Pediatrics

PECARN cervical spine rule outperforms NEXUS and CCR in children after blunt trauma

In >22,000 children after blunt trauma, 1.9% had cervical spine injury (CSI). The PECARN CSI rule showed higher sensitivity (93.3%) than NEXUS (85.7%) and Canadian C-spine rule (90.8%) for detecting CSI. Negative predictive value was very high for all rules, but highest with PECARN (99.8%). Strict application of PECARN projected the lowest CT use (6.9% vs 10.8% for NEXUS and 13.2% for Canadian C-spine). Findings support PECARN as the preferred rule to minimize missed pediatric CSI while reducing CT exposure. 1

Cerebral oximetry–guided management stabilizes cerebral oxygenation in extremely preterm infants

In a 5-center randomized trial, 100 infants <29 weeks’ gestation were assigned to NIRS-guided vs standard care within 6 hours of birth. Intervention infants received protocolized responses when cerebral saturations fell outside 65% to 90%. NIRS-guided care reduced the burden of cerebral hypoxia/hyperoxia from a median 39.6% hours to 5.7% hours, a large adjusted decrease. Mortality, major morbidities before discharge, and NIRS-related skin injury were similar between groups. Results support cerebral oximetry–guided protocols to improve cerebral oxygen stability, though effects on neurodevelopment remain unproven. 2

Medicaid as a platform for individualized nutrition interventions

This Viewpoint argues that Medicaid is a key vehicle for delivering individual-level nutrition interventions. Authors highlight opportunities to integrate food and nutrition supports into routine care for Medicaid beneficiaries. They emphasize aligning payment, benefits, and delivery models to support tailored nutrition services. The piece calls for rigorous evaluation of nutrition interventions’ clinical impact and cost-effectiveness within Medicaid programs. 3