Artificial intelligence (AI) is increasingly used in echocardiography and point-of-care ultrasound (POCUS) to support image acquisition, view recognition, image-quality assessment, segmentation, automated quantification, disease classification, reporting, and bedside decision support. This narrative review summarizes clinically relevant applications, with emphasis on clinical integration, pediatric and congenital heart disease considerations, and safe implementation. The strongest clinical evidence supports automated left ventricular segmentation and ejection fraction estimation, AI-guided acquisition, and workflow efficiency. Video-based deep learning has enabled beat-to-beat assessment of ventricular function, and a randomized workflow trial showed that AI-generated initial ejection fraction assessment was noninferior to sonographer assessment and required fewer cardiologist corrections. Regulatory-authorized acquisition and analysis tools demonstrate growing clinical adoption for specified adult indications. Recent multiview and disease-phenotyping models extend AI toward more comprehensive interpretation, while AI-enabled POCUS may improve focused image acquisition by non-expert users. However, external validation, pediatric and congenital heart disease data, cross-device generalizability, clinical outcome evidence, uncertainty communication, automation bias, and medicolegal responsibility remain important limitations. AI should currently be viewed as an augmentative rather than autonomous technology. The safest near-term model is human-AI collaboration, in which validated tools improve acquisition, reproducibility, and workflow while clinicians retain responsibility for interpretation and patient-centered decisions. Pediatric and congenital heart disease applications require age- and anatomy-specific datasets, multicenter validation, local performance monitoring, and clinician-supervised deployment. AI can assist across the echocardiography workflow, from acquisition guidance and view recognition to segmentation, quantification, disease screening, and structured reporting. The most mature clinical evidence supports left ventricular segmentation, ejection fraction estimation, AI-guided acquisition, and workflow efficiency rather than autonomous diagnosis. AI-enabled POCUS may improve acquisition by non-expert users, but image adequacy, interpretation, and clinical integration must remain clinician-supervised. Pediatric and congenital heart disease applications are promising but remain less mature than adult applications and require anatomy-specific datasets and multicenter validation. Safe implementation requires external validation, local monitoring, bias assessment, uncertainty display, audit trails, and institutional governance.
Pediatric nephrotic syndrome (PNS) is a clinically defined disorder characterized by proteinuria and edema but exhibits substantial biological heterogeneity that is not captured by conventional classifications. This review synthesizes current transcriptomic evidence to better understand disease mechanisms and explore its relevance for precision medicine. Advances in transcriptomic technologies, including bulk RNA sequencing, single-cell and single-nucleus approaches, and spatial transcriptomics, have revealed distinct molecular signatures in PNS. Key pathways involve podocyte cytoskeletal disruption, immune and inflammatory activation, extracellular matrix remodeling, and mitochondrial dysfunction. These findings differentiate molecular profiles across phenotypes such as minimal change disease, focal segmental glomerulosclerosis, and steroid-sensitive versus steroid-resistant disease. Emerging high-resolution approaches further enable cell-type-specific and spatial insights into disease progression. Transcriptomics has redefined PNS as a spectrum of molecularly distinct endotypes and offers promising avenues for biomarker discovery and targeted therapy. However, clinical translation remains limited by small sample sizes, technical variability, and lack of longitudinal validation. Integration with multi-omics and functional studies is essential to develop reproducible, clinically actionable strategies for improving pediatric outcomes.
There have been several advancements in the fetal diagnosis of congenital heart disease (CHD) in the past decade. However, there remains a discrepancy in the rates of prenatal detection of congenital heart disease based on region and CHD type. The purpose of this review is to focus on key advancements and new frontiers that have improved prenatal diagnosis and management of congenital heart disease. Early fetal echocardiography, AI integration, 3D/4D STIC imaging, and fetal cardiac MRI have gained immense traction in the world of fetal cardiology as they show promise in significantly improving our prenatal detection rate of CHD. In summary, emerging strategies—including early fetal echocardiography, artificial intelligence–enabled acquisition and interpretation, 3D/4D spatiotemporal image correlation (STIC) with intelligent navigation (FINE), and fetal cardiac MRI—are reshaping prenatal assessment of congenital heart disease as supplementary tools to 2D fetal echocardiography, which remains the mainstay of diagnosis of fetal CHD. Continued multicenter validation, standardized protocols, and thoughtful implementation to ensure equitable access will be critical to integrating these technologies as adjuncts to high-quality 2D fetal echocardiography and serial follow-up.
Diabetic kidney disease (DKD) is a significant complication of youth‑onset diabetes with profound implications for long-term morbidity and mortality. Early structural changes precede the onset of albuminuria and functional decline, and are largely driven by a broader cardiometabolic risk milieu extending beyond suboptimal HbA1C targets. Management in paediatrics centres on early recognition and timely intervention targeting these modifiable factors. Strict blood pressure, lipid, and weight control alongside encouraging physical activity and smoking cessation should be combined with intensive glycaemic regulation aiming for near-normoglycaemia with reduced variability. Renin–angiotensin system blockade is recommended for persistent albuminuria and/or hypertension. SGLT2 inhibitors and GLP‑1 agonists are established in adult DKD management and their renoprotective role in paediatrics is evolving as promising adjuncts when initiated for glycaemic and/or weight indications. Vigilance for atypical features suggesting non‑diabetic kidney injury is advised to ensure appropriate diagnosis and management. Emerging biomarkers aim to detect evidence of early structural kidney injury prior to overt functional decline although not yet adapted for clinical practice. Embedding a multidisciplinary, nephrology‑engaged DKD prevention bundle including individualised risk stratification, active surveillance, and early renoprotective interventions into routine paediatric diabetes care is currently the most effective approach to offset DKD development and slow progression.
Pediatricians have long considered lifestyle factors in caring for adolescents, yet these practices have rarely been framed within the growing discipline of lifestyle medicine. This article reviews how pediatric clinicians can intentionally integrate lifestyle medicine principles to promote individual and population health. Nutrition, physical activity, sleep, stress management, social connections, avoidance of risky/toxic exposures, and contact with nature are presented as foundational pillars for optimal growth, development, and lifelong health. Practical strategies for integrating lifestyle medicine specifically into adolescent clinical practice within a family-centered and socioecological framework are presented, including a proposed acronym of NOURISH, designed to serve as a practical reminder to screen and counsel across key lifestyle domains during clinical encounters. This approach contextualizes adolescent heath behaviors within the influence of families, schools, communities, and policies. Clinicians can extend their impact through strategic partnerships with schools and community organizations. This review highlights opportunities for education, research, and systems-level change to position pediatric practice as foundational for preventing chronic disease, advancing health equity, and supporting healthier adolescents.
This article examines how vulnerabilities shape the ways in which risks and opportunities in digital gaming environments may translate into harm or benefits for children and adolescents. The study adopts an ecological framework to analyse how individual, social, digital, and national contexts interact in structuring children’s gaming experiences. Drawing on qualitative interviews with 30 experts from Brazil and the United Kingdom, the article aims to map multilevel vulnerability factors associated with content, contact, conduct, and contract-related risks in digital games. Findings indicate that vulnerability is relational and context-dependent rather than intrinsic to the child. Developmental stage, mental health status, neurodivergence, gender, socioeconomic position, and family adversity interact with platform design, monetisation systems, communication affordances, and regulatory frameworks to shape exposure pathways. Recent evidence suggests that the impact of gaming-related risks is moderated by individual, social, digital, and national contexts. Cross-national differences suggest that structural inequality, platform predominance (e.g., mobile versus console), and regulatory models influence how risks are distributed and mitigated. Importantly, the same gaming environments may simultaneously create opportunities for social connection, learning, and belonging while also increasing exposure to harm. Digital gaming environments should be understood as structured systems in which vulnerability emerges relationally from the intersection of individual, digital, social, and national contexts. Professional assessment should move beyond screen-time measures towards contextualised evaluation of the four risk categories. Practitioners should exercise heightened clinical attention with children presenting identifiable vulnerability profiles. Digital games have become a central environment for play, learning, and socialisation in childhood. Professionals should avoid focusing exclusively on screen time or gaming frequency and instead examine the conditions under which gaming-related risks may escalate into harm. In clinical and preventive practice, digital gaming should be understood within a broader ecological framework that encompasses individual, social, digital, and national dimensions. Although considerable attention has been given to identifying gaming disorder, other categories of risk (such as content, contact, conduct, and contract risks) may receive less scrutiny. Preventive childcare should therefore incorporate approaches that identify vulnerability profiles and protective factors, recognising that risks do not automatically result in harm. Attention should be paid to how specific vulnerabilities may interact with gaming environments. Assessment should consider the broader context of gaming, including the types of games played, their affordances, the devices used, where gaming takes place, and with whom it is experienced. It should also extend to the wider platform ecosystem, including communication, streaming, and community platforms. Opportunities for cognitive development, creativity, social connection, and well-being should be considered alongside potential risks. At the individual level, younger children, those with limited emotional regulation, neurodivergent conditions, pre-existing physical or mental health difficulties, or experiences of displacement or family adversity may be more susceptible to certain risks. Social context also matters. Families vary in digital literacy, access to information about games, and capacity for mediation. Clinical guidance should assess parental mediation strategies. Active mediation, such as shared play and open dialogue about in-game experiences is more appropriate than relying solely on restrictive technical controls. At the digital level, games differ widely in content, communication features, monetisation systems, and design. Professionals should therefore enquire directly about children’s gaming preferences and practices. National regulatory frameworks and age-rating systems may be protective factors. Professionals must remain informed about evolving regulations to provide accurate guidance and support children’s rights and protections.
This review provides an overview of the different types of single ventricle congenital heart disease and associated pathophysiology and reviews the medical and surgical approaches to management. Single ventricle congenital heart disease is a complex and varied group of congenital cardiac malformations that require meticulous care and multiple surgeries. Advances in surgical approaches and technology have improved outcomes over time but care of this complex patient populations remains challenging. In this review, we detail the different lesions that make up single ventricle heart disease, the typical surgical pathway, clinical considerations for each stage, and evolving approaches to single ventricle care.
This article summarizes the current state of youth suicide prevention programs, including types of interventions, examples, and evidence of effectiveness. It also briefly reviews recent data on risk factors for suicide, including concerns about the influence of social media and artificial intelligence. Suicide remains a leading cause of death for youth and young adults. Recent systematic reviews find many gaps in evidence regarding prevention, but support pediatricians taking action to identify youth at risk, conducting short pragmatic interventions, and connecting youth to planned monitoring and care. We know more about what works to prevent suicides in adults than in young people. However, there are practical options for pediatricians to help youth and young adults. This includes brief screening in primary care, followed by safety planning and lethal means restriction. Existing evidence also supports school-based youth education on mental health and suicide. Dialectical behavioral therapy shows promise. More research is needed on social media, apps, and AI to understand and mitigate potential risks, and to exploit their low cost and wide reach.
Although studies of outcomes associated with video gaming in adolescence and young adulthood largely focus on potential harms, video game use may also promote certain health benefits. This review synthesizes the positive health outcomes associated with video gaming, while providing recommendations to clinicians for considering and evaluating both beneficial and adverse effects. Recent evidence suggests that video gaming may strengthen the development of cognitive and executive functioning in adolescents and young adults. Moreover, video game use may also contribute positively to social connection and personal identity formation. Clinicians should engage in open, nonjudgmental dialogue with youth to better explore the context and patterns of their video gaming. The American Academy of Pediatrics’ 5 Cs framework and Family Media Plan offer evidence-based frameworks that can be referenced to facilitate thoughtful discussions about video game use.
This review aims to provide an updated overview of the genetic basis, pathophysiology, clinical presentation, diagnostic approach, management strategies, and outcomes for cardiomyopathies presenting in the neonatal population. Neonatal cardiomyopathies represent a rare and complex group of disorders that are typically classified by ventricular morphology, with dilated, hypertrophic, and left ventricular noncompaction phenotypes being the most commonly seen in the neonatal population. Advances in genetic testing have revealed a strong and complex genetic basis for neonatal cardiomyopathies, with wide variability in penetrance and phenotypic expressivity, even among family members sharing the same pathogenic variant. Neonates with cardiomyopathy typically present with symptoms of heart failure that may mimic other diseases of childhood, such as respiratory and gastrointestinal illnesses. The intricate etiologies of each cardiomyopathy makes targeted treatment difficult, and heart failure management is largely supportive in nature. Although medications and interventions exist to manage symptoms, heart transplantation remains the final potential therapeutic option for patients with end-stage heart failure. Neonates and infants diagnosed with cardiomyopathy overall have worse outcomes compared to children who are older at the time of diagnosis and carry a high risk of progression to death or need for heart transplant, highlighting the need to better understand the complex interactions leading to the development of cardiomyopathy in neonates and to continue developing treatment options for this vulnerable population.
Biologic therapies have transformed the management of severe asthma, particularly for patients with Type 2 (T2) inflammation. These targeted monoclonal antibodies offer a personalized approach for patients with eosinophilic or allergic phenotypes who remain uncontrolled despite high-dose inhaled corticosteroids and additional controller medications. Recent updates in guidelines, such as GINA 2025, reflect the growing integration of these therapies into asthma treatment algorithms. To provide a comprehensive review of current biologic options for severe asthma, including patient selection strategies, clinical efficacy, safety profiles, and areas of ongoing investigation. We performed a narrative synthesis of pivotal trials, real-world evidence, and recent guideline updates on five FDA-approved biologics—omalizumab, mepolizumab, benralizumab, dupilumab, and tezepelumab—alongside emerging data on depemokimab. Clinical eligibility criteria, mechanism of action, biomarker guidance, and outcome measures were compared. Emphasis was placed on individualized therapy and endotype-driven decision-making. All biologics demonstrated significant reductions in exacerbation rates, oral corticosteroid (OCS) use, and improved asthma control in appropriate T2-high populations. Dupilumab and tezepelumab showed additional benefits on lung function and broader applicability across biomarker thresholds. Depemokimab, a long-acting anti-IL-5 agent, has shown promising efficacy in the SWIFT-1 and SWIFT-2 trials, supporting semi-annual dosing and sustained eosinophil suppression. Real-world studies reinforce clinical trial data, and safety profiles were favorable, with minor adverse events in a limited number of patients. Biologic therapies have redefined care for patients with severe T2 asthma, enabling biomarker-guided precision medicine. Despite significant progress, gaps remain in treating T2-low asthma, pediatric populations, and long-term treatment strategies. Ongoing research into omics-based predictors, dual-target therapies, and cost-accessibility will shape future asthma management paradigms.
Skeletal development begins in childhood with all bone accrual complete by early adulthood, making bone health an important topic in pediatric medicine. This is especially true for patients with diabetes as these and other chronic conditions are associated with increased lifelong risk of fracture. The purpose of this review is to give a broad overview of bone health in diabetes including etiology, pathogenesis, and current recommendations for management. Studies continue to demonstrate lifelong increased risk of osteoporotic fractures in patients with diabetes. Like all diabetes complications, tight glycemic control, nutrition, and exercise play crucial roles in the prevention of this diabetes complication. Bisphosphonate therapy for osteoporosis in pediatrics is limited to those with a history of fragility fractures. Pediatricians should promote lifestyle modifications to optimize bone health for all patients with diabetes, including ensuring adequate nutrition (vitamin D and calcium intake), exercise, and glycemic control. Dual-energy x-ray absorptiometry (DXA) scan should be considered for any patient with diabetes and a history of clinically significant fracture (vertebral fracture, low impact long-bone fracture, or multiple fractures). Referral to an endocrinologist with experience in osteoporosis treatment is appropriate for any patient with diabetes and a history of pathologic fracture.
Purpose: Polycystic ovary syndrome (PCOS) is a common endocrine condition among women, associated with cardiometabolic comorbidities. This review explores the risk of metabolic disease in adolescents with PCOS and its association with disease phenotypes.Methods: We reviewed current literature on metabolic risk in adolescents with PCOS, including studies on insulin resistance, cardiovascular and adipose tissue dysfunction, and hepatic steatosis.Results: Evidence indicates that adolescents with PCOS have increased risk for insulin resistance, cardiovascular and adipose tissue dysfunction, and hepatic steatosis. These metabolic risks vary according to disease phenotypes and may persist into adulthood.Conclusion: Early diagnosis of PCOS and targeted lifestyle interventions are critical to mitigating cardiometabolic risk and improving long-term health outcomes.
Cardiovascular-kidney-metabolic (CKM) syndrome is a recently introduced term by the American Heart Association to describe the interconnected nature of obesity, chronic kidney disease, type 2 diabetes, and cardiovascular disease. These conditions are major contributors to adult morbidity and mortality; however, not limited to adults. There is a notable gap in the literature regarding CKM in pediatric population. In this context, we explore CKM syndrome in children, its pathophysiology, definition, age-specific risk factors, diagnostic options, and suggest early intervention strategies that could significantly influence CKM outcomes. CKM syndrome originates from chronic inflammation and oxidative stress triggered by excessive and dysfunctional adipose tissue, resulting in damage to the arteries, heart, and kidneys, and contributing to insulin resistance. Components of CKM syndrome are key factors in the development and progression of cardiovascular disease, with evidence of deleterious effects on vascular injury and atherosclerosis from very early life, even prenatal exposure. Several cardiovascular risk factors have been linked to early vascular changes, leading to the onset of CKM syndrome during childhood or increasing the risk of its earlier manifestation in adulthood. Children may remain asymptomatic for a long time, making screening and early identification critical. Obesity is often the entry point into the CKM pathway. In addition, genetic and familial conditions (e.g., familial hypercholesterolemia, monogenic diabetes, congenital nephropathies) should be considered early. The pathophysiological effects of obesity in children lead to the development of cardiovascular-kidney-metabolic syndrome in adulthood. Childhood is an entry point for early identification and intervention.
To summarize advances in transcatheter patent ductus arteriosus (PDA) device closure, with a particular focus on premature infants. This review emphasizes early and late post-procedural outcomes and highlights device innovation as well as the need for further studies evaluating clinical changes following closure. Transcatheter PDA closure has become the standard of care for PDA closure in premature infants given the improved safety profiles and reduced procedural morbidity compared to surgical ligation. FDA approval of the Amplatzer Piccolo Occluder in 2019 for use in extremely low birth weight (ELBW) infants ≥ 700 g has allowed for closure in smaller, higher risk patients, enabling further investigation into short-term and long-term outcomes in this population. PDA closure traditionally relied on medical and surgical approaches, with a catheter-based approach now the standard of care. While outcomes in term and older infants are well established, growing clinical experience and the availability of smaller profile devices such as the Piccolo Occluder, have enabled safe and effective closure in this high-risk population. These advances have driven continued interest in evaluating short- and long-term post-procedural outcomes, with a growing interest in understanding the clinical trajectories following closure.
Artificial Intelligence (AI) and Machine Learning (ML) are rapidly evolving fields with growing implications for pediatric healthcare, education, and research. This review synthesizes current evidence, highlights key applications across pediatric subspecialties, and outlines limitations and future directions. It explores how AI tools that range from diagnostic models to large language models (LLMs) are being leveraged in pediatric clinical practice, medical education, and research, while emphasizing the need for careful integration, validation, and oversight. AI applications in pediatrics include diagnostic support, prognostic modeling, risk prediction, therapeutic planning, treatment monitoring, and clinical decision support. In specialties like endocrinology, neurology, and emergency medicine, AI has demonstrated potential to enhance early diagnosis, optimize resource use, and reduce errors. LLMs are increasingly used for personalized feedback, curriculum development, and patient communication. In research, AI is enabling new insights through natural language processing and advanced predictive modeling. However, challenges persist, including variability in model performance, data bias, ethical and medicolegal concerns, and limitations in transparency (‘black box’ problem). LLMs also pose risks of inconsistency, misinformation, and over-reliance by users. Pediatric-specific governance frameworks and professional education programs, such as those led by the American Academy of Pediatrics, are emerging to address these issues. AI and ML hold significant promise for transforming pediatric care, education, and research. However, realizing this potential requires rigorous clinical validation, thoughtful implementation, and strong ethical safeguards. Pediatricians must remain engaged in AI development and evaluation to ensure these tools enhance, rather than replace, clinical judgment. Educating clinicians about responsible AI use, improving data quality and equity, and embedding tools into clinical workflows are key priorities. Generative AI, particularly LLMs, should be embraced cautiously, with clear oversight, stakeholder input, and ongoing professional development to ensure alignment with the unique needs of pediatric populations.
The impact of GLP1 receptor agonist (GLP1-RA) medications on eating disorders is not established in large scale clinical trials with adult or pediatric populations. Whether GLP1-RA improve or worsen eating disorders is an important clinical question. This review integrates emerging evidence and clinical experience to offer guidance for pediatric GLP1-RA prescribing in the context of observed eating disorders or suspected eating disorders. We provide a review of the controversy around prescribing GLP1-RA to children and adolescents, outline existing research on GLP1-RA and eating disorders with adults, review clinical experience with pediatric populations with comorbid eating disorders and obesity treated with GLP1-RA, and provide initial guidance to providers prescribing GLP1-RA in the absence of established research studies. Many children and adolescents will likely benefit from GLP1-RA treatment for Binge Eating Disorder, Night Eating Syndrome, and Other Specified Eating or Feeding Disorder. However, GLP1-RA may have iatrogenic effects with respect to Atypical Anorexia, Bulimia Nervosa, and ARFID. Early data and clinical experience indicate that GLP1-RA are beneficial for some pediatric patients with co-morbid obesity and eating disorders. However, some types of eating disorders could worsen with GLP1-RA and require monitoring and treatment by registered dietitian and/or behavioral health providers who specialize in eating disorders, with appropriate referrals to higher levels of care for disordered eating.
We highlight the importance of consensus building methodologies, specifically a modified nominal group technique, to help medical educators determine curricular priorities for trainees. Three standard consensus building methodologies exist – the Delphi technique, the nominal group technique, and the consensus development panel. The nominal group technique is ideal for decision making around curricular priorities. It is a structured face-to-face interaction that is used to generate ideas and build consensus around a specific question via a small group of experts. It has a broad array of applications across fields and is particularly helpful in organizational decision making and problem solving. It is essential for the public health that schools and training programs train competent clinicians. Unfortunately, governing boards in the United States do not stipulate specific topics that should be included in individual curricula. Consensus building methodologies can be utilized to help determine priorities using panels of experts. Our team found that the NGT is best suited to determine curricular priorities at our institution. A modified NGT conducted in the virtual environment with an additional step of prioritizing the included topics has been successfully utilized to develop curricular priorities for a pediatrics residency program.
The purpose of this paper is to describe the literature on Safety Planning Intervention (SPI), a brief intervention that focuses on management of immediate suicide risk and transition to ongoing treatment to address and stabilize suicidal thoughts and behaviors. In particular, this paper focuses on studies conducted examining the use of SPI among children and adolescents, identifies gaps in the literature, and makes suggestions for future research directions. Numerous studies document the efficacy of SPI in reducing suicide attempts and increasing treatment engagement among adults. However, the evidence to support SPI among children and adolescents at risk for suicide is more limited. Available research suggests that effective implementation strategies may be essential to ensure consistent delivery of SPI among youth, with technology-assisted approaches showing early promise. More research is needed to better understand whether SPI is effective in reducing suicidal thoughts and behaviors among children and adolescents. Advancing this work will require rigorous evaluation of SPI’s efficacy and effectiveness, as well as identification of optimal strategies for implementation among young people.
