Pediatrics

ICP >14–15 mm Hg predicts poor functional outcome after pediatric TBI

In this multicenter STARSHIP cohort of 135 children with moderate to severe TBI, higher mean ICP strongly correlated with worse 12‑month functional outcomes. Threshold analyses identified ICP levels of 14–15 mm Hg as most discriminatory for poor outcome, lower than the traditional 20‑mm Hg threshold. Static and dynamic ICP metrics above 14–15 mm Hg were associated with markedly increased odds of unfavorable outcome on the Pediatric GOS-E. Across treatment intensities, patients with better ICP control had more favorable prognosis, while treatment intensity itself was not independently predictive. 1

Influenza vaccination reduces pediatric hospitalizations and outpatient visits across three recent seasons

This multicenter New Vaccine Surveillance Network study evaluated nearly 20 000 US children with acute respiratory illness from 2021–2024. Overall influenza vaccine effectiveness against hospitalization and outpatient visits ranged from 34% to 60% across seasons. Effectiveness was higher against influenza B, intermediate for A/H1N1, and lower for A/H3N2, with variation by clade and season. Despite moderate protection, only about half of influenza-negative children were vaccinated each season, indicating substantial room to reduce disease burden. 2

Nirsevimab and maternal RSV vaccine substantially reduce severe RSV in young infants at the population level

This Washington state difference‑in‑differences analysis evaluated 16 775 RSV-associated ED visits and hospitalizations in children ≤24 months across three seasons. After initial limited uptake, the second year of nirsevimab and antenatal RSVpreF use showed a 43% relative reduction in RSV hospitalizations and ED visits among infants ≤7 months. Benefits exceeded temporal trends observed in 8–24‑month‑old comparators, suggesting a true prevention effect in the target age group. Impact was generally consistent across racial groups, with notable exception for Native Hawaiian or Other Pacific Islander children, indicating potential equity gaps. 3

ASH/ISTH 2026 guidelines narrow indications for pediatric VTE prophylaxis

These ASH/ISTH guidelines issue 12 GRADE-based recommendations on anticoagulant prophylaxis for children at risk of VTE. For pediatric patients with solid cancer, trauma, or critical illness, the panel conditionally recommends against routine pharmacologic prophylaxis. Conditional recommendations favor prophylaxis for children with antiphospholipid antibody syndrome and those requiring long-term total parenteral nutrition. Other groups, including children with acute leukemia, lymphoma, surgery, hospitalization, or central lines, are addressed, but evidence quality remains low. The authors highlight urgent needs for validated pediatric VTE risk models and trials of risk-stratified prophylaxis strategies. 4