The edition · Paediatrics
Paediatric sepsis is often decided before the ICU, and the inequities behind cerebral palsy
Sharper sepsis definitions and the reality that many deaths are set before intensive care, regional variation in who survives, a negative trial in ataxia telangiectasia, and the modifiable, unequal causes of cerebral palsy after the newborn period.
The edition in brief
Today's paediatrics edition leads with a review of paediatric sepsis, where the Phoenix criteria have reframed sepsis around organ dysfunction rather than inflammation and conjugate vaccines have reshaped invasive infection, but early recognition remains hard and many deaths occur within 24 hours of intensive-care referral, so outcomes are often determined before admission. A US cohort of 36,552 sepsis episodes found 3.9% community-acquired 30-day mortality with wide regional variation, lower where a children's hospital served the region. The NEAT phase 3 trial of encapsulated dexamethasone in ataxia telangiectasia was negative, with no significant change in ataxia score at six months, though the drug was safe. A clinic pearl reinforces weight-based dosing and fluids in children. The edition closes on a 35-year population study showing cerebral palsy acquired after the newborn period has fallen overall, but infection- and head-injury-related cases persist in the most deprived children, a prompt for targeted prevention.
Paediatric sepsis: the outcome is often set before the ICU
Prioritise early recognition and timely escalation of the unwell child, since paediatric sepsis outcomes are often determined before intensive care.
Where a child is treated for sepsis is linked to survival
Recognise that paediatric sepsis survival varies by region and is better where specialist children's services are available; strengthen referral pathways.
A long-studied steroid fails its first proper trial in ataxia telangiectasia
Do not rely on encapsulated dexamethasone for ataxia telangiectasia outside a trial; a phase 3 study found no significant neurological benefit at six months.
Dose and fluid-prescribe children by weight, and record the weight
Base every paediatric dose and fluid calculation on a current measured weight, and record it for the next clinician.
Cerebral palsy after the newborn period is falling, but not equally
Focus modifiable-cause prevention, infection care and injury prevention, on the most deprived infants, where postneonatal cerebral palsy risk persists.
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