The edition · Paediatrics
Vitamin K refusal is rising, and intracranial bleeding tracks it
Two million Swedish births show what happens when newborn vitamin K is declined; clarithromycin outperformed azithromycin in hospitalised infants with pertussis; and a single night of oximetry misses obstructive sleep apnoea in children with Down syndrome.
The edition in brief
Five findings for paediatric practice. A Swedish national cohort of 2,020,302 live births at 35 weeks or more, followed to six months, found 24,089 infants with no record of intramuscular vitamin K at birth; non-receipt fell to 0.66% by 2006 and then more than doubled to 1.50% by 2021. Those infants had adjusted odds of any bleeding diagnosis of 1.52 (95% CI 1.27–1.81) and of intracranial bleeding of 2.91 (2.13–3.96). A target trial emulation across 11 Italian centres in 196 infants hospitalised with pertussis found azithromycin associated with higher odds of a severe course than clarithromycin (Pertussis Severity Score above 5 in 60% versus 33%, odds ratio 1.80, 95% CI 1.01–3.21), with more oxygen requirement, complications and intensive care admissions, and both deaths in the azithromycin group. The AAP's 2026–2027 technical report recommends RSV immunisation for all infants under eight months entering their first season unless protected by maternal vaccination, and extends second-season protection to a widened high-risk group aged 8 through 19 months. Among 3,520,531 US children aged 8 to 11 with obesity and without diabetes, GLP-1 receptor agonist prescribing rose from 0.03% in 2019 to 9.3% in 2026, reaching 0.6% overall, concentrated in children with obesity-related comorbidity (188.9 per 10,000) and less common in those with high social vulnerability (49.2 versus 76.1 per 10,000). And in children with Down syndrome, 53% of three-night oximetry studies crossed the diagnostic threshold on some nights but not others.
Declining vitamin K at birth nearly triples the odds of intracranial bleeding
Give intramuscular vitamin K at birth, document it, and when parents hesitate quote the near-threefold increase in intracranial bleeding rather than a general reassurance.
AAP widens RSV protection into a second season
For infants under eight months, immunise against RSV unless maternal vaccination gave documented protection, and identify the expanded high-risk group who need a second season.
GLP-1 prescribing in 8 to 11 year olds went up 310-fold, and not evenly
Expect GLP-1 questions from families of 8 to 11 year olds, and when you prescribe, check that the decision is being driven by comorbidity rather than by who can access the drug.
One night of oximetry is not a sleep apnoea screen in Down syndrome
Treat a single normal night of oximetry in a child with Down syndrome as inconclusive, and repeat over three nights before excluding obstructive sleep apnoea.
The apnoea comes before the whoop
In an infant under three months with unexplained apnoea or a cluster cough, treat for pertussis on suspicion rather than waiting for a whoop or a PCR result.
Clarithromycin beat azithromycin in hospitalised infants with pertussis
Choose clarithromycin over azithromycin when treating an infant admitted with pertussis; the evidence is observational but consistent and the drug is equally available.
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