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To evaluate changes in glycated haemoglobin (HbA1c) following initiation of hybrid closed-loop (HCL) insulin pump therapy in children and young people (CYP) with previously elevated HbA1c in a real-world multicentre setting. Retrospective multicentre observational cohort study. 13 National Health Service paediatric diabetes units within a regional diabetes network in England, UK. CYP aged ≤19 years with type 1 diabetes of more than 1 year's duration and HbA1c ≥69 mmol/mol at the time of HCL initiation and at least 3 months prior. Initiation of HCL insulin pump therapy. Primary outcome was change in HbA1c following HCL initiation. Secondary outcomes included subgroup and pump system comparisons and changes in diabetes-related hospital admissions. A total of 220 participants were included. HbA1c decreased significantly following HCL initiation (p<0.001), falling from a mean of 82.5 mmol/mol at baseline to 72.8 mmol/mol within the first 3 months and remaining stable thereafter with a mean value of 69.3 mmol/mol at 12 months. Improvements were observed across all subgroups, with the greatest reductions in those with very high baseline HbA1c (>100 mmol/mol) and in participants transitioning from multiple daily injections. Outcomes were similar across HCL pump systems, and diabetes-related hospital admissions decreased overall following HCL initiation. In this large, real-world cohort of CYP with high HbA1c, initiation of HCL therapy was associated with sustained improvements in glycaemic control and fewer diabetes-related hospital admissions, supporting its use in this high-risk population.
Host inflammatory responses contribute substantially to infection-related morbidity, and in severe cases such as sepsis, acute respiratory distress syndrome (ARDS) and haemophagocytic lymphohistiocytosis, immune-mediated tissue injury may exceed the direct effects of pathogens themselves. Although traditional wisdom has considered immunosuppression risky when antimicrobial therapy is required, modern insights into immune biology reveal a more nuanced landscape in which targeted immunomodulators can attenuate harmful inflammation without broadly compromising host defence. This evolution is particularly relevant in paediatrics, influenced by developmental stage, distinct exposure history and patterns of host response. The COVID-19 pandemic catalysed wider acceptance of immunomodulation in infection management, including corticosteroids in children and highlighted safe use of agents such as baricitinib. Platform trials of the hyperinflammatory syndrome (paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2) also identified benefits of methylprednisolone and tocilizumab in select groups. For other paediatric infections, including dengue, influenza and Epstein-Barr virus, the evidence remains sparse, with emerging mechanistic and early-phase clinical studies exploring interleukin (IL)-1 blockade, corticosteroids, immunoglobulin and anticytokine biologics. In paediatric sepsis, immunophenotype-guided trials represent a major conceptual advance. Adaptive studies, such as TRIPS and GRACE-2, aim to tailor immunomodulation to hyperinflammation or immunoparalysis, though definitive efficacy data are awaited. Parallel efforts in ARDS explore statins, IL-6 blockade and cell-based therapies, but robust paediatric evidence is still lacking. Collectively, evolving insights and trial designs offer renewed opportunities to use targeted immunomodulation in the management of paediatric infection. Large-scale, collaborative paediatric research networks will be essential to translate these advances and better integrate infection research into everyday paediatric practice.
As an emergent secondary analysis of a wider qualitative study, we aimed to understand how paediatricians apply the Medical Emergencies in Eating Disorders (MEED) guidelines in relation to recommending nasogastric tube feeding under physical restraint. Paediatric wards in England. We recruited clinicians working in acute paediatric settings in England via adverts using three professional networks. Participants were from a variety of professions within the multidisciplinary team involved with caring for those with an eating disorder. Individual interviews using semistructured interviews were conducted. The interviews were recorded and transcribed by Microsoft Teams and checked for accuracy. This secondary analysis applied Braun and Clarke's approach to thematic analysis. 20 participants (five males and 15 females) were recruited across 15 National Health Service Trusts. Overlapping themes between participants identified three main themes of 'positives of MEED', 'negatives of MEED' and 'learning how to use MEED well'. Subthemes of 'tolerating risk', 'individualised meal plans', 'second opinion', 'more time' and 'teamworking' were identified. This research identifies that paediatric clinicians find the MEED guidelines helpful in understanding who needs to be admitted. Additionally, participants reported their learning on how to make these admissions more successful through personalisation of treatment planning.
The clinical presentation of childhood soft tissue sarcoma (STS) creates a diagnostic challenge; however, time to diagnosis is significantly associated with survival. This Delphi consensus process aims to contribute to the development of clinical guidelines for healthcare professionals (HCPs) assessing children and young people presenting with signs/symptoms suggestive of STS. Invitation emails were sent to HCPs to join the Delphi panel. 48 statements were derived from an evidence review by a multidisciplinary team. Participants ranked their level of agreement with each statement on a 9-point Likert scale (1=strongly agree, 9=strongly disagree), with responses ≥7 indicating agreement. Statements not reaching consensus were rewritten and reissued in a subsequent round. In round 1 (R1), 87/117 (74%) participants responded and 68/87 (78%) completed round 2 (R2).In R1, 47/48 (98%) statements achieved consensus, with 16/48 (33%) gaining more than 90% consensus. One statement did not reach consensus, with 26/87 (29%) scoring <7. All statements reached numerical consensus at the end of R2.There was strong consensus for urgent referral and investigations in cases with strong clinical suspicion, urgent discussion with secondary care if clinical uncertainty exists, increasing HCP education and institutional support to overcome potential barriers to timely diagnosis. Dissent was due to logistical and systematic barriers and a concern for misinterpretation if intended setting is not clearly specified. These statements will be included in a clinical guideline for suspected STS for use in both primary and secondary care and translated into public awareness tools as part of the Child Cancer Smart national awareness campaign.
To assess feasibility of recruitment and compare clinical outcomes in a trial of early selective treatment of a moderate-severe patent ductus arteriosus (PDA) or no intervention in the first 7 postnatal days in extremely preterm infants. Multicentre, open-label, parallel-design pilot randomised controlled trial SETTING: Seven tertiary/quaternary neonatal intensive care units. Infants <26 weeks gestational age (GA) with a PDA diagnosed within 72 hours after birth. Participants were randomised to an early echocardiographic screening within the first 72 hours followed by selective medical treatment (SMART) strategy of a moderate-severe PDA shunt or no intervention in the first 7 days. The primary feasibility outcome was the proportion of eligible infants enrolled. Important secondary outcomes included a composite clinical endpoint of survival without major morbidity. 116 of 185 eligible infants were enrolled (63%, 95% CI 56% to 70%; SMART, n=51, Control, n=53). Of them, 104/116 (90%) (mean GA 24.3 weeks, birth weight 714 g) were randomised. Protocol deviation was 1.9%. Based on the treatment algorithm, 24% infants randomised to SMART never required treatment. Median treatment initiation age in the SMART arm was 2 days (IQR 1-2.5 days). The SMART strategy demonstrated an 85% probability of a better Win ratio (1.34, 95% CrIs 0.73 to 2.5) compared with control. A trial of selective early PDA pharmacotherapy based on clinical and echocardiography grading of PDA shunt volume in the smallest infants is feasible with minimal protocol deviation. Early echocardiography screening and selective pharmacotherapy using the SMART-PDA algorithm may enhance the probability of survival with less morbidities in infants born <26 weeks GA. NCT05011149.
To determine the diagnostic accuracy and inter-rater reliability of the traditional index finger vein inspection ('Zhiwen') for assessing pneumonia severity in children. Cross-sectional diagnostic accuracy study adhering to Standards for Reporting of Diagnostic Accuracy Studies 2015 guidelines. A tertiary paediatric referral hospital in Ho Chi Minh City, Vietnam. 406 children aged ≤3 years with clinically diagnosed pneumonia were enrolled between March and May 2024. Participants underwent independent, blinded assessment by a paediatrician (reference standard: WHO pneumonia classification) and traditional medicine practitioners (index test: 'Zhiwen' inspection). Veins were classified into 'Wind', 'Qi' or 'Life' bars based on distal extension. Diagnostic accuracy metrics (sensitivity, specificity, predictive values, likelihood ratios) and inter-rater reliability (Cohen's kappa (κ)). Inter-rater reliability was excellent (κ=0.91; 95% CI 0.88 to 0.94). A significant graded association was observed between vein extension and pneumonia severity (p<0.001). The 'Life bar' extension was strongly associated with very severe pneumonia, demonstrating a sensitivity of 95.2% (95% CI 76.2% to 99.9%) and specificity of 96.4% (95% CI 94.0% to 98.0%). Crucially, the absence of the 'Life bar' yielded a negative predictive value (NPV) of 99.7%, effectively ruling out critical illness. The traditional 'Zhiwen' inspection is a reproducible and valid physical biomarker for pneumonia severity. Its high NPV suggests its potential as a rapid, no-cost adjunctive tool for risk stratification in children with established pneumonia in resource-constrained settings.
Assess the incidence, presentation, management and short-term outcomes of neonatal stroke in the UK and Ireland (ROI). Active surveillance (British Paediatric Surveillance Unit) study and meta-analysis of national surveillance studies. UK and ROI. Neonatal stroke presenting <90 days old in term and preterm infants between March 2022 and April 2023. Reporting clinicians completed questionnaires and uploaded de-identified neuroimages via a purpose-built data platform. 68 neonatal stroke cases were reported in the UK and ROI. UK incidence was 9.0 per 100 000 live births (95% CI 6.9 to 11.6). Three-quarters were arterial ischaemic and unilateral. Arterial ischaemic and cerebral venous sinus thrombosis (CVST) strokes commonly presented with seizures at 2-3 days of age, while haemorrhagic stroke commonly presented with encephalopathy in the first ten days of age. Neonatal stroke was associated with fetal distress in utero. 61% of infants had an umbilical pH <7.25 and 28% required significant resuscitation at birth, respectively. A meta-analysis of 3 607 864 infants found our reported incidence and associated conditions were similar to surveillance studies in Germany and Australia.Guidelines were available in a quarter of reporting hospitals. 87% of infants with arterial ischaemic and CVST stroke received antiseizure medications. 82% of infants were discharged home at 12 days old (median) with antiseizure medications (42%) alongside paediatric/neonatal (91%), physiotherapy (77%) and paediatric neurology (63%) follow-up. Neonatal stroke is rare, with distinct subtypes associated with different presentations, timings and management strategies, highlighting the need to better understand this condition.
To compare automated closed-loop oxygen therapy using the FreeO2 device versus conventional manual oxygen therapy with regard to length of hospital stay among spontaneously breathing infants with bronchiolitis. Multicentre randomised controlled trial conducted from 2018 to 2023. Ten paediatric departments across France. 103 infants, 1-12 months of age, hospitalised for acute bronchiolitis requiring oxygen therapy with SpO2 <92%, excluding severe bronchiolitis. Patients were randomised to receive either automated oxygen administration via the FreeO2 device or conventional manual administration. The primary endpoint was length of hospital stay in hours from emergency admission to discharge. Secondary endpoints included re-hospitalisation at 7 and 30 days, use of non-invasive ventilation (NIV), transfer to intensive care within 3 days and time spent in hypoxia (SpO2<92%) or hyperoxia (SpO2>98%). The median hospital stay was 71.00 hours (IQR 45.8-97.6) in the FreeO2 group and 69.6 hours (IQR 47.5-116.7) in the manual group (p=0.39). The percentage of time within the oxygen target zone was 89.4% in the FreeO2 group vs 74.9% in the manual group (p<0.05). Median oxygen flow was 0.1 L/min (IQR 0.1-0.2) in the FreeO2 group vs 0.3 L/min (IQR 0.2-0.5) in the manual group (p<0.05). The groups did not significantly differ in re-hospitalisation at D7 (p=1.00) or D30 (p=1.00) or NIV use (p=0.47). While we did not find evidence of a reduced length of stay, which may be due to low study recruitment, we did find the FreeO2 device yielded a positive reduction in flow rates of oxygen.
Hypoglycaemia is common in neonates. Repeated hypoglycaemic episodes impose a risk of subsequent neurodevelopmental impairment. We aimed to assess the feasibility of using continuous glucose monitoring (CGM) in a group of infants at risk of hypoglycaemia. Observational feasibility study. Level 2 neonatal unit, Norway. Infants of mothers with diabetes or infants born large for gestational age. A blinded CGM-device was applied on the upper lateral thigh of the neonate shortly after birth to record tissue glucose during the infant's admission at the postnatal ward. Capillary blood glucose screening samples were analysed by oxidase method. Accuracy of tissue glucose values. Tissue glucose variations during the first 3 days after birth. Number of silent hypoglycaemic events. We included 25 infants. Tissue glucose values were higher than blood glucose values but estimated discrepancy decreased from 1.0 mmol/L at 6 hours to 0.5 mmol/L at 18 hours of age. The lowest tissue glucose values were observed around 50 hours postnatal age. From 28 hours postnatal age until discharge, CGM detected 49 silent hypoglycaemic events in 10 infants. We observed no significant harm from the devices on skin or subcutaneous tissue. Accuracy of tissue glucose increased with time in comparison to capillary blood glucose, but the device could not detect glucose values <2.2 mmol/L. Tissue glucose levels were lowest at ~50 hours postnatal age and hypoglycaemia occurred later than expected. CGM may be a feasible supplement, but approved CGM-devices for neonates are called for.
IntroductionTopical oestradiol gel is now widely used in hormone replacement therapy (HRT), but the risk of inadvertent secondary transfer to children is under-recognised. While accidental exposure to testosterone gels has been documented, oestradiol gel transfer as a cause of precocious puberty in prepubertal girls is rare.We undertook a 20-year literature review and discuss the case of a 5-year-old girl presented with Tanner stage 3 breast development, pubic hair stage 2, growth acceleration and mood changes. Laboratory evaluation revealed markedly elevated oestradiol levels with suppressed gonadotrophins, consistent with peripheral precocious puberty. Bone age was advanced by 4 years 6 months. Imaging, karyotype, endocrine and dermatology investigations excluded central precocious puberty, ovarian or adrenal tumours and McCune-Albright syndrome. History, previously not disclosed, revealed daily co-sleeping with her mother, who had been applying oestradiol gel to her upper arms for 18 months as part of HRT. No other oestrogen sources were identified. Maternal oestradiol gel was discontinued and replaced with a transdermal patch. The child's oestradiol levels normalised and pubertal signs regressed over subsequent months.This review highlights a rare but important cause of peripheral precocious puberty due to unintentional transfer of topical oestradiol gel through routine parent-child contact, including co-sleeping. As topical hormone therapies become increasingly common, clinicians must counsel patients on safe application practices and consider exogenous hormone exposure in children presenting with unexplained pubertal development. Switching caregivers from gel to patch formulations can reverse hormone excess in exposed children.
In 1974, a paper published in Archives described a series of children who suffered serious acute and, usually long-term, neurological events after inoculation with the combined diphtheria/tetanus/pertussis vaccine. Despite this being a case series, with no controls, the authors posited a causal connection and blamed the whole-cell pertussis component. This message was taken up by the UK media and raised in Parliament. Almost overnight the uptake of the combined vaccine fell and notifications of pertussis rose. It took 15 years for uptake of the vaccine to recover.Twenty-four years following publication of the Archives paper, a smaller case series was published in the Lancet, claiming a link between bowel problems and autism. A temporal association with the MMR vaccine was noted and the lead author called for a ban on the combined vaccine. This resulted in a fall in MMR vaccine uptake. There is now a significant body of evidence in favour of no causal link but many parents remain hesitant about vaccinating their children.Authors, editors and publishers should be aware of the effect that an article published in a high-quality academic publication can have on public health. Although it is not appropriate to suppress good research, whatever the message, it is an ethical imperative to ensure it is truly evidence-based.
We set out to describe the amount of fluid administered within the first 24 hours of sepsis treatment with an exploratory analysis of associations. This prospective observational study used data from the Sepsis Epidemiology in Australian and New Zealand Emergency Departments Study, collected from 2021 to 2023. Participants were children aged 0 years to <18 years with suspected community-acquired sepsis admitted to the hospital through 11 emergency departments in Australia and New Zealand. We describe the volumes of fluid administered and mortality rates associated with different fluid volumes. A total of 5352 patients were included in the analysis, with a median age of 2.6 years (IQR 0.4-7.5 years), in-hospital mortality of 58 (1.1%), and 293 (5.5%) of whom met Phoenix sepsis criteria. The median total volume of fluid administered over the initial 24 hours of hospitalisation was 40.0 mL/kg (IQR 20.6-61.5 mL/kg), including: bolus fluid 10.0 mL/kg (IQR 9.4-19.9 mL/kg), maintenance fluid 27.1 mL/kg (IQR 10.2-47.3 mL/kg) and medication carrier fluid 0.0 mL/kg (IQR 0.0-0.9 mL/kg). In-hospital mortality increased with increasing volume of bolus fluid but not with increasing volume of total fluid (unadjusted OR for in-hospital mortality for >55 mL/kg vs <15 mL/kg bolus fluid: 20.5, 95% CI 8.0 to 52.5; p<0.001). Although maintenance fluids accounted for the largest proportion of total fluid volume, bolus fluids showed the strongest association with in-hospital mortality in unadjusted analyses.
Children born extremely preterm (EPT) vary greatly regarding academic outcomes, underscoring the need to investigate subgroups in large representative samples. This study aimed to (1) examine academic outcomes in EPT children versus full-term controls and (2) examine the role of maternal education, child sex, maternal origin, cognitive ability and the presence of attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) diagnosis. National cohort study. Sweden. 12-year follow-up of a cohort study, the Extremely Preterm Infants in Sweden Study, including children born EPT (n=449) and full-term controls (n=365). Data on school grades (mathematics, Swedish and English) and special education school attendance were obtained from registers. EPT group versus controls and subgroup analyses within the EPT group. Compared with full-term controls, children born EPT more often attended special education schools (13.6% vs 0.5%; OR 28.5 (95% CI 6.9 to 117.5)) and those attending mainstream school more often received at least one failing grade (32.3% vs 5.2%; OR 8.7 (95% CI 5.2 to 14.5)). Of children with gestational age (GA) ≤23 weeks, 39% attended mainstream school and passed all three core subjects, compared with 65% of those born at 26 weeks (OR 0.34 (95% CI 0.17 to 0.62)). Among EPT children attending mainstream education, low GA, low maternal education, cognitive impairment and ADHD/ASD diagnosis increased the risk of poor academic achievement. EPT birth was associated with poor academic achievement, but the risk varies substantially within the EPT group, primarily based on cognitive impairment, ADHD/ASD diagnosis and maternal education. However, the risk of poor academic achievement among children born EPT remained after adjusting for confounders and mediators.
Sleep studies are recommended in children suspected to have severe obstructive sleep apnoea (OSA) to stratify perioperative risk before adenotonsillectomy and to avoid unscheduled high-dependency unit admission. The mean desaturation nadir (MDN) is thought to be a useful measure of the overall hypoxic burden from sleep disordered breathing (SDB) events. MDN values have been reported in healthy children but not in those with severe OSA or other categories of SDB. We report the findings of a cross-sectional observational study in children with SDB assessed with multichannel sleep studies (MCSS) in a UK secondary care centre between July 2022 and November 2024. We evaluated data from 1031 children recorded in a sleep study database, which is maintained for audit and service evaluation purposes. Following exclusions, the data of 889 children were analysed for MDN values according to SDB categories. The parameters measured with MCSS include oximetry, video, sound, movement, heart rate and pulse transit time but do not include airflow or an Apnoea-Hypopnoea Index (AHI) which is reported with cardiorespiratory studies or polysomnography. SDB categories were determined using oximetry and video criteria. We found that MDN falls with increasing severity of SDB, most notably in children with moderate and severe OSA. Approximately 4% of the cohort (n=37) had severe OSA (defined using McGill's criteria) and had a mean MDN of 88% (95% CI 87% to 89%). Our findings suggest that MDN values <90% can identify children with severe OSA who may have increased perioperative risk.
A 4-year-old boy presented with fever and unilateral neck swelling, initially treated as bacterial lymphadenitis with intravenous antibiotics. Over the following days, he developed bilateral non-purulent conjunctival injection, palmar erythema, mucosal changes, raised liver transaminases and rising inflammatory markers. The evolving picture led to a diagnosis of Kawasaki disease in the second week of illness.Cervical lymphadenitis is a common paediatric presentation, with infective aetiology being the most common. However, inflammatory conditions such as Kawasaki disease and haematological malignancy can present similarly. Among these, 'Node-first' Kawasaki disease, in which cervical lymphadenopathy precedes other features, while a recognised phenotype, is a rarer presentation and therefore a diagnostic pitfall. The similarity to infective lymphadenitis, together with overlapping laboratory and imaging findings, may delay definitive treatment and increase the risk of complications. An acute presentation of cervical lymphadenitis in a febrile child with inadequate or no response despite antibiotics and persistent high inflammatory markers should raise suspicion of possible alternative diagnoses like Kawasaki disease.
This study aimed to identify and prioritise practical risk mitigation strategies that can be implemented by paediatric teams to improve the safety of children and young people (CYP) in mental health crises admitted to acute paediatric care. A sequential two-stage mixed-methods exploratory study. UK acute paediatric hospitals/wards. 16 Healthcare Professionals/CYP experts through experience. None. In stage 1, risk mitigation strategies were identified through a systematic review and qualitative interviews followed by thematic analysis. In stage 2, strategies were prioritised using a hybrid Nominal Group Technique and modified Delphi process and stratified according to clinical risk level (low, medium, high, very high) using a validated paediatric mental health risk assessment framework. 26 risk mitigation strategies were identified, of which 16 achieved expert consensus (≥70%) for clinical usefulness. Clinically actionable strategies included: structured safety checks on admission and daily thereafter; proactive environmental modification to reduce triggers (noise, crowding, ligature risks); active 1:1 observation focused on therapeutic engagement rather than surveillance; prioritisation of timely assessment and escalation to specialist mental health services and routine use of multidisciplinary safety huddles. Strategies were mapped to risk level, enabling paediatric teams to tailor interventions proportionately to assessed risk. This study provides an evidence-informed, consensus-based set of risk mitigation strategies that can be implemented immediately within acute paediatric care. By embedding structured safety checks, therapeutic engagement and risk-informed environmental controls into routine practice, non-mental health clinicians can enhance safety and consistency of care for CYP admitted in mental health crisis.
Postmortem (PM) examination can be valuable after a baby's death, providing information about the cause of death and support for families. However, worldwide trends indicate declining neonatal PM rates. We aimed to analyse trends in PM offer and completion after deaths in neonatal units. We used data from the National Neonatal Research Database on deaths in neonatal units in England, Wales and the Isle of Man (2017-2022). We used regression models to estimate rates of PM offer and completion and their association with selected clinical, socio-demographic and service-related variables. We report the relative risk (RR), with a p value <0.05 considered statistically significant. PM offer and completion rates ranged from 56% to 62% and 15% to 18%, respectively. Compared with extremely preterm infants, term infants had higher PM completion rates (RR 2.25, 95% CI 1.94 to 2.62, p<0.001). PM completion was less likely for babies of Asian (RR 0.58, 95% CI 0.46 to 0.72, p<0.001) or black mothers (RR 0.78, 95% CI 0.60 to 0.99, p=0.04) when compared with babies of white mothers. Babies of mothers in the country's least deprived decile were more likely to have a PM completed (RR 1.38, 95% CI 1.04 to 2.48, p=0.04), in comparison with the most deprived centile. This national study provides a near-contemporaneous perspective on neonatal PM and adds to existing evidence of low rates. These data indicate the need to address the root causes of variation in PM completion to ensure equity in the care of families after a neonatal death.
To compare the efficacy and safety of intravenous rehydration (IVR) versus oral rehydration (OR) strategies in children with severe acute malnutrition (SAM) and severe dehydration. Systematic review and meta-analysis. Lower-to-middle-income countries. Children with SAM are hospitalised with severe dehydration secondary to gastroenteritis. Randomised trials of IVR and OR (standard of care) MAIN OUTCOME MEASURES: Primary: in-hospital mortality. Secondary: fluid overload events, development of shock requiring intravenous boluses, severe electrolyte abnormalities at 24 hours and day 28 mortality. We identified three RCTs comprising 484 participants with severe malnutrition (72 had kwashiorkor, two had some risk of bias, and one had low risk of bias). The pooled risk ratio (RR) for in-hospital mortality for IVR versus OR is 0.71 (95% CI 0.46 to 1.10; I2=0.0%) with moderate certainty of evidence. No fluid overload events were reported, pooled RR 0.99 (95% CI 0.10 to 9.35). The pooled RR of severe hyponatraemia (sodium <125 or <130 mmol/L) at 24 hours was 0.66 (95% CI 0.44 to 0.99). Only one trial reported RR for shock development, hypernatraemia (sodium >145 mmol/L) or 28-day mortality with IVR versus OR (RRs 0.56, 95% CI 0.21 to 1.48; RR 2.05, 95% CI 0.50 to 8.58 and RR 0.85, 95% CI 0.44 to 1.65, respectively). Subgroup analyses for in-hospital mortality were carried out for region and risk of bias rating, giving p=0.85 and p=0.54 for heterogeneity, respectively. The estimated effect of using IVR versus OR in children with SAM with severe dehydration ranges from a 54% relative reduction to a 10% relative increase in the risk of death, with IVR resulting in fewer adverse events. CRD42025637956.
This article describes a case of warm autoimmune haemolytic anaemia (w-AIHA) in a 16-month-old refractory to first-line treatment. W-AIHA typically responds to systemic corticosteroids. Here, management proved challenging with re-emergence of haemolysis during initial steroid course. Rituximab offered a turning point, demonstrating the utility of targeted anti-CD20 antibody therapy in achieving a sustained haematological response. The patient's clinical course was not without further complications potentially attributable to treatments administered. This paper reviews the management of w-AIHA, beyond steroid therapy, with an additional focus on supportive care measures.