Search Results (356)

Introduction: Congenital structural anomalies of the pulmonary artery in children, encompassing defects such as pulmonary atresia (PA), pulmonary stenosis (PS), pulmonary artery hypoplasia, and tetralogy of Fallot (ToF), pose significant challenges in pediatric cardiac surgery due to impaired blood flow in pulmonary circulation. Traditional options for conventional repair—including autologous materials such as the native pericardium and synthetic materials such as artificial patches—have limitations including a lack of growth potential and vulnerability to restenosis over time. ProxiCor^® patches, based on the extracellular matrix (ECM), have emerged as biologically compatible substitutes capable of fostering tissue regeneration. The primary outcomes of this study were the safety (absence of patch-related complications such as restenosis, dilation, aneurysm, infection, or thrombosis) and feasibility (intraoperative handling and surgical success) of ProxiCor^® for pulmonary artery and right ventricular outflow tract (RVOT) reconstruction in a single-center pediatric cohort. Secondary outcomes included mortality, postoperative complications (prolonged mechanical ventilation > 72 h, need for continuous renal replacement therapy (CRRT), and intensive care unit (ICU) and hospital stay), and qualitative echocardiographic assessment of vessel patency during follow-up. Patients and methods: A retrospective analysis was conducted in 25 consecutive pediatric patients who underwent pulmonary artery or RVOT reconstruction with ProxiCor^® at the Department of Pediatric Cardiac Surgery in Poznań (Poland) between the years 2023 and 2024. Surgical techniques, clinical outcomes, and follow-up data were assessed using transthoracic echocardiography (TTE). Results: The median age was 224 (Q1–Q3: 124–362) days, and median weight was 4.2 (Q1–Q3: 2.8–8.5) kg. Procedures targeted repairs of the main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA), and RVOT. Diagnoses included tetralogy of Fallot (ToF), pulmonary artery stenosis (PS), pulmonary atresia (PA), pulmonary artery hypoplasia, and anomalous left coronary artery from the pulmonary artery (ALCAPA). The mortality rate stood at 8% (2/25), stemming from multiorgan failure and hemorrhagic stroke, unrelated to the patch. Over a median observation period of 483 (Q1–Q3: 363–584) days, no patch-related complications (e.g., restenosis or dilation) arose. The median hospitalization time was 22 (Q1–Q3: 8.5–38.5) days. Conclusions: ProxiCor^® ECM patches appear to be safe and feasible for use in pulmonary artery and RVOT reconstruction, with favorable early outcomes. However, the small cohort size, lack of a control group, and limited mid- to long-term echocardiographic data preclude definitive conclusions about long-term outcomes or comparative effectiveness. Full article

Background: Secondary hepatic dysfunction is a frequent yet often under-recognized complication in critically ill children. It commonly arises as a consequence of systemic processes—particularly sepsis, hypoperfusion, hypoxia, and multiorgan dysfunction—rather than primary hepatobiliary disease. This study aimed to determine the incidence, clinical characteristics, and prognostic significance of secondary hepatic dysfunction in a pediatric intensive care unit (PICU) cohort, and to evaluate its relationship with PRISM III and PELOD-2 scores. Methods: This retrospective study included patients hospitalized in a tertiary PICU between January 2022 and December 2024. Children with pre-existing liver disease or primary acute liver failure were excluded. Hepatic dysfunction was defined by elevations in age-adjusted biochemical markers. Demographic variables, clinical interventions, laboratory values, and outcomes were recorded. Mortality risk and prolonged PICU stay (>7 days) were analyzed in relation to hepatic dysfunction, PRISM III, and PELOD-2 scores. Results: Among 567 PICU admissions, 50 patients (8.8%) met criteria for secondary hepatic dysfunction. The cohort had a median age of 57.5 months and 66% were male. Hepatocellular injury predominated (96%), while cholestatic patterns were less common (4%). Overall mortality was 22%. Mortality was significantly associated with sepsis (p = 0.04), mechanical ventilation (p < 0.01), and inotropic support (p < 0.01). Both PRISM III and PELOD-2 scores were higher in non-survivors on day 1 and day 7 (p ≤ 0.01). ALT ≥ 2 × ULN and total bilirubin > 2 mg/dL were not independently predictive of mortality. Conclusions: Secondary hepatic dysfunction is relatively common in critically ill children and is associated with adverse clinical outcomes. Its prognostic relevance appears to extend beyond conventional severity scores, particularly with respect to morbidity-related outcomes such as prolonged PICU stay, suggesting that routine hepatic assessment may contribute to early risk stratification in the PICU setting. Full article

Background: Respiratory tract infections (RTIs) represent one of the most prevalent reasons for visits to Pediatric Emergency Departments (PEDs). Because viral and bacterial presentations frequently overlap, a substantial proportion of antibiotic prescriptions in pediatric acute care are potentially unnecessary, contributing to antimicrobial resistance. Rapid Diagnostic Tests (RDTs) for respiratory viruses have been suggested as tools to enhance diagnostic precision and support antimicrobial stewardship. However, evidence regarding their real-world impact in pediatric emergency settings is limited. Objectives: This study aimed to assess the association between point-of-care RDT results and antibiotic management in a tertiary PED, focusing on both the discontinuation of antibiotics in children already receiving treatment and the avoidance of new antibiotic prescriptions in untreated children. The secondary objective was to evaluate the short-term safety through 72-h return visits. Methods: A retrospective cohort study was conducted at a tertiary PED during two epidemic seasons (December–February 2023–2024 and 2024–2025). Children aged <18 years who underwent RDTs for febrile respiratory illnesses were included. Patients were stratified based on whether they were already receiving antibiotic therapy at presentation. The primary outcomes were antibiotic discontinuation among treated patients and initiation among untreated patients. Unplanned return visits to the PED within 72-h post-discharge were used as a pragmatic short-term safety outcome to capture early clinical deterioration. RDTs (SD Biosensor Standard F Antigen) were performed at the bedside with a turnaround time of 10–15 min. Results: A total of 1238 children were included, of whom 330 (26.6%) tested positive for influenza and/or adenovirus. Among the 234 children already receiving antibiotics, discontinuation was significantly more frequent in the RDT-positive group (p < 0.001; OR 0.044). Among the 1004 untreated children, antibiotic prescription was significantly lower in the positive group than in the negative group (p < 0.001; OR 0.097). Return visits within 72-h did not differ between the groups in either cohort. No invalid tests occurred. Conclusions: Influenza/adenovirus RDT positivity was associated with lower antibiotic initiation among untreated children and higher discontinuation among those already receiving antibiotics, with no differences in 72-h return visits. These findings suggest a potential role for bedside viral testing as a decision-support tool for antibiotic management in the PED. Full article

Timely recognition of type 1 diabetes (T1D) in children and adolescents is crucial to prevent acute complications such as diabetic ketoacidosis (DKA). This narrative review examines the pathophysiology, clinical presentation, and diagnostic challenges of childhood T1D, including the young age of onset, clinician training gaps, and overlapping symptomatology between T1D and other common pediatric illnesses. Despite increased awareness, a significant proportion of children still present with DKA at diagnosis due to misinterpretation of symptoms, such as polydipsia, polyuria, and weight loss. This work emphasizes the importance of early recognition, timely intervention, and the use of structured management algorithms for primary care clinicians. Strategies to reduce DKA incidence, based on existing literature, successful real-world examples, and current guidelines, include enhanced screening for high-risk populations, educational initiatives, and improved diagnostic protocols. By implementing systematic approaches and public health campaigns, healthcare providers can improve early T1D detection and prevent severe DKA complications, ultimately enhancing patient outcomes and reducing long-term morbidity. Full article

Although the American Academy of Pediatrics has long recommended universal autism-specific screening at well-child pediatric visits, implementation challenges in primary care settings interfere with high-fidelity universal autism screening. These challenges delay autism identification for some children, leading to delays in needed services and supports. Prior findings indicate that new solutions must be developed to bridge the gap in access to autism screening for families, particularly among those who are under-resourced. One approach is expanding screening to other community settings, such as childcare centers, but there are barriers to this approach, which this commentary aims to address. We discuss challenges and barriers in childcare screening identified through our recently completed pilot study screening for autism in childcare centers, with suggested strategies to address them. These challenges include hesitation among childcare staff to guide conversations or concerns about autism, and stigma around autism diagnosis and presentation. Other challenges relate to emerging concerns regarding legal, ethical, and professional roles and responsibilities surrounding informed consent and data privacy, as well as the identification of children without timely follow-up evaluation and services. There is a need for increasing public awareness as an essential component of autism screening across settings. Our commentary discusses different considerations and practice strategies to meet these needs. Full article

Background: Metabolic acidosis is a frequent and serious complication in critically ill neonates, particularly preterm infants, and is associated with an increased risk of mortality, intraventricular hemorrhage, and long-term neurodevelopmental impairment. Despite limited evidence, sodium bicarbonate (SB) is widely administered in neonatal intensive care units (NICUs) to correct acidosis, largely extrapolated from adult and pediatric practice. However, concerns have been raised about its potential adverse effects, including paradoxical intracellular acidosis, impaired cerebral autoregulation, and increased risk of neurological injury. Given the uncertainty regarding both its efficacy and safety, we conducted a systematic review and meta-analysis to evaluate the role of SB administration in the neonatal population. Methods: MEDLINE, Scopus, and the Cochrane Library were searched using specific medical subject headings and terms. We included all study published up to July 2025 that involved newborns treated with SB. The primary outcome was positive response to treatment, while secondary outcomes included mortality, morbidity, and long-term impairment. Results: We analyzed 10 studies (9 randomized and 1 unrandomized study, including 660 neonates). Pooled results from the randomized controlled studies showed no efficacy of SB in newborns. Data from one unrandomized study showed an increased risk for mortality (OR 13.1 p = 0.02), clinical seizures (OR 2.8, p = 0.01), and a combined outcome of death or neurological damage (OR 3.1 p < 0.01) for neonates treated with SB. Conclusions: Current evidence is insufficient to support the routine administration of SB in NICUs. Neonatologists have the responsibility to administer only drugs of proven efficacy, personalizing therapy on the basis of a pathology’s etiology, in order to reduce risk and optimize benefits. In the absence of robust, statistically significant data, the indiscriminate use of SB should be discouraged in current clinical practice. PROSPERO registration number: CRD420251132502. Full article

Primary hyperoxaluria type 1 (PH1) is a rare autosomal recessive disorder that causes progressive renal failure, nephrolithiasis, and nephrocalcinosis in children. It is characterized by hepatic overproduction of oxalate. Conventional management, which involves combined liver–kidney transplantation, vitamin B6 supplementation, and intense hydration, does not address the underlying metabolic defect for most patients and it generally provides only supportive care. The first approved disease-modifying treatment for pediatric PH1 is Lumasiran, a small interfering RNA (siRNA) therapeutic. By specifically inhibiting the hepatic glycolate oxidase mRNA, Lumasiran lowers the production of oxalate at its origin. Along with fewer kidney stone events and stabilization of nephrocalcinosis, clinical trials (ILLUMINATE-A/B/C) showed significant decreases in urinary oxalate excretion. The most frequently reported adverse event is mild injection-site reactions, which are generally well tolerated. The molecular mechanism, pharmacokinetics, and clinical effectiveness of Lumasiran in children with PH1 are compiled in this review. We go over possible long-term safety concerns, the impact of early intervention on renal outcomes, and the function of siRNA therapies in pediatric precision medicine. Furthermore, we highlight Lumasiran’s importance as a model for targeted treatment in uncommon pediatric kidney diseases by considering it in the larger context of RNAi-based therapies. A paradigm shift in pediatric nephrology is signaled by Lumasiran, which changes the therapeutic approach from supportive care to precision, targeted medicine. Further research and empirical data will clarify its long-term advantages, the best ways to treat it, and the possible use of siRNA technologies for other genetic renal disorders. Full article

Background/Objectives: Fever and pain are among the most common symptoms in pediatric infections and chronic diseases, causing significant discomfort for children and concern for caregivers. Effective management is essential to relieve distress while avoiding overtreatment or undertreatment. Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), particularly ibuprofen, are the primary antipyretic and analgesic agents in pediatric care, but their use in children with chronic conditions might be challenging. Methods: A narrative review and clinical expert judgment were used to synthesize current evidence on the use of paracetamol and NSAIDs (especially ibuprofen) in children with some common chronic diseases. Results: Paracetamol is often considered a first-line option in several chronic conditions. Caution is warranted in children with pre-existing malnutrition, obesity, and neuromuscular disorders as these factors might increase the risk of hepatotoxicity. NSAIDs provide additional anti-inflammatory effects and comparable analgesic efficacy but should be used cautiously in some high-risk populations due to potential gastrointestinal, renal, and bleeding complications. Their use is contraindicated in children with dehydration, renal impairment, nephrotic syndrome relapses, while careful risk-benefit assessment is required in small and vulnerable neonates. Some data also suggests NSAIDs may worsen outcomes in certain acute bacterial and viral infections. Data on chronic infections such as tuberculosis, HIV, and viral hepatitis are limited, highlighting the need for further research. Combination therapy with paracetamol and ibuprofen may enhance analgesia in postoperative settings without significantly increasing adverse events. Overall, available evidence is limited and largely observational. Conclusions: This narrative review synthesizes current evidence and clinical expertise to provide practical guidance on the rational use of paracetamol and NSAIDs in children, emphasizing individualized therapy according to comorbidities, risk factors, and clinical context, particularly in vulnerable populations. A risk-adapted, evidence-based approach ensures optimal symptom control while minimizing harm, supporting safer, more effective, and family-centered care for children with fever and pain. Full article

Background/Objectives: Sleep disorders represent a significant health burden among children and adolescents with autism spectrum disorder (ASD), affecting their core symptoms, behavior, and quality of life. While physical activity has shown promise in managing sleep disorders in the general pediatric population, its effectiveness for children and adolescents with ASD remains understudied. Methods: This retrospective cohort study analyzed electronic health records from 132 healthcare organizations, examining 155,860,529 individuals to determine sleep disorder prevalence in ASD populations and evaluate the impact of physical activity interventions. We identified 248,940 children and adolescents with ASD aged 5–18 years, of whom 38,976 had documented sleep disorders. Propensity score matching was performed to compare patients with ASD and sleep disorders who received physical activity interventions with matched controls. Primary outcomes included sleep disorder resolution and medication utilization changes at 1- and 5-year follow-up. Bonferroni correction was applied to secondary analyses to account for multiple comparisons. Results: The prevalence of sleep disorders was markedly higher in children and adolescents with ASD (19.25%) compared to non-ASD peers (3.37%), with risk ratios escalating from childhood (RR = 5.34, 95% CI: 5.28–5.40) to adolescence (RR = 6.12, 95% CI: 6.05–6.19). After matching, 3709 patients were included in each group. Physical activity interventions were associated with significantly higher sleep disorder resolution at 1 year (−59.9% vs. −5.05%, p = 0.001) and sustained benefit at 5 years (−49.83% vs. +7.26%, p = 0.001). After Bonferroni correction, improvement in sleep apnea at 1 year remained statistically significant (−62.26% vs. +9.39%, Bonferroni-adjusted p = 0.040). Improvements in parasomnia and insomnia did not survive correction and were considered exploratory. Age emerged as a key effect modifier: adolescents (12–18 years) demonstrated sustained improvements in overall sleep outcomes at both 1- and 5-year follow-up that met Bonferroni-corrected thresholds, whereas younger children (5–11 years) showed limited and inconsistent responses. Among comorbidity groups, anxiety-comorbid patients exhibited the strongest overall improvement (−58.7% vs. −12.4%, p < 0.01), while reductions in amphetamine use and changes in melatonin prescribing patterns should be interpreted as exploratory findings requiring prospective confirmation. Conclusions: This large-scale observational study suggests structured physical activity interventions are associated with sustained improvements in overall sleep disorders among children and adolescents with ASD. While subtype- and subgroup-specific associations were observed, many attenuate after multiple comparison adjustments, highlighting the need for cautious interpretation. Findings support exploring physical activity in comprehensive care plans, with prospective randomized trials needed to confirm causality, optimize protocols, and address multiplicity. Full article

Background: Vascular malformations (VMs) are congenital anomalies of the vascular system—capillary, venous, lymphatic, arteriovenous, or combined—frequently associated with notable morbidity and reduced quality of life. Electrochemotherapy (ECT), a locoregional treatment that combines chemotherapeutic agents (most commonly bleomycin) with electroporation, has emerged as a promising alternative in managing therapy-resistant or anatomically challenging lesions. Methods: A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and the Cochrane Library were searched from inception to January 2025 for studies reporting on the efficacy and/or safety of ECT for vascular malformations. Data extraction encompassed study design, patient demographics, VM type, ECT protocols, outcomes, follow-up duration, and adverse events. Studies that lacked relevant outcome data or focused solely on other therapeutic approaches were excluded. Results: Twelve primary studies met the inclusion criteria and were analyzed. These covered diverse VMs, including venous, slow-flow, high-flow malformations, aggressive hemangiomas, and composite lesions in adult and pediatric populations. ECT protocols usually combined bleomycin (or occasionally other agents such as pingyangmycin or polidocanol foam) with various electroporation parameters. Across studies, ECT resulted in meaningful lesion-size reduction (50–97% in most cohorts), symptom relief (e.g., reduced pain and bleeding), and favorable cosmetic outcomes. While side effects (local edema, hyperpigmentation, procedure-related discomfort) were occasionally reported, they were typically mild and transient. Conclusions: ECT represents a valuable minimally invasive option in the therapeutic armamentarium for vascular malformations. Despite consistent demonstrations of efficacy and acceptable toxicity profiles, future high-quality, multicenter studies are warranted to confirm outcomes, refine treatment guidelines, and potentially expand its use as a standard of care. Full article

Background/Objectives: This study explores the perceptions, experiences, and expectations of pediatric healthcare professionals regarding the implementation of virtual visits (VVs) in routine pediatric practice. Methods: Using the Consolidated Framework for Implementation Research (CFIR) to analyze individual, organizational, and contextual factors influencing the adoption of pediatric virtual visits, we conducted a descriptive cross-sectional survey distributed nationwide among pediatricians, pediatric nurses, and residents. Results: A total of 308 Spanish healthcare professionals correctly completed the REDCap survey and were included in the analysis. The mean age was 44.3 years, and respondents represented both hospital-based (55.8%) and primary care professionals (44.2%). Overall, 74.8% had previous experience with telephone consultations, while only 11% had performed virtual visits. Most professionals believed VVs could be useful in primary care (81.3%) and hospital out-patient settings (73.9%), especially for follow-up appointments, communication of test results, and chronic-care monitoring. VVs were perceived as more appropriate for older children and adolescents than for infants. Major concerns included poor internet connection (52.6%), and data security (37.4%); however, a particularly relevant finding was the low confidence in using digital tools, particularly among older professionals. Comparative analyses by age and workplace setting identified differences in interest, perceived barriers, and access to technical resources. Hospital-based clinicians reported greater interest in adopting VVs and better access to technological resources compared with primary care professionals. The professionals’ age was inversely associated with interest in VVs. Notably, 72.6% of respondents expressed interest in receiving specific VV training, and nearly 90% believed virtual visits should be offered in their workplace. Conclusions: These findings show a high overall acceptance of VVs but also underline persistent barriers related to infrastructure, digital literacy, and clinical applicability in younger children. Addressing these obstacles through training, improved equipment, and clear clinical protocols will be essential for the successful implementation of pediatric VV programs. Full article

Background: Survival among children and adolescents and young adults (AYA) with cancer has improved substantially over recent decades; however, dominant survivorship models remain reactive—activated post-treatment and anchored to static exposure- and organ-based screening. This design underuses the anticipatory window at diagnosis and overlooks environmental and social determinants that modulate outcomes across the life course. Methods: We narratively reviewed international frameworks including the Children’s Oncology Group (COG), the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG), the Pan-European Network for Care of Survivors after Childhood and Adolescent Cancer (PanCare) and the National Comprehensive Cancer Network (NCCN), and synthesized evidence on environmental determinants, exposomics, toxicogenomics, and implementation. Building on two decades of real-world practice, we describe the evolution from the Pediatric Environmental History (PEHis) to the Ambiomic Health Compass (AHC), integrating genomic, exposomic, geospatial, clinical, and biomonitoring layers into routine care. In this framework, survivorship is conceptualized as beginning at the time of cancer diagnosis (“day 0”). Results: PEHis operationalizes guideline-based care with structured environmental and social assessment, personalized plans, and community integration, contributing to improved survival, healthier behaviors, reduced treatment-related mortality and stronger oncology–primary-care coordination. AHC extends PEHis with dynamic risk recalibration, contextual alerts, targeted biomonitoring, and toxicogenomic interpretation, enabling anticipatory decisions from day 0. The manuscript summarizes the paradigm shift (current vs. Ambiomic models), the domain-specific expansion over existing guidelines, the core clinical/system tools, and time-bound metrics (12, 24, 60 months) to support implementation and evaluation. Conclusions: Survivorship should move upstream—from late surveillance to ambiomic, exposure-aware care beginning at diagnosis. Integrating advanced exposomics, mutational epidemiology, and explainable analytics can reduce preventable events and chronicity, enhance equity, and align pediatric oncology with planetary health. The PEHis–AHC continuum offers a scalable blueprint for next-generation survivorship programs in Europe and beyond. Ambiomic medicine does not replace precision medicine—it completes and extends it by integrating exposomics, social context, and anticipatory analytics from day 0. Full article

Background: The inappropriate and empirical use of antibiotics in early childhood remains a major global public health concern, contributing significantly to the rise of antimicrobial resistance (AMR). In Kosovo, the COVID-19 pandemic further influenced prescribing behaviors in primary care, increasing the reliance on symptom-based treatment in the absence of laboratory confirmation and age-appropriate formulations. Aim: This study aimed to assess the prevalence and patterns of antibiotic prescribing among children aged 1–7 years in primary health care centers in Prishtina and Ferizaj from January 2022 to December 2025, and to compare regional differences in prescribing practices and guideline adherence. Methods: A retrospective observational study was conducted using data from the national electronic health record system and protocol books. All pediatric visits for children aged 1–7 years with infectious diagnoses were included. Descriptive statistics, Chi-square tests, and multivariable logistic regression were used to evaluate prescribing prevalence, demographic and seasonal variations, and independent predictors of antibiotic use, including assessment of appropriateness based on international pediatric guidelines. Results: Of 4320 pediatric visits, 1328 (30.7%) resulted in an antibiotic prescription. Prescribing prevalence was higher in Ferizaj (34.2%) than in Prishtina (28.5%, p < 0.01). Amoxicillin–clavulanic acid (42.9%) and amoxicillin (21.5%) were the most frequently prescribed agents, while macrolides (11.7% vs. 6.2%) and cephalosporins (7.9% vs. 3.4%) were more common in Ferizaj. Only 61.4% of prescriptions were fully guideline-concordant. Younger age (1–3 years), winter season, and residence in Ferizaj were independently associated with higher odds of receiving an antibiotic. Conclusions: Pediatric antibiotic prescribing in Kosovo remains high and predominantly empirical, reflecting real-world limitations in diagnostic capacity and formulation availability. Significant proportions of partially appropriate and inappropriate prescriptions highlight the need for standardized pediatric guidelines, improved diagnostic support, and strengthened stewardship initiatives within primary care. Full article

Background: Obesity is a chronic disease that has negative health consequences for children. Peer support models have been used to manage chronic diseases like diabetes; however, little is known about how a peer support intervention might promote healthy infant growth to prevent pediatric obesity. The aim of this project was to explore parental perspectives on how a peer support intervention might be developed to support healthy infant weight gain and nutrition. Methods: Data were collected from November 2022 to October 2023 at a single pediatric primary care clinic. Semi-structured interviews explored parents’ perspectives of how a peer parent coach could promote healthy infant nutrition and growth. Interviews focused on (1) common infant feeding and nutrition questions, (2) the role and importance of peer support during the newborn period, and (3) strategies for addressing and facilitating connections to food-related resources and addressing food insecurity. Results: A total of 18 interviews were conducted. Average parental age was 32.1 years (range 20–46 years). Thirty-three percent of the participants identified as Black, 28% identified as White, 11% identified as Asian, and the remaining identified as Other or preferred not to report. Half of the sample reported a household income of <$20,000, 67% reported having public insurance, and 11% reported household food insecurity. Themes that emerged included: peer parent coaches can (1) provide emotional support to families with young infants, (2) education focused on infant nutrition, and (3) facilitate connections with nutrition resources. Participants also noted the importance of understanding a family’s unique culture when counseling on infant growth and nutrition. Conclusions: Multiple themes were identified about how a peer support intervention could support healthy infant nutrition and growth. Future work should test the feasibility and acceptability of a peer support intervention to promote healthy infant weight gain. Full article

Background: Nutritional support in patients receiving extracorporeal membrane oxygenation (ECMO) is a clinical challenge. Hemodynamic instability and concerns about gut perfusion delay enteral nutrition (EN), resulting in frequent use of total parenteral nutrition (TPN). This study aimed to compare nutritional practices in patients on venoarterial (VA) vs. venovenous (VV) ECMO, and to evaluate the associations between prolonged TPN use, feeding status, circuit change frequency, length of stay, and survival. Methods: Retrospective cohort study of ECMO patients in a quaternary pediatric intensive care unit. Nutritional variables included route and amount of nutrition delivery. The primary outcome was the nutrition type (enteral vs. parenteral) in association with ECMO mode (VV vs. VA). Secondary outcomes included associations between nutrition variables (TPN by Day 14, lack of EN by Day 5 or 7) and circuit changes, ECMO duration, ICU/hospital length of stay (LOS), and mortality. Analyses by Mann–Whitney and chi-square tests. Multivariable Poisson regression was used to identify independent predictors of circuit change frequency. Results: Patients on VV ECMO achieved higher enteral intake than those on VA ECMO. Persistent need for TPN by Day 14 was associated with longer PICU LOS, hospital LOS, and ECMO duration and was independently associated with 71% higher circuit change frequency. Survival did not differ significantly by TPN duration or early EN exposure. Conclusions: VV ECMO patients received higher enteral nutrition. Persistent need for TPN by day 14 was associated with worse outcomes. These findings underscore the need for standardized, evidence-based feeding strategies in this population. Full article