Pediatrics

Maternal RSV vaccine and nirsevimab substantially reduced infant RSV hospitalizations in 2024–2025

This seven-center US surveillance study enrolled 5029 children under 2 years with medically attended acute respiratory illness during the 2024–2025 RSV season. Among infants younger than 6 months, maternal RSV vaccination reduced medically attended RSV by 64% and RSV hospitalization by 70%. In infants under 8 months, nirsevimab reduced RSV-associated hospitalization by 81%, with 77% effectiveness persisting 130–210 days post-dose. RSV hospitalization rates in 2024–2025 were markedly lower than pre-pandemic seasons or modeled counterfactuals, indicating large population-level impact. 1

Continuous Medicaid eligibility decreased coverage gaps and ED use, especially for children with special needs

Using 2016–2022 National Survey of Children’s Health data, investigators compared publicly versus privately insured children before and during the Medicaid disenrollment pause. Continuous Medicaid eligibility was associated with a 3.1 percentage point reduction in insurance coverage gaps among publicly insured children. ED use fell by 3.9 percentage points overall, with a larger 7.5 percentage point reduction among children with special health care needs. For these high-need children, continuous eligibility also increased the prevalence of excellent general health by 6.4 percentage points. Other access measures, such as unmet specialty or mental health needs, showed no significant improvements, indicating residual care barriers. 2

Dose–response links between adolescent cannabis use and adverse academic and emotional outcomes

This cross-sectional study analyzed 162,532 US students in grades 8, 10, and 12 from 2018–2022 Monitoring the Future surveys. Overall, 26.2% reported any cannabis use, including noncurrent, monthly, weekly, and near-daily patterns. Compared with nonusers, even noncurrent and monthly users had higher odds of poor grades, impaired self-regulation, and adverse emotional states. Odds of adverse psychosocial outcomes generally increased in a graded fashion with higher cannabis use frequency. Adolescents younger than 16 years appeared more vulnerable for academic and emotional problems, underscoring the need for early, routine substance-use inquiry. 3

ECSTATIC trial shows pediatric ECMO platelet-threshold randomization is feasible with similar safety outcomes

The ECSTATIC randomized trial enrolled 50 children on ECMO without significant early bleeding across 10 centers. Patients were assigned to prophylactic platelet transfusion at either <90×10⁹/L or <50×10⁹/L, achieving a 32×10⁹/L pre-transfusion separation. Protocol adherence reached 99.2%, demonstrating strong feasibility of maintaining distinct thresholds in this high-acuity setting. Overall, 22% experienced severe bleeding, severe clotting, or death, with similar rates across both transfusion strategies. These results support conducting a larger outcomes trial to define optimal platelet thresholds for children on ECMO. 4