BMC Pediatrics最新文献

{"title":"Moral distress in pediatric complex care coordinators: a reflexive thematic analysis.","authors":"Simran Chahal, Genevieve Currie, Seong Eon Ha, Skanda Kaushik, Ishnoor Nahal, Myka Estes, Shannon Jaskela, Kiran Pohar Manhas, Julie Lauzon, Ian Mitchell, Stacey Page, Jennifer Zwicker, Deborah Dewey, W Ben Gibbard, Sarah J MacEachern","doi":"10.1186/s12887-026-07421-1","DOIUrl":"10.1186/s12887-026-07421-1","url":null,"abstract":"<p><strong>Background: </strong>Moral distress can occur in situations where one wants to follow a desired course of action but experiences restraints from internal and external barriers. Unaddressed moral distress is associated with negative outcomes (e.g., burnout). Due to the nature of their work with medically and neurodevelopmentally complex children and their families, pediatrics complex care coordinators are at risk of experiencing moral distress. However, there is limited understanding of moral distress in this professional population. Study objectives were to: (1) understand how pediatric complex care coordinators at a tertiary pediatric hospital defined moral distress; (2) explore factors that influence and modulate moral distress in these care coordinators; and (3) explore the impacts of moral distress on care coordinators.</p><p><strong>Methods: </strong>Semi-structured virtual interviews were conducted with twelve pediatric complex care coordinators from a pediatric tertiary care centre to explore experiences with moral distress. Interviews ranged from 25 to 60 min. Interview transcripts were examined by two researchers using inductive reflexive thematic analysis for each objective. The data were analyzed and coded and a 15-point checklist was utilized throughout each phase of the analysis process for consistency amongst coders.</p><p><strong>Results: </strong>All participants reported experiencing moral distress using the seminal definition of moral distress. Care coordinators added additional context and depth to this definition. Factors influencing and modulating moral distress in care coordinators were identified: (1) restrictiveness of their scope and capacity; (2) individual experiences; (3) availability of coping mechanisms; (4) the nature of their interactions; and (5) resolution. Four themes on the impact of moral distress were also identified: (1) changes in perspective; (2) impacts on well-being; (3) need for internal and external change; and (4) influence on interpersonal relationships.</p><p><strong>Conclusion: </strong>An expanded definition of moral distress was co-created with care coordinators and identified factors that influenced moral distress and impacts of moral distress. This work is an important first step to developing a better understanding of moral distress in care coordinators and could inform future interventions to address moral distress in this population.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13700320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149262714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental perspectives on clinician guidance in value-laden NICU conversations: a qualitative study.","authors":"Christine Arnold, Julian Eychmüller, Dina Hediger, Stephanie Vanessa Schmid, Sophie Jaisli, André Kidszun","doi":"10.1186/s12887-026-07304-5","DOIUrl":"10.1186/s12887-026-07304-5","url":null,"abstract":"<p><strong>Background: </strong>Value-laden decisions about life-sustaining treatment for critically ill infants in the neonatal intensive care unit (NICU) present profound emotional and ethical challenges for parents and clinicians. In such situations, clinicians must balance providing guidance with respecting parental autonomy. We explored parental perspectives on clinician guidance and effective communication during these decisions.</p><p><strong>Methods: </strong>We conducted a secondary qualitative analysis within a randomized clinical trial using parental free-text responses to a simulated neonatal decision-making scenario. The study was carried out online between February and April 2024 in Switzerland, Germany, and Austria. Eligible participants were German-speaking parents of preterm infants with prior NICU experience, recruited through patient and parent organizations. Data were analyzed using qualitative content analysis.</p><p><strong>Results: </strong>Among 128 participants (84% female), parents emphasized the importance of clear, detailed, and evidence-based information about their child's condition and treatment options, as well as empathetic, honest, and individualized communication. They valued sufficient time for discussion and reflection, access to second opinions, and attention to the child's quality of life. Parents appeared to retain a sense of decision ownership, while differing in their preferences regarding clinician guidance. Some welcomed explicit recommendations, whereas others preferred neutral, value-sensitive communication that preserved space for independent deliberation.</p><p><strong>Conclusions: </strong>Parents facing complex medical decisions value both high-quality information and empathetic and honest communication. While they generally retain decision ownership, preferences regarding clinician guidance vary, suggesting that clinicians should actively explore how much direction parents want and tailor their communication accordingly.</p><p><strong>Trial registration: </strong>ISRCTN registry under number ISRCTN16123073, registration date: 17/01/2024, ( https://www.isrctn.com/ISRCTN16123073 ).</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13700193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149262830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of pharmacologic therapies for reducing bronchopulmonary dysplasia and mortality in preterm infants: a network meta-analysis.","authors":"Runjia Zhao, Wei Guo","doi":"10.1186/s12887-026-07408-y","DOIUrl":"10.1186/s12887-026-07408-y","url":null,"abstract":"<p><strong>Background: </strong>Bronchopulmonary dysplasia (BPD) is a major complication of prematurity and is associated with substantial respiratory morbidity, impaired growth, and increased mortality in severe cases. Pharmacologic prevention strategies have been evaluated in randomized trials, but their comparative effects remain uncertain.</p><p><strong>Aim: </strong>This network meta-analysis aimed to summarize the comparative evidence for pharmacologic interventions evaluated for reducing BPD incidence and pre-discharge mortality in preterm infants.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane Library, and Web of Science for randomized controlled trials (RCTs) investigating pharmacological therapies for BPD prevention, with a search cutoff of September 1, 2025. Data analysis was conducted using R 4.2.3 software. The primary outcome was BPD incidence, and the secondary outcome was pre-discharge mortality. BPD definitions and assessment timepoints were extracted from individual studies and interpreted considering variation across NIH 2001, NIH 2018, Shennan, or study-specific criteria.</p><p><strong>Results: </strong>Thirty-six randomized controlled trials involving 11,414 preterm infants were included in the systematic review. Of these, 24 trials contributed to the BPD incidence network, and 19 trials contributed to the pre-discharge mortality network. Several interventions showed comparative signals for lower odds of BPD incidence or pre-discharge mortality when compared with placebo; however, the strength and precision of these signals varied across comparisons. In the BPD incidence network, some estimates excluded the null, but several comparisons were informed partly by indirect evidence or sparsely connected nodes. In the pre-discharge mortality network, favorable estimates were less certain because mortality events were sparse and several 95% credible intervals (CrIs) were wide. The certainty of evidence was moderate for BPD incidence and low for pre-discharge mortality. SUCRA rankings were therefore interpreted only as probabilistic summaries within the network and not as evidence of clinical superiority.</p><p><strong>Conclusion: </strong>This network meta-analysis identified several comparative signals for pharmacologic prevention of BPD and reduction of pre-discharge mortality in preterm infants. However, these findings are constrained by low-to-moderate certainty of evidence, indirect comparisons, sparse network nodes, and imprecision in several estimates. The results should therefore be interpreted as evidence-mapping and hypothesis-generating rather than as treatment recommendations. Future studies should prioritize direct head-to-head comparisons, phenotype- or severity-specific analyses, and long-term respiratory and neurodevelopmental outcomes.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intussusception as a rare cause of abdominal pain in a child with idiopathic nephrotic syndrome: a case report and review of literature.","authors":"A S Athapathu, A K Fathima Nisra, K E G P Padmasiri, R P A S Rajapakshe, N D W Arachchige","doi":"10.1186/s12887-026-07417-x","DOIUrl":"10.1186/s12887-026-07417-x","url":null,"abstract":"<p><strong>Background: </strong>Intussusception is a rare cause of abdominal pain in children with nephrotic syndrome with only a few reported cases. The best management pathway has still not yet been determined, with two case reports describing the response to intravenous albumin infusion with loop diuretics, and others reporting the need for pneumatic, hydrostatic, or surgical reduction. This case report describes a child with nephrotic relapse with two simultaneous intussusceptions: an ileo-ileal intussusception that responded to intravenous albumin with Furosemide, and a colo-colic intussusception that needed hydrostatic reduction.</p><p><strong>Case presentation: </strong>A seven-year-old boy with idiopathic nephrotic syndrome presented with his first relapse. On admission he had mild periorbital and ankle oedema and was started on prednisolone induction therapy. On day five of induction, the patient developed abdominal pain. He had developed significant weight gain and worsening oedema. The periumbilical pain escalated within hours to an excruciating continuous central abdominal pain with a poor response to analgesics. Even though he developed a fever spike, he remained well perfused with good urine output and no clinical evidence of peritonitis. Inflammatory markers including C-reactive protein were negative. The serum albumin level was markedly low, and the serum amylase level was normal. An intravenous infusion of 20% albumin 1g/kg over 4 hours with Furosemide had negligible effect on abdominal pain. Abdominal ultrasound revealed one ileo-ileal and another colo-colic intussusception. Ultrasound was repeated 5 hours after the albumin infusion which was able to visualize only the colo-colic intussusception, which was then hydrostatically reduced. The ileo-ileal intussusception had already been reduced following the albumin infusion. The boy's abdominal pain improved soon after, and he made a complete recovery achieving nephrotic remission on day fifteen of induction.</p><p><strong>Conclusion: </strong>A broad differential diagnosis of abdominal pain in children with nephrotic syndrome is vital. If pain persists despite exclusion and treatment of common causes, an ultrasound would be useful for identifying intussusception. Compared with colo-colic intussusception, ileo-ileal intussusception in nephrotic syndrome patients may be more amenable to treatment with intravenous albumin and loop diuretics.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13693192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149243043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What shapes participation in cerebral palsy? A Co-produced PEM-CY scoping review with mothers with lived experience.","authors":"Jaíza Marques Medeiros E Silva, Jean Bendito Félix, Viviann Alves de Pontes, Lívia Ferreira Coutinho Alonso, Michele Gomes da Silva, Mayra Conceição Lima da Silva Paiva, Hércules Ribeiro Leite, Kennea Martins Almeida Ayupe, Rosane Luzia de Souza Morais, Paula Silva de Carvalho Chagas, Ana Cristina Resende Camargos, Ana Carolina de Campos, Rafaela Silva Moreira, Luiz Medeiros Araujo Lima-Filho, Egmar Longo","doi":"10.1186/s12887-026-07282-8","DOIUrl":"10.1186/s12887-026-07282-8","url":null,"abstract":"<p><strong>Background: </strong>Children and adolescents with cerebral palsy (CP) may experience restricted participation across different settings. Although several instruments assess participation, the Participation and Environment Measure for Children and Youth (PEM-CY), a caregiver-report instrument, is a robust tool for evaluating both Participation and Environment. This study aimed to map Participation and Environment in the home, school, and community settings of children and adolescents with CP using the PEM-CY, in partnership with a Public and Patient Involvement (PPI) group, to ensure that the review reflects the experiences and priorities of families.</p><p><strong>Methods: </strong>This scoping review was structured according to the guidelines provided by the Joanna Briggs Institute (JBI) and adapted to incorporate contributions from the PPI group, comprising mothers of children with CP, three physiotherapists, and one occupational therapist. Partner mothers contributed to developing the guiding research question, selecting search keywords, reviewing the results, interpreting the findings, and refining the review's implications and conclusions. Searches were conducted in six electronic databases (Medline/PubMed, Embase, Scopus, Web of Science, Lilacs, and CINAHL). We included original observational studies that examined Participation and Environment using the PEM-CY. Data were collected using a custom extraction form and presented in tables and figures.</p><p><strong>Results: </strong>Twelve studies from different countries were included. Participation was higher at home and lower in the community, both in frequency and involvement, while the desire for change was most pronounced in community activities. Children with CP showed lower participation and less environmental support than peers without disabilities, and higher motor function and physical activity were associated with greater participation.</p><p><strong>Conclusion: </strong>Children and adolescents with CP face greater challenges in participating in activities, particularly in community settings, when compared to their peers without disabilities. Higher levels of physical activity, environmental adaptation, and family and clinical support increases participation among children and adolescents with CP. The inclusion of the PPI group added social relevance and sensitivity to the theoretical process of the review, helping ensure that the findings better reflect the needs and priorities of families. Retrospectively registered: 10.17605/OSF.IO/VPQM5.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13693240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149242971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic and genomic determinants of antimicrobial resistance in indian children: a systematic review and meta-analysis.","authors":"Sunil Kumar, Santenna Chenchula, Rahul Bhalsenge, Rupesh Kumar Gupta, Padmavathi R, Manav Yadav, Manjari Gupta, Shubham Atal, Chandramohan S Reddy, Sharad Yadav, Diwakar Patel, Niket Rai, Tushaar Chandrakant Baheti, Raj Kumar Sharma, Ashrai Padavala, Mohan Krishna Ghanta, Sri Vasista T","doi":"10.1186/s12887-026-07389-y","DOIUrl":"10.1186/s12887-026-07389-y","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) is a major public health challenge, especially in the pediatric population in low- and middle-income countries, particularly India, where the burden of pediatric infections is high. However, nationally representative, pediatric-specific estimates of AMR with geographic stratification remain lacking. We conducted a systematic review and meta-analysis to define the magnitude and regional variation of AMR among Indian children.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 and the Joanna Briggs Institute guidelines. PubMed/MEDLINE, Scopus, and the Cochrane Library were searched from inception to December 2025 for studies reporting antimicrobial resistance in bacterial isolates from children (≤ 18 years) in India. Given substantial clinical and methodological heterogeneity across pathogens, antibiotic classes, and settings, we conducted stratified random-effects meta-analyses by geographic zone for key resistance phenotypes.</p><p><strong>Results: </strong>Forty-seven studies met the inclusion criteria, of which 23 contributed to the quantitative synthesis. Pronounced geographic heterogeneity in AMR was observed across India. The number of studies contributing to each pooled estimate ranged from 2 to 8, and heterogeneity (I²) ranged from 19% to 79%. Carbapenem resistance among neonatal intensive care unit isolates ranged from 12% (95% CI 8-18) in Central India to 80% (70-88) in North India. Extended-spectrum β-lactamase production was consistently high (60-80%) across most regions, but lower in Central India (38%). Methicillin-resistant Staphylococcus aureus prevalence ranged from 35% (26-44) to 61% (49-72). Fluoroquinolone resistance exceeded 85% in North, South, and East/Northeast regions, whereas colistin resistance remained ≤ 8% nationally. Genomic data demonstrated widespread dissemination of blaCTX-M-15 and regional clustering of carbapenemase genes (blaNDM, blaOXA), supporting both clonal spread and horizontal gene transfer.</p><p><strong>Conclusion: </strong>Antimicrobial resistance in Indian children is highly prevalent and geographically heterogeneous, with up to five-fold regional differences in carbapenem resistance. In high-burden regions, these resistance levels are likely to compromise the effectiveness of standard empirical therapies, particularly in neonatal and critical care settings. These findings support the urgent need for region-specific empirical treatment guidelines, pediatric-focused antimicrobial stewardship, and integrated phenotypic-genomic surveillance systems.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13693051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149243012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise tolerance test in Kawasaki patients without coronary lesions.","authors":"Ehsan Aghaei-Moghadam, Vahid Ziaee, Keyhan Sayadpour Zanjani, Fatemeh Tahghighi Sharabian, Payman Sadeghi, Fatemeh HadavandKhani, Sadatinejad Seyyed Mohsen","doi":"10.1186/s12887-026-07397-y","DOIUrl":"10.1186/s12887-026-07397-y","url":null,"abstract":"<p><strong>Introduction: </strong>Kawasaki disease (KD) is a systemic vasculitis of unknown origin and the leading cause of acquired heart disease in children in developed countries. If untreated, it can cause coronary artery damage in up to 25% of cases. Lifelong follow-up is essential, even for patients without obvious coronary lesions (risk level-I KD). Since some cardiac abnormalities may not be apparent at rest, stress testing offers valuable insight. This study aimed to evaluate exercise tolerance test (ETT) outcomes in children with a history of risk level-I KD compared to a control group.</p><p><strong>Materials and methods: </strong>This case-control study included children aged 5-17 years with documented KD without coronary lesions and at least six months since disease onset. After ethics approval, participants underwent a standardized treadmill test (modified Bruce protocol). A control group of healthy children was also included; however, exact age-matched analysis was not possible due to recruitment constraints.</p><p><strong>Results: </strong>Sixty children were divided equally into KD and control groups. The KD group had significantly lower mean age, height, weight, and BSA compared to the control group. After adjusting for these variables, most exercise indices showed no significant difference between groups, except for chronotropic incompetence which was more prevalent in the KD group. However, most differences became non-significant after adjusting for age and BMI.</p><p><strong>Conclusion: </strong>Children with KD generally showed normal exercise tolerance, but a reduced chronotropic response may indicate subtle residual cardiac effects. These findings suggest a potential for subtle cardiac effects and may support the consideration of stress-based evaluation in select patients; however, further larger prospective studies are needed to confirm these observations.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13693174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149243035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive management of pediatric hereditary spherocytosis: severity-stratified biliary risk and indications for simultaneous cholecystectomy and biliary intervention at laparoscopic splenectomy - a single-center retrospective study.","authors":"Radek Ambrož, Petr Birke, Jiří Kysučan, Martin Stašek, Štefan Kolcún, Dušan Klos, Martin Loveček, Barbora Ludíková, Zbyněk Novák, Dagmar Pospíšilová","doi":"10.1186/s12887-026-07358-5","DOIUrl":"10.1186/s12887-026-07358-5","url":null,"abstract":"<p><strong>Background: </strong>Hereditary spherocytosis (HS) is an inherited hemolytic anemia in which splenectomy may be indicated in moderate to severe disease. Chronic hemolysis increases the risk of cholelithiasis and biliary complications, but optimal timing of cholecystectomy remains uncertain.</p><p><strong>Methods: </strong>A retrospective single-center analysis of pediatric patients with moderate to severe HS who underwent laparoscopic splenectomy between January 2017 and January 2024. Evaluated variables included disease severity, demographics, cholelithiasis, biliary manifestations, requirement for endoscopic retrograde cholangiopancreatography (ERCP), operative time, postoperative complications, and length of hospital stay.</p><p><strong>Results: </strong>Thirteen patients were included (5 male, 8 female; mean age 11.9 ± 4.3 years): 6 with moderate HS and 7 with severe HS. Cholelithiasis was present in 9 patients (69.2%). Major biliary complications (biliary pancreatitis or obstructive jaundice) occurred in 4/7 patients with severe HS (57.1%) compared with 1/6 patients with moderate HS (16.7%); ERCP was required in the same proportions. Mean operative time was 124.7 ± 44.7 min and mean hospital stay was 6.1 ± 1.9 days. No major postoperative surgical complications occurred; one patient developed pleural effusion (Clavien-Dindo grade I). Hemoglobin, reticulocyte count, and bilirubin levels improved after surgery and remained improved during follow-up.</p><p><strong>Conclusions: </strong>Laparoscopic splenectomy was safe and effective in this small cohort of children with hereditary spherocytosis. These preliminary findings suggest that children with severe HS and cholelithiasis may represent a subgroup in whom the potential role of concomitant or early cholecystectomy warrants prospective evaluation. Because of the small sample size, retrospective design and absence of a direct comparison between prophylactic and delayed cholecystectomy strategies, these findings should not be interpreted as a clinical recommendation. The data are insufficient to support a subgroup-specific conclusion for children with moderate HS.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13693155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149242989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A practical strategy to reduce perioperative hypothermia in NICU patients.","authors":"Anna Chizuko Hoover, Anne Harrington, Francine Yudkowitz, Courtney Juliano, Shanna Spain, Brian Arrinza Coakley","doi":"10.1186/s12887-026-07290-8","DOIUrl":"10.1186/s12887-026-07290-8","url":null,"abstract":"<p><strong>Background: </strong>Neonates and infants undergoing surgery are at particularly high risk of developing hypothermia, as defined by a temperature less than 36 °C. Perioperatively, they are vulnerable to temperature dysregulation during transport to and from the operating room as well as exposure during the surgery itself. Additionally, their unique body composition makes heat conservation and thermoregulation challenging as compared to adults. Our aim was to reduce the rate of perioperative hypothermia in neonates and infants hospitalized in the neonatal intensive care unit (NICU) who underwent a surgical procedure.</p><p><strong>Methods: </strong>Our team utilized the Model for Improvement with sequential Plan-Do-Study-Act (PDSA) cycles to implement interventions aimed at reducing perioperative hypothermia rates. This included development of a hypothermia prevention bundle, creation of checklists and education tools for providers, regular case review and supplemental bundle interventions for the highest risk patients.</p><p><strong>Results: </strong>Perioperative hypothermia rates decreased significantly to less than 5% after study interventions compared to a baseline rate of 16.9%. There was no change in the pre-specified balancing measure of postoperative hyperthermia.</p><p><strong>Conclusion: </strong>This quality improvement initiative, which prioritized implementation of a prevention bundle, addition of specialized bundle elements for high-risk cohorts, and regular case review, resulted in a decrease in perioperative hypothermia rates for NICU patients undergoing surgical procedures.</p>","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13711726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149262719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the efficacy of pentazocine and tramadol for reducing emergence agitation in children after general anesthesia: a retrospective cohort study.","authors":"Weilian Ren, Bingqi Wang, Baoyu Han, Hao Li","doi":"10.1186/s12887-026-07410-4","DOIUrl":"10.1186/s12887-026-07410-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Emergence agitation (EA) is a common postoperative complication in pediatric anesthesia that can lead to serious safety events and increased healthcare burden. Both pentazocine and tramadol are frequently used for postoperative analgesia in children, but their comparative effectiveness in preventing EA remains unknown. This study aimed to compare the efficacy of a single intravenous dose of tramadol versus pentazocine for reducing EA in children undergoing tonsillectomy and adenoidectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center retrospective cohort study included 240 children aged 2-12 years who underwent elective tonsillectomy and adenoidectomy under general anesthesia with remimazolam induction. Patients received either pentazocine 0.4 mg/kg or tramadol 1 mg/kg intravenously immediately after surgery. The primary outcome was the incidence of EA, defined as a Pediatric Anesthesia Emergence Delirium (PAED) scale score ≥ 10 at any time during the post-anesthesia care unit (PACU) stay. Secondary outcomes included PAED score trajectories over time, PACU stay duration, postoperative pain (FLACC scale), and adverse events (nausea/vomiting, respiratory depression). Statistical analyses primarily used multivariable logistic regression; secondary and sensitivity analyses (linear mixed models, generalized estimating equations, spline-based models, and Cox regression) were performed to assess robustness and are detailed in the Supplementary Material.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The unadjusted incidence of EA was 0.8% (1/120) in the tramadol group and 14.2% (17/120) in the pentazocine group (relative risk 17.00, 95% CI: 2.30-125.73, p &lt; 0.001). Multivariable logistic regression, adjusting for potential confounders, showed that the pentazocine group had higher odds of EA (OR = 12.61, 95% CI: 2.33-234.43, p = 0.017), although the wide confidence intervals reflect the low event rate. Linear mixed models suggested a significant group-by-time interaction (p &lt; 0.001), with higher PAED scores in the pentazocine group at 5 and 10 min but convergence by 20 min. Exploratory time-to-event analyses (Kaplan-Meier and Cox regression) suggested that the pentazocine group had a slower agitation resolution rate compared with the tramadol group (HR = 0.73, 95% CI: 0.56-0.96, p = 0.025), consistent with faster resolution in the tramadol group. However, these results should be interpreted cautiously due to fixed-time assessments. PACU stay was shorter in the tramadol group (median 32 vs. 34 min, p &lt; 0.001). Adverse event rates were low and comparable between groups. Extended analyses (GEE, spline-based models) consistently supported the primary findings (see Supplementary Material).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this retrospective cohort, tramadol was associated with a lower incidence of EA and faster recovery compared with pentazocine, without an observed increase in short-term adverse events. The adjusted odds ratio of 1","PeriodicalId":9144,"journal":{"name":"BMC Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13689030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149236854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}