Childhood UTI: shorter, oral, and usually without prophylaxis, says the evidence behind the new AAP guideline

The edition in brief

The technical report behind the American Academy of Pediatrics' updated UTI guideline pooled 60 studies. At low to very low certainty, courses of seven days or fewer did not appear to raise recurrence and reduced adverse effects, oral treatment looked as effective as intravenous, continuous prophylaxis did not clearly reduce breakthrough infection or scarring in reflux or bladder-bowel dysfunction but may increase resistant infections, and evaluation within 72 hours of symptoms was associated with less scarring. A Canadian technical update suggests that intact umbilical cord milking may be considered for infants of 35 weeks or more who remain non-vigorous after 15 seconds of deferred clamping and stimulation, to reduce moderate-to-severe hypoxic-ischaemic encephalopathy, without a clear rise in jaundice needing phototherapy. A quality-improvement programme for transient tachypnoea of the newborn cut NICU stay from 90 to 51 hours with fewer drips, cannulas and blood tests and no rise in readmissions. An Australian and New Zealand cohort of 5,119 children with suspected sepsis found 9.6% received corticosteroids, mostly outside refractory shock, with wide variation between hospitals. The pearl: in a febrile infant, get a clean urine sample before the first antibiotic dose.