The edition · Paediatrics
Honey matched pharmacological antitussives for children's acute cough, and beat them on sleep
A meta-analysis of six trials and 576 children found honey no worse than antitussives across most endpoints and better for the cough's effect on a child's sleep. Given what paediatric antitussives cost in adverse effects, no worse is the argument. An international Delphi has also settled a consensus definition of neonatal encephalopathy.
The edition in brief
The most immediately usable finding concerns a prescription many of us write to end a consultation rather than to treat anything. A meta-analysis of six randomised trials and 576 children aged three to five compared honey with pharmacological antitussives for acute cough. Across most endpoints there was no significant difference; the exception was the cough's effect on the child's sleep, better with honey by 0.73 points. Heterogeneity was high, and only after a leave-one-out sensitivity analysis did honey come out ahead on everything — which the authors correctly describe as hypothesis-generating rather than definitive. The clinical argument does not depend on superiority: equivalence is enough when one arm carries the established adverse-effect profile of paediatric antitussives and the other is honey. An international real-time Delphi with 235 complete responses from 52 countries, a fifth from low- and middle-income settings and 6% from parents and caregivers, has established a consensus definition of neonatal encephalopathy. The terms neonatal encephalopathy, hypoxic-ischaemic encephalopathy and perinatal asphyxia have been used interchangeably in trials for years, which makes the literature harder to synthesise than the biology warrants. Also today: video laryngoscopy did not reduce pain during less invasive surfactant administration in 42 preterm neonates, and school-based diet and activity interventions across Africa produced no significant change in BMI-for-age.
Honey held its own against antitussives, which is all it needs to do
Honey performed comparably to pharmacological antitussives for acute cough in children over one year old and better for sleep disturbance, which makes it the better first choice given antitussive adverse effects.
An international consensus definition for neonatal encephalopathy
An international Delphi has agreed a consensus definition of neonatal encephalopathy that separates the observed syndrome from any claim about its cause, which the interchangeable use of hypoxic-ischaemic encephalopathy had blurred.
Video laryngoscopy did not reduce pain during surfactant administration
Video laryngoscopy did not reduce procedural pain, attempts or duration during less invasive surfactant administration compared with conventional laryngoscopy in experienced hands.
School-based diet and activity programmes did not shift BMI-for-age in Africa
School-based diet and activity interventions in Africa showed no significant effect on BMI-for-age when pooled, on an evidence base of eleven mostly non-randomised studies concentrated in one country.
The evidence on minimising blood sampling in preterm infants, assembled
A Cochrane review has assembled the randomised evidence on reducing iatrogenic blood loss in preterm infants, covering cord sampling, non-blood fluids, micro-sampling, blood-return devices and strict sampling protocols.
Equivalence is enough when one arm carries the harm
When two options differ in harm or cost, evidence that they work equally well is sufficient reason to choose the safer one — superiority is not required.
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