Pediatrics

Most BRUEs have excellent short-term outcomes; routine broad testing adds little value

Across 24 studies including 6603 infants with BRUE, serious underlying diagnoses occurred in about 6%. Three-month mortality was extremely low, approximately 1 death per 1851 infants. Multiple prior events and prematurity increased risk of a serious diagnosis, whereas age ≤60 days did not. Metabolic panels, ECGs, and chest radiographs had extremely low diagnostic yields with very high numbers needed to test. These findings support targeted evaluation of higher-risk infants and avoidance of broad routine testing in typical BRUE presentations. 1

Persisting symptoms after early childhood concussion are common and track with initial symptom burden

This cohort included 418 children younger than 6 years: 235 with concussion, 108 orthopedic injuries, and 75 community controls. At 1 month, 28% of concussion patients had persisting symptoms, versus 10% with orthopedic injuries and 2% of community controls. Persisting symptoms remained in 24% at 3 months and 16% at 12 months after concussion. Higher total symptom burden in the ED predicted 1-month persistence, while age, loss of consciousness, and imaging did not. These data support structured ED symptom assessment and planned follow-up for highly symptomatic preschoolers after concussion. 2

Reflux-nephropathy ESKD declined despite reduced VCUG use after UTI guideline changes

Using US Renal Data System data from 2002 to 2021, investigators identified patients ≤24 years with ESKD attributed to reflux nephropathy. Overall pediatric and young adult ESKD incidence decreased over time, as did reflux-nephropathy–related ESKD. Reflux-nephropathy ESKD showed an average annual decline of about 4% despite decreased VCUG after the 2011 AAP UTI guideline. ESKD from obstructive uropathies and renal dysplasia also declined, while some nonspecific congenital anomalies increased. These trends suggest that selective VCUG after febrile UTI has not produced a detectable increase in reflux-related ESKD. 3

Pediatric platelet transfusions are frequent, often at higher thresholds, and product features affect increments

Among 249340 inpatient encounters, 8874 children (3.6%) received platelet transfusions, with median age 2.5 years. Most nonbleeding neonates and older children were transfused above 25×10³/µL and 10×10³/µL, respectively, indicating relatively liberal thresholds. Neonates received higher mL/kg doses and had higher pretransfusion platelet counts than older children. Pathogen reduction, platelet additive solution, storage beyond 3 days, male sex, and older donor age were associated with smaller platelet increments. Pathogen-reduced and PAS platelets were linked to higher subsequent transfusion burden, highlighting trade-offs between infectious safety and hemostatic efficacy. 4