The edition · Paediatrics
Oseltamivir was linked to 31% fewer ICU admissions in children hospitalised with influenza
Nine US seasons of surveillance data support treating every hospitalised child with flu. Also: erythropoietin adds nothing to cooling for HIE, a sepsis alert that missed most cases, and budesonide with surfactant.
The edition in brief
A US surveillance cohort of about 6,000 children hospitalised with laboratory-confirmed influenza over nine seasons found oseltamivir treatment, modelled as a time-dependent exposure, was associated with a 31% lower hazard of ICU admission (aHR 0.69) and shorter stays. The PAEAN trial randomised 313 newborns with moderate or severe hypoxic-ischaemic encephalopathy already being cooled to erythropoietin or placebo; death or disability at two years did not differ (34.1% vs 28.7%, RR 1.19). A multicentre evaluation of a commercial paediatric sepsis alert across 167,000 emergency visits found it detected only 36% of sepsis cases, with a positive predictive value of 3% and lower sensitivity in under-fives. A meta-analysis of 15 trials found budesonide mixed with surfactant reduced BPD only in trials giving it within four hours of birth, a post hoc finding that does not yet support routine use. The pearl covers fever in young infants.
Erythropoietin did not improve outcomes after neonatal HIE
Do not use erythropoietin as an add-on to cooling for neonatal HIE; it did not improve two-year outcomes.
A commercial sepsis alert missed most children with sepsis
Treat electronic sepsis alerts as a supplement, never a substitute, for bedside assessment of an unwell child.
Budesonide with surfactant: benefit only when given early, and not yet proven
Budesonide with surfactant is not yet a routine BPD prevention; the early-timing benefit needs confirmation in a large trial.
Fever in infants under three months
Assess every febrile infant under three months the same day, with urine testing as a minimum, and a low threshold for full workup.
Give oseltamivir to children admitted with influenza
Start oseltamivir as soon as possible in every child hospitalised with suspected or confirmed influenza.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for paediatrics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free