Pediatrics — Weekly Evidence Brief

Parents of very low birthweight (VLBW) children are at higher risk for fair/poor physical health, highlighting the need for pediatricians to screen for caregiver health concerns during NICU discharge and well-child visits 1. This is particularly critical as Black Canadian parents report experiencing racism and discrimination in the NICU, alongside significant emotional burdens, underscoring the necessity for culturally sensitive mental health and peer support programs 2. Encouragingly, early discharge for very preterm infants does not appear to impair growth up to three months postmenstrual age, supporting earlier family integration without compromising infant development 3. Furthermore, implementing an exclusive human milk diet, especially with human milk-derived fortifiers, significantly reduces the incidence of necrotizing enterocolitis in VLBW infants, improving outcomes for this vulnerable population 4.

Children with recurrent critical illness exhibit diverse trajectories of functional status, with identified classes varying by demographics and clinical characteristics, necessitating tailored long-term care strategies 5. Following pediatric mild traumatic brain injury, parental adjustment, protectiveness, and social support are significant predictors of postconcussive symptom trajectories, emphasizing the crucial role of the family environment in recovery 6. For children with sickle cell disease, early neurodevelopmental screening using the Ages and Stages Questionnaire (ASQ) can predict academic problems in toddlers and preschoolers, and also stroke risk in preschoolers, enabling timely intervention 7. Moreover, survivors of childhood leukemia face an elevated risk of obesity and metabolic syndrome, with cranial radiotherapy, corticosteroid use, and younger age at diagnosis identified as key risk factors, underscoring the need for personalized prevention 8.

Cardiovascular events are a leading cause of mortality in pediatric dialysis patients, emphasizing the critical importance of early diagnosis and management of modifiable risk factors to improve long-term outcomes 9. In congenital heart disease, Fontan patients now represent the largest subgroup for heart transplant listings; while waitlist outcomes have improved, post-transplant graft loss remains higher, with timely ventricular assist device (VAD) use potentially improving survival in this high-risk population 10. A new predictive model, utilizing readily available clinical parameters (heart failure classification, BNP, troponin, and ST deviation), can assess the 1-year risk of major adverse cardiovascular events in childhood restrictive cardiomyopathy, aiding in the optimal timing for heart transplantation 11. Additionally, delayed prenatal care initiation is associated with a higher probability of delivery at a pediatric cardiac center, especially for severe congenital heart defects, highlighting the role of prenatal care in regionalized care 12.

Persistent disparities in pediatric postoperative mortality are evident, with children from very low opportunity neighborhoods facing a 27% higher risk, a burden that high-volume centers do not fully mitigate 13. Quality of Emergency Medical Services (EMS) pediatric care also shows variability, with patient factors such as age, race, and ethnicity influencing performance on measures like pain improvement in trauma, where Black and Hispanic children receive less improvement 14. Furthermore, children's hospitals exhibit wide variation in low-value care delivery, with substantial opportunities for improvement in areas such as C-reactive protein/ESR testing for community-acquired pneumonia and electrolyte testing for febrile seizures 15. Lastly, acute kidney injury in extremely premature neonates is associated with poorer neurodevelopmental outcomes at 22-26 months corrected gestational age, highlighting another critical area for intervention and quality improvement 16.