Search Results (1,068)

Post-hemorrhagic hydrocephalus (PHH) is a serious neurological sequela of severe intraventricular hemorrhage (IVH) in premature infants and remains one of the leading indications for ventriculoperitoneal (VP) shunt placement. Evaluating possible VP shunt-related complications can be challenging because clinical manifestations are often nonspecific, neuroimaging may initially appear unchanged, and microbiological cultures may remain negative. We report the case of a 19-month-old male born at 28 weeks’ gestation who developed Grade IV germinal matrix/intraventricular hemorrhage with bilateral intraparenchymal extension, early periventricular cystic leukomalacia, and post-hemorrhagic communicating hydrocephalus requiring multiple cerebrospinal fluid diversion procedures culminating in long-term VP shunt dependence. His medical history was notable for recurrent neonatal meningitis, secondary epilepsy with previous episodes of status epilepticus, secondary adrenal insufficiency, and severe global developmental delay. He presented with fever, recurrent coffee-ground vomiting, abdominal distension, progressive lethargy, reduced responsiveness, and localized erythematous swelling over the cranial VP shunt reservoir, raising concern for possible shunt-related pathology. During hospitalization, he deteriorated with status epilepticus and respiratory failure, with clinical concern for increased intracranial pressure, requiring admission to the Pediatric Intensive Care Unit (PICU). Laboratory investigations demonstrated leukocytosis, elevated C-reactive protein, cerebrospinal fluid pleocytosis, markedly elevated CSF protein, and CSF glucose of 2.0 mmol/L, for which a paired serum glucose value was unavailable, while repeated blood, urine, wound, and CSF cultures remained negative. Initial computed tomography (CT) demonstrated no significant interval change in the chronic hydrocephalus despite progressive neurological deterioration; however, serial neuroimaging later revealed progressive bilateral extra-axial fluid collections with radiological features suggestive of an evolving subacute subdural hemorrhage. The patient was managed with empirical broad-spectrum intravenous antibiotics, aggressive seizure control, stress-dose corticosteroids, respiratory support, and continuous multidisciplinary monitoring. His neurological and respiratory status subsequently improved, and he returned to his pre-admission neurological baseline before discharge with planned further evaluation at a tertiary pediatric neurosurgical center. This case highlights the diagnostic uncertainty surrounding acute neurological deterioration in a child with shunt-dependent PHH. VP shunt-related infection or malfunction remained important but unconfirmed diagnostic considerations, alongside competing or potentially overlapping contributors including status epilepticus, evolving extra-axial collections, respiratory infection, and endocrine or metabolic decompensation. No single etiology was definitively established. The case emphasizes the importance of serial neurological assessment, consideration of alternative diagnoses, repeat neuroimaging, and multidisciplinary evaluation when initial investigations do not establish the cause of deterioration. Full article

Background and Clinical Significance: Diabetic ketoacidosis (DKA) is a common presentation of new-onset type 1 diabetes mellitus in children; however, severe DKA complicated by acute pancreatitis, dialysis-requiring acute kidney injury (AKI), severe hypertension, and neurological involvement is uncommon. Early recognition of these complications is essential because they may substantially increase morbidity and complicate standard DKA management; Case Presentation: An 11-year-old Saudi girl with morbid obesity (BMI 43 kg/m²), previously in good health, was brought to the emergency department after being found semi-conscious. She had experienced intermittent abdominal pain for five weeks and vomiting for four days. On presentation, she was critically ill, dehydrated, and confused (Glasgow Coma Scale 11/15) and exhibited Kussmaul breathing and abdominal tenderness. Laboratory investigations confirmed severe new-onset DKA, with a blood glucose level of 684 mg/dL, pH < 7.0, HbA1c 12.2% and an anion gap > 37 mEq/L. Despite standard DKA management, metabolic acidosis persisted and renal function progressively deteriorated, accompanied by oliguria and severe hypertension reaching 200 mmHg. By day 4, the patient developed anuria and marked creatinine elevation to 560 µmol/L. Brain magnetic resonance imaging demonstrated cerebral microhemorrhages in the setting of multifactorial encephalopathy. Continuous kidney replacement therapy was initiated for KDIGO stage 3 AKI with refractory metabolic acidosis. Autoimmune testing supported the diagnosis of type 1 diabetes mellitus, while renal biopsy demonstrated acute tubular injury; Conclusions: This case highlights a rare, severe multisystem presentation of pediatric DKA. Close monitoring for renal, neurological, pancreatic, and hypertensive complications is crucial, particularly when the clinical course does not improve as expected with standard therapy. Full article

Background/Objectives: Preterm birth remains the leading cause of neonatal morbidity and mortality, with cervical insufficiency being a major risk factor. Quantitative fetal fibronectin (qfFN) and the QUiPP App version 2.0 are established tools for preterm birth prediction; however, the value of repeated assessments remains unclear. This study aimed to evaluate the prognostic accuracy of longitudinal qfFN measurements and QUiPP risk assessment in women with progressive cervical insufficiency and to evaluate the prognostic performance of repeated assessments. Methods: In this retrospective cohort study, 88 women with progressive cervical insufficiency who underwent repeated qfFN measurements were included. Cervical length, qfFN, and QUiPP risk were assessed at diagnosis and at subsequent time points. Prognostic performance for delivery within one week and before 34 and 37 gestational weeks was evaluated. Results: The prognostic performance represented by the area under the curve increased from 0.71 to 0.75 for qfFN and from 0.74 to 0.82 for QUiPP from the first to the final assessment, although neither difference reached statistical significance (qfFN p = 0.522; QUiPP risk p = 0.135). For imminent preterm birth, qfFN demonstrated excellent rule-out performance, with a negative predictive value of 100% at <10 ng/mL. QUiPP risk provided superior risk stratification and achieved excellent prognostic accuracy for delivery before 34 weeks at the final assessment (area under the curve = 0.82). Receiver operating characteristic analysis identified optimal cutoffs of approximately 40 ng/mL for qfFN and 23% for QUiPP risk in predicting delivery before 34 weeks. Conclusions: Repeated qfFN assessment combined with QUiPP risk estimation was associated with numerically higher discriminatory performance at the final assessment. While the identified optimal cutoff values need to be validated in prospective trials, they might have the potential to safely reduce unnecessary interventions in the future. qfFN functioned as an effective rule-out test, whereas QUiPP enhanced risk stratification, supporting their combined repeated use to guide clinical management before 34 + 0 weeks of gestation. Full article

Background: Early discharge with home nasogastric (NGT) feeding has been associated with favorable infant outcomes and high parental satisfaction. However, its impact on parental mental health has been insufficiently studied. We aimed to evaluate symptoms of anxiety and depression in mothers and fathers of very preterm infants discharged with or without NGT feeding. Methods: This prospective cohort study was conducted at a German tertiary perinatal center between October 2020 and May 2024. A total of 238 preterm infants with a birth weight ≤ 1500 g and/or a postmenstrual age (PMA) ≤ 32 weeks were included; 131 were discharged with full oral feeding and 107 with NGT feeding. Symptoms of anxiety and depression were assessed in mothers and fathers using the Hospital Anxiety and Depression Scale (HADS-D) at discharge and at three months corrected age (CA). A total of 201 parent–infant dyads were included. HADS-D assessments were completed by 155 mothers and 135 fathers at discharge and by 121 mothers and 119 fathers at three months CA. Results: At discharge, depression and anxiety scores did not differ between parents of infants discharged with and without NGT feeding. At three months CA, mothers of infants discharged on full oral feeding had higher depression and anxiety scores than mothers of infants discharged with NGT feeding (4.95 ± 3.62 vs. 3.18 ± 2.89; p ≤ 0.01 and 6.42 ± 3.85 vs. 4.79 ± 3.72; p = 0.04), and clinically significant depression scores (≥8) were more frequent (23.53% vs. 10.45%; p = 0.04). Similarly, fathers in the non-tube-feeding group had higher depression scores at 3 months CA (4.78 ± 3.74 vs. 3.48 ± 2.72; p = 0.04), with a trend towards a greater proportion showing clinically significant depression scores (24.14% vs. 13.11%; p = 0.12. Conclusions: Early discharge of very preterm infants with home NGT feeding was not associated with increased parental psychological distress at discharge and at 3 months CA. Across the outcomes, parental distress tended to be lower at 3 months CA with NGT feeding at discharge. However, as no NGT × time interaction was statistically significant after correction for multiple testing, these group differences should be interpreted as exploratory in nature. Full article

Objective: To evaluate the response of various oxygenation indices to the oxygen challenge test (OCT), prior to decannulation, in neonates supported with VA ECMO for respiratory indications, and to compare these responses between survivors and non-survivors. Design: Single-center retrospective observational study. Setting: Single, tertiary care, 40-bed Pediatric Intensive Care Unit in Miami, Florida. Patients: Neonates cannulated to VA ECMO for respiratory failure from 2012 to 2022 who had an OCT. Patients with congenital heart disease were excluded. Measurements and Main Results: A total of 63 neonates were included, of whom 13 patients died (20.6%). Oxygenation indices compared before and during OCT include PaO2, Delta PaO2, P/F ratios, Alveolar-arterial gradient, arterial/alveolar ratios, and shunt fraction. The Wilcoxon signed-rank test demonstrated increases in all oxygenation indices during OCT compared to pre-OCT, except for P/F ratios. There were no differences in oxygenation indices between survivors and non-survivors during OCT. However, after decannulation, all oxygenation indices were worse in non-survivors (p < 0.05). Linear regression analysis demonstrated that delta FiO2 on the ventilator, P/F before OCT, and ECMO flow during OCT significantly affected PaO2 response during OCT. Shunt fraction above 28.8% after decannulation demonstrated the highest discriminatory ability for mortality (AUC 0.853). Conclusions: The OCT response during ECMO is not a reliable predictor of survival in neonates on VA ECMO, and its value in assessing readiness for ECMO trial-off warrants further evaluation. Further studies investigating the role of oxygenation indices at the time of trial-off for predicting outcomes may be helpful. Full article

Background/Objectives: Diaphragm ultrasonography enables noninvasive bedside assessment of diaphragmatic structure and function. However, longitudinal changes in diaphragm ultrasound parameters across different respiratory support modalities remain insufficiently characterized in critically ill children. This exploratory study aimed to evaluate serial changes in diaphragm ultrasound parameters and to explore whether these changes differed according to the initial respiratory support modality or showed a relationship with respiratory outcomes. Methods: This prospective, single-center observational cohort study included children aged 1 month to 18 years who required respiratory support for acute respiratory failure between March 2025 and March 2026. Diaphragm excursion (DE), end-expiratory diaphragm thickness (DTee), end-inspiratory diaphragm thickness (DTei), and diaphragm thickening fraction (TFdi) were measured at baseline, 48 h, and immediately before discontinuation of respiratory support. Patients were grouped according to the initial respiratory support modality: high-flow nasal cannula, nasal noninvasive ventilation, mask noninvasive ventilation, or invasive mechanical ventilation. Results: A total of 100 children were included; the median age was 4 months, and 66% were male. No statistically significant longitudinal changes were observed in DE (p = 0.210), TFdi (p = 0.850), DTee (p = 0.492), or DTei (p = 0.467). Baseline values and longitudinal percentage changes did not differ significantly among the four respiratory support groups. No statistically significant relationship was observed between serial changes in DE, TFdi, or DTee and total respiratory support duration. Conclusions: No statistically significant longitudinal changes in diaphragm ultrasound parameters were detected during short-term respiratory support, and no statistically significant differences were identified among the initial respiratory support groups. These findings should not be interpreted as demonstrating physiological equivalence between respiratory support modalities. Serial diaphragm ultrasonography should be interpreted within the broader clinical context rather than as an isolated prognostic tool. Full article

Background/Objectives: Ferritin and soluble interleukin-2 receptor α (sIL-2Rα) are HLH-related biomarkers, but their comparative discrimination in pediatric critical illness is uncertain. We primarily compared their discrimination for adjudicated HLH in hyperferritinemic PICU children and secondarily assessed PICU mortality. Methods: This prospective single-center study enrolled 75 children aged 1 month–18 years with ferritin ≥500 ng/mL: 25 each with HLH, sepsis/septic shock, or other diseases. Both biomarkers were measured from the same admission sample. Research-use sIL-2Rα was reported in ng/mL without cross-calibration to the HLH-2004 U/mL scale; adjudicators were blinded to sIL-2Rα, whereas ferritin informed the reference process. Analyses used ROC, Firth regression, targeted post hoc paired AUC tests with Holm adjustment, bootstrap optimism correction, and cross-validation. Results: For adjudicated HLH, ferritin showed greater discrimination than sIL-2Rα (AUC, 0.898 vs. 0.690; ΔAUC, 0.208; Holm-adjusted p = 0.019). The exploratory 1614-ng/mL ferritin cutoff had 92% sensitivity and 76% specificity. Although sIL-2Rα remained associated with HLH after ferritin adjustment (OR, 1.089 per ng/mL; p = 0.002), adding it did not significantly improve discrimination beyond ferritin (p = 0.663). For secondary mortality, ferritin showed greater discrimination than sIL-2Rα (AUC, 0.754 vs. 0.495; Holm-adjusted p = 0.019). Adding ferritin to PRISM III increased the apparent AUC from 0.725 to 0.811, but the comparison was not statistically significant (p = 0.105); the bootstrap optimism-corrected AUC was 0.800. Conclusions: In this hyperferritinemic PICU cohort, ferritin showed greater discrimination for adjudicated HLH than the studied sIL-2Rα assay, and adding sIL-2Rα did not significantly improve discrimination. Findings should be interpreted in the context of the studied assay and reference process. The exploratory mortality model requires external validation. Full article

Background/Objectives: Genomic sequencing can shorten the diagnostic pathway for selected symptomatic neonates and young infants, but evidence from such cohorts should not be extrapolated to population newborn screening. This study describes molecular findings and potential clinical implications in 25 unrelated patients younger than 6 months at referral with heterogeneous, predominantly neurological phenotypes and no established molecular diagnosis. Methods: The first 17 patients underwent whole-exome sequencing (WES), and the subsequent 8 underwent whole-genome sequencing (WGS) under sequential laboratory protocols; allocation was not randomized, and the study was not designed to compare platforms. Results: Pathogenic or likely pathogenic findings providing a definitive or likely molecular diagnosis were identified in 7/25 patients (28.0%; 95% confidence interval [CI], 14.3–47.6), including sequence variants, one 20q13.33 deletion, and mosaic trisomy 9. An additional RANBP2 variant was interpreted as a susceptibility-associated finding in a patient with infection-related encephalitis, yielding clinically relevant findings in 8/25 patients (32.0%; 95% CI, 17.2–51.6). Three definitive diagnoses involved disorders with established disease-specific management considerations; however, patient-level treatment changes, turnaround times, and outcomes were not systematically assessed. Conclusions: These findings support the diagnostic value of genomic testing in selected symptomatic neonates and young infants, while the small, heterogeneous cohort, sequential non-equivalent workflows, and incomplete outcome data preclude conclusions about comparative WES/WGS performance or population newborn screening. Full article

Background: Pediatric head trauma is a common reason for emergency department presentation. Although most children have minor injuries, a small proportion harbor clinically important traumatic brain injuries requiring urgent intervention. Artificial intelligence (AI) may offer structured support in computed tomography (CT) decision making, but evidence regarding the performance of general-purpose large language models in pediatric head trauma remains limited. Objective: To evaluate the association between AI-based cranial CT recommendations and clinically meaningful outcomes in pediatric patients with blunt head trauma and to assess the diagnostic performance and clinical utility of the model. Methods: This retrospective single-center observational study included pediatric patients younger than 18 years with blunt head trauma who underwent cranial CT imaging and had complete outcome data. A general-purpose large language model generated binary CT recommendations (“CT recommended” or “CT not recommended”) using structured clinical information available at the time of emergency department presentation. The primary outcome was a composite adverse clinical outcome defined as the occurrence of at least one of the following: emergency surgical intervention, intensive care unit admission, intubation, neurological sequelae or mortality. Diagnostic performance metrics, calibration analysis and decision curve analysis were performed. Results: A total of 819 pediatric patients were included, and the AI model recommended CT in 530 patients (64.7%). The primary outcome occurred in 143 patients (17.5%) and was significantly more frequent in the CT-recommended group than in the CT-not recommended group (24.5% vs. 4.5%; OR 6.90, 95% CI 3.82–12.45; p < 0.001). Abnormal CT findings, emergency surgery, intubation and neurological sequelae were also significantly more common in patients for whom CT was recommended by the AI system. For the primary outcome, the AI recommendation demonstrated a sensitivity of 90.9%, specificity of 40.8%, positive predictive value of 24.5% and negative predictive value of 95.5%. Calibration analysis showed acceptable agreement between predicted probabilities and observed event rates. Decision curve analysis demonstrated greater net benefit than both the “treat-all” and “treat-none” strategies across a range of threshold probabilities. Conclusions: In this clinically selected cohort of pediatric patients with blunt head trauma who underwent cranial CT imaging, AI-based CT recommendations were strongly associated with adverse clinical outcomes and demonstrated high sensitivity and negative predictive value for identifying children at risk of clinically important events. These findings suggest that, within a clinically selected cohort of children who underwent cranial CT imaging, AI-generated CT recommendations were associated with clinically meaningful outcomes. However, these results should not be interpreted as validation of CT decision making in the broader pediatric head trauma population and require prospective validation in unselected cohorts. Full article

Purpose: Extubation timing after paediatric cardiac catheterisation under general anaesthesia remains a challenging clinical decision, particularly in children with cyanotic or haemodynamically significant congenital heart disease. This study aimed to evaluate factors associated with non-on-table extubation and to assess early postoperative respiratory outcomes in this high-risk population. Design: This was a single-centre retrospective cohort study conducted in a paediatric cardiac catheterisation laboratory. Methods: Paediatric patients with cyanotic or haemodynamically significant/complex congenital heart disease who underwent cardiac catheterisation under general anaesthesia with endotracheal intubation were included. Patients were grouped according to whether they were extubated on-table in the catheterisation laboratory or transferred to the intensive care unit with ongoing invasive mechanical ventilation. The primary outcome was non-on-table extubation. Secondary outcomes included extubation timing, reintubation within 48 h, major respiratory complications within 48 h, intensive care unit length of stay, hospital length of stay, and 7-day and 30-day mortality. Logistic regression analysis was used to identify factors associated with non-on-table extubation. Findings: Seventy-two patients were included. On-table extubation was performed in 52 patients (72.2%), whereas 20 patients (27.8%) were not extubated on-table. Patients not extubated on-table were younger, had lower body weight, higher American Society of Anesthesiologists physical status IV (ASA IV) frequency, higher Catheterization Risk Score for Pediatrics (CRISP) scores, lower baseline SpO₂, and were more frequently undergoing emergency procedures. Reintubation within 48 h occurred only in the non-on-table extubation group (15.0% vs. 0.0%; p = 0.019). Major respiratory complications within 48 h were more frequent in patients not extubated on-table (20.0% vs. 3.8%; p = 0.047). Intensive care unit and hospital length of stay were also longer in this group. In multivariable analysis, higher CRISP score (adjusted odds ratio 1.22; 95% confidence interval 1.009–1.476; p = 0.040) and emergency procedure (adjusted odds ratio 8.74; 95% confidence interval 1.365–55.927; p = 0.022) were independently associated with non-on-table extubation. No 7-day mortality occurred in either group. Conclusions: On-table extubation after paediatric cardiac catheterisation under general anaesthesia was feasible in most selected patients with cyanotic or haemodynamically significant/complex congenital heart disease. Higher CRISP score and emergency procedures were independently associated with non-on-table extubation. These findings suggest that catheterisation-specific risk assessment may help anticipate postoperative ventilatory requirements in high-risk paediatric cardiac catheterisation patients. Full article

Background/Objectives: The objective of this study is to evaluate the efficacy and safety of maintaining antimicrobial (AM) therapy or adjusting AM therapy during episodes of febrile neutropenia (FN) catalogued as a fever of unknown origin (FUO) in children with cancer. Methods: This is a prospective, multicenter, noninferiority, randomized study, approved by ethics committee, in children with episodes of FN in eight hospitals in Chile. Microbiological and molecular samples were drawn at admission. Patients with FUO (negative bacterial and viral study with no clinical focus suggesting infection) and favorable evolution during the first 48–72 h of AM therapy were randomized 1:1 to maintain or adjust treatment, reducing the number and spectrum of AMs. The primary endpoint was the percentage of episodes with an uneventful resolution; the secondary endpoints were the re-adjustment of AM therapy, days of fever/hospitalization/AM therapy, days of vancomycin and meropenem per 1000 days of neutropenia, number of AMs after randomization, pediatric intensive care unit (PICU) admission, sepsis, and death. Results: A total of 266 of 939 FN episodes recruited between March 2021 and January 2024 were catalogued as FUO, of which 231 had a favorable evolution at 48–72 h and were randomized, 111 to maintain and 120 to adjust AM therapy. Both groups presented the same percentage of uneventful resolution, with 106 (96%) in the group that maintain AM therapy and 114 (95%) in the adjusted group (p = 1.00); relative risk 1.01, (95%CI 0.95–1.06); absolute risk difference 0.01, (95%CI −0.05–0.06). Conclusions: The main finding of this study demonstrates that adjusting antimicrobial therapy appears safe in carefully selected FUO cases with a favorable early evolution, during episodes of FN catalogued as FUO in children with cancer. These findings open an opportunity to new AM stewardship strategies in this population, with a possible future impact on AM resistance. Full article

Background: Empiric antibiotic prescribing is frequently used in low- and middle-income countries because microbiological diagnostic capacity is often limited, highlighting the need for locally generated microbiological data to support evidence-informed empiric antibiotic selection. However, data on pediatric antibiotic prescribing practices in Mozambique remain scarce. This study aimed to characterize empiric antibiotic prescribing among hospitalized pediatric patients at Maputo Central Hospital prior to the implementation of a syndromic antibiogram intervention. Methods: An exploratory, retrospective, descriptive baseline analysis was conducted among pediatric patients aged 1 month to 14 years admitted with suspected bacterial infections between January and December 2023, prior to the implementation of a syndromic antibiogram intervention. Sociodemographic, clinical, microbiological, and antibiotic prescribing data were extracted from clinical records. Antibiotics were classified according to the WHO AWaRe framework, and associations between patient characteristics, treatment strategies, and outcomes were analyzed using R software version 4.6.0. Results: A total of 358 pediatric patients were included, with a median age of 14 months (IQR: 6–48), and 57% were male. Lower respiratory tract infections were the most frequent diagnosis. Empiric treatment predominated, accounting for 89% of cases, whereas microbiologically guided therapy was observed in only 11%. Urinary tract infections showed significantly higher proportions of microbiologically guided treatment compared with respiratory infections (p < 0.001). Monotherapy predominated, while Watch antibiotics accounted for 64.7% of prescriptions. Prolonged hospitalization was associated with respiratory distress, decreased skin turgor, referral status, infection type, and anemia. Conclusions: Pediatric antibiotic prescribing was characterized by extensive empiric therapy and high Watch antibiotic use, highlighting important antimicrobial stewardship challenges in Mozambique. Full article

Objective: Intentional pharmaceutical poisoning is one of the most common methods of self-harm among adolescents and frequently results in pediatric intensive care unit (PICU) admission because of the potential for severe pharmaceutical-related toxicity. Although mortality is generally low, a subset of patients may require advanced intensive care interventions. Methods: This retrospective observational cohort study was conducted in the pediatric intensive care unit of a tertiary referral hospital between January 2022 and January 2026 and included adolescents admitted to the PICU due to intentional pharmaceutical poisoning. Demographic characteristics, psychiatric history, clinical findings, laboratory parameters, administered treatments, and clinical outcomes were evaluated. The primary outcome measure was defined as the requirement for a major PICU intervention, including invasive or noninvasive mechanical ventilation, vasoactive support, continuous renal replacement therapy (CRRT), therapeutic plasma exchange, extracorporeal membrane oxygenation (ECMO), intensive care-level seizure management, or clinically significant arrhythmia requiring intensive care support. Patients with and without major PICU intervention requirements were compared. Results: A total of 125 adolescent patients were included in the study, and the majority were female. Multiple-pharmaceutical ingestion and a history of psychiatric diagnoses were common comorbidities. Although the clinical course was stable in most patients, 15 patients (12%) required major pediatric intensive care interventions. Patients requiring major interventions had lower Glasgow Coma Scale scores, higher lactate levels, more frequent symptomatic presentation, and higher rates of Poisoning Severity Score (PSS) ≥ 3. Overall mortality in the cohort was low. Conclusions: Although most adolescents admitted to the PICU due to intentional pharmaceutical poisoning experienced mild-to-moderate toxicity, a subgroup required advanced intensive care support. Neurological impairment at presentation, symptomatic clinical presentation, and markers of increased physiologic stress appeared to be associated with more severe clinical courses. In pediatric poisonings, evaluating the need for advanced intensive care support rather than focusing solely on mortality may better reflect clinical severity. Full article

Background/Objectives: To describe therapy-associated oral stomatitis and perianal mucosal lesions in pediatric oncohematology patients and compare healing time according to the treatment approach used in routine clinical practice. Methods: This retrospective observational study was conducted at Meyer Children’s Hospital, Florence, Italy. Electronic health records of patients admitted to the Oncology or Bone Marrow Transplantation units between 1 January and 31 December 2024, were screened. Eligible patients were aged 0 to 18 years and had documented oral stomatitis and/or perianal mucosal lesions with sufficient clinical and nursing documentation to determine lesion localization, treatment, clinical evolution, and healing time. Demographic, clinical, pharmacological, nutritional, and nursing variables were extracted. Oral mucositis severity was classified using the World Health Organization Oral Toxicity Scale. Results: Among 525 screened records, 89 eligible patients aged 5 months to 18 years were included in the final analysis. Lesions were distributed across three mutually exclusive categories: oral-only (39.3%), perianal-only (42.7%), and combined oral–perianal involvement (18.0%). Most oral cases were grade 2 to 4. Oral stomatitis treated with Mucosamin^® Spray healed faster than conventional therapy (3.5 ± 0.8 vs. 6.7 ± 1.1 days; mean difference, −3.21 days; 95% CI, −3.75 to −2.67; p < 0.001). Perianal fissures treated with Mucosamin^® Rectal Gel also showed a shorter healing time than conventional therapy (3.4 ± 0.8 vs. 6.1 ± 0.8 days; mean difference, −2.76 days; 95% CI, −3.30 to −2.21; p < 0.001). Conclusions: Mucosamin^® Spray and Rectal Gel were associated with shorter documented healing times than conventional approaches in this real-world pediatric cohort. These findings should be interpreted as preliminary and confirmed in controlled prospective multicenter studies. Full article

Background/Objectives: Delirium and iatrogenic withdrawal syndrome (IWS) overlap clinically in critically ill children. We used latent profile analysis (LPA) of nurse-administered assessments to identify score patterns, not diagnoses; no independent reference standard was available. Methods: This single-center retrospective cohort included 203 pediatric intensive care unit (PICU) records from 84 patients. Raw scores from the IWS and delirium subscores of the Japanese Sophia Observation withdrawal Symptoms–Paediatric Delirium (SOS-PD) scale, the Richmond Agitation–Sedation Scale (RASS), and the Face, Legs, Activity, Cry, Consolability (FLACC) scale were modeled using tied-diagonal Gaussian mixtures for K = 1–5. Selection used the Bayesian information criterion (BIC), entropy, and posterior probabilities. Results: The selected four-profile solution had BIC = 3245.4, entropy = 0.887, and 91.6% of records had a maximum posterior probability ≥ 0.70. Patient-level analyses provided partial support (adjusted Rand index = 0.833); standardization yielded an adjusted Rand index of 0.977. The profiles were Profile 1 (Delirium-predominant), Profile 2 (High-symptom mixed), Profile 3 (Withdrawal-predominant), and Profile 4 (Low-symptom at-target). Separation was strongest and inverse on the SOS-PD subscores (within-input |d| = 3.05 withdrawal; 2.26 delirium), describing input-scale divergence rather than diagnostic discrimination. Untied, categorical, and count models favored two profiles. Conclusions: Joint bedside scores contained model-specific candidate patterns, and profile number was model-dependent. Before prospective external validation, profiles should be treated only as descriptive score summaries and should not be used in clinical care. Full article