These findings underscore the clinical and genetic heterogeneity of acromelic dysplasias and emphasize that integrated clinical and molecular evaluation is essential for accurate classification and follow-up. • Acromelic dysplasias are rare connective tissue disorders characterized by short stature, brachydactyly, and joint stiffness, caused by variants in genes involved in extracellular matrix organization and TGF-β- related signaling. • Five novel variants in ADAMTSL2, ADAMTS10, and ADAMTS17 expand the molecular spectrum of acromelic phenotypes. • Tiptoe walking, in association with early findings including short stature, acromelia, and broad proximal phalanges on radiographs, may suggest ADAMTSL2-related geleophysic dysplasia.

This series supports the use of routine immediate POCUS for all neonatal PICC lines and consideration of real-time ultrasound-guided PICC placement. Warning signs of intra-arterial placement include abnormal line trajectory on radiographs, insertion site oozing, high pump pressures and limb ischaemia (including contralateral limb involvement). Particularly high-risk neonates include those with congenital diaphragmatic hernia whereby mediastinal shift renders radiographic confirmation of PICC position unreliable. • Neonatal PICC position is usually confirmed by radiography, and accidental arterial cannulation (AAC) is considered rare. • AAC occurred more frequently than previously reported and was often not detected clinically or on radiographs. • Point-of-care ultrasound improved identification of AAC and may improve neonatal PICC safety.

In this pediatric cohort, stool toxin A/B detection did not provide additional clinical value beyond PCR positivity for C. difficile toxin genes (tcdA/tcdB). PCR alone, when interpreted in the context of compatible symptoms and epidemiological risk factors, may be sufficient to guide treatment decisions for suspected pediatric CDI. Given the limited incremental value of stool toxin A/B testing, optimized diagnostic algorithms and further multicenter pediatric studies are warranted. • Pediatric CDI diagnosis is complicated by high asymptomatic colonization; PCR for C. difficile toxin genes (tcdA/tcdB) is sensitive but cannot distinguish colonization from infection. • Stool toxin A/B EIAs are more specific but less sensitive, and guidelines often recommend multistep algorithms. • In our cohort of pediatric patients with PCR positivity for C. difficile toxin genes (tcdA/tcdB), stool toxin A/B status was not associated with clinical severity, risk factors, laboratory findings, outcomes, or treatment initiation. • When clinical features are compatible, PCR positivity for C. difficile toxin genes (tcdA/tcdB) alone may be sufficient to guide treatment, with limited incremental value of stool toxin A/B testing.

Adolescence is a high-risk period for non-adherence to immunosuppressive therapy after pediatric liver transplantation, especially as medication responsibility shifts from parent-led routines toward increasing adolescent participation. However, limited evidence explains how adolescents manage medication demands in daily life within school, family, and peer contexts. We conducted a single-center qualitative descriptive study in a tertiary pediatric liver transplant clinic in Southwest China. Using purposive sampling, we recruited adolescents aged 13-17 years who were at least 1 year post-transplant and remained in pediatric follow-up at the time of interview (N = 12). None had transferred to adult services. Semi-structured one-to-one interviews were conducted between July and August 2025, audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Analytic depth was supported through reflexive memoing, post-interview debriefing, preliminary coding during recruitment, dialogic discussion within the research team, and an audit trail. Four interrelated tensions shaped medication self-management during the developmental transition of responsibility: (1) regimen requirements versus school-day routines; (2) growing expectations for autonomy versus uneven readiness for self-management; (3) family and school support that was both enabling and conflict-provoking; and (4) a desire for empowerment and peer normalcy in the context of stigma and limited youth-oriented resources. Participants described overlapping self-management patterns rather than fixed types. In two accounts, episodes of repeated compromise, treatment fatigue, or reduced engagement suggested ongoing vulnerability in particular contexts. Conclusions: Medication non-adherence in adolescence may be shaped by contextual constraints as well as knowledge or motivation. Support should extend beyond standardized education to include individualized medication planning, staged autonomy-building within pediatric follow-up, practical school-day planning, and discreet youth-centered adherence strategies that better fit adolescents' daily lives.

To estimate the risk projection of temperature on pediatric asthma severity and hospitalization under four Shared Socioeconomic Pathways (SSPs) possible future climate scenarios using the Intergovernmental Panel on Climate Change (IPCC) model.A retrospective study was conducted involving 102,160 pediatric asthma patients from the Taipei Medical University Clinical Research Database (TMUCRD). We utilized global climate model (GCM) outputs to project future temperature for each subject from optimistic (SSP126) to pessimistic (SSP585) projections. A multinomial logistic regression was used to examine the odds ratio of pediatric asthma severity and hospitalization.A 1°C increase in 1-year, 5-year, and 10-year average temperatures was associated with 1.004-fold (95% CI: 1.003-1.005) and 1.332-fold (95% CI: 1.327-1.338), 1.004-fold (95% CI: 1.002-1.005) and 1.303-fold (95% CI: 1.298-1.308), and 1.005-fold (95% CI: 1.004-1.006) and 1.282-fold (95% CI: 1.278-1.287) increase in the OR for mild persistent and hospitalization of pediatric asthma. We observed a non-linear association between temperature under SSP126, SSP245, SSP370 and SSP585 with moderate persistent pediatric asthma and pediatric asthma hospitalization, with the highest OR increases observed in 2033 at 33.4% and 32.3%, 27.6% and 32.3%, 29.1% and 32.4%, and 27.2% and 32.3%, respectively.Conclusion:Projected future temperature changes as a result of climate change may be associated with a possible increase in pediatric asthma severity and hospitalization in the coming years, with an expected increase of 8.0% and 2.5% per 1°C increase, respectively. Pediatric asthma patients may be more susceptible to poorer outcomes under climate change in the future. What is Known: • Rising temperatures have been linked to increased asthma severity and hospitalization. • Climate change worsening pediatric asthma outcomes and increasing the healthcare burden. What is New: • Long-term exposure to rising ambient temperatures and PM2.5 is significantly associated with increased odds of moderate and severe persistent asthma in children. • Theoretical projections linking multiple climate model scenarios (SSP126-SSP585) with future pediatric asthma burden.

Linezolid is commonly used in children for the treatment of severe gram-positive infections; however, data on metabolic adverse effects remain limited. We evaluated lactate abnormalities in pediatric patients receiving intravenous linezolid. Among 215 children, hyperlactatemia/lactic acidosis occurred in 55.8%. Hyperlactatemia and/or lactic acidosis tended to develop early after treatment initiation and was more frequently observed in younger children and in those with complex underlying conditions, including neurometabolic and hemato-oncologic disorders. These findings suggest that host-related factors may influence susceptibility to lactate disturbances during linezolid therapy and support careful clinical monitoring in selected pediatric populations.

The most common symptom in children is severe pain that is disproportionate to the inciting event. Critical gaps in the evidence base such as the absence of age appropriate, validated diagnostic criteria, lack of research understanding the lived experience and impact of the condition or exploring treatment efficacy, were identified as knowledge gaps within the field. • Complex Regional Pain Syndrome is a difficult to diagnose and hard to treat pain condition. Among children, it is not well documented or understood, there are no agreed diagnostic criteria or treatment guidelines. •This scoping review summarises and presents the published research regarding presentation, diagnosis and non-pharmacological treatment of paediatric CRPS. • Issues relating to the use of treatments lacking demonstrable efficacy and the need for quick and reliable diagnoses are discussed. • Using the PAGER Framework, this review exposes critical gaps in both research (the lack of research around condition experience and treatment efficacy) and practice (the lack of validated diagnostic criteria and treatment pathways) outlining clear and urgent recommendations.

Telitacicept effectively reduces proteinuria, improves renal function, and enhances clinical remission rates in pediatric IgAVN, demonstrating a favorable safety profile. • Telitacicept, a dual BAFF/APRIL inhibitor, has shown potential effi cacy in IgA nephropathy (IgAN) and IgA vasculitisnephritis (IgAVN), particularly in reducing proteinuria and maintaining stable renal function. • Evidence regarding the use of telitacicept in pediatric IgAVN remains limited and is mainly derived from small case series and retrospective studies. • This study provides real-world data on the use of telitacicept in pediatric IgAVN, showing improvement in proteinuria with stable renal function during follow-up. • Most patients were able to discontinue glucocorticoids and/or immunosuppressive agents within 3-6 months after telitacicept initiation, suggesting a potential steroid- and immunosuppressant-sparing effect.

Evaluate variation in care of febrile infants presenting to London hospitals and adherence to national Clinical Practice Guidelines (CPGs). Retrospective multicentre cohort study conducted at 21 London hospitals. Infants ≤ 90days of age presenting with fever or caregiver reported fever between 1st April 2021-31st March 2022 were included. Outcome measures were variationsin patient management and adherence to national CPGs. Of 2,008 presentations, 41.1% were febrile during assessment. 73.7% had blood tests (range across hospital sites: 55.4-96.7%), 40.8% had cerebrospinal fluid (CSF) testing (17.1-70.7%), 63.4% had urinalysis (43.4-85.4%) and 62.2% were investigated for SARS-CoV2 (26.5-91.7%). Antibiotics were started in 57.7% (35.4-90.2%) and 63.5% (46.7-99.2%) were admitted. Infants aged < 28days and infants febrile during assessment were more likely to undergo investigations and be admitted. Adherence varied significantly across sites: full adherence to CPGs was achieved in 21.9% (site range 8.8-35.4%), partial adherence in 24.4% (18.0-35.3%), non-adherence in 31.2% (10.6-47.4%), and over-adherence in 23.5% (8.0-44.7%). CPG adherence was higher in infants aged < 28days.Conclusions: There was wide variation in care across London hospitals with limited adherence to guidelines. This highlights the need to focus on refining and updating decision models and CPGs, with more specific recommendations for managing infants who are afebrile during initial assessment. Clear guidance with a focus on reducing missed diagnosis may impact patient safety and economical expenditure.