Pediatrics

Phoenix Sepsis Criteria and PELOD-2 refine early PICU sepsis risk stratification

In 687 PICU patients with suspected infection, Phoenix Sepsis Criteria (PSC) showed higher sensitivity and positive predictive value for mortality than IPSCC criteria on days 1 and 2. Day 1 PSC sensitivity for mortality was 96.4% versus 82.1% for IPSCC, with modestly higher positive predictive value. By day 2, PSC sensitivity reached 100.0%, compared with 75.0% for IPSCC, again with similar or better positive predictive value. For mortality prognostication, PELOD-2 had the highest precision–recall performance on both days and outperformed IPSCC Severe Sepsis and Phoenix-based scores. 1

Antiviral treatment for hospitalized pediatric influenza declined after the COVID-19 pandemic

Across seven US sites, 1560 children hospitalized with influenza had suboptimal antiviral use both before and after the COVID-19 pandemic. Prepandemic antiviral use ranged from 48.3% to 56.8%, falling to 38.1% in 2021–2022 and 46.1% in 2022–2023. Overall antiviral use was 23% lower in the late pandemic versus prepandemic period (incidence proportion ratio 0.77; 95% CI, 0.68–0.87). During the late pandemic, treatment was more likely with underlying conditions, current-season influenza vaccination, clinical influenza testing, ICU admission, and at certain sites. 2

Universal home TCB screening improves detection of treatable neonatal hyperbilirubinemia

In 2314 near-term and term neonates receiving home midwifery care, universal transcutaneous bilirubin (TCB) screening detected more treatment-threshold hyperbilirubinemia than visual inspection alone. Of 78 infants exceeding treatment thresholds, 28 were identified only through TCB, representing many cases missed by visual assessment. TCB screening increased heel pricks versus visual inspection (244 vs 142), with most missed cases attributable to user misinterpretation or laboratory bias. Selective TCB only in visibly jaundiced infants reduced extra heel pricks without losing diagnostic performance. 3

Parent-focused and multicomponent psychosocial programs reduce disruptive behavior in children

This meta-analysis included 64 randomized trials of psychosocial treatments for disruptive behavior in preschool and school-aged children, plus 20 additional adolescent trials. In preschoolers, parent-only and multicomponent interventions both produced moderate to large reductions in disruptive behavior immediately posttreatment. In school-aged children, both intervention types also reduced disruptive behavior, with somewhat smaller, but still meaningful, effect sizes. Longer-term follow-up effects were inconsistent, and adolescent studies were too heterogeneous for pooled estimates. 4