Children and adolescents diagnosed with cancer often require treatment that includes oral medications. These oral medications frequently include both antineoplastic agents essential to cancer treatment and associated supportive care medications. Oral chemotherapy and supportive care regimens are often administered by the child or parent at varied dosing schedules, often for prolonged periods of time (Landier, 2011b). Thus, medication management is an important topic to be addressed with newly diagnosed patients and their parents and is considered a mandatory topic for the pediatric leukemia and lymphoma population (Haugen et al., 2016). Nonadherence to 6-mercaptopurine (6MP), defined as less than 95% adherence to 6MP as prescribed over a period of 6 months, has been associated with a significantly increased risk of relapse in childhood acute lymphoblastic leukemia (ALL) (Bhatia et al., 2012; Bhatia et al., 2014). Pediatric ALL patients who were nonadherent to 6MP demonstrated a 2.7-fold increased 835451J POXXX10.1177/1043454219835451Journal of Pediatric Oncology NursingCoyne et al.

Objectives: In this systematic review and meta-analysis we asked: Do predictors of fluid responsiveness in children perform comparably: 1) in the PICU as in non-PICU settings? 2) in shock states compared with nonshock states? Additionally, 3) is there an association between preload responsiveness and clinical response? Data Sources: Ovid Medline, PubMed, and Embase databases were searched from inception through May 2022. Study Selection: Included studies reported physiological response to IV fluid administration in humans less than 18 years. Only studies reporting an area under the receiver operating characteristic curve (AUROC) were included for descriptive analysis. Only studies for which a se could be estimated were included for meta-analysis. Data Extraction: Title, abstract, full text screening, and extraction were completed by two authors (S.B.W., J.M.W.). Variables extracted included predictors (“tools”) and outcome measures (“reference tests”) of fluid responsiveness, demographic, and clinical variables. Data Synthesis: We identified 62 articles containing 204 AUROCs for 55 tools, primarily describing mechanically ventilated children in an operating room or PICU. Meta-analysis across all tools showed poor predictive performance (AUROC, 0.66; 95% CI, 0.63–0.69), although individual performance varied greatly (range, 0.49–0.87). After controlling for PICU setting and shock state, PICU setting was associated with decreased predictive performance (coefficient, –0.56; p = 0.0007), while shock state was associated with increased performance (0.54; p = 0.0006). Effect of PICU setting and shock state on each tool was not statistically significant but analysis was limited by sample size. The association between preload responsiveness and clinical response was rarely studied but results did not suggest an association. Ultrasound measurements were prone to inherent test review and incorporation biases. Conclusions: We suggest three opportunities for further research in fluid responsiveness in children: 1) assessing predictive performance of tools during resuscitation in shock states; 2) separating predictive tool from reference test when using ultrasound techniques; and 3) targeting decreasing time in a shock state, rather than just increase in preload.

Objective: Agitation in children in acute care settings poses significant patient and staff safety concerns. While behavioral approaches are central to reducing agitation and oral medications are preferred, parenteral medications are used when necessary to promote safety. The goal of this systematic review was to evaluate the effectiveness and safety of an ultra-short-acting parenteral medication, droperidol, for the management of acute, severe agitation in children in acute care settings. Methods:A systematic review of randomized controlled trials, observational studies, and case series/reports examined the effectiveness and safety of parenteral droperidol for management of acute agitation in patients ≤21 years old in acute care settings.Effectiveness outcomes included time to sedation and need for a subsequent dose of medication. Safety outcomes were adverse effects such as QTc prolongation, hypotension, respiratory depression, and dystonic reactions. Results: A total of 431 unique articles were identified. Six articles met inclusion criteria: two in the prehospital setting, one in the emergency department, and three in the inpatient hospital setting. The articles included a prospective observational study, three retrospective observational studies, and two case reports. The largest study reported a median time to sedation of 14 min (interquartile range 10-20 min); other studies reported a time to sedation of 15 min or less. Across studies, 8%-22% | 1467 RAMSDEN Et Al. BACKG ROUND AND IMP ORTAN CE Acute agitation in children in the hospital setting poses a serious safety risk to patients and staff. In a national survey of pediatric How to cite this article: Ramsden SC, Pergjika A, Janssen AC, et al. A systematic review of the effectiveness and safety of droperidol for pediatric agitation in acute care settings. Acad

Purpose:We systematically reviewed the variability in definitions of kidney abnormality (KA) outcomes in individuals with spina bifida (SB).Materials and Methods:A systematic scoping review was conducted using MEDLINE, Embase™, Cochrane Library, CINAHL, PsycInfo®, Web of Science™ and ClinicalTrials.gov for articles from time of database inception to September 2020. No language or patient age restrictions were applied. Primary research articles involving individuals with SB where KA was assessed as an outcome were included. Means of assessing KA and defining KA severity were abstracted.Results:Of 2,034 articles found, 274 were included in the review. Most articles were published after 1990 (63.5%) and included pediatric-only populations (0–18 years; 60.5%). KA outcomes were identified by imaging-based anatomical outcomes (84.7%), serum-based outcomes (44.9%), imaging-based functional outcomes (5.5%), urine-based outcomes (3.3%) and diagnoses of end-stage kidney disease (2.6%) or chronic kidney disease otherwise unspecified (1.8%). Hydronephrosis was the most commonly used specific outcome (64.6%, 177/274) with 19.8% (35/177) of articles defining hydronephrosis severity. Hydronephrosis was used more frequently in articles with pediatric-only populations. Creatinine and cystatin-C were used in 82.1% (101/123) and 17.9% (22/123) of articles reporting serum-based outcomes, respectively, with 32.7% and 50.0% of articles defining estimated glomerular filtration rate (GFR) severity. Serum-based outcomes were more common in articles including adults >18 years. Measured GFR was assessed in 9.9% (27/274) of articles, with 44.4% (12/27) of articles defining GFR severity.Conclusions:Significant variability exists in how authors define KA with few specifically defining KA severity. Consensus and consistency in defining KA outcomes are needed.

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