Steroids given in one in ten septic children, almost all outside refractory shock

The edition in brief

A prospective cohort across 11 Australian and New Zealand emergency departments recorded what happened to 5,119 children admitted with suspected community-acquired sepsis between 2021 and 2023. Median age was 1.6 years and in-hospital mortality 1.0%. Corticosteroids were given within 24 hours to 9.6% overall and to 31.3% of the 252 children meeting Phoenix sepsis criteria, whose mortality was 12.7%. Dexamethasone accounted for 69.5% of use and hydrocortisone 25.4%, with wide variation between sites. Use tracked with older age, multiple comorbidities, raised lactate, large-volume fluid and vasopressors - but the authors note most was given outside fluid- or catecholamine-refractory shock, which is the only setting where guidelines suggest it. The American Academy of Pediatrics has issued a clinical report on congenital cytomegalovirus, recommending hearing-targeted screening plus expanded testing, and covering diagnosis, initial evaluation and treatment of both symptomatic disease and isolated sensorineural hearing loss. SUNRISE gives the first international step-count percentiles for preschool children: 3,570 children aged 3 and 4 across 44 countries, weighted median 18,542 steps a day (95% CI 18,318-18,812). Boys walked more than girls at most percentiles, and children in low- and middle-income countries and rural settings walked more than those in high-income and urban ones. Across 12,030 US children with isolated mild traumatic brain injury, head CT was used in 43.5% to 51.5% of cases with little change from 2017 to 2023 - 59.5% at adult hospitals against 38.8% at paediatric ones.