The edition · Paediatrics
A GP visit within a week of PICU discharge was linked to fewer returns, and which macrolide for infant pertussis
Across 180,000 PICU stays, early primary care follow-up went with less emergency and hospital use; in hospitalised infants, azithromycin was associated with more severe pertussis than clarithromycin.
The edition in brief
Today's paediatrics edition opens with an Italian target trial emulation of 196 infants hospitalised with pertussis (Lancet Child & Adolescent Health, 3 September). After propensity weighting, azithromycin was associated with higher odds of a severe course than clarithromycin (60% vs 33%; OR 1.80), with more oxygen use, complications and intensive care; both deaths were in the azithromycin group. The design is observational and the study small. A meta-analysis of 12 observational studies from low-resource settings (6,411 children) found household second-hand smoke linked to about 2.7 times the odds of TB infection or disease, with consistent results across studies. A randomised trial in braced adolescents with idiopathic scoliosis found supervised Schroth-based exercises reduced the Cobb angle by about 3 degrees more than self-directed exercise at 24 months — below the 5-degree threshold that matters clinically — with no quality-of-life gain. The pearl is screening child contacts of every adult with pulmonary TB. The practice changer is a US claims study in Pediatrics of 180,516 paediatric intensive care stays: children seen in primary care within seven days of discharge had fewer emergency visits and readmissions over the next three months (IRR 0.93 public insurance, 0.70 private), with larger associations in older children and after sepsis. It is observational, but a booked early review is cheap and low-risk, and many PICU survivors leave without one.
Azithromycin linked to more severe pertussis than clarithromycin in infants
Azithromycin was associated with more severe infant pertussis than clarithromycin in one observational study; keep to guidance and monitor closely.
Second-hand smoke at home linked to nearly three times the odds of childhood TB
Household second-hand smoke was linked to about 2.7-fold odds of childhood TB; ask about smokers at home in every childhood TB assessment.
Supervised scoliosis exercises added little to bracing at two years
In braced adolescents with idiopathic scoliosis, supervised exercises gave a small, clinically unimportant extra curve reduction; focus on brace wear.
Every adult with pulmonary TB has child contacts to screen
Ask every adult with pulmonary TB about children at home, and screen them.
Seeing a GP within a week of PICU discharge linked to fewer returns
Consider booking a review within a week of PICU discharge for every child; it was linked to fewer emergency visits and readmissions.
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