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Objective Methods Results Significance We comprehensively characterized a large pediatric cohort with focal cortical dysplasia (FCD) type 1 to expand the phenotypic spectrum and to identify predictors of postsurgical outcomes.We included pediatric patients with histopathological diagnosis of isolated FCD type 1 and at least 1 year of postsurgical follow‐up. We systematically reanalyzed clinical, electrophysiological, and radiological features. The results of this reanalysis served as independent variables for subsequent statistical analyses of outcome predictors.All children (N = 31) had drug‐resistant epilepsy with varying impacts on neurodevelopment and cognition (presurgical intelligence quotient [IQ]/developmental quotient scores = 32–106). Low presurgical IQ was associated with abnormal slow background electroencephalographic (EEG) activity and disrupted sleep architecture. Scalp EEG showed predominantly multiregional and often bilateral epileptiform activity. Advanced epilepsy magnetic resonance imaging (MRI) protocols identified FCD‐specific features in 74.2% of patients (23/31), 17 of whom were initially evaluated as MRI‐negative. In six of eight MRI‐negative cases, fluorodeoxyglucose–positron emission tomography (PET) and subtraction ictal single photon emission computed tomography coregistered to MRI helped localize the dysplastic cortex. Sixteen patients (51.6%) underwent invasive EEG. By the last follow‐up (median = 5 years, interquartile range = 3.3–9 years), seizure freedom was achieved in 71% of patients (22/31), including seven of eight MRI‐negative patients. Antiseizure medications were reduced in 21 patients, with complete withdrawal in six. Seizure outcome was predicted by a combination of the following descriptors: age at epilepsy onset, epilepsy duration, long‐term invasive EEG, and specific MRI and PET findings.This study highlights the broad phenotypic spectrum of FCD type 1, which spans far beyond the narrow descriptions of previous studies. The applied multilayered presurgical approach helped localize the epileptogenic zone in many previously nonlesional cases, resulting in improved postsurgical seizure outcomes, which are more favorable than previously reported for FCD type 1 patients. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion The variability in patients' risk of oral mucositis (OM) has been, in part, attributed to differences in host genomics. The aim better define the role of genomics as an OM risk by investigating the association between genetic variants and the presence and severity of OM in pediatric patients with osteosarcoma (OS) undergoing chemotherapy (CT).A longitudinal observational retrospective study was conducted. Severity of OM was assessed daily using World Health Organization (WHO) criteria. Blood samples were collected, and DNA was extracted. 54 coding regions were analyzed for 17 candidate genes using next‐generation sequencing.A total of 164 CT cycles were evaluated in 14 pediatric patients being treated for OS with HDMTX (66.9%) and doxorubicin + cisplatin (34.1%). OM was diagnosed in 129 cycles (78.7%). Whereas the presence of OM was associated with ABCA3 (rs13332514) in HDMTX cycles, OM severity was associated with ABCC2 (rs2273697) in multivariate analysis. In doxorubicin + cisplatin, genetic variants of ABC family genes (ABCC2 and ABCC6) were associated with OM in multivariate analysis.Oral mucositis risk and severity in a pediatric population being treated for OS with HDMTX, doxorubicin, and cisplatin were associated with genes in the ABC family (ABCA3, ABCC2, and ABCC6 genes). [ABSTRACT FROM AUTHOR]

Tinea capitis presents a significant public health care challenge due to its contagious nature, and potential long‐term consequences if unrecognized and untreated. This review explores the prevalence, risk factors, diagnostic methods, prevention strategies, impact on quality of life, and treatment options for pediatric tinea capitis. Epidemiological analysis spanning from 1990 to 1993 and 2020 to 2023 reveals prevalence patterns of pediatric tinea capitis influenced by geographic, demographic, and environmental factors. Notably, Trichophyton species is most prevalent in North America; however, Microsporum species remain the primary causative agent globally, with regional variations. Risk factors include close contact and environmental conditions, emphasizing the importance of preventive measures. Accurate diagnosis relies on clinical evaluation, microscopic examination, and fungal culture. Various treatment modalities including systemic antifungals show efficacy, with terbinafine demonstrating superior mycological cure rates particularly for Trichophyton species. Recurrent infections and the potential development of resistance can pose challenges. Therefore, confirming the diagnosis, appropriately educating the patient/caregiver, accurate drug and dose utilization, and compliance are important components of clinical cure. Untreated or poorly treated tinea capitis can lead to chronic infection, social stigma, and psychological distress in affected children. Prevention strategies focus on early detection and healthy lifestyle habits. Collaborative efforts between healthcare providers and public health agencies are important in treating pediatric tinea capitis and improving patient outcomes. Education and awareness initiatives play a vital role in prevention and community‐level intervention to minimize spread of infection. Future research should explore diagnostic advances, novel treatments, and resistance mechanisms in order to mitigate the disease burden effectively. [ABSTRACT FROM AUTHOR]

Introduction: Bronchial blocker balloons inflated with small volumes of air increase balloon pressure, involving a risk of airway injury especially in young children. However, there are no established guidelines regarding the appropriate volumes of air required to provide safe bronchial occlusion. Methods: This study aimed to introduce a novel method for calculating the amount of air required for safe bronchial blocker balloon occlusion for one lung anesthesia in young children. We included 79 pediatric patients who underwent video‐assisted thoracoscopic surgery at our hospital. Preoperatively, the balloon pressure and corresponding diameter of 5F bronchial blockers inflated with different volumes of air were measured. Intraoperatively, bronchial diameters measured by computerized tomographic scans were matched to the ex vivo measured balloon diameters. The quality of lung isolation, incidence of balloon repositioning, and airway injury were documented. Postoperatively, airway injury was evaluated through fiberoptic bronchoscopy. Results: Balloon pressure and balloon diameter showed linear and nonlinear correlations with volume, respectively. The median lengths of the right and left mainstem bronchi were median (interquartile range) range: 5.3 mm (4.5–6.3) 2.7–8.15 and 21.8 (19.6–23.4) 14–29, respectively. Occluding the left mainstem bronchus required <1 mL of air, with a balloon pressure of 27 cm H2O. The isolation quality was high with no case of mucosal injury or displacement. Occluding the right mainstem bronchus required a median air volume of 1.3 mL, with a median balloon pressure of 44 cm H2O. One patient had poor lung isolation due to a tracheal bronchus and another developed mild and transient airway injury. Conclusion: The bronchial blocker cuff should be regarded as a high‐pressure balloon. We introduced a new concept for safe bronchial blocker balloon occlusion for one‐lung ventilation in small children. [ABSTRACT FROM AUTHOR]

Genetic disorders pose great challenges for affected individuals and their families, as they must cope with the irreversible nature of the disease and a life‐long dependence on medical assistance and treatment. Children and adolescents dealing with Pompe disease (PD) often struggle to keep up with their peers in physical activities. To gain valuable insights into their subjective experiences and better understand their perception and coping related to daily challenges linked to their condition and treatment, the use of standardized questionnaires is crucial. This study introduces the novel PompeQoL 1.0 questionnaire for children and adolescents with PD, designed for comprehensive assessment of both disease‐specific FDH and HRQoL through self‐ and proxy reports. Content validity was ensured through patients' and parents' involvement at the initial stages of development and in subsequent cognitive debriefing process. Participants found the questionnaire easy to understand, answerable, relevant, and comprehensive. Adjustments based on feedback from patients and their parents improved its utility as a patient‐ and observer‐reported outcome measure. After careful item examination, 52 items were selected, demonstrating moderate to excellent test–retest reliability for most scales and initial evidence for satisfactory construct validity. The PompeQoL questionnaire stands as a valuable screening instrument for both clinical and research purposes. Future research should prioritize additional revisions and larger validation studies, focusing on testing the questionnaire in clinical practice and trials. Nevertheless, the PompeQoL 1.0 stands out as the first standardized measure providing insights into disease‐specific FDH and HRQoL among children and adolescents with various forms of PD. [ABSTRACT FROM AUTHOR]

Throughout the COVID‐19 pandemic, rhinovirus (RV) remained notable persistence, maintaining its presence while other seasonal respiratory viruses were largely suppressed by pandemic restrictions during national lockdowns. This research explores the epidemiological dynamics of RV infections among pediatric populations on Hainan Island, China, specifically focusing on the impact before and after the zero‐COVID policy was lifted. From January 2021 to December 2023, 19 680 samples were collected from pediatric patients hospitalized with acute lower respiratory tract infections (ARTIs) at the Hainan Maternal and Child Health Hospital. The infection of RV was detected by tNGS. RV species and subtypes were identified in 32 RV‐positive samples representing diverse time points by analyzing the VP4/VP2 partial regions. Among the 19 680 pediatric inpatients with ARTIs analyzed, 21.55% were found to be positive for RV infection, with notable peaks observed in April 2021 and November 2022. A gradual annual decline in RV infections was observed, alongside a seasonal pattern of higher prevalence during the colder months. The highest proportion of RV infections was observed in the 0–1‐year age group. Phylogenetic analysis on 32 samples indicated a trend from RV‐A to RV‐C in 2022. This observation suggests potential evolving dynamics within the RV species although further studies are needed due to the limited sample size. The research emphasizes the necessity for ongoing surveillance and targeted management, particularly for populations highly susceptible to severe illnesses caused by RV infections. [ABSTRACT FROM AUTHOR]

Introduction: Transfusion may increase the risk of organ failure through immunomodulatory effects. The primary objective of this study was to assess for patient or transfusion‐related factors that are independently associated with the risk of acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS) in a cohort of children with life‐threatening bleeding from all etiologies. Methods: In a secondary analysis of the prospective observational massive transfusion in children (MATIC) study, multivariable logistic regression was performed in an adjusted analysis to determine if blood product ratios or deficits were independently associated with AKI or ARDS in children with life‐threatening bleeding. Results: There were 449 children included with a median (interquartile range, IQR) age of 7.3 years (1.7–14.7). Within 5 days of the life‐threatening bleeding event, AKI occurred in 18.5% and ARDS occurred in 20.3% of the subjects. Every 10% increase in the platelet to red blood cell transfusion ratio is independently associated with a 12.7% increase in the odds of AKI (adjusted odds ratio 1.127; 95% confidence interval 1.025–1.239; p‐value.013). Subjects with operative or medical etiologies were independently associated with an increased risk of AKI compared to those with traumatic injury. No transfusion‐related variables were independently associated with the risk of developing ARDS. Conclusion: The use of increased platelet to red blood cell transfusion ratios in children with life‐threatening bleeding of any etiology may increase the risk of AKI but not ARDS. Prospective trials are needed to determine if increased platelet use in this cohort increases the risk of AKI to examine possible mechanisms. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Transverse colonic volvulus (TCV) is a serious condition with a mortality rate of up to 33%. It is very rare, especially in children. Despite its rarity, surgeons should have a high index of suspicion and include it in the list of differential diagnoses, especially in patients with developmental delays and associated uncommon syndromes. Resection and anastomosis, whether as a one‐stage or two‐stage procedure, proved to be the best treatment options for children. Since prompt identification and management are vital, this paper presents useful information on the presentation, treatment, and outcome of this case report. [ABSTRACT FROM AUTHOR]

Surgical indications for patients with pulmonary arterial hypertension (PAH) and congenital heart defects are controversial. The treat and repair strategy has demonstrated efficacy in adult populations, but there have been no studies on pediatric patients. This study included pediatric patients with PAH and simple congenital heart defects who underwent corrective repair between 2012 and 2021. According to the preoperative treatment strategies, the patients were divided into a regular strategy group (Group 1) and a treat‐and‐repair strategy group (Group 2). Postoperative recovery and follow‐up results were compared between the two groups. A total of 33 patients were included in this study. Group 1 consisted of 19 patients, whereas Group 2 consisted of 14 patients. The pulmonary vascular resistance index in Group 2 was higher than that in Group 1 (10.9 ± 4.1 vs. 8.2 ± 1.6 WU, p = 0.031). There were no differences in postoperative recovery between the two groups (p > 0.05). During follow‐up, five patients were lost (three in Group 1 and two in Group 2). The median follow‐up period was 59 months. One patient died in Group 1, and two patients died in Group 2. There was no significant difference in the survival curve (p = 0.39). At the last follow‐up, another seven patients had experienced a non‐low‐risk condition, with a total of three non‐low‐risk patients in Group 1 and seven in Group 2, including one patient in each group who had a history of ICU admission. According to the ROC curve, a preoperative PVRi <8.2 WU×m2 can predict postoperative persistent low‐risk state, PVRi <5.2 WU×m2 can avoid postoperative death and/or ICU administration. In pediatric patients with PAH and simple congenital heart defects, the treat and repair strategies may provide surgery opportunities, PVRi should be <8 WU×m2, and <5.2 WU×m2 is the best choice. [ABSTRACT FROM AUTHOR]

Background and Aims: The genetic epidemiology of inherited neuropathies in children remains largely unknown. In this study, we specifically investigated the genetic profile of a Brazilian cohort of pediatric patients with pure or complex axonal neuropathies, a crucial knowledge in the near future for establishing treatment priorities and perspectives for this group of patients. Methods: Fifty‐three pediatric patients who were assessed prior to reaching the age of 20, and who had clinical diagnoses of axonal hereditary neuropathy or presented with axonal neuropathy as the primary clinical feature, were included in the study. The recruitment of these cases took place from January 1, 2018, to December 31, 2020. The diagnosis was based on clinical and electrophysiological data. A molecular assessment was made using target‐gene panel or whole‐exome sequencing. Subsequently, segregation analysis was performed on available family members, and all candidate variants found were confirmed through Sanger. Results: A molecular diagnosis was reached in 68% of the patients (n = 36/53), considering only pathogenic and probably pathogenic variants. Variants in MFN2 (n = 15) and GJB1 (n = 3) accounted for half of the genetically confirmed patients (50%; n = 18/36). The other 18 genetically diagnosed patients had variants in several less common genes. Interpretation: Apart from MFN2 and GJB1 genes, universally recognized as a frequent cause of axonal neuropathies in most studied population, our Brazilian cohort of children with axonal neuropathies showed an important genetic heterogeneity, probably reflecting the multi ethnicity of the Brazilian population. Diagnostic, counseling, and future interventions should consider this characteristic. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of psychotropic medication prescription use in youth has increased over the past several years. Despite recommendations and practice parameters established by the American Diabetes Association‐American Psychiatric Association (ADA‐APA) outlining metabolic monitoring of patients prescribed second‐generation antipsychotic (SGA) medication, monitoring adherence for the pediatric patient population remains inadequate. Aims: This project aimed to improve metabolic monitoring of pediatric patients prescribed SGAs and discharge recommendations for follow‐up monitoring within a small, child, and adolescent psychiatric hospital. Methods: This project compared metabolic monitoring adherence rates pre and postimplementation of a metabolic monitoring organizational policy developed to provide procedural guidance, using ADA‐APA guidelines. Participants included prescribing clinicians (physicians and psychiatric nurse practitioners). Results: Phase 1 chart reviews found no records of fasting blood glucose, fasting lipid profile or waist circumference. Following project implementation, chart review found that fasting blood glucose and fasting lipid profile was recorded in 21 (72.4%) of the charts, and waist circumference was recorded in 18 (62.1%) of the charts for patients prescribed SGA medication. For patients discharged on an SGA, written recommendations for follow‐up metabolic monitoring improved from 13% to 70% (<0.001). Conclusions: Implementing an organizational metabolic monitoring policy and protocol can improve clinician adherence to ADA‐APA guidelines for recording in‐patient monitoring of metabolic parameters and discharge recommendations for pediatric patients prescribed SGA medication. [ABSTRACT FROM AUTHOR]

Background and Aims: Virtual reality has been shown to be an effective non‐pharmacological intervention for reducing anxiety of pediatric patients. A newer immersive technology, that of augmented reality, offers some practical advantages over virtual reality, and also seems to show beneficial effects on anxiety. The main objective of this study was to determine whether augmented reality could reduce preoperative anxiety in pediatric patients undergoing elective day surgeries. A secondary outcome was to document the level of satisfaction from pediatric patients toward augmented reality intervention. Methods: Children and adolescents aged between 5 and 17 years old scheduled for elective day surgery under general anesthesia were randomly divided into two groups. Patients in the control group received standard care, whereas patients in the augmented reality group were accompanied by two virtual characters who taught them relaxation techniques and provided emotional and informational support. Anxiety was measured at the time of admission and at the time of induction using the short version of the modified Yale Preoperative Anxiety Scale. Results: The analysis included 37 pediatric patients in the augmented reality group and 64 in the control group. Anxiety scores were statistically significantly lower in the augmented reality group than those in the control group at the time of admission (median difference [95% CI]: 6.3 [0–10.4], p =.01), while no difference was observed between groups at the time of induction (median difference [95% CI]: −4.2 [−5.2–4.2], p =.58). Most patients in the augmented reality group wished to wear the glasses again and reported to be very satisfied with the intervention. Conclusion: To our knowledge, this study is the first large randomized controlled trial to provide empirical evidence of reduction in anxiety for children and adolescents using augmented reality prior to induction of general anesthesia. [ABSTRACT FROM AUTHOR]

This article discusses a retrospective cohort study that aimed to evaluate the effectiveness of switching from the JAK inhibitor baricitinib to the biological treatment dupilumab in pediatric patients with atopic dermatitis (AD). The study collected data from pediatric patients who had been treated with baricitinib for at least 6 months before switching to dupilumab. The study found that after switching to dupilumab, patients experienced positive outcomes, including complete response and partial response, with notable itch improvement. However, the study has limitations due to its small size and retrospective nature, and further research is needed to confirm the efficacy of dupilumab after JAK inhibitor failure in pediatric AD. [Extracted from the article]

Background: The incidence of coronavirus disease 2019 (COVID‐19) in children has been increasing worldwide since the onset of the pandemic. This study examined the risk factors and characteristics of COVID‐19 among pediatric patients compared to other respiratory viral infections. Methods: This was a prospective cross‐sectional study. Patients aged 0–18 years presenting with respiratory symptoms from October 2020 to December 2021 were included. Demographic and clinical data were reviewed. Results: In total, 738 pediatric patients were enrolled. Of these, 48.5% had COVID‐19, and 41.3% were infected with another respiratory virus. The COVID‐19 incidence increased from 0.5% during the original strain outbreak (October 2020 to March 2021) to 56.5% and 73.4% during the alpha (April to June 2021) and delta (July to December 2021) periods, respectively. Children aged 6‐18 years, being female, obesity, exposure to household members with COVID‐19, and the delta period were risk factors for COVID‐19. Being aged 1‐5 years, obesity, shortness of breath, productive cough, and chest pain were associated with COVID‐19 pneumonia. Children aged 5–18 years, underlying neurological disease, a history of COVID‐19 pneumonia, and the delta period were associated with long COVID. Conclusions: Pediatric COVID‐19 patients presenting with respiratory symptoms who are obese or have been exposed to household members with COVID‐19 should be tested for COVID‐19. COVID‐19 patients who are obese, younger than five years old, or who present with shortness of breath, productive cough, or chest pain should be evaluated for pneumonia. COVID‐19 patients with a history of COVID‐19 pneumonia or underlying neurological disease should receive follow‐up for long COVID. [ABSTRACT FROM AUTHOR]

Unfractionated heparin (UFH) is a commonly used anticoagulant for pediatric patients undergoing extracorporeal membrane oxygenation (ECMO), but evidence is lacking on the ideal dosing. We aimed to (1) develop a population pharmacokinetic (PK) model for UFH, measured through anti–factor Xa assay; (2) optimize UFH starting infusions and dose titrations through simulations; and (3) explore UFH exposure–clinical outcomes relationship. Data from 218 patients admitted to Utah's Primary Children's Hospital were retrospectively collected. A 1‐compartment PK model with time‐varying clearance (CL) adequately described UFH PK. Weight on CL and volume of distribution and ECMO circuit change on CL were significant covariates. The typical estimates for initial CL and first‐order rate constant to reach steady‐state CL were 0.57 L/(h·10 kg) and 0.02/h. Comparable to non‐ECMO patients, the typical steady‐state CL was 0.81 L/(h·10 kg). Simulations showed that a 75 IU/kg UFH bolus dose followed by starting infusions of 25 and 20 IU/h/kg for patients aged younger than 6 years and 6 years or older, respectively, achieved the therapeutic target in 56.6% of all patients, whereas only 3.1% exceeded the target. The proposed UFH titration schemes achieved the target in more than 90% of patients while less than 0.63% were above the target after 24 and 48 hours of treatment. The median intensive care unit survival time in patients within and below the target at 24 hours was 136 and 66 hours, respectively. In conclusion, PK model of UFH was developed for pediatric patients on ECMO. The proposed UFH dosing scheme attained the anti–factor Xa target rapidly and safely. [ABSTRACT FROM AUTHOR]

Background: Thanks to an improved therapeutic regimen in childhood B‐cell precursor acute lymphoblastic leukemia (BCP‐ALL), 5 year‐overall survival now exceeds 90%. Unfortunately, the 25% of children who relapse have an initial poor prognosis, potentially driven by pre‐existing or emerging molecular anomalies. The latter are initially and essentially identified by cytogenetics. However, some subtle alterations are not visible through karyotyping. Methods: Single nucleotide polymorphisms (SNP) array is an alternative way of chromosomal analysis allowing for a more in‐depth evaluation of chromosomal modifications such as the assessment of copy number alterations (CNA) and loss of heterozygosity (LOH). This method was applied here in retrospective diagnosis/relapse paired samples from seven children with BCP‐ALL and in a prospective cohort of 38 newly diagnosed childhood cases. Results: In the matched study, compared to the initial karyotype, SNP array analysis reclassified two patients as poor prognosis cases. Modulation during relapse was seen for 4 CNA and 0.9 LOH. In the prospective study, SNP reclassified the 10 patients with intermediate karyotype as 7 good prognosis and 3 poor prognosis. Ultimately, in all the children tested, SNP array allowed to identify additional anomalies compared to conventional karyotype, refine its prognostic value and identify some druggable anomalies that could be used for precision medicine. Overall, the anomalies detected could be segregated in four groups respectively involved in B‐cell development, cell proliferation, transcription and molecular pathways. Conclusion: SNP therefore appears to be a method of choice in the integrated diagnosis of BCP ALL, especially for patients initially classified as intermediate prognosis. This complementary method of both cytogenetics and high throughput sequencing allows to obtain further classified information and can be useful in case of failure of these techniques. [ABSTRACT FROM AUTHOR]

Families of children with developmental delays but no diagnosed genetic condition may benefit from connection to genetic systems of care. This work examines the role of occupational therapy as a space for families of pediatric patients to gain access to genetic services. Between September 2021 and February 2022, we interviewed 20 occupational therapists in New England who work primarily with pediatric patients. We transcribed the interviews and used a grounded theory approach to identify and code recurring themes. The data reveal several barriers to linking pediatric patients to genetic systems of care, including lack of insurance coverage, wait times for appointments and test results, hesitant primary care providers, and familial and cultural stigma of disability. We discuss the unique role of occupational therapists as professionals who spend substantial time with patients, often in their everyday environments, to bridge these barriers. We also address challenges associated with occupational therapists facilitating connections to genetics services, including their lack of specialized knowledge of genetics and barriers fully integrating with others on the medical team. [ABSTRACT FROM AUTHOR]

Objectives: The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus causes coronavirus disease 2019 (COVID‐19), a respiratory infection that has spread worldwide and is responsible for a high death toll. Although respiratory symptoms are the most common, there is growing evidence that oral signs of COVID‐19 can also be seen in children. The purpose of this systematic review is to provide a comprehensive analysis of the available data on the oral manifestations of COVID‐19 in children and to recommend appropriate methods of diagnosis and treatment. Methods: A systematic search of the MEDLINE, EMBASE, Scopus, and Web of Science databases was done to discover relevant papers published between their establishment and January 2023. Articles detailing oral symptoms in pediatric patients with confirmed COVID‐19 infection were included, and data on clinical characteristics, diagnosis, treatment, and outcomes were extracted and evaluated. Results: A total of 24 studies involving 2112 pediatric patients with COVID‐19 were included in the review. The most common presentations are oral lesions, taste and smell disorders, oral candidiasis, hemorrhagic crust, tongue discoloration, lip and tongue fissuring, gingivitis, and salivary gland inflammation. These manifestations were sometimes associated with multi‐system inflammatory syndrome in children (MIS‐C) or Kawasaki disease (KD). Management strategies varied depending on the severity of the oral manifestation and ranged from symptomatic relief with topical analgesics to systemic medications. Conclusion: Oral symptoms of COVID‐19 are relatively prevalent in juvenile patients and can be accompanied by severe systemic diseases, such as MIS‐C or Kawasaki illness. Early detection and adequate care of these oral symptoms are critical for the best patient results. Understanding the underlying pathophysiology and developing targeted treatments requires more investigation. [ABSTRACT FROM AUTHOR]

Introduction: Following approval in 2009 of vagus nerve stimulation (VNS Therapy) for drug‐resistant epilepsy (DRE) in the Russian Federation, this is the first multicenter study across Russia to evaluate the safety and efficacy of adjunctive VNS Therapy. Methods: The retrospective, observational registry included 58 pediatric patients with DRE (5–17 years old at implantation) who had ≥2 years of VNS. To ensure a robust evaluation process, changes in seizure frequency were evaluated for all seizure types as well as "most disabling" seizures (defined as seizures accompanied by falls, physical trauma, and/or incontinence in the absence of preventative measures). Results: With 2 years of VNS Therapy, 37 of 49 patients (76%) experiencing the most disabling epileptic seizures had a >50% decrease in frequency of such seizures, and 16 (33%) reported no longer experiencing the "most disabling" seizure type. In addition, based on the McHugh Outcome scale, VNS Therapy had a positive outcome on both frequency and severity of all epileptic seizure types, with a >50% decrease in frequency of all epileptic seizure types noted in 37 of 58 patients (64%), and 31% of patients had a Class I outcome, including 11 patients (19%) who achieved seizure freedom. VNS Therapy also had a positive effect on the frequency of status epilepticus: 13 patients (22%) had status epilepticus prior to implantation with a mean rate of 9.4 ± 17.7 events per year (range, 0–52), and after VNS Therapy, only one patient continued to experience status epilepticus (at 1 event per 4–6 months). VNS Therapy had an acceptable safety profile and no adverse events leading to VNS discontinuation were reported. Conclusions: The results demonstrate that VNS Therapy is being safely and effectively applied to pediatric patients in the Russian healthcare system. [ABSTRACT FROM AUTHOR]

Immobility and lack of sensation during perioperative procedures increase the risk of patients developing pressure injuries (PIs). Such injuries can cause pain and result in serious infections, thereby leading to increased health care costs. The recently developed AORN "Guideline for prevention of perioperative pressure injury" provides perioperative nurses and leaders with applicable recommendations for preventing these injuries. In addition to a brief overview of a health care facility's interdisciplinary perioperative PI prevention program, this article discusses a variety of concepts related to PI prevention, including prophylactic materials, intraoperative considerations, hand‐over communication, pediatric patient concerns, policies and procedures, quality management, and education. It also provides a pediatric patient–specific scenario that illustrates the implementation of the described recommendations. Perioperative nurses and leaders should review the guideline in its entirety and apply the recommendations to prevent PIs as appropriate for their facility and patient population. [ABSTRACT FROM AUTHOR]

Background: Maintaining a good nutritional status during the hematopoietic cell transplantation (HCT) procedure is challenging in the pediatric population. Methods: In a multicentric retrospective study, we compared the outcome of nutritional status and HCT‐related parameters in 227 pediatric patients during and after HCT between 2005 and 2015. 112 patients received a gastrostomy before the start of HCT (GS group), and 115 did not receive a gastrostomy (NGS). Data collection was performed at HCT, 3, 6, and 12 months post‐HCT. Results: At time point of HCT the Standard Deviation Score (SDS) of weight was 0.17 in the NGS group, and 0.71 in the GS group (p =.01) Patients in the NGS group lost more weight during the first 3 months after HCT than patients in the GS group. At 12 months, patients in the NGS remained at a lower weight, while patients in the GS group slightly increased their weight. There were no differences between the groups in the incidence of acute graft‐versus‐host‐disease (GvHD), overall survival, and non‐relapse mortality. However, the number of febrile episodes requiring intravenous treatment with antibiotics, was higher in the GS group as compared to the NGS group, during the first 3 months post‐HCT (p <.001). Conclusions: Our results indicate that gastrostomy can be utilized in children undergoing HCT without any negative effects on mortality. Therefore, the use of a gastrostomy appears to be a safe option to maintain a good nutritional status during the HCT procedure. [ABSTRACT FROM AUTHOR]

Viral metagenomics has been extensively applied for the identification of emerging or poorly characterized viruses. In this study, we applied metagenomics for the identification of viral infections among pediatric patients with acute respiratory disease, but who tested negative for SARS‐CoV‐2. Twelve pools composed of eight nasopharyngeal specimens were submitted to viral metagenomics. Surprisingly, in two of the pools, we identified reads belonging to the poorly characterized Malawi polyomavirus (MWPyV). Then, the samples composing the positive pools were individually tested using quantitative polymerase chain reaction for identification of the MWPyV index cases. MWPyV‐positive samples were also submitted to respiratory virus panel testing due to the metagenomic identification of different clinically important viruses. Of note, MWPyV‐positive samples tested also positive for respiratory syncytial virus types A and B. In this study, we retrieved two complete MWPyV genome sequences from the index samples that were submitted to phylogenetic inference to investigate their viral origin. Our study represents the first molecular and genomic characterization of MWPyV obtained from pediatric patients in South America. The detection of MWPyV in acutely infected infants suggests that this virus might participate (coparticipate) in cases of respiratory symptoms. Nevertheless, future studies based on testing of a larger number of clinical samples and MWPyV complete genomes appear to be necessary to elucidate if this emerging polyomavirus might be clinically important. [ABSTRACT FROM AUTHOR]

Background: Hematopoietic stem cell transplantation is used in the treatment of children with malignant and non‐malignant diseases. However, apheresis of peripheral blood stem cells (PBSC) represents a challenge in children below 10 kg. Methods: A retrospective trial was conducted in the Cellular Therapy Department of Portuguese Oncology Institute of Porto. Inclusion criteria: children with body weight inferior to 10 kg who underwent autologous PBSC apheresis until 2021. Demographic and clinical data were collected and our institutional protocol was described. COBE Spectra apheresis system (TerumoBCT, Lakewood, Colorado) until 2012 and then Spectra Optia (TerumoBCT) were used. Results: Sixteen leukocytaphereses were performed in 13 patients—nine females (69%). Mean age and weight were 13.31 months (±5.26) and 8.31 kg (±1.17), respectively. The initial CD34+ cells/μL in peripheral blood was 70.8 (±61.9). A central venous catheter (CVC) was exclusively used in all but one patient, in whom a peripheral vein was also required. In 10 procedures, both heparin and anticoagulant citrate dextrose solution—formula A (ACD‐A) were used; in the remaining ones, only ACD‐A was employed. The median duration of each procedure was 168 minutes (±45) and 2.96 blood volumes (±0.31) were processed. Median CD34+ cells yield per leukocytapheresis was 6.52 × 106/kg (±9.87 × 106). CD34+ cell extraction rates were not significantly different between the two apheresis systems. Platelet and magnesium levels were significantly lower after collection (P <.001 and P =.009, respectively). Conclusions: Although recommendations are lacking, we have successfully and safely performed leukocytaphereses in children with body weight below 10 kg. The authors believe that a permanent and dynamic comprehensive evaluation of each child is paramount for attaining good results. [ABSTRACT FROM AUTHOR]

Accumulation of diverse mutations across the structural and nonstructural genes is leading to rapid evolution of SARS‐CoV‐2, altering its pathogenicity. We performed whole genome sequencing of 239 SARS‐CoV‐2 RNA samples collected from both adult and pediatric patients across eastern India (West Bengal), during the second pandemic wave in India (April–May 2021). In addition to several common spike mutations within the Delta variant, a unique constellation of eight co‐appearing non‐Spike mutations was identified, which revealed a high degree of positive mutual correlation. Our results also demonstrated the dynamics of SARS‐CoV‐2 variants among unvaccinated pediatric patients. 41.4% of our studied Delta strains harbored this signature set of eight co‐appearing non‐Spike mutations and phylogenetically out‐clustered other Delta sub‐lineages like 21J, 21A, or 21I. This is the first report from eastern India that portrayed a landscape of co‐appearing mutations in the non‐Spike proteins, which might have led to the evolution of a distinct Delta subcluster. Accumulation of such mutations in SARS‐CoV‐2 may lead to the emergence of "vaccine‐evading variants." Hence, monitoring of such non‐Spike mutations will be significant in the formulation of any future vaccines against those SARS‐CoV‐2 variants that might evade the current vaccine‐induced immunity, among both the pediatric and adult populations. [ABSTRACT FROM AUTHOR]

The use of dental implants in pediatric patients may create unique complications. A 38‐year‐old patient presented with a mobile, cement‐retained implant crown due to an abutment screw loosening. The maxillary right central incisor implant was placed when the patient was 10 years old. Pus discharge from the peri‐implant sulcus was observed. The mucosal margin of the implant was at the level of the mucogingival junction of neighboring teeth. Radiographically, the platform of the implant appeared to be at the level of the apical third of the adjacent roots. After removing the existing implant‐retained crown, the inflamed peri‐implant tissue covering the implant platform was removed and the stability of the implant was confirmed. A new screw‐retained implant crown was made using an angulated screw channel to correct the labiopalatal angulation of the implant and allow for retrievability. Pink porcelain was used to match the mucosal margin of the implant crown to that of the maxillary left central incisor. This case report highlights the risk of implant placement in pediatric patients and agrees with previous reports that implants should be delayed until growth is complete. [ABSTRACT FROM AUTHOR]

Background: Maintaining cerebral blood flow is important in intraoperative management of moyamoya disease patients. Aims: To access changes in the carotid artery blood flow velocity in response to fluid challenge, blood pressure, and cardiac output under general anesthesia in pediatric patients with moyamoya disease. Methods: This observational study included pediatric patients with moyamoya disease undergoing general anesthesia for encephaloduroarteriosynangiosis. Each patient underwent an ultrasound assessment thrice as follows: after anesthetic induction (T1), after fluid challenge (10 ml/kg, T2), and at the end of surgery (T3). The primary outcome was the change in the internal carotid artery blood flow velocity after fluid challenge and was assessed using a paired t‐test. The secondary outcomes comprised changes in the internal, external, and common carotid artery blood flow peak velocities after fluid challenge and the factors influencing these changes. Results: We enrolled and analyzed 30 patients with a mean age of 7.2 years. After fluid challenge, the systolic (p =.003) and mean blood pressure (p =.017), stroke volume index (p =.008), and cardiac index (p =.140) were higher than those at T1. However, both internal carotid artery blood flow velocities did not change after fluid challenge (p =.798, mean difference and 95% confidence interval [CI], −1.1 and −10.3 to 8.0 for right, p =.164, mean difference and 95% CI, −5.2 and −12.7 to 2.2 for left). The internal carotid artery blood flow velocity was correlated with the cardiac index, stroke volume index, and mean and diastolic blood pressure, with low significance. Conclusions: The internal carotid artery blood flow velocity did not increase in pediatric patients with moyamoya disease under general anesthesia, despite fluid challenge and corresponding changes in the blood pressure and cardiac output. Intraoperative hemodynamic management to improve the cerebral blood flow in these patients requires further investigation. [ABSTRACT FROM AUTHOR]

Objective: Thyroid hormone abnormalities have been linked to antiseizure medications (ASMs). Oxcarbazepine is considered safer than carbamazepine because it induces the hepatic cytochrome P450 metabolic enzymes less than the carbamazepine does. However, limited data exist for the influence of oxcarbazepine on thyroid function in children and adolescents. The objective of this study was to determine the effect of oxcarbazepine on thyroid function in these patients. Methods: A total of 162 pediatric patients with epilepsy who started oxcarbazepine for the first time between April 2003 and May 2020 were enrolled. The longitudinal effects of oxcarbazepine for thyroid functions were confirmed using general estimating equations. Results: Serum triiodothyronine (T3), thyroxine (T4), and free thyroxine (fT4) levels decreased significantly during 5 years of follow‐up (all p's <.001). In particular, T3 and fT4 levels were reduced steeply in the first 2 years of oxcarbazepine treatment. There was no significant change in thyroid‐stimulating hormone during oxcarbazepine treatment. Significance: Serum T3, T4, and fT4 levels decreased significantly during oxcarbazepine use, and this change was maintained during the treatment period. In patients receiving oxcarbazepine, it is recommended that periodic thyroid function testing should be performed, especially within the first 2 years after starting this ASM. Our results indicate that oxcarbazepine‐induced hypothyroidism does not appear to be accompanied by a significant increase in TSH, and consequently might be missed if TSH alone is monitored as a measure of thyroid dysfunction. [ABSTRACT FROM AUTHOR]

Tapinarof is a nonsteroidal, topical, aryl hydrocarbon receptor agonist approved for the treatment of atopic dermatitis (AD) in Japanese patients aged ≥12 years. We evaluated the efficacy and safety of tapinarof in Japanese pediatric patients aged 2 to 11 years with AD in a phase 2, multicenter, randomized, double-blind, vehicle-controlled trial. Eligible patients (N = 121) were randomized 1:1:1 to receive tapinarof cream 0.5%, tapinarof cream 1%, or vehicle cream once daily for 8 weeks. At week 8, the least-squares mean percent change from baseline in Eczema Area and Severity Index (EASI) score (the primary endpoint) was -81.29% in the tapinarof 0.5% group, -77.62% in the tapinarof 1% group, and - 18.56% in the vehicle group. Reductions in EASI score at week 8 were significantly greater in the tapinarof groups than in the vehicle group (p < 0.0001 for both comparisons). The proportion of patients with ≥75% improvement from baseline in EASI score at week 8 was 77.5% in the tapinarof 0.5% group, 70.7% in the tapinarof 1% group, and 15.0% in the vehicle group. The proportion of patients who achieved an Investigator's Global Assessment score of 0 (clear) or 1 (almost clear) with ≥2-grade improvement from baseline at week 8 was 32.5% in the tapinarof 0.5% group, 43.9% in the tapinarof 1% group, and 17.5% in the vehicle group. No treatment-related serious adverse events (AEs) were reported; all of the AEs were mild or moderate. Common AEs in tapinarof-treated patients included gastroenteritis, application site irritation, and nasopharyngitis. The incidence of trial discontinuations due to AEs was low in tapinarof-treated patients (one patient for each strength). In summary, both strengths of tapinarof cream demonstrated greater efficacy than vehicle cream and were well tolerated in Japanese pediatric patients with AD., (© 2024 The Author(s). The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.)

This study has developed and validated a novel LC–MS/MS assay method to quantify perampanel in pediatric patients with epilepsy in Xinjiang, China. Our assay reduces current specimen volume requirements and decreases the turnaround time for results. Samples were separated by gradient elution and then injected into the mass spectrometer with a total run time of 3 min per sample. The ions from the analytes were detected using multiple reactions by monitoring transitions of m/z 350.2–219.0 for perampanel and m/z 359.1–323.1 for the internal standard, as precursor ion and product ion, respectively. The peak area ratios of perampanel with internal standard within the plasma samples were linear in the concentration range of 0.1–3.2 μg/mL (y = 2.87x + 0.61; r2 ≥ 0.99). The within‐run and between‐run precision coefficient of variation (%) did not exceed 11.03%, and the accuracy (bias) ranged from −1.07 to 6.69%. The mean absolute recoveries of perampanel for four QC levels (lower limit of quantification, low quality control, middle quality control, and high quality control) determined by this method were 87.69, 94.04, 107.50, and 95.15%, respectively. The stability results for this method showed that the plasma samples of perampanel were stable under all tested conditions (86.43–104.81%), with a coefficient of variation (%) maximum of 8.74%. [ABSTRACT FROM AUTHOR]

Introduction: Mobilization regimes in pediatric patients at high risk for poor mobilization are not standardized across different institutions. We present a retrospective analysis of our experience with a high‐dose granulocyte colony‐stimulating factor (G‐CSF) regime of 12 μg/Kg per body weight (BW) twice a day for 4 days used in high‐risk patients. Material and methods: We report the results of all pediatric patients mobilized with high‐dose G‐CSF between January 1999 and February 2021 in our center. A successful mobilization was defined as a peripheral blood (PB) CD34+ cell count of ≥10 CD34+ cells/μl on the fifth day of mobilization immediately before leukapheresis. A minimum cell yield of ≥2 × 106 CD34+ cells/Kg of BW was required for a successful collection. Results: Of the 262 patients included in the analysis, mobilization failure was found in 27 (10.3%). In a univariate analysis, this was associated with age, weight, baseline diagnosis, and having undergone a previous mobilization cycle, the latter being the only factor that remained significantly associated in a multivariate analysis (P = 0.03). The 54 patients (20.6%) did not reach the minimum required CD34+ cell yield. 50.4% of the patients reported adverse events (AEs) during the mobilization period, and 23 (9.1%) reported 3 or more concomitant AEs. However, all of them were mild and did not affect the mobilization schedule. Conclusions: Although most high‐risk pediatric patients are successfully mobilized with the high‐dose G‐CSF regime, this approach does not salvage all of them and significantly increases the presence of AEs in comparison to standard‐dose regimes. [ABSTRACT FROM AUTHOR]

Background: Hypertrophic cardiomyopathy (HCM) is an inherited autosomal dominant heart disease, characterized by increased left ventricular wall thickness and abnormal loading conditions. Imaging modalities are the first choice for diagnosis and risk stratification. Although heart dimensions have been characterized widely in HCM adults from cardiac imaging, there is limited information about children affected by HCM. The aim of this study is to evaluate left ventricular function and left heart dimensions in a small population of children diagnosed with HCM. Methods: A total of 16 (seven male, nine female) pediatric patients with an average age of 14.0 ± 2.5 years diagnosed with HCM at Great Ormond Street Hospital for Children were included in this study. Cardiac magnetic resonance (CMR) images were used to measure left and right ventricular dimensions, and septal and left ventricular free wall thicknesses in Simpleware ScanIP. The gender groups were compared using student t‐test or non‐parametric Mann‐Whitney U‐test depending on the sample distribution. Results: Differences in heart rate, left ventricular end‐diastolic volume and end‐diastolic volume index, left ventricular stroke volume and stroke volume index, left ventricular end‐systolic long axis length, left ventricular end‐systolic long axis length index, left ventricular end‐diastolic mid‐cavity diameter, left ventricular end‐diastolic free wall thickness, left ventricular end‐diastolic free wall thickness index, right ventricular end‐diastolic long axis length were statistically significant in males and females. Conclusion: Left ventricular wall and intraventricular septal thickness increase affecting left ventricle cavity dimensions and there may be differences in anatomical and physiological parameters in males and females affected by HCM. [ABSTRACT FROM AUTHOR]

Lung‐protective ventilation (LPV) has been adopted in the theater environment as a strategy to reduce pulmonary complications under anesthesia. Postoperative pulmonary complications are not infrequent and may have significant implications on the postoperative length of stay as well as the morbidity and mortality of pediatric patients. There is evidence in the adult literature to suggest that intraoperative LPV strategies may reduce the risk of such complications. The utility of LPV strategies in healthy children is not well researched, and the data from critical care studies appear to be conflicting. To ascertain the value of intraoperative LPV in pediatric patients, it is important to understand the pathophysiology of pediatric ventilator‐induced lung injury and the basis of LPV strategies. The current evidence in adult and pediatric populations, including pediatric intensive care, is reviewed to gain insight into the role and value of intraoperative LPV for pediatric patients. [ABSTRACT FROM AUTHOR]

To assess the pharmacokinetic parameters of vancomycin in Chinese critically ill pediatric patients, children treated with vancomycin, hospitalized in the intensive care unit were included. Samples to determine peak and trough serum concentrations were obtained on the third day of treatment. Half-life was significantly longer in neonates and showed a decreasing trend in infants and children. In patients aged ≥1 month, AUC24/MIC ≥400 was achieved in 31.8% at the dose of 40 mg/kg/d, and in 48.7% at the dose of 60 mg/kg/d with an assumed MIC of 1 mg/L. Augmented renal clearance (ARC) was present in 27.3% of children, which was associated with higher vancomycin clearance and lower AUC values. A good correlation was observed between trough concentration and AUC24, and the trough concentration that correlated with AUC24 of 400 were varied according to the dosage regimens, 8.42 mg/L for 6-hintervals, and 6.63 mg/L for 8-h intervals. To conclude, vancomycin trough concentration that related to the AUC24 of 400 was much lower in critically ill children than that in adults. The dosage of 60 mg/kg/day did not enough for producing AUC24 in the range of 400–600 mg h/L in critically ill children, especially in those with ARC. [ABSTRACT FROM AUTHOR]

We evaluated the Panbio™ COVID‐19 Ag Rapid Test Device as a point‐of‐care diagnostic tool for COVID‐19 in 357 patients at a pediatric emergency department. Thirty‐four patients tested positive by reverse transcription polymerase chain reaction, of which 24 were positive by the antigen assay. The sensitivity and specificity of the assay were 70.5% and 100%, respectively. Highlights: The PanBio RAD assay performed well for identifying SARS‐CoV‐2 infected children displaying high viral loads in the upper respiratory tract [ABSTRACT FROM AUTHOR]

Hyperglycemic hyperosmolar syndrome (HHS) is a rare complication of diabetes mellitus among pediatric patients. Since its treatment differs from diabetic ketoacidosis (DKA), hence, pediatricians should be aware of its diagnosis and management. [ABSTRACT FROM AUTHOR]

Background: PGF is historically associated with high morbidity and mortality after allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Methods: In this study, we report our multicenter experience on stem cell boost (SCB) for PGF, or incomplete donor engraftment, in 16 pediatric patients. Donors were HLA‐matched siblings (n = 4), unrelated donors (n = 11), or haploidentical family members (n = 1). Ten patients had two‐lineage cytopenia, 5 had one‐lineage cytopenia, and 1 had poor immunological reconstitution together with a low percentage of donor cell engraftment. A median of 6.6x106 selected CD34+/Kg was infused after 194 days from allo‐HSCT (48‐607). Results: In 4 out of 5 patients, one‐lineage cytopenia was resolved, while among the 10 patients with two‐lineage cytopenia, 4 resolved both cytopenia, 5 resolved one‐lineage, and one did not respond. All patients reverted their mixed chimera to full donor chimera. OS was 56%, transplant‐related mortality (TRM) 32%, and RI 12%. The main causes of failure were related to infections with 4 out of 7 deaths caused by this. Conclusions: SCB may rescue over 50% of patients with PGF after allo‐HSCT. An earlier treatment may reduce the infectious complications and improve survival. [ABSTRACT FROM AUTHOR]

Background: Pediatric mitral regurgitation (MR), especially with bileaflet prolapse, is relatively rare, of high complexity, and frequently associated with other congenital cardiac abnormalities. It remains a major therapeutic challenge for surgeons. This study reports our experience of surgical treatment of this mitral disease and midterm follow-up results.Methods: Between January 2016 and April 2020, nine pediatric patients, six females and three males, age ranged from 3 to 12 years (median age was 6 years) with a weight range of 12-36 kg (median weight was 25 kg), who all had over moderate regurgitation caused by bileaflet prolapse with mean distance of leaflet coaptation beyond annular plane 5.89 ± 1.66 mm (4-9 mm), received mitral valve (MV) repair. Various surgical techniques were used to repair MV.Results: The median follow-up period was 23(6-51) months, only one patient had moderately severe recurrent of MR, no patient developed systolic anterior motion (SAM) or mitral stenosis. Freedom from reoperation was 100% during the follow-up period. Compared to preoperation, the left atrial (LA) diameter and left ventricular end-diastolic diameter (LVEDD) decreased significantly from 2.94 ± 0.49 cm to 2.37 ± 0.38 cm (LA, p < .01) and from 4.13 ± 0.73 cm to 3.62 ± 0.49 cm (LVEDD, p < .01) respectively, ejection fraction (EF) decreased significantly (p < .05) from 68.56 ± 3.98% to 62.89 ± 4.48% before discharged.Conclusion: We share our experience of surgical repair of mitral valve bileaflet prolapse in pediatric patients. Several surgical methods are considered to be used to repair the MV due to the high complexity of lesions. Anatomic correction or functional correction in our reports almost reaches the same result, while functional correction means simpler operation. [ABSTRACT FROM AUTHOR]

Background: Ventricular arrhythmias (VAs) are rare in pediatric patients, especially in absence of structural heart disease (SHD). Few data are available regarding the invasive VAs treatment with catheter ablation (CA) in pediatric patients and predictors of outcomes have not been fully investigated. Objective: To describe the clinical presentation, procedural characteristics, and outcomes in pediatric patients undergoing CA for VAs. Methods: Eighty‐one consecutive pediatric patients (58 male [72%], 15.5 ± 2.2 years) treated by CA for ventricular tachycardia (VT) or premature ventricular beats (PVBs) were retrospectively evaluated. Study endpoints were VAs recurrence and mortality for any cause. Results: Ninety‐five procedures were performed in 81 patients, 52 (55%) PVBs and 43 (45%) VT ablations. During a follow‐up of 35.0 months (interquartile range = 13.0–71.0), 14 patients (14.7%) had a VA recurrence: 11 (33.3%) patients treated with CA for VT and 3 (6.2%) patients treated for PVBs (p <.001). One patient (1%) died 26 months after the procedure during an electrical storm. Patients with SHD had higher VAs recurrence rate, as compared with idiopathic VAs (pairwise log‐rank p <.001). Patients treated with CA for VT had higher VA recurrence rate, as compared with PVB patients (pairwise log‐rank p =.002). At Cox multivariate analysis only SHD was an independent predictor of VAs recurrence (hazard ratio = 5.56, 95% confidence interval = 2.68–11.54, p <.001). Conclusion: CA of VAs is effective and safe in a pediatric population. CA of idiopathic and fascicular VAs are associated with lower recurrence rate, than VAs in the setting of SHD. [ABSTRACT FROM AUTHOR]

We report the case of a 12‐year old female patient with Friedreich's ataxia and diabetes mellitus. Due to a progressive multiorgan failure, a veno‐arterial extracorporeal membrane oxygenation was implanted through the axillary vessels. However, due to a lack of ejection and severe dilatation of the left ventricle, an Impella 2.5 was implanted. Due to the small diameter of the femoral arteries, we performed a trans‐aortic implantation through a median sternotomy via a Dacron tube graft. We report on the procedure and perioperative outcome. [ABSTRACT FROM AUTHOR]

Importance: The use of factor VIII (FVIII) concentrates under pharmacokinetic (PK) guidance has become the main approach for treatment of hemophilia. However, limited PK research has been conducted in Chinese pediatric patients. Objective: To investigate the PK parameters of various FVIII concentrates in Chinese pediatric patients. Methods: Seventy‐nine patients were enrolled (28 treated with Kogenate FS®, 23 treated with Advate ®, and 28 treated with GreenMono™). All enrolled patients participated in single‐dose PK analysis after at least a 3‐day washout period. Blood samples were collected predose, as well as at 1 h, 9 h, 24 h, and 48 h after infusion; FVIII levels were measured using a one‐stage clotting assay. von Willebrand Factor Antigen (VWF:Ag) levels and blood types were also determined. PK parameters were evaluated by WAPPS‐Hemo. Results: Mean values of terminal elimination half‐life time (t1/2) for the Kogenate FS®, Advate®, and GreenMono™ FVIII groups were 12.24 h, 10.18 h, and 9.62 h; median clearance values were 4.16, 6.23, and 5.11 mL·kg−1·h−1; and median in vivo recovery values were 1.97, 1.55, and 1.61 IU/dL per IU/kg. Longer t1/2, higher in vivo recovery, and lower clearance were observed in patients with higher VWF:Ag level who were treated with recombinant concentrates. Interpretation: Chinese pediatric patients with hemophilia had FVIII PK characteristics similar to those previously observed in non‐Chinese children, including large variation among individuals. VWF:Ag level and FVIII brand were associated with differences in FVIII PK. Thus, PK‐guided dosing should be used to optimize individualized therapy in Chinese children. [ABSTRACT FROM AUTHOR]

The specific description, risk factors, and outcomes of aGVHD in pediatric haplo- HSCT using TCR protocols without PT-Cy have not been well described previously. We evaluated the incidence, risk factors, and outcomes of aGVHD in 350 consecutive pediatric patients receiving TCR haplo-HSCT without PT-Cy according to the Glucksberg and NIH aGVHD classifications between January 2015 and December 2017 at Peking University Institute of Hematology. The cumulative incidences of grade I, II, III, and IV aGVHD were 28%, 29.7%, 8.3%, and 5.1%, respectively. The type of aGVHD onset was classic in 243 patients (97.2%), and persistent/recurrent/late-onset aGVHD was in seven patients (2.8%). None of the considered variables significantly influenced the incidence of grade III-IV aGVHD. The 3-year OS, DFS, cumulative incidence of NRM, and relapse in malignant disease between severe aGVHD (III-IV) group and grade 0-II aGVHD group were 61.5% vs 77.2% (P = .027), 58.6% vs 75.1% (P = .014), 19.8% vs 5.3% (P = .002), and 21.6% vs 19.6% (P = .59), respectively; in non-malignant diseases, the 3-year OS, DFS, and NRM were 81.8% vs 97.4% (P = .05), 81.8% vs 97.4% (P = .05), and 18.2% vs 2.6% (P = .05), respectively. Under the protocol of pediatric TCR haplo-HSCT without PT-Cy, the persistent/recurrent/late-onset aGVHD was rare, and the incidence of severe aGVHD was acceptable and significantly contributed to NRM and lower survival in both malignant disease and non-malignant diseases. [ABSTRACT FROM AUTHOR]

The common practice of therapeutic drug monitoring (TDM) involves the quantification of drug plasma concentrations at a specific time in a dosing window. Although TDM for antibiotics is not considered mandatory, it may represent a valid tool for clinicians in order to limit antibiotic resistance and avoid therapeutic failures. The aim of our study was to develop and validate a high‐performance liquid chromatography–diode array detection method for simultaneous quantification of 10 antibiotics in plasma. This method has a fast analytical procedure that uses the same chromatographic conditions to quantify ceftazidime, ceftriaxone, meropenem, ertapenem, ciprofloxacin, tigecycline, ampicillin, levofloxacin and piperacillin, plus the β‐lactamase inhibitor tazobactam. Method validation was ensured by testing selectivity, accuracy, precision, limits of detection and quantification, recovery and stability. The calibration ranges, established accordingly to the expected plasma concentration in patients, showed a coefficient of determination >0.996 for all compounds. Within‐ and between‐days precisions reported a coefficient of variation >15%. Similarly, the accuracy evaluation reported a relative standard deviation of <10% for each antibiotic. The recovery ranged between 97 and 103% for all compounds. This method could represent a useful tool for TDM of antibiotics. [ABSTRACT FROM AUTHOR]

Background: Leukemia can create a significant economic burden on the patients and their families. The objective of this study is to assess the medical expenditure and compensation of pediatric leukemia, and to explore the incidence and determinants of catastrophic health expenditure (CHE) among households with pediatric leukemia patients in China. Methods: A cross‐sectional interview was conducted among households living with pediatric leukemia using a questionnaire in two tertiary hospitals. CHE was defined as out‐of‐pocket (OOP) payments that were greater than or equal to 40% of a household's capacity to pay (CTP). Chi‐square tests and logistic regression analysis were performed to identify the determinants of CHE. Results: Among 242 households living with pediatric leukemia, the mean OOP payment for pediatric leukemia healthcare was $9860, which accounted for approximately 35.7% of the mean household's CTP. The overall incidence of CHE was 43.4% and showed a downward trend with the lowest income group at 69.0% to the highest income group at 16.1%. The logistic regression model found that medical insurance, frequency of hospital admissions, charity assistance, and income level were significant predictors of CHE. Conclusion: The results revealed that pediatric leukemia had a significant catastrophic effect on families, especially those with lower economic status. The occurrence of CHE in households living with pediatric leukemia could be reduced by addressing income disparity. In addition, extending coverage and improving compensation from medical insurance could also alleviate CHE. Some other measures that can be implemented are to address the barriers of charity assistance for vulnerable groups. [ABSTRACT FROM AUTHOR]

Background: Intralesional vitamin D3 has recently emerged as a new treatment for cutaneous warts. The use of the measles, mumps, and rubella (MMR) vaccine for this purpose is an established modality. However, relevant data on the efficacy of either the MMR vaccine or vitamin D3 as immunotherapy for cutaneous warts in the pediatric population are limited. Objectives: To compare the efficacy and safety of intralesional injections of MMR vaccine to intralesional injections of vitamin D3 in children aged 8‐16 years with multiple warts. Methods: A total of 74 children were randomly allocated into two groups. Group A patients received intralesional MMR vaccine into the largest wart, and group B received intralesional vitamin D3 into the largest wart. The injections were repeated every 4 weeks until clearance or for a maximum of three treatments. After the last injection, children were followed up every 2 weeks for 3 months, and at the sixth month, a final clinical assessment was conducted. Results: Of 74 children, 60 completed the study, with 30 children in each group. Complete clearance of the injected wart was observed in 26 (86.67%) patients in the MMR group (group A) and 23 (76.7%) patients in the vitamin D3 group (group B). Distant warts cleared in 23 (76.7%) patients in group A compared to 20 (66.6%) patients in group B. There was no significant difference between groups. No recurrence was seen in group A, whereas two (6.6%) children in group B exhibited recurrence in the ensuing 6‐month follow‐up. The most common adverse events were injection site pain and swelling. Conclusion: Both intralesional MMR and vitamin D3 are safe, generally well‐tolerated, and equally effective in children for the treatment of cutaneous warts. [ABSTRACT FROM AUTHOR]

There is a current outbreak of coronavirus disease 2019 (COVID‐19), with a global spread. With the rapid increase in the number of infections, an increase is observed in the number of children with COVID‐19. Most research findings are regarding adult cases, which are not always transferrable to children. Evidence‐based studies are still expected to formulate clinical decisions for pediatric patients. In this review, we included 2597 pediatric patients that reported recently and evaluated the demographic, clinical, laboratory, and imaging features of children with COVID‐19. We found that even lymphopenia was the most common lab finding in adults; it infrequently occurred in children (9.8%). Moreover, elevated creatine kinase MB isoenzyme was much more commonly observed in children (27.0%) than that in adults, suggesting that heart injury would be more likely to occur in pediatric patients. Our analysis may contribute to determine the spectrum of disease in children and to develop strategies to control the disease transmission. Highlights: There is a current outbreak of coronavirus disease 2019 (COVID‐19), with a global spread. Most research findings are regarding adult cases, which are not always transferrable to children. Here, we include 2597 pediatric patients and summarize the demographic, clinical, laboratory, and imaging characteristics of children with COVID‐19. [ABSTRACT FROM AUTHOR]

This paper reports a case of a labial pyogenic granuloma in the lower lip of a 15-year-old boy due to chronic trauma from the maxillary left central incisor. The case report is based on the CARE (CAse REport) Checklist developed by the Joanna Briggs Institute. A further aim is to present a mini-review about the link between labial pyogenic granuloma and trauma, through searching in three databases (MEDLINE, EMBASE, and Global Health) using a predefined search strategy and keywords. The Cochrane Library and PROSPERO were also searched for published and ongoing systematic reviews, respectively. Only five case reports were found that discussed the link between labial pyogenic granuloma and trauma. Chronic trauma was found to be the most common cause of pyogenic granuloma affecting the lip. Excisional biopsy was the preferable treatment due to the advantage of allowing histopathologic assessment, which is necessary to establish a definitive diagnosis. Dentists advise to include labial pyogenic granuloma in their differential diagnosis (ie, mucocele, cyst, abscess, hematoma, minor salivary gland trauma or tumor) when assessing lesions in the upper and lower lips, in particular when related to a history of trauma. [ABSTRACT FROM AUTHOR]

Background: The use of lung‐protective ventilation strategies with low tidal volumes may reduce the occurrence of postoperative pulmonary complications. However, evidence of the association of intraoperative tidal volume settings with pulmonary complications in pediatric patients undergoing major spinal surgery is insufficient. Aims: This study examined whether postoperative pulmonary complications were related to tidal volume in this population and, if so, what factors affected the association. Methods: In this retrospective cohort study, data from pediatric patients (<18 years old) who underwent posterior spinal fusion between 2016 and 2018 were collected from the hospital electronic medical record. The associations between tidal volume and the clinical outcomes were examined by multivariate logistic regression and stratified analysis. Results: Postoperative pulmonary complications occurred in 41 (16.1%) of 254 patients who met the inclusion criteria. For the entire cohort, tidal volume was associated with an elevated risk of pulmonary complications (adjusted odds ratio [OR] per 1 mL/kg ideal body weight [IBW] increase in tidal volume, 1.28; 95% confidence interval [CI], 1.01‐1.63, P =.038). In subgroup analysis, tidal volume was associated with an increased risk of pulmonary complications in patients older than 3 years (adjusted OR per 1 mL/kg IBW increase in tidal volume, 1.43, 95% CI: 1.12‐1.84), but not in patients aged 3 years or younger (adjusted OR, 0.78, 95% CI: 0.46‐1.35), indicating a significant age interaction (P =.035). Conclusion: In pediatric patients undergoing major spinal surgery, high tidal volume was associated with an elevated risk of postoperative pulmonary complications. However, the effect of tidal volume on pulmonary outcomes in the young subgroup (≤3 years) differed from that in the old (>3 years). Such information may help to optimize ventilation strategy for children of different ages. [ABSTRACT FROM AUTHOR]

Methotrexate (MTX) pharmacokinetics has substantial inter‐individual variability and toxicity. In children with medulloblastoma treated with high‐dose methotrexate (HD‐MTX), the pharmacokinetic properties of methotrexate have not been established. A total of 660 serum samples from 105 pediatric patients with medulloblastoma were included in a population pharmacokinetic (PPK) analysis of methotrexate by using the nonlinear mixed‐effects modeling method. The basic one‐compartment population pharmacokinetic model was established by NONMEM software and the first‐order conditional estimation (FOCE) method, and the final covariate model was obtained by the stepwise regression method. Weight (WT), creatinine clearance (CrCL), and whether the treatment was combined with dexamethasone (DEX) were covariates that had significant effects on the clearance rate (CL) of the model. The pharmacokinetic equation of CL in the final covariate model was as follows: CLi = 9.23× (1 + 0.0005× (θCrCL‐105.78)) × (1 + 0.0017× (θWT‐16)) × eηcl,i (L/h), IF (θDEX) CLi = 1.19× CLi (L/h). The estimation accuracy of all pharmacokinetic parameters were acceptable (relative standard error < 14.74%). The goodness‐of‐fit diagram and bootstrap tests indicated that the final PPK model was stable with acceptable predictive ability. The PPK model may be useful for determining personalized medication levels in pediatric medulloblastoma patients undergoing HD‐MTX therapy. [ABSTRACT FROM AUTHOR]

Mycosis fungoides (MF) is the most common primary cutaneous lymphoma in pediatric patients. Given the indolent nature of MF, symptoms often present in childhood but may not be diagnosed as MF until adulthood. Delayed diagnosis is associated with poor long‐term prognosis. Thus, increased clinician recognition and accurate diagnosis of early‐stage MF in pediatric patients is critically important. In this review, we summarize the clinical features of the most common pediatric MF subtypes and highlight important differences between pediatric and adult MF. Moreover, we reviewed all pediatric MF case series published between 2008 and 2018 to analyze treatment modalities and identify emerging therapies. As treatment of pediatric MF is complex, selection of therapy varies significantly depending upon the specific clinical characteristics, disease severity, and patients' preferences. [ABSTRACT FROM AUTHOR]