Objective: To evaluate clinical, laboratory, cerebrospinal fluid (CSF), and imaging factors associated with significant CSF abnormality in children undergoing lumbar puncture (LP). Methods: We retrospectively analyzed 153 patients who underwent LP between 2017 and 2022. Significant CSF abnormality was defined using prespecified CSF criteria. Results: Significant CSF abnormality occurred in 41 patients (26.8%); 38 (24.8%) had definite or suspected central nervous system infection, including 13 microbiologically confirmed. Vomiting, headache, and meningeal irritation signs were more frequent, whereas seizures were less frequent, in patients with significant CSF abnormality. Procalcitonin showed limited discrimination (area under the receiver operating characteristic curve [AUC], 0.596; 95% CI, 0.479-0.712; P = .107). Meningeal irritation signs and headache remained independently associated with the outcome. Conclusion: In this LP-selected cohort, clinical findings were more informative than systemic inflammatory biomarkers.
Cerebral palsy (CP) is a non-progressive neurodevelopmental disorder in which motor features and their functional impact may change across development. Although longitudinal surveillance and multidisciplinary management are established components of CP care, motor phenotype is often treated as static. This narrative review proposes iterative motor phenotyping as a conceptual framework for repeatedly characterizing spasticity, dystonia, ataxia, hypotonia, and mixed motor features in relation to function, participation, comfort, safety, and child- and family-centered goals. Reassessment may be scheduled during follow-up or triggered by developmental transitions, functional changes, by pain, or by limited or unexpected treatment response. Updated characterization can inform individualized management and may prompt targeted diagnostic evaluation when emerging or atypical features raise concern for an alternative diagnosis. Iterative motor phenotyping is intended to complement, rather than replace longitudinal surveillance, rehabilitation, multidisciplinary care, and diagnostic evaluation. Prospective studies are needed to determine whether this framework improves treatment selection or functional outcomes.
This retrospective cohort study investigated the effect of intravenous methylprednisolone on immune outcomes in 624 children with Mycoplasma pneumoniae pneumonia (MPP) admitted from April 2023 to April 2025. Data were retrospectively extracted from electronic medical records. Based on treatment received, patients were divided into control (azithromycin-based therapy) and observation (additional methylprednisolone) groups. After treatment, the observation group showed significantly higher CD4⁺ and CD4⁺/CD8⁺ levels, lower CD8⁺ levels, greater reductions in IL-6 and IL-8, and greater increase in IL-10 compared with controls (all P < .05). Symptom resolution times were significantly shorter in the observation group ( P < .05). Adverse reaction rates were similar between groups (11.54% vs 15.38%, P > .05). Adding intravenous methylprednisolone to standard therapy was associated with improved immune and inflammatory markers, faster symptom resolution, and good tolerability in children with MPP. Prospective trials are needed to validate these findings.
Despite an ongoing youth mental health crisis, mental health screening practices by pediatric health systems are unknown. The aim of the current study is to describe mental health screening practices in pediatric health systems and identify potential targets for improvement. Pediatric health systems enrolled in a quality improvement study regarding mental health services were surveyed regarding mental health screening practices. Thirty-four of 39 enrolled pediatric health systems from 24 states completed the survey. All systems reported screening for suicide, with most also screening for depression (94%), substance use (94%), and anxiety (88%). Screening was most common for patients over 12 and in primary care and outpatient psychiatry settings. Results highlight areas for improvement in pediatric mental health screening practices and underscore the need for further research.
Attention to spiritual needs at the end-of-life remains an issue that deserves to be implemented in oncology, especially when it comes to pediatric patients. Using different end-of-life stories experienced at the pediatric oncology unit of the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan as a starting point, this work would like to analyze the approach to spirituality and religiosity in pediatric palliative care. There are no specific inclusion/exclusion criteria for this study. We selected 4 representative cases of terminally ill pediatric patients treated and died from January 1, 2011, to September 30, 2024, in whom spiritual or religious beliefs played a significant role in care planning. The aim is descriptive and educational. To date, there are no real guidelines. Several groups recommend providing interprofessional psychosocial support for pediatric patients with cancer throughout the care trajectory. Based on our experience, our working group also agrees in strongly recommending spiritual support, and here too we would like to emphasize the importance of the “team.”
