Pediatrics

Standardized suicide risk screening remains uncommon and uneven across pediatric subspecialties

Among 5003 surveyed pediatricians, only 36.7% reported using standardized suicide risk screening tools in their practice. Pediatric emergency physicians were much more likely than general pediatricians to use standardized tools (AOR 2.83, 95% CI 2.13–3.77). Being moderately or very knowledgeable about AAP suicide screening recommendations was associated with higher screening use (AOR 1.53, 95% CI 1.29–1.83). Among clinicians who screened, 73.1% used universal screening for patients ≥12 years, with notable differences in tools across subspecialties. 1

Automated insulin delivery improves real-world glycemic control in youth with type 1 diabetes

This SWEET registry analysis followed 2170 children and adolescents with type 1 diabetes for 12 months before and after automated insulin delivery initiation. Automated insulin delivery significantly increased time in range (70–180 mg/dL) and tight range (70–140 mg/dL) compared with pre-initiation periods. Mean sensor glucose, glycemic variability, and time below range (<70 mg/dL) all decreased, indicating improved stability and less hypoglycemia. Hemoglobin A1c improved without significant change in total daily insulin dose, suggesting greater efficiency rather than higher insulin exposure. 2

Multiomics identifies persistent mortality signatures in acutely ill children in Africa and South Asia

Researchers studied 3101 acutely ill hospitalized children at nine sites in sub-Saharan Africa and South Asia with nested multiomic profiling in 1008 cases. They identified a mortality signature involving immune, inflammatory, metabolic dysregulation and gut dysbiosis that persisted from admission through discharge. Malnourished children had greater baseline perturbations, helping explain their elevated inpatient and post-discharge mortality despite guideline-based care. Some children with low clinical severity showed high biomarker-predicted mortality, suggesting current tools miss high-risk patients. 3

Massive LV hypertrophy sharply increases adverse outcomes in pediatric hypertrophic cardiomyopathy

This multiregistry analysis included 587 patients with pediatric-onset hypertrophic cardiomyopathy, of whom 186 had massive LV hypertrophy by wall thickness criteria. Children with massive LV hypertrophy were diagnosed younger (median 9.2 vs 13.6 years) and more frequently carried sarcomeric variants (72% vs 61%). Massive LV hypertrophy was associated with higher HCM-related mortality (HR 3.3, 95% CI 1.2–9.7) and major ventricular arrhythmia events (HR 3.1, 95% CI 1.8–5.2). Risks of major adverse cardiac events (HR 2.6, 95% CI 1.7–3.9) and heart failure events (HR 1.9, 95% CI 1.1–3.1) were also increased. 4