Pediatrics

Preterm infants <6 months hospitalized with RSV face substantially worse in-hospital outcomes than term peers

Among 5844 RSV hospitalizations in children <2 years, 21% were born premature, including a small subgroup with bronchopulmonary dysplasia (BPD). Compared with term infants, all premature infants <6 months had higher risks of prolonged stay, ICU admission, and assisted ventilation (aRRs ~1.3–2.0). Premature infants with BPD remained at increased risk of prolonged hospitalization through 23 months, beyond early infancy. Premature children accounted for 1 in 5 RSV hospitalizations, underscoring their disproportionate burden and priority for prophylaxis and close monitoring. 1

Chest radiographs in pediatric ED asthma are frequent, variable, and linked to more pneumonia diagnoses and returns

In 145 059 pediatric ED asthma encounters (2016–2024), chest radiographs were obtained in 22.3% of visits despite guideline cautions. Use showed wide interhospital variation (13.1%–37.7%) with no meaningful overall temporal decline, except among children ultimately diagnosed with pneumonia. Higher imaging rates were associated with younger age, female sex, white race, private insurance, and winter presentations, suggesting inequitable practice patterns. Hospitals that imaged more often had more pneumonia diagnoses and 3-day return visits, without differences in admissions, length of stay, or charges. Findings support targeted stewardship—decision support, feedback, and benchmarking—to reduce low-value chest radiography in asthma exacerbations. 2

Influenza vaccination benefits children with chronic conditions but has lower effectiveness, especially in respiratory comorbidities

This test-negative study enrolled 15 875 US children (6 months–17 years) over five influenza seasons in EDs and hospitals. Overall vaccine effectiveness against lab-confirmed, medically attended influenza was 53% in children without underlying conditions and 43% in those with conditions. Effectiveness was lowest in children with respiratory conditions, at 31%, indicating attenuated but meaningful protection in this high-risk group. Results support strong vaccination recommendations for all children and highlight the need for early antiviral treatment in medically complex, especially respiratory, patients. 3

MRI plus early motor assessments in preterm infants offers highly specific but incompletely sensitive early CP prediction

In a cohort of 395 preterm infants (≤32 weeks), 338 had follow-up to 22–26 months; 11.5% developed cerebral palsy (CP). Abnormal structural MRI combined with absent fidgety movements on GMA yielded 100% specificity but only 22% sensitivity for any CP diagnosis by 2 years. Combining MRI with a low HINE score had similarly high specificity (98%) and modest sensitivity (32%) for any CP. For more severe CP (GMFCS II–V), these combined tools achieved substantially higher sensitivity (78%–90%) while maintaining near-perfect specificity. Clinicians should use early MRI plus GMA/HINE to identify high-risk infants but maintain long-term developmental surveillance to detect milder CP. 4