BMJ

Objectives To examine whether epidural analgesia in labour is associated with neonatal neurological morbidity, other neonatal morbidity, neonatal sepsis, low Apgar score, neonatal mortality, and childhood cerebral palsy.Design National population based cohort study.Setting All NHS hospitals in Scotland, using Scottish NHS administrative linked data.Participants 495 695 women in labour with a singleton pregnancy between 24+0 and 42+6 weeks’ gestation delivering vaginally or via unplanned caesarean birth between 1 January 2007 and 31 December 2019.Main outcome measures The primary outcome was neonatal neurological morbidity defined using ICD-10 codes as one or more of hypoxic ischaemic encephalopathy, neonatal seizures, intraventricular haemorrhage, intraventricular infarction, periventricular leukomalacia, meningitis, encephalitis, kernicterus, hypotonia, birth asphyxia, or other cerebral diagnosis occurring within 28 days of birth. Secondary outcomes were other neonatal morbidity (one or more of acidosis at birth (cord artery pH <7.10), traumatic birth injury, brachial plexus injury, necrotising enterocolitis, respiratory distress syndrome, respiratory failure, pneumothorax, hypoglycaemia, or hypothermia), neonatal sepsis, Apgar score <4 at five minutes following birth, neonatal mortality, and cerebral palsy diagnosed at any point during childhood.Results Of the 495 695 women, 114 897 (23.2%) had epidural analgesia in labour. Neonatal neurological morbidity occurred in 434 babies (0.9 per 1000 births, 95% confidence interval (CI) 0.8 to 1.0). No association was found between epidural analgesia in labour and neonatal neurological morbidity (adjusted relative risk 0.87, 95% CI 0.68 to 1.12), other severe neonatal morbidity (1.17, 0.90 to 1.51), neonatal sepsis (1.11, 0.90 to 1.37), Apgar score <4 at five minutes (0.97, 0.87 to 1.09), neonatal mortality at 28 days (0.81, 0.62 to 1.06), or cerebral palsy in childhood (0.80, 0.60 to 1.06). Findings were consistent across subgroups including women considered to have high risk pregnancies, preterm births, and across different modes of birth.Conclusion Epidural analgesia during labour was not associated with clinically significant risks of harm to newborn babies or children, including risks of neonatal morbidity, death, or cerebral palsy. These findings have important policy implications, and support widening availability and equitable access to epidural analgesia as a safe component of intrapartum care.Data sharing: De-personalised study data are not held by the authors and cannot be made available directly by the authors. Access to these data may be granted to accredited researchers who submit an application to NHS Scotland’s electronic Data Research and Innovation Service (eDRIS), and whose application is approved in accordance with the relevant governance and regulatory requirements. The authors of this manuscript have no authority to grant access to, share, or approve the release of the data.

MPs and health experts have urged the soon-to-be prime minister Andy Burnham to withdraw from the US-UK drug deal after an analysis in The BMJ showed its deadly cost.The deal has committed the UK to doubling the proportion of gross domestic product it spends on new branded medicines from 0.3% to 0.6%.It has also forced the National Institute for Health and Care Excellence (NICE) to increase its cost effectiveness threshold for drugs from £20 000-£30 000 to £25 000-£35 000.1Researchers calculated that the agreement could lead to 229 000 excess deaths over the next decade. This is because the NHS will have to make cuts to existing services to pay for the increased drug costs—estimated at £45bn for England alone.2Speaking to The BMJ at a parliamentary event on the deal on 13 July, Sally Gainsbury—senior policy analyst for think tank …

Ban this counterproductive form of disciplinePhysical, or corporal, punishment—euphemistically known as smacking, spanking, and slapping—involves hitting or otherwise hurting children to modify their behaviour.1 Most countries do not consider it assault and permit its use in homes and schools.2 Unicef estimates that over 1 billion of the world’s 2.4 billion children are disciplined this way each year, making it the commonest form of violence against children.34In 2025 a World Health Organization report cited “overwhelming scientific evidence” that physical punishment is linked entirely with harms and no benefits to children, describing it as a public health concern requiring policy and educational interventions to end its use.5 This body of research from lower and higher income settings shows four main findings.First, physical punishment is ineffective at improving children’s behaviour in the short or long term.678 Instead, children who are physically punished tend to become more aggressive and have more behaviour problems than others.567 A recent analysis of UK representative data, for example, found that adolescents who experienced physical punishment in early childhood were 35% more likely to report having hit, pushed, or shoved someone at age 14 years.9Second, it increases the risks of numerous harms to children. Children who are physically punished have significantly worse …

Cave and Harnden are right that passive pharmacovigilance is no longer adequate for modern medicines regulation.1 The burden of adverse drug reactions makes this a patient safety problem, not merely a data management inconvenience.2 The unresolved question is how the proposed UK Health Data Research Service will convert …

European Union officials plan to ban under 13s from signing up to social media platforms across the bloc, and the move could come as soon as this autumn.In a press conference on 13 July European Commission president Ursula von der Leyen pledged to push for EU-wide rules on restricting social media access to children.1“Social media is not a toy . . . Now we need action at European level,” she said.The announcement came after the publication the same week of a report from the EC’s Special Panel on Child Safety Online, which found that nearly 60% of children and adolescents in Europe had experienced emotional or psychosocial problems online.The panel found that young people spend 4-6 hours a day on screens, adding up …

Martin Savage was a distinguished and internationally renowned paediatric endocrinologist who, with his colleagues in Italy, was among the first to study “transition” in paediatric endocrinology. This is now widely recognised as a vital part of the care of children as they move through the often difficult teenage years to full adult independence.Savage developed a busy paediatric endocrinology department while a consultant at Queen Elizabeth Hospital in Hackney. He also ran the diabetes service and understood that the future care of lifelong disease required collaboration in the transition between childhood and adult care.The pivotal moment for Savage was his appointment at Barts, not solely as a paediatric endocrinologist but also as a member of the adult department. His warmth and enthusiasm led to close relationships with his adult colleagues, and he became deeply involved in both his varied clinical practice and the rapidly developing molecular biology research in the department at that time.Savage described himself as primarily a clinician and clinical scientist, but he was also an innovator with a talent for hypothesis driven research and a work …

Almost 300 000 patients will be eligible for a new heart failure drug after its approval by the National Institute for Health and Care Excellence (NICE).In final draft guidance NICE recommended the pill finerenone as an option for adults with symptomatic chronic heart failure with preserved or mildly reduced ejection fraction to reduce the risk of unplanned admission to hospital.1Adding finerenone to usual care reduces the total number of worsening heart failure events, including the need for people with heart failure to visit hospital urgently or having to stay in hospital, by about 18% when compared with a placebo, NICE said.Finerenone may also reduce the risk death from a cardiovascular event such as a heart attack or stroke, or other causes, a study published in 2024 found, although the evidence for this is more …

In this paper by Fiolet and colleagues ( BMJ 2018;360:k322; doi:10.1136/bmj.k322, published 14 February 2018), a transcription error was identified.In the final sentence of the results section, the hazard ratio and 95% confidence interval …

A national newborn screening programme for spinal muscular atrophy (SMA) will be rolled out throughout England, the government has announced.It comes after campaigners complained that existing plans for a more limited testing programme were unfair.The government announced in April that a pilot scheme to include testing for SMA as part of the heel prick test would start in October 2026. Taken when babies are 5 days old, this blood test currently screens for 10 rare but serious conditions such as sickle cell disease and cystic fibrosis.However, the pilot scheme would cover only 72% of newborns in England, prompting criticism that this amounted to a postcode lottery.In response, the government …