The edition · Paediatrics
Oseltamivir in children admitted with influenza was linked to a lower rate of ICU admission
Nine seasons of US surveillance data back treating early, even as use declines. Also: erythropoietin added nothing to cooling in neonatal HIE, a commercial sepsis alert missed most septic children, and rotavirus persists after vaccination in lower-middle-income countries.
The edition in brief
Today's paediatrics edition closes on antiviral treatment for children admitted with influenza. In 6,044 children from nine US seasons, oseltamivir was associated with a lower hazard of ICU admission (adjusted HR 0.69, 0.60 to 0.80) and a shorter stay, supporting existing advice to treat as soon as possible. The PAEAN trial randomised 313 newborns with moderate or severe hypoxic-ischaemic encephalopathy already being cooled to erythropoietin or placebo; death or moderate-to-severe disability at two years did not differ (34.1% vs 28.7%, RR 1.19, 0.84 to 1.68). An independent evaluation of a widely used commercial paediatric sepsis alert across 166,943 emergency visits found sensitivity of 36% and positive predictive value of 3%, with lower sensitivity in children under five. A meta-analysis of 35,704 children under five with diarrhoea in lower-middle-income countries found rotavirus in 24% and norovirus in 13% after rotavirus vaccine introduction. The pearl revisits oral rehydration and zinc.
Erythropoietin added no benefit to cooling for neonatal HIE
Erythropoietin does not improve outcomes when added to cooling for neonatal HIE; focus on early, well-delivered hypothermia.
A commercial paediatric sepsis alert caught about a third of septic children
Do not rely on an automated sepsis alert to identify septic children; repeat clinical assessment remains the safeguard.
Rotavirus still caused about a quarter of childhood diarrhoea after vaccine introduction
Keep rotavirus vaccination coverage high and manage acute watery diarrhoea in under-fives as viral unless features suggest otherwise.
Low-osmolarity ORS and zinc: still the backbone of diarrhoea care
Treat acute diarrhoea in children with low-osmolarity ORS, continued feeding and 10–14 days of zinc.
Oseltamivir for children admitted with influenza: associated with fewer ICU transfers
Start oseltamivir as soon as possible in every child admitted with suspected or confirmed influenza, without waiting for the test result.
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