The edition · Paediatrics
Take the admission bloods from the placenta, not the baby
A Cochrane review finds cord blood sampling for admission tests likely reduces treatment-requiring retinopathy of prematurity, the AAP widens second-season RSV immunisation, and five-year data show most children with type 1 SMA on risdiplam are alive and feeding orally.
The edition in brief
A Cochrane review of five randomised trials in 365 preterm infants, all with mean gestational age under 29 weeks, examined ways to reduce iatrogenic blood loss. Taking admission laboratory samples from cord or placental blood rather than from the infant likely reduced retinopathy of prematurity requiring treatment (risk ratio 0.52, 95% CI 0.32 to 0.85, moderate certainty) and may have reduced severe intraventricular haemorrhage (RR 0.35, 0.14 to 0.89, low certainty). Two of the five trials were Indian. Devices that reintroduce blood after analysis and strict sampling protocols showed nothing. The AAP has updated RSV immunisation policy: immunise all infants under 8 months entering their first RSV season unless protected by maternal vaccination, and widen the high-risk criteria for children 8 through 19 months entering a second season. It has also issued 2026-2027 COVID-19 vaccine recommendations — routine for all children 6 through 23 months, a single dose for those 2 through 18 at increased risk. Five-year FIREFISH extension data in type 1 spinal muscular atrophy: of 62 children started on risdiplam in infancy, 56 (90%) were alive at year 5 and 50 (80%) alive without permanent ventilation; 62% could sit unsupported for 5 seconds and 72% still fed orally. Pneumonia was the commonest serious adverse event, in 45%. A meta-analysis of six trials and 576 children found honey at least matched pharmacological antitussives for acute cough, and improved the child's sleep. A video laryngoscope did not reduce pain during less invasive surfactant administration. Today's pearl: moderate procedural pain in a neonate is a nursing problem before it is a drug problem.
Cord blood for admission tests: likely fewer babies needing ROP treatment
Set up a standing protocol to take admission laboratory samples from cord or placental blood rather than from the preterm infant — it likely halves the risk of retinopathy needing treatment.
AAP widens second-season RSV immunisation and sets the 2026-2027 COVID vaccine schedule
Check your second-season RSV criteria against the AAP's widened high-risk list, and use its risk-based framework rather than age alone when deciding on COVID vaccination for children over two.
Five years of risdiplam in type 1 SMA: alive, sitting, and still eating by mouth
Five years of risdiplam started in infancy leaves most children with type 1 SMA alive, ventilation-free, sitting and feeding orally — but half develop pneumonia, so respiratory prophylaxis is part of the treatment.
Honey holds its own against cough medicines, and helps the child sleep
Offer honey rather than a cough medicine to a child over one year with acute cough — it is at least as effective and improves the child's sleep.
A video laryngoscope did not make surfactant administration less painful
Pain during less invasive surfactant administration is moderate and brief regardless of laryngoscope type — manage it with sucrose and containment rather than sedation.
Write the comfort plan into the procedure order, not into the nursing notes
Attach a specific comfort measure — sucrose, non-nutritive sucking, facilitated tucking — to each painful procedure order rather than leaving it to general nursing guidance.
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