With millions of journal articles published yearly, it is impossible to keep up. This time the second DFTB Bubble Wrap, from Aghia Sophia Children’s Hospital ED, Athens, Greece tell us what is new in the world of paediatric literature…
Led by Spyridon Karageorgos, Locum Consultant at Paediatric Emergency Department, Honorary Lecturer at QMUL and proud QMUL DFTB PEM MSc alumni and Stavros Antonopoulos who is the Chief of PEM department at Aghia Sophia Children’s Hospital.
Happy reading!
If you or your team want to submit a review, please get in touch with Dr Vicki Currie at @DrVickiCurrie1 or vickijanecurrie@gmail.com.
Article 1: Readmission to ED post-Acute Respiratory Infection
Cappelli E, Ciofi Degli Atti M, Ravà L, Zama B, D’Amore C, Ricotta L, Cristaldi S, Barbieri MA, Villani A, Raponi M. Factors Predicting Readmission to the Emergency Department After a Diagnosis of Acute Respiratory Infection: A Two-year Experience at a Pediatric Tertiary Care Hospital in Italy. Pediatr Infect Dis J. 2025 Aug 27. doi: 10.1097/INF.0000000000004941. Epub ahead of print. PMID: 40865117.
What’s it about?
This single-center retrospective cohort study examined factors associated with emergency department (ED) readmission within seven days post discharge in children with acute respiratory infections (ARIs).
Among 33,933 patients, 2,203 (8.8%) were readmitted. Variables analyzed included demographics, diagnosis, time/date of presentation to the ED and clinical condition at arrival, triage code, comorbidities and treatment-related factors.
Multivariate logistic regression models identified strong predictors of readmission (OR>2): systematic antibacterial prescription at the first visit, absence of symptoms at initial evaluation and first triage code assignment. Age did not significantly influence readmission. Regarding diagnosis, children with acute bronchiolitis had a significantly higher risk of return (OR: 1.85) compared with those with pneumonia, croup, or other respiratory conditions.
Why does it matter?
ARIs are the most common reason for ED visits. Understanding readmission causes, offers chances to develop targeted interventions that optimize discharge, improve care effectiveness and lessen healthcare burden.
Take a step back and dive into this post Respiratory Tract Infections in children – Don’t Forget the Bubbles
Clinically Relevant Bottom Line
Recognizing key predictors of ARI readmission enables safer discharge, reduces use of antibiotics, guides parental education regarding warning signs and ultimately improves health care quality.
Reviewed by Argyro Konstantopoulou & Maria – Eirini Polymenopoulou
Article 2: Paediatric Cross Sectional Cardiac Imaging in Europe
Ramcharan T, Roest A, Voges I, Cantinotti M, Grotenhuis H, Garrido AO, Pasqualin G, Di Salvo G, Krupickova S, Róth G, Jossif A, Salaets T, Brun H, Grant B, Glessgen C, Petropoulos A, Doros G, Pärna H, Koubsky K, Olejnik P, Lubaua I, Herberg U, Idorn L, Rotés AS, Khraiche D, Anjos R, Bharucha T, Bonello B, Marek J, Valsangiacomo E, Greil FG, Miller O, Raimondi F, McMahon CJ. Pediatric Cross-Sectional Cardiac Imaging in Europe: Current Status, Disparities, and Potential Solutions: A Survey from the Association for European Pediatric and Congenital Cardiology (AEPC) Imaging Working Group. Pediatr Cardiol. 2025 Sep 20. doi: 10.1007/s00246-025-04027-9. Epub ahead of print. PMID: 40974416
What’s it about?
The AEPC Imaging Working Group surveyed 95 affiliated centers on current practices regarding Cross-Sectional Cardiac Imaging (Cardiac Computed Tomography – CCT and Cardiac Magnetic Resonance imaging – CMR) in Pediatric Cardiology; 42 (44%) centers in 25 European countries responded.
The results show that adoption is high: 40/42 centres perform CCT and 38/42 perform CMR. Most have >10 years’ experience (CCT 90%, CMR 84%). CCT is usually led by paediatric radiologists (61%), whereas CMR is mostly led by paediatric cardiologists (58%); many of the remainder are performed jointly. Only one centre runs interventional CMR. 80% use 3D printing, while extended-reality segmentation is less common. There is marked inter-centre variability in anaesthesia/sedation strategies for younger children.
Training in cross-sectional imaging is patchy: about half of centers train fellows in CCT/CMR and some send trainees elsewhere. Training requirements and minimum case-log thresholds vary between centres.
Most respondents (84%) favours AEPC-led guidelines and believes that cross-sectional imaging research could be improved.
Why does it matter?
Cross-sectional imaging is a quickly growing subfield of Paediatric Cardiology and is critical for CHD diagnosis and management. Yet European practice varies in who runs the service, how young children are imaged and how cardiologists are trained. This article raises awareness on current practice and could consequently serve as a guidance for future educational and research programs in the field.
A reminder of some CHD basics can be found here: Congenital heart disease in the ED – Don’t Forget the Bubbles
Clinically Relevant Bottom Line
The authors and respondents call for AEPC-endorsed guidelines, structured fellowships, and clearer certification. Extended collaboration, standardized protocols and expanded training will result in improved care for paediatric patients.
Reviewed by Athanasios Sarigiannidis & Loukia Ioannidou
Article 3: : Take-home ondansetron for kids with gastroenteritis
Freedman SB, Williamson-Urquhart S, Plint AC, Dixon A, Beer D, Joubert G, Pechlivanoglou P, Finkelstein Y, Heath A, Zhang JZ, Wallace A, Offringa M, Klassen TP; Pediatric Emergency Research Canada Innovative Clinical Trials Study Group. Multidose Ondansetron after Emergency Visits in Children with Gastroenteritis. N Engl J Med. 2025 Jul 17;393(3):255-266. doi: 10.1056/NEJMoa2503596. PMID: 40673584.
What’s it about?
This multicenter, randomized, double-blind trial in six Canadian pediatric emergency departments asked whether giving families a short supply of ondansetron to use at home after an ED visit for gastroenteritis could reduce illness severity. A total of 1030 children were randomised in the trial. Caregivers were provided with six oral doses to use as needed over 48 hours. The primary outcome was moderate-to-severe gastroenteritis within seven days, defined by the modified Vesikari score. ~5% of children in the ondansetron group developed moderate-to-severe illness compared with 12.5% in the placebo group—an absolute risk reduction of 7.4%. Ondansetron also reduced the total number of vomiting episodes during the first 48 hours. However, there was no difference in vomiting duration, unscheduled healthcare visits, or IV fluid use. Safety outcomes were similar across groups, with no new concerns identified.
Why does it matter?
A single ED dose of ondansetron is common practice, but prescribing additional doses has remained controversial. Clinicians have worried about masking dehydration or rare cardiac complications, whereas evidence is limited. This trial provides high-quality prospective data that a short take-home course reduces clinically meaningful illness severity without increasing return visits or adverse events. For families, it means less vomiting, fewer trips back to ED, and greater confidence managing illness at home.
Check out this post Gastroenteritis – Don’t Forget the Bubbles
Clinically Relevant Bottom Line
For children six months and older with gastroenteritis-related vomiting who are well enough for discharge, a short as-needed ondansetron course after ED treatment can reduce disease severity and vomiting burden. It appears safe, effective, and practical, provided contraindications are considered and hydration advice is emphasized.
Reviewed by Georgia Panagiotou & Vassiliki Theologi
Article 4: Incidence, Diagnoses, and Outcomes of Paediatric Nontraumatic Chest Pain Attended by Ambulance
Okyere D, Nehme E, Mahony E, Stub D, Dawson LP, Ball J, Meadley B, Anderson D, McManamny T, Nehme Z. Incidence, Diagnoses, and Outcomes of Pediatric Nontraumatic Chest Pain Attended by Ambulance. JAMA Netw Open. 2025 Sep 2;8(9):e2533962. doi: 10. Okyere D, Nehme E, Mahony E, Stub D, Dawson LP, Ball J, Meadley B, Anderson D, McManamny T, Nehme Z. Incidence, Diagnoses, and Outcomes of Pediatric Nontraumatic Chest Pain Attended by Ambulance. JAMA Netw Open. 2025 Sep 2;8(9):e2533962. doi: 10.1001/jamanetworkopen.2025.33962.
What’s it about?
This retrospective, population-based cohort study aims to determine the incidence, diagnoses and outcomes of pediatric EMS-attended nontraumatic pain (4277 children) and included all pediatric patients (<18 years of age) who sought care through Emergency Medical Services (EMS) during the period from January 1, 2015, to June 20,2019, in Victoria, Australia. Data were obtained from EMS records documenting all calls and patient encounters within the specified timeframe. The main outcome was a serious outcome (death, cardiac arrest, resuscitation, ICU admission) within 72 hours.
The findings indicated a predominance among female patients, older age groups, and individuals residing in underprivileged areas. The most common clinical presentation was an asthmatic profile. Children exhibiting abnormal vital signs were associated with more severe outcomes and hospital admission within 72 hours. Cardiological cases accounted for no more than 10% of the total, with approximately 2.5% classified as cardiac in nature.
This study only looks at presentations that contacted EMS therefore is not truly representative of the population as a whole (as does not include patients who presented directly to ED).
Why does it matter?
Chest pain is a common complaint in the community; however it is relatively uncommon among children. Nevertheless, certain characteristics must be highlighted to distinguish cases that require urgent medical evaluation from those considered to be of non-critical significance.
Clinically Relevant Bottom Line
These results suggest the need for clear, standardized clinical pathways and risk stratification tools specific to paediatric chest pain to improve assessment accuracy and avoid unnecessary escalation of care.
Reviewed by Aikaterini Vougiouklaki & Anastasia Polytarchou
Article 5: ICS-LABA versus SABA for kids with mild asthma
Hatter L, Holliday M, Oldfield K, Kearns C, Barry T, Black M, Bruce P, Colman A, Dickinson E, Eathorne A, Harwood M, Hills T, Lamb R, Kerse K, Krishnamoorthy S, Martindale J, Semprini A, Shortt N, McNamara D, Byrnes CA, Dalziel SR, Bush A, Weatherall M, Beasley R; CARE study team. Budesonide-formoterol versus salbutamol as reliever therapy in children with mild asthma (CARE): a 52-week, open-label, multicentre, superiority, randomised controlled trial. Lancet. 2025 Oct 4;406(10511):1473-1483. doi: 10.1016/S0140-6736(25)00861-X. Epub 2025 Sep 28. PMID: 41033330.
What’s it about?
This was a 52-week, open-label, multicentre RCT in 360 children (5–15 y) with mild asthma using SABA-only, comparing as-needed budesonide–formoterol vs as-needed salbutamol.
Primary outcome included the annualised moderate/severe attack rate. Budesonide–formoterol reduced attacks 0.23 vs 0.41/patient-year (RR 0.55, 95% CI 0.35–0.86); time-to-first attack was longer for this group (HR 0.48, 95% CI 0.31–0.74). Safety and growth were similar among groups.
Strenghs are: This was the first paediatric RCT (down to 5 y) showing an ICS–formoterol reliever prevents more attacks than SABA-only in children 5-15yrs—with no growth penalty. This is a practical, real-world regimen (pMDI+spacer)
Limitations are that secondary outcomes weren’t adjusted for multiplicity. This was an open-label design → potential bias. There were no dose counters, so reliever use/ICS exposure could not be compared. This was during the COVID-19 era recruitment lowered severe-attack rates → underpowered for severe outcomes.
Check out this post The new Australian Sustainable Asthma Care Roadmap – Don’t Forget the Bubbles
Why does it matter?
This is the first randomised controlled trial of ICS–formoterol versus SABA as reliever monotherapy in children aged 5–15 years with asthma in a real-world setting. The available evidence suggests that for patients aged 5–15 years with asthma currently using SABA reliever monotherapy, switching to budesonide–formoterol reliever monotherapy is more effective at preventing asthma attacks.
Clinically Relevant Bottom Line
This study supports the existing evidence and describes the profile of the asthmatic patient who would benefit the most of using the ICS-formoterol as needed regimen (male adolescent (12-15 years), never smoker with high FeNO, without severe asthma attacks in the past 12 months). However, younger patients might benefit from such a regimen as well, with no proven growth penalty.
Reviewed by Vassiliki Maria Kymioni & Panagiota Panagiotou
If we missed something useful or you think other articles are worth sharing, please add them in the comments!
That’s it for this month—many thanks to our reviewers for scouring the literature so you don’t have to.
Vicki Currie, DFTB Bubble Wrap Lead, reviewed all articles.