The edition · Paediatrics
Prophylactic dextrose gel does nothing for school-age cognition and may cost something else, while a single RSV antibody dose covers a whole season
Seven-year follow-up of the hPOD trial finds no cognitive benefit from prophylactic buccal dextrose gel and a signal of worse emotional-behavioural outcomes; clesrovimab matches monthly palivizumab with one dose; a maternal high egg and peanut diet does not prevent infant allergy; and a point-of-care alert held a stewardship gain for two years after the teaching stopped.
The edition in brief
School-age follow-up of the hPOD trial assessed 1,067 New Zealand children at 6 to 7 years who as at-risk newborns received a single 0.2 g/kg buccal dose of dextrose gel or placebo at one hour of age. Neurocognitive impairment was 59% with dextrose gel and 57% with placebo (adjusted risk difference 3%, 95% CI -3% to 9%). Among eleven exploratory outcomes, emotional-behavioural difficulty was more common with dextrose gel (24% vs 18%, aRD 7%, 95% CI 1-12) as was low psychosocial function (17% vs 12%, aRD 6%, 1-10). The SMART trial randomised 997 palivizumab-eligible infants to a single 105 mg dose of clesrovimab or up to five monthly palivizumab doses: adverse events were comparable, and RSV-associated medically attended lower respiratory infection through day 150 was 3.2% versus 3.4%; a 210 mg dose before a second season was well tolerated, with 7.3% incidence through day 180. PrEggNut randomised 2,137 pregnant women at high familial allergy risk to a high or standard egg and peanut diet; infant IgE-mediated egg or peanut allergy at one year was 7.8% versus 8.4% (RR 0.93, 95% CI 0.69-1.26). A paediatric network sustained short-course prescribing for skin and soft tissue infection at 88.5%, up from 62.5%, for 21 months after active teaching ended, using a point-of-care alert alone. A Medicaid cohort of 36,552 sepsis episodes found 30-day mortality of 3.9% with wide regional variation.
One clesrovimab dose matched five monthly palivizumab injections, and a second-season dose was tolerated
Where a long-acting RSV monoclonal is available, one dose a season replaces five monthly injections at comparable safety and comparable infection rates.
Loading the maternal diet with egg and peanut did not prevent infant allergy
Advise normal maternal intake of egg and peanut; the prevention that works is timely introduction to the infant at weaning.
A point-of-care alert held a prescribing gain for 21 months after the teaching stopped
Build the reminder into the prescribing step rather than into the teaching; the alert, not the education, is what held this gain for two years.
Paediatric sepsis mortality varied more across regions than illness severity explains
Familiarity with paediatric sepsis appears to be protective; where there is a choice, send the child to the unit that sees them most often.
Treat a low point-of-care glucose in a symptomatic newborn before the laboratory confirms it
Act on the point-of-care glucose in a symptomatic newborn and send the laboratory sample at the same time; never let the confirmation delay treatment.
Prophylactic dextrose gel: no cognitive benefit at 6 to 7 years, and a signal in the wrong direction
Stop prophylactic dextrose gel in at-risk normoglycaemic newborns; it did not protect cognition at school age and may have cost something.
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