A maternal vaccine for RSV, and shorter TB prevention for children

The edition in brief

A network meta-analysis of paediatric preventive TB regimens found the shorter courses — three months of isoniazid–rifapentine (3HP), four months of isoniazid–rifampicin (4HR) and four months of rifampicin (4R) — had better adherence than nine months of isoniazid (9H), and 4HR reduced active TB at up to five years (relative risk 0.49 vs 9H). Adverse reactions were more frequent with 3HP than 4HR or 4R, and least with 4R — useful when choosing between short regimens for a child contact. A meta-analysis of nebulised salbutamol for transient tachypnea of the newborn found shorter durations of respiratory support, CPAP, oxygen and hospital stay, but no reduction in the tachypnea itself or NICU stay, on low to very low certainty evidence — not grounds for routine use. A Toronto cohort of 5379 children linked longer breastfeeding to slightly lower BMI z-scores and less overweight, and longer formula feeding to the opposite, with 24 months of formula feeding associated with 72% higher odds of overweight versus breastfeeding — an association, not proof. A clinic pearl: rehydrate most children with gastroenteritis orally with low-osmolarity ORS and zinc, reserving IV fluids for shock or failed oral rehydration. Finally, a meta-analysis of post-implementation data (7 studies, 7112 infants) found the maternal RSV vaccine RSVpreF, given at least 14 days before delivery, was 82% effective against RSV lower-respiratory-tract hospitalisation in the first three months and 78% through six months — real-world support for antenatal RSV immunisation.