This Week in Pediatrics — Sep 7, 2026

Welcome to This Week in Pediatrics. This week we're covering 10 notable papers spanning infectious disease prevention and treatment, chronic disease management from obesity to Crohn's disease, and neonatal and child protection practice. Let's dive in.

We'll start with infection, where one paper changes what you might reach for at the bedside and another closes the door on a popular preventive idea. In The Lancet Child and Adolescent Health, Lo Vecchio and colleagues tackled a question that has become urgent as pertussis re-emerges across Europe: among hospitalised infants, does it matter which macrolide you choose? Using a target trial emulation across eleven Italian centres, they studied 196 infants aged twelve months or younger admitted with pertussis between late 2023 and the end of 2024, with a median age of about 86 days. Roughly three quarters of the infants received clarithromycin and the remainder azithromycin, with the choice made on clinical judgement and confounding handled by propensity score weighting. Severe disease, defined by a pertussis severity score above five, occurred in about 60 percent of azithromycin-treated infants compared with about a third of those given clarithromycin — meaning azithromycin was associated with close to a doubling of the odds of a severe course. Infants on azithromycin also more often needed oxygen, more often went to intensive care, and had more complications; both deaths in the cohort occurred in that group. This is observational data with a modest azithromycin group and treatment was not randomised, so residual confounding by indication is a real concern. Still, given that both drugs sit as first-line options in current guidance, the signal favours clarithromycin in the hospitalised young infant, and it deserves a look at your local protocol. [1] On the prevention side, the European Journal of Pediatrics reports a well-conducted negative trial. Halley and colleagues randomised 428 New Zealand children by household to daily oral Streptococcus salivarius K12 or placebo from six to twenty-four months of age, aiming to prevent acute otitis media in the general infant population. Doctor-recorded otitis media occurred in about 39 percent of placebo recipients and about 37 percent of probiotic recipients — no meaningful difference. Time to first episode, severity, respiratory infections, antibiotic prescribing and healthcare use were all unchanged, and restricting to the most adherent families did not rescue the result. Whatever this probiotic does in children with recurrent otitis media, routine use for prevention in ordinary infants is not supported. [2] Staying with prevention, Acta Paediatrica carries a review by Dillner on accelerating cervical cancer elimination through human papillomavirus vaccination. The core argument is one for the paediatric clinic: because these vaccines prevent infection and not just precancer, herd effects mean the population coverage needed to drive the virus below its extinction threshold is moderate, especially with gender-neutral programmes. Catch-up vaccination of adolescents, single-dose schedules, and using population human papillomavirus prevalence to monitor programmes are the levers proposed. [3]

Turning to chronic disease management, two papers ask how aggressively and how equitably we are treating children. In Pediatrics, Orandi and colleagues used the Epic Cosmos database to track glucagon-like peptide-1 receptor agonist prescribing in children aged eight to eleven with obesity and without diabetes — more than three and a half million children. Overall, only about 0.6 percent ever received one of these drugs, so this remains uncommon. But the trajectory is steep: prevalent prescribing rose from a fraction of a percent in 2019 to just over nine percent in 2026. Prescriptions concentrated in older children, in girls, and above all in children with obesity-related comorbidity, where the rate was roughly four times the overall average — evidence that clinicians are reserving these agents for the highest cardiometabolic risk. The equity finding is the one to sit with: children from the least socially vulnerable areas were markedly more likely to be prescribed than those from the most vulnerable, despite obesity burden running the other way. [4] From the Journal of Pediatric Gastroenterology and Nutrition, Pevzner and colleagues compared two nutritional strategies for inducing remission in paediatric Crohn's disease across 52 weeks. In a historical cohort of 159 children, 75 received exclusive enteral nutrition and 84 the Crohn's disease exclusion diet. At six weeks, clinical remission rates were essentially identical at about three quarters in each group, adherence was high and similar in both, and C-reactive protein normalisation, faecal calprotectin below 150, and non-invasive mucosal inflammation scores showed no significant differences. Out to a year, there was no separation in flares, steroid or biologic use, hospitalisation, or surgery. This is retrospective and not randomised, but for the family who cannot face eight weeks of formula only, the exclusion diet appears to be a defensible equivalent rather than a compromise. [5]

Three papers this week refine how we assess and support vulnerable children. In the Journal of Pediatrics, Dolan and colleagues retrospectively analysed prospectively collected data on 114 neonates with hypoxic-ischaemic encephalopathy and found that magnetic resonance imaging performed during therapeutic hypothermia agreed with imaging done at a median of eleven days of age in 95 percent of cases, for both pattern and severity of injury. That means the earlier scan is a reliable read on the degree of brain injury, which brings forward parental counselling, clinical decisions and trial enrolment rather than waiting out the rewarming period. [6] Also in the Journal of Pediatrics, Fierro and colleagues examined outpatient respiratory outcomes in infants who survived extremely preterm birth and attended a bronchopulmonary dysplasia clinic. Among those born at 22 to 23 and six-sevenths weeks, respiratory outcomes over the first three years did not appear worse than in infants born at 24 to 25 and six-sevenths weeks. That is a survivor cohort attending a specialty clinic, so it says nothing about survival itself, but it is useful counselling material for families at the limits of viability. [7] And in Archives of Disease in Childhood, MacDonald and colleagues revisited whether the second skeletal survey earns its radiation. Auditing 168 children under two who had safeguarding imaging in Wales over seven years, they found additional fractures beyond the presenting injury in about six percent of children on the first survey and just over seven percent on the second, with one child in whom a normal first survey was followed by a fracture found only on the second. This contradicts recent suggestions that the repeat survey yields too little to justify itself, and the authors argue for keeping the two-survey protocol. [8]

Two remaining papers deal with symptom burden and disease definition. In Pediatrics, Wong and colleagues randomised 128 children aged six to twelve starting their first chemotherapy to immersive virtual reality or usual care in an assessor-blinded trial. Anxiety fell significantly more in the virtual reality group at every time point across the first two chemotherapy cycles, with the effect growing from medium to large by the second cycle, and the intervention group reported fewer episodes of anticipatory nausea and of chemotherapy-induced nausea and vomiting. It is a single-centre trial with subjective primary outcomes and no sham, but this is a low-cost, easily deployed adjunct. [9] Finally, Developmental Medicine and Child Neurology publishes a review by Kaufmann on Rett syndrome in the therapeutic era. With trofinetide approved and gene replacement programmes advancing, the field now faces questions it could previously defer: how to diagnose before developmental regression, how to handle atypical presentations including affected males, the role of MECP2 testing in the diagnosis itself, what instruments capture clinical change, what counts as meaningful improvement, and how these therapies will be paid for. [10]

If you only have time for one paper this week, make it the Italian pertussis comparison in The Lancet Child and Adolescent Health [1]. With pertussis resurgent and both macrolides sitting side by side in guidelines, this is the rare comparative effectiveness study that could change your next prescription for a sick infant.

Here are the key takeaways from this week in Pediatrics. In hospitalised infants with pertussis, clarithromycin was associated with less severe disease than azithromycin, and both deaths occurred in the azithromycin group. Daily Streptococcus salivarius K12 does not prevent otitis media or respiratory infection in ordinary infants — do not recommend it routinely. Glucagon-like peptide-1 receptor agonist prescribing in eight to eleven year olds is rising sharply but remains uncommon, is targeted to those with comorbidity, and is skewed away from the most socially vulnerable children. For inducing remission in paediatric Crohn's disease, the Crohn's disease exclusion diet matched exclusive enteral nutrition on every outcome through a year. Magnetic resonance imaging during therapeutic hypothermia reliably reflects the eventual injury pattern, so counselling need not wait. And the second skeletal survey in safeguarding evaluations continues to find injuries the first one missed.

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.