Pediatric

Liberal clear-fluid fasting in children showed no rise in pulmonary aspiration, meta-analysis finds

Across 33 studies with 580,197 children, pooled aspiration incidence was 0.03% under both conventional (≥2 h) and liberal (<2 h) clear-fluid policies (risk ratio 0.77, 95% CI 0.40-1.47). Vomiting occurred in 0.99% vs 0.76%.

Why it matters. Adds reassurance for programs shortening clear-fluid fasting in children, though aspiration is too rare to compare precisely.

Limitation. Very low certainty of evidence, pooling randomized and non-randomized studies.

Cardiac arrest followed 1.2% of PICU intubations, and each extra attempt raised the odds

Among 27,773 intubations in international PICUs and pediatric cardiac ICUs (2015-2023), intubation-associated cardiac arrest occurred in 1.2%. Each additional attempt raised the odds (aOR 1.70), shock (aOR 4.67) and oxygenation failure (aOR 2.29) were strong risk factors, and video laryngoscopy was associated with lower odds (aOR 0.76).

Why it matters. Adds registry evidence for prioritizing first-attempt success, including video laryngoscopy, in critically ill children.

Limitation. Retrospective registry analysis; associations may reflect confounding.

Furosemide stress test predicted AKI progression (AUC 0.89), but evidence certainty is low

Across 20 studies (n = 1979), the furosemide stress test predicted progression to stage 3 AKI with sensitivity 0.69 and specificity 0.88 (AUC 0.89), and successful KRT liberation with AUC 0.89. FST-guided early KRT did not change short-term mortality (RR 1.00; 2 RCTs).

Why it matters. Supports the FST as a low-cost bedside risk-stratification tool, not as a trigger for early dialysis.

Limitation. Low to very low certainty of evidence.

Equivalence of Oral Melatonin and Oral Midazolam in Preoperative Anxiolysis for Pediatric Fast-Track Cardiac Surgery

Phase 2/3 trial planning 100 participants, sponsored by Ain Shams University. Status: active not recruiting. Conditions: Comparative Effectiveness.

Intravenous Dexamethasone for ESP Block Analgesia in Children Undergoing Idiopathic Scoliosis Surgery

Phase 4 trial planning 90 participants, sponsored by Poznan University of Medical Sciences. Status: not yet recruiting. Conditions: Adolescent Idiopathic Scoliosis (AIS).

Dexmedetomidine Use for Greater Occipital Nerve Block in Pediatric Posterior Fossa Tumor Surgery

Phase 3 trial planning 260 participants, sponsored by Children's Cancer Hospital Egypt 57357. Status: recruiting. Conditions: Posterior Fossa Tumor.