Pediatric Hospital Medicine (PHM) is a field rich with ambition and new advancements, and it is an annual tradition that the top 10 publications within the PHM literature are presented at the PHM 2025 conference.
To select the top 10 articles, 33 journals were chosen, which included relevant pediatric journals along with the journal with the highest impact factor in each pediatric field, comprising a total of 57,399 articles. After applying an inclusive pediatric-term filter, 11,173 articles were evaluated utilizing Covidence review software, with 676 articles undergoing abstract screening and 125 articles for full-text screening to select the top 10. In the selection of the top 10, the three authors sought to represent the diversity of practice within PHM, including community and general PHM, newborn medicine, community health, quality improvement, and equitable care. Screening questions included: Is it research? Is it relevant to pediatric hospital medicine? Is it practice changing?
The following review highlights the top 10 articles.
1. Management and Clinical Outcomes of Neonatal Hypothermia in the Newborn Nursery
This large retrospective single-center study (n = 24,009) analyzed late preterm and term infants (up to 35 weeks) to assess the management and outcomes of hypothermia in the newborn nursery.1 Both mild hypothermia (defined as one temperature 36.0° to 36.4°C) and moderate or recurrent hypothermia (under 36.0°C and/or at least 2 temperature measurements under 36.5°C) were associated with increased odds of NICU transfer, sepsis workup, antibiotic administration, and hypoglycemia. However, there was no associated increased risk for early onset sepsis (EOS) in hypothermic infants with zero cases of culture-positive sepsis, and no increased rates of culture-negative sepsis (defined as antibiotic use for 72 hours or longer). These findings suggest that hypothermia may trigger potentially unnecessary interventions in otherwise healthy infants.
This study helps to reassure newborn physicians that hypothermia was not associated with increased EOS risk. With additional studies, nursery protocols could re-evaluate their response to mild or moderate hypothermia in late preterm and term infants. Avoiding unnecessary NICU transfers, sepsis evaluations, and antibiotic use could reduce healthcare costs, minimize interventions for well-appearing infants, and promote high-value care.
2. Implementing Critical Care Billing on a Pediatric Hospital Medicine Service
This is a quality improvement (QI) initiative at a tertiary children’s hospital aimed at increasing critical care billing for PHM patients receiving 5 L oxygen or more via high-flow nasal cannula or continuous albuterol.2 From a baseline of 21%, critical care billing rose to 74% through structured interventions including provider education, electronic health record (EHR) tools, documentation templates, and clinician audits. These interventions also led to a threefold increase in relative value units (RVUs) (from 709 to 2,092) and a fourfold rise in estimated reimbursement (from $55,051 to $222,934). Documentation supporting billing also improved from 31% to 70%. Interventions were sustained with minimal insurance denials. This initiative highlights an opportunity to capture a revenue stream in PHM for critically ill patients managed outside of the intensive care unit.
PHM teams can implement structured systems—including education, documentation templates, and EHR tools—to consistently identify and bill for critical care services delivered outside of the ICU. Doing so can substantially increase RVUs and reimbursement with minimal additional effort, helping optimize resource use and support institutional financial health.
3. First-Attempt Success in Ultrasound-Guided vs Standard Peripheral Intravenous Catheter Insertion: The EPIC Superiority Randomized Clinical Trial
In this randomized clinical trial (n = 164), ultrasound-guided peripheral IV catheter (PIV) insertion significantly outperformed standard palpation techniques in achieving first-attempt success in hospitalized children across all difficulty levels.3 Success rates were 86% with ultrasound versus 33% with the standard technique. The benefit was observed regardless of the difficulty of IV access, with risk differences favoring ultrasound across low, medium, and high-risk groups. Though ultrasound guidance incurred slightly higher immediate costs (approximately $6 per patient), ultrasound guidance improved efficiency, boasted fewer failed attempts, and improved patient and parent satisfaction.
Expansion of the use of ultrasound-guided PIV insertion for children of all IV access risk levels, not just those with difficult access, has the potential to improve efficiency and patient and parent satisfaction. Training generalist staff in ultrasound-guided techniques could significantly improve first-attempt success, reduce patient distress, and enhance procedural efficiency despite slightly higher upfront costs.
4. Twenty-four-Month Outcomes of Extended Versus Standard-Course Antibiotic Therapy in Children Hospitalized with Pneumonia in High-Risk Settings: A Randomized Controlled Trial
Among 324 high-risk children hospitalized with radiograph-confirmed, uncomplicated community-acquired pneumonia (CAP), extending amoxicillin-clavulanate from five to six days to 13 to 14 days did not reduce chronic respiratory symptoms, rehospitalizations, or radiographic abnormalities at 24 months, supporting shorter courses of antibiotics for hospitalized CAP.4
5. Comparison of Procedural Sedation Outcomes in Children With and Without Autism Spectrum Disorder
In an analysis of 64,708 patients from the Pediatric Sedation Research Consortium database, 4,421 children with autism spectrum disorder undergoing non-OR procedural sedation experienced significantly more airway-related complications (hypoxia, complete or partial obstruction) and required more respiratory interventions, highlighting the need for heightened airway vigilance and preparation when sedating this population.5
6. Low-Intensity Social Care and Child Acute Health Care Utilization: A Randomized Clinical Trial
A double-blinded trial of a low-intensity, automated, resource-referral program including automated text messaging and discharge support for caregivers of hospitalized children lowered 12-month emergency department visits (30% versus 52%) and hospital readmissions (15% versus 34%) among food-insecure families.6
7. External Validation of Brief Resolved Unexplained Events Prediction Rules for Serious Underlying Diagnosis
In this multicenter Canadian cohort study of 1,042 infants with brief resolved unexplained events, or BRUE, newly derived and calibrated BRUE prediction rules significantly outperformed the American Academy of Pediatrics higher-risk criteria in predicting both serious underlying diagnoses and event recurrence, providing clinicians with more accurate, individualized risk estimates.7
8. Accuracy of Screening Tests for the Diagnosis of Urinary Tract Infections in Young Children
In a 4,188-child multicenter study, 20% of febrile infants and toddlers with catheter-culture-confirmed urinary tract infections (UTIs) had no pyuria, and all available pyuria tests had only 76% to 88% sensitivity, indicating that “requiring pyuria” will miss many UTIs and reflex culturing based solely on pyuria is unsafe.8
9. Intravenous Immunoglobulin Alone for Coronary Artery Lesion Treatment of Kawasaki Disease: A Randomized Clinical Trial
In a Taiwanese multicenter, non-inferiority, randomized, clinical trial of 134 patients, intravenous immunoglobulin (IVIG) alone was as effective as IVIG plus high-dose aspirin for preventing six-week coronary artery lesions, questioning whether high-dose aspirin adds meaningful benefit in acute kidney disease management.9
10. Management of Pustules and Vesicles in Afebrile Infants up to 60 Days Evaluated by Dermatology
A review of 183 afebrile hospitalized infants up to 60 days old, seen by dermatology, found no invasive bacterial infections, 7% with neonatal herpes simplex virus (HSV) (mostly term infants), and 3% with angioinvasive fungal disease (all extremely preterm), supporting limited serious bacterial infection work-ups in well-appearing term infants once HSV is excluded.10
Dr. Parr
Dr. Hairston
Dr. Kumar
Dr. Parr is a second-year fellow at Cohen Children’s Medical Center in New Hyde Park, N.Y., and is passionate about pediatric research. Her work encompasses prospective clinical studies and pioneering the use of artificial intelligence to advance both medical education and clinical decision-making in pediatric hospital medicine. Dr. Hairston is a pediatric hospital medicine fellow at Johns Hopkins University in Baltimore, where his clinical focus is caring for children with medical complexity. He has developed innovative curricula addressing social determinants of health, published scholarship in leading pediatric journals, and presented nationally on hospital medicine and complex care. Dr. Kumar is a pediatric hospitalist and pediatric infectious disease provider at Ochsner Children’s Hospital and a volunteer adjunct faculty at Tulane University, both in New Orleans, and a senior lecturer with the University of Queensland in Brisbane, Australia.
References
1. Dang R, et al. Management and clinical outcomes of neonatal hypothermia in the newborn nursery. Hosp Pediatr. 2024;14(9):740-748. doi:10.1542/ hpeds.2023-007699.
2. Ramazani SN, et al. Implementing critical care billing on a pediatric hospital medicine service. Hosp Pediatr. 2025;15(6):449-456. doi:10.1542/hpeds.2024-008183.
3. Kleidon TM, et al. First-attempt success in ultrasound-guided vs standard peripheral intravenous catheter insertion: the EPIC superiority randomized clinical trial. JAMA Pediatr. 2025;179(3):255-263. doi:10.1001/ jamapediatrics.2024.5581.
4. Kok HC, et al. Twenty-four month outcomes of extended- versus standard-course antibiotic therapy in children hospitalized with pneumonia in high-risk settings: a randomized controlled trial. Pediatr Infect Dis J. 2024;43(9):872-879. doi:10.1097/ INF.0000000000004407.
5. Kannikeswaran N, et al. Comparison of procedural sedation outcomes in children with and without autism spectrum disorder. Hosp Pediatr. 2025;15(5):398-406. doi:10.1542/hpeds.2024-008153.
6. Lindau ST, et al. Low-intensity social care and child acute health care utilization: a randomized clinical trial. JAMA Pediatr. 2025;179(6):610-620. doi:10.1001/jamapediatrics.2025.0484.
7. Nama N, et al. External validation of brief resolved unexplained events prediction rules for serious underlying diagnosis. JAMA Pediatr. 2025;179(2):188-196. doi:10.1001/ jamapediatrics.2024.4399.
8. Shaikh N, et al. Accuracy of screening tests for the diagnosis of urinary tract infections in young children. Pediatrics. 2024;154(6):e2024066600. doi:10.1542/ peds.2024-066600.
9. Kuo HC, et al. Intravenous immunoglobulin alone for coronary artery lesion treatment of Kawasaki disease: a randomized clinical trial. JAMA Netw Open. 2025;8(4):e253063. doi:10.1001/jamanetworkopen.2025.3063.
10. Yun S, et al. Management of pustules and vesicles in afebrile infants ≤60 days evaluated by dermatology. Pediatrics. 2024;154(1):e2023064364. doi:10.1542/ peds.2023-064364.