Pediatrics

Intranasal saline is an effective first-line therapy for pediatric sleep-disordered breathing; steroids add no benefit

Children 3–12 years with obstructive sleep-disordered breathing received 6 weeks of once-daily intranasal saline before randomization. After the saline run-in, nearly 30% had symptom resolution, avoiding further intervention. Among those still symptomatic, adding intranasal mometasone for 6 weeks did not improve symptom resolution versus continued saline (≈36% in each arm). Behavior, quality of life, and parental perception of surgical need were similar between steroid and saline groups. The authors conclude that 3 months of intranasal saline is an effective short-term first-line strategy before polysomnography or surgical referral. 1

Virtual family-centered rounds in the NICU increase parent attendance and reduce 30-day ED revisits

In this single-site cluster RCT, NICU families were randomized to usual rounds or an option for virtual participation plus usual care. Infants in the virtual-rounds arm had about 4.8 times the parent attendance rate compared with controls. The intervention also reduced odds of a 30-day emergency department revisit to roughly one-third that of usual care. No significant benefits were seen for length of stay, breastmilk feeding, or neonatal growth. Offering virtual round options appears to be a scalable strategy to strengthen family engagement and postdischarge outcomes. 2

Parent-led enhanced developmental intervention for very preterm infants improves executive function at school age

Very preterm or very low birth weight infants were randomized to a parent-led enhanced developmental intervention starting in the NICU and continuing to age 2, versus usual care. At a mean age of 7 years, children who received the intervention showed significantly higher executive function scores across auditory attention, inhibition, design fluency, and motor persistence. Effect sizes were medium to large, and findings remained significant after Bonferroni correction. Intervention children also had higher odds of expected performance in design fluency versus usual care. Results support investing in structured, parent-mediated early intervention programs for very preterm infants to improve later executive functioning. 3

Severe infant microcephaly is predominantly genetic, with substantial residual diagnostic uncertainty

This multinational surveillance study pooled 118 infants with severe microcephaly reported from pediatric surveillance networks in four high-income settings. Median age at diagnosis was 17 days, with mean head circumference about 4 SD below the mean. Genetic etiologies accounted for 50% of cases, acquired causes for 18%, and 32% remained unexplained. Most infants underwent brain MRI and DNA microarray, and about half had CMV screening. Authors recommend systematic inclusion of genomic sequencing and brain imaging in evaluating all infants with severe microcephaly. 4