A procalcitonin-based rule cut antibiotic use in febrile infants by about a third; IV fluids in severe malnutrition remain unproven

The edition in brief

In an open cluster randomised trial in 25 European paediatric emergency departments, 4,882 children aged 6 days to 36 months with fever without source were managed with usual care or with a decision rule using age, symptoms, urine analysis and point-of-care procalcitonin. Antibiotic exposure within 15 days was 26.2% with the rule and 38.0% with usual care (OR 0.57, 95% CI 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) of intravenous versus oral rehydration in severe acute malnutrition with severe dehydration found in-hospital mortality RR 0.71 (95% CI 0.46 to 1.10), compatible with a large benefit or a modest harm. Pooled case-control data from 22 countries estimated rotavirus vaccine effectiveness of 75.8% (95% CI 28.4 to 91.8) against rotavirus-positive gastroenteritis deaths but no clear effect on all-cause gastroenteritis deaths. In South African children followed to age five, a single-dose-plus-booster PCV13 schedule stayed non-inferior to two doses plus booster, whereas PCV10 one-dose schedules did not by age four. A retrospective cohort of 220 UK children with type 1 diabetes and high HbA1c found mean HbA1c fell from 82.5 to 69.3 mmol/mol over 12 months after starting hybrid closed-loop pumps.