Journal of paediatrics and child health最新文献

Aim: To investigate the long-term quality of life and surgical outcome of female patients with congenital adrenal hyperplasia (CAH).

Methods: Questionnaires for health-related quality of life (HRQoL) outcome (WHO-5, SF-36), lower urinary tract symptoms (ICIQ-FLUTS) and sexual outcome (ICIQ-FLUTSsex) were administered to adult CAH patients. Paediatric CAH patients and their parents were invited to complete WHO-5, PedsQL-4.0-SF15-Generic Core Scales and ICIQ-CLUTS.

Results: Six (46%) adults and 7 (54%) children with 21-hydroxylase-deficiency (age ranged from 8 years to 53 years) were recruited. Eleven (85%) had undergone a feminising genitoplasty. In the adult group, no statistically significant difference was identified in the HRQoL and ICIQ-FLUTS scores. Mean overall score of ICIQ-FLUTSsex was lower but not significantly in adult patients compared to controls (7.3 ± 2.9 vs. 2.9 ± 3.4, P = 0.06). A statistically significant negative correlation (r = -0.98, P = 0.02) was found between age at first operation and role limitations due to emotional problems in SF-36. No statistically significant difference was identified in the self-reported HRQoL and ICIQ-CLUTS scores in the paediatric group compared to controls. However, parent's report showed a statistically significant difference in school functioning (73.8 ± 18.9 vs. 91.2 ± 18.7, P = 0.02) and emotional functioning (80.3 ± 15.9 vs. 94.7 ± 12.7, P = 0.007).

Conclusions: Our data did not show an impaired HRQoL nor long-term lower urinary tract symptoms in CAH patients' self-reports. Healthcare team should pay more attention to adult patient's sexual function.

Aim: This study sought to assess the clinical efficacy of honey suppositories in managing functional constipation in pre-school children, with a focus on those exhibiting Yin deficiency and intestinal dryness according to traditional Chinese medicine principles. The investigation aimed to determine whether honey suppositories could serve as a safer and more efficacious alternative to standard treatments.

Methods: A randomised controlled trial was conducted involving pre-school children diagnosed with functional constipation. They were allocated to either a control group or a treatment group. While both groups received standard care, the treatment group also received honey suppositories. The efficacy of the treatment was evaluated based on the 'Guiding Principles for Clinical Research of New Chinese Medicines', and statistical analysis was performed using SPSS 25.0.

Results: Following treatment, the treatment group demonstrated significantly lower constipation scoring system scores and higher bowel movement frequencies compared with the control group (P < 0.05). The clinical efficacy of the treatment group was notably superior, with a higher rate of complete recovery and effectiveness observed (P < 0.05). Additionally, no significant differences in baseline characteristics were found between the groups, confirming the comparability of the study cohorts.

Conclusions: Honey suppositories offer a promising therapeutic intervention for paediatric functional constipation, with significant clinical benefits over standard care.

Background: Children with cerebral palsy (CP) can develop neuromuscular hip dysplasia (NHD) and radiographic surveillance is recommended, guided by gross motor function classification system (GMFCS) level. This study evaluated the clinical practice of hip surveillance for NHD in a children's hospital and risk factors for abnormal first and subsequent X-rays.

Method: Health data were extracted for 159 participants with CP, 98 male, 52 GMFCS level IV or V (birth years 2008-2018) and linked to electronic radiology datasets.

Results: The median age at diagnosis of CP was 18 months (1-96 months). Thirty-eight participants had X-rays prior to diagnosis and 10 (6%) had no X-ray. Seventy-nine of 111 children classified as GMFCS levels II to V (71%) met both 2008 and 2020 Australian Hip Surveillance Guidelines (AHSG) having the first hip X-ray by 24 months of age. Sixteen participants (11%) had abnormal first hip X-ray (subluxation or migration percentage >30% in 14; MP 90%-100% or dislocation in 2). Univariate analyses showed NHD (MP > 30%) or dislocation at first X-ray was associated with GMFCS IV or V (OR = 6.98 (2.12-22.94), P = 0.001); >4 months between diagnosis and first hip X-ray (OR = 5.60 (1.52-20.59), P < 0.0009) and more common in NZ Māori children than non-Māori children (OR = 3.71 (1.25-11.01), P = 0.012).

Conclusion: Surveillance for NHD did not follow guidelines in almost a third of children, with delays in screening associated with greater risk of NHD at first X-ray. Inequities found for Indigenous NZ Māori children with CP require further investigation and stakeholder consultation.

Aim: This study aimed to describe current strengths and gaps in services for children with feeding needs in Southeast Queensland, Australia from the perspective of key professionals involved in service design and provision.

Methods: A web-based survey was distributed to health professionals involved in providing services to children with feeding needs, staff who triaged/managed referrals, and/or service team leaders in Southeast Queensland.

Results: There were 79 responses to the survey, with 61 of these responses included in the analysis. Respondents identified several strengths in paediatric feeding disorder (PFD) service provision, particularly in the quality of care available for children who met service eligibility requirements. However, respondents also described services as disjointed, with limited coordinated multidisciplinary care available. Respondents frequently described service limitations relating to public service eligibility criteria, long waiting lists, and scant communication between services. Gaps were reported in the care available for children with 'mild' feeding difficulties and/or children who were not considered medically complex. Respondents also identified gaps in services secondary to a limited number of confident and trained professionals offering PFD care, particularly in the private sector.

Conclusions: This study described service providers' perceptions of available care for children with PFD in Southeast Queensland. Overall, the availability of PFD services appeared to be limited by eligibility criteria, service design, and staff capacity, suggesting that children with PFD are not receiving timely, multidisciplinary care in this geographical area. Further research into ideal service design is required to support preventative PFD care.

Aim: This is a retrospective cross-sectional study of oral and maxillofacial biopsies in paediatric population, up to 16 years of age from 1991 to 2021. This study aimed to investigate the frequency, demographic and clinicopathological characteristics of paediatric biopsies according to the diagnosis categories of the main tertiary centre in Malaysia.

Methods: A total of 17294 histopathological reports from Diagnostic Oral Pathology Unit between 1991 and 2021 were retrieved. One thousand eleven histopathological reports that fulfilled the inclusion and exclusion criteria were included. Information of interest was extracted from histopathological reports. The lesions were categorised into 10 diagnosis categories. Descriptive and correlation analysis were performed.

Results: Paediatric oral and maxillofacial biopsies accounted for 5.9% of the total biopsies received. The peak incidence of diagnosis was in age range of 12 to 16 years old and mean age of 11.6 years old (±3.5), with female preponderance. The most common category of diagnosis was salivary gland pathology with mucocele (30%) being the most frequently diagnosed lesions. Lip and labial mucosa were the commonest site of occurrence. Specimen sizes smaller than 1 cm were the most common specimen diameter with mean size of 1.6 cm (±1.5). Age, site of occurrence and specimen size were statistically significant (P < 0.05) with paediatric oral and maxillofacial biopsies.

Conclusion: This is a large-scale study of paediatric oral and maxillofacial biopsies of a tertiary centre over three decades. We hope this data is useful for chairside assessment and aids in diagnosis making.

Aim: Few reports have shown Quality-of-Life long-term outcomes in children with congenital diaphragmatic hernia (CDH) who received extracorporeal membrane oxygenation (ECMO) support. We reviewed the short- and long-term outcomes in CDH patients that were supported with ECMO during their neonatal treatment.

Methods: Telephone interviews of parents of CDH children were performed. The Functional Status Scale (FSS) and the Paediatric Quality of Life Inventory (PedQL, Version 4.0) were completed with the parents. All children with a CDH and supported with ECMO from 2010 to 2023 were included in the study.

Results: Twenty children were identified, with two having two ECMO runs. Birth weight was 3.2 kg (median). ECMO support lasted for (median) 13.6 days (range 3.8 to 39). Twelve patients were alive at the time of the survey. The age (median) at time of the interview was 6.3 years (range 1 to 12). The FSS score showed no impairment (FSS score 6) in any domain in eight patients. Two patients had a score of 7, and two patients had a score of 8 and 9, respectively. The PedQL showed a median score 84.5, with a physical health summary score of 92.5 and a psychosocial health summary score of 78.7. The cardiac specific PedQL inventory score was 77.

Conclusions: ECMO support for CDH patients is associated with functional and Quality of Life outcomes that are similar to that in other PICU discharge populations. Denying ECMO support to CDH patients on the basis of predicted poor long-term outcomes does not appear to be justified.

Aim: Safer Care Victoria updated a clinical guideline on extreme prematurity in 2020, reducing the threshold for offering resuscitation from 23 to 22 weeks gestation. The zone of parental discretion is the interval of shared decision-making between parents and doctors regarding resuscitation decisions. It is especially relevant at this periviable gestation. Our study aimed to establish current practices in antenatal counselling and steroid administration at this cusp of viability, and examine the decisions made during the zone of parental discretion.

Methods: Single centre retrospective cohort study. Sixteen thousand three hundred fifty-four admissions and emergency department presentations between January 2021 and July 2023 were retrieved from Birthing Outcomes System (BOS) and patient details were imported and manually reviewed on Microsoft Excel, with particular note to the gestation at admission/emergency department presentation and duration of admission. Eighty-seven patients were identified as present in the hospital between 21 + 0 and 22 + 6 weeks gestation. These 87 scanned records on Clinical Patient Folder (CPF) were then manually reviewed to identify if antenatal counselling occurred during this window. Thirty-six patients were included who received antenatal counselling between 21 + 0 and 22 + 6 weeks gestation (the remaining patients did not receive antenatal counselling during this window), and relevant data was subsequently extracted from the scanned medical record and analysed using SPSS software (IBM SPSS Statistics 29).

Results: Thirty-six women received antenatal counselling between 21 + 0 and 22 + 6 weeks. 58% decided on full resuscitation and 39% opted for comfort care if their infant was to be born between 22 + 0 and 22 + 6 weeks. All but one baby born premature were exposed to steroids, with 83.3% receiving a full course. Twenty-eight infants (62.2%) were fully steroid loaded at the time of delivery. In those fully steroid loaded, 31.1% of the time steroids were initiated prior to transfer, 50% of the time deferred until neonatal review and a decision regarding the resuscitation status of the baby, and on one occasion requested by the neonatologist before counselling.

Conclusion: Patients at risk for premature birth who attended our hospital at the cusp of viability were generally counselled about the opportunity for resuscitation between 22 + 0 and 22 + 6 weeks gestational age, and offered steroids. Further studies are required to establish whether the content of antenatal counselling, and the timing of steroids, are consistent in this population.