At-a-Glance
Pediatric obstructive sleep-disordered breathing: Six weeks of once-daily intranasal saline resolved symptoms in 29.5% of children 3-12 years old, with cumulative resolution near 50% after 12 weeks. Adding mometasone after nonresponse did not improve outcomes.¹
Nirsevimab seasonal administration: RSV protection is delivered as a single intramuscular dose per season, 50 mg if <5 kg and 100 mg if ≥5 kg, and can be given with routine vaccines.
Pediatric soft tissue sarcoma guidance: The NCCN released its first dedicated pediatric rhabdomyosarcoma guidelines, emphasizing risk-adapted therapy to balance cure and long-term toxicity.²
New & Notable
In a randomized trial of 150 children aged 3-12 years with obstructive sleep-disordered breathing, 6 weeks of once-daily intranasal saline led to symptom resolution in 29.5%.
Among children with persistent symptoms after saline, an additional 6 weeks of intranasal mometasone 50 µg daily resulted in resolution in 35.6%, compared with 36.4% in those who continued saline. The risk difference was -0.9% (95% CI -20.7% to 19%), with no meaningful benefit from corticosteroid therapy.
Cumulative symptom resolution approached 50% after 12 weeks of intranasal therapy, regardless of corticosteroid use. Behavior and quality-of-life outcomes were similar between groups.
Adverse events were common but mild and included nasal irritation and epistaxis.
The study did not include an observation-only control group, limiting assessment of spontaneous improvement.
Findings support intranasal saline as first-line (short-term) therapy before specialist referral.¹
Clinical Pearl
Nirsevimab (Beyfortus): RSV Protection for Infants
Nirsevimab provides passive immunity against RSV as a single intramuscular dose per RSV season, typically October through March. It may be co-administered with routine vaccines.
Infants born during RSV season should receive the dose within the first week of life or at hospital discharge. Those born outside of RSV season should receive it shortly before the season begins. The preferred injection site is the anterolateral thigh.
Topical EMLA cream and oral sucrose should be used to reduce injection pain.
Full video with dosing details and bedside administration tips:
Pediatric Pulse
NCCN Releases First-Ever Pediatric Soft Tissue Sarcoma Guidelines
The National Comprehensive Cancer Network has published its first guidelines dedicated to pediatric soft tissue sarcoma, focusing initially on rhabdomyosarcoma. The guideline emphasizes that pediatric sarcomas are biologically distinct from adult tumors and require age-specific risk stratification.²
For pediatric clinicians, this provides a structured framework to guide treatment intensity while limiting long-term toxicity. The guidance may improve alignment across institutions and support shared decision-making in complex oncologic care.
References
Nixon GM, Anderson D, Baker A, et al. Intranasal treatments for children with sleep-disordered breathing: the MIST+ randomized clinical trial. JAMA Pediatr. Published online January 20, 2026. doi:10.1001/jamapediatrics.2025.5717.
National Comprehensive Cancer Network. NCCN publishes inaugural pediatric soft tissue sarcoma guidelines. February 17, 2026. https://www.nccn.org/home/news/newsdetails?NewsId=5421
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— Dr. Su