The Hospital for Sick Children (HSC), corporately branded as SickKids, is a major pediatric teaching hospital located on University Avenue in Toronto, Ontario, Canada. It is affiliated with the Faculty of Medicine of the University of Toronto. The hospital's Peter Gilgan Centre for Research and Learning is believed to be the largest pediatric research tower in the world at 69,677.28 square metres. Founded in 1875, the hospital was inspired by the example of Great Ormond Street Hospital in London.The hospital is located in the Discovery District of Downtown Toronto on University Avenue, adjacent to the Toronto General Hospital and across from Mount Sinai Hospital and the Princess Margaret Cancer Centre—collectively forming a complex known as Hospital Row, each connected by tunnels and bridges. The hospital is known for its advertisement campaigns and the largest amounts of donations received for any Canadian hospital.
Corticosteroids (CS) and exclusive enteral nutrition (EEN) are effective induction therapies for pediatric Crohn’s disease (CD), but comparative studies evaluating long-term outcomes in small bowel CD are lacking. Children (2–18 years) with newly diagnosed small bowel CD involving the ileum prospectively enrolled in the multicenter Canadian CIDsCaNN or European PIBD-SETQuality inception cohorts receiving CS or EEN induction treatment were evaluated longitudinally. The primary outcome was sustained steroid-free remission (SSFR) at 1 year. Secondary outcomes included changes in height z-scores, time-to-first-biologic and time-to-luminal-resection. Results were confirmed after propensity score matching (PSM). In total, 208 children (61
Central Nervous System (CNS) tumors are the leading solid malignancies in children, 50
To assess whether multi-echo T2* MRI can differentiate neonatal hemochromatosis (NH) from other causes of neonatal liver failure (NLF) by evaluating siderosis in the liver and extrahepatic organs. This retrospective study evaluated 26 infants ≤ 20 weeks of age, who underwent MRI with Gradient-Recalled (GRE) multi-echo T2* sequence for liver failure. Two radiologists noted the degree of siderosis in the liver, pancreas, thyroid, spleen and renal cortex using a semiquantitative scale. Kendall’s tau was used to assess the correlation between siderosis grades and final diagnosis. Consensus review by hepatologist, neonatologist, and pathologist using integrated clinical, biochemical, imaging and histopathologic data served as the reference standard for the final diagnosis. Of 26 patients, 7 had NH and 19 had other causes of NLF. Interobserver agreement was highest for liver (κ = 0.97), followed by kidney (κ = 0.87), spleen (κ = 0.84), thyroid (κ = 0.80), and pancreas (κ = 0.73). Significant positive correlations between siderosis grades and NH diagnosis were found for thyroid (Kendall’s tau = 0.70, p < 0.01), pancreas (Kendall’s tau = 0.67, p < 0.01), and liver (Kendall’s tau = 0.42, p = 0.03), while spleen showed a significant negative correlation (Kendall’s tau = −0.51, p < 0.01). MRI demonstrated 100
Life participation is a priority outcome for children and families living with chronic kidney disease (CKD). This study aimed to assess the construct validity of the PRO-Kid-LP, a novel three-item tool measuring CKD’s impact on children’s life participation. Participants were children aged 8–18 years from Canada, with stages 3–5 CKD, who were part of the PRO-Kid validation cohort. Using 5-point adjectival scales, the PRO-Kid-LP tool measures CKD’s impact on three domains over 1 week: (1) school participation, (2) meaningful time with family and friends, (3) participation in hobbies/recreational activities. Higher scores reflected more impact of CKD on life participation. The PedsQL™ and PRO-Kid symptom assessment tool were also completed. Construct validity was evaluated with Spearman correlations and internal consistency, with Cronbach’s alpha (Cα). Ninety-seven children were included, with a mean age of 14.4 years (IQR 11, 16.6), and 62.9
OBJECTIVES:To update evidence-based management recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with sepsis or septic shock. DESIGN:A panel of 68 international experts, representing 13 international organizations, as well as six methodologists, was convened. A formal conflict-of-interest policy was developed at the onset of the process and applied throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and subgroup leads as well as within subgroups, served as an integral part of the guideline development process. METHODS:New priority topics and recommendations from the prior guideline iteration were used to identify Population, Intervention, Control, and Outcomes (PICO) questions likely to have new or updated evidence. We conducted a systematic review to identify the best available evidence, summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or conditional, or as a good practice statement. "In our practice," statements were included when evidence was inconclusive to issue a recommendation but the panel felt that some guidance based on practice patterns may be appropriate. RESULTS:The panel provided 61 statements on the management of children with sepsis or septic shock. Overall, five were strong recommendations, 24 were conditional recommendations, and ten were good practice statements. For 22 PICO questions, no recommendations could be made, but, for seven of these, "in our practice" statements were provided. Compared with the 2020 guidelines, 20 recommendations were new, 13 were updated for clarity and/or new evidence, six were reviewed but not changed, and 22 were carried forward based on consensus of the panel that new evidence was not available. Only three recommendations were based on high or moderate certainty of evidence. CONCLUSIONS:Updated management guidelines were issued by a panel of international experts for the best care of children with sepsis or septic shock, acknowledging that most aspects of care continue to have relatively low quality of evidence.
