Pediatrics Commons^™

When Probiotics Guidelines Differ: A Practical Guide For Clinicians And Researchers, Geoffrey A Preidis, Hania Szajewska, Marla Cunningham, Howard Bauchner, Daniel J Merenstein

Faculty, Staff and Students Publications

Many professional organizations publish clinical practice guidelines for the use of probiotics in gastrointestinal disorders. Generally, no two guidelines align perfectly, and some differ markedly. These discrepancies occur because clinical practice guidelines are not purely mechanical outputs of data synthesis. They are shaped by structured interpretation, value judgments, and predefined thresholds for uncertainty. These elements become particularly visible when effect sizes are small, heterogeneity is high, and outcomes vary in clinical relevance-as is the case with probiotic research. This article examines why discordance among probiotic guidelines is predictable and provides practical guidance for clinicians who must decide among conflicting recommendations …

Use Of Extracorporeal Membrane Oxygenation In Neonates With Congenital Anomalies Of The Kidney And Urinary Tract: A Multicenter Survey Of Current Practices Across Chnc And Pedi-Ecmo Centers., Syed Ahmed, Burhan Mahmood, John M. Daniel Iv, Sandy Johng, Amy Strong, John Ibrahim, June Hu, Kara Short, Kelsey Montgomery, Keri Drake, Kushal Bhakta, Leslie Lusk, Mary Revenis, Pratibha Thakkar, Ruth Seabrook, Samir Pandya, Sarah Keene, Sharada Gowda, Suma Hoffman, Tahagod Mohamed, Tara Beck, Tasnim Najaf, Robert Digeronimo, Natalie Rintoul, Abhishek Makkar

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: This study aimed to characterize practices and decision-making for extracorporeal membrane oxygenation (ECMO) for congenital anomalies of the kidney and urinary tract (CAKUT).

METHODS: General practices (GP) section inquired about institutional practices and barriers, ECMO criteria, and dialysis. The hypothetical cases (HC) illustrated four clinical scenarios with varying degrees of renal severity for ECMO candidacy.

RESULTS: Then, 99 (42 centers) and 91 (38 centers) physicians completed the GP and HC components, respectively. The majority considered ECMO on a case-by-case basis (66%). Bilateral renal agenesis was the most common diagnosis for exclusion (52%). Prenatal markers used for ECMO exclusion included …

The Epidemiology Of Kidney And Urinary Tract Infections In Pediatric Chronic Kidney Disease: Prevalence, Risk Factors And Association With Gfr Decline In The Chronic Kidney Disease In Children Study., Derek K. Ng, Andrea R. Molino, Siyao Zhang, Emily J. Stonebrook, Craig S. Wong, Pratyush Gyawali, Kimberly J. Reidy, Susan L. Furth, Bradley A. Warady, Jeffrey J. Fadrowski, Ckid Study Investigators

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Urinary tract and kidney infections are potential complications in pediatric chronic kidney disease (CKD), especially among patients with congenital anomalies of the kidney and urinary tract (CAKUT). We characterized the prevalence of self-reported infections from childhood through young adulthood; evaluated risk factors; and quantified the association with CKD progression.

METHODS: Infections in the past year were self-reported at annual Chronic Kidney Disease in Children (CKiD) study visits. Age-specific infection prevalences were stratified by sex and CKD diagnoses (glomerular, non-glomerular non-CAKUT, CAKUT low-risk for infections, and three CAKUT high-risk categories: reflux nephropathy, obstructive uropathy, and other high-risk). Repeated measures logistic …

Peritoneal Dialysis Catheter Complications In Neonates With Kidney Failure., Shannon Reinert, Maanasa Yarlagadda, Alexander Bondoc, Donna Claes, Stefanie Riddle, Meredith P. Schuh

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Neonates with kidney failure require placement of a peritoneal dialysis catheter (PD-C) shortly after birth. PD-C malfunction and peritonitis, both common in this population, are associated with PD failure. The aim of this study was to describe our center's PD-C-related practices and outcomes in neonates with kidney failure.

METHODS: We performed a retrospective chart review of neonates who required kidney replacement therapy (KRT) within the first 30 days of life from 01/2018-12/2023. We evaluated for PD-C duration, PD-C replacement or revision, and peritonitis.

RESULTS: Twenty-four neonates had PD-C placed for chronic dialysis at a median of 9.7 days and …

Clinical Presentations, Treatments, And Outcomes Of Pediatric Lupus Nephritis: A Prospective Cohort Study From The Pediatric Nephrology Research Consortium., Melonie Phillips, Mahmoud Kallash, Chloe Tang, Steve Rust, Kia Jubert-Bacon, Scott Wenderfer, Smriti Mohan, Neal Blatt, Don Batisky, Alejandro Quiroga, Tetyana L. Vasylyeva, Nilka Dejesus, Jerome C. Lane

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: There are few prospective studies of mycophenolate mofetil (MMF) versus cyclophosphamide (CYC) for pediatric lupus nephritis (pLN) and none evaluating rituximab (RTX).

METHODS: The Prospective Pediatric Lupus Nephritis Registry (ProPeL-R) enrolled patients <  21 years within 4 weeks of an initial kidney biopsy diagnostic of pLN. Demographic, clinical, and laboratory data were collected prospectively at enrollment, 3 months, 6 months, and then every 6 months thereafter for up to 5 years of follow-up. For this study, we compared patients receiving initial therapy with corticosteroids (CS) and either MMF (n = 33) vs. CYC (n = 18), and those treated with CS, either MMF or CYC, with RTX (n = 20) vs. without RTX (n = 51).

RESULTS: Histology consisted of 18% class III; 35% class IV; 25% mixed class; and 22% pure class V. Eighty-two percent were female. No significant differences in response or infection rates were identified between those receiving MMF or CYC. There was a significant increase in combined complete (CR) and partial response (PR) at 24 months with RTX use. Overall CR rates at 6 and 24 months were 35% …

Ceftaroline Pharmacokinetics On Ecmo, A Pediatric Case Report., Kathryn Pavia, Ashton Bellamy, Alaina Burns, Allison Scott, Ethan A. Poweleit

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: In-vitro studies suggest that patients on extracorporeal membrane oxygenation (ECMO) may struggle to achieve therapeutic ceftaroline exposure to treat infections due to antibiotic sequestration within the ECMO oxygenator; however, there are no published data regarding ceftaroline concentrations from patients supported by ECMO.

PATIENT PRESENTATION: Here we present an analysis of ceftaroline pharmacokinetics in a 5-y-old patient supported on ECMO due to influenza-associated necrotizing pneumonia.

RESULTS: A total of nine concentrations were analyzed, including three concentrations prior to cannulation and six on ECMO. ECMO cannulation was associated with a relatively small change in the volume of distribution (0.17 L/kg to …

Ambulatory Blood Pressure Thresholds And Left Ventricular Hypertrophy In Children Aged 6-12 Years: A Pediatric Nephrology Research Consortium Study., Afsana Jahan, Matthew Schuchman, Mahie Abdullah, Meghan Mclaughlin, Emilia Maria Cadiz, Eshanika Manchanda, Aftab Chishti, Maggie Murphy, Sarah Twichell, Alexandra Mazo, Dmitry Samsonov, Aesha Maniar, Hannah Kim, Francis Lomanta, Ashok Chakravarthy Patibandla, Rachel Frank, Tarak Srivastava, Ikuyo Yamaguchi, Christine Sethna

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To evaluate the diagnostic performance of ambulatory blood pressure monitoring (ABPM) thresholds for predicting left ventricular hypertrophy (LVH) in children aged 6-12 years.

STUDY DESIGN: A retrospective, multicenter study was conducted across 11 Pediatric Nephrology Research Consortium sites and included children aged 6-12 years who underwent ABPM and 2-dimensional echocardiography for diagnostic assessment of elevated BP. The diagnostic accuracy of fixed ABPM thresholds and the current 95th percentile for sex and height were assessed using area under the receiver operating characteristic, sensitivity, specificity, and Youden index. Multivariable logistic regression models, adjusted for age, sex, and body mass index z-score, …

Bile Acid Metabolites And Carotid Intima Media Thickness In The Chronic Kidney Disease In Children (Ckid) Study., Arthur M. Lee, Mark M. Mitsnefes, Jennifer Roem, Bradley A. Warady, Susan L. Furth, Michelle R. Denburg, Ckid Study Investigators

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Gastrointestinal Symptoms In Kawasaki Disease And Multisystem Inflammatory Syndrome In Children., Marianna Fabi, Ashraf S. Harahsheh, Geetha Raghuveer, Melissa Wehrmann, Michael A. Portman, Nagib Dahdah, Arash A. Sabati, Nilanjana Misra, Marco Antonio Yamazaki-Nakashimada, Michael Khoury, Supriya S. Jain, Balasubramanian Sundaram, William Orr, Jacqueline Szmuszkovicz, Audrey Dionne, Deepika Thacker, Deepa Prasad, Nicole Sutton, Mark D. Hicar, Tyler H. Harris, Mona Elganzoury, Stacie Knutson, Jamie Cruz, Matthew D. Elias, Seda Tierney, Tapas Mondal, Frederic Dallaire, Simon Lee, Michelle Grcic, Benjamin Barnes, Luis Martin Garrido, Cedric Manlhiot, Pedrom Farid, Brian W. Mccrindle, International Kawasaki Disease Registry

Manuscripts, Articles, Book Chapters and Other Papers

Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) are systemic inflammatory diseases sharing clinical and laboratory features. Gastrointestinal (GI) symptoms are common presenting features of both conditions. We aimed to determine the association of GI symptoms and clinical features and outcomes for KD and MIS-C. The International Kawasaki Disease Registry enrolled contemporaneous KD and MIS-C patients <  18 years of age from 42 sites from January 1, 2020, through October 31, 2023. The association of GI symptoms (abdominal pain, vomiting and diarrhea), demographics, clinical and laboratory features, and cardiac involvement were determined using ordinal logistic regression incorporating interaction terms with diagnosis. We included 883 KD and 1827 MIS-C patients with confirmed diagnostic criteria. The presence of at least one GI symptom (vomiting, abdominal pain, diarrhea) was more prevalent for MIS-C patients (88% versus 57%; p <  0.001). A greater number of GI symptoms was significantly associated with older age and higher adiposity, presentation with shock, intensive care unit admission, inotropic support, and greater immunomodulatory therapy. Greater number of GI symptoms was significantly associated with higher peak markers of inflammation and organ dysfunction, and higher peak NT-proBNP and lower left ventricular ejection fraction, but not with coronary artery involvement. There were few differences related to diagnosis group. A greater number of presenting GI features is associated with features that may indicate a more severe form of KD and MIS-C, including cardiac involvement, and may merit increased attention.

Next Steps In Advancing Pediatric Care In Southern Nevada, The Lincy Institute

Lincy Institute Events

The Lincy Institute released new research evaluating the Southern Nevada pediatric care ecosystem. The report, "An Evaluation of Southern Nevada’s Pediatric Care Ecosystem," offers recommendations to develop a stronger and more coordinated pediatric care ecosystem before the stand-alone children’s hospital being developed by Intermountain Health opens in 2030 and identifies the components of an integrated statewide network to provide all of Nevada’s children with access to high-quality care. The event also featured panel discussions with pediatric care providers and policymakers.

Panel 1 - Pediatric Care Providers

Moderator — Tina Quigley, Project Facilitator, The Lincy Institute

Panelists — Lisa …

An Evaluation Of Southern Nevada’S Pediatric Care Ecosystem, David Damore, Tina Quigley, Nick Fiore

Policy Briefs and Reports

In 2024, The Lincy Institute and the Nevada Health and Bioscience Corporation released a report prepared by the consulting firm Tripp Umbach detailing the case for a stand-alone children’s hospital in Southern Nevada. Shortly thereafter, Intermountain Health announced it would build Nevada’s first such facility in Las Vegas, expected to open in 2030. To complement the hospital’s development, The Lincy Institute undertook an independent evaluation of the regional pediatric care landscape. The analysis draws on secondary data and discussions with advocates, health system administrators, practitioners, and providers. The report examines:

• Fiscal, resource, and workforce challenges underlying Nevada’s poor population-level pediatric …

When Should You Repeat A Child's Cbc?, Mike Smith, Sara Mcelroy

Pediatrics in Practice: A CME Podcast

"I found an unexpected abnormal CBC — should I repeat it or refer?" This episode focuses on repeat testing and early steps for abnormal CBCs. Sara McElroy, MD, pediatric hematologist at Children's Mercy explains when mild changes can be safely rechecked versus urgent referral. She covers transient marrow suppression with infection, lab artifact and repeat timing (about 4–6 weeks), the role of return precautions, and when to escalate to hematology or the ER.

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What Causes Heavy Menstrual Bleeding In Teens?, Sarah Gubara, Ashli Lawson, Lauren Amos Md, Ms

Pediatrics in Practice: A CME Podcast

Curious why your teen’s periods are so heavy? Heavy menstrual bleeding and its causes are discussed. Lauren Amos, MD, MS, Pediatric Hematology/Oncology at Children's Mercy - Pediatrics in Practice - CME, and Ashli Lawson, MD, MS, Program Director, Pediatric & Adolescent Gynecology Fellowship at Children's Mercy - Pediatrics in Practice - CME, explain common contributors such as anovulatory cycles, underlying bleeding disorders (up to 30% in affected adolescents), and when to consider a transabdominal pelvic ultrasound or thyroid (TSH) check.

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What Causes Enlarged Lymph Nodes In Kids?, Mike Smith, Lori E. Morgan

Pediatrics in Practice: A CME Podcast

Why are my child's lymph nodes enlarged? Lymphadenopathy — Lori Morgan, MD, MCR, Physician, Hematology and Oncology at Children's Mercy - Pediatrics in Practice - CME, explains that infection is the most common cause and why lymph nodes enlarge during immune responses. Hear about typical locations (cervical, submandibular, submental), how thin children may show prominent nodes, why parents commonly discover them, and when a history should prompt further evaluation.

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When To Refer A Child With High Blood Pressure, Corinn Cross, Douglas Blowey

Pediatrics in Practice: A CME Podcast

Should my child with persistent high BP see a specialist? Douglas Blowey, MD, Director of the Hypertension Clinic at Children's Mercy - Pediatrics in Practice - CME, outlines practical referral triggers for pediatricians. He discusses persistent or stage‑2 hypertension, symptomatic or emergency presentations, age under six, evidence of kidney disease or protein/blood on urinalysis, and failure of lifestyle changes — plus the initial tests primary care should obtain before referral.

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Is My Child's Heart Murmur Dangerous?, Bob Underwood, Mahmoud Jaara, Pezad Doctor

Pediatrics in Practice: A CME Podcast

Is my child's heart murmur dangerous or just harmless? Heart murmurs and when they matter — Pezad Doctor, MD, Pediatric Cardiology at Children's Mercy - Pediatrics in Practice - CME, and Mahmoud Jaara, MD, pediatric cardiology fellow at Children's Mercy - Pediatrics in Practice - CME, explain how to tell innocent murmurs (soft, systolic, short, position‑dependent) from concerning ones, which symptoms and family history raise concern, and what to expect at a cardiology visit (exam, oxygen saturation, pulses).

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Strengthening Health System-Community Partnerships To Address Pediatric Social Needs: A Qualitative Study, Joy Friedman, Melissa A. Alderfer, Kelsey Higgins, Aaron Carpenter, Jennifer Sciolla, Sarah E. Wawrzynski

Department of Pediatrics Faculty Papers

IntroductionStructural and social conditions influence pediatric health outcomes. Successful implementation of social needs screening and referral programs depends on community-based organizations (CBOs) to provide resources that address health-related social needs (HRSN). We explored current practices and perspectives of health care workers and CBO representatives on improving health system-CBO partnerships.MethodsParticipants were purposively recruited from a variety of health care settings involved in HRSN screening and CBOs delivering resources in the community. Participants completed semi-structured interviews. Qualitative thematic analysis was used to summarize data.ResultsTen key informants participated (six health care workers and four CBO representatives). Four themes were identified: 1) mismatches in …

Blinatumomab Care Delivery For Pediatric B-Cell Acute Lymphoblastic Leukemia, Daniel Zheng, Katelyn Oranges, Subhash Ramakrishnan, Lingyun Ji, Melissa Beauchemin, Sarah Alexander, Allison Leahy, Kira Bona, Emi Caywood, Sharon Castellino, Sumit Gupta, Douglas Hawkins, Olga Militano, Kathleen Montgomery, Haley Newman, Rachel Rau, Susan Rheingold, Joanna Robles, Michael Roth, David Teachey, Sarah Vargas, Sue Zupanec, Susan Parsons

Department of Pediatrics Faculty Papers

IMPORTANCE: Blinatumomab, a novel immunotherapy administered as a 28-day continuous infusion, has fundamentally shifted the treatment paradigm for pediatric B-cell acute lymphoblastic leukemia (B-ALL) and is now considered a component of standard therapy for the most common childhood cancer. However, the care delivery challenges in transitioning from an experimental agent on a clinical trial to widespread clinical implementation are unknown.

OBJECTIVE: To characterize the clinical landscape of pediatric blinatumomab care-delivery practice and challenges in the US from the perspective of treating centers.

DESIGN, SETTING, AND PARTICIPANTS: This survey study was conducted from February to March 2025 among US member institutions …

Newborn Screening Reduces Survival Disparities In Scid After Stem Cell Transplant: A Pidtc Report, Lena E Winestone, Brent R Logan, Xuerong Liu, Olatundun Williams, Elizabeth A Dunn, Monica S Thakar, Sharon A Kidd, Talal Mousallem, Morna J Dorsey, Richard J O'Reilly, Neena Kapoor, Lisa Forbes Satter, Malika Kapadia, Soma C Jyonouchi, Sharat Chandra, Christen L Ebens, Deepakbabu Chellapandian, Sonali Chaudhury, Karin Chen, Blachy J Dávila Saldaña, Ahmad Rayes, Troy C Quigg, Shanmuganathan Chandrakasan, Jeffrey J Bednarski, Kenneth B Desantes, Pierre Teira, Alfred P Gillio, Hesham Eissa, Alan P Knutsen, Victor M Aquino, Evan B Shereck, Theodore B Moore, Emi H Caywood, Mark T Vander Lugt, Jacob Rozmus, Larisa Broglie, Lolie C Yu, Ami J Shah, Avni Y Joshi, Rebecca H Buckley, Jasmeen Dara, Joseph H Oved, Hisham Abdel Azim, Caridad A Martinez, Susan Prockop, Kathleen E Sullivan, Jack J Bleesing, Michael D Keller, Lisa M Madden, Suhag Parikh, Shalini Shenoy, Christine M Seroogy, Tamar Rubin, Jennifer Licata, Jeffrey R Andolina, Donald B Kohn, Lauri Burroughs, Jennifer W Leiding, Rebecca A Marsh, Luigi D Notarangelo, Sung-Yun Pai, Troy R Torgerson, Michael A Pulsipher, Jennifer Heimall, Geoffrey D E Cuvelier, Linda M Griffith, Jennifer M Puck, Christopher C Dvorak, Morton J Cowan, Elie Haddad

Faculty, Staff and Students Publications

Black race and Hispanic ethnicity are associated with higher mortality in severe combined immunodeficiency (SCID) following hematopoietic cell transplantation (HCT), though mechanisms remain unclear. We evaluated 796 children with SCID who received nonsibling HCT between 1982 and 2020 using data from the Primary Immune Deficiency Treatment Consortium. Overall survival for Black (aHR 2.47, 95%CI 1.64, 3.71) and Asian/Pacific Islander patients (aHR 1.82, 95%CI 1.00, 3.30) was significantly lower compared with non-Hispanic White patients, while Hispanic patients had lower event-free survival (aHR 1.83, 95%CI 1.27, 2.63) compared with non-Hispanic White patients. Even after adjusting for age and infection, Black patients with …

Is My Child's Pink Eye Contagious?, Sarah Gubara, Jennifer N. Qayum

Pediatrics in Practice: A CME Podcast

Is my child's pink eye contagious and how long will it last? Jennifer Qayum, OD, FAAO, Optometrist at Children's Mercy - Pediatrics in Practice - CME, explains how viral, bacterial, and allergic conjunctivitis spread and how long contagion can persist. She discusses unilateral vs bilateral onset, discharge types (yellow/green versus watery), typical contagious periods for viral cases, and practical prevention steps like hand hygiene and laundering linens to reduce household spread.

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