. The prevalence of VFMI was 27.1%. Absolute agreement between evaluations was 98.8% (kappa 0.97, 95% CI: 0.91–1.00, P < 0.001). The sensitivity and specificity of LUS in detecting VFMI was 95.7% and 100%, yielding a positive predictive value (PPV) of 100% and negative predictive value (NPV) of 98.4% (95% CI: 90–100%). Diagnostic accuracy was 98.8% (95% CI: 93–100%). ConclusionLUS is a highly accurate modality in evaluating VFMI in children. While FL remains the gold standard for diagnosis, LUS offers a low-risk screening modality for children at risk for VFMI such that only those with an abnormal LUS or presence of clinical symptoms discordant with LUS findings should undergo FL. Type of StudyProspective, single-center, single blinded (rater), cohort study. Level of EvidenceLevel II.

Nonpharmacological Interventions to Reduce Sedation and General Anesthesia in Pediatric MRI: A Meta-analysis.

Nonpharmacological strategies are increasingly used in pediatric procedures, but in pediatric MRI, sedation and general anesthesia are still commonly required. To evaluate the effectiveness of nonpharmacological interventions in reducing use of sedation and general anesthesia in pediatric patients undergoing MRI, and to investigate effects on scan time, image quality, and anxiety. We searched Ovid Medline, CINAHL, Embase, and CENTRAL from inception through October 10, 2022. We included randomized controlled trials and quasi-experimental designs comparing the effect of a nonpharmacological intervention with standard care on use of sedation or general anesthesia, scan time, image quality, or child and parental anxiety among infants (<2 years), children, and adolescents (2-18 years) undergoing MRI. Standardized instruments were used to extract data and assess study quality. Forty-six studies were eligible for the systematic review. Limited to studies on children and adolescents, the meta-analysis included 20 studies with 33 873 patients. Intervention versus comparator analysis showed that nonpharmacological interventions were associated with reduced need for sedation and general anesthesia in the randomized control trials (risk ratio, 0.68; 95% confidence interval, 0.48-0.95; l2 = 35%) and nonrandomized studies (risk ratio, 0.58; 95% confidence interval, 0.51-0.66; l2 = 91%). The effect was largest among children aged 3 to 10 years when compared with older children and adolescents aged 11 to 18 years. There was substantial heterogeneity among nonrandomized studies. Nonpharmacological interventions must be considered as standard procedure in infants, children, and adolescents undergoing MRI.