The edition · Paediatrics
A procalcitonin-based rule cut antibiotics in febrile infants from 38% to 26% with no detected rise in harm
A European cluster trial shows point-of-care procalcitonin and urine testing can spare antibiotics in fever without source with no detected rise in harm; pooled trials question the rule of oral-only rehydration in severe malnutrition; and simple family-centred care eases NICU parents' anxiety.
The edition in brief
In a cluster-randomised trial in 25 European paediatric emergency departments, 4,882 children aged 6 days to 36 months with fever without source were managed by usual care or a decision rule combining age, clinical signs, urinalysis and point-of-care procalcitonin. Antibiotic exposure within 15 days fell from 38.0% to 26.2% (OR 0.57, 0.43 to 0.75), with similar morbidity and mortality (OR 0.83, 0.57 to 1.22). A meta-analysis of three trials (484 children) in severe acute malnutrition with severe dehydration found intravenous rehydration associated with a risk ratio for in-hospital death of 0.71 (0.46 to 1.10) and less severe hyponatraemia (RR 0.66), with no fluid overload events reported but too few children to rule harm in or out; the evidence is too thin to change WHO guidance. A meta-analysis of 160 studies of NICU parents found psychotherapy and emotional support, family-centred care and education, and bonding interventions all reduced parental anxiety, with family-centred care among the cheapest to deliver.
Intravenous rehydration in severe malnutrition: three small trials found no clear difference in deaths
Follow current SAM rehydration protocols; the trial evidence is too limited to show benefit or harm from intravenous fluids.
Psychotherapy, family-centred care and bonding support each reduced anxiety in NICU parents
Involving parents in NICU care and offering emotional support measurably reduces their anxiety; start with the low-cost measures.
Hybrid closed-loop pumps lowered HbA1c in young people with poorly controlled type 1 diabetes
Offer hybrid closed-loop therapy to young people with persistently high HbA1c where available; they may benefit most.
In a febrile infant with no source, test the urine first
In a young child with fever and no focus, get a proper urine sample first, unless the child is seriously unwell, when antibiotics must not be delayed for a sample.
A procalcitonin-based rule cut antibiotic use by a third in febrile infants with no source
For young children with fever and no source, a rule using urinalysis and procalcitonin avoided about one in three antibiotic courses in this trial, with no detected increase in morbidity or mortality.
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