Systematic ReviewResearchPatient Education

MRI rim lesions were common in pediatric-onset MS, but diagnostic evidence remains limited

Journal of neurology (PubMed)Aug 22, 2026

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

Brief summary

A systematic review found paramagnetic rim lesions were common in pediatric-onset multiple sclerosis, while limited comparative data and variable central-vein-sign findings leave pediatric diagnostic accuracy uncertain.

What NurseJet pulled from the source

Eleven studies were included. Across seven studies, 71.6% of patients with pediatric-onset MS had at least one paramagnetic rim lesion; across six studies, the pooled mean proportion of central-vein-sign-positive lesions was 57.9%. Comparative evidence was too limited for quantitative diagnostic-accuracy analysis, and the 40% central-vein-sign threshold estimate varied widely.

Why this matters for nurses

Pediatric and neuro nurses often help families navigate an unfamiliar diagnostic workup. The review can support careful explanation that newer MRI markers may add context, but diagnosis still requires specialist interpretation of the complete clinical, laboratory, and imaging picture.

Bedside takeaway

Treat these MRI findings as specialist-interpreted diagnostic clues, not stand-alone proof of pediatric MS.

How This Applies in Practice

Use this when: Preparing or teaching a child and family during a pediatric demyelinating-disease or multiple-sclerosis workup.

On your shift

Record the neurologic symptom timeline, prior episodes, and relevant testing history for the specialist assessment.
Use the approved pediatric MRI preparation and safety workflow for the ordered susceptibility-based imaging.
Explain that the radiologist and neurology team interpret these markers alongside the complete diagnostic evaluation.

Keep in mind: Neither marker establishes pediatric MS on its own. Follow the neurology plan, facility policy, and provider orders.

Key takeaways

Eleven studies evaluated paramagnetic rim lesions or the central vein sign in pediatric-onset multiple sclerosis.
Across seven studies, 71.6% of patients had at least one paramagnetic rim lesion.
The pooled mean proportion of central-vein-sign-positive lesions was 57.9% across six studies.
Comparative pediatric data were sparse, so these findings do not establish stand-alone diagnostic performance.

Practice implications

Document the patient's symptoms and prior neurologic history accurately, prepare families for ordered MRI procedures, and route questions about rim lesions or the central vein sign to the neurology team. Avoid presenting either marker as diagnostic by itself.

Limitations & cautions

Only 11 studies were included, sample sizes differed by outcome, and comparative diagnostic-accuracy data were too limited for meta-analysis. Central-vein-sign thresholds showed substantial variability, limiting direct translation to individual patients.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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Journal of neurology (PubMed)

Journal of neurology (PubMed). Central vein sign and paramagnetic rim lesions in pediatric-onset multiple sclerosis: a systematic review and meta-analysis.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42632831/

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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Journal of midwifery & women's health (PubMed)Sep 7, 2026Research Article

A retrospective analysis of US natality data found no statistically significant yearly difference in neonatal mortality between freestanding birth centers and hospitals among term, singleton, vertex births without major medical risk factors from 2015 through 2024.

L&D / OB PedsAI summaryReview source

Research ArticleResearchPatient EducationAI summary · original source linked below

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.

Key takeaways

The analysis was restricted to births meeting selected low-risk criteria.
The study found no evidence that higher birth-center use during the pandemic years increased neonatal mortality.
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.

Citations · exact source links

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

Open original sourceFull brief

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

Pediatric emergency care (PubMed)Sep 7, 2026Research Article

A double-blind randomized trial found no reduction in vomiting or faster oral tolerance with intravenous pantoprazole versus placebo in children with acute gastroenteritis and persistent vomiting after ondansetron.

Peds EmergencyAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

The trial randomized 100 children. Vomiting episodes and oral tolerance at 6 and 12 hours did not differ significantly, while median hospital stay was 2 days with pantoprazole and 1 day with placebo.

Key takeaways

The median participant age was 14 months, and 67% of participants were male.
Oral tolerance at 12 hours was 86% in both groups.
The longer stay associated with pantoprazole requires cautious interpretation because this was a single-center trial.

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.

Limitations & cautions

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.

Citations · exact source links

Pediatric emergency care (PubMed). Effect of Intravenous Pantoprazole on Clinical Outcomes in Pediatric Acute Gastroenteritis: A Placebo-Controlled RCT.

Open original sourceFull brief

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

Journal of neurosurgical anesthesiology (PubMed)Sep 4, 2026Research Article

A five-center randomized trial found similar rescue-opioid use and moderate-to-severe PACU pain with dexmedetomidine-based opioid-sparing analgesia and fentanyl-based analgesia during elective craniotomy for brain tumors.

Emergency ICUAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

The trial randomized 500 adults. Moderate-to-severe PACU pain occurred in 145 of 242 assessed participants in the fentanyl group and 138 of 233 in the dexmedetomidine group, with no significant difference.

Key takeaways

Intraoperative rescue fentanyl use did not differ significantly between groups.
Hypotension was more common with dexmedetomidine, while postoperative shivering was less common.
Other in-hospital outcomes were similar between the two regimens.

Why this matters on shift

An opioid-sparing label did not translate into better early pain control in this trial, and the differing hypotension and shivering profiles remain relevant during perioperative handoff and recovery monitoring.

Bedside takeaway

Monitor pain, hemodynamics, sedation, and shivering in relation to the analgesic regimen and local protocol.

Nursing implications

During PACU and postoperative handoff, monitor pain, hemodynamics, sedation, and shivering according to the administered regimen and local protocol.

Limitations & cautions

Abstract-only summary. The trial involved elective tumor craniotomy at five Indian centers, both groups also received locoregional analgesia, and the abstract does not provide longer-term outcome results in detail.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of neurosurgical anesthesiology (PubMed). Opioid-Sparing Versus Opioid-Based Analgesia for Craniotomy: A Multicenter Randomized Controlled Trial.

Open original sourceFull brief

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

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Low-risk birth-center births showed no higher neonatal mortality in a 10-year analysis

IV pantoprazole did not improve vomiting or oral tolerance in pediatric gastroenteritis

Dexmedetomidine did not improve early pain outcomes versus fentanyl for craniotomy