Why exclude children with medical complexity?

In this Complex Care Journal Club podcast episode, Drs. Kathleen Chiotos and Jeffrey Gerber discuss a post hoc time-series analysis of clinician feedback reports and antibiotic prescribing for community-acquired pneumonia in children with medical complexity (CMC). They describe why children with medical complexity are often excluded from guideline-based interventions, what the data suggest about antibiotic choice and duration in this population, and next steps to design studies that include all children. SPEAKERS Kathleen Chiotos, MD, MSCE Associate Professor of Anesthesiology and Critical Care University of Pennsylvania, Children's Hospital of Philadelphia Jeffery Gerber, MD, PhD Professor of Pediatrics and Epidemiology University of Pennsylvania School of Medicine; Children's Hospital of Philadelphia HOST Kristina Malik, MD Assistant Professor of Pediatrics, University of Colorado School of Medicine Medical Director, KidStreet Pediatrician, Special Care Clinic, Children's Hospital Colorado DATE Initial publication date: February 17, 2026. JOURNAL CLUB ARTICLE Chiotos K, Dutcher L, Grundmeier RW, Szymczak JE, Lautenbach E, Neuhauser MM, Hicks LA, Hamilton KW, Li Y, Muller BM, Meyahnwi D, Congdon M, Kane E, Hart J, Utidjian L, Cressman L, Jaskowiak-Barr A, Gerber JS. Off-target Impact of Clinician Feedback Reports on Antibiotic Use in Children With Medical Complexity Hospitalized With Community-Acquired Pneumonia. J Pediatric Infect Dis Soc. 2025 Oct 2;14(10):piaf089. doi: 10.1093/jpids/piaf089. PMID: 41051365. OTHER ARTICLES REFERENCED Chiotos K, Dutcher L, Grundmeier RW, Meyahnwi D, Lautenbach E, Neuhauser MM, Hicks LA, Hamilton KW, Li Y, Szymczak JE, Muller BM, Congdon M, Kane E, Hart J, Utidjian L, Cressman L, Jaskowiak-Barr A, Gerber JS. Impact of Clinician Feedback Reports on Antibiotic Use in Children Hospitalized With Community-acquired Pneumonia. Clin Infect Dis. 2025 Feb 24;80(2):263-270. doi: 10.1093/cid/ciae593. PMID: 39656188; PMCID: PMC12120840. Feudtner C, Feinstein JA, Zhong W, Hall M, Dai D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr. 2014 Aug 8;14:199. doi: 10.1186/1471-2431-14-199. PMID: 25102958; PMCID: PMC4134331. TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/bgxn4mqgk45zjxhxpxgxf3px/Chiotos_and_Gerber_podcast_2-13-26 Clinicians across healthcare professions, advocates, researchers, and patients/families are all encouraged to engage and provide feedback! You can recommend an article for discussion using this form: https://forms.gle/Bdxb86Sw5qq1uFhW6. Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Chiotos K, Gerber JS, Malik K. Evidence for Everyone: Studying Antibiotic Use for Pneumonia in Children With Medical Complexity. 2/2026. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/evidence-for-everyone-studying-antibiotic-use-for-pneumonia-in-children-with-medical-complexity.