The edition · Paediatrics
Five days of antibiotics for non-severe childhood pneumonia: same failure rate, far better adherence
Short-course therapy for paediatric pneumonia, pathways that cut PICU transfers in general hospitals, what a human milk fortifier does and does not add, and breastfeeding and later BMI.
The edition in brief
A meta-analysis of 10 randomised trials (8,970 children) with non-severe community-acquired pneumonia found no difference in treatment failure (RR 1.07, 95% CI 0.93–1.24) or relapse between courses of five days or less and longer courses, while short courses cut non-adherence by about two thirds (RR 0.35). A cluster randomised trial in 43 US general hospitals found that implementing pathways for asthma, pneumonia and bronchiolitis together raised adherence to evidence-based practices by 9.9 points and lowered intensive care transfers (aOR 0.69). A meta-analysis of nine trials found no benefit of human milk-derived over bovine fortifiers when the base diet was the same; necrotising enterocolitis fell only in trials where donor milk also replaced preterm formula. In a Toronto cohort of 5,379 children, each extra month of exclusive breastfeeding was associated with slightly lower BMI z-score and lower odds of overweight, with 24 months of formula feeding linked to 72% higher odds compared with recommended breastfeeding.
Respiratory pathways in general hospitals cut PICU transfers for children
Bundled respiratory pathways with order sets improved evidence-based care and reduced ICU transfers in general hospitals.
Human milk fortifier showed no advantage over bovine fortifier on the same diet
Focus effort on mother's own and donor milk; a human milk-derived fortifier added no clear benefit on its own.
Each month of breastfeeding linked to slightly lower childhood BMI
Longer breastfeeding was associated with modestly lower childhood BMI; support it without stigmatising formula feeding.
In bronchiolitis, support breathing and feeding; the drugs do not help
Treat typical bronchiolitis with oxygen and feeding support only.
Short antibiotic courses matched longer ones in non-severe childhood pneumonia
Consider five days of antibiotics for non-severe childhood pneumonia; outcomes matched longer courses and adherence was better.
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