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Letter to the Editor. 致编辑的信
IF 1.6 4区 医学 Q2 PEDIATRICS Pub Date : 2024-10-07 DOI: 10.1111/jpc.16687
Qian Zhang
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引用次数: 0
Novel pathogenic variant in GATA6 causes neonatal diabetes mellitus due to pancreas malformation and congenital heart disease. GATA6 的新型致病变体会导致胰腺畸形和先天性心脏病引起的新生儿糖尿病。
IF 1.6 4区 医学 Q2 PEDIATRICS Pub Date : 2024-10-07 DOI: 10.1111/jpc.16683
María Tornero-Hernández, Alba Cayuela-Hernández, Clara Chover-Martínez, Sara León-Cariñena, Juan Diego Toledo, Sergio Martín-Zamora, Álvaro Solaz-García
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引用次数: 0
Psychosocial impact of alopecia areata in paediatric and adolescent populations: A systematic review. 儿童和青少年群体中斑秃对社会心理的影响:系统综述。
IF 1.6 4区 医学 Q2 PEDIATRICS Pub Date : 2024-10-07 DOI: 10.1111/jpc.16678
Isabella J Tan, Mohammad Jafferany

Alopecia areata is an autoimmune disorder characterised by sudden hair loss, and can range from patchy baldness to more severe forms such as alopecia totalis and universalis. Hair loss can have a profound impact on self-esteem and body image, particularly during childhood and adolescence. Understanding the psychosocial impact of alopecia areata in paediatric and adolescent populations is crucial to address the emotional and social challenges faced by these patients. The aim is to review the existing literature for clinical studies and reports investigating the psychosocial impact of alopecia areata in paediatric and adolescent populations. A systematic review of the literature was performed using PubMed, Cochrane and Embase databases from inception to July 2023. Included articles assessed the psychosocial impact of alopecia areata in paediatric and adolescent populations. Of 79 total articles, 10 were identified as meeting the inclusion criteria. Several studies highlighted self-esteem, emotional distress and social challenges as features of psychosocial manifestations. Factors such as stress, psychiatric comorbidities and familial issues are significantly associated with alopecia areata in these populations. The heterogeneity of studies precluded data synthesis and analysis. A majority of the included studies evaluated short-term findings. Alopecia areata has significant psychosocial impacts in paediatric and adolescent populations, with studies emphasising the negative effects on self-esteem, body image and quality of life. Additional research is required to better elucidate this relationship and draw meaningful conclusions to guide clinical support and interventions.

斑秃是一种以突然脱发为特征的自身免疫性疾病,可以是斑秃,也可以是更严重的全秃和普秃。脱发会对自尊和身体形象产生深远影响,尤其是在儿童和青少年时期。了解斑秃对儿童和青少年群体的社会心理影响对于解决这些患者面临的情感和社会挑战至关重要。本研究旨在回顾现有文献中有关调查儿童和青少年群体中斑秃对社会心理影响的临床研究和报告。我们使用 PubMed、Cochrane 和 Embase 数据库对从开始到 2023 年 7 月的文献进行了系统性回顾。纳入的文章评估了儿童和青少年群体中斑秃对社会心理的影响。在总共 79 篇文章中,有 10 篇符合纳入标准。一些研究强调,自尊、情绪困扰和社会挑战是心理社会表现的特征。在这些人群中,压力、精神疾病合并症和家庭问题等因素与斑秃密切相关。由于研究的异质性,无法对数据进行综合分析。纳入的大多数研究都对短期结果进行了评估。斑秃对儿童和青少年的心理社会影响很大,研究强调了斑秃对自尊、身体形象和生活质量的负面影响。要更好地阐明这种关系,并得出有意义的结论以指导临床支持和干预措施,还需要进行更多的研究。
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引用次数: 0
Subclinical left ventricular dysfunction and laboratory predictor of activity in children with ulcerative colitis: A single-centre study. 亚临床左心室功能障碍和溃疡性结肠炎患儿活动的实验室预测因子:单中心研究
IF 1.6 4区 医学 Q2 PEDIATRICS Pub Date : 2024-10-05 DOI: 10.1111/jpc.16681
Ahmed Said Behairy, Gehan Hussein, Ahmed Afifi, Mary Michel, Amera M Hasnoon

Aim: We aimed to detect subclinical cardiac impairment in children with ulcerative colitis (UC) and test the association between absolute monocytic count (AMC) and lymphocyte-to-monocyte ratio (LMR) with disease activity.

Methods: A group of children with UC and a comparable group as healthy controls were included. All children underwent history-taking, clinical examination and blood testing for complete blood counts with white blood cell differentials, LMR and erythrocyte sedimentation rate (ESR). Disease severity was assessed using the Paediatric UC Activity Index score. We used echocardiography for tissue Doppler, M-Mode, two-dimensional and three-dimensional (3D) speckle tracking echocardiography (STE) for left ventricular function assessment.

Results: Forty children were included, 20 with UC as cases, and 20 healthy controls. Disease activity was mild in 75% cases and moderate in 25% cases. Cases had significantly higher ESR than the control group (P < 0.001). Among cases, positive correlations were observed between monocytic, and platelet counts with left ventricular end-diastolic diameter (r = 0.5, P = 0.02; r = 0.5, P = 0.03). Children with UC had significantly lower ejection fraction and impaired left ventricular systolic function compared to the control group (P < 0.001) assessed by 3D STE, yet this observation was not reached by the conventional method (P = 0.3).

Conclusions: In children with UC, 3D STE could detect subclinical left ventricular systolic dysfunction that conventional echocardiography could not. AMC and LMR showed no significant difference between children with UC and controls.

目的:我们旨在检测溃疡性结肠炎(UC)患儿的亚临床心脏功能损害,并检验单核细胞绝对计数(AMC)和淋巴细胞与单核细胞比值(LMR)与疾病活动性之间的关联:方法:纳入一组 UC 患儿和一组健康对照组。所有儿童均接受了病史采集、临床检查和血液检测,包括全血细胞计数和白细胞差值、淋巴细胞与单核细胞比值(LMR)和红细胞沉降率(ESR)。疾病严重程度采用儿科 UC 活动指数评分进行评估。我们使用超声心动图进行组织多普勒、M型、二维和三维斑点追踪超声心动图(STE)评估左心室功能:共纳入 40 名儿童,其中 20 名为 UC 病例,20 名为健康对照组。75%的病例有轻度疾病活动,25%的病例有中度疾病活动。病例组的血沉明显高于对照组(P在 UC 患儿中,三维 STE 可检测出亚临床左心室收缩功能障碍,而传统超声心动图则无法检测。AMC 和 LMR 在 UC 患儿和对照组之间无明显差异。
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引用次数: 0
Empowering general practitioners to diagnose and treat attention-deficit/hyperactivity disorder: Insights from an Australian pilot program 增强全科医生诊断和治疗注意力缺陷/多动症的能力:澳大利亚试点项目的启示。
IF 1.6 4区 医学 Q2 PEDIATRICS Pub Date : 2024-10-04 DOI: 10.1111/jpc.16684
Alison Poulton, Simone Heiler, Jessica Bedford, Lujing Liu, Marilyn Dyson, Habib Bhurawala
<p>As the number of Australians seeking treatment for attention-deficit/hyperactivity disorder (ADHD) has been steadily increasing,<span><sup>1</sup></span> this has put increasing strain on the pathways to treatment. In 2023, the Australian Senate published a report on Assessment and support services for people with ADHD, noting the barriers to accessing assessment and treatment for ADHD.<span><sup>2</sup></span> The government has yet to respond. A particular issue was the limited capacity and high costs of specialist treatment. These findings are consistent with the 2019 Henry Review,<span><sup>3</sup></span> which identified a serious problem with access to ADHD services for young people in New South Wales.</p><p>The difficulties with accessing specialist treatment for ADHD are putting increased pressure on general practitioners (GPs). A recent survey of Australian GPs found that 92% had identified ADHD in one or more of their patients within the previous year,<span><sup>4</sup></span> but inadequate access to specialists for diagnosis and treatment was a major concern.</p><p>In order to address this bottleneck, we are piloting a model of integrated care with upskilled GPs. Our model differs from the pilot study of integrated GP-paediatrician care by Hiscock and colleagues in Victoria.<span><sup>5</sup></span> In that study, the paediatricians attended the individual practices to support the GPs with paediatric consultations. Our study relates solely to ADHD in individuals aged 4–25 years, diagnosed in childhood. With this particular cohort of patients, it is more time-efficient to train GPs in a specialised ADHD clinic. The GPs work at the weekly ADHD clinic for 3 months under supervision and are delivered a four-module course on ADHD. After an assessment of competence, they are authorised to diagnose and treat children and adolescents with ADHD independently in general practice.</p><p>Three GPs have qualified from this program since June 2023 and are running a weekly ADHD clinic in primary care. Between them, they see up to six new patients per week and have enrolled 98 participants in the ethically approved pilot study. They now have a 4-week waiting time and are receiving referrals from Orange to Sydney. Reflections from the GPs are given in Table 1.</p><p>We will shortly review our first year in terms of the number treated, clinical outcomes and patient satisfaction. The clinical outcomes of interest are changes in teacher ratings using the IOWA Conners,<span><sup>6</sup></span> growth parameters and adverse effects of medication (including medication changes made due to side effects). In the long term, we hope to increase the capacity for treating ADHD within the Nepean Blue Mountains Local Health District. This model of care could be expanded to include adults and implemented in other districts across Australia (in the first instance expanded into a multicentre study), ultimately empowering GPs to provide accessible, holistic care to t
由于寻求治疗注意力缺陷/多动症(ADHD)的澳大利亚人数量一直在稳步增加,1 这给治疗途径带来了越来越大的压力。2023 年,澳大利亚参议院发布了一份关于多动症患者评估和支持服务的报告,指出了多动症评估和治疗方面存在的障碍。一个特别的问题是专科治疗能力有限且费用高昂。这些发现与 2019 年的 "亨利审查"(Henry Review)3 一致,该审查发现新南威尔士州的青少年在获得多动症服务方面存在严重问题。最近对澳大利亚全科医生进行的一项调查发现,92%的全科医生在过去一年中曾发现一名或多名患者患有多动症4 ,但无法获得专科医生的诊断和治疗是一个主要问题。为了解决这一瓶颈问题,我们正在与经过培训的全科医生一起试行一种综合护理模式。我们的模式不同于希斯科克及其同事在维多利亚州进行的全科医生-儿科医生综合护理试点研究5 。我们的研究只针对 4-25 岁、在儿童时期被诊断出的多动症患者。对于这种特殊的患者群体,在专门的多动症诊所培训全科医生更为省时省力。全科医生每周在 ADHD 诊所工作 3 个月,接受指导,并学习关于 ADHD 的四单元课程。经过能力评估后,他们被授权在全科诊所独立诊断和治疗患有多动症的儿童和青少年。自 2023 年 6 月以来,已有三名全科医生从该计划中获得资格,并在初级保健中开设了每周一次的多动症诊所。三位全科医生自 2023 年 6 月起获得了该计划的资格,他们每周都会在基层医疗机构开设多动症门诊。他们每周会接诊多达六名新患者,并已招募了 98 名参与者参与这项获得伦理批准的试点研究。他们现在的候诊时间为 4 周,并接受从奥兰治到悉尼的转诊。表 1 列出了全科医生的反思。我们很快将从治疗人数、临床结果和患者满意度等方面对第一年的工作进行回顾。我们关注的临床结果是教师使用 IOWA Conners6 进行评分的变化、生长参数和药物治疗的不良反应(包括因副作用而更换药物)。从长远来看,我们希望提高尼皮恩蓝山地方卫生区治疗多动症的能力。这种治疗模式可以扩大到成人,并在澳大利亚其他地区实施(首先扩大到多中心研究),最终使全科医生有能力为各年龄段的多动症患者提供方便、全面的治疗。AP披露了Shire/武田公司的个人酬金和非经济支持,以及提交作品之外的收入和来自Disruptive Publishing(《简单治疗多动症》)的图书版税;其他作者未披露任何信息。
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引用次数: 0
Oral feeding practices in medically complex infants receiving prolonged high-flow nasal cannula support: A retrospective cohort study. 长期接受高流量鼻插管支持的病情复杂婴儿的口服喂养方法:回顾性队列研究。
IF 1.6 4区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 DOI: 10.1111/jpc.16679
Emily Cox, Jasneek Chawla, Madison Moore, Sandra Schilling, Miriam Cameron, Sally Clarke, Chelsea Johnstone, Jeanne Marshall

Aim: To characterise the feeding profile and care pathway for infants receiving prolonged high-flow nasal cannula (HFNC) respiratory support for management of a chronic condition at one facility from January to December 2021.

Methods: Data regarding medical history, HFNC admission details (reason for HFNC, HFNC duration, flow rate), feeding outcomes and speech pathology care were collected from electronic records of HFNC-dependent infants (requiring HFNC ≥2-3 L/kg for ≥5 consecutive days). Infants with acute respiratory conditions (e.g. bronchiolitis) were excluded.

Results: This study included 24 participants (median corrected age at admission 5.3 weeks, range -6 to 18.6). Of these, 15 (60%) had a condition/s that affected more than one body system (e.g. congenital diaphragmatic hernia), requiring the care of multiple specialities. Median length of HFNC use was 37.5 days (range 11-188). Twenty (83.3%) infants were referred for speech pathology (SLP) input while on HFNC support. For those referred, frequency of SLP input was variable (0-3 sessions/week), and HFNC support requirements were the most common barrier to SLP intervention (n = 9, 45%). Twelve (54.5%) infants demonstrated improvement in their primary feeding method by discharge; however, only two (9.1%) infants were discharged on full oral feeds.

Conclusions: This study demonstrates variability in oral feeding management in infants with prolonged HFNC-dependence at our centre. Respiratory support with HFNC was identified as a barrier to progressing oral feeding. Further research is required to determine if oral feeding can be safely undertaken in this cohort. This is imperative to ensure that long-term feeding outcomes are not negatively impacted by current practice.

目的:分析一家医疗机构在2021年1月至12月期间为治疗慢性病而接受长时间高流量鼻插管(HFNC)呼吸支持的婴儿的喂养情况和护理路径:从依赖 HFNC 的婴儿(需要 HFNC ≥2-3 L/kg,连续≥5 天)的电子记录中收集有关病史、HFNC 入院详情(HFNC 原因、HFNC 持续时间、流速)、喂养结果和语言病理学护理的数据。患有急性呼吸道疾病(如支气管炎)的婴儿除外:这项研究包括 24 名参与者(入院时矫正年龄中位数为 5.3 周,范围为 -6 至 18.6 周)。其中 15 人(60%)的病情影响到一个以上的身体系统(如先天性膈疝),需要多个专科的护理。使用 HFNC 的中位时间为 37.5 天(11-188 天不等)。有 20 名婴儿(83.3%)在接受 HFNC 支持期间转诊到语言病理科(SLP)接受治疗。在这些转诊婴儿中,SLP 咨询的频率不一(0-3 次/周),而 HFNC 支持要求是 SLP 干预的最常见障碍(n = 9,45%)。12名婴儿(54.5%)在出院时主要喂养方式有所改善;然而,只有2名婴儿(9.1%)出院时采用全口喂养:这项研究表明,本中心对长期依赖 HFNC 的婴儿的口服喂养管理存在差异。使用 HFNC 的呼吸支持被认为是促进口喂的一个障碍。还需要进一步研究,以确定是否可以安全地对这部分婴儿进行口喂。这对于确保长期喂养结果不会受到当前做法的负面影响至关重要。
{"title":"Oral feeding practices in medically complex infants receiving prolonged high-flow nasal cannula support: A retrospective cohort study.","authors":"Emily Cox, Jasneek Chawla, Madison Moore, Sandra Schilling, Miriam Cameron, Sally Clarke, Chelsea Johnstone, Jeanne Marshall","doi":"10.1111/jpc.16679","DOIUrl":"https://doi.org/10.1111/jpc.16679","url":null,"abstract":"<p><strong>Aim: </strong>To characterise the feeding profile and care pathway for infants receiving prolonged high-flow nasal cannula (HFNC) respiratory support for management of a chronic condition at one facility from January to December 2021.</p><p><strong>Methods: </strong>Data regarding medical history, HFNC admission details (reason for HFNC, HFNC duration, flow rate), feeding outcomes and speech pathology care were collected from electronic records of HFNC-dependent infants (requiring HFNC ≥2-3 L/kg for ≥5 consecutive days). Infants with acute respiratory conditions (e.g. bronchiolitis) were excluded.</p><p><strong>Results: </strong>This study included 24 participants (median corrected age at admission 5.3 weeks, range -6 to 18.6). Of these, 15 (60%) had a condition/s that affected more than one body system (e.g. congenital diaphragmatic hernia), requiring the care of multiple specialities. Median length of HFNC use was 37.5 days (range 11-188). Twenty (83.3%) infants were referred for speech pathology (SLP) input while on HFNC support. For those referred, frequency of SLP input was variable (0-3 sessions/week), and HFNC support requirements were the most common barrier to SLP intervention (n = 9, 45%). Twelve (54.5%) infants demonstrated improvement in their primary feeding method by discharge; however, only two (9.1%) infants were discharged on full oral feeds.</p><p><strong>Conclusions: </strong>This study demonstrates variability in oral feeding management in infants with prolonged HFNC-dependence at our centre. Respiratory support with HFNC was identified as a barrier to progressing oral feeding. Further research is required to determine if oral feeding can be safely undertaken in this cohort. This is imperative to ensure that long-term feeding outcomes are not negatively impacted by current practice.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Force is strong with this one 这一次,"原力 "很强大。
IF 1.6 4区 医学 Q2 PEDIATRICS Pub Date : 2024-09-30 DOI: 10.1111/jpc.16680
Mick O'Keeffe
<p>And now here you are. Last day of training.</p><p>New job as a consultant paediatrician starting soon.</p><p>Taking a moment to look back on your journey to this point.</p><p>Fleeting images strung together, a montage of your rise through the ranks.</p><p>You recall the early inklings of a professional affinity.</p><p>Perhaps your student immersion in paediatrics piqued your curiosity.</p><p>No other rotation came close.</p><p>Maybe as a junior doctor you found yourself volunteering to see the youngsters in a mixed emergency department, with colleagues only too happy for you to take on this responsibility.</p><p>‘A bit of a knack’ with kids? You wondered whether you might be on to something.</p><p>Others noticed and gave encouragement. <i>You should think about paediatrics……</i>.</p><p>Think about it you did. Felt it as well.</p><p>Something special in these encounters.</p><p>You met the unblinking gaze of wary toddlers, the boisterous fidgeting of primary schoolers, the half-smile of self-conscious teenagers, and wondered each time; ‘How can I best help you today, cherished child?’</p><p>A feeling that……<i>what could possibly be better than this?!</i></p><p>Your decision was made. To test the waters, to dive into paediatrics training.</p><p>Starry-eyed ambitions soon crashed up against the reality of the task ahead.</p><p>The grind.</p><p>The daily worksheet. Overtime. Night shifts. Weekends.</p><p>Study somehow shoehorned into the remainder of a week, month after month after….</p><p>Trying to help your loved ones understand. Thankful that they did.</p><p>Gratitude also for the work itself. The adrenaline charge of the life-threatening. The intricacies of each subspecialty. The challenge of weaving together the threads of complex care. The slow-burning turnaround of the developmental and behavioural.</p><p>The unique therapeutic triad; a child, their parents, and you.</p><p>Brain crammed with knowledge, skills polished bright, you took a deep breath and entered the pressure chamber of exams. Nowhere to hide in there. Under the intense gaze of peer review, you summoned your best……and unlocked your future.</p><p>Elation!</p><p>And then…. post-exam blues.</p><p>A strange feeling of having summited……only to realise that greater peaks, previously hidden, lay beyond. The expedition needed to resume.</p><p>More years of advanced apprenticeship. Yet another level reached.</p><p>And having now arrived at this point, how will the world react?</p><p>Pride from your family of course.</p><p>A low-key acknowledgement from friends and workmates.</p><p>A certificate.</p><p>Precious little fanfare. No coronation ceremony.</p><p>Bit of an anti-climax?</p><p>Do not be fooled. This IS a momentous day!</p><p>After all the long years of study, training and working……finally achieving your dream of becoming a specialist paediatrician.</p><p>A watershed in your professional life.</p><p>Those of us who have walked this same path are proud of you.</p><p>Excited for you
现在你在这里。培训的最后一天,作为儿科顾问的新工作即将开始。花点时间回顾一下你走过的历程,一闪而过的画面串联起来,就是你晋升的蒙太奇。也许是学生时代在儿科的熏陶激起了你的好奇心,其他轮转科室都无法与之相提并论。也许是初级医生时,你发现自己主动要求在混合急诊科为年轻人看病,而同事们也非常乐意让你承担这项责任。"对孩子有点诀窍"?其他人也注意到了这一点,并给予了鼓励。你应该考虑一下儿科.......。你每次都在想:'今天我怎样才能更好地帮助你呢,亲爱的孩子?'这种感觉......,还有什么比这更好的呢?你决定了。你决定试一试,投身儿科培训。满怀希望的雄心壮志很快就撞上了未来任务的现实。加班。夜班周末。学习被莫名其妙地塞进一周的剩余时间,月复一月....,试图帮助你的亲人理解。感谢他们的理解。也感谢工作本身。肾上腺素飙升,生命垂危。每个亚专科的错综复杂。将复杂的护理工作串联起来的挑战。孩子、家长和您这三方独特的治疗组合。脑子里塞满了知识、技能和亮点,您深吸一口气,进入了考试的压力室。在那里无处藏身。在同行评审的强烈注视下,你鼓起勇气,......,开启了自己的未来。兴奋!然后.... 考后的忧郁。一种奇怪的感觉是,你登上了......,却意识到之前隐藏的更高峰还在后面。需要重新开始征程。当然,你的家人会为你感到骄傲,朋友和同事会低调地对你表示认可。没有加冕仪式。这是一个重要的日子!经过多年的学习、培训和工作,......,您终于实现了成为儿科专科医生的梦想。这是您职业生涯的分水岭。我们这些走过这条路的人都为您感到骄傲,为您感到兴奋。我们期待着与您交手,与您共事,与您交换故事!所以,请一定要庆祝一下。作为一名训练有素的临床医生,你拥有一套罕见的技能,帮助孩子们重新走上健康积极的未来之路!
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引用次数: 0
Inguinal hernias in children: Update on management guidelines 儿童腹股沟疝气:更新管理指南。
IF 1.6 4区 医学 Q2 PEDIATRICS Pub Date : 2024-09-25 DOI: 10.1111/jpc.16677
Mariana Morgado, Andrew JA Holland

Inguinal hernia repair is one of the most performed procedures in children, but aspects of care remain controversial. The aim of this review was to provide a critical appraisal of recently published guidelines on the management of inguinal hernias in children, by the American Academy of Pediatrics (2023) and the European Pediatric Surgeons' Association Evidence and Guideline Committee (2022). This was achieved by delineating areas of controversy and reviewing the most relevant recent literature on these topics. Currently available moderate-to-low quality evidence recommends postponing hernia repair in premature infants until after discharge, to reduce the risk of respiratory difficulties and recurrence. Laparoscopic repair provides similar outcomes to open but may shorten operative time in bilateral cases. No clear recommendation can be made for contralateral exploration, therefore should be evaluated case by case. In preterm infants, consideration of regional anaesthesia may reduce post-operative apnoea and pain, with no difference in neurodevelopment outcomes.

腹股沟疝修补术是儿童中实施最多的手术之一,但在护理方面仍存在争议。本综述旨在对美国儿科学会(2023 年)和欧洲儿科外科医生协会证据和指南委员会(2022 年)最近发布的儿童腹股沟疝管理指南进行批判性评估。为此,我们划分了存在争议的领域,并回顾了与这些主题最相关的最新文献。目前现有的中低质量证据建议将早产儿疝气修补术推迟到出院后进行,以降低呼吸困难和复发的风险。腹腔镜修补术的效果与开腹手术相似,但可缩短双侧病例的手术时间。对于对侧疝气的探查,目前还没有明确的建议,因此应根据具体情况进行评估。对于早产儿,考虑采用区域麻醉可减少术后呼吸暂停和疼痛,但对神经发育的影响没有差别。
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引用次数: 0
Abandonment of paediatric peripheral intravenous catheter insertion in the emergency department: A retrospective cohort study. 急诊科放弃儿科外周静脉导管插入术:一项回顾性队列研究。
IF 1.6 4区 医学 Q2 PEDIATRICS Pub Date : 2024-09-25 DOI: 10.1111/jpc.16675
Zoe Clarke, Clayton Lam, Amy L Sweeny, Peter J Snelling

Aim: Children and their families have reported peripheral intravenous catheter (PIVC) insertion as the most stressful part of their emergency department (ED) encounter, with some enduring multiple attempts without a successful insertion. The purpose of this study was to identify factors associated with abandonment of paediatric PIVC insertion.

Methods: A retrospective cohort study was conducted at the Gold Coast University Hospital. All patients 16 years of age and younger, presented in 2019 with a PIVC insertion attempted in the ED were eligible. The electronic medical records were screened by two reviewers to identify those who required a PIVC insertion. Logistic regression analysis was performed to assess variables associated with PIVC insertion abandonment.

Results: Of 6394 records screened, 2401 (8.3%) had a PIVC insertion attempted, with 99 (4.1%) being abandoned. Age <12 months was the strongest predictor of PIVC abandonment at a rate of 11.3% (38/336), with a >10-fold increased risk for infants less than 3 months old and 3-12 months old; adjusted odds ratio (95% confidence interval) 12.4 (5.1-30.2) and 14.8 (5.8-37.4), respectively. Indications of 'infection' or 'rehydration' were associated with a decreased likelihood of abandonment when compared to 'investigation only' in multivariate modelling (odds ratio (95% confidence interval): 0.181 (0.099-0.332) and 0.262 (0.100-0.686), respectively).

Conclusions: This study suggests the rate of PIVC insertion abandonment in children is relatively infrequent. However, more than one in 10 children aged <12 months had PIVC attempts without successful insertion. PIVC abandonment was less likely when there was an indication that necessitated PIVC insertion, such as a serious bacterial infection.

目的:据儿童及其家人反映,外周静脉导管(PIVC)插入是他们在急诊科(ED)就诊过程中压力最大的部分,有些人多次尝试都没有成功插入。本研究旨在确定与放弃儿科 PIVC 插管相关的因素:方法:黄金海岸大学医院开展了一项回顾性队列研究。所有于 2019 年在急诊室尝试插入 PIVC 的 16 岁及以下患者均符合条件。两名审查员对电子病历进行筛选,以确定需要插入 PIVC 的患者。进行了逻辑回归分析,以评估与放弃插入 PIVC 相关的变量:结果:在筛选出的 6394 份记录中,有 2401 份(8.3%)曾尝试插入 PIVC,其中 99 份(4.1%)被放弃。年龄小于 3 个月和 3-12 个月的婴儿的风险增加了 10 倍;调整后的几率比(95% 置信区间)分别为 12.4(5.1-30.2)和 14.8(5.8-37.4)。在多变量模型中,与 "仅调查 "相比,"感染 "或 "补液 "与放弃的可能性降低相关(几率比(95% 置信区间):0.181(0.0.0%)):结论:本研究表明,儿童放弃插入 PIVC 的情况相对较少。然而,每 10 名儿童中就有超过一名
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引用次数: 0
Pruritic rash as a clue to organ dysfunction 瘙痒性皮疹是器官功能障碍的线索。
IF 1.6 4区 医学 Q2 PEDIATRICS Pub Date : 2024-09-23 DOI: 10.1111/jpc.16676
Adambarage Chandima De Alwis, Thankappan Sham Kumar
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引用次数: 0
期刊
Journal of paediatrics and child health
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