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Study Type: Single-centre prospective observational cohort study

Key Question: Does clinical or biological (atopic/eosinophilic) phenotype influence the amount of oral corticosteroid (OCS) use during acute attacks in children with severe, recurrent preschool wheeze?

Key Findings:

• Median lifetime OCS courses per child was 10 (IQR 6–18), with 5 (IQR 3–7) in the preceding 12 months alone.
• Atopic children had significantly higher blood eosinophil counts when well (0.65–0.7 ×10⁹/L vs 0.3 ×10⁹/L, p=0.003 to <0.0001, depending on atopy definition).
• Despite this, OCS use during acute attacks did not differ by eosinophil count, clinical atopy, or objective sensitisation status.

Clinical Relevance: Highlights indiscriminate, high-burden OCS prescribing in preschool wheeze across NHS respiratory services, unsupported by phenotype-directed evidence, underscoring need for trials to rationalise steroid use in this population.

Limitations: Single-centre design with a selected tertiary referral population limits generalisability to broader primary/secondary care preschool wheeze cohorts.

Study Type: Horizon-scanning study with foresight analysis (clinical trial registry review)

Key Question: Will currently ongoing clinical trials meaningfully close the evidence gaps on effectiveness and safety of medicines used for children and young people with gender incongruence/dysphoria?

Key Findings:

• 15 ongoing studies identified globally (23 registries; total planned/actual n=1073), 12 based in the USA; interventions limited to GnRH analogues, cross-sex hormones, anti-androgens and progesterone.
• Most studies focus on older adolescents and physiological outcomes (puberty/reproduction, cardiovascular, bone, metabolic, BMI); only 3 studies assess gender identity/dysphoria outcomes directly.
• Methodological rigour is limited: no control group in 8/15 studies, no randomisation in 11/15, no blinding in 12/15.

Clinical Relevance: Highlights that robust, adequately powered evidence—such as that expected from NHS England's forthcoming puberty-suppression trial—remains essential, as the current global research pipeline is unlikely to resolve UK clinical and policy uncertainty in this area.

Limitations: Registry-based horizon scanning cannot assess study quality beyond registered design features, and findings may become outdated as new trials are registered.

Study Type: Cross-sectional survey

Key Question: Do commercial baby foods sold in spouted pouches meet recommended texture and nutrient standards for complementary feeding, compared with other packaging types?

Key Findings:

• 60% of 298 UK wet baby foods were in spouted pouches; 49% were liquid in texture versus only 7% of other packaging.
• Spouted pouch foods more often had higher sugar (61% vs 8%) and lower protein (49% vs 91% below breastmilk threshold) than other formats.
• Only 8% of pouch foods met all desired energy/protein/sugar criteria (vs 32% of others); 29% met none (vs 2% of others).

Clinical Relevance: UK clinicians advising parents on weaning should be aware that many spouted pouch products are nutritionally and texturally more akin to sweet drinks than appropriate complementary foods, with implications for infant nutrition and oral motor development.

Limitations: Nutrient and age data relied on manufacturer packaging rather than independent laboratory analysis, and the cross-sectional design cannot assess actual infant intake or health outcomes.

Study Type: Pooled prospective cohort study (ECHO consortium, 20 US sites)

Key Question: Is prenatal organophosphate pesticide exposure associated with autism-related traits in childhood?

Key Findings:

• Among 3339 mother-child pairs, crude models suggested inverse associations between urinary OP biomarkers (TCPy, ΣDAP) and SRS scores, but these attenuated to non-significance after full adjustment (TCPy: β = -0.13; 95% CI, -0.57 to 0.31; ΣDAP: β = -0.42; 95% CI, -1.03 to 0.19).
• No effect modification by child sex or maternal diet quality; findings were consistent across quantile, logistic, and sensitivity analyses.

Clinical Relevance: Provides reassurance for UK clinicians counselling families on environmental/dietary pesticide exposure concerns during pregnancy, as no independent association with autism-related traits was found at typical population exposure levels.

Limitations: Exposure was based on single/limited spot urinary measurements, which may not capture true prenatal OP exposure variability, and residual confounding or unmeasured higher-exposure/mixture effects cannot be excluded.

Study Type: Systematic review and meta-analysis (longitudinal cohort studies)

Key Question: Is alcohol marketing exposure in youth (<25 years) longitudinally associated with subsequent drinking behaviour?

Key Findings:

• Pooled analysis of 19 cohorts (23 publications, 94 relative risks, n=82,498) found high vs low marketing exposure was associated with increased risk of drinking (RR, 1.50; 95% CI, 1.37–1.63), moderate certainty evidence (upgraded for dose-response).
• Television advertising showed the strongest association with drinking among exposure subtypes.
• Narrative synthesis suggested the association is mediated by changes in attitudes and cognitions toward alcohol.

Clinical Relevance: Supports public health advocacy for stricter alcohol marketing regulation (e.g., watershed advertising restrictions) as a preventive lever in UK adolescent health, relevant to paediatricians engaging in population health and safeguarding discussions.

Limitations: All included studies relied on self-reported drinking outcomes, introducing risk of bias, and evidence was drawn almost exclusively from high-income countries, limiting generalisability.

Study Type: Retrospective population-based cohort study

Key Question: How has the incidence and pathogen profile of late-onset sepsis (LOS) in very preterm infants changed over 2010–2023?

Key Findings:

• Among 66,441 VPIs, 9.0% developed LOS (15.4% mortality); CoNS (34.5%), *S. aureus* (18.1%), *E. coli* (10.9%), and *Klebsiella* (7.2%) were leading pathogens.
• LOS incidence fell from 15.0% to 8.2% during 2010–2017 (aAPC −5.5%), then rose from 2018–2023 (aAPC +2.1%), driven by non-CoNS gram-positive (+5.4%) and gram-negative (+5.3%) organisms.
• *S. aureus* LOS increased throughout both periods (aAPC +4.3% then +7.7%); *Klebsiella* LOS rose sharply post-2018 (aAPC +9.9%).

Clinical Relevance: UK neonatal units should be alert to a resurgence in *S. aureus* and gram-negative LOS, prompting review of local infection prevention bundles, antimicrobial stewardship, and empirical antibiotic guidance for preterm infants.

Limitations: Observational data from California networks limit generalisability to UK neonatal populations and cannot establish causality for the observed trend shifts.

Study Type: Retrospective cohort study

Key Question: Does routine DAT screening add clinical value beyond transcutaneous bilirubin (TcB) monitoring in predicting phototherapy need for low-risk neonates with ABO or RhD incompatibility?

Key Findings:

• In ABO-incompatible infants (n=310), TcB alone predicted phototherapy need well (AUC 0.887); adding DAT gave negligible improvement (AUC 0.896).
• In ABO-compatible/RhD-incompatible infants (n=308), 14.0% had DAT positivity from passive anti-D, uncorrelated with TcB; only 1.0% required phototherapy.

Clinical Relevance: Supports adopting the 2022 AAP guidance to discontinue routine DAT in these low-risk groups, potentially reducing unnecessary neonatal blood sampling and laboratory workload in UK maternity/neonatal units, provided maternal antibody screening is complete.

Limitations: Retrospective single-population design limits generalisability, particularly where maternal antenatal antibody screening practices differ from those assumed in this study.

Study Type: RCT (follow-up study of the BeNeDuctus trial)

Key Question: Does early ibuprofen treatment for PDA in extremely preterm infants improve survival without neurodevelopmental impairment at 24 months' corrected age compared with expectant management?

Key Findings:

• Survival without neurodevelopmental impairment: 49% (51/104) expectant management vs 49% (47/96) early ibuprofen (RR 1.00; 95% CI 0.76–1.33).
• No significant differences in biometry, abnormal neurological examination, or vision/hearing impairment between groups.
• Follow-up data available for 85.7% of original cohort (234/273), with primary endpoint assessed in 85.5% of those.

Clinical Relevance: Supports current shift towards conservative PDA management in extremely preterm infants, reinforcing that routine early pharmacological closure with ibuprofen offers no neurodevelopmental benefit at 2 years—relevant to NHS neonatal unit PDA management guidelines.

Limitations: Loss to follow-up (~14%) and missing primary outcome data in some assessed patients may introduce attrition bias affecting precision of estimates.