This Week in Pediatrics — Aug 10, 2026

Welcome to This Week in Pediatrics. This week we're covering 10 notable papers spanning antibiotic stewardship and diagnostics in the office and emergency department, technology at the bedside in the neonatal intensive care unit, and the systems that surround vulnerable children — schools, child protective services, telemedicine, and immunisation delivery. Let's dive in.

We'll start with two papers about how we make diagnostic decisions in acute care. In the Journal of Pediatrics, a randomized controlled trial enrolled 40 primary care pediatricians who all had above-average rates of treating acute otitis media with antibiotics, and randomised them to performance feedback with education, a digital otoscope, both, or neither [1]. Using a difference-in-differences approach, the feedback-plus-education arm cut the acute otitis media treatment rate by nearly 13 percentage points relative to control, and the combined arm by about 10 points. Digital otoscopy on its own did not produce a statistically significant change — the confidence interval crossed zero. That's an important negative signal, because the intuitive assumption is that if you can see the drum better you'll diagnose more accurately. Clinicians did report better visualisation and 70 percent preferred the digital device, so the technology may still have a role, but this trial says the active ingredient for stewardship is showing clinicians their own data alongside the diagnostic criteria. If your practice is trying to reduce antibiotic prescribing for ear infections, invest in audit and feedback first, not hardware.

Staying with diagnostics, the European Journal of Pediatrics published a prospective study of 197 children presenting to a tertiary pediatric emergency department with syncope, plus 50 healthy controls, asking whether NT-proBNP can help separate cardiac from non-cardiac causes [6]. Cardiac aetiology was found in under 9 percent of cases, with vasovagal and idiopathic syncope dominating. Median NT-proBNP was around 437 nanograms per litre in cardiac syncope versus roughly 45 in non-cardiac syncope and 37 in healthy children. A cut-off of 145 nanograms per litre gave an area under the curve of 0.76, with sensitivity of only about 64 percent but specificity of 98 percent and a negative predictive value of 97 percent. Read that carefully: the test misses about a third of cardiac cases, so a normal value cannot substitute for history, electrocardiogram, and examination. Its value is as a rule-in signal — an elevated NT-proBNP in a child with syncope should push you toward cardiology evaluation and echocardiography.

Two neonatal papers this week both ask whether we can make invasive bedside procedures safer and less radiation-dependent. Pediatric Research reports a multicentre real-world retrospective cohort from three tertiary neonatal units in China comparing point-of-care ultrasound-guided nasojejunal tube placement with conventional blind insertion confirmed by radiography, in 46 neonates [5]. First-pass success was 87.5 percent with ultrasound guidance versus 36 percent with the conventional pathway — more than a twelvefold difference in odds. Ultrasound guidance halved the median number of attempts, cut technical insertion time from 19 minutes to 7, reduced the median number of radiographs from two to zero, and got postpyloric feeding started within about an hour rather than five hours. There were no insertion-related cardiorespiratory events in either group. This is retrospective, small, and reflects pathways chosen in routine practice rather than randomisation, so confounding by operator skill is plausible, and the authors themselves call for prospective validation and standardised training requirements. Still, for units with ultrasound expertise, this is a credible radiation-sparing option.

Alongside that, the Journal of Pediatrics published a single-arm feasibility study from a level three unit in Hanoi using newly developed preterm-sized supraglottic airways to deliver surfactant to 45 infants with birth weights between 800 and 1500 grams [10]. Placement succeeded in 98 percent of infants, 82 percent on the first attempt, with a median time to airway placement of 21 seconds — and notably, for over a quarter of cases this was the provider's first ever use of the device. Surfactant was delivered by supraglottic airway in 93 percent, and median fraction of inspired oxygen fell from 0.40 to 0.25 an hour later. There were three desaturations below 60 percent and one bradycardia, with no other procedure-related serious adverse events, and no signal of worse performance in the smallest infants under 1000 grams. This is feasibility and safety data only, with no comparator, so it does not yet tell us whether supraglottic surfactant matches intubation or less-invasive catheter techniques on clinically important outcomes. But it suggests the technique is learnable quickly, which matters most in settings where skilled intubation is scarce.

The final group of papers is about the systems around the child rather than the child in front of you. Pediatrics published an analysis of school asthma readiness in a nested cohort of 202 children aged 5 to 13 enrolled in a larger randomized trial, an almost entirely Black cohort in which nearly three-quarters had visited an emergency department for asthma in the previous year [7]. While 79 percent of schools knew the child had asthma, only 31 percent had reliever medication and a valved holding chamber available, and just 7 percent had an asthma care plan on file. Counterintuitively, more exacerbations in the prior year were associated with higher school readiness — roughly a 30 percent increase in the odds per additional exacerbation in adjusted analysis. In other words, schools appear to get equipped after a child has already had a crisis. The practical implication is that school asthma paperwork and rescue medication should be part of every asthma visit, proactively, not a reaction to the last emergency department trip.

Also in Pediatrics, a retrospective cross-sectional study linked child protective services and Medicaid data for over 610,000 children reported to child protective services in Kentucky and Florida between 2017 and 2020, and found that 8.7 percent had a complex chronic condition — a proportion that rose from about 6 percent to nearly 11 percent over those four years [9]. Children in foster care were more than twice as likely to have a complex chronic condition as those who were not, and children reported for medical neglect had roughly four and a half times the odds compared with those reported for basic needs neglect. Substantiation and foster care placement were both independently associated with complex chronic conditions. For clinicians managing medically complex children, that reframes missed appointments and treatment non-adherence as a signal to intensify care coordination and family support before the situation escalates into a child protective services report.

The systems theme continues on the delivery side. Pediatrics also reports national electronic health record data from 1088 primary care practices covering nearly 20 million problem-based visits between 2019 and 2024, showing telemedicine rising from under 1 percent of visits to a peak of 55 percent in April 2020 and settling at 6 percent in 2024 [3]. Use is highly domain-specific: about 20 percent of endocrinology and obesity visits and 15 percent of behavioural health visits, versus only 3 percent of respiratory visits. Before mid-2023 telemedicine visits produced no significant net change in total visit volume; after May 2023 each additional telemedicine visit was associated with roughly two additional total visits, suggesting telemedicine is now adding access rather than merely substituting for in-person care. On immunisation delivery, the Journal of Pediatrics reports meningococcal B vaccination patterns across 10 Vaccine Safety Datalink health systems from 2015 to 2023 [4]. Coverage among 16 to 25 year olds ranged from 6 percent in the Western region to 17 percent in the Eastern region, most initiation happened at age 18 rather than 16, and series completion among those starting at 18 or older ranged from 39 to 68 percent. Most strikingly, among children with high-risk conditions only 39 percent had received even one dose — 48 percent with asplenia, 44 percent with sickle cell disease, and just 19 percent with complement component deficiency. Those are the children for whom this vaccine is a firm recommendation, not a shared decision. Complementing that, the Journal of Pediatric Gastroenterology and Nutrition published a European Reference Network TransplantChild position paper on vaccination in pediatric solid organ and haematopoietic stem cell transplant recipients, emphasising that incomplete pre-transplant immunisation and post-transplant immune impairment leave this group at high risk of vaccine-preventable infection, hospitalisation, and graft loss [2]. The message from both papers is the same: our highest-risk children are the least well vaccinated.

One more brief note: the European Journal of Pediatrics reports a cross-sectional study of 604 four and five year olds in which nearly 89 percent used screens to fall asleep and 17 percent had more than four hours of daily screen time [8]. Prolonged screen time was independently associated with higher overall sleep disturbance scores, daytime sleepiness, and sleep-wake transition disorders, while bedtime media use was linked to difficulty initiating and maintaining sleep. Associations were modest — on the order of a 12 to 17 percent higher prevalence — and cross-sectional, so direction of causality is unresolved, but it supports asking about bedtime screens at preschool visits.

If you only have time for one paper this week, make it the acute otitis media stewardship trial in the Journal of Pediatrics [1]. It is a randomized trial with a concrete, deployable intervention that changes prescribing behaviour, and it usefully deflates the assumption that better imaging technology alone will fix diagnostic overtreatment.

Here are the key takeaways from this week in Pediatrics. Performance feedback with education reduces antibiotic treatment for ear infections; digital otoscopy alone did not, despite clinicians preferring the device. An NT-proBNP above 145 nanograms per litre should raise your suspicion for cardiac syncope, but a normal value misses about a third of cases and does not rule it out. Point-of-care ultrasound guidance for neonatal nasojejunal tubes substantially improved first-pass success and nearly eliminated radiographs in a small retrospective multicentre cohort, and preterm-sized supraglottic airways were feasible and quickly learnable for surfactant delivery in infants down to 800 grams — both need prospective trials. Meningococcal B coverage is low overall and, more concerning, fewer than half of children with asplenia, sickle cell disease, or complement deficiency have received a single dose. And children with complex chronic conditions are over-represented in child protective services reports and foster care, especially for medical neglect, arguing for earlier and more intensive family support.

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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