The edition · Paediatrics
The ban on drips in severe malnutrition rests on less evidence than the alternative
Three trials, 484 children: intravenous rehydration in severe acute malnutrition with severe dehydration caused no fluid overload and halved severe hyponatraemia; a procalcitonin-based rule cut antibiotics in febrile infants by a third; and silver diamine fluoride arrests half of active caries lesions.
The edition in brief
The paediatrics desk opens with a meta-analysis of the three randomised trials comparing intravenous with oral rehydration in children hospitalised with severe acute malnutrition and severe dehydration — 484 children in total. In-hospital mortality was lower with the drip but not significantly so (RR 0.71, 95% CI 0.46 to 1.10, I² 0%), no fluid overload events occurred in either arm, and severe hyponatraemia at 24 hours was less frequent with intravenous rehydration (RR 0.66, 0.44-0.99). An open cluster randomised trial across 25 European paediatric emergency departments tested a decision rule combining age, symptoms, urinalysis and point-of-care procalcitonin in 4,882 children aged 6 days to 36 months with fever without source: antibiotic exposure at 15 days fell from 38.0% to 26.2% with no difference in morbidity or mortality. A phase 3 trial in 830 US children found 38% silver diamine fluoride arrested 54.0% of active dentin lesions at six months against 22.5% with placebo. A real-world cohort of 220 UK children with type 1 diabetes and HbA1c at or above 69 mmol/mol found a fall to a mean of 69.3 mmol/mol at 12 months after starting hybrid closed-loop therapy. A review sets out where the Phoenix criteria have moved paediatric sepsis. A pearl covers the febrile infant under three months.
Intravenous rehydration in severe malnutrition: the harm did not appear
In a severely malnourished child with severe dehydration who cannot drink, give intravenous fluid rather than persisting with a failing oral attempt.
Silver diamine fluoride arrested half the lesions it was painted on
For a young child with active cavitated caries and no realistic route to restorative treatment, silver diamine fluoride arrests about half the lesions — as long as the parents are warned about the black staining.
Closed-loop pumps moved the children whose HbA1c would not move
Offer hybrid closed-loop therapy to the children with the worst control, not only to those already engaged.
Paediatric sepsis after Phoenix: the deaths happen before intensive care
Invest in recognition on the ward and in the emergency department; that is where paediatric sepsis outcomes are being decided.
Under three months, the fever is the diagnosis until proven otherwise
Under 28 days, a fever gets a septic screen and antibiotics regardless of how well the infant appears.
A procalcitonin-based rule cut antibiotics by a third without cost
If your emergency department can run procalcitonin at the bedside, adopt a structured rule for fever without source — it removes about a third of antibiotic courses with no measured cost.
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