Children's Hospital of Philadelphia

Correlation of polygenic risk score and clinical phenotype in patients with genetic generalized epilepsy

Abstract Objective The polygenic risk score (PRS) for individuals with genetic generalized epilepsy (GGE) quantifies the common risk variants in genes identified in genome‐wide association studies. We hypothesized that the phenotype of GGE patients differs based on their GGE PRS....

Empiric MRSA Coverage for Children with Osteoarticular Infections: 2015 to 2024

BACKGROUND AND OBJECTIVES Staphylococcus aureus is the most common causative pathogen for children with acute hematogenous osteomyelitis (AHO) and acute bacterial arthritis (ABA). National guidelines recommend empiric coverage for methicillin-resistant S. aureus (MRSA) at hospita...

Corticolimbic structure-function coupling is sensitive to childhood adversity and buffers adversity-related symptoms during development

Abstract Childhood adversity is a potent predictor of mental health problems across the lifespan, and a rich cross-species literature implicates stress-sensitive corticolimbic circuits in adversity-related psychopathology. Structure-function coupling (SFC) is a promising multimod...

Two-Year-Old Girl With Chronic Cough and Lymphadenopathy

A 27-month-old previously healthy girl presented with 3 months of cough and 1 day of fever and rhinorrhea. Her parents had immigrated from Africa, but our patient had been born in the United States and had no notable environmental exposures. An alarming chest radiograph suggested...

Hemodynamic Effects of Topical Oxymetazoline During Pediatric Flexible Bronchoscopy

BACKGROUND: Bleeding is a well-recognized complication in flexible bronchoscopy, especially with advanced procedures. Oxymetazoline is a topical vasoconstrictor often used to reduce or treat bleeding in the nares and airways. METHODS: A retrospective cohort study was conducted on...

Variation in In-Hospital Emergency Transfer Rates Across Pediatric Hospitals

BACKGROUND: Clinical deterioration with late escalation, termed emergency transfer (ET), is a key safety metric. However, national benchmarking is limited by variable definitions. We sought to estimate pooled ET rates and assess variation across pediatric hospitals. METHODS: We p...

Early life exposures association with later diagnosis of spondyloarthritis: A population-based case-control study

Objective To assess whether early-life antibiotics are associated with spondyloarthritis (SpA) diagnosed by age 21. Methods In this population-based, matched case–control study, we used Danish live births (1997-2023) restricted to those reaching minimum relevant ages by December...

Authentic and Sustained Family Partnership in Neonatal and Pediatric Research

Improving the health and well-being of children requires sustained partnerships with parents, community members, advocates, and researchers to identify and answer high-impact research questions. Meaningful engagement with families and communities in the design, conduct, and disse...

How to Train Your Chatbot: Information‐Theoretic Foundations of Diagnostic Questioning in Inborn Errors of Immunity

BACKGROUND: Navigating the more than 550 inborn errors of immunity (IEI) requires efficient diagnostic reasoning. Information theory suggests questions should be prioritized by their capacity to reduce diagnostic uncertainty (entropy); yet whether experts or large language models...

Homicide at home: setting the agenda for an international collaboration to improve support for children bereaved due to family violence

Background: Bereavement due to fatal family violence (e.g. intimate partner homicide, filicide, parricide, siblicide) is a profoundly disruptive experience for children, with lifelong psychosocial consequences. Although the need for fatal family violence prevention is increasingl...

Impact of the COVID-19 Pandemic on Viral Respiratory Testing in Children With Abnormal Urinalysis

OBJECTIVE Respiratory viral panels (RVP) are common, expensive tests that often do not change treatment, especially in children with suspected urinary tract infections. In children with abnormal urinalysis (UA) results, we hypothesize that RVP overuse existed before the COVID-19...

Postoperative Interventions and Cost Associated With Disposition After Tonsil and Adenoidectomy

OBJECTIVE To evaluate postoperative disposition and resource use among patients admitted to the inpatient unit or pediatric intensive care unit (PICU) following tonsillectomy, adenoidectomy, and tonsillectomy/adenoidectomy (T/A). PATIENTS AND METHODS This retrospective cohort stu...

Futility and Termination of Resuscitation Variation for Pediatric Out-of-Hospital Cardiac Arrest

OBJECTIVES To evaluate agency-level differences in determinations of futility (defined as withholding resuscitative efforts by emergency medical services [EMS]) and termination of resuscitation (TOR) during prehospital encounters for pediatric out-of-hospital cardiac arrest (OHCA...

Beyond ‘diagnostic error’: an ethnography of resilient behaviours and system adaptations in paediatric outpatient diagnosis

Background Improving paediatric diagnosis by addressing errors (Safety-I) is insufficient for diagnostic excellence. Resilience engineering’s approach to understanding adaptations to achieve success in everyday work may elucidate how individuals and systems manage diagnostic comp...

Optimizing safety and efficacy of asparaginase and blinatumomab therapy in frontline acute lymphoblastic leukemia regimens in diverse health care settings—international expert consensus

Frontline blinatumomab combined with chemotherapy has resulted in improved outcomes in both pediatric and adult patients with acute lymphoblastic leukemia and is considered the new cornerstone of acute lymphoblastic leukemia treatment. The role of asparaginase in this new landsca...

Moving Upstream: Perinatal Cash Transfers as a Tool to Address Inequities in Birth Outcomes

The United States has an exceptionally high preterm birth rate, which features inequities that impact many Black, Indigenous, and Pacific Islander families. Unconditional perinatal cash transfers, which offer cash assistance to pregnant and postpartum women with no strings attach...

Prenatal therapies to improve outcomes in gastroschisis: a systematic scoping review protocol

INTRODUCTION: Gastroschisis is a congenital birth defect with a rising incidence. The herniation of intestines into the amniotic cavity leads to prenatal bowel injury, which contributes to significant postnatal morbidity and mortality. Current management focuses on postnatal inte...

Asthma Exacerbation Risk and School Asthma Readiness

OBJECTIVES: School-based asthma management is a key facet of child asthma care. We aimed to describe the proportion of students whose schools have child-specific components of asthma care, derive a composite metric of these components ("school asthma readiness"), and assess its a...

Adaptive oncogenesis of β-catenin emerges from declining liver tissue integrity

Abstract Mutations are fundamental to oncogenesis, yet they cannot fully explain cancer progression, as oncogenic mutations frequently accumulate in healthy tissues without immediate malignancy. In the liver, β-catenin mutations are highly prevalent in hepatocellular carcinoma bu...

Neurological Pupil Index and Outcome After Cardiac Arrest in Children: Single-Center, Retrospective Cohort, 2018–2023

OBJECTIVES: To determine the association between abnormal pupillary reactivity using automated infrared pupillometry and unfavorable outcome after pediatric cardiac arrest (CA). DESIGN: Single-center, retrospective, cohort study, 2018-2023. SETTING: Large tertiary PICU in the Uni...