Johns Hopkins All Children's Hospital, formerly All Children's Hospital, is a pediatric acute care children's hospital located in St. Petersburg, Florida. The hospital has 259 beds and is affiliated with the USF Morsani College of Medicine and Johns Hopkins University School of Medicine. The hospital provides comprehensive pediatric specialties and subspecialties to pediatric patients aged 0–21 throughout western Florida. Johns Hopkins All Children's Hospital also features a Level 2 Pediatric Trauma Center.In 2011, All Children's Hospital became the first center outside the Baltimore-Washington, D.C. area to integrate with the Johns Hopkins Health System. In 2016, it officially took the name Johns Hopkins All Children's Hospital.
This review summarizes considerations within the existing recent literature that guide the practice of interval appendectomy (IA) after initial non-operative management (NOM) of complicated appendicitis (CA) in children. A systematic review of English language articles published from 2000 to 2025 was conducted in Medline, Embase, and Cochrane Central Register of Controlled Trials to address four elements which could impact the decision for IA after NOM of CA: (1) the incidence of recurrent appendicitis; (2) the time period in which recurrence occurs; (3) the patient or disease-related risk factors which increase recurrence; and (4) the incidence of appendiceal neoplasms identified by IA. Of the 3,022 articles initially reviewed, 46 met inclusion criteria. Recurrence was reported in 2–50
Prospective, multi-institutional surgical data collection in pediatric neuro-oncology remains limited despite substantial variation in operative and perioperative management across institutions. To address this, we are developing the NeuroPoint Alliance (NPA) Quality Outcomes Database (QOD) Pediatric Tumor Surgery Registry. Here, we used a modified Delphi process to define a core outcome set for the registry. A modified Delphi study was conducted among pediatric neurosurgeons serving as site principal investigators for the proposed registry. Candidate data elements were rated on a 9-point Likert scale. Consensus for inclusion was predefined as ≥70
Background Venous thromboembolism (VTE) is a significant cause of morbidity in children, particularly among hospitalized patients and those with chronic medical conditions. There is a lack of consensus on anticoagulant prophylaxis strategies. Objective These evidence-based guidelines from the American Society of Hematology (ASH) and the International Society on Thrombosis and Haemostasis (ISTH) are intended to support patients and health care professionals in decisions about anticoagulant prophylaxis for pediatric VTE prevention. Methods ASH formed a multidisciplinary guideline panel that included 1 patient representative. The University of Kansas Health System supported the guideline development process, including systematic evidence reviews up to April 2025. Clinical questions and outcomes were prioritized according to their importance for clinicians and patients. The panel used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to assess certainty in the evidence and make recommendations. Results The panel agreed on 12 recommendations. For pediatric patients with solid cancer, who have experienced trauma, or who are critically ill, the panel issued conditional recommendations suggesting no anticoagulant prophylaxis. For pediatric patients with antiphospholipid antibody syndrome, or those on long-term total parenteral nutrition, the panel issued conditional recommendations suggesting the use of anticoagulant prophylaxis. Other pediatric subgroups addressed included patients with acute lymphoblastic leukemia or lymphoma, surgical and hospitalized patients, and those with a central venous access device. Conclusions High-quality data on anticoagulant prophylaxis for pediatric VTE prevention are scarce. Key research priorities include the development and validation of subgroups-specific VTE risk assessment models, and evaluation of the safety and efficacy of risk-stratified anticoagulant prophylaxis strategies across different pediatric subgroups.
BACKGROUND:In children with Chiari type I malformation and syringomyelia, neurosurgical posterior fossa decompression (PFD) provides clinical improvement, but whether duraplasty (incising the dura and placing a dural graft) improves outcomes is unclear. METHODS:We conducted a multicenter, cluster-randomized, controlled trial of PFD with duraplasty (PFD-D) as compared with PFD alone. Persons 21 years of age or younger with cerebellar tonsillar ectopia of at least 5 mm and a maximum syrinx diameter of 3.0 to 9.9 mm were enrolled at 38 centers. Centers were cluster-randomized: all the participants within each center underwent the same intervention. The primary outcome was surgical complications within 6 months. Secondary outcomes were clinical improvement, syrinx reduction, and repeat decompression at 10 to 24 months and the change in overall health-related quality of life at 6 to 24 months. RESULTS:A total of 162 participants were included in the trial, of whom 78 were assigned to undergo PFD-D and 84 to undergo PFD alone. The percentage of participants with complications within 6 months was 14% with PFD-D and 6% with PFD (adjusted odds ratio, 2.59; 95% confidence interval [CI], 0.86 to 7.84; P = 0.11). At 24 months, the percentage of participants with clinical improvement was 58% with PFD-D and 46% with PFD; the mean (±SD) syrinx reduction was 3.08±2.33 mm and 1.22±1.79 mm, respectively; and the percentage of participants with repeat decompression was 3% and 14%. Changes in health-related quality of life were similar in the two groups. CONCLUSIONS:The percentage of participants with surgical complications did not differ significantly between those who underwent PFD-D and and those who underwent PFD alone. Larger trials are needed to determine the relative benefits and risks of these two procedures. (Funded by the Patient-Centered Outcomes Research Institute and others; ClinicalTrials.gov number, NCT02669836.).
Importance:Platelet transfusions are critical interventions for neonates and children who are at risk of or who are experiencing bleeding. Objective:To describe the epidemiology of platelet transfusions and associations of blood donor and platelet characteristics with posttransfusion platelet increments, transfusion burden, and clinical outcomes in neonates and children. Design, Setting, and Participants:This cohort study included patients younger than 18 years of age (with birth weights higher than 2500 g) between April 1, 2019, and June 30, 2023, from the Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric Vein-to-Vein multicenter, retrospective, donor-component-recipient-linked database. Neonates were considered individuals less than 28 days of age; otherwise, participants were considered older children. Exposure:Platelet transfusion. Main Outcome and Measures:The main outcomes were posttransfusion platelet increments and subsequent transfusion burden associated with platelet processing and donor characteristics. Results:Of 249 340 inpatient encounters, platelet transfusion was reported in 8874 (3.6%) patients (4934 of 131 592 encounters [3.7%] male; median [IQR] age 2.5 [0.6-11.2] years). Platelet transfusion was lowest among children younger than 1 year of age (2.6%) and highest among children 1 to less than 6 years of age (4.7%; P < .001). The median (IQR) dose was 14.9 mL/kg for neonates and 9.6 mL/kg for older children. After excluding patients with bleeding, most transfusions in neonates (67.8%) and older children (81.0%) were performed at pretransfusion platelet counts greater than 25 × 103/µL and greater than 10 × 103/µL, respectively. Median (IQR) pretransfusion platelet counts in neonates (34 × 103/µL [20-54 × 103/µL]) were significantly higher than in older children (22 × 103/µL [11-40 × 103/µL]; P < .001). Pathogen reduction (PR) (adjusted odds ratio [AOR], 0.82 [95% CI, 0.73-0.92]), use of platelet additive solution (PAS) (AOR, 0.32 [95% CI, 0.27-0.37]), platelet storage duration longer than 3 days (AORs ranged from 0.67 [95% CI, 0.58-0.76] to 0.82 [95% CI, 0.76-0.88]), male sex (AOR, 0.92 [95% CI, 0.86-0.98]), and donor age 40 years or older (AOR, 0.79 [95% CI, 0.72-0.86]) were associated with lower platelet increments (all P < .001). Use of PR platelets (adjusted rate ratio [ARR], 1.05 [95% CI, 1.02-1.07), use of PAS (ARR, 1.44 [95% CI, 1.40-1.47]), storage duration longer than 3 days (ARR, 1.11 [95% CI, 1.09-1.13] for 4 to <5 days and ARR, 1.28 [95% CI, 1.26-1.30] for ≥5 days), and donor age of 40 years or older (ARR, 1.15 [95% CI, 1.13-1.17] for 40 to <60 years and ARR, 1.10 [95% CI, 1.08-1.12] for ≥60 years) on the first transfusion were associated with a significantly higher rate of receiving a subsequent transfusion. These factors were not associated with hospital length of stay or mortality. Conclusions and Relevance:In this multicenter, donor-product-recipient linked cohort study, after excluding patients with bleeding, most transfusions among neonates and older children were at high pretransfusion platelet counts. Use of PAS, PR, longer storage duration, male donors, and donor age older than 40 years were independently associated with lower posttransfusion platelet increments. Use of PAS, PR, platelet storage longer than 3 days, and donor age 40 years or older were associated with a significantly higher overall platelet transfusion burden but were not associated with hospital length of stay or mortality. These results have important implications for transfusion practices for platelets among neonates and children and need validation in well-designed prospective studies.
