Low-risk birth-center births showed no higher neonatal mortality in a 10-year analysis

Urinary tract infections (UTIs) occur in approximately 7% of febrile infants and represent one of the most common bacterial infections in pediatric practice. Replacing the 2011 guidance, the American Academy of Pediatrics issued an updated clinical practice guideline with three companion technical reports for children 8 days to 5 years of age with low medical complexity. Developed using the GRADE framework with evidence-to-decision panels, the update provides eight Key Action Statements (two strong and six conditional recommendations ranging from low to very low certainty of evidence) and four Good Practice Statements. Core guidance spans the diagnostic evaluation of suspected UTI, targeted antimicrobial selection and treatment duration, indications for renal and bladder ultrasound and voiding cystourethrography, prevention of structural sequelae including vesicoureteral reflux, and structured screening and treatment for bowel and bladder dysfunction.

Continuous non-clinical labor support has drawn increasing interest to address severe maternal health disparities and high obstetric intervention rates across the United States. This systematic review and meta-analysis evaluated 30 US-based studies (12 randomized controlled trials and 18 nonrandomized studies of interventions) examining doula care compared with standard maternity care. Using GRADE methodology, the investigators found moderate-certainty evidence that doula support is likely associated with lower rates of preterm birth, decreased cesarean delivery, improved maternal birth experiences, and higher postpartum visit attendance. Low-certainty evidence suggested potential associations with improved prenatal mood, increased spontaneous vaginal birth and vaginal birth after cesarean (VBAC), earlier breastfeeding initiation, reduced epidural analgesia use, shorter labor duration, and lower infant mortality. Doula support was not associated with reductions in hypertensive disorders of pregnancy, maternal readmissions, or NICU admissions. Notably, four of five studies focusing specifically on populations experiencing structural disparities (by race, incarceration, low income, or Medicaid insurance) documented positive maternal-infant benefits.

Vaso-occlusive pain episodes represent the primary driver of emergency department visits and acute inpatient admissions in sickle cell disease (SCD). Patients frequently exhibit acute arginine deficiency during pain crises, and earlier phase 2 single-center trials suggested supplemental arginine might reduce hospital stay and opioid requirements. The multicenter phase 3 STArT trial, conducted across 10 US children's hospitals, evaluated whether intravenous arginine (200 mg/kg loading dose followed by 100 mg/kg every 8 hours) improved clinical outcomes compared to saline placebo in patients aged 3 to 21 years presenting to the ED with SCD pain requiring parenteral opioids. Among 274 randomized patients (271 received study drug; mean age 14.3 years; 51% male; 92% Black), the trial was halted early for futility. Time to crisis resolution—defined as time from initial infusion to final parenteral opioid dose—did not differ between arginine and placebo (median 60.8 hours [IQR 34.8–109.0] vs 65.8 hours [IQR 31.1–111.1]; absolute difference 7.2 hours; 95% CI -21.6 to 35.9). Secondary endpoints including cumulative parenteral opioid consumption, numeric pain scores, and safety profiles showed no significant differences.