A recent Paediatrics digest,
as sent to subscribers

Study Type: Retrospective cohort study

Key Question: What racial and ethnic inequities exist in accessing early intervention services for very preterm infants (<32 weeks gestation)?

Key Findings:

• Among 7,169 very preterm infants in Massachusetts, overall rates were 84% referred, 71.3% evaluated, and 64.5% received individualized plans
• Non-Hispanic Black infants had lower rates at each step compared to non-Hispanic White infants: referral (81.3% vs 84.6%), evaluation (62.5% vs 75.4%), and receiving services (55.0% vs 68.4%)
• Inequities were partially explained by social determinants but persisted after adjustment

Clinical Relevance: This highlights systematic barriers preventing equitable access to proven developmental interventions for high-risk preterm infants, with potential implications for UK early intervention pathways and health visiting services.

Limitations: Single-state US data may not generalise to other healthcare systems, and residual confounding from unmeasured social factors likely remains.

Study Type: Systematic review and meta-analysis

Key Question: What is the prevalence of invasive bacterial infections among well-appearing febrile infants aged 60-90 days presenting to emergency departments or outpatient settings?

Key Findings:

• Pooled prevalence of invasive bacterial infection was 1.11% (95% CI 0.84%-1.47%) among 34,835 infants from 59 studies
• Bacteraemia accounted for most cases at 1.01% (95% CI 0.76%-1.34%), while bacterial meningitis was rare at 0.11% (95% CI 0.08%-0.16%)
• Results remained consistent across multiple sensitivity analyses excluding retrospective studies, fever without source cohorts, and studies with shorter follow-up

Clinical Relevance: These contemporary prevalence estimates provide evidence-based data to inform UK guideline development and support shared decision-making between clinicians and parents when managing well-appearing febrile infants in their third month of life.

Limitations: The analysis was limited to studies published after 2000, potentially excluding earlier data, and included predominantly retrospective cohorts which may introduce selection bias.

Study Type: Policy statement

Key Question: What are the causes of gender-based pay inequities in pediatrics and what strategies can address them?

Key Findings:

• Gender pay gaps persist across pediatric subspecialties even after controlling for work hours, duties, and productivity
• Contributing factors include systemic bias, unequal access to mentorship/leadership roles, inadequate parental leave policies, and part-time work patterns
• Subspecialties with higher proportions of women face workforce shortages and lower overall salaries

Clinical Relevance: This highlights systemic issues affecting pediatric workforce sustainability that UK clinicians should recognise, particularly given similar gender demographics in NHS pediatrics and potential parallels with UK pay equity challenges.

Limitations: As a policy statement rather than original research, it synthesises existing evidence without presenting new empirical data on the magnitude or specific mechanisms of pay inequities.

Study Type: Technical report/guidance document

Key Question: What should paediatric clinicians know about prescribing generic drugs and biosimilars in children and adolescents?

Key Findings:

• Generic drugs are identical to brand-name drugs and must demonstrate bioequivalence, while biosimilars are "highly similar" but may differ in clinically inactive components
• FDA requires extensive evidence for both generics and biosimilars to ensure equivalent safety and effectiveness profiles
• Current regulatory standards should provide confidence for clinicians to substitute with generics and biosimilars

Clinical Relevance: Updates 1987 guidance on generic prescribing for UK paediatric clinicians, particularly relevant given increasing use of biologics and biosimilars in paediatric practice and NHS cost-containment priorities.

Limitations: This is US-focused guidance that may not fully align with MHRA/EMA regulatory frameworks used in the UK.

Study Type: Prospective cohort study

Key Question: What are the associations between prenatal exposure to nicotine, alcohol, cannabis, and opioids with birth weight and gestational age outcomes?

Key Findings:

• Cannabis exposure was associated with 272g lower birth weight (95% CI -445 to -100g) and 8.2 lower birth weight centiles (95% CI -15.3 to -1.1)
• Opioid exposure was associated with 295g lower birth weight (95% CI -575 to -16g) and 14.4 lower birth weight centiles (95% CI -25.5 to -3.4)
• No significant associations were found between any substance exposure and gestational age at delivery

Clinical Relevance: This provides quantified evidence for counselling families about fetal growth restriction risks from prenatal cannabis and opioid use, supporting existing UK guidance on substance use in pregnancy.

Limitations: Results were sensitive to model specifications, suggesting potential confounding or methodological issues affecting the robustness of findings.