Research ArticleResearchMedication SafetyPatient Education

Cold-saline oral care reduced methotrexate mucositis in children with acute lymphoblastic leukemia

Supportive care in cancer (PubMed)Aug 14, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

In a single-center randomized trial, ice-cold saline oral rinses during high-dose methotrexate were associated with less oral mucositis by day 14 than standard oral care alone in children with acute lymphoblastic leukemia.

What NurseJet pulled from the source

Among 118 participants with outcome data, any-grade mucositis occurred in 22.0% with oral cryotherapy and 44.1% with standard care; grade II or worse occurred in 6.8% and 23.7%. Mucositis duration did not differ, and nine of 127 randomized children were excluded from the primary per-protocol analysis.

Why this matters for nurses

Pediatric oncology nurses assess oral integrity, deliver supportive care, and teach families when high-dose methotrexate raises mucositis risk. The trial supports a low-technology prevention option while leaving age suitability, timing, tolerance, and implementation to the chemotherapy pathway.

Bedside takeaway

When protocol-approved, pair timed cold-saline rinses with standard oral care and close mucositis assessment during high-dose methotrexate.

How This Applies in Practice

Use this when: Caring for a child receiving high-dose methotrexate for acute lymphoblastic leukemia when oral cryotherapy is included in the treatment plan.

On your shift

Confirm the ordered timing, rinse method, developmental readiness, swallowing ability, aspiration risk, and standard oral-care components before treatment.
Assess oral mucosa, pain, intake, hydration, adherence, and tolerance at baseline and through the expected mucositis window.
Use age-appropriate teaching and escalate ulceration, bleeding, reduced intake, fever, suspected infection, or inability to complete the planned rinses.

Keep in mind: The evidence comes from one center and does not define eligibility for every child. Follow the oncology protocol, facility medication policy, and provider orders.

Key takeaways

The open-label trial randomized 127 children aged 3 to 18 years receiving high-dose methotrexate for acute lymphoblastic leukemia.
The primary per-protocol analysis included 118 participants with available day-14 outcomes.
Any-grade and grade II or worse oral mucositis were less frequent with ice-cold saline rinses than with standard oral care alone.
Mucositis duration did not differ significantly, and no serious oral-cryotherapy-related adverse events were reported.

Practice implications

If oral cryotherapy is ordered in the treatment plan, verify timing and technique, assess developmental ability and aspiration risk, monitor tolerance and oral findings, and continue the standard oral-care bundle. Escalate pain, reduced intake, bleeding, ulceration, fever, or suspected infection.

Limitations & cautions

This was a single-center, open-label trial with a per-protocol primary analysis that excluded nine randomized participants, seven from the cryotherapy group. The subgroup findings were exploratory, and multicenter confirmation with intention-to-treat analysis is needed before routine implementation.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

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Supportive care in cancer (PubMed)

Supportive care in cancer (PubMed). Effectiveness of oral cryotherapy in preventing methotrexate-induced oral mucositis in pediatric patients with acute lymphoblastic leukemia: a randomized controlled trial.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42599331/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Among 161 adult hospitalizations meeting serum-creatinine criteria for acute kidney injury, 39 cases (24.2%) were undocumented. Length of stay and in-hospital mortality did not differ significantly by documentation status.

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In the 149 hospitalizations with a demonstrable creatinine change, 33 cases (22.1%) were undocumented.
Higher maximal creatinine was associated with lower adjusted odds of underdocumentation.
The study did not test whether a detection or documentation intervention improves care or outcomes.

Why this matters on shift

A smaller creatinine rise may receive less attention even when it meets the study's laboratory definition of acute kidney injury, which can affect how renal risk is communicated across the inpatient team.

Bedside takeaway

Trend ordered renal-function results and communicate clinically important changes through local escalation and documentation workflows.

Nursing implications

Trend ordered renal-function results and communicate clinically important changes through the care team according to local escalation and documentation workflows.

Limitations & cautions

Abstract-only summary. This was a retrospective, single-center study of 161 hospitalizations; urine-output criteria and reliable preadmission creatinine values were unavailable, and the reference creatinine method may affect case classification.
AI-summarized from the linked source. Review the original article before applying to practice.

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Renal failure (PubMed). Underdocumentation of laboratory-defined acute kidney injury in internal medicine wards: a retrospective cohort study.

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AI-summarized from the linked source. Review the original article before applying to practice.

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Adjusted neonatal-mortality odds for freestanding birth centers fluctuated around 1.0 across the 10-year study period. No individual year showed a statistically significant difference from hospital births, including 2020 and 2021 when birth-center volume increased.

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The analysis was restricted to births meeting selected low-risk criteria.
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The observational design cannot establish that birth setting itself caused the mortality pattern.

Why this matters on shift

The findings add national outcome data for counseling and systems planning around freestanding birth-center care for appropriately selected low-risk pregnancies.

Bedside takeaway

Apply local eligibility, surveillance, escalation, and transfer protocols when caring for planned low-risk birth-center patients.

Nursing implications

Keep eligibility, surveillance, escalation, and transfer decisions anchored to local birth-center criteria and maternal-newborn protocols.

Limitations & cautions

Abstract-only summary. The study used retrospective vital-record data, was limited to selected low-risk births, and cannot exclude residual differences between people who delivered in birth centers and hospitals.
AI-summarized from the linked source. Review the original article before applying to practice.

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Journal of midwifery & women's health (PubMed). Neonatal Mortality Risk Among Births in Freestanding Birth Centers, 2015 to 2024.

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Why this matters on shift

The trial does not support empiric intravenous proton-pump inhibition for persistent vomiting in pediatric acute gastroenteritis after ondansetron.

Bedside takeaway

Clarify the indication for empiric acid suppression and keep hydration and oral-tolerance assessment central to care.

Nursing implications

Prioritize the ordered hydration and oral-tolerance plan, document ongoing emesis, and clarify the indication before administering empiric acid suppression.

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Abstract-only summary. This was a single-center study of 100 children in Tehran, and the abstract does not describe adverse events or explain why hospitalization was longer in the pantoprazole group.
AI-summarized from the linked source. Review the original article before applying to practice.

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