Most children with CHD who undergo cardiac surgery in infancy require anaesthesia for additional non-cardiac procedures early in childhood. The purpose of our study was to characterise the use of non-cardiac procedures during the first year of life among neonates requiring cardiac surgery in order to set family and care team expectations.

We conducted a retrospective descriptive study comprising data collection from the medical record since programme inception from September 1, 2018, to November 3, 2025. The records of all patients undergoing neonatal cardiac surgery were reviewed if they reached their first birthday during the study period. Infants who died during hospitalisation were excluded.

Three hundred fourteen unique neonates underwent 862 procedures (Figure 1). The typical neonate underwent 2.75 procedures during the first year of life (not including cardiac surgery). The surgical complexity STAT scores of the neonatal operation categories 1–5 had 48, 57, 92, 78, and 39 participants, respectively. The STAT category associated with the most frequent use of anaesthetics was STAT 5. The most common procedures were peripherally inserted central catheter line, cardiac catheterisation, CT with angiography, and gastrostomy tube placement.

We conducted a retrospective descriptive study comprising data collection from the medical record since programme inception from September 1, 2018, to November 3, 2025. A requirement for non-cardiac procedures in the first year of life is common but not universal. Neonates undergoing more complex cardiac procedures (STAT 3–5) underwent more frequent non-cardiac anaesthetics compared with STAT 1–2.

Hospital surge capacity is pivotal for disaster response, yet the effectiveness of assessment and planning tools remains underexplored.

This systematic review evaluates the reliability, validity, and applicability of surge capacity tools across disaster scenarios.

Following PRISMA guidelines, we analyzed 24 Q1 studies (PubMed, Scopus) using the PICO framework. Risk of bias was assessed via ROBINS-E, and meta-analysis (random-effects model) quantified pooled effect sizes (ES). Subgroup analyses compared simulation tools, surveys, and resource strategies.

The combined ES was 0.74 (95% CI: 0.67–0.82), indicating moderate improvement in preparedness. Simulation tools (Group A) showed the highest consistency (ES = 0.81, I2 = 0%), while resource strategies (Group C) had wider variability (ES = 0.71, I2 = 74.42%). Egger’s regression revealed publication bias (P = 0.004), and heterogeneity was substantial (I2 = 76.70%).

Simulation-based tools are most effective for surge capacity, whereas resource strategies require contextual adaptation. Policymakers should prioritize standardized benchmarks and DSS integration, with future research addressing equity and real-world implementation gaps.

The Fontan procedure, a palliative surgical approach for single-ventricle physiology, has significantly improved long-term survival. However, it is frequently associated with reduced exercise capacity and multiorgan dysfunction. In this context, peripheral muscle function and body composition may influence functional outcomes.

The aim of the study was to evaluate the relationships among body composition, handgrip strength, and functional capacity in Fontan patients, as well as to investigate the impact of Fontan-related variables on these parameters.

This single-centre study included 30 clinically stable patients (age range: 7.0–33.0 years) with Fontan circulation. Data collected included pre-operative primary diagnosis, pre-Fontan mean pulmonary artery pressure, and laboratory parameters such as B-type natriuretic peptide, haemoglobin, creatinine, alanine aminotransferase, aspartate aminotransferase, albumin, and uric acid levels. 6-minute walk test (6MWT), handgrip strength, and body composition via bioelectrical impedance were assessed. Correlation and subgroup analyses were performed according to pre-Fontan surgery history, Bidirectional Glenn, Fontan type, fenestration, and other clinical factors.

The median 6MWT distance was 564 m, handgrip strength was 28.3 ± 11.1 kg, and ΔSpO2 was 4% (IQR: 2–5). Patients with intra-extracardiac Fontan and fenestration exhibited significantly higher ΔSpO2 (p = 0.03 and p = 0.003, respectively). ΔSpO2 was inversely correlated with 6MWT distance (r = −0.531, p = 0.008) and handgrip strength (r = −0.472, p = 0.017). Fat-free mass was positively correlated with both 6MWT distance (r = 0.598, p < 0.001) and handgrip strength (r = 0.537, p = 0.002). Red cell distribution width was negatively correlated with 6MWT (r = −0.631, p < 0.001) and grip strength (r = −0.413, p = 0.029).

In Fontan patients, reduced handgrip strength, lower fat-free mass, and greater post-exercise oxygen desaturation were associated with impaired exercise capacity, supporting the clinical value of simple functional and muscle strength assessments in routine follow-up.

This study evaluated whether the 3-minute Step Test, a submaximal measure of cardiorespiratory fitness, can predict cardiometabolic and arterial health in youth with atherosclerosis-promoting cardiometabolic risk factors.

Children and adolescents attended a paediatric preventive cardiology clinic for management of cardiometabolic risk factors. Cardiorespiratory fitness was assessed using a 3-minute Step Test, where an individual steps up/down on a 6-inch step at 24 steps/min for 3 minutes. The percentage of age-predicted maximum heart rate that was attained at the end of the Step Test was recorded as a measure of physiological work (cardiorespiratory fitness). Lifestyle-influenced cardiometabolic risk factors included: body anthropometrics [body mass index z-score, waist-to-height ratio z-score], systolic blood pressure, and serum markers [triglycerides, high-density lipoprotein cholesterol, haemoglobin A1C, alanine aminotransferase, vitamin D]. Arterial function was assessed by measuring pulse wave velocity and was normalised to sex and height-specific z-score.

The sample included 482 patients [age 14.31 ± 2.38 years, 261 (53%) male]. A higher percent predicted peak heart rate strongly correlated with worse lifestyle-influenced cardiometabolic risk factors and with higher pulse wave velocity, suggesting increased arterial stiffness.

Percent predicted peak heart rate from the 3-minute Step Test was associated with cardiometabolic and arterial health. The 3-minute Step Test is an inexpensive, quick, and low-resource-intensive method to estimate cardiorespiratory fitness, cardiometabolic and arterial health in an outpatient clinical setting.

Hyperbolic tapering is increasingly recommended for the gradual reduction of psychiatric drugs to minimise withdrawal symptoms, yet available formulations rarely accommodate the small dose regimens required.

To evaluate whether pharmaceutical manipulation strategies – as proposed in clinical guidelines for hyperbolic tapering – can produce progressively smaller haloperidol doses with adequate accuracy and precision.

Strategies included whole and split tablets, liquid dispensed via dropper or dosing syringe, diluted solutions and tablet suspension, applied under controlled laboratory conditions. Haloperidol was used as a model, following an exponential 10% dose reduction schedule from 5 to 0 mg, generating multiple tapering steps that mirrored real-world scenarios. Drug content was quantified by high-performance liquid chromatography and interpreted according to an adapted pharmacopoeial criterion.

All strategies yielded mean doses within 90–110% of expected values, demonstrating satisfactory accuracy and reproducibility. Variability was higher with tablet splitting, drop-based measurements and tablet suspension (relative standard deviation of 8.0%), whereas the use of whole tablets, dosing syringe and diluted liquid improved precision (relative standard deviation of 3.3%). These findings demonstrate the technical feasibility of achieving progressively smaller doses through standardised manipulation strategies, providing experimental support for hyperbolic tapering in clinical practice.

Although off-label, such approaches currently offer the only practical means for safe dose reduction in the absence of smaller dose formulations, highlighting a regulatory gap between product design and clinical needs. Aligned with clinical guidelines, our findings support manipulation strategies as a practical and reliable component of individualised dose reduction in psychiatric care.

Paediatric mechanical circulatory support with Berlin Heart—EXCOR® Paediatric is predominantly used as a bridge to transplant or recovery, specifically in children up to 30 kg. While survival with ventricular assist devices has improved, insights into morbidity and quality of life remain limited. Safely discharging children, particularly with the new driving unit EXCOR® Active (BH-EA), is now of clinical interest. Multidisciplinary and caregiver perspectives are needed to inform practice.

Through semi-structured interviews with 22 professionals (physicians, nurses, psychologists, engineers, physiotherapists, social workers, child education specialists, chaplains) and three caregivers of hospitalised children on BH-EA, we explored: (1) device safety and daily care; (2) hospital environmental factors; (3) requirements for transitioning home with EXCOR® Active.

Qualitative analysis yielded three main themes; of which two are explored in this publication: alarm management and home-discharge requirements for paediatric BH-EA patients. Participants described frequent low-priority alarms contributing to alarm fatigue. They called for clearer procedures, shared responsibilities, and enhanced caregiver training and identified prerequisites for safe discharge, including a 24/7 emergency hotline, remote monitoring, comprehensive system-wide support, caregiver training, and strong healthcare networks.

The interviews highlight that the BH-EA alarm management is conceptualised for in-hospital care, which leads to reservations concerning reliable home monitoring during medical events, such as blood clot formation. Multidisciplinary efforts are essential to enhance device safety, empower caregivers, and develop effective discharge programmes for children on BH-EA. Furthermore, organ allocation systems should be adjusted to avoid disadvantages in organ waiting times following home discharge.

Emerging evidence suggests that an impaired foetal environment—defined as maternal factors such as hypertensive disorders and diabetes—might contribute to outcomes in neonates with CHD. With this multicentre study, we prospectively collected data regarding impaired foetal environment to assess the impact on mortality in two ventricle and single ventricle neonates with CHD.

A module of prospectively collected maternal-foetal environment data was linked to established Pediatric Cardiac Critical Care Consortium data from June 2019 to July 2020. All neonates undergoing cardiothoracic surgery were included in this study. The outcome was in-hospital mortality. The primary predictor was the degree of impaired foetal environment defined as none, mild, or significant based on the presence of maternal hypertensive and glucose homeostasis disorders.

There were a total of 1913 neonates included in this study from 26 different centres. 218 patients had at least 1 missing impaired foetal environment data field (11.8%). Impaired foetal environment was not associated with increased mortality; however, there was a strong trend in the preterm single ventricular population.

While the overall cohort did not demonstrate a statistically significant relationship between impaired foetal environment and mortality, a notable trend emerged among preterm infants with single-ventricle physiology, suggesting increased mortality associated with more severe impaired foetal environment. The absence of statistical significance in this subgroup is likely attributable to the limited sample size and the substantial proportion of missing data highlighting the challenges of the mother-baby dyad in data collections.