Most paediatric sepsis deaths are decided before the PICU, and speech therapy that starts before speech

The edition in brief

The Phoenix Sepsis Criteria have moved paediatric sepsis from an inflammation-based definition to one centred on life-threatening organ dysfunction, and conjugate vaccine programmes have changed which children present with invasive bacterial infection. A review in Archives of Disease in Childhood sets out what remains unsolved: many deaths still occur within 24 hours of referral to intensive care, meaning outcomes are largely determined before admission; screening tools perform poorly in unselected febrile children; and biomarkers remain adjuncts, leaving clinicians relying on gestalt and parental concern. A randomised trial in Ecuador gave 111 pregnant women weekly deliveries of eggs, fish, fruit and vegetables from 12 weeks' gestation against 104 controls: dietary diversity improved, fetal corpus callosum length grew 0.19 cm more and gangliothalamic ovoid height 0.15 cm more between 21 and 35 weeks — but femur length was 0.10 cm shorter, a finding that complicates the story rather than confirming it. In 44 infants with classic galactosemia randomised to a caregiver-delivered, telehealth-coached speech intervention starting before 6 months or at 15 months, both groups outperformed usual care, and those starting before 6 months had a rate of clinically concerning scores equal to typically developing peers. The practice-changer is a systematic review of 41 studies covering six paediatric delirium tools: the Cornell Assessment of Pediatric Delirium has the largest evidence base, while the Sophia Observation withdrawal Symptoms - Pediatric Delirium scale had the most favourable certainty profile across measurement properties.