What changed recently

NG246 consolidates CG189 and several other NICE obesity products into one guideline covering children as well as adults, and reframes overweight and obesity as chronic conditions needing continuing support rather than episodic weight-loss episodes. It drops the tiered weight-management service model in favour of a range of services, and adds recommendations on non-judgemental language and on the wider determinants of obesity.

The first joint BTS/NICE/SIGN guideline replaced NICE NG80 and parts of BTS/SIGN 158, ending short-acting beta-agonist monotherapy: every patient with asthma should receive inhaled corticosteroid-containing treatment. For those aged 12 and over the preferred pathway is now anti-inflammatory reliever or MART with combination ICS-formoterol, and the diagnostic pathway was reworked around objective testing.

The October 2023 update revised two recommendations: clinicians are reminded that jaundice-related skin colour change is harder to detect in babies with darker skin, and routine urine culture was withdrawn so that it is now considered only where urinary tract infection is clinically suspected.

The 2022 AAP revision raised the bilirubin thresholds for both phototherapy and exchange transfusion in infants of 35 or more weeks' gestation, on evidence that the 2004 curves led to substantial overtreatment. Studies applying the new curves retrospectively found roughly half of infants treated under the old thresholds would no longer qualify, without more severe hyperbilirubinaemia.

Rather than rewriting EPR-3, the 2020 report issued GRADE-based updates in six priority areas: intermittent inhaled corticosteroids and single maintenance-and-reliever ICS-formoterol therapy, add-on long-acting muscarinic antagonists, fractional exhaled nitric oxide testing, indoor allergen reduction, subcutaneous and sublingual immunotherapy, and bronchial thermoplasty. FeNO is newly recommended as an adjunct when the asthma diagnosis or the choice of controller is uncertain in patients aged 5 and over.

The 2020 AAP report replaced the 2006 algorithm with a single unified surveillance-and-screening framework covering developmental, behavioural, social-emotional, autism-specific, motor and psychosocial concerns rather than separate parallel pathways. It sets out a new clinical algorithm, a comparison table of validated screening instruments, and explicit linkage from a positive screen into ongoing care and early intervention referral.

The 2019 AAP guideline replaced the 2011 version with mostly incremental changes, the main substantive addition being a new key action statement requiring clinicians to screen for and manage coexisting emotional, behavioural, developmental and physical conditions in children evaluated for ADHD. Parent training in behaviour management remains first-line for preschoolers aged 4 to 6.

NG87 replaced CG72 with new recommendations spanning recognition, information and support, non-pharmacological management, medication choice, adherence, follow-up and planned discontinuation, and aligned diagnosis with the current DSM criteria. The September 2019 amendment clarified that a pre-treatment ECG is unnecessary before stimulants, atomoxetine or guanfacine when cardiovascular history and examination are normal.