Pediatric Setting Research Articles

CIRSE Standards of Practice on Transjugular Intrahepatic Portosystemic Shunts.

Proposed in the early 1980s as a solution for managing complications of portal hypertension, the percutaneous creation of transjugular intrahepatic portosystemic shunt has consistently gained a central role. Increasingly lower complication rates have been observed thanks to improvements in both technologies and the skills of interventional radiologists. This document is aimed at interventional radiologists and provides best practice recommendations for transjugular intrahepatic portosystemic shunt creation, describing patient selection, intraprocedural management and follow-up, in addition to recommendations in paediatric settings. The CIRSE Standards of Practice Committee established a writing group consisting of seven European clinicians with recognised expertise in the creation of transjugular intrahepatic portosystemic shunt. The writing group reviewed the existing literature performing a pragmatic evidence search using PubMed to select relevant publications in the English language and involving human subjects, preferably published from 2009 to 2024. The final recommendations were developed by consensus. TIPS creation has an established role in the successful management of portal hypertension and its complications. This Standards of Practice document provides up-to-date recommendations for patient selection, materials, its safe performance, and follow-up with complications management.

Efficient labeling for fine-tuning chest X-ray bone-suppression networks for pediatric patients.

Pneumonia, a major infectious cause of morbidity and mortality among children worldwide, is typically diagnosed using low-dose pediatric chest X-ray [CXR (chest radiography)]. In pediatric CXR images, bone occlusion leads to a risk of missed diagnosis. Deep learning-based bone-suppression networks relying on training data have enabled considerable progress to be achieved in bone suppression in adult CXR images; however, these networks have poor generalizability to pediatric CXR images because of the lack of labeled pediatric CXR images (i.e., bone images vs. soft-tissue images). Dual-energy subtraction imaging approaches are capable of producing labeled adult CXR images; however, their application is limited because they require specialized equipment, and they are infrequently employed in pediatric settings. Traditional image processing-based models can be used to label pediatric CXR images, but they are semiautomatic and have suboptimal performance. We developed an efficient labeling approach for fine-tuning pediatric CXR bone-suppression networks capable of automatically suppressing bone structures in CXR images for pediatric patients without the need for specialized equipment and technologist training. Three steps were employed to label pediatric CXR images and fine-tune pediatric bone-suppression networks: distance transform-based bone-edge detection, traditional image processing-based bone suppression, and fully automated pediatric bone suppression. In distance transform-based bone-edge detection, bone edges were automatically detected by predicting bone-edge distance-transform images, which were then used as inputs in traditional image processing. In this processing, pediatric CXR images were labeled by obtaining bone images through a series of traditional image processing techniques. Finally, the pediatric bone-suppression network was fine-tuned using the labeled pediatric CXR images. This network was initially pretrained on a public adult dataset comprising 240 adult CXR images (A240) and then fine-tuned and validated on 40 pediatric CXR images (P260_40labeled) from our customized dataset (named P260) through five-fold cross-validation; finally, the network was tested on 220 pediatric CXR images (P260_220unlabeled dataset). The distance transform-based bone-edge detection network achieved a mean boundary distance of 1.029. Moreover, the traditional image processing-based bone-suppression model obtained bone images exhibiting a relative Weber contrast of 93.0%. Finally, the fully automated pediatric bone-suppression network achieved a relative mean absolute error of 3.38%, a peak signal-to-noise ratio of 35.5dB, a structural similarity index measure of 98.1%, and a bone-suppression ratio of 90.1% on P260_40labeled. The proposed fully automated pediatric bone-suppression network, together with the proposed distance transform-based bone-edge detection network, can automatically acquire bone and soft-tissue images solely from CXR images for pediatric patients and has the potential to help diagnose pneumonia in children.

Addressing tobacco screening and treatment among racially and ethnically minoritized parents in pediatric clinics: barriers and facilitators.

Household secondhand smoke (SHS) exposure remains a significant health issue for racially and ethnically minoritized children in the United States. Delivering parental tobacco treatment during pediatric primary care visits can reduce children's SHS exposure. This study examined current tobacco screening practices and health system stakeholder perceptions of facilitators and barriers to addressing tobacco use during pediatric visits among racially and ethnically minoritized parents. We conducted 25 semi-structured interviews with clinicians, staff, and health system leaders from 5 pediatric primary care clinics in Minneapolis-St. Paul, Minnesota. The study was informed by the Health Equity Implementation Framework. Interviews were analyzed using both directed content and thematic analysis. Participants identified multilevel facilitators and barriers to addressing parental tobacco use in minoritized families. Within the clinical encounter, barriers included linguistic and cultural barriers, health system navigational challenges, medical mistrust, low levels of clinician and staff knowledge, skills, and confidence, time constraints, and lack of alignment with external metrics. Facilitators centered on leveraging interpreters' cultural knowledge and the presence of culturally-congruent clinicians and staff to reduce medical mistrust and stigma, developing linguistically and culturally relevant resources, and integrating prompts and resources into the electronic health record. Participants described how lessons from previous system change mechanisms would facilitate this work. Addressing health system, training and resources, and linguistic and cultural barriers among clinicians and staff is essential to strengthen their capacity to address household SHS exposure among racially and ethnically minoritized populations as a component of pediatric preventive care. Clinicians and health system staff perceive unique barriers to identifying and addressing parental tobacco use among racially and ethnically minoritized parents during pediatric primary care visits. Solutions to expand tobacco treatment access to minoritized parents in pediatric settings must attend to clinician training needs on tobacco treatment, embedding clinical encounter resources and reminders that match the linguistic and cultural needs and preferences of their patient populations, and increasing access to high quality interpreting services and culturally-congruent staff.

Extravasation Identification and Management in Neonates and Pediatrics: A Cross Sectional Survey.

To explore current practice and guidelines surrounding the identification and management of extravasation injuries in Australian and New Zealand neonatal and pediatric settings. Between February and September 2023, an internet-based descriptive cross-sectional survey was distributed to Australian and New Zealand neonatal and pediatric clinicians using exponential nondiscriminative snowball sampling. Survey data domains included demographics, extravasation identification, management, local guidelines, and resources. Of the 141 responses, the majority of respondents were registered nurses (n = 96, 68.1%), with greater than 20 years of experience (n = 51, 36.2%). Over two-thirds of respondents had no extravasation identification and management training (n = 98, 69.5%). Half of the respondents (n = 70, 49.6%) reported that increased presentation of risk factors did not alter monitoring frequency. Extravasations were primarily associated with the hand and wrist region (n = 118, 43.7%). Maintenance fluids, antibiotics and parenteral nutrition accounted for extravasation events. Acute management practices (immediate cessation of infusion) showed consistency (n = 124, 87.9%), whereas varying degrees of adoption were observed for aspirating the residual fluid. The majority of respondents (n = 119, 84%) reported the absence of a formal grading scale for extravasation severity. Clinicians reported challenges and inconsistencies in neonatal and pediatric extravasation injury identification and management. This underscores the need for effective monitoring and identification, standardized management practices, and education to minimize the burdens of extravasation for patients, families, and the health care system.

Clinical Pathways Programs in Children's Hospitals.

Clinical pathways translate best evidence into the local context of a care setting through structured, multidisciplinary care plans. Little is known about clinical pathway programs in pediatric settings. The purpose of this study was to determine the prevalence of clinical pathway programs and describe similarities and differences. We performed a cross-sectional web survey to assess the existence of a clinical pathway program, number, type, and creation or revision of clinical pathways, and its characteristics in the 111 hospitals of the Pediatric Research in Inpatient Settings network. Eighty-one hospitals responded to the survey (73% response rate). Most hospitals had a clinical pathway program (63%, n = 50 of 80) that was hospital-wide (70%, n = 35 of 50). Freestanding children's (48%, n = 39 of 81), academic (60%, n = 43 of 72), teaching hospitals (96%, n = 78 of 81) made up the largest proportion of survey respondents. There was no funding for nearly half of the programs (n = 21 of 46, 46%). Over a quarter of survey respondents reported no data collected to assess pathway utilization and/or care outcomes (n = 19 of 71, 27%). Greater than half of respondents confirmed existence of a program. Freestanding, academic teaching hospitals accounted for the most responses. However, nearly half of surveyed programs were unfunded, and many are unable to measure their pathway outcomes or demonstrate improvement in care. Survey respondents were enthusiastic about participating in a national collaborative on pediatric clinical pathways.

The Effect of Emotional Coworker Support on Work Engagement Among Pediatric Health Care Providers: The Mediator Role of Emotional Regulation.

Previous findings demonstrated that healthcare workers with a high level of social support are likely to engage in their work. Healthcare workers are not only engaged in the physical problems of their patients but also in their emotional difficulties. Pediatric professionals must express and regulate their own emotions during their interactions with young patients and their families. The purpose of this study was to explore the impact of coworkers' emotional support on healthcare workers' work engagement in pediatric healthcare settings and the emotional regulation mechanisms by which emotional coworker support leads to work engagement. A cross-sectional study was distributed in a Belgian pediatric hospital between October 2021 and December 2021. The sample consisted of 274 healthcare workers who were in direct contact with patients. Participants completed a questionnaire consisting of measures of coworker emotional support, work engagement, emotional suppression, and cognitive reevaluation. Emotional suppression partially mediated the effects of perceived emotional coworker support on work engagement. Coworkers' emotional support fosters work engagement by reducing the negative effects of emotional suppression. Moreover, cognitive evaluation was positively associated with work engagement. These results provide insight into the influence of perceived emotional coworkers, emotional suppression, and cognitive reevaluation on work engagement.

EOLP-01. PROPOSED FRAMEWORK FOR A PILOT MULTIDISCIPLINARY BEREAVEMENT FOLLOW-UP AND BRAIN AUTOPSY REVIEW FOR BEREAVED CAREGIVERS IN PEDIATRIC NEURO-ONCOLOGY

Abstract INTRODUCTION Brain tumors remain the leading cause of cancer-related death in children. The death of a child is distressing for caregivers and often associated with negative psychosocial outcomes. Bereaved caregivers frequently desire ongoing support after their child’s death. At our institution, brain autopsies with the option for tissue donation to research are offered to all families after the death of a child. Specific follow-up conducted to date and review of autopsy results have varied widely. We propose a pilot study to (1) evaluate feasibility of a comprehensive, multidisciplinary bereavement follow-up meeting with autopsy results review and grief supports for bereaved caregivers in pediatric neuro-oncology at Nationwide Children’s Hospital and (2) assess caregiver and provider perceptions regarding this follow-up meeting using mixed-methods design. METHODS/DESIGN Bereaved caregivers of children with a brain tumor who died and underwent brain autopsy through our institutional tissue donation protocol will be offered a follow-up meeting after their child’s death. The follow-up meeting will test an established PICU bereavement framework in the pediatric neuro-oncology setting with the addition of brain autopsy results review. Meetings will include caregivers and providers from neuro-oncology, palliative care, and psychosocial team (e.g., psychologist, social worker, chaplain). Caregivers will complete a Likert-scale questionnaire followed by a semi-structured interview via telephone. The goal is to conduct 7-10 meetings. Providers will participate in a focus group to provide feedback. Interviews and the focus group will be recorded, transcribed, and analyzed qualitatively. Concepts to be explored include perceived need for follow up; overall experience; satisfaction with structure, modality, and content; and perceived benefit and meaning of autopsy review. LONG-TERM GOAL To develop, evaluate, and formalize a comprehensive multidisciplinary bereavement follow-up meeting, guided by caregiver and provider feedback, that can be expanded to other institutions and become a “standard of care” for bereaved caregivers in pediatric neuro-oncology.

Analgosedation in Pediatric Emergency Care: A Comprehensive Scoping Review

Effective management of pain and anxiety in pediatric emergency room is crucial for ensuring both the physical and emotional well-being of young patients. Analgosedation, a combination of analgesia and sedation, is commonly used to facilitate various procedures in children. However, selecting the optimal agent and administration route remains challenging due to the unique pharmacological profiles and side effects of available drugs. This scoping review aims to provide a comprehensive analysis of the pharmacological agents used for procedural analgosedation in pediatric emergency settings, focusing on their efficacy, safety, administration routes, and potential side effects. A systematic review of the literature was conducted, focusing on key agents such as ketamine, midazolam, dexmedetomidine, fentanyl, and nitrous oxide. Studies were included based on their relevance to pediatric procedural sedation, particularly in emergency settings. Literature analysis showed that ketamine and fentanyl are effective for managing moderate to severe pain, with a rapid onset of action. Fentanyl is preferred for acute pain management following fractures and burns, while ketamine and midazolam are commonly used for emergency analgosedation. Dexmedetomidine, which induces sedation similar to natural sleep, is particularly effective in preventing pain and agitation during procedures and is well tolerated in children, especially those with developmental disorders. Nitrous oxide, when used in a 50% oxygen mixture, offers a valuable option for conscious sedation during mildly to moderately painful procedures, maintaining respiratory and airway reflexes. No single drug is ideal for all pediatric patients and procedures and the choice of agent should be tailored to the specific clinical scenario, considering both the sensory and affective components of pain. Future research should prioritize large-scale comparative studies, the exploration of combination therapies, and the development of non-pharmacological adjuncts to enhance the safety and efficacy of pediatric analgosedation.

Wearable biosensors for pediatric hospitals: a scoping review.

As wearable biosensors are increasingly used in healthcare settings, this review aimed to identify the types of wearable biosensors used for neonate and pediatric patients and how these biosensors were clinically evaluated. A literature search was conducted using PubMed, CINAHL, Embase, Web of Science, and Cochrane. The studies published between January 2010 and February 2024 were included. Descriptive statistics were used to present counts and percentages of types, locations, clinical evaluation methods, and their results. Seventy-nine studies were included. 104 wearable sensors and 40 devices were identified. The most common type of biosensor was optoelectrical sensors (n = 40, 38.5%), and used to measure heart rate (n = 22, 19.0%). The clinical evaluation was tested by a combination of validity (n = 68, 86.1%) and reliability (n = 14, 17.7%). Only two-thirds of the wearable devices were validated or reported acceptable reliability. The majority of the biosensor studies (n = 51, 64.5%) did not report any complications related to wearable biosensors. The current literature has gaps regarding clinical evaluation and safety of wearable biosensor devices with interchangeable use of validity and reliability terms. There is a lack of comprehensive reporting on complications, highlighting the need for standardized guidelines in the clinical evaluation of biosensor medical devices. IMPACT: The most common types of biosensors in pediatric settings were optoelectrical sensors and electrical sensors. Only two-thirds of the wearable devices were validated or reported acceptable reliability, and more than half of the biosensor studies did not report whether they assessed any complications related to wearable biosensors. This review discovered significant gaps in safety and clinical validation reporting, emphasizing the need for standardized guidelines. The findings advocate for improved reporting clinical validation processes to enhance the safety of wearable biosensors in pediatric care.

Physician perspectives on communication quality in pediatric care.

We aimed to explore physician perspectives on communication quality across pediatric contexts. We conducted semi-structured interviews over a 4-month period. Purposive sampling was conducted to ensure a broad sampling of pediatricians from multiple subspecialties and practice settings. Interviews were conducted until thematic saturation was reached. An interview guide was created based on existing literature. Interviews were transcribed and analyzed for key themes. Eleven pediatricians enrolled in our study. Following thematic analysis, results were organized into four primary themes: Communication Education, High Quality Communication; Low Quality Communication; and Communication Factors and Barriers. Participants prioritized information transfer as a key aspect of communication quality. They identified communication quality as having wellness implications for clinicians. Participants prioritize information transfer and state that clinicians often neglect bidirectional information exchange. Participants often lacked formal communication skills training which may make it difficult to navigate common barriers such as language and cultural differences, lack of time, and interprofessional dysfunction. Formal communication skills training may help overcome challenges and may enhance physician wellness while improving patient care. While the importance of clinician-parent communication in pediatric settings has been established, little is known about provider perceptions of communication quality. Participants identified information transfer as a key aspect of communication quality, often neglecting bidirectional information exchange. Participants often lacked formal communication skills training which may make it difficult to navigate common barriers such as language and cultural differences, lack of time, and interprofessional dysfunction. Formal communication skills training may help with these challenges and may enhance physician wellness while improving patient care. More work is needed to explore the impact of communication skills training on each of these factors.

Treatment of acute pharyngitis in children: an Italian intersociety consensus (SIPPS-SIP-SITIP-FIMP-SIAIP-SIMRI-FIMMG).

Sore throat represents one of the main causes of antibiotic overprescription in children. Its management is still a matter of debate, with countries considering streptococcal pharyngotonsillitis a benign and self-limiting condition and others advocating for its antibiotic treatment to prevent suppurative complications and acute rheumatic fever. Italian paediatricians frequently prescribe antibiotics on a clinical basis regardless of microbiological results. Moreover, broad-spectrum antibiotics are inappropriately prescribed for this condition. In this regard, an intersociety consensus conference was issued to promote the judicious use of antibiotic therapy in paediatric outpatient settings. A systematic review of the literature was performed, and updated recommendations were developed according to the GRADE methodology. Antibiotic treatment with amoxicillin (50mg/kg/day) for 10 days is recommended in all children with proven streptococcal pharyngitis. Benzathine-penicillin could be prescribed in children with impaired intestinal absorption or inability to tolerate enteral intake and in those at high risk of suppurative complications with low compliance to oral therapy. In children with suspected amoxicillin allergy, third-generation cefalosporins for five days are recommended in low-risk patients, and macrolides are recommended in high-risk ones. Candidates for tonsillectomy due to recurrent pharyngitis could be treated with amoxicillin-clavulanic acid, clindamycin, or combined therapy with amoxicillin plus rifampicin for four days, in an attempt to avoid surgery.

Comparison of ultraviolet C light and isopropyl alcohol for the disinfection of cellular phones in a paediatric intensive care unit setting.

A considerable proportion of cellular phones (cell phones) used by healthcare workers (HCWs) have been shown to be contaminated with pathogenic micro-organisms, making these devices reservoirs to infect susceptible patients. Although many units have well-defined infection control protocols, methods for the decontamination of cell phones are scarce. To compare the efficacy of ultraviolet C (UVC) light with that of 70% isopropyl alcohol in disinfecting cell phones used by HCWs in a paediatric intensive care unit (ICU). A randomised controlled study in a paediatric ICU setting was conducted. Cell phones of HCWs or other personnel entering the ICU were swabbed prior to and after decontamination with either the 70% isopropyl alcohol or UVC light method. The reduction ratio of colony-forming units (CFUs) before and after intervention was analysed using the Mann-Whitney U-test. In addition, the effectiveness of the disinfection methods was compared using the Wilcoxon signed-rank paired test. A total of 74 cell phones were acquired from HCWs working in the paediatric ICU. After excluding 5, 69 samples were therefore available for statistical analysis, with 34 samples subjected to disinfection using 70% isopropyl alcohol-based swabs and 35 samples treated with UVC light disinfection. Disinfection with 70% isopropyl alcohol (z=5.16; p<0.000001) and with UVC light (z=3.28; p<0.005) were individually statistically significantly effective in reducing CFUs. The CFU reduction ratio indicated that disinfection using a 70% isopropyl alcohol solution was 67% more effective than UVC light disinfection (Mann-Whitney U-test score 968; p<0.001). Although both 70% isopropyl alcohol and UVC light disinfection effectively reduced CFUs following decontamination, 70% isopropyl alcohol was determined to be much more effective.

Pediatric genital warts successfully treated with photodynamic therapy

Genital warts (GWs) are the most common sexually transmitted infections worldwide, caused by the human papillomavirus (HPV). In adults, the primary mode of transmission is through sexual contact, whereas in children it can occur through skin-to-skin or skin-to-mucosa contact and be sexual or non-sexual. The increasing prevalence of GWs in children has renewed the interest in therapeutic management which still presents a unique challenge, being influenced by many variables including size, quantity, and location of warts, as well as the presence of comorbidities. Photodynamic therapy (PDT) has already shown encouraging results in treating viral warts in adult patients, but its use is still not standardized in the pediatric population. On this topic, we report the case of an otherwise healthy 5-year-old child affected by GWs, successfully treated with three sessions of PDT with 10% 5-aminolaevulinic acid (ALA), at one-month intervals. Our case is paradigmatic of the potentiality of PDT to treat difficult lesions in a pediatric setting.

Paediatric Nurses' Personal Accounts of Being Told Not to Disclose Information to Children With Serious Illness-An Interpretative Phenomenological Study.

To explore the experiences, and perceptions of nurses who are told to withhold clinical information from children diagnosed with serious illnesses. An interpretative qualitative phenomenological design was used for the study. Sampling was purposive and data were collected using semi-structured interviews from nurses working in a paediatric setting within the preceding 5 years. Nurse-participants described their personal experiences of withholding situations ('non-disclosure directives'). Their accounts of specific examples of situations ('personal accounts') were extracted from the interview transcripts and analysed using inductive content analysis to identify patterns and concepts within the descriptions. Data management was supported using Dedoose. Nurse-participants were interviewed face-to face and online between November 2019 and December 2020. Twenty-six Australian nurses who have cared for seriously ill children within the preceding 5 years participated in the study. Thirty-nine accounts of non-disclosure situations (personal accounts) were extracted from interview transcripts. Four types of non-disclosure were identified in the personal accounts: withholding information, temporary withholding, lying and combined withholding/lying. The inductive content analysis identified three key aspects of nurse-participants' accounts: beliefs and perceptions (about the child and parents), the nature of the experience and feelings about the experience. Moral distress occurred when nurses' actions conflicted with their moral values in response to a non-disclosure directive, particularly when asked to directly lie to children. Nurses felt disempowered by the parent's authority and the institutional hierarchy that limited their ability to participate in discussions where a non-disclosure directive was given. Nurse-participants were afforded a platform for reflection which proved valuable in allowing them to process their experiences in a non-disclosure situation. Nurses directed to withhold medical information from children should be afforded opportunities for reflection to mitigate moral distress. Nurses should be included in the planning of ethically appropriate responses to withholding directives.

Do new quality measures for social risk screening 'measure up'?

New social risk screening standards and quality metrics reward or penalize healthcare delivery organizations for social risk screening. After summarizing the recent literature on social risk screening in pediatric healthcare settings we consider how this evidence - and persistent evidence gaps - might inform future standards development. Reported social risk screening rates, measures, and modality differ greatly across recent work. Although many caregivers report acceptability of screening, experiences and expectations around effective follow-up vary. Likewise, although most frontline clinical providers find screening acceptable, they report significant implementation challenges related to time constraints, insufficient workforce, and availability of social services. Qualitative findings suggest opportunities to improve screening implementation. Literature examining the impacts of screening continues to focus on immediate posited impacts of assistance programs; few studies assess health outcomes. The existing literature does not clearly indicate whether, when, how, or for whom social risk screening standards focused on screening quantity will contribute to child health or health equity. Informed by studies on patient experience, quality measures focused on screening quantity (e.g. how many individuals are screened) should be paired with efforts to improve screening quality (i.e. patient/caregiver screening experience) as well as social and health outcomes.

Understanding prescribing errors for system optimisation: the technology-related error mechanism classification.

Technology-related prescribing errors curtail the positive impacts of computerised provider order entry (CPOE) on medication safety. Understanding how technology-related errors (TREs) occur can inform CPOE optimisation. Previously, we developed a classification of the underlying mechanisms of TREs using prescribing error data from two adult hospitals. Our objective was to update the classification using paediatric prescribing error data and to assess the reliability with which reviewers could independently apply the classification. Using data on 1696 prescribing errors identified by chart review in 2016 and 2017 at a tertiary paediatric hospital, we identified errors that were technology-related. These errors were investigated to classify their underlying mechanisms using our previously developed classification, and new categories were added based on the data. A two-step process was used to identify and classify TREs involving a review of the error in the CPOE and simulating the error in the CPOE testing environment. The technology-related error mechanism (TREM) classification comprises six mechanism categories, one contributing factor and 19 subcategories. The categories are as follows: (1) incorrect system configuration or system malfunction, (2) opening or using the wrong patient record, (3) selection errors, (4) construction errors, (5) editing errors, (6) errors that occur when using workflows that differ from a paper-based system (7) contributing factor: use of hybrid systems. TREs remain a critical issue for CPOE. The updated TREM classification provides a systematic means of assessing and monitoring TREs to inform and prioritise system improvements and has now been updated for the paediatric setting.

The intersection of child protection and healthcare: Paediatric social admissions

AbstractObjectivesIn the context of a national shortage of specialist placements for children with complex needs in Ireland, this study examines the impact of healthcare professionals' management of paediatric social admissions (PSAs) in paediatric hospital settings, with particular attention to the child protection and welfare challenges encountered.Design and ParticipantsA qualitative research design was utilised, employing semistructured interviews with healthcare professionals as the primary data collection method.FindingsThematic analysis of the interviews identified three principal themes: the spectrum of social admissions, influences and barriers, and the moral imperative of managing PSAs. The study found that social factors significantly influence the management and decision‐making processes in paediatric cases, often resulting in prolonged hospital stays. The findings highlight complex child protection issues, including severe shortages in specialist placements and the frequent discharge of children to environments other than their homes.ConclusionsThe children involved in this study often remained in acute care settings for protracted periods, ranging from 6 months to several years. These extended stays deprived them of normal routines, education, and family life, underscoring substantial child protection concerns. This study calls for urgent systemic improvements to address these issues and ensure that the rights and well‐being of children involved with PSAs are upheld.

Offering complex genomic screening in acute pediatric settings: family decision-making and outcomes.

Families of children in pediatric acute care offered ultra-rapid genomic sequencing are making complex decisions in a high stress period. To reduce complexity for families and clinicians, we offered genomic screening for the child and parents after completion of diagnostic testing. We evaluated uptake, understanding and service delivery preferences. A cohort of 235 families who had completed ultra-rapid diagnostic genomic sequencing at 17 Australian hospitals were offered up to three screens on their genomic data: pediatric-onset, adult-onset, expanded couple carrier screening. We investigated decision-making, understanding and service delivery preferences using surveys at three timepoints (pre-counseling, post-counseling, post-result) and performed inductive content analysis of pre-test genetic counseling transcripts. 119 families (51%) attended genetic counseling with 115 (49%) accepting genomic screening. Survey respondents were more likely to find decisions about couple carrier screening 'easy' (87%) than adult (68%; p=0.002) or pediatric (71%; p=0.01) screening decisions. All respondents with newly detected pathogenic variants accurately recalled this one month later. A delayed offer of screening was acceptable to most respondents (78%). Separating genomic screening from the stressful diagnostic period is supported by families who demonstrate good knowledge and recall. Our results suggest delaying genomic screening should be trialed more widely.

Impact of Antibiotic Stewardship on Treatment of Hospitalized Children with Skin and Soft-Tissue Infections

Background: Skin and soft-tissue infections (SSTIs) are common infectious syndromes in children. Overusing broad-spectrum antibiotics has contributed to rising antibiotic resistance, complicating treatment outcomes. To address this issue, antimicrobial stewardship programs (ASPs) have been implemented to optimize antibiotic use. This study evaluated the impact of a multifaceted ASP on antibiotic prescribing practices for SSTIs in a pediatric acute care setting over eight years. Methods: We conducted a quasi-experimental study at the Pediatric Acute Care Unit of the Padua University Hospital, including children admitted with SSTIs from October 2014 to September 2022, to evaluate the impact of a multifaceted ASP implemented in October 2015. The study was divided into three periods: pre-implementation (October 2014–September 2015), post-implementation (October 2015–March 2020), and COVID-19 (April 2020–August 2022). Data on antibiotic prescriptions and microbiological results were collected and analyzed. Results: The implementation of the ASP led to a significant reduction in the use of broad-spectrum antibiotics, particularly third-generation cephalosporins (from 40.4% to 9.8%) and glycopeptides (from 21.1% to 1.6%). There was a notable increase in the prescription of Access antibiotics, from 30% in the pre-implementation to over 60% in the post-implementation and 80% during COVID-19. No increase in the hospital length of stay was observed. Microbiological results showed no significant changes in bacterial profiles over time. Conclusions: The use of the ASP effectively improved antibiotic prescribing practices, reducing reliance on broad-spectrum antibiotics even during the COVID-19 pandemic. These findings highlight the value of ongoing stewardship efforts and suggest the need for similar programs in ambulatory settings to further address antibiotic resistance.

Changes in Pediatric End-of-Life Process After the Enforcement of the Act on Life-Sustaining Treatment Decisions-The Experience of a Single Children's Hospital.

Background: The Act on Life-Sustaining Treatment (LST) for patients at the end of life (the Korean LST Decision Act), implemented in the Republic of Korea in February 2018, has led to changes in the end-of-life decision-making (EOLDM) process in children. This study aimed to investigate changes in pediatric EOLDM process and LST practices since the Korean LST Decision Act. Methods: This retrospective cohort study included 107 patients who died at Kyungpook National University Children's Hospital from January 2015 to December 2020. Patients were divided into two groups: pre-law (January 2015-January 2018, n = 55) and post-law (February 2018-December 2020, n = 52). We analyzed medical records for EOLDM process, patient characteristics, intensive care unit (ICU) admission, documentation types, and LST withholding or withdrawal decisions. Results: After the Korean LST Decision Act, the median total hospitalization duration decreased significantly (14 days [IQR, 3-80] vs. 6 days [IQR, 2-18], p = 0.020), as did the median ICU length of stay (3 days [IQR 1-33] vs. 2.5 days [IQR 1-10.3], p = 0.002). The time from admission to end-of-life decision documentation was significantly shorter in group 2 (6 days [IQR 1-31] vs. 4 days [IQR 1-9], p = 0.027). The use of physician orders for life-sustaining treatment (POLST) documents increased (0% to 33.3%), while do-not-resuscitate (DNR) orders decreased (85.3% to 16.7%). Notably, LST withdrawal decisions increased from 0% to 27.8% (p = 0.001) in the post-legislation period. Conclusions: The Korean LST Decisions Act has led to significant changes in the EOLDM process for terminally ill children, including earlier decision-making, increased use of POLST documents, more frequent LST withdrawal decisions, and shorter hospital and ICU stays. These findings suggest a shift towards more structured and timely end-of-life care discussions in pediatric settings.