This week in Pediatrics

This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.

Welcome to This Week in Pediatrics. This week we're covering 10 notable papers spanning newborn and perinatal prevention, infection and antimicrobial stewardship, and acute and specialty therapeutics. Let's dive in.

We begin with prevention in the earliest weeks of life, where several papers test decisions that families and clinicians make before and just after birth. The largest is a retrospective cohort in JAMA from Scott and colleagues, drawing on more than five million infants born at 35 weeks or later across all 50 states in the Epic Cosmos dataset [1]. The share of newborns not receiving intramuscular vitamin K more than doubled over the study period, from about 3 percent in 2017 to nearly 7 percent in 2025. Over the same years, bleeding by six months rose in both groups, but infants who missed vitamin K carried roughly a 50 percent higher adjusted risk of any bleeding, about two and a half times the risk of intracranial bleeding, and nearly triple the risk of death with concurrent bleeding during the birth hospitalization. These are coded diagnoses rather than confirmed vitamin K deficiency bleeding, and families who decline prophylaxis may differ in other ways, but the scale and consistency of the signal give clinicians concrete figures for counselling conversations. A related question about prenatal exposure comes from Hughes and colleagues in JAMA Pediatrics, a prospective matched cohort from the Maternal-Fetal Medicine Units Network [2]. Among 217 matched pairs of toddlers aged 18 to 30 months, overall developmental questionnaire scores were statistically equivalent whether or not mothers received an mRNA SARS-CoV-2 vaccine during or just before pregnancy, and there were no differences in behaviour, autism screening, or temperament measures. The cohort is modest and relies on parent-reported screening tools, but the authors conclude the findings support continued recommendations for vaccination in pregnancy. Rounding out this theme, Whooten and colleagues report in Pediatrics on First Heroes, a randomized trial of 227 mother-father pairs testing a father-inclusive program of virtual coaching and multimedia content from pregnancy through the first year [3]. The intervention roughly halved the odds of rapid infant weight gain at six and at twelve months, and fathers lost a modest amount of body mass index, but infant overweight at twelve months and maternal weight outcomes did not differ. The result is mixed on its primary outcomes and comes from a single health system, so it is better read as proof that fathers can be engaged than as an established prevention strategy.

Our second theme is infection, and specifically how often diagnostic labels and reflexes drive treatment. Wattier and colleagues, in Pediatrics, studied 1150 emergency and urgent care visits in Northern California where children had a urinalysis [4]. Low-level pyuria, meaning trace leukocyte esterase or only a handful of white cells, was associated with more than six-fold higher odds of starting antibiotics compared with no pyuria. The key insight is asymmetry: this low-pyuria response accounted for about 17 percent of overtreatment in children whose cultures ruled out infection, but under 2 percent of appropriate treatment for confirmed infection. It is cross-sectional work from one region, yet it points stewardship efforts toward a specific, measurable trigger. A companion piece in Pediatrics, a review led by Larson, addresses another label that drives antibiotic choices [5]. Nearly one in ten people carries a penicillin allergy label, about 95 percent of those labelled are not truly allergic, and most labels are placed in childhood. The authors summarise guidance that now strongly supports proactive delabeling, with direct oral amoxicillin challenge recommended for children judged low risk on history, and they frame this as work for generalists rather than only allergists. Turning to children with cancer, Slatnick and colleagues, also in Pediatrics, reviewed 322 episodes of Staphylococcus aureus bloodstream infection across several centres [6]. Catheter salvage was attempted in just over half of the children with a central line, and after propensity weighting, salvage was associated with more than three times the odds of major complications such as recurrent bacteremia, deep abscess, endocarditis, or death, with the excess concentrated early. Methicillin resistance, implanted ports, sepsis, and persistent bacteremia also predicted complications. Retrospective data cannot fully exclude confounding by which catheters clinicians chose to keep, but the findings reinforce existing guidance favouring removal. Finally, a brief commentary in Acta Paediatrica by Benoune revisits the BALTIC trial in neonatal intensive care [7]. That trial found hand hygiene alone was noninferior to routine gowns and gloves plus hand hygiene for preventing Gram-negative bloodstream infections, and the commentary argues this supports reconsidering extended barrier precautions outside outbreak settings, a question many units have debated for years.

Our third theme covers acute and specialty therapeutics, where the week brought one clear trial result, one null synthesis, and one encouraging registry. In the BMJ, Han and colleagues randomized 400 children aged two to six years undergoing adenotonsillectomy at four Chinese tertiary hospitals to a laryngeal mask airway or an endotracheal tube [8]. Perioperative respiratory adverse events fell from just over half of children with a tube to under a quarter of children with a laryngeal mask, an absolute reduction of 35 percentage points, driven largely by less severe cough, desaturation, and airway obstruction after surgery. Only three laryngeal masks needed conversion, and neither group had serious adverse events. The authors stress that experienced anaesthesiologists delivered the airways, so generalising to less experienced teams or different surgical techniques remains an open question. In contrast, a systematic review and meta-analysis in the European Journal of Pediatrics by Rabelo and colleagues found no meaningful difference between balanced electrolyte solutions and normal saline in pediatric diabetic ketoacidosis [9]. Across the randomized trials, time to resolution, hospital and intensive care length of stay, cerebral edema, and acute kidney injury were all similar. The randomized evidence involves fewer than 300 children and very imprecise estimates for rare complications, so the authors conclude the data cannot show superiority, inferiority, or comparative safety for either fluid. That is a genuine evidence gap rather than proof of equivalence. Last, Russo and colleagues, in Pediatrics, report on 109 children with eosinophilic esophagitis treated with dupilumab across 22 centres in the European pEEr registry [10]. Combined clinical, endoscopic, and histologic remission was reached in about half of patients at six months and in 86 percent at twelve months, and by one year most patients were on dupilumab alone, with nearly all reducing other esophagitis therapies. There were no discontinuations for tolerability. The cohort was mostly adolescent and retrospective, without a comparison group, but it adds real-world pediatric support for long-term use.

If you only have time for one paper this week, make it the JAMA vitamin K study from Scott and colleagues [1]. It puts national, contemporary numbers on a preventable harm that is quietly growing, and it gives every clinician who counsels new families concrete evidence of what declining prophylaxis costs.

That's your roundup for This Week in Pediatrics. The full transcript and references are available on the episode page. See you next week.

If this weekly briefing is useful, follow the show in your podcast app so new episodes arrive automatically. And a quick rating on Apple Podcasts or Spotify helps other physicians discover the show.

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