Monthly pediatrics bulletin — October 6, 2026
Period covered: September 6 to October 6, 2026. A solid month: 13 verified items, including a new AAP guideline (urinary tract infection), two large neutral JAMA trials that challenge habits (initial oxygen in moderate-late preterm infants and blood pressure targets in the pediatric ICU), three FDA approvals and the regional measles alert. Six items come from outside North America and Western Europe. Nothing verifiable this month in general pediatric surgery (appendicitis, hernia, malformations), or from Japan, Korea, Russia, Turkey, the Arab world or Brazil: searches in Japanese, Korean, Russian, Turkish, Arabic and Portuguese returned nothing dated within the period that could be confirmed. Several regulatory data points come from secondary coverage (Contemporary Pediatrics) because primary sources blocked access; this is flagged in each case.
Neonatology
1. AIROPLANE: 30% oxygen versus air at birth in moderate-to-late preterm infants
[Clinical trial] [Australia]
Cluster-randomized crossover trial in 26 maternity hospitals in Victoria and New South Wales (8 tertiary, 18 non-tertiary), published in JAMA on September 9. The analysis included 1,818 infants born at 32+0 to 35+6 weeks who started respiratory support within 3 minutes of birth: initial FiO2 0.30 (n=964) versus 0.21 (n=854). Primary outcome, ongoing respiratory support at delivery room departure: 72.6% versus 73.3% (risk difference −0.83 percentage points; 95% CI −4.33 to 2.67; P=.64). Secondary outcomes: later endotracheal ventilation 6.4% versus 9.3% (RR 0.69) and surfactant 7.6% versus 9.9% (RR 0.77).
Why it matters: Pragmatic, academic and prospectively registered (ACTRN12621001267842); the primary result is neutral, so there is no basis for routinely starting at 30% in this gestational range, and the intubation and surfactant differences are secondary and hypothesis-generating only. Applicable to Dominican delivery rooms with a blender; where none is available, the data support starting in air and titrating by oximetry.
https://doi.org/10.1001/jama.2026.14201
https://www.criticalcarereviews.com/paediatrics/airoplane
2. CHAMPS: 80% of stillbirths and under-5 deaths studied were preventable; Klebsiella dominates neonatal sepsis
[Publication] [Sub-Saharan Africa and South Asia; published by the US CDC]
MMWR Surveillance Summary (September 8) from the CHAMPS network in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa (December 2016 to December 2024): 8,500 deaths analyzed out of 18,784 eligible, using minimally invasive tissue sampling, laboratory testing, verbal autopsy and clinical record review. About 80% were judged preventable or possibly preventable. Among 3,230 neonatal deaths, the leading causes were preterm complications (~40%), asphyxia (~38%) and sepsis (~37%); Klebsiella pneumoniae accounted for nearly half of neonatal sepsis. Among 3,199 stillbirths, perinatal asphyxia or hypoxia was present in ~80%.
Why it matters: This is the best available approximation of true cause of death in high-mortality settings, but catchment areas are not nationally representative and facility-based selection bias applies. For Dominican neonatal units, the gram-negative predominance (Klebsiella) questions classic empirical regimens and reinforces infection control; it does not replace local resistance data.
https://doi.org/10.15585/mmwr.ss7506a1
Infectious diseases, vaccines and emergency care
3. New AAP urinary tract infection guideline: 8 days to 5 years, race removed, courses of 7 days or fewer
[Guideline] [United States]
On September 28 the American Academy of Pediatrics released its clinical practice guideline for the diagnosis and treatment of urinary tract infection (Pediatrics, October issue; 158(4):e2026078565), with three accompanying technical reports. It replaces the 2011 guideline (2 to 24 months), retired in 2021: it extends the age range to 8 days–5 years, removes race as a risk factor, updates diagnostic criteria, prefers courses of 7 days or fewer for most children (longer for young infants, difficult infections or high risk), recommends evaluation within 72 hours for children 2 months to 5 years with unexplained fever or urinary symptoms, and brings constipation and bladder-bowel dysfunction into the prevention of recurrence.
Why it matters: This is the most direct practice change of the month and is applicable in the Dominican Republic with almost no adaptation. Limitation of this summary: the full Pediatrics text was not accessible (403), so exact urinalysis and culture thresholds and imaging criteria should be read in the original and in the AAP algorithms before changing protocols.
https://www.aap.org/en/patient-care/urinary-tract-infection-clinical-practice-guideline/
https://www.healthychildren.org/English/news/Pages/aap-updates-guidance-on-urinary-tract-infections-(utis)-in-young-children.aspx
4. Measles in the Americas: 53,957 confirmed cases and 68 deaths in 2026
[Epidemiological alert] [Latin America and the Caribbean — PAHO]
PAHO situation report No. 12 (September 24; epidemiological weeks 1 to 37): 53,957 confirmed cases and 68 deaths (case fatality 0.13%). Guatemala 33,866 cases and 45 deaths; Mexico 12,943 and 22 deaths; United States 3,471; Peru 2,292; Canada 1,120. In Guatemala, 67.5% of cases had no vaccination history and 63% occurred at ages 15 to 39, although infants under one year remain the highest-risk group.
Why it matters: Official, dated data; the report does not mention cases in the Dominican Republic, but with this level of circulation in Central and North America the importation risk is real. It calls for checking two MMR doses at every visit, considering the zero dose (6 to 11 months) for travelers to outbreak areas, and suspecting measles in fever with rash.
https://www.paho.org/sites/default/files/2026/09/pahomeaslessitrep12eng.pdf
5. Bangladesh: measles outbreak passes one thousand deaths, almost all in children
[Epidemiological alert] [Bangladesh]
According to the Directorate General of Health Services (DGHS) as cited by the UNI news agency on September 21, since March 15 there have been 184,035 people with measles symptoms, 20,646 confirmed cases, 159,804 hospitalizations and 1,063 deaths; six children died in the preceding 24 hours alone. According to the country's health ministry, 82% of those infected are under five. The emergency vaccination campaign (6 to 59 months) began in April.
Why it matters: News agency source, not a WHO report: the death count mixes confirmed and suspected deaths and figures differ between outlets, so they should be read as an order of magnitude. Even so, it is the starkest demonstration this year of the cost of falling coverage, and a useful argument against vaccine hesitancy.
https://www.uniindia.com/world/bd-measles-death-toll-1063/187979
https://en.wikipedia.org/wiki/2026_Bangladesh_measles_outbreak
6. Dominican Republic, week 36: dengue up 50%, pertussis from 1 to 8 cases, malaria down 82%
[Epidemiological alert] [Dominican Republic]
Epidemiological bulletin No. 36 of the Ministry of Public Health (through September 12), reported by Listín Diario on September 26, records 338 confirmed dengue cases and one death versus 220 in the same period of 2025. Pertussis: from 1 to 8 cases. Meningococcal disease: from 14 to 20. Leptospirosis: from 135 to 275 cases with 19 deaths. Malaria: from 760 to 137 cases. Cumulative infant deaths went from 1,372 to 1,349 (−2%) and maternal deaths from 126 to 101.
Why it matters: Absolute numbers are low and reporting-dependent (dengue incidence remains among the lowest in the region), so percentages overstate the change. Actionable for pediatricians: rising pertussis (check Tdap in pregnancy and the infant schedule) and meningococcal disease; the data come from press coverage citing the official bulletin, not from the bulletin itself.
General pediatrics, development, nutrition and adolescence
7. STEP Young: weekly semaglutide in children aged 6 to 11 years with obesity (topline results)
[Industry] [Multinational — Novo Nordisk, Denmark]
On September 8 Novo Nordisk announced topline results of the phase 3 STEP Young trial: 165 children aged 6 to under 12 years, semaglutide 1.7 or 2.4 mg weekly (by baseline weight) versus placebo, both with lifestyle intervention, for 68 weeks (follow-up to week 104). The trial met its primary endpoint (percentage change in BMI), with the magnitude not disclosed. At 68 weeks, 40.4% of treated children were below the obesity threshold versus 0% on placebo.
Why it matters: Manufacturer announcement, not peer-reviewed, without the primary endpoint figure or adverse event rates; full data are expected at ObesityWeek 2026. It does not change practice yet: long-term safety for growth, puberty and bone mass is missing, and cost puts it out of reach for most Dominican families.
8. Epicutaneous peanut patch (Viaskin): BLA submitted to the FDA for children aged 4 to 7 years
[Industry] [France / United States — DBV Technologies]
On September 29 DBV Technologies announced submission of its biologics license application to the FDA. It rests on the phase 3 VITESSE trial (NCT05741476): 654 children aged 4 to 7 years at 86 sites in the United States, Canada, the United Kingdom, Europe and Australia; at 12 months, 46.6% responded with the patch versus 14.8% with placebo (difference 31.8 points; P<.001). Discontinuations for adverse events 3.2% versus 0.5%; treatment-related anaphylaxis 0.5%.
Why it matters: This is a submission, not an approval (the FDA has not yet said whether it accepts the file or grants priority review), and the data come from the sponsor. The benefit is partial desensitization against accidental exposure, not tolerance; local relevance is low for now, but it is the least burdensome alternative to oral immunotherapy under review.
Pediatric surgery and subspecialties
9. PRESSURE: permissive blood pressure target in critically ill children
[Clinical trial] [Multinational, 3 countries]
Randomized trial published in JAMA on September 28: 1,900 children with hypotension in 23 pediatric intensive care units in 3 countries (1,814 analyzed; median age 4 years). A permissive mean arterial pressure target above the 5th percentile for age versus usual care. No difference in the composite of mortality and duration of invasive ventilation at 30 days (probabilistic index 0.52; 95% CI 0.49–0.54; P=.23). Total vasoactive dose (norepinephrine equivalents) was 37.5% lower and PICU stay among survivors slightly shorter (159 versus 166 hours).
Why it matters: Large and prospectively registered (ISRCTN20609635); it does not show superiority, but tolerating a lower mean pressure did not worsen outcomes and reduced vasoactive exposure. Applicable to Dominican units at no extra cost, with the caveat that the control arm was usual care rather than a fixed higher target.
https://doi.org/10.1001/jama.2026.19747
https://www.citedrive.com/en/discovery/permissive-blood-pressure-targets-in-pediatric-critical-care/
10. FDA approves apitegromab (Isembyld), the first muscle-targeted therapy for spinal muscular atrophy
[Regulatory FDA] [United States]
Approved on September 11 for patients aged 2 years and older already receiving SMN-targeted therapy. It is a monoclonal antibody that inhibits myostatin activation. SAPPHIRE trial (NCT05156320): 188 nonambulatory patients; in the primary analysis (156 children aged 2 to 12 years) the Hammersmith Functional Motor Scale Expanded improved by 2.2 points versus placebo at one year with 10 mg/kg, and 34.2% versus 13.5% gained 3 points or more. Labeling carries a warning for a signal of increased fracture risk.
Why it matters: Manufacturer-sponsored (Scholar Rock); the gain is modest, it is added to already very costly therapies rather than replacing them, and the fracture signal needs follow-up. No immediate impact in the Dominican Republic, where the bottleneck remains access to baseline therapy and early diagnosis. Data taken from secondary coverage.
11. FDA approves obinutuzumab (Gazyva) for childhood-onset idiopathic nephrotic syndrome
[Regulatory FDA] [United States]
Approved on September 25 to reduce relapse risk in patients aged 2 years and older with frequently relapsing or steroid-dependent childhood-onset idiopathic nephrotic syndrome in complete remission. INShore trial (NCT05627557): 85 patients aged 2 to 25 years; sustained complete remission at week 52 in 95.5% with obinutuzumab versus 73.2% with mycophenolate mofetil (adjusted difference 23.36 points; P=.003). Grade 3 or higher adverse events: 25.0% versus 7.3%; infusion-related reactions 36.4%.
Why it matters: The first drug with a formal indication for this disease in decades, but based on a single 85-patient manufacturer-sponsored trial (Genentech/Roche), with more than triple the severe events and no head-to-head comparison with rituximab, which is already used off label at lower cost. In the Dominican Republic it does not displace rituximab until that comparison exists.
12. FDA extends mavacamten (Camzyos) to adolescents with obstructive hypertrophic cardiomyopathy
[Regulatory FDA] [United States]
Approved on September 30 for pediatric patients weighing 30 kg or more with symptomatic obstructive hypertrophic cardiomyopathy. Phase 3 SCOUT-HCM trial: 44 adolescents aged 12 to 17 years (mean 14.6); the Valsalva left ventricular outflow tract gradient fell by 48.5 mm Hg with mavacamten versus 0.5 mm Hg with placebo (P<.001). Adverse events were similar between groups; no patient had an ejection fraction below 50% and there were no deaths.
Why it matters: The first cardiac myosin inhibitor for adolescents, but based on 44 patients, a hemodynamic rather than clinical endpoint, and manufacturer sponsorship (Bristol Myers Squibb); it requires serial echocardiography because of the risk of systolic dysfunction. Of interest to referral pediatric cardiology; availability and cost limit local use. Data from secondary coverage.
Cross-cutting
13. China announces market exclusivity for pediatric and rare disease medicines
[Regulatory NMPA] [China]
At a State Council Information Office press conference (September 20), the deputy commissioner of the National Medical Products Administration, Yang Sheng, announced that a market exclusivity regime for pediatric and rare disease medicines will be established during the 15th Five-Year Plan (2026–2030), together with implementation of trial data protection. He cited 59 innovative drugs approved so far this year and the "Starlight" program for pediatric oncology.
Why it matters: A policy announcement with no exclusivity periods or published regulation and no clinical data; it is included because it would replicate, in the world's second-largest pharmaceutical market, the incentive that multiplied pediatric trials in the United States and Europe. No immediate practical effect. (source in Chinese)
https://finance.sina.com.cn/tech/roll/2026-09-21/doc-inispymz0815635.shtml
Upcoming meetings and dates
- AAP National Conference & Exhibition 2026: October 2–6, San Diego (closes today). The program included implementation of the new urinary tract infection guideline; abstracts are worth reviewing over the coming weeks.
- ObesityWeek 2026: full STEP Young results (semaglutide in children aged 6 to 11 years) are expected. Exact date not verified; confirm on the meeting website.
- Dates for ALAPE, SLIPE or Dominican Society of Pediatrics meetings in the next 6 weeks could not be verified.
Ready-to-paste LinkedIn post
Monthly pediatrics bulletin — October 6, 2026 13 verified items from the past month: JAMA, Pediatrics, MMWR, PAHO reports and FDA decisions. Three worth your time: • New AAP urinary tract infection guideline: covers 8 days to 5 years, removes race as a risk factor and prefers courses of 7 days or fewer. Diagnostic thresholds should be read in the original. • AIROPLANE (JAMA, n=1,818): in infants born at 32 to 35 weeks, starting with 30% oxygen did not reduce ongoing respiratory support versus air (72.6% vs 73.3%). Neutral result; secondary outcomes are hypothesis-generating only. • PRESSURE (JAMA, n=1,900): a permissive mean arterial pressure target in critically ill children gave the same outcomes with 37.5% less vasoactive drug. It does not show superiority. Full bulletin, with a critical reading of each study and links to primary sources: https://boletinesmedicos.com/en/pediatria/2026-10-06.html #Pediatrics #Neonatology #ChildHealth #UTI #CriticalCare
Ready-to-paste X (Twitter) post
Pediatrics, October 2026: AAP's new UTI guideline (8 days to 5 years, antibiotics ≤7 days) and AIROPLANE (n=1,818) finds no benefit of starting at 30% oxygen vs air in moderate-late preterm infants. https://boletinesmedicos.com/en/pediatria/2026-10-06.html
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