Two Paeds In A Pod

Dr Ian Lewins
  • 5.0 (1)
  • MEDICINE

2 Paeds in a Pod is a clinical paediatrics podcast exploring the decisions, dilemmas, and systems that shape everyday practice. While rooted in paediatric emergency medicine, the conversations range across the breadth of paediatrics — from acute presentations and diagnostic uncertainty to wider service design, professional development, and the evolving evidence base. Each episode brings structured discussion to real-world clinical questions. Alongside practical case-based reflection, we highlight research that has caught our eye and consider how emerging evidence should — or should not — influence frontline care. This podcast is for paediatric consultants, trainees, advanced practitioners, and clinicians who want thoughtful, evidence-aware conversation grounded in the realities of modern practice. This podcast is for medical education purposes only and should not replace advice you have received from a medical practitioner.

  1. 1D AGO

    Episode 84: The Febrile Infant Lottery

    2 PAEDS IN A POD Episode 84 | The Febrile Infant Lottery Released: [24th May 2026] | Runtime: 19 minutes ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ EPISODE SUMMARY ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ This episode opens with a large London study showing that the care a febrile young infant receives depends heavily on which hospital they attend, with full adherence to national guidance achieved in only one in five presentations and over-investigation almost as common as under-investigation. The second main story examines a French randomised controlled trial of automated closed-loop oxygen titration in bronchiolitis — negative on its primary endpoint of length of stay, but with coherent secondary signals on saturation targeting and oxygen flow that make it a useful lesson in reading past the abstract. What's Caught My Eye covers a systematic review of electronic sepsis alerts in children, a multicentre cohort of in-hospital neonatal head injury on the postnatal ward, and a study asking whether comprehensive respiratory virus panels change outcomes in discharged children. ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ MAIN STORY 1: How much does the febrile infant's hospital matter? ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ The febrile infant under ninety days is one of the highest-stakes presentations in paediatric emergency and acute care. National guidance exists precisely to compress that diagnostic uncertainty into something consistent. This retrospective study across twenty-one London hospitals, run through the London REACH network, tested whether care actually looks the same once that guidance is applied — and the answer is that it does not. Key findings: - 2,008 presentations of infants aged 90 days or younger; 41.1% were febrile at the point of assessment - Blood tests performed in 73.7% overall, but ranging from 55.4% to 96.7% across sites; lumbar puncture 40.8% overall, range 17.1% to 70.7%; urinalysis 63.4% overall, range 43.4% to 85.4% - Antibiotics started in 57.7% overall (site range 35.4% to 90.2%); admission in 63.5% overall (site range 46.7% to 99.2%) - Full adherence to national clinical practice guidelines in only 21.9% of presentations; partial adherence 24.4%; non-adherence 31.2%; over-adherence 23.5% - Adherence was higher in infants under 28 days and in those febrile during assessment The clinical message is that variation runs hard in both directions. We tend to fear under-investigation and the missed serious bacterial infection, but over-investigation — unnecessary lumbar puncture, septic screen, intravenous antibiotics and admission in a well baby — was almost as common, and it is not a neutral act. The practical focus for departments is the infant who is afebrile by the time they are assessed, where the guidance gives least direction and the variation is widest. This is London-specific, retrospective, and the study period overlaps the later pandemic, so the absolute numbers will not transfer directly to a district general setting. Reference: Habermann S, Hartzenberg R, Loucaides EM, et al. (London REACH Network). European Journal of Pediatrics. Published May 2026. DOI: https://doi.org/10.1007/s00431-026-06938-y ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ MAIN STORY 2: Automated oxygen titration in bronchiolitis ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Oxygen titration in bronchiolitis is a constant low-level drain on nursing time across the winter. This trial tested whether handing the titration to a closed-loop device improves the outcome that matters to families and to flow — length of hospital stay. Key findings: - Multicentre randomised controlled trial, ten paediatric departments in France, 2018 to 2023; 103 infants aged 1 to 12 months with acute bronchiolitis requiring oxygen, severe bronchiolitis excluded - Primary endpoint negative: median stay 71.0 hours with the FreeO2 device versus 69.6 hours with manual titration (p=0.39) - Time within the target oxygen saturation zone 89.4% with automation versus 74.9% with manual titration (p0.05) - Median oxygen flow 0.1 L/min with automation versus 0.3 L/min manual (p0.05); no significant difference in re-hospitalisation at 7 or 30 days or in non-invasive ventilation use The bottom line is that automated titration does not shorten length of stay, so it should not be argued for on that basis, but the secondary signals are coherent — better time in target range at lower oxygen flows. The wider teaching point is that a negative primary endpoint in an underpowered trial (103 infants over five years, across the pandemic) is not the same as nothing having happened; length of stay in bronchiolitis is driven by feeding and overall trajectory far more than by oxygen delivery precision, so it may always have been an insensitive endpoint for this intervention. This sits within the larger UK conversation on permissive hypoxaemia and oxygen saturation targets in bronchiolitis; it is worth reading alongside the BIDS trial and current oxygen-target guidance rather than in isolation. Reference: Cros P, Martin A, Consigny M, et al. Archives of Disease in Childhood. Published online May 2026 (advance online publication). DOI: https://doi.org/10.1136/archdischild-2025-329523 ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ WHAT'S CAUGHT MY EYE ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ 1. Do electronic sepsis alerts actually save children? A systematic review and narrative synthesis of twelve studies of EMR-embedded automated sepsis alerts in children under eighteen. Alerts improved process measures — faster time to antibiotics in four of six studies and faster fluids in two of five — without increasing hospital admissions or overall antibiotic use, but a mortality benefit was shown in only one study, in a PICU population. As more NHS trusts switch on electronic sepsis triggers, this is the honest evidence position to know: the process metrics move, the hard outcome data do not yet exist. Reference: Driver B, Babl FE, Cheng D, et al. Journal of Paediatrics and Child Health. Published online May 2026 (advance online publication). DOI: https://doi.org/10.1111/jpc.70412 --- 2. The neonatal head injury that happens on your postnatal ward A retrospective cohort across fifteen Italian maternity units of newborns who fell during routine postnatal stay, with the PECARN rule applied retrospectively. Thirty-nine newborns, median age at injury 32 hours, most falls at night in rooming-in; a quarter (25.6%) had a clinically important traumatic brain injury but none needed neurosurgery or had sequelae, while 88.9% of low-risk babies were imaged anyway. A low-severity, high-anxiety event most clinicians never see described, sitting right at the edge of where PECARN was never validated — the newborn. Reference: Corsini I, Cecchetti M, Giacalone M, et al. Hospital Pediatrics. Published online May 2026 (advance online publication). DOI: https://doi.org/10.1542/hpeds.2025-008952 --- 3. Does a bigger respiratory virus panel change anything? A retrospective cohort of 2,346 children discharged from a paediatric emergency department with a viral respiratory illness, comparing a limited three-pathogen panel against a comprehensive twenty-two-pathogen panel. There was no difference in seven-day return visit rate after adjustment (aOR 0.96, 95% CI 0.67–1.38) and no difference in interventions or disposition on return. For the well child being discharged with an obvious viral illness, the bigger panel did not change outcomes — a clean stewardship argument for testing less, not more. Reference: Stephan AM, Pérez-Lizardi JY, Stern LM, et al. Pediatric Emergency Care. Published online May 2026 (advance online publication). DOI: https://doi.org/10.1097/PEC.0000000000003622 ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ KEY TAKEAWAYS ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ - Febrile infant care varies widely between hospitals, with full guideline adherence in only one in five presentations - Over-investigation of the well febrile infant is almost as common as under-investigation, and is not a harmless default; the afebrile-on-assessment infant is where guidance is weakest - Automated oxygen titration in bronchiolitis did not reduce length of stay, but a negative primary endpoint in an underpowered trial warrants reading the secondary data and asking what the trial was powered to find - Electronic sepsis alerts reliably speed up antibiotics and fluids but the mortality evidence is not yet established — useful context before a trust adopts one - For the well child discharged with a viral respiratory illness, a comprehensive virus panel did not improve outcomes over a limited one ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ FULL REFERENCE LIST ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ All articles retrieved from PubMed. 1. Habermann S, Hartzenberg R, Loucaides EM, Lawson G, Carr D, Maconochie I, Nijman RG; London REACH Network. Variation in management of febrile infants younger than 90 days across London: a retrospe

    18 min

  2. MAY 10

    Episode 83: Knife Crime, Febrile Infants, and What's Caught My Eye

    2 Paeds in a PodShow Notes — Episode 83Knife Crime, Febrile Infants, and What's Caught My EyeReleased: May 2026 | Runtime: ~20 minutes In this episode, Ian covers what's caught his eye in the paediatric literature this fortnight. The main story looks at a landmark national review of child deaths from knife wounds in England — and what it means for those of us working in paediatric emergency and urgent care. He then turns to new data on febrile infants aged 29 to 60 days and the evolving evidence base around risk stratification in that notoriously tricky age group. The episode closes with three quick picks from this fortnight's journal sweep: point-of-care lung ultrasound for pneumonia, reframing conversations about paediatric palliative care, and a flag for the new Surviving Sepsis Campaign paediatric guidelines — which we'll be coming back to in a dedicated episode soon. Main Story 1 — Knife Crime Deaths in Children in England (2019–2024)Knife-related deaths in children and young people represent one of the most pressing — and most inequitable — public health challenges in England today. This month, Roberts and colleagues published a review using the National Child Mortality Database covering every child under 18 who died of a knife wound between April 2019 and March 2024. The headline findings: 145 children died over the five-year period — roughly one every two weeksMean age at death was 14.4 years; 90% were maleBlack or Black British children died at a rate more than 13 times higher than white children when corrected for population sizeChildren in the most deprived areas of England had over 7 times the risk of death compared with those in the least deprived areas60% of children died before reaching hospitalOf those who reached hospital, 57% underwent a thoracotomy — reflecting the severity of injuries sustainedInjuries to the chest and neck were responsible for 76% of fatal wounds75% of children had been known to social services prior to their death58% had experienced domestic violence and abuse51% had documented neurodiversity or mental health concerns Why this matters for paediatric practice: These were not invisible children. The vast majority were known to statutory services. For clinicians working in paediatric emergency and urgent care, this paper is a reminder that every child who comes through our doors carries a history — and that our role extends beyond the presenting complaint. It also raises important questions about pre-hospital intervention, penetrating trauma training in paediatric settings, and the role of the ED as a potential point of early intervention for children at risk. Knife injuries are not confined to major urban centres — the data show deaths distributed across all regions of England. Reference: Roberts T, Odd D, Coveney J, et al. Emergency Medicine Journal. Published April 2026. https://doi.org/10.1136/emermed-2025-215154 Main Story 2 — Bacteraemia and Bacterial Meningitis in Low-Risk Febrile Infants Aged 29–60 DaysThe febrile infant aged 29 to 60 days occupies some of the most uncomfortable clinical territory in paediatric emergency medicine. Too old for the automatic full-septic-screen approach applied under 28 days, but too young to rely on clinical examination alone. This paper from Burstein, Xie, and Kuppermann — published in JAMA Pediatrics — examines how the updated PECARN (Pediatric Emergency Care Applied Research Network) febrile infant rule performs in an international sample. What the PECARN rule involves: The rule uses a combination of clinical and laboratory parameters to stratify infants into low, intermediate, and higher risk for invasive bacterial infection (bacteraemia and bacterial meningitis). Key components include temperature, urinalysis findings, absolute neutrophil count, procalcitonin, and — where indicated — CSF analysis. Why this paper matters: The original PECARN derivation and validation studies were predominantly North American. This international validation is an important step in understanding how the rule performs across different healthcare systems, bacterial epidemiology, and rates of prior antibiotic exposure. The full data are behind a paywall, but the publication itself signals continued maturation of the evidence base. For UK practice: NICE guidance for this age group tends towards more liberal investigation. Whether structured risk stratification tools like PECARN could safely reduce lumbar punctures and admissions in a subset of genuinely low-risk infants is an active and important question for UK paediatric emergency practice. Key learning point: Know the PECARN framework. Know its components. And watch this space — this is a field moving quickly. Reference: Burstein B, Xie J, Kuppermann N. JAMA Pediatrics. Published April 2026. https://doi.org/10.1001/jamapediatrics.2026.0971 What's Caught My Eye1. Point-of-Care Lung Ultrasound for Paediatric PneumoniaA review in Pediatric Emergency Care summarising the diagnostic performance of bedside lung ultrasound (LUS) for pneumonia in children. Multiple meta-analyses demonstrate sensitivity up to 94% and specificity up to 96% — at least comparable to chest X-ray, often better, and without the radiation burden or logistical delay. The key caveat: distinguishing bacterial consolidation from viral illness or asthma on ultrasound requires training and careful clinical correlation. Overlapping sonographic appearances are common and the technique is operator-dependent. For anyone working in paediatric ED or acute settings who hasn't yet developed confident POCUS skills for respiratory presentations — this is the evidence base saying it's worth the investment. Reference: Marzook N. Pediatric Emergency Care. Vol 42(5):391–399. Published April 2026. https://doi.org/10.1097/PEC.0000000000003533 2. Shifting the Narrative Around Paediatric Palliative CareStewart and colleagues at Evelina London Children's Hospital, writing in BMJ Paediatrics Open, have produced a thoughtful narrative review examining why paediatric palliative care referral happens late — and what we can do about it. The central argument: the words "palliative care" carry such strong associations with dying that clinicians often delay conversations for fear of undermining hope, and families often hear "giving up" where clinicians intend "additional support." Crucially, directly debunking this myth — saying "palliative care isn't just about end-of-life" — can backfire by activating the very association you're trying to dispel. What works better, the authors argue, is replacing the narrative rather than fighting it. Lead with what palliative care actually looks like — coordinated, holistic, life-enhancing support that runs alongside active treatment from the point of diagnosis. The paper offers a useful metaphor: palliative care is the umbrella, not the rain. You reach for it before the storm, not once you're soaked. A practical, communication-focused paper with something genuinely useful for anyone — trainee or consultant — who has ever felt uncomfortable raising that conversation. Reference: Stewart CE, Vare C, Kerr-Elliott T, et al. BMJ Paediatrics Open. Vol 10(1). Published April 2026. https://doi.org/10.1136/bmjpo-2025-004413 3. Surviving Sepsis Campaign Paediatric Guidelines 2026 — FlagThe 2026 update to the Surviving Sepsis Campaign international guidelines for paediatric sepsis and septic shock is out. A panel of 68 international experts produced 61 statements — including 20 new recommendations and 13 updates from the 2020 version. Of note: only three of the 61 recommendations are based on high or moderate quality evidence. We'll be covering this in full in an upcoming episode. For now — get it on your reading list. Reference: Weiss SL, Peters MJ, et al. Pediatric Critical Care Medicine. Vol 27(4):379–434. Published March 2026. https://doi.org/10.1097/PCC.0000000000003927 Key TakeawaysThe knife crime mortality data are a call to action for every clinician working with children — clinically, in terms of safeguarding awareness, and as advocates for the children most at riskPECARN febrile infant risk stratification is maturing internationally — if your department doesn't use a structured approach for the 29–60 day febrile infant, now is the time to revisitPoint-of-care lung ultrasound for paediatric pneumonia has strong diagnostic performance — sensitivity and specificity both exceed 90% in meta-analyses, and the skill is worth developingWhen introducing paediatric palliative care, replace the narrative rather than debunking it — lead with what it is, not what it isn'tThe new Surviving Sepsis Campaign guidelines are out — full episode coming soon ReferencesAll articles retrieved from PubMed. Based on articles retrieved from PubMed: Roberts T, Odd D, Coveney J, et...

    18 min
  3. IV Aminophylline in Acute Severe Asthma: Does It Still Have a Role in Paediatric Emergency Care?

    10/25/2025

    IV Aminophylline in Acute Severe Asthma: Does It Still Have a Role in Paediatric Emergency Care?

    Clinical Question In children presenting with acute severe asthma, does intravenous aminophylline improve meaningful clinical outcomes compared to standard therapy? ⸻ Background IV aminophylline has historically been used as a second-line infusion in severe paediatric asthma. However, contemporary escalation strategies increasingly prioritise: • Oxygen • High-dose nebulised salbutamol • Systemic corticosteroids • IV magnesium sulphate This raises the question: does aminophylline still offer incremental benefit? ⸻ The Evidence Reviewed A systematic review published in Archives of Disease in Childhood analysed: • 9 randomised controlled trials • 466 children • Standard therapy ± IV aminophylline Outcomes assessed: • Asthma severity scores • Length of stay • Admission rates • PICU admission • Intubation rates • Adverse effects ⸻ Key Findings No significant benefit in: • Speed of clinical improvement • Admission rates • PICU transfer • Intubation rates • Length of hospital stay Significant increase in adverse effects: • Nausea and vomiting (3–5x higher) • Headache • Tremor • Irritability • Arrhythmias Overall: No improvement in meaningful outcomes, with increased morbidity. ⸻ Important Caveat A 1998 study (Young & South) suggested possible benefit in the most critically unwell, treatment-refractory children, including: • Reduced duration of intubation • Potential improvement in lung function This suggests a potential narrow rescue-therapy window. ⸻ Implications for Paediatric Emergency Practice (2025) Current best evidence supports: 1. Oxygen 2. Nebulised salbutamol 3. Systemic corticosteroids 4. IV magnesium 5. Structured escalation planning IV aminophylline should be considered: • A rescue therapy of last resort • Not routine second-line treatment ⸻ Take-Home Message IV aminophylline has historical presence but limited modern evidence of benefit. For most children with acute severe asthma, it increases adverse effects without improving outcomes. Its role in 2025: rare, selective, and critically contextual.

    3 min
  4. Episode 82: The FIDO study

    12/20/2024

    Episode 82: The FIDO study

    In this episode we talk to Dr Etimbuk Umana, the lead author of the FIDO study looking at the management of febrile infants in the Emergency Department. FIDO is a PERUKI sponsored study and was recently published in The Lancet: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00540-6/fulltext

    31 min
  5. Episode 81: Priority Setting in PEM research with PERUKI

    05/12/2024

    Episode 81: Priority Setting in PEM research with PERUKI

    2 Paeds returns with a fresh new look, new in association with team at PERUKI. In our first collaboration we talk to Dr Charlotte Sloane about the current major PERUKI project - establishing the current research priorities for the next 5 years in paediatric emergency medicine. If you want to get involved go to www.peruki.org.uk or email Charlotte at csloane04@qub.ac.uk You can also watch us on YouTube

    26 min
  6. Episode 80: Dexmedetomidine for paediatric sedation

    05/08/2022

    Episode 80: Dexmedetomidine for paediatric sedation

    We talk to Dr Tom Jackson about his article in Archives of Disease in Childhood looking at the use of Dexmedetomidine as a sedative agent fro children undergoing MRI scans in a district general hospital. Is it better the NICE recommended medications? Article can be found here: https://adc.bmj.com/content/early/2022/03/10/archdischild-2021-322734

    27 min
  7. Episode 79: Infant Milks and Formulae

    04/03/2022

    Episode 79: Infant Milks and Formulae

    There are so many infant milks and formulae available that it can be confusing to healthcare professionals, let alone parents. Where did they come from, what do they contain and what about specialist prescription-only formulae. Host Dr Ashley Reece takes a deep dive into all these issues with our special guest Bahee Van de Bor - dietician and spokesperson of the British Dietetic Association. You can explore more about Bahee's work at www.ukkidsnutrition.com

    42 min
  8. Episode 78: Climate Change and paediatrics

    11/14/2021

    Episode 78: Climate Change and paediatrics

    We are all busy professionals with lots to do in a very limited amount of time, so why should we be concerned about climate change? That's nothing to do with paediatricians surely? Dr Katie Knight explains why its everything to do with paediatricians and the number one public health emergency for our patients not just tomorrow but today.

    21 min
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About

2 Paeds in a Pod is a clinical paediatrics podcast exploring the decisions, dilemmas, and systems that shape everyday practice. While rooted in paediatric emergency medicine, the conversations range across the breadth of paediatrics — from acute presentations and diagnostic uncertainty to wider service design, professional development, and the evolving evidence base. Each episode brings structured discussion to real-world clinical questions. Alongside practical case-based reflection, we highlight research that has caught our eye and consider how emerging evidence should — or should not — influence frontline care. This podcast is for paediatric consultants, trainees, advanced practitioners, and clinicians who want thoughtful, evidence-aware conversation grounded in the realities of modern practice. This podcast is for medical education purposes only and should not replace advice you have received from a medical practitioner.

Information

  • Creator
    Dr Ian Lewins
  • Years Active
    2017 - 2026
  • Episodes
    85
  • Rating
    Clean
  • Copyright
    © All rights reserved
  • Show Website
    Two Paeds In A Pod

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