Research ArticleResearchMedication Safety

Balanced fluid showed no significant major kidney-event benefit in pediatric septic shock

The New England journal of medicine (PubMed)Apr 24, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

PRoMPT BOLUS found no significant difference in major adverse kidney events between balanced fluid and 0.9% saline.

What NurseJet pulled from the source

This randomized trial enrolled children aged two months to under 18 years at 47 emergency departments. The primary composite was death, new renal-replacement therapy, or persistent kidney dysfunction by day 30 or discharge, whichever came first.

Why this matters for nurses

A difference in electrolyte findings did not translate into demonstrated benefit on the primary clinical outcome.

Bedside takeaway

Distinguish electrolyte differences from demonstrated clinical-outcome benefit.

How This Applies in Practice

Use this when: Handing off pediatric septic-shock fluid resuscitation.

On your shift

Communicate the fluid administered and available kidney and electrolyte results.

Keep in mind: Follow the pediatric sepsis protocol and provider orders.

Key takeaways

Primary events occurred in 3.4% versus 3.0% with balanced fluid and saline, respectively (risk ratio 1.10; 95% CI 0.88-1.40).
Hyperchloremia was reported in 31.4% versus 49.0%, respectively.

Practice implications

Keep fluid-type documentation and ordered monitoring clear; this result does not justify independently changing the resuscitation plan.

Limitations & cautions

Abstract-only summary. A nonsignificant result does not prove equivalence. Findings concern children with suspected septic shock and abnormal perfusion.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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The New England journal of medicine (PubMed)

The New England journal of medicine (PubMed). Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42028918/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Journal of midwifery & women's health (PubMed)Sep 7, 2026Research Article

A retrospective analysis of US natality data found no statistically significant yearly difference in neonatal mortality between freestanding birth centers and hospitals among term, singleton, vertex births without major medical risk factors from 2015 through 2024.

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Adjusted neonatal-mortality odds for freestanding birth centers fluctuated around 1.0 across the 10-year study period. No individual year showed a statistically significant difference from hospital births, including 2020 and 2021 when birth-center volume increased.

Key takeaways

The analysis was restricted to births meeting selected low-risk criteria.
The study found no evidence that higher birth-center use during the pandemic years increased neonatal mortality.
The observational design cannot establish that birth setting itself caused the mortality pattern.

Why this matters on shift

The findings add national outcome data for counseling and systems planning around freestanding birth-center care for appropriately selected low-risk pregnancies.

Bedside takeaway

Apply local eligibility, surveillance, escalation, and transfer protocols when caring for planned low-risk birth-center patients.

Nursing implications

Keep eligibility, surveillance, escalation, and transfer decisions anchored to local birth-center criteria and maternal-newborn protocols.

Limitations & cautions

Abstract-only summary. The study used retrospective vital-record data, was limited to selected low-risk births, and cannot exclude residual differences between people who delivered in birth centers and hospitals.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of midwifery & women's health (PubMed). Neonatal Mortality Risk Among Births in Freestanding Birth Centers, 2015 to 2024.

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AI-summarized from the linked source. Review the original article before applying to practice.

Pediatric emergency care (PubMed)Sep 7, 2026Research Article

A double-blind randomized trial found no reduction in vomiting or faster oral tolerance with intravenous pantoprazole versus placebo in children with acute gastroenteritis and persistent vomiting after ondansetron.

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The trial randomized 100 children. Vomiting episodes and oral tolerance at 6 and 12 hours did not differ significantly, while median hospital stay was 2 days with pantoprazole and 1 day with placebo.

Key takeaways

The median participant age was 14 months, and 67% of participants were male.
Oral tolerance at 12 hours was 86% in both groups.
The longer stay associated with pantoprazole requires cautious interpretation because this was a single-center trial.

Why this matters on shift

The trial does not support empiric intravenous proton-pump inhibition for persistent vomiting in pediatric acute gastroenteritis after ondansetron.

Bedside takeaway

Clarify the indication for empiric acid suppression and keep hydration and oral-tolerance assessment central to care.

Nursing implications

Prioritize the ordered hydration and oral-tolerance plan, document ongoing emesis, and clarify the indication before administering empiric acid suppression.

Limitations & cautions

Abstract-only summary. This was a single-center study of 100 children in Tehran, and the abstract does not describe adverse events or explain why hospitalization was longer in the pantoprazole group.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Pediatric emergency care (PubMed). Effect of Intravenous Pantoprazole on Clinical Outcomes in Pediatric Acute Gastroenteritis: A Placebo-Controlled RCT.

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AI-summarized from the linked source. Review the original article before applying to practice.

Journal of neurosurgical anesthesiology (PubMed)Sep 4, 2026Research Article

A five-center randomized trial found similar rescue-opioid use and moderate-to-severe PACU pain with dexmedetomidine-based opioid-sparing analgesia and fentanyl-based analgesia during elective craniotomy for brain tumors.

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Research ArticleResearchMedication SafetyAI summary · original source linked below

The trial randomized 500 adults. Moderate-to-severe PACU pain occurred in 145 of 242 assessed participants in the fentanyl group and 138 of 233 in the dexmedetomidine group, with no significant difference.

Key takeaways

Intraoperative rescue fentanyl use did not differ significantly between groups.
Hypotension was more common with dexmedetomidine, while postoperative shivering was less common.
Other in-hospital outcomes were similar between the two regimens.

Why this matters on shift

An opioid-sparing label did not translate into better early pain control in this trial, and the differing hypotension and shivering profiles remain relevant during perioperative handoff and recovery monitoring.

Bedside takeaway

Monitor pain, hemodynamics, sedation, and shivering in relation to the analgesic regimen and local protocol.

Nursing implications

During PACU and postoperative handoff, monitor pain, hemodynamics, sedation, and shivering according to the administered regimen and local protocol.

Limitations & cautions

Abstract-only summary. The trial involved elective tumor craniotomy at five Indian centers, both groups also received locoregional analgesia, and the abstract does not provide longer-term outcome results in detail.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of neurosurgical anesthesiology (PubMed). Opioid-Sparing Versus Opioid-Based Analgesia for Craniotomy: A Multicenter Randomized Controlled Trial.

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AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

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

IV pantoprazole did not improve vomiting or oral tolerance in pediatric gastroenteritis

Dexmedetomidine did not improve early pain outcomes versus fentanyl for craniotomy