This Week in Pediatrics — Sep 21, 2026

Welcome to This Week in Pediatrics. This week we're covering 10 notable papers spanning congenital cytomegalovirus screening and its downstream evaluations, nutrition and gastrointestinal care from intestinal failure to scurvy, and risk recognition in acutely ill newborns and adolescents. Let's dive in.

We start with congenital cytomegalovirus, which dominates the week, with three papers in Pediatrics that together take us from guidance to implementation to what the evaluation should actually include. Tesini and colleagues provide a clinical report on care of the infant with congenital cytomegalovirus infection, expanding on the current Red Book and addressing the knowledge gaps clinicians keep running into: how to distinguish symptomatic disease from isolated sensorineural hearing loss, when to treat, and how to screen [1]. The key operational recommendation is hearing-targeted screening plus expanded testing, rather than pure targeted or pure universal approaches, with key action statements attached. Alongside that guidance, Tanzo and colleagues report what happened when a large health system actually did it [2]. Across more than fifty thousand live births in the Cleveland Clinic Ohio enterprise, they used a hybrid protocol, universal screening in the neonatal intensive care units and targeted screening in newborn nurseries. Annual testing rose from roughly one hundred and fifty infants to over two thousand, and case detection increased about two and a half fold, with thirty-four confirmed cases. Interestingly, the yield was higher in the targeted nursery group than in the universally screened intensive care group, about three quarters of a percent versus a third of a percent, a statistically significant difference. The most common findings in affected infants were abnormal neuroimaging and small size for gestational age. The sobering part is the back end: protocols slotted into workflows quickly, but audiology follow-up lagged because of logistical, socioeconomic and educational barriers for families. Screening without a follow-up pathway is a detection exercise, not a care program.

The third cytomegalovirus paper asks what we can safely stop doing. Consensus guidelines recommend an eye examination for every newborn with congenital cytomegalovirus, but Leahy and colleagues, also in Pediatrics, reviewed structured ophthalmic examinations in a population-based Ontario dried blood spot screening program [3]. Among three hundred and ninety-four screen-positive infants, nearly nine in ten had an eye examination. Only two infants had chorioretinal scars attributable to cytomegalovirus, about half a percent of all screen-positive infants, and both were symptomatic with significant systemic manifestations and had already been referred to ophthalmology before their screening result came back. No infant with asymptomatic infection had cytomegalovirus-related ocular findings. The authors argue that a universal eye examination after a positive screen is not routinely indicated, and that referral could reasonably be reserved for symptomatic infants and those with other concerning features. Read that against the clinical report, which recommends a defined initial evaluation, and you have a live tension worth watching as screening mandates spread across the United States: broader screening finds more asymptomatic infants, and the evaluation bundle we built for symptomatic disease may not transfer to them.

Moving to nutrition and gastroenterology, where three papers converge on the theme of watching what children actually eat and absorb. In Pediatric Research, Jimenez and colleagues report a multicenter post-marketing registry of one hundred and forty children with intestinal failure from short bowel syndrome treated with teduglutide across fourteen centers [4]. Effectiveness was measured in one hundred and twenty children, and the reduction in parenteral calories deepened steadily over time, averaging about a sixth by one year and close to half by three years. Cumulative enteral autonomy reached roughly a third of children by three years. Five patients developed inflammatory or foveolar polyps. The caution is nutritional: the modeled proportion of children with a low weight-for-age Z score rose from about two percent at baseline to roughly thirteen percent at three years, and mean body mass index Z scores declined, though height did not. So as you wean parenteral support, growth surveillance has to intensify, not relax. At the other end of the nutritional spectrum, the Journal of Pediatric Gastroenterology and Nutrition publishes a nationwide Japanese study of childhood scurvy by Masuda and colleagues, covering forty-seven children from thirty-five hospitals over a decade [5]. Nearly all had a selective diet, and about seven in ten had autism spectrum disorder. Median age was under four years. The presentation that should stick with you is gait disturbance, present in almost nine in ten, while weight loss occurred in only about a fifth and most children were not underweight by body mass index. Nearly a third were misdiagnosed and close to four in ten underwent potentially harmful investigations. A limping toddler with a restricted diet deserves a dietary history before a bone marrow aspirate.

Still in the same journal, Romanchuk and colleagues surveyed Italian pediatric inflammatory bowel disease centers on Clostridioides difficile management, with a ninety percent response rate across twenty-seven centers [6]. The variability is striking: testing strategies differ widely, only about four in ten centers test routinely at inflammatory bowel disease diagnosis while the large majority test during flares, and for a first non-severe episode vancomycin and metronidazole were chosen equally often. Oral vancomycin was near-universal for recurrence, and fidaxomicin was the leading option for third or subsequent recurrences, with fecal microbiota transplantation and bezlotoxumab used rarely. Two thirds of centers described a cautious approach to starting biologics in acute severe colitis with concurrent infection. This is a survey of opinion, not outcomes, but it documents a genuine evidence vacuum where pediatric-specific guidance is needed.

Two papers this week are about recognising risk in the sickest and smallest patients. In the European Journal of Pediatrics, Ravichandran and colleagues report the first national Irish study of paediatric sepsis admissions, using inpatient enquiry data covering more than four thousand four hundred episodes [7]. Roughly seven in ten were community-onset and three in ten hospital-onset, and hospital-onset sepsis was far more severe, with critical care admission in about eighty-four percent versus a third, and mortality of roughly eight percent versus under two percent. Among community-onset episodes, having one or more comorbidities raised the odds of critical care admission roughly threefold in neonates and around fivefold in older children, and was associated with about seven times the odds of death. The message the authors emphasise, though, is that a substantial share of critical care admissions and deaths occurred in children with no documented comorbidity at all, so comorbidity status cannot be used to downgrade concern in a previously well child. Complementing that, in Acta Paediatrica, Canova and colleagues studied late-onset hypoglycaemia in a single-centre cohort of two hundred and eleven infants born under twenty-eight weeks or under a thousand grams [8]. Nearly one in five had at least one glucose below two point six millimoles per litre after day seven while on full enteral feeds, and risk rose with lower gestational age, lower birth weight and lower birth weight Z score. The practical implication is that glucose monitoring in these infants should not automatically stop at the end of the first week.

Finally, two papers on everyday exposures we tend to reassure families about. In the European Journal of Pediatrics, Abd Rab El Rasool and colleagues followed forty children with newly diagnosed attention-deficit hyperactivity disorder and forty matched controls through six months of methylphenidate, using two-dimensional speckle tracking echocardiography [9]. Heart rate and both systolic and diastolic blood pressure rose significantly on treatment, and both left and right ventricular systolic strain and diastolic function declined, while conventional echocardiography detected nothing and no child had an arrhythmia. This is a small, single-centre study of subclinical imaging changes with unknown clinical meaning, so it is not a reason to withhold stimulants, but it supports baseline cardiovascular assessment and ongoing blood pressure and heart rate follow-up. And in JAMA Pediatrics, Lee and colleagues surveyed a nationally representative pilot sample of about four hundred and seventy United States adolescents aged thirteen to seventeen across twenty platforms [10]. Close to half of adolescents witnessed harassment in the past four weeks and roughly three in ten experienced it directly. Online exposure clearly exceeded offline exposure for violent imagery, unwanted sexual images and content encouraging self-harm, while direct harassment occurred at similar rates online and offline. More than half of adolescents reported technology-related sleep disruption, and prevalence varied considerably by platform, which suggests the screening question is not just how much screen time, but which platforms and what happened there.

If you only have time for one paper this week, make it the clinical report on care of the infant with congenital cytomegalovirus infection in Pediatrics [1]. With screening mandates expanding, this is the document that will define what you owe every screen-positive newborn in your practice, and the two accompanying papers show exactly where implementation succeeds and where it overreaches.

Here are the key takeaways from this week in Pediatrics. Hybrid congenital cytomegalovirus screening is feasible and roughly doubles detection, but the binding constraint is audiology follow-up, so build that pathway before you expand testing. Routine eye examination for every screen-detected infant looks low yield, with no ocular findings at all in asymptomatic infection. Teduglutide produces progressive weaning from parenteral support over three years, at the cost of drifting weight and body mass index Z scores that demand active nutritional monitoring. Think of scurvy in a limping child with a selective diet, especially with autism spectrum disorder, because most of these children are not underweight. Severe sepsis outcomes occur in previously healthy children as well as those with comorbidity, and extremely preterm infants remain at real risk of hypoglycaemia well past the first week of life. And when you ask adolescents about screens, ask which platforms, what they have seen, and how they are sleeping.

That's your roundup for This Week in Pediatrics. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.