Children's Hospital of Philadelphia

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...

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...

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...

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...

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...

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...

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...

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...

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...

Safety and Tolerability of Chronic Carvedilol in Pediatric Dilated Cardiomyopathy: A Report from the Pediatric Cardiomyopathy Registry

Long-term studies on safety of beta-blockers in pediatric heart failure (HF) are scant. We describe the safety profile, dose ranges, and tolerability of carvedilol in pediatric dilated cardiomyopathy (DCM). The Pediatric Cardiomyopathy Registry (PCMR) was used to identify patient...

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...

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...

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...

Association between clinician team structure and continuous pulse oximetry overuse among infants hospitalized with bronchiolitis: An Eliminating Monitor Overuse Trial substudy

Abstract Continuous pulse oximetry (cSpO 2 ) monitoring for hospitalized children with bronchiolitis not requiring supplemental oxygen is an established form of medical overuse. We examined whether clinician team structure influences cSpO 2 overuse. In this secondary analysis of...

Longitudinal evaluation of sleep disturbances in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study

Abstract Purpose The current study examines longitudinal changes in sleep disturbances and the risks they pose for new-onset health conditions in survivors of childhood cancer. Methods Five-year survivors ( N = 1081; median [range] age 50.0 [45.2–55.0] years) and siblings ( N = 2...

Integrative transcriptomic and functional profiling reveals neutrophil-associated immune dysregulation in bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD) is the most common chronic lung disease in preterm infants. Although inflammation is broadly recognized as a key contributor to BPD, the precise roles and underlying mechanisms of immune cells in BPD pathogenesis remain incompletely understood. Mo...

Pre-trained knowledge transfer with application in multisystem inflammatory syndrome subphenotyping in children

Multisystem inflammatory syndrome in children (MIS-C) is a severe post-acute sequela of SARS-CoV-2 infection in children and presents with highly heterogeneous signs and symptoms. Disentangling the clinical manifestations of MIS-C by characterizing its subphenotypes can help iden...

HeartMate 3 in Pediatric and Complex Populations: Physiologic Rationale, Patient Selection, and Management Strategies

The HeartMate 3 (HM3) left ventricular assist device (LVAD), initially designed for adults, is increasingly utilized in children, small adults, and those with congenital heart disease (CHD), necessitating expanded knowledge and collaborative efforts. This review highlights key ph...

Telemedicine Use in Primary Care for Children: 2019–2024

BACKGROUND AND OBJECTIVES We lack national data on the maturing clinical use of telemedicine (TM) in children’s primary care. This manuscript describes patterns of TM use for problem-based visits overall, across clinical domains, and associations of use with clinic visit volume....

Distraction in anterior plagiocephaly: technique, risks, and long-term results

PURPOSE: The purpose of this study is to define the perioperative outcomes and long-term aesthetic outcomes of patients with unicoronal craniosynostosis (UCS) treated with fronto-orbital distraction osteogenesis (FODO) and compare them to a contemporaneous cohort treated with con...