Pediatrics Commons^™

Ten Tips On How To Optimize Nutrition In Children With Chronic Kidney Disease Or On Dialysis., Nonnie Polderman, Vanessa Shaw, Caroline E. Anderson, An Desloovere, Louise Mcalister, Christina L. Nelms, Fabio Paglialonga, Pearl Pugh, Leila Qizalbash, Evelien Snauwaert, José Renken-Terhaerdt, Jetta Tuokkola, Larry A. Greenbaum, Rukshana Shroff

Manuscripts, Articles, Book Chapters and Other Papers

Optimal nutrition is central to growth and development in all children, and is particularly relevant in those with chronic illnesses. This document provides 10 practical, evidence-informed tips on the assessment and management of the nutritional prescription in children with chronic kidney disease (CKD) and those receiving dialysis. The 10 tips synthesize work of the Paediatric Renal Nutrition Taskforce, an international team of pediatric renal dietitians and pediatric nephrologists who develop clinical practice recommendations for the nutritional management of children with kidney diseases. We describe a comprehensive, three-dimensional nutritional assessment (anthropometry, dietary intake, biochemical markers) and regular monitoring tailored to age, …

Factors Associated With Child Protective Services Referrals In Young Children With Isolated Skull Fractures., Karli Breeden-Carino, Joanne N. Wood, Cindy W. Christian, Tagrid M. Ruiz-Maldonado, Daniel M. Lindberg, Angela Bachim, Lori Frasier, Terra N. Frazier, Nancy S. Harper, Sara E. Kruczek, Farah Brink, Jennifer E. Wolford, Jan Leonard, M Katherine Henry

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Many young children with isolated skull fractures are referred to child protective services (CPS) despite being assessed to have a low likelihood of abuse. We sought to identify factors associated with CPS referrals in this population and to quantify hospital-level variation.

METHODS: We performed a multicenter retrospective cross-sectional study of children < 2 years with skull fractures with or without a small underlying intracranial hemorrhage (ICH) and no additional injuries undergoing a child abuse pediatrics (CAP) subspecialty evaluation. We explored associations between demographic factors, clinical characteristics, psychosocial risk factors, and hospital site with CPS referral status. We performed multivariable logistic regression, adjusting for transfer status and all significant covariates from unadjusted analyses. We utilized marginal standardization to calculate the estimated probability of CPS referrals at each site, adjusting for all factors in the final model.

RESULTS: Of 528 children, 303 (57.4%) were referred to CPS, with 86.5% referred before CAP consultation. In multivariable logistic regression, presence of psychosocial risk factors (OR 4.00; 95% CI 2.25, 7.11), in-person CAP consult (OR 3.93; 1.61, 9.62), inflicted or no trauma history provided (OR 6.15; 3.30, 11.45), …

Confessions In Cases Of Child Physical Abuse-A Capnet Study., Margaret R. Russell, Antoinette L. Laskey, Henry T. Puls, Suzanne P. Starling, Joanne N. Wood, Daniel M. Lindberg, Nancy S. Harper, Caitlin R. Mcnamara, Angela W. Bachim, Farah W. Brink, Lori D. Frasier, James Anderst, Porcia Vaughn, Kristine A. Campbell

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Prior research on confessions of physical abuse (PA) has explored mechanisms of injury. Little is known about conditions supporting a confession of abuse or how confessions may influence case outcomes.

METHODS: This cross-sectional study of suspected PA in children aged < 10 years at 10 centers participating in CAPNET, a multicenter child PA research network, included children with in-person Child Abuse Pediatrics (CAP) consultations between February 2021 and December 2022 and excluded children without injury. Our focus was a confession of inflicted injury known to the CAP during clinical involvement. We compared child and clinical characteristics, out-of-home (OOH) placements, and arrests between cases with and without confessions. Multivariable models using generalized estimating equations (GEE) produced adjusted predicted probabilities (APP) clustering by CAPNET site.

RESULTS: Confessions were known to CAPs in 115/4297 (2.7%) cases, with significant site variability. In a multivariable GEE model, confessions were more likely in cases with injuries with high specificity for abuse (APP 6.0% vs 1.6%, P < .001), near-fatality (APP 5.6% vs 2.3%, P < .001), and older children (APP 4.8% vs 2.5%, P = .025). OOH placements and arrests were more common in cases with confessions. CAP awareness of confessions, OOH placements, and arrests did not follow racial or ethnic patterns seen in the US child welfare system. Lower socioeconomic status was associated with OOH placements and arrests but not with CAP awareness of confessions.

CONCLUSIONS: Our findings highlight differences in case characteristics and outcomes where a confession is known to the CAP and raise questions about …

Exploitive Adolescent Labor And Labor Trafficking: Clinical Perspectives For Adolescent Healthcare Providers., Romina Barral, Michele A. Kelley, Abigail English, Marissa Raymond-Flesch, Tonya Chaffee, Veronica Svetaz, Tamera Coyne-Beasley, Nuray Kanbur

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Protocol For Non-Invasive Assessment Of Skeletal Muscle Structure And Function In Adolescents With Single Ventricle Heart Disease: A Cross-Sectional, Case-Control Study., Tyler A. Fick, Trent J. Herda, Emily Cramer, David A. White, Daniel Forsha

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Congenital heart disease (CHD) is the most common congenital malformation, and the most severe type, single ventricle (SV) heart disease, requires the Fontan surgical palliation. Fontan palliation minimizes hypoxemia and volume overload by separating systemic and pulmonary circulations, resulting in the absence of a sub-pulmonary pump. Skeletal muscle health may have a greater relative contribution to overall functional capacity of those with SV physiology, via the skeletal muscle (SkM) pump mechanism and oxidative capacity. The purpose of this study is to comprehensively evaluate multiple domains of SkM in this population compared to those with normal cardiac anatomy.

METHODS: Forty …

Exploring How Parental Involvement Impacts Police Encounters And Delinquent Behaviors Among Black Adolescent Girls, Danielle Porter, Elizabeth A. Otto, Dyamon Brown, Jasmine Alli, Robyn Douglas, Noni Gaylord-Harden

Presentations

Adolescents’ contact with police is a complex outcome that is influenced by both individual behavior and the broader social context. Specifically, while delinquent behavior can lead to more police contact (Crutchfield et al., 2012), hyper-surveillance often occurs in marginalized communities, increasing unjustified police contact for youth of color (Campos-Manzo et al., 2020; Geller, 2021). Indeed, racial disparities in police contact during adolescence persist even after accounting for delinquent behavior (Campos-Manzo et al., 2020; Crutchfield et al., 2012). Thus, it is important to identify factors that may protect Black youth from contact with police. Parental involvement refers to parents’ active and …

Antibiotic-Pathogen Concordance In Pediatric Complicated Community-Acquired Pneumonia, Makenna Steger Md, Marina Dantas Md, Mscr, Berina Karisik Do, Smit Shah, Alaina Burns Pharmd, Jessica Markham

Presentations

Background Complicated community-acquired pneumonia (cCAP)—defined by effusion, empyema, abscess, cavitation, or necrosis—is associated with worse outcomes than uncomplicated pneumonia. Methicillin resistant Staphylococcus aureus (MRSA) data in cCAP are limited and often merged with uncomplicated cases. Although guidelines recommend MRSA coverage only in select cases, it is empirically used in >70% of encounters. Lack of pathogen identification likely drives overuse due to diagnostic uncertainty. Clarifying Member of AAP, APA, APS, SPR, ASPN, or PIDS? PIDS JM Jessica Markham, MD, MSc Position: Associate Professor of Pediatrics Organization: Children's Mercy Hospitals and Clinics Email: [email protected] Role: Co-Author Disclosure Status: Complete Disclosure: Nothing to …

Adults And Adolescents With High-Intensity Neurologic Impairment Hospitalized At Children’S Hospitals, Charles Maloy, Matt Hall, Joanna Thomson, Jean-Baptist Lepichon, Henry T. Puls

Posters

Introduction: Children with high-intensity neurologic impairment (HINI) account for a sizeable proportion of inpatient resources. As survival into adulthood for children with medical complexity increases, children’s hospitals will likely admit adults with HINI. Understanding adult HINI hospitalization patterns is necessary to develop effective care strategies for this population. Objective: Compare characteristics of adults and adolescents with HINI hospitalized at children’s hospitals and describe hospital-level variation in hospitalizations for adults with HINI. Methods: This retrospective cross-sectional study included discharges of patients with HINI aged 12-29 years from 41 children’s hospitals in the Pediatric Health Information System between 2022-24. Hospitals were excluded …

Variation In Dexamethasone Prescribing Practices For Pediatric Asthma Exacerbations In Acute Care Settings, Hannah Reilly, Natalie J. Kane, Sian Best, Mark A. Hoffman, Kathryn Kyler

Posters

No abstract provided.

Scoliosis, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Cannabinoid Hyperemesis Syndrome, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Atopic Dermatitis, Children's Mercy Kansas City

Clinical Pathways

No abstract provided.

Croup: Observation Time Post Racemic Epinephrine, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

Croup: Dexamethasone Dosing, Children's Mercy Kansas City

Clinical Critically Appraised Topics

No abstract provided.

Evaluating And Treating Pediatric Scoliosis, Bob Underwood, Michael Benvenuti, K Aaron Shaw

Pediatrics in Practice: A CME Podcast

In this episode, pediatric orthopedic surgeons Aaron Shaw, DO, and Michael Benvenuti, MD, discuss how pediatricians can confidently assess, evaluate, and refer children with suspected scoliosis. They cover practical screening tips, red flags that warrant further workup, and how treatment decisions are made—from observation and bracing to surgical care—offering clear guidance for partnering with families and orthopedic specialists.

Click here to stream the podcast episode.

From Screen To Newborn: Making Sense Of Prenatal Genetics In Primary Care, Bob Underwood, Lylach Haizler-Cohen

Pediatrics in Practice: A CME Podcast

This episode dives into the essentials of prenatal genetic testing and its significance for pediatricians. Learn about different types of tests like NIPT and microarrays, and how to interpret results to better care for newborns. Join Dr. Lylach Heisler Cohen, a prenatal genetic testing expert, as she breaks down the complexities of pediatric genetics.

Click here to stream the podcast episode.

Advancing Hope: Clinical Trials In Pediatric Cancer, Michael Smith, Kevin Ginn

Pediatrics in Practice: A CME Podcast

Clinical trials are the backbone of progress in pediatric oncology, offering new pathways to treatment and survival for children facing cancer. In this episode, we sit down with Kevin Ginn, MD, a leading expert in pediatric cancer research, to explore why clinical trials matter, how pediatricians can support families through the process, and what innovations are shaping the future of care. From ethical considerations to practical challenges, Dr. Ginn shares insights that empower pediatricians to guide families with confidence and compassion.

Click here to stream the podcast episode.

Ear Infections In Pediatrics: Prevention, Treatment And When To Refer, Michael Smith, Laura Neff

Pediatrics in Practice: A CME Podcast

Ear infections are one of the most common conditions seen in pediatrics. In this episode, Laura Neff, MD, pediatric otolaryngologist, shares practical guidance on preventing and treating ear infections in children.

We discuss antibiotic decision‑making, watchful waiting, prevention strategies, and when recurrent infections or hearing concerns should prompt an ENT referral. Pediatricians will leave with clear, evidence‑based takeaways for everyday practice.

Click here to stream the podcast episode.

Genomic Medicine In Pediatrics: What Pediatricians Need To Know Now, Michael Smith, Scott T. Younger

Pediatrics in Practice: A CME Podcast

Genomic medicine is playing an increasingly important role in pediatric care, but it can feel complex for general pediatricians. In this episode of Pediatrics in Practice, Scott Younger, PhD, discusses how genomics is already influencing pediatric diagnosis and care today, common scenarios where genetic insights may be helpful, and why genomic testing can be valuable even when it doesn’t lead to a targeted therapy. This conversation offers practical guidance on when to consider genomics, when to refer, and how pediatricians can partner with genetics and subspecialty teams to support patients and families.

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Pediatric Thyroid Disorders: What Pediatricians Need To Know About Diagnosis, Referral, And Surgical Care, Michael Smith, John Dahl

Pediatrics in Practice: A CME Podcast

Pediatric thyroid disorders can present subtly but have significant implications if missed. In this episode, Jake Dahl, MD, PhD, MBA, discusses how pediatric thyroid disease differs from adult presentations, when pediatricians should consider specialty referral, and how endocrinology and surgery work together to guide care. The conversation offers practical insights to help pediatricians recognize red flags, navigate referrals, and support families through diagnosis and treatment.

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Characteristics Of Young Children Hospitalized With Acute Respiratory Failure From Infection With Respiratory Syncytial Virus, Sars-Cov-2, Or Both, November 2023-March 2024., Regina M. Simeone, Margaret M. Newhams, Laura D. Zambrano, Jemima M. Calixte, Katherine Lindsey, Amber Orzel-Lockwood, Amanda B. Payne, Natasha B. Halasa, Satoshi Kamidani, Aline B. Maddux, Kathleen Chiotos, Hillary Crandall, Jennifer E. Schuster, Danielle M. Zerr, Lora M. Martin, Melissa A. Cameron, Katherine Irby, Shira J. Gertz, Steven L. Shein, Ryan A. Nofziger, Samina S. Bhumbra, Janet R. Hume, Michele Kong, Mia Maamari, Bria M. Coates, Judith A. Guzman-Cottrill, Mary Allen Staat, Thomas J. Connors, Matt S. Zinter, Jigar C. Chauhan, Tamara T. Bradford, Kari Wellnitz, Angela P. Campbell, Adrienne G. Randolph, Overcoming Covid-19 Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Respiratory syncytial virus (RSV) and SARS-CoV-2 can cause acute respiratory failure in children. We compared characteristics and outcomes of children aged < 2 years with respiratory failure from infection with RSV, SARS-CoV-2, or both viruses.

METHODS: We used data from a US pediatric respiratory virus hospitalization surveillance network including children with ICU admission for acute respiratory failure (receiving high-flow oxygen or mechanical ventilation) with RSV and/or SARS-CoV-2 during November 2023-March 2024. Demographic, clinical characteristics, and hospitalization outcomes were stratified by a positive test for RSV, SARS-CoV-2, or both viruses, and compared using chi-squared or Kruskal-Wallis tests. Multivariable analyses assessed independent associations between outcomes and infection.

RESULTS: Overall, 1406 children were included: 1253 (89.1%) …

Integrated Multi-Omic Analysis Reveals Novel Subtype-Specific Regulatory Interactions In Pediatric B-Cell Acute Lymphoblastic Leukemia., Irina Pushel, Zachary S. Clark, Lisa A. Lansdon, Byunggil Yoo, Michaella J. Rekowski, Nicole Wood, Michael P. Washburn, Midhat S. Farooqi

Manuscripts, Articles, Book Chapters and Other Papers

Background/Objectives: Molecular subtyping of pediatric B-cell acute lymphoblastic leukemia (B-ALL) has improved patient outcomes through stratification and selection of targeted therapies. Despite extensive genomic and transcriptomic profiling of this cancer, few studies to date have characterized the proteomic landscape, although proteins are the direct targets of many therapeutic agents. Methods: In this study, we demonstrate the utility of multi-omic integration of global transcriptomic, proteomic, and phosphoproteomic profiles of samples from patients diagnosed with either of two B-ALL subtypes-Ph-like (BCR::ABL1-like) and ETV6::RUNX1. Through individual and multi-omic analysis, we recapitulate known transcriptomic findings and identify novel subtype-specific …

Tongue Reduction For Pediatric Obstructive Sleep Apnea: A Systematic Review., Adrian Williamson, Rohit Nallani, Jason R. Brown

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Obstructive sleep apnea (OSA) is a prevalent pediatric disorder that, if untreated, can result in substantial developmental and health consequences. Tongue reduction procedures, such as midline posterior glossectomy (MPG), are increasingly used to address tongue base obstruction. This systematic review evaluates the effectiveness and safety of tongue reduction procedures for pediatric OSA.

DATA SOURCES: Embase, PubMed, and Web of Science databases were queried for studies from inception to September 20, 2023.

REVIEW METHODS: Studies reporting on outcomes of pediatric patients (≤21 years) undergoing tongue reduction surgery for OSA were included.

RESULTS: From 477 abstracts, 9 studies met the inclusion …

Pediatric H3 G34-Mutant Diffuse Hemispheric Glioma: Clinical, Imaging And Molecular Prognostic Factors, Mgmt Expression, And Temozolomide Response., Dana Tlais, Qunyu Zhang, Jordan T. Roach, Christopher L. Tinkle, Tong Lin, Xiaoyu Li, Ayatullah Mostafa, Daniel C. Moreira, Rene Y. Mcnall-Knapp, Sarah Z. Rush, Brian H. Le, Sara Sinno, Apeksha Ramnarayan, Kevin Ginn, Sonia Partap, Arzu Onar-Thomas, Larissa V. Furtado, Asim K. Bag, Jason Chiang

Manuscripts, Articles, Book Chapters and Other Papers

Previous studies have demonstrated poor outcomes in pediatric patients with H3 G34-mutant diffuse hemispheric glioma (DHG). However, the biological basis for this therapeutic resistance remains poorly understood. Furthermore, the effectiveness of temozolomide (TMZ) and the role of surgery in pediatric patients remain uncertain. Therefore, we performed a multi-institutional retrospective analysis of the clinical, imaging, and molecular characteristics of 36 pediatric (≤ 18 years) patients with newly diagnosed H3 G34-mutant DHG. The median age of the cohort was 14 years (8-18 years). The median progression-free survival (PFS) was 0.7 years (95% CI 0.4-1.2 years), and the median overall survival (OS) was …

Clinical Validation Of Targeted Somatic Structural Variant Detection In Pediatric Cancer Via Long-Read Sequencing, Aravindh Nagarajan, Byunggil Yoo, Emily Farrow, John Herriges, Lei Zhang, Elena Repnikova, Tomi Pastinen, Carol J. Saunders, Midhat Farooqi, Lisa Lansdon

Posters

Introduction: Structural variants (SVs) leading to gene fusions are one of the most common classes of driver mutations in pediatric cancer. Clinical SV detection relies on a combination of techniques including karyotyping, FISH, microarray and RNA fusion testing, and, more recently, optical genome mapping. SV detection via long-read genome sequencing (lr-GS) offers the advantage of breakpoint and complex event resolution; however, its implementation has been limited by the lack of an optimized somatic SV caller, among other factors. Here we describe the clinical validation of lr-GS for targeted somatic SV detection in pediatric cancer using Severus, a newly available somatic …

Eeg Features And Rotterdam Head Ct Score Predict Early Favorable Outcome In Pediatric Severe Tbi, Xuexin Lu

Presentations

INTRODUCTION Accurate prognostication after pediatric severe TBI (sTBI) remains challenging. We examined the utility of continuous EEG (cEEG) and Rotterdam head CT score in predicting short-term favorable outcome. METHODS 7-yr (01/2018-12/2024) retrospective study of children aged 1.5-18 yrs admitted to our PICU with sTBI and receiving cEEG monitoring per institutional protocol. Early favorable outcome was defined as Pediatric Cerebral Performance Category scale 1-3 at PICU discharge. cEEG features (background, sleep architecture, reactivity, and seizure) during the 1st 12-hrs of monitoring and initial Rotterdam head CT scores were recorded. Demographics, GCS score, pupillary reactivity, injury severity score (ISS), clinical seizure, cardiac …

Geographic Access To Pediatric Ecmo And Ecpr: A Geospatial Study Of Transport Networks And Disparities., Allan M. Joseph, Andrew J. Lautz, Carlie N. Myers, Ranjit S. Chima, Juan P. Gurria, Shafee Salloum, Wendy Hasson, Matthew P. Malone, Jenna Miller, Maya L. Dewan

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND AND AIM: Extracorporeal membrane oxygenation (ECMO) can help children survive severe cardiac and/or respiratory failure, but it is only provided in specialized centers. There are disparities in access by ground transport to ECMO services, but it is unknown to what extent interfacility transfer systems can expand access. Additionally, the number of children who live in proximity to centers that perform extracorporeal cardiopulmonary resuscitation (ECPR) to be potential candidates in case of out-of-hospital cardiac arrest (OHCA) is unknown. We conducted a geospatial analysis to answer these questions.

METHODS: We conducted a geospatial analysis of the Extracorporeal Life Support Organization (ELSO) …

Defining The Society Of Pediatric Liver Transplantation (Split) Research Agenda: A Delphi Consensus Project., Sharad I. Wadhwani, Pooja Reddy Spector, Amy G. Feldman, Katryn N. Furuya, Kayla Hartjes, Chaowapong Jarasvaraparn, Beau Kelly, Stacee M. Lerret, Krupa Mysore, Arti Pawaria, Philip Rosenthal, Amy Shui, Voytek Slowik, Sarah Taylor, Jennifer Vittorio, Pamela L. Valentino, Society Of Pediatric Liver Transplantation (Split)

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Despite major advances in surgical and medical management, only one-third of pediatric liver transplant (LT) recipients remain morbidity-free at 10 years. The Society of Pediatric Liver Transplantation (SPLIT) published a research agenda over 10 years ago, and much progress has been made since then. An updated consensus-driven SPLIT research agenda could guide future research and funding priorities. We aimed to identify and prioritize key research needs across the continuum of pediatric LT care using a modified Delphi consensus approach.

METHODS: We conducted a three-round modified Delphi process among SPLIT members. In round 1, participants submitted open-ended research priorities. In …

Complications Leading To Reoperation After Pediatric Tibial Spine Fracture Fixation., Benjamin R. Caruso, Suzanna M. Ohlsen, Keinan Agonias, Robert L. Van Pelt, Michelle M. Son, Michael G. Saper, Jason Rhodes, J Marc Cardelia, Jay C. Albright, Shital N. Parikh, Kevin G. Shea, Henry B. Ellis, Philip L. Wilson, Members Of The Score Quality Improvement Registry, Sheila Algan, Jennifer J. Beck, Richard E. Bowen, Jennifer M. Brey, Matthew J. Brown, Christian Clark, Allison Crepeau, Eric W. Edmonds, Matthew Ellington, Peter D. Fabricant, Jeremy Frank, Theodore J. Ganley, Daniel W. Green, Benton Heyworth, Ryan Koehler, Alfred A. Mansour, Stephanine Mayer, Scott D. Mckay, Molly C. Meadows, Matthew Milewski, Emily L. Niu, Donna M. Pacicca, Stephanie S. Pearce, Matthew R. Schmitz, Stephen Storer, Curtis Vandenberg, Yi-Meng Yen, Gregory A. Schmale

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Tibial spine fractures (TSFs) are uncommon injuries in pediatric patients, often requiring operative fixation. While complications such as arthrofibrosis and anterior cruciate ligament (ACL) insufficiency have been previously reported, the risk factors associated with unplanned reoperation remain incompletely understood.

PURPOSE: To identify the most common complications leading to reoperation and to evaluate associated risk factors, using a multicenter quality improvement registry.

STUDY DESIGN: Case-control study; Level of evidence, 3.

METHODS: A multicenter registry of operatively treated pediatric TSFs was retrospectively reviewed from July 2018 to March 2025 across 27 institutions. Grade 3 complications were defined as complications resulting in …

Leappt: Leveraging Generative Artificial Intelligence-Pediatric Pulmonology Training. Curriculum And Content Development., Alvin Singh, Erin Khan, Mary Moffatt

Manuscripts, Articles, Book Chapters and Other Papers

After redesigning the curriculum of the pediatric pulmonology fellowship program at Children's Mercy-Kansas City, leadership continued to make changes based on feedback from a faculty survey concerned about the quality and structure of didactics. These changes included leveraging generative artificial intelligence to create a detailed course content outline containing specific objectives and study points for each subject related to pediatric pulmonology. Using the content outline as a foundational reference for learners, fellowship leadership continues to enhance the curriculum by creating testing questions, flipped classroom sessions and evaluations, and hope that these specific changes will help address decreased passing rates on …