About

Karthik Balakrishnan is an Associate Professor of Otolaryngology - Head & Neck Surgery at Stanford University and serves as the medical director for surgical performance improvement at Stanford Lucile Packard Children’s Hospital. He is a pediatric otolaryngologist specializing in the care of children with complex disorders of breathing, voice, and swallowing. His expertise includes complex surgical reconstruction of the larynx and trachea, innovative approaches to pediatric airway reconstruction, and vascular anomalies of the head and neck. Dr. Balakrishnan is dedicated to improving the quality, safety, and value of pediatric surgical care, reducing healthcare costs, and enhancing the healthcare experience for patients, families, and caregivers. He also has a focus on healthcare disparities, injustice, and how cognitive and implicit bias may influence medical decision-making. An accomplished educator, he has mentored numerous fellows, residents, medical students, and undergraduates, many of whom have pursued careers in otolaryngology, and has developed innovative educational programs. Dr. Balakrishnan has a distinguished record of research and publication, including over 70 peer-reviewed papers, textbook chapters, and a textbook on vascular anomalies. He has served as an associate editor for prominent journals and is actively involved in national and international quality and research initiatives, including co-chairing the Aerodigestive Research Collaborative. His professional background includes training at Johns Hopkins University School of Medicine, the University of Washington, Cincinnati Children’s Hospital, and the Mayo Clinic, where he contributed significantly to pediatric airway and aerodigestive programs. Since joining Stanford in 2020, he has taken on leadership roles in diversity, equity, and inclusion, teamwork, and quality improvement, and was appointed the Susan B. Ford Surgeon-in-Chief of Lucile Packard Children’s Hospital in 2022.

Research topics

• Medicine
• Political Science
• Pathology
• Intensive care medicine
• Surgery
• Medical emergency
• Information Retrieval
• Computer Science
• Nursing
• Economics
• Economic growth
• Business
• Internal medicine
• Medical physics
• Environmental health
• World Wide Web

Selected publications

• Amplified gene expressions were implicated in the gastric carcinogenesis of the intestinal subtype

  Genome Instability & Disease · 2026-01-13 · 1 citations

  article1st authorCorresponding
  PublisherDOI

• Standardizing Management of Pediatric Vocal Fold Immobility After Cardiothoracic Surgery

  JAMA Otolaryngology–Head & Neck Surgery · 2026-02-26

  articleOpen access

  Importance: Unilateral vocal fold immobility (UVFI) is a common complication of cardiothoracic surgery in pediatric populations, yet no standardized treatment guidelines exist. The current literature supporting pediatric injection laryngoplasty (IL) has been limited by heterogeneity in patient populations, treatment approaches, and outcomes analysis. Objective: To implement a standardized, multidisciplinary protocol for managing pediatric UVFI after cardiothoracic surgery and describe recovery patterns and outcomes observed among patients treated with IL vs conservative approaches. Design, Setting, and Participants: This prospective cohort study was conducted at a tertiary care referral center and included patients who were undergoing cardiothoracic surgery involving the aortic arch at age 1 year or younger between August 2015 and September 2024. Data were analyzed from September 2024 to October 2024. Patients with adjusted age of 36 weeks or younger at the time of surgery or a preoperative diagnosis of dysphagia were excluded. Additional exclusion criteria removed patients who did not complete postoperative feeding evaluations due to clinical decline and those who underwent IL outside the initial admission after cardiothoracic surgery. Exposure: Injection laryngoplasty. Main Outcomes and Measures: The primary outcome was oral diet advancement at time of discharge after cardiothoracic surgery, which was defined by improvement in frequency, volume, or consistency of oral intake. Secondary outcomes included nasogastric feeding tube (NGT) requirements, rate of gastrostomy tube placement, and hospital length of stay. Results: A total of 128 patients (53 [41.4%] female and 75 [58.6%] male; median [IQR] age, 17 [6-87] days) were included. Of the 45 patients (35.1%) with UVFI, 17 underwent IL and 28 did not. More IL patients achieved oral diet advancement by discharge compared with non-IL patients (17 of 17 [100%] vs 18 of 28 [64.3%]; difference, 35.7%; 95% CI, 12%-54%). Fourteen IL patients (82%) were discharged with an NGT vs 18 (64%) non-IL patients (difference, 18%; 95% CI, -9% to 40%). The median (IQR) time to NGT removal for IL vs non-IL patients was 30 (24.5) days vs 58 (89.5) days (difference, -28 days), and the median (IQR) hospital length of stay for IL vs non-IL patients was 28 (14.0) vs 23 (19.5) days (difference, 5 days). Conclusions and Relevance: Implementing a clinical pathway for managing UVFI after cardiothoracic surgery may standardize treatment and outcome assessment. In this cohort study, IL patients more frequently achieved oral diet advancement during the immediate postoperative period than those treated conservatively. However, these groups differed in baseline clinical characteristics that were associated with treatment selection; therefore, the observed differences in outcomes cannot be attributed to treatment choice alone.

  PublisherOA PDFDOI

• Tracheal cartilaginous sleeve prevalence in syndromic craniosynostosis: A single institution study

  International Journal of Pediatric Otorhinolaryngology · 2026-01-24

  articleSenior authorCorresponding
  PublisherDOI

• Error mitigation with stabilized noise in superconducting quantum processors

  Nature Communications · 2025-09-26 · 6 citations

  articleOpen access

  Pre-fault tolerant quantum computers have already demonstrated the ability to estimate observable values accurately, at a scale beyond brute-force classical computation. This has been enabled by error mitigation techniques that often rely on a representative model of the device noise. However, learning and maintaining these models is complicated by fluctuations in the noise over unpredictable time scales, for instance, arising from resonant interactions between superconducting qubits and defect two-level systems (TLS). Such interactions affect the stability and uniformity of device performance as a whole, but also affect the noise model accuracy, leading to incorrect observable estimation. Here, we experimentally demonstrate that tuning of the qubit-TLS interactions helps reduce noise instabilities and consequently enables more reliable error-mitigation performance. These experiments provide a controlled platform for studying the performance of error mitigation in the presence of quasi-static noise. We anticipate that the capabilities introduced here will be crucial for the exploration of quantum applications on solid-state processors at non-trivial scales. Interactions between qubits and defect-related two-level systems in superconducting qubit devices are a major source of noise fluctuations that hinder error-mitigation performance. Here, the authors experimentally show that modulating this interaction can reduce noise fluctuation and improve error mitigation performance.

  PublisherOA PDFDOI

• Endobronchial Valves For Persistent Air Leak in Children: Two Case Reports and Review of the Literature

  Pediatric Pulmonology · 2025-06-30

  preprintOpen access

  Background: Persistent air leak (PAL) is a rare but serious issue in children, often caused by necrotizing pneumonia, thoracic surgery, or chest trauma. While many cases respond to basic treatment, severe PAL may require prolonged respiratory support and invasive procedures. Endobronchial valves (EBVs), mainly used in adults, are becoming an option for select pediatric patients. Case Summary: We report two cases of necrotizing pneumonia in children that were complicated by severe PAL, leading to extended extracorporeal membrane oxygenation (ECMO) support. In both cases, placing Zephyr® EBVs (Pulmonx, Redwood City, CA, USA) successfully resolved the air leak, allowing for decannulation and hospital discharge without major complications. We also reviewed pediatric literature and identified 22 published cases of EBV use in children with PAL. Most cases reported favorable outcomes with minimal adverse effects. Conclusion: EBVs help heal bronchopleural and alveolopleural fistulas by causing targeted atelectasis in affected lung areas. Success depends on careful planning before the procedure. This includes imaging and bronchoscopic localization of the leak, especially in smaller children’s airways. Zephyr valves come in smaller sizes, which may benefit this group. Our report and the literature review show that EBVs are a safe and effective, minimally invasive option for treating severe PAL in critically ill children. More research is needed to establish selection criteria, procedural techniques, and long-term follow-up.

  PublisherOA PDFDOI

• Care of Infants and Children with Tracheostomies. An Official American Thoracic Society Clinical Practice Guideline

  American Journal of Respiratory and Critical Care Medicine · 2025-10-22 · 5 citations

  article

  These guidelines aim to standardize and improve the management of pediatric patients with tracheostomies by providing evidence-based recommendations for ethical considerations, discharge planning, and diagnostic assessments. Implementing these guidelines aims to enhance patient safety and quality of life through a structured and patient-centered approach.

  PublisherDOI

• Efficacy of microbial cell‐free DNA testing for detecting pathogens in pediatric patients with head and neck infections—An initial study

  Pediatric Investigation · 2025-01-06

  articleOpen access

  We investigate the utility of microbial cell-free DNA (mcfDNA) from the blood to predict surgical culture results. In this study, only 26.9% of patients had mcfDNA results that were considered predictive of the causative organism(s). There was a significant burden of contamination in the cohort, emphasizing that dedicated protocols must be followed when running gene-based diagnostics. Healthy patients showed detectable mcfDNA signals, though typically at lower molecules per milliliter for similar pathogens. Pediatric ear, nose, and throat (ENT) infections are common and vary from simple to life-threatening cases, including complicated sinusitis, deep neck space abscesses, and mastoiditis. ENT infections in children are a primary driver of antibiotic prescriptions.1 While invasive surgical cultures often yield successful pathogen identification, they require anesthesia and inpatient care. Patients are prescribed broad-spectrum antibiotics until the culture results become available. Clinical management varies due to the ambiguity of the underlying pathogen and is partly driven by patient and provider factors, such as patient age, comorbidities, clinical history, examination, and community pathogen data. The combination of variables, in turn, leads to even more differences in antibiotic choice and timing, imaging use (computer tomography, nuclear magnetic resonance imaging, and ultrasound), extent of surgery, and inpatient care (acute or intensive care unit-level). Such uncertainty contributes to increased costs of care and the risk of developing hospital-acquired conditions. Despite continuous efforts to mitigate some aspects of complexity through pediatric antimicrobial stewardship interventions, harmful effects associated with antibiotics still persist in children.2-4 Recent studies have investigated the use of microbial cell-free DNA (mcfDNA) testing to improve the diagnosis of infections which include invasive fungal infection, endocarditis, and pneumonia.5-8 However, it remains unstudied in complicated infections of the head and neck. The head and neck area has several highly vascularized regions such as the sinonasal cavity and the oropharynx. Therefore, we anticipate that significant infections in these regions will produce enough mcfDNA signal to be detectable on commercial testing. In this study, we investigate and examine a commercially available mcfDNA assay's diagnostic potential. We hypothesize that mcfDNA testing may offer an alternative to traditional surgical culture techniques and can be a reasonable assay for the head and neck which is well vascularized. This prospective, diagnostic study took place at Lucile Packard Children's Hospital in the Stanford Medicine Children's Health organization. This study was approved by the Stanford Institutional Review Board (#47957) and written informed consent and minor assent were obtained per the IRB protocol. All study participants were children (n = 127) with a circulating blood volume of at least 1000 mL. Circulating blood volume estimations were based on the following parameters: 70 mL/kg in adolescents, 80 mL/kg in children, and 90 mL/kg in infants. Children with a history of immunocompromise, prior chemotherapy use, history of transplant, or current use of chronic antibiotics were excluded. Case patients (n = 28) were children admitted to the hospital with suspicion of an acute, complex infection of the head and neck. The patient must have been seen by an attending pediatric otolaryngologist within 24 h of presentation. This was to offer some consistency in clinical courses and management decisions and prevent unnecessary testing. Eligible diagnoses included cervical lymphadenitis, cervical abscess, peritonsillar abscess, retropharyngeal abscess, parapharyngeal space abscess, acute sinusitis with Chandler classification of I–V, mastoiditis, and tracheitis. These diagnoses were included because they were anticipated to be amenable to yielding results on traditional culture thereby serving as a “gold standard” to which to compare the cell-free DNA results, such as ultrasound-guided aspiration of a cervical abscess or sputum culture in a patient with tracheitis. Blood was obtained from leftover lab draws collected at the time of admission. The minimum volume requirement for analysis was 2.5 mL of leftover blood. The blood was processed by Clinical & Translational Research Unit staff trained in clinical research into a K2–ethylenediaminetetraacetic acid (K2-EDTA) tube within 24 h of the lab draw. The mcfDNA testing results were blinded to each patient's care provider team to not influence the clinical care. All results were clinically adjudicated by an independent panel of five otolaryngologists as described in the following section. Control patients (n = 99) consented prior to elective surgical procedures performed for non-infectious etiologies (e.g., tonsillectomy for sleep apnea, cochlear implant, etc.). We also verified the eligibility of the controls by screening their electronic medical record. These non-infected negative controls were recruited to establish normative data of children not suspected to have any acute or chronic infection.​ A total of 5 mL of blood was collected from the patient at the time of surgery using the same intravenous line that was initially placed for the procedure. Blood was collected by either the pediatric anesthesiologist or the circulating nurse into a proprietary tube obtained from Karius Diagnostics which is optimally designed for the assay, plasma preparation tube. All samples were frozen and batch-shipped to Karius Diagnostics for analysis. Karius is a Clinical Laboratory Improvement Amendments-certified clinical diagnostic laboratory. Demographic and clinical data was abstracted from the electronic medical record. In addition, the following were collected from patients: the number of days admitted, clinical and radiographic signs of infection, antibiotic use within the past 6 months (if available), vaccination status, microbiologic data, and culture results, laboratory results. The primary objective of this study was to examine the diagnostic performance of mcfDNA testing as compared with microbiological and clinical data including conventional microbiological diagnostic tests (i.e., blood and intraoperative cultures for bacteria and fungi, in-house targeted bacterial and fungal sequencing on intraoperative samples, and viral polymerase chain reactions [PCRs]), radiological studies, and clinical adjudication. Clinical adjudication determined the mcfDNA result to be “Consistent with infection”, “Unclear”, “Not consistent with a clinical presentation” or “Contaminant”. Descriptive statistics are reported. We tested the difference between cases and controls using the Mann-Whitney U test used for non-normally distributed continuous variables and Fisher's exact test for categorical variables. Statistical analysis was conducted and supported through the Quantitative Sciences Unit at Stanford Medicine. The median age of the cases was slightly older than the controls (12.5 years vs. 7.0 years). There were no significant differences in sex, ethnicity, or race (Table 1). The proportion of case patients with a history of antibiotic use in the last 6 months was higher when compared to the controls, which was expected as many case patients had received outpatient antibiotics in the days prior to presentation with a complicated infection. Two patients were excluded from the infected cohort after being discovered to have an immunodeficiency (n = 1) or be status-post solid organ transplant and receiving immunosuppression (n = 1). The mcfDNA test was successful in reporting bacteria, viruses, and fungi. Clinical adjudication was performed by a panel of clinical experts. There were 7/26 (26.9%) patients who had a mcfDNA result that was deemed to be “Consistent with infection”, as outlined in Table S1. These patients had acute, invasive infections: peritonsillar abscess (n = 4), complicated sinusitis (n = 2), and mastoiditis (n = 1). Four of the seven were naive to antibiotic exposure at the time of testing. The interpretation was “Unclear” for 2/26 (7.7%) patients. Despite the identification of a possible organism through mcfDNA testing, this result differed from that obtained by traditional cultures from the surgical intervention. For instance, Fusobacterium necrophorum was identified by mcfDNA in one case of peritonsillar abscess, and Haemophilus influenzae was identified in one case of mastoiditis. These are both plausible organisms for causing the respective clinical presentations. However, traditional cultures from these cases detected Klebsiella pneumoniae in the peritonsillar abscess case and Streptococcus anginosus group in the mastoiditis case. It remains uncertain whether any of these pathogens were indeed the causative organisms. Ten (38.5%) patients had no result on mcfDNA testing and were classified as “Not consistent with a clinical presentation”. Of these, five patients had been recently exposed to antibiotics. Overall, these patients had more smoldering and less severe presentations than the group of patients with “Consistent with infection” results. The mcfDNA result was interpreted to reflect a contaminant(s) in 7/26 (26.9%) cases. Of these, one patient's results were also indicative of a possible pathogen: F. necrophorum in the setting of mastoiditis. However, there were no gram-negative rods on the gram stain, and surgical culture yielded a different organism; therefore, this was felt to be considered a result of “Contaminant” rather than “Consistent with infection”. The most common contaminants were Burkholderia cepacia complex (n = 4), Acinetobacter haemolyticus (n = 2), and Aspergillus glaucus (n = 2). There were also secondary pathogens deemed to be contaminants detected in the samples of those patients considered to have “Consistent with infection” results. In such cases, the overall test result was deemed as a true positive, but with note of likely contaminants. Interestingly, 31/99 (31.3%) control patients had a positive mcfDNA test result. The majority of which (n = 23, 74.2%) were monomicrobial and the remaining were polymicrobial with a maximum of 14 pathogens detected in a single patient. Among the controls, there were a total of 25 different pathogens detected. Overall, the molecules per milliliter (MPM) of the findings were significantly less in the control patients (median = 65.6, interquartile range [IQR] = 46.0–109.2) versus the infected patients (median = 168.7, IQR = 86.0–333.2) (P < 0.0001). There was an overlap in the MPM at the lower end of the range, likely representing similar signals of contaminant DNA. A. haemolyticus, possibly a contaminant, was the most frequently detected pathogen in control patients (n = 12), followed by H. influenzae (n = 10). When a pediatric patient is suspected of having a complex infection of the head and neck, providers often prescribe broad-spectrum antibiotics while awaiting clinical diagnostics such as radiographic findings and surgical cultures. The period of clinical uncertainty can be a source of frustration for patients, parents, and healthcare providers. Moreover, the use of broad-spectrum antibiotics can have patient-specific side effects and may lead to antibiotic resistance, a public health crisis.9-11 For instance, the Centers for Disease Control and Prevention reported that there are approximately 250 000 Clostridium difficile infections caused by antibiotic use each year, resulting in 14 000 deaths.12 Most notably, children, particularly those admitted to hospitals, have been emphasized to experience antibiotics overuse and misuse.13-15 Plasma-based mcfDNA assays are potentially less invasive, agnostic, and faster than traditional cultures. The mcfDNA testing detects infections by identifying and quantifying cell-free pathogen DNA present in the blood which is derived from dead and dying organisms throughout the body. If successful, mcfDNA testing has the potential to decrease the turnaround time for specific pathogen detection and increase targeted treatment, such as culture-directed antimicrobial therapy, thereby facilitating antibiotic stewardship and precision medicine.16 In our prospective diagnostic study, we applied a commercial assay to detect mcfDNA with modest utility. The use of mcfDNA testing in this study demonstrated varying degrees of utility in predicting the causative organism in patients with acute, invasive infections. Out of 26 patients, seven had mcfDNA results that aligned with the organism thought to be causing their clinical presentation. These cases included peritonsillar abscess, complicated sinusitis, and mastoiditis, with four of the seven patients being antibiotic-naive at the time of testing. Of these seven patients, five patients did not ever have growth on a traditional culture or positive microbial result. Therefore, mcfDNA testing was the only data point to name the pathogen. This could be potentially very useful in cases of refractory disease or severe presentations. However, there were instances where the mcfDNA results did not match the traditional cultures from surgical interventions, leading to uncertainty in interpretation. This raises questions about the accuracy of mcfDNA in these patients which is at best misguided and at worst a dangerous clinical paradigm. Additionally, there were patients for whom mcfDNA testing yielded no result. These patients generally presented with less severe symptoms compared to those with mcfDNA results “Consistent with infection”, though the limited sample size prevents from generalizing this observation. About 50% of both the “Consistent with infection” and the “no call” (no identified microbial pathogens on cell-free DNA testing) groups had been exposed to antibiotics leaving the question of how antibiotic use may influence mcfDNA testing results unanswered. The high level of contamination in our samples is concerning. Because these samples also did not yield pathogens that were consistent with infection, there may have been a shortcoming in the processing of the samples. Furthermore, these samples were all frozen and then run in batches, raising the possibility of contamination or cross-contamination at the time of storage or shipping. It is unclear if those potential shortcomings influenced the utility of the assay; there were also contaminants noted alongside “Consistent with infection” results as well which raises the possibility that contamination may not totally negate the test's ability to detect a pathogen. Apart from one patient who tested positive for adenovirus by rapid viral panel upon admission, the result for mcfDNA testing would have been available sooner (turnaround time 28–40 h depending on the day/time of patient's initial presentation and availability of courier service) than traditional culture results, generally estimated to be 1–3 days for aerobic bacteria and 2–5 days for anaerobic bacteria. Because the number of positive results on either viral PCR panel, blood culture, or surgical culture was so low, we were unable to perform statistical analysis on the significance of this observation. In clinical review, it is unlikely that the difference in turnaround time would have changed the need for operative intervention, but it is possible that there may have been a narrowing of the antimicrobial regimen in four patients prior to a change in medication based on traditional cultures and clinical standards. We interpret the consistency of positive results in the control cohort to be reflective of what is likely the non-pathologic baseline in children of this age group in addition to some instances of sample contamination. The significant difference in MPM levels between positive results in the infected group and control group underscores the importance of understanding if the quantity of circulating pathogen DNA may be indicative of pathology or severity of disease and is an area for future research. Imperative to this is the ability to establish a cutoff separating infection from non-infection, and this is an additional area for additional study. It may be that this test will not be a standalone predictor, but rather included in predictive models which include clinical parameters such as vital signs, other laboratory studies, and additional information. Meanwhile, there were potential limitations. From a methodological and process standpoint, the time interval in which the sample was collected to the time of centrifugation may have varied secondary to available staff. There were also time interval variations between the time the samples were collected and the time the samples were analyzed since the blood samples were sent in batches. We tried to minimize the variability by storing samples in a −80°C freezer, but we could not be certain about whether the variation of time differences affected the results of the samples. Lastly, our sample size for infected patients is underpowered. We estimated our power calculation based on the accuracy of mcfDNA testing with a recruiting goal of 50 patients in the infected cohort and 100 patients in the control cohort. This study was conducted during the coronavirus disease 2019 pandemic and did not reach the recruitment levels of case patients needed to achieve statistical power. Our sample size for patients (n = 28) is also not sufficient to generalize findings into the bigger pediatric patient populations, and we are unable to subdivide amongst infections (deep neck space versus mastoiditis, for example) that may be best suited for this type of adjunctive diagnostic testing. In addition, there was limited availability of traditional culture data in the infected cohort, and therefore much of the data was generated by clinical adjudication. There is a potential bias in the clinical adjudication process; however, the panel was composed of five expert pediatric otolaryngologists. Overall, while mcfDNA testing showed promise in predicting causative organisms in some cases of acute, invasive infections, its utility was variable in this cohort and potentially influenced by factors such as antibiotic exposure and the possible influence of contamination. As such, the use of mcfDNA in the studied algorithm is not anticipated to routinely change current clinical practice in pediatric otolaryngology. This is like recent publications in pediatric hospital medicine, pediatric invasive fungal sinusitis, and pediatric oncology.17-20 However, it may augment traditional clinical and microbiologic data as it relates to the rapidity of results. It may serve as a complement to the traditional gold standard but should not be relied upon to replace the current algorithms. In addition, a negative result on this testing should not be interpreted as the absence of infectious disease just as a positive result must be interpreted within the clinical context of the patient's clinical presentation. Additional prospective studies are needed to understand the role of mcfDNA testing in pediatric infectious disease and whether the quantitative strength of the signal is clinically meaningful. Further research is needed to determine the optimal use and interpretation of mcfDNA testing in pediatric clinical settings. This study was approved by the Stanford Institutional Review Board (#47957) and written informed consent and minor assent were obtained per the Institutional Review Board protocol. We would like to thank Yiwen Wang for her statistical expertise and collaboration. This work was supported by the Maternal Child Research Institute, Stanford Medicine Children's Health, Clinician Educator Grant. The authors declare no conflict of interest. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

  PublisherOA PDFDOI

• Corrigendum to “Pediatric tracheal mucoepidermoid carcinoma treated with cricotracheal resection: A rare case and review of literature” [Otolaryngology 34 (2025) 100654]

  Otolaryngology Case Reports · 2025-04-08

  erratumOpen access
  PublisherDOI

• Composition and Priorities of Multidisciplinary Pediatric Thyroid Programs: A Consensus Statement

  Thyroid · 2025-02-14 · 4 citations

  review

  Background: The incidence of pediatric thyroid cancer has been increasing, and care varies due to socioeconomic disparities or differing practice patterns. Clinical guidelines call for care in multidisciplinary teams to minimize variance and provide protocols. Based on expert opinion, we hope to describe the form and function of such multidisciplinary teams for pediatric thyroid programs. Methods: A modified Delphi method to reach consensus statements over two rounds. Twenty-one experts with varying backgrounds responded to each statement on a 9-point Likert scale. Upon completion of the survey, the panel reviewed and shared the results and comments from participants and modified the statements accordingly. This process was repeated such that statements reached consensus, were deemed no consensus, or had no change in the mean. Results: There was an 88% and 83% completion rate for Rounds 1 and 2, respectively. A consensus was observed that there is a distinct definable model of care for pediatric thyroid patients. No consensus was reached for the age range of patients, but programs should care for children with medullary thyroid cancer, differentiated thyroid cancer, and patients with genetic predisposition syndromes. A comprehensive team includes, but is not limited to, a thyroid surgeon, a pediatric endocrinologist, a high-volume fine-needle aspiration (FNA) proceduralist, an oncologist, a nuclear medicine physician, a pediatric pathologist, a pediatric radiologist, and a nurse coordinator. Necessary support services involve care coordination, access to a multidisciplinary tumor board, ability to perform ultrasound-guided FNA, and access to molecular testing. The panel emphasized cross-institutional collaborative research prioritizing guidelines development, disease-specific outcomes, treatment toxicity, and the molecular landscape of thyroid cancer. Conclusions: These consensus statements can be beneficial in improving multidisciplinary care, by describing which elements of pediatric thyroid programs should be consistent across institutions. Overall, the panel agreed that pediatric thyroid centers should provide integrated care with defined team members, services, resources, and research priorities. This model has the potential to standardize various aspects of clinical care and enhance our ability to study patient outcomes, improve health care delivery, and increase scholarly collaboration.

  PublisherDOI

• Comparison of Outcomes Between Primary Laryngotracheal Reconstruction and Partial Cricotracheal Resection in Moderate Grade Pediatric Subglottic Stenosis: A Systematic Review and Meta‐Analysis

  Laryngoscope Investigative Otolaryngology · 2025-07-16 · 1 citations

  reviewOpen access

  Objective: This systematic review and meta-analysis compare the outcomes of primary laryngotracheal reconstruction (LTR) and partial cricotracheal resection (PCTR) in managing moderate-grade pediatric subglottic stenosis (severe Grade II and Grade III). While both surgical approaches are widely used, no clear consensus exists on the superior technique. Methods: A systematic literature search was conducted across PubMed, Embase, and Scopus following PRISMA guidelines. Studies reporting outcomes of LTR and PCTR in pediatric patients (< 18 years) with severe Grade II (> 60%) or Grade III subglottic stenosis were included. The primary outcome was successful extubation or decannulation. Statistical analysis, including pooled prevalence estimates and heterogeneity assessment, was performed using STATA software. Results: = 0.47). Failed decannulation in both groups was associated with factors such as neurological disorders, severe airway scarring, and coexisting airway anomalies. PCTR demonstrated slightly better functional outcomes in voice and swallowing, whereas LTR was associated with a higher risk of restenosis and revision surgeries. Conclusion: Both LTR and PCTR are viable options for moderate-grade pediatric subglottic stenosis, with comparable decannulation success rates. PCTR may offer advantages in functional outcomes, but further research with standardized reporting is necessary to establish an optimal surgical approach. Level of Evidence: II.

  PublisherOA PDFDOI

Recent grants

• NIH Grant F32HL090226

  NIH · $32k · 2009

Frequent coauthors

• Douglas R. Sidell

  Stanford University

  63 shared

• Catherine K. Hart

  Cincinnati Children's Hospital Medical Center

  51 shared

• Michael J. Rutter

  University of Cincinnati

  43 shared

• Alessandro de Alarcón

  Cincinnati Children's Hospital Medical Center

  41 shared

• R. Paul Boesch

  Mayo Clinic in Florida

  39 shared

• Jeremy D. Prager

  Children's Hospital Colorado

  35 shared

• Karen B. Zur

  University of Pennsylvania

  30 shared

• Reza Rahbar

  Boston Children's Hospital

  28 shared

Labs

• Stanford Medicine Children's HealthPI

Education

• M.D.

  Stanford University

• Other

  University of California, Berkeley

• B.S.

  University of California, Berkeley

Awards & honors

• Fellowship in the American College of Surgeons
• Fellowship in the American Academy of Pediatrics