| Endotracheal poractant alfa did not reduce the duration of invasive mechanical ventilation in infants with critical bronchiolitis in a 232-patient sham-controlled phase 2 trial (median 64.9 h vs 62.0 h; p=0.86).1 |
| Carbapenem use increases the risk of invasive fungal infection in extremely preterm and very low birth weight neonates, and fluconazole prophylaxis should be considered when additional fungal risk factors are present. |
| The FDA announced a nationwide Class II recall of approximately 89,000 bottles of Children's Ibuprofen Oral Suspension after consumer reports of a gel-like mass and black particles in the berry-flavored liquid.2 |
Secondary outcomes including ventilation index, oxygenation index, oxygen saturation index, time to readiness for spontaneous breathing trial, and duration of PICU stay did not differ between groups. No deaths occurred in either arm, and air leak rates were equivalent at 1%.1
The safety profile of poractant alfa was similar to sham, with seven serious adverse events in six infants in the surfactant group versus six events in six infants in the sham group. These findings contrast with three earlier small trials (pooled n=79) that had favored surfactant for reducing IMV duration and improving gas exchange.1
Limitation: The dose regimen (200 mg/kg initial, then 100 mg/kg) may not be optimal for the complex pathophysiology of bronchiolitis compared with neonatal surfactant deficiency.
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Clinical Implication
Routine early endotracheal surfactant administration should not be recommended for infants with critical bronchiolitis requiring mechanical ventilation. Surfactant remains a potential rescue option only in scenarios such as proven severe surfactant deficiency or failure to meet oxygenation targets on conventional ventilation.
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Meropenem disrupts protective flora and increases the risk of invasive fungal infection in extremely preterm and very low birth weight neonates who already carry multiple fungal risk factors. Fluconazole prophylaxis should be considered for neonates receiving carbapenems with additional risk factors such as central venous catheters or parenteral nutrition.
| When to Consider Meropenem | Stewardship Considerations |
|---|---|
| Prior broad-spectrum antibiotic exposure with treatment failure | Avoid use when narrower spectrum agents are appropriate |
| Risk factors for MDR gram-negative organisms | Reserve as a last-line agent across all age groups |
| Confirmed resistant infections | Carbapenem-resistant Enterobacteriaceae risk with overuse |
| Bottom line: Meropenem should be reserved for infants and children with prior broad-spectrum antibiotic exposure, MDR gram-negative risk factors, or confirmed resistant infections. In neonates, concurrent fluconazole prophylaxis should be considered when additional fungal risk factors are present. |
Nearly 90,000 Bottles of Children's Ibuprofen Recalled Due to Foreign Substance
The FDA announced a Class II recall of approximately 89,000 bottles of Children's Ibuprofen Oral Suspension (100 mg/5 mL, berry flavor) manufactured by Strides Pharma for Taro Pharmaceuticals. The recall was initiated on March 2 after consumer reports of a gel-like mass and black particles in the liquid. Affected lot numbers are 7261973A and 7261974A (expiration January 31, 2027).2
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What This Means in Practice
Advise caregivers to check for lot numbers 7261973A and 7261974A on Children's Ibuprofen Oral Suspension bottles and discontinue use immediately if found. The foreign substance may pose a choking hazard or cause gastrointestinal irritation.
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- Semple MG, Donohue C, Price L, et al. Endotracheal surfactant for infants with life-threatening bronchiolitis (BESS): a randomised, blinded, sham-controlled, phase 2 trial. Lancet Respir Med. Published online March 21, 2026.
- Nearly 90,000 bottles of children's ibuprofen recalled due to reports of foreign substances. CBS News. March 20, 2026. Accessed March 26, 2026. https://www.cbsnews.com/news/childrens-ibuprofen-recall-90000-bottles-fda/
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