Kidney and bladder ultrasound missed half of vesicoureteral reflux after a first childhood UTI

The edition in brief

The American Academy of Pediatrics published an updated clinical practice guideline on 28 September 2026 for urinary tract infection in children aged 8 days to 5 years, replacing the 2011 version. It uses GRADE and contains eight key action statements, two strong and six conditional, with low to very low certainty evidence, plus four good practice statements. A technical report behind it pooled 90 studies and found renal and bladder ultrasound detected only 50% of reflux after a first infection (specificity 71%), and 66% of high-grade reflux. In an Italian target trial emulation of 196 infants hospitalised with pertussis, azithromycin was associated with more severe disease than clarithromycin (60% vs 33%, OR 1.80). In a Swedish cohort of two million births, infants who did not receive intramuscular vitamin K had higher odds of bleeding (aOR 1.52) and intracranial bleeding (aOR 2.91). An Indian randomised trial of 50 children with nephrotic oedema found adding metolazone to furosemide did not increase urine output.