Clinical Insights - Jan 27, 2026

Recent retrospective data describe real-world antihypertensive prescribing patterns in preterm neonates in the absence of formal guidelines. In a single-center cohort of 87 preterm infants with a median gestational age of 32.1 weeks, propranolol was the most frequently used agent (61%), followed by esmolol (12%) and captopril (8.8%). Propranolol was typically initiated near a target dose, with a median minimum dose of 1.14 mg/kg/day, and maintained with few adjustments over a median treatment duration of 292 hours. In contrast, captopril was started at lower doses (median 0.17 mg/kg/day) and titrated upward over time, reflecting cautious escalation in the setting of immature renal function.¹

Infants born at younger gestational ages (median 29.5 weeks) required significantly higher weight-based propranolol doses and experienced longer hospitalizations, suggesting that degree of prematurity influences both dosing intensity and duration of therapy. Notably, only 11% of infants treated with antihypertensive agents carried a formal ICD diagnosis of neonatal hypertension, highlighting a disconnect between bedside treatment decisions and documentation practices.

These findings are primarily descriptive. The retrospective, single-center design and substantial missing birthweight data (55%) limit generalizability and preclude assessment of efficacy or safety outcomes. Nonetheless, the study provides a useful snapshot of current practice patterns that may inform future multicenter studies and guideline development.¹ 

Empiric antibiotic selection for hospitalized children with community-acquired pneumonia depends on vaccination status and severity. 

For fully immunized children with mild to moderate CAP, IV ampicillin or penicillin G are appropriate first-line agents. Ceftriaxone should be reserved for children who are not fully vaccinated, have severe CAP, or when higher pneumococcal MICs are a concern.

Routine atypical or MRSA coverage is not recommended. Macrolides should be added only when atypical pathogens cannot be ruled out, and MRSA coverage limited to specific high-risk presentations such as respiratory failure, empyema, necrotizing pneumonia, or influenza. Consider transitioning to oral antibiotics at 48-72h if there is clinical improvement.

Watch the full video for a step-by-step inpatient CAP antibiotic framework.

Neonatal pharmacy staffing standards released by the Neonatal and Paediatric Pharmacists Group on January 12 emphasize the need for expanded pharmacy involvement at both the clinical and system levels to support medication safety and standardization across neonatal services. The guidance includes recommendations for dedicated pharmacist capacity to oversee network-wide initiatives, reflecting increasing recognition of pharmacists’ role beyond individual patient care.

While formal network-level neonatal pharmacist roles are uncommon in the U.S., the standards reinforce concerns about insufficient neonatal pharmacy staffing and highlight opportunities for health systems to strengthen pharmacy support to improve safety and quality of care.²

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— Dr. Su