McMaster Children's Hospital

Hypogammaglobulinemia is a common side effect of rituximab that can result in life-threatening infections. The risk of hypogammaglobulinemia and infections should be weighed against the effectiveness of rituximab for nephrotic syndrome management. Prospero registration: CRD42024536465. •Rituximab, a chimeric anti-CD20 monoclonal antibody, is commonly used for complicated pediatric nephrotic syndrome. •Post-rituximab hypogammaglobulinemia is a recognized adverse effect that may predispose to severe, including fatal, infections; however, the magnitude of risk of poorly understood in pediatric population. •The pooled incidence of hypogammaglobulinemia in children with nephrotic syndrome receiving rituximab was 11.4%. Rituximab exposure was associated with a significantly higher risk of hypogammaglobulinemia compared with children not receiving rituximab (risk ratio 1.81). •In 517 episodes of hypogammaglobulinemia, 93 (18%) infections occurred, four of which were fatal.

Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.

Part of the June 2026 issue supplement, to be published in its entirety on May 12, 2026.

https://youtu.be/Y0k1zEu0uIc BACKGROUND: Congenital heart defects (CHD) are structural heart abnormalities affecting 1% of children. At school-age, these children report lower quality of life, particularly when CHD is complex. Less is known about quality of life and its relationship to defect severity or treatment among very young children with CHD or innocent murmurs. This study investigated parent reports of quality of life for their very young children with CHD and compared their scores to published data for healthy children. METHODS: Study data were collected from families who were enrolled in an observational trial of physical activity and motor development. Inclusion criteria for the study were children aged 1 to 3 with a diagnosis of CHD or an innocent heart murmur. Parents completed the Pediatric Quality of Life Inventory (PedsQL) core, cardiac and family impact modules at the baseline visit. Demographic data were obtained through family reports on the child's age, sex, CHD treatment history, and family income. RESULTS: Complete PedsQL and demographic data sets were obtained from parents of 119 children (mean child age: 1.75 ± 0.82 year) with varying degrees of CHD treatment (no intervention (n=41, 22 female), CHD surgery without cardiopulmonary bypass (n=17, 11 female), CHD surgery with bypass (n=36, 19 female)) or innocent murmurs (n=25, 10 female). When compared to the PedsQL Core module standard for healthy children, 83.00 ± 14.79 (Varni 2001), the children in this study reported a better quality of life with a mean score of 93.26 ± 7.72, resulting in a mean difference of 10.26 ± 1.37 (p<0.0001). Core quality of life generally decreases as disease severity increases, being the best for children with innocent heart murmurs (95.02 ± 6.73) or those not requiring CHD intervention (94.08 ± 7.40), and lower among children who have undergone CHD surgery either with (91.79 ± 8.47) or without (91.82 ± 7.99) bypass. Females tended to have an overall lower quality of life based on the core (mean difference: 2.26 ± 1.41; p=0.11) and cardiac-specific (mean difference: 3.21 ± 1.77; p=0.07) modules. Lower family income is associated with lower family quality of life, with the mean difference between family income <$99,000 (n=48) and >$100,000 (n=59) being 7.55 ± 2.19 (p=0.002). CONCLUSIONS: This study provided key insights into the quality of life of toddlers with CHD, a previously understudied population. While the findings support a high quality of life relative to healthy children, there are still areas of discrepancy, including lower core quality of life for children who undergo CHD surgery with and without bypass, lower core and cardiac quality of life for female children, and lower family quality of life for children with lower family incomes. Future research should explore larger groups of children and conduct further stratification analysis to determine other risk factors for low quality of life among this vulnerable population.

IntroductionRoad traffic injuries are a leading cause of death in children worldwide. Over 90% of road traffic deaths occur in low-income and middle-income countries. Unfortunately, there is very little data on child restraint system (CRS) use in major regions globally. Using data from nine cities, the objectives of this study were to examine the prevalence of CRS and how this has changed over time, and to investigate factors associated with CRS use.MethodsThe nine cities included in the analysis were Accra, Addis Ababa, Bandung, Bangkok, Bogota, Fortaleza, Ho Chi Minh City, Mumbai and Sao Paulo. This was a cross-sectional study, with eight rounds of roadside observational data collected from February 2015 to March 2019.ResultsThere were 34 247 child passengers between the ages of 0–12. The overall prevalence of CRS use was 37.07% for children under 5 and 7.54% for children over 5. Sao Paulo had the highest overall prevalence of CRS use under 5 (40.08%) while Bandung had the lowest (1.25%). Only Mumbai had a significant increase in CRS use over time. Child passengers had higher odds of using CRS if they were younger, in the rear seat, with fewer passengers in the vehicle, and if the driver was wearing their seatbelt.ConclusionsThe prevalence of correct utilisation of CRS is concerningly low and shows large variation globally. This study highlights the urgency of implementing a multifaceted approach to reach the Second Decade of Road Safety Goal of increasing child restraint use to close to 100% by 2030.

This systematic review evaluates long-term outcomes after anterior cruciate ligament reconstruction (ACLR) with lateral extra-articular tenodesis (LET), including patient-reported outcome measures (PROMs), failure rates, objective knee scores and radiographic osteoarthritis (OA). A search of MEDLINE, Embase and Emcare was conducted until April 2025. Studies were eligible if they reported ≥10-year outcomes following combined ACLR and LET in adults. Exclusion criteria included cadaveric, biomechanical, paediatric and non-English studies. Methodological quality was assessed using Risk of Bias 2.0 Tool (RoB 2) for randomized trials and methodological index for non-randomized studies (MINORS) for non-randomized studies. Narrative synthesis and descriptive statistics were performed. Eleven studies (n = 603) were included, with a mean follow-up of 15.8 years (standard deviation [SD] 5.9). Graft failure rates ranged from 0% to 19.5%, with lower rates in studies using stricter revision-based definitions. LET was associated with lower failure and instability rates compared to isolated ACLR in three studies. Radiographic OA findings were mixed: some reported increased lateral OA (notably with bone-patellar tendon-bone [BTB] grafts), while others suggested protective effects, especially in patients with hamstring grafts and prior meniscectomy. Lysholm scores consistently exceeded 85, while Tegner activity levels declined modestly. International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were favourable, and most patients achieved IKDC objective Grade A or B. This review demonstrated that ACLR augmented with LET provided durable long-term outcomes, including high rates of subjective satisfaction and objective stability, without being consistently associated with increased radiographic OA or unacceptable failure rates. However, heterogeneity in study design, surgical technique and outcome reporting limits definitive conclusions. Level IV.

Abstract Background Childhood obesity can result in adverse health outcomes. Objectives Objectives were to describe the prevalence of obesity and determine the association between obesity at cancer diagnosis and event-free survival (EFS) and overall survival (OS) in children diagnosed with cancer in Canada. Design/Methods We conducted a retrospective cohort study using the Cancer in Young People in Canada database, a population-based surveillance program collecting data from all paediatric cancer patients. This study included all children with newly diagnosed cancer aged 2 to 18 years across Canada from 2001 to 2020. Obesity was defined as age and sex-adjusted body mass index ≥ 95th percentile. EFS was defined as the time from diagnosis to first event (relapse, progression, secondary malignancies, or death). Univariate and multivariable Cox proportional hazards models compared EFS and OS between patients with and without obesity. Results A total of 11,291 patients were included (37.1% leukemias, 14.5% lymphomas, 21.8% central nervous system (CNS) tumors, 26.6% non-CNS solid tumors). At diagnosis, 10.5% were obese and the prevalence of obesity was significantly higher at 1 year (15.7%, p<0.001) and 2 years (20.1%, p<0.001) after diagnosis. The prevalence of obesity was higher in the leukemia and lymphoma cohort compared to other cancer categories (11.4% vs. 9.5%, p=0.001). In multivariable models controlling for age at diagnosis, sex, ethnicity, neighborhood income quintile, treatment era and cancer categories, obesity at diagnosis remained significantly associated with inferior EFS [adjusted HR (aHR) 1.16, 95% CI 1.02–1.32] and OS [aHR 1.29, 95% CI 1.11–1.49]. In children with acute lymphoblastic leukemia (ALL) (n=3458, 82.5% of all leukemias), after adjusting for high-risk features such as age, white blood cell count and CNS status, obesity at diagnosis remained significantly associated with inferior EFS [aHR 1.55, 95% CI 1.17–2.04] and OS [aHR 1.75, 95% CI 1.23–2.49]. In patients with CNS tumors, obesity at diagnosis was also independently associated with inferior EFS [aHR 1.38, 95% CI 1.09–1.76] and OS [aHR 1.47, 95% CI 1.13–1.91]. Conclusion In this population-based study of children with cancer, the prevalence of obesity was 11% at diagnosis and continued to increase in the following 2 years. Obesity at cancer diagnosis was independently associated with inferior survival across the entire cohort, especially in children with ALL and CNS tumors. Prevention of childhood obesity should be emphasized as it can lead to several adverse health outcomes in children with cancer.

BackgroundGuided self-help family-based treatment (GSH-FBT) is emerging as a promising, more efficient alternative to traditional family-based treatment (FBT). The present study is designed to examine the real-world implementation of GSH-FBT at pediatric treatment sites across nine provinces in Canada.MethodsImplementation teams at each site consisting of a GSH-FBT coach, a medical provider, and a program administrator will be formed. Clinician coaches will be trained in this new modality and supported with weekly GSH-FBT consultation. Each site will recruit ten families with an adolescent with anorexia nervosa and the parents will undergo ten virtual GSH-FBT sessions. The implementation approach will be evaluated using qualitative and quantitative methods. Outcomes of interest include (1) treatment fidelity, (2) treatment wait times, (3) change in adolescent symptoms and parent/caregiver self-efficacy, (4) change in provider readiness, attitudes, and confidence towards the intervention, and (5) the overall experience of the implementation of the intervention from the perspective of the provider teams, and participant families.DiscussionThe findings of this study will help to identify factors important to the acceptability and implementation of GSH-FBT in real-world clinical settings.Trial registrationThis study was first registered with clinicaltrials.gov (registration # NCT06851273) on February 12, 2025 (url: https://clinicaltrials.gov/study/NCT06851273?id=NCT06851273&rank=1).