The edition · Internal Medicine
First-trimester benzodiazepines showed no rise in major malformations across four million pregnancies
Reassurance on benzodiazepines in early pregnancy, automated oxygen titration that cut hyperoxaemia on the ward, fluvoxamine for long COVID fatigue, and a hospitalist-run rehabilitation unit that shortened discharge waits.
The edition in brief
A US cohort of about 4.2 million pregnancies in Medicaid and commercial insurance data found no increase in major congenital malformations after first-trimester benzodiazepine exposure (pooled RR 0.99, 95% CI 0.96 to 1.03), with no dose-response and similar results across individual drugs; coexposure with other psychoactive drugs gave inconsistent signals. SAVE-O2 AI, a four-hospital randomised trial in 300 acutely ill adults on supplemental oxygen, found that a closed-loop device kept saturations in the 90 to 96% range 85% of the time against 63% with manual titration, mainly by cutting time spent above 96% from 29% to 9%. A Brazilian adaptive trial in 399 adults with long COVID fatigue found fluvoxamine 100 mg twice daily modestly improved fatigue scores at 60 and 90 days compared with placebo; metformin results were inconclusive. A US VA hospitalist-led short-stay rehabilitation unit cut mean referral-to-discharge time from 6.9 to 3.4 days over two years. The pearl covers oxygen targets on the ward.
Manual oxygen titration left ward patients above 96% saturation for 29% of the time
Check oxygen prescriptions on every ward round and turn oxygen down when saturation sits above target.
Fluvoxamine modestly reduced long COVID fatigue over 90 days
Fluvoxamine may be worth discussing for persistent long COVID fatigue, with a clear trial period and attention to interactions.
A hospitalist-led short-stay rehabilitation unit halved the wait from referral to discharge
Where patients wait in acute beds for rehabilitation placement, a physician-led step-down unit is a model worth considering.
Prescribe oxygen to a target range, not a flow rate
Write a saturation target on every oxygen prescription: usually 94 to 98%, or 88 to 92% where hypercapnic respiratory failure is a risk.
First-trimester benzodiazepine use was not associated with more major malformations
When a woman taking a benzodiazepine finds she is pregnant, counsel that malformation risk does not appear raised, and avoid stopping abruptly out of fear of birth defects.
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