Urinary Biomarkers and Attainment of Cefepime Therapeutic Targets in Critically Ill Children.

Background: Critically ill children are at risk for subtherapeutic antibiotic concentrations. The frequency of target attainment and risk factors for subtherapeutic concentrations of cefepime in children have not been extensively studied.

Methods: We performed an observational study in critically ill children receiving a new prescription of standard dosing of cefepime for suspected sepsis (≥2 systemic inflammatory response syndrome criteria within 48 hours of cefepime start).

Rapid MRI for acute pediatric MSK infections: survey of current utilization and procedural practices.

Background: Some institutions have implemented rapid MRI protocols for acute musculoskeletal (MSK) infections as an attempt to improve early diagnosis.

Objective: To assess current utilization of pediatric rapid MSK MRI protocols (abbreviated protocol, no IV (intravenous) contrast, and no sedation) using a survey.

Materials And Methods: A 10-question survey was sent to members of the Society for Pediatric Radiology (SPR) and the Society of Skeletal Radiology, which differed depending on whether a rapid protocol was used or not.

Polygenic Scores of Cardiometabolic Risk Factors in American Indian Adults.

Importance: Numerous efforts have been made to include diverse populations in genetic studies, but American Indian populations are still severely underrepresented. Polygenic scores derived from genetic data have been proposed in clinical care, but how polygenic scores perform in American Indian individuals and whether they can predict disease risk in this population remains unknown.

Objective: To study the performance of polygenic scores for cardiometabolic risk factors of lipid traits and C-reactive protein in American Indian adults and to determine whether such scores are helpful in clinical prediction for cardiometabolic diseases.

Update on Cancer Screening Recommendations for Individuals with Li-Fraumeni Syndrome.

Li-Fraumeni syndrome (LFS) is an autosomal dominant cancer predisposition condition characterized by a high lifetime risk for a wide spectrum of malignancies associated with germline pathogenic/likely pathogenic (P/LP) variants in the TP53 tumor suppressor gene. Secondary malignant neoplasms are particularly common. Early cancer detection through surveillance enables early intervention and leads to improved clinical outcomes with reduced tumor-related mortality and treatment-related morbidity.

Germline analysis of an international cohort of pediatric diffuse midline glioma patients.

Background: Factors that drive the development of diffuse midline gliomas (DMG) are unknown. Our study aimed to determine the prevalence of pathogenic/likely pathogenic (P/LP) germline variants in pediatric patients with DMG.

Methods: We assembled an international cohort of 252 pediatric patients with DMG, including diffuse intrinsic pontine glioma (n=153), with germline whole genome or whole exome sequencing.

Ophthalmology Examinations in Children With Skull Fractures and Underlying Focal Hemorrhage.

Objectives: To assess the frequency and yield of retinal examination in children below 2 years old undergoing abuse evaluations in the setting of skull fracture(s) and small underlying intracranial hemorrhage.

Methods: This cross-sectional study used CAPNET, a multicenter child physical abuse network, to identify children below 2 years with a skull fracture(s) and intracranial injury limited to an underlying small focal intracranial hemorrhage undergoing subspeciality child abuse evaluations. Our outcomes of interest were (1) the performance of a retinal examination, (2) the identification of retinal hemorrhages, and (3) associations of clinical factors and CAPNET site with the performance of retinal examinations.

Trends in Cardiac Arrest Outcomes & Management in Children with Cardiac Illness Category Compared to Non-Cardiac Illness Category: An Analysis from the AHA Get With The Guidelines®-Resuscitation Registry.

Introduction: Contemporary rates of survival after pediatric in-hospital CPR events and trends in survival over the last 20 years have not been compared based on illness category. We hypothesized that survival to hospital discharge for surgical-cardiac category is higher than the non-cardiac category, and rates of survival after in-hospital CPR increased over time in all categories.

Methods: The AHA Get With The Guidelines®-Resuscitation registry was queried for index CPR events in children < 18 years of age from 2000 to 2021.

White matter microstructure as a potential contributor to differences in resting state alpha activity between neurotypical and autistic children: a longitudinal multimodal imaging study.

We and others have demonstrated the resting-state (RS) peak alpha frequency (PAF) as a potential clinical marker for young children with autism spectrum disorder (ASD), with previous studies observing a higher PAF in school-age children with ASD versus typically developing (TD) children, as well as an association between the RS PAF and measures of processing speed in TD but not ASD. The brain mechanisms associated with these findings are unknown. A few studies have found that in children more mature optic radiation white matter is associated with a higher PAF.

Microbiota and metabolite-based prediction tool for colonic polyposis with and without a known genetic driver.

Despite extensive investigations into the microbiome and metabolome changes associated with colon polyps and colorectal cancer (CRC), the microbiome and metabolome profiles of individuals with colonic polyposis, including those with (Gene-pos) and without (Gene-neg) a known genetic driver, remain comparatively unexplored. Using colon biopsies, polyps, and stool from patients with Gene-pos adenomatous polyposis ( = 9), Gene-neg adenomatous polyposis ( = 18), and serrated polyposis syndrome (SPS,  = 11), we demonstrated through 16S rRNA sequencing that the mucosa-associated microbiota in individuals with colonic polyposis is representative of the microbiota associated with small polyps, and that both Gene-pos and SPS cohorts exhibit differential microbiota populations relative to Gene-neg polyposis cohorts. Furthermore, we used these differential microbiota taxa to perform linear discriminant analysis to differentiate Gene-neg subjects from Gene-pos and from SPS subjects with an accuracy of 89% and 93% respectively.

Atherogenic lipoproteins associate with loss of glycemic control in youth-onset type 2 diabetes: Results from the TODAY study.

Background: Type 2 diabetes (T2D) in adolescents is associated with an unfavorable lipid profile, but lipoprotein particle subspecies and branched-chain amino acid (BCAA) data are scarce.

Objective: To evaluate lipoprotein particle distributions, lipoprotein insulin resistance index (LP-IR), and BCAA levels longitudinally and their relationships with sex, race/ethnicity, treatment, and loss of glycemic control in adolescents with youth-onset T2D.

Methods: Participants from the TODAY study (n = 348) had samples analyzed yearly for glycated hemoglobin and nuclear magnetic resonance lipoprotein and BCAA assessments.

Conservative Management of Macroglossia in Beckwith-Wiedemann Syndrome.

Introduction: While severe macroglossia in Beckwith-Wiedemann syndrome (BWS) is often treated with tongue reduction surgery, most patients with mild to moderate macroglossia are nonsurgically managed. Given that outcomes for these conservatively managed patients are not well characterized, this study aims to describe the natural history of patients with macroglossia and BWS who did not undergo early surgery.

Methods: Records of patients with BWS and macroglossia seen between 2004-2024 were reviewed.

The Effect of a Brief Medical Huddle on Patient and Family Experience During Rounds.

Background: Initial studies of patient- and family-centered rounds (PFCR) in pediatrics used parental interest in participating as the primary outcome. There are mixed results of family satisfaction with the process when compared with standard rounding. To date, there are limited data examining hybrid models of rounding and communication.

Incidence of food allergic reactions among adolescents engaged in food allergy management.

Background: While fatal food-induced anaphylaxis is rare, adolescence is the period of highest risk. However, we lack strong estimates of the incidence of food allergic reactions among adolescents.

Objective: To estimate the incidence of food allergic reactions and anaphylactic reactions among adolescents with food allergy who have a prescription for epinephrine.

Restoration of LAT activity improves CAR T cell sensitivity and persistence in response to antigen-low acute lymphoblastic leukemia.

Chimeric antigen receptor (CAR) T cells induce responses in patients with relapsed/refractory leukemia; however, long-term efficacy is frequently limited by relapse. The inability to target antigen-low cells is an intrinsic vulnerability of second-generation CAR T cells and underlies most relapses following CD22BBz CAR T cell therapy. Here, we interrogate CD22BBz CAR signaling in response to low antigen and find inefficient phosphorylation of the linker for activation of T cells (LAT) limiting downstream signaling.

Paediatric Pain Management Experiences of Parents of Children in Botswana Referral Hospitals.

Aim: To describe the experience and understanding of paediatric acute pain management practices by parents/guardians' of hospitalised children in Botswana.

Design: Descriptive qualitative study.

Methods: Face-to-face semistructured interviews were conducted in two public hospitals.

Intergenerational trauma, parenting, and child behavior among African American families living in poverty.

Objective: Limited research has documented the continuity of trauma exposure between parents and young children and the relation between intergenerational trauma and maternal parenting and child outcomes. This study examined intergenerational trauma among African American families from low-income backgrounds and its relation to parenting processes and children's behavior.

Method: Participants represent a subsample of 157 African American mothers and their 4- to 7-year-old children in an urban prekindergarten program.

Measuring Spatial Social Polarization in Public Health Research: A Scoping Review of Methods and Applications.

Spatial social polarization (SSP) refers to the uneven spatial distribution and subsequent concentration of polarized social and/or economic groups in a specified geographic area. However, there is heterogeneity in how SSP is measured and operationalized in research. To this end, we conducted a scoping review to characterize the use of SSP measures in public health research, providing a foundation for those seeking to navigate this complex literature, select measurement options, and identify opportunities for methodological development.

Impact of Food Insecurity on Malnutrition Treatment Response in Nigerian Children With Sickle Cell Anemia and Severe Acute Malnutrition.

Background: In this planned ancillary analysis of our completed clinical trial, we hypothesized that among older children with sickle cell anemia (SCA) and severe acute malnutrition, those with higher levels of food insecurity would have lower end-of-trial body mass index (BMI) z-scores compared to their peers with SCA and lower levels of food insecurity.

Procedure: Data from 108 children who completed the feasibility trial for managing severe acute malnutrition in older children with SCA in Nigeria were analyzed. Children aged 5-12 years old with severe acute malnutrition (BMI z-score of <-3.

Surgical resection of diffuse pulmonary arteriovenous malformations (PAVMs).

Objective: Patients with pulmonary arteriovenous malformations (PAVM) can have significant morbidity and mortality. Surgical resection in isolation or with embolization is reported to treat diffuse-type PAVMs. Herein, we describe outcomes for children and adults for whom PAVMs were managed with elective surgical resection.

Use of bupivacaine liposomal injectable suspension in children aged 2 to 6 years undergoing cardiac surgery does not accelerate recovery.

Objective: Bupivacaine liposomal injectable suspension is proven safe and effective for selective postsurgical analgesia in children older than 6 years. We evaluated if intraoperative bupivacaine liposomal injectable suspension administration decreases postoperative opioid use, peak pain scores, and length of stay in children aged 2 to 6 years undergoing cardiac surgery via median sternotomy.

Methods: Serial patients aged 2 to 6 years undergoing cardiac surgery received 4 mg/kg bupivacaine liposomal injectable suspension mixed with 0.

Aligning prediction models with clinical information needs: infant sepsis case study.

Objective: Sepsis recognition among infants in the Neonatal Intensive Care Unit (NICU) is challenging and delays in recognition can result in devastating consequences. Although predictive models may improve sepsis outcomes, clinical adoption has been limited. Our focus was to align model behavior with clinician information needs by developing a machine learning (ML) pipeline with two components: (1) a model to predict baseline sepsis risk and (2) a model to detect evolving (dynamic) sepsis risk due to physiologic changes.