Pediatrics

GFAP and NfL provide early warning of brain injury and outcome in children on ECMO

In this 11-center cohort of 219 children (224 ECMO courses), serial plasma GFAP and NfL rose before neuroimaging-confirmed acute brain injury (ABI). GFAP increased 6.4% and NfL 16.1% for each 24 hours before ABI diagnosis, suggesting biomarker lead-time over imaging. Higher initial and peak GFAP and NfL strongly associated with in-hospital death or new moderate-to-severe neurologic impairment at discharge. A twofold rise from the first ECMO sample independently predicted unfavorable outcome (GFAP adjusted HR 1.48; NfL 1.43), whereas tau was not prognostic. 1

Parent mindfulness plus nutrition blunts early obesity risk in preschoolers

This randomized trial assigned 114 overweight parents and their 2–5-year-old children to mindfulness-plus-nutrition (PMH+N) or control-plus-nutrition (CTL+N) for 12 weeks. Child BMI z-score increased significantly in CTL+N but remained unchanged with PMH+N over three months, indicating prevention of short-term BMI gain. Parent stress decreased only in the mindfulness arm, which also showed greater improvements in observed positive parenting. Reductions in unhealthy child food intake and improved Toy-Wait Task parenting were largely driven by PMH+N, implicating parent stress as a modifiable target. 2

Gestational diabetes control trajectories and offspring obesity through age 10

This Kaiser Permanente cohort followed 206,464 pregnancies, including 14,870 with gestational diabetes mellitus (GDM), and offspring BMI from ages 2–10. Four glycemic management trajectories were identified, from stably optimal to slowly improving suboptimal control after GDM diagnosis. Children of mothers with stably optimal control had BMI and obesity risk at age 10 similar to offspring unexposed to GDM. Offspring from less optimal trajectories had progressively higher BMI and obesity risk, persisting after adjustment for prepregnancy BMI. These data support early, sustained glycemic control as a key prenatal strategy to mitigate childhood obesity risk in GDM-exposed offspring. 3

RSV rapid testing in primary care reduces toddler antibiotic prescribing

In Italian primary care, 256 children aged 9–36 months with viral LRTI symptoms received RSV antigen rapid diagnostic testing. RSV-positive children had fewer antibiotic prescriptions than RSV-negative peers, with a relative risk of 0.52. Compared with matched untested VLRTI cohorts, RSV testing lowered antibiotic use (relative risks about 0.54–0.61 across seasons and diagnoses). Findings support integrating RSV point-of-care testing into outpatient LRTI and bronchiolitis pathways to strengthen antibiotic stewardship. 4