{"title":"18F-FDG PET/CT in paediatric Staphylococcus aureus bacteraemia","authors":"Karan Bir Singh, Kevin I London","doi":"10.1111/jpc.1_16560","DOIUrl":"10.1111/jpc.1_16560","url":null,"abstract":"","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748370","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}
Thuraiya Al Rumhi, Sheikha S Al-Badi, Fathiya Al-Rahbi, Reem Abdawani, Buthaina H Al-Musalhi
{"title":"Recurrent indurated red plaques","authors":"Thuraiya Al Rumhi, Sheikha S Al-Badi, Fathiya Al-Rahbi, Reem Abdawani, Buthaina H Al-Musalhi","doi":"10.1111/jpc.1_16501","DOIUrl":"10.1111/jpc.1_16501","url":null,"abstract":"","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748372","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}
{"title":"Child with headache and small head","authors":"Drew Brownell, Anderson H Kuo","doi":"10.1111/jpc.1_16513","DOIUrl":"10.1111/jpc.1_16513","url":null,"abstract":"","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748371","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}
Thuan Anh Le Nguyen, Vanessa Raileanu, Bernice Smith, Alison Griffin, Shaheen Shah
Aim
To evaluate level of agreement of specialist trained retinopathy of prematurity (ROP) nurses compared with an experienced paediatric ophthalmologist in detection of referral-warranted ROP (RWROP) using wide-field digital retinal imaging.
Methods
This is a prospective, observational, blinded study of neonates in a level III neonatal intensive care unit, from July 2020 to November 2022. Image capture using wide-field digital retinal imaging followed by ROP grading and staging was completed by trained ROP nurses. This was then compared with findings by an experienced paediatric ophthalmologist. The primary outcome was presence of RWROP in either eye.
Results
One hundred and ninety-five neonates (55% male) with a total of 768 screening visits were included. At the initial screen, nurse and ophthalmologist agreed about presence of RWROP for 191 of 195 neonates (98%, kappa = 0.79, P < 0.0001), with 100% sensitivity for RWROP detection. Including all 768 screening episodes, agreement was 98% for RWROP. There was disagreement in 16 screenings (2%) for 11 (6%) neonates. Of the five screenings (0.7%) that the ophthalmologist thought were RWROP and the nurse did not, three were disagreements about whether the zone was posterior zone 2 or zone 1.
Conclusions
We found excellent levels of agreement and add evidence that interpretations by specialist trained nurses could be safely integrated into a ‘hybrid ROP screening system’.
{"title":"Excellent accuracy of trained neonatal nurses in the detection of referral-warranted retinopathy of prematurity within an established telemedicine screening programme","authors":"Thuan Anh Le Nguyen, Vanessa Raileanu, Bernice Smith, Alison Griffin, Shaheen Shah","doi":"10.1111/jpc.16621","DOIUrl":"10.1111/jpc.16621","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To evaluate level of agreement of specialist trained retinopathy of prematurity (ROP) nurses compared with an experienced paediatric ophthalmologist in detection of referral-warranted ROP (RWROP) using wide-field digital retinal imaging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a prospective, observational, blinded study of neonates in a level III neonatal intensive care unit, from July 2020 to November 2022. Image capture using wide-field digital retinal imaging followed by ROP grading and staging was completed by trained ROP nurses. This was then compared with findings by an experienced paediatric ophthalmologist. The primary outcome was presence of RWROP in either eye.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and ninety-five neonates (55% male) with a total of 768 screening visits were included. At the initial screen, nurse and ophthalmologist agreed about presence of RWROP for 191 of 195 neonates (98%, kappa = 0.79, <i>P</i> < 0.0001), with 100% sensitivity for RWROP detection. Including all 768 screening episodes, agreement was 98% for RWROP. There was disagreement in 16 screenings (2%) for 11 (6%) neonates. Of the five screenings (0.7%) that the ophthalmologist thought were RWROP and the nurse did not, three were disagreements about whether the zone was posterior zone 2 or zone 1.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found excellent levels of agreement and add evidence that interpretations by specialist trained nurses could be safely integrated into a ‘hybrid ROP screening system’.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734419","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}
Georgina K Alexander, Siva P Namachivayam, Roberto Chiletti, Warwick Butt
Background
Extracorporeal membrane oxygenation (ECMO) is used in critically ill children with cardiac and/or respiratory failure. Use is increasing in children with high-risk comorbidities. Reasons children do not survive ECMO are poorly described.
Aims
Describe characteristics and cause of death, compare mortality in children with high-risk comorbidities, evaluate mortality trends over a decade.
Method
All children <18 years old who received ECMO at this institution from 1 January 2011 to 31 December 2020 were described and categorised by outcome: died on or <48 h post-ECMO, died ≥48 h post-ECMO, survived to hospital discharge. Children who did not survive ECMO (DNSE) were categorised to: ECMO withdrawal for irrecoverable original condition, withdrawal for poor prognosis neurological condition, brain death, withdrawal for poor prognosis with multiple complex conditions, and unsupportable. Poison regression was used to analyse survival trends.
Results
Four hundred twenty-eight children received ECMO, 19% DNSE, 14% died ≥48 h post-ECMO and 67% survived. ECMO was electively withdrawn for irrecoverable original condition (39%), poor prognosis for neurological condition (32%) or multiple complex conditions (18%). One hundred twenty-two children had ≥1 high-risk comorbidity. Children with genetic syndromes (58%), risk-adjusted congenital heart surgery score-1 ≥4 (53%), primary immunodeficiency (50%) had lower hospital survival. No children with malignancy/bone marrow transplant survived to hospital discharge. Overall hospital survival was 67%, with no significant change during the study period (P-trend = 0.99).
Conclusion
Children who DNSE have therapy electively withdrawn for irrecoverable disease or poor prognosis. Children with high-risk comorbidities have a reasonable chance of survival. This study informs clinicians ECMO may be a therapeutic option.
{"title":"Why do children not survive extracorporeal membrane oxygenation?","authors":"Georgina K Alexander, Siva P Namachivayam, Roberto Chiletti, Warwick Butt","doi":"10.1111/jpc.16614","DOIUrl":"10.1111/jpc.16614","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Extracorporeal membrane oxygenation (ECMO) is used in critically ill children with cardiac and/or respiratory failure. Use is increasing in children with high-risk comorbidities. Reasons children do not survive ECMO are poorly described.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Describe characteristics and cause of death, compare mortality in children with high-risk comorbidities, evaluate mortality trends over a decade.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>All children <18 years old who received ECMO at this institution from 1 January 2011 to 31 December 2020 were described and categorised by outcome: died on or <48 h post-ECMO, died ≥48 h post-ECMO, survived to hospital discharge. Children who did not survive ECMO (DNSE) were categorised to: ECMO withdrawal for irrecoverable original condition, withdrawal for poor prognosis neurological condition, brain death, withdrawal for poor prognosis with multiple complex conditions, and unsupportable. Poison regression was used to analyse survival trends.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four hundred twenty-eight children received ECMO, 19% DNSE, 14% died ≥48 h post-ECMO and 67% survived. ECMO was electively withdrawn for irrecoverable original condition (39%), poor prognosis for neurological condition (32%) or multiple complex conditions (18%). One hundred twenty-two children had ≥1 high-risk comorbidity. Children with genetic syndromes (58%), risk-adjusted congenital heart surgery score-1 ≥4 (53%), primary immunodeficiency (50%) had lower hospital survival. No children with malignancy/bone marrow transplant survived to hospital discharge. Overall hospital survival was 67%, with no significant change during the study period (<i>P</i>-trend = 0.99).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Children who DNSE have therapy electively withdrawn for irrecoverable disease or poor prognosis. Children with high-risk comorbidities have a reasonable chance of survival. This study informs clinicians ECMO may be a therapeutic option.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734420","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}
Aim: To identify the barriers and facilitators for timely detection and optimal management of otitis media (OM) in Aboriginal children in a primary care setting from the perspective of carers of Aboriginal children.
Methods: A qualitative, Aboriginal co-designed, participatory action research study with interviews and focus groups in a large town in the Kimberley, Western Australia. The Consolidated Framework for Implementation Research informed stakeholder group identification and interview framework development. Data underwent thematic analysis using NVivo software.
Results: Thirty-two carers of Aboriginal children participated. Key barriers identified for the detection of OM were limited information about OM provided to carers and carers feeling disempowered to express their concerns. Key facilitators identified were the provision of health information through health promotion and the use of culturally secure resources. Having a culturally secure clinical environment was identified as essential, with Aboriginal Health Workers playing a vital role in clinical care. No barriers to management of OM in primary care were reported. Facilitators included health care practitioners (HCPs) emphasising the importance of completing antibiotic course and the clinic providing necessary medications.
Conclusions: A culturally secure health promotion strategy with health promotion teams, campaigns and resources is needed to increase community awareness of OM signs and symptoms and facilitate appropriate health seeking. It is essential that the local Aboriginal community co-lead and co-develop these initiatives to ensure the unique wisdom and knowledge of Aboriginal people are captured. HCPs and the clinic effectively facilitate management of OM by providing medications and emphasising completion of antibiotics.
目的：从原住民儿童照顾者的角度出发，确定在初级护理环境中及时发现和优化管理原住民儿童中耳炎（OM）的障碍和促进因素：方法：在西澳大利亚州金伯利的一个大城镇开展一项由原住民共同设计的参与式定性行动研究，包括访谈和焦点小组。实施研究综合框架为利益相关者小组的确定和访谈框架的制定提供了依据。使用 NVivo 软件对数据进行了主题分析：结果：32 名土著儿童的照顾者参加了此次活动。发现 OM 的主要障碍是向照护者提供的有关 OM 的信息有限，以及照护者感到无力表达他们的担忧。发现的主要促进因素是通过健康宣传提供健康信息和使用文化上安全的资源。拥有一个文化安全的临床环境被认为是至关重要的，原住民卫生工作者在临床护理中发挥着至关重要的作用。据报告，在初级保健中管理 OM 没有障碍。促进因素包括医护人员（HCPs）强调完成抗生素疗程的重要性以及诊所提供必要的药物：结论：需要制定一项文化安全的健康促进战略，通过健康促进团队、活动和资源来提高社区对 OM 症状和体征的认识，并促进适当的就医。当地原住民社区必须共同领导和制定这些措施，以确保原住民的独特智慧和知识得到充分体现。保健医生和诊所通过提供药物和强调完成抗生素治疗，有效促进对 OM 的管理。
{"title":"Identifying barriers and facilitators for the effective diagnosis and provision of primary health care for otitis media from the perspective of carers of Aboriginal children.","authors":"Gloria Lau, Roz Walker, Pamela Laird, Philomena Lewis, Jafri Kuthubutheen, André Schultz","doi":"10.1111/jpc.16626","DOIUrl":"https://doi.org/10.1111/jpc.16626","url":null,"abstract":"<p><strong>Aim: </strong>To identify the barriers and facilitators for timely detection and optimal management of otitis media (OM) in Aboriginal children in a primary care setting from the perspective of carers of Aboriginal children.</p><p><strong>Methods: </strong>A qualitative, Aboriginal co-designed, participatory action research study with interviews and focus groups in a large town in the Kimberley, Western Australia. The Consolidated Framework for Implementation Research informed stakeholder group identification and interview framework development. Data underwent thematic analysis using NVivo software.</p><p><strong>Results: </strong>Thirty-two carers of Aboriginal children participated. Key barriers identified for the detection of OM were limited information about OM provided to carers and carers feeling disempowered to express their concerns. Key facilitators identified were the provision of health information through health promotion and the use of culturally secure resources. Having a culturally secure clinical environment was identified as essential, with Aboriginal Health Workers playing a vital role in clinical care. No barriers to management of OM in primary care were reported. Facilitators included health care practitioners (HCPs) emphasising the importance of completing antibiotic course and the clinic providing necessary medications.</p><p><strong>Conclusions: </strong>A culturally secure health promotion strategy with health promotion teams, campaigns and resources is needed to increase community awareness of OM signs and symptoms and facilitate appropriate health seeking. It is essential that the local Aboriginal community co-lead and co-develop these initiatives to ensure the unique wisdom and knowledge of Aboriginal people are captured. HCPs and the clinic effectively facilitate management of OM by providing medications and emphasising completion of antibiotics.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731263","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}
Surgery for congenital scoliosis correction in children is often associated with considerable blood loss. Decrease in regional oxygen saturation (rScO2) can reflect insufficient cerebral perfusion and predict neurological complications. This retrospective observational study explored the relationship between blood loss during this surgery and a decrease in rScO2 in children.
Methods
The following clinical data of children aged 3–14 years who underwent elective posterior scoliosis correction between March 2019 and July 2021 were collected: age, sex, height, weight, baseline rScO2, basal mean invasive arterial pressure (MAP), preoperative Cobb angle, number of surgical segments, preoperative and postoperative haemoglobin level, percentage of lowest rScO2 below the baseline value that lasted 3 min or more during the operation (decline of rScO2 from baseline, D-rScO2%), intraoperative average invasive MAP, end-tidal carbon dioxide pressure, fluid infusion rate of crystalloids and colloids, operation time, and percentage of total blood loss/patient's blood volume (TBL/PBV).
Results
A total of 105 children were included in the study. Massive haemorrhage (TBL/PBV ≥50%) was reported in 53.3% of patients, who had significantly higher D-rScO2 (%) (t = −5.264, P < 0.001) than those who had non-massive haemorrhage (TBL/PBV <50%). Multiple regression analysis revealed that TBL/PBV (β = 0.04, 95% CI: 0.018–0.062, P < 0.05) was significantly associated with D-rScO2%.
Conclusions
Intraoperative massive blood loss in children significantly increased D-rScO2%. Monitoring should be improved, and timely blood supplementation should be performed to ensure maintenance of the blood and oxygen supply to vital organs, improve the safety of anaesthesia, and avoid neurological complications.
{"title":"Influence of blood loss on cerebral oxygen saturation in paediatric patients undergoing surgery for scoliosis correction: A retrospective observational study","authors":"Jia Gao, Lijing Li, Zhengzheng Gao, Yi Ren, Fang Wang, Xiaoxue Wang, Duoyi Li, Guoliang Liu, Xuejun Zhang, Jianmin Zhang","doi":"10.1111/jpc.16619","DOIUrl":"10.1111/jpc.16619","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Surgery for congenital scoliosis correction in children is often associated with considerable blood loss. Decrease in regional oxygen saturation (rScO<sub>2</sub>) can reflect insufficient cerebral perfusion and predict neurological complications. This retrospective observational study explored the relationship between blood loss during this surgery and a decrease in rScO<sub>2</sub> in children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The following clinical data of children aged 3–14 years who underwent elective posterior scoliosis correction between March 2019 and July 2021 were collected: age, sex, height, weight, baseline rScO<sub>2</sub>, basal mean invasive arterial pressure (MAP), preoperative Cobb angle, number of surgical segments, preoperative and postoperative haemoglobin level, percentage of lowest rScO<sub>2</sub> below the baseline value that lasted 3 min or more during the operation (decline of rScO<sub>2</sub> from baseline, D-rScO<sub>2</sub>%), intraoperative average invasive MAP, end-tidal carbon dioxide pressure, fluid infusion rate of crystalloids and colloids, operation time, and percentage of total blood loss/patient's blood volume (TBL/PBV).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 105 children were included in the study. Massive haemorrhage (TBL/PBV ≥50%) was reported in 53.3% of patients, who had significantly higher D-rScO<sub>2</sub> (%) (<i>t</i> = −5.264, <i>P</i> < 0.001) than those who had non-massive haemorrhage (TBL/PBV <50%). Multiple regression analysis revealed that TBL/PBV (<i>β</i> = 0.04, 95% CI: 0.018–0.062, <i>P</i> < 0.05) was significantly associated with D-rScO<sub>2</sub>%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Intraoperative massive blood loss in children significantly increased D-rScO<sub>2</sub>%. Monitoring should be improved, and timely blood supplementation should be performed to ensure maintenance of the blood and oxygen supply to vital organs, improve the safety of anaesthesia, and avoid neurological complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731264","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}
The purpose of this study was to determine the risk factors for death in children with influenza-associated encephalopathy (IAE) in the paediatric intensive care unit (PICU).
Methods
Forty-six paediatric patients with IAE admitted to the PICU at shenzhen Children's Hospital between December 2009 and December 2021 were evaluated. Their clinical characteristics were retrospectively analysed.
Results
A total of 46 patients were diagnosed with influenza A virus infection and encephalopathy. The cases were concentrated in children <5 years of age (27/46, 58.7%). Twenty-nine patients (63.0%) survived and 17 patients (37.0%) died, of which 70.6% (12/17) of the patients died within 1 week of hospitalisation. Thirty-two patients (69.6%) developed neurological symptoms within 1–2 days of fever onset. Common symptoms included fever (45/46, 97.8%), loss of consciousness (39/46, 84.8%), seizures (31/46, 67.4%), cough (19/46, 41.3%), and vomiting (16/46, 34.8%). Multivariate logistic regression analysis indicated that vomiting (odds ratio [OR], 11.005), loss of consciousness (AVPU score: P; OR, 15.871), lymphopenia (OR, 8.964), alanine aminotransferase (>80 IU/L; OR, 32.060) and serum sodium concentration (>145 mmol/L or <135 mmol/L; OR, 16.264) were related to mortality.
Conclusions
The mortality in this study population was 37.0%. Children with IAE who have corresponding clinical manifestations and abnormal examination results in PICU should be warned of the high mortality rate.
{"title":"Mortality risk factors in children with influenza-associated encephalopathy admitted to the paediatric intensive care unit between 2009 and 2021","authors":"Jiajia Bi, Xiaoxin Wu, Jikui Deng","doi":"10.1111/jpc.16611","DOIUrl":"10.1111/jpc.16611","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The purpose of this study was to determine the risk factors for death in children with influenza-associated encephalopathy (IAE) in the paediatric intensive care unit (PICU).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Forty-six paediatric patients with IAE admitted to the PICU at shenzhen Children's Hospital between December 2009 and December 2021 were evaluated. Their clinical characteristics were retrospectively analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 46 patients were diagnosed with influenza A virus infection and encephalopathy. The cases were concentrated in children <5 years of age (27/46, 58.7%). Twenty-nine patients (63.0%) survived and 17 patients (37.0%) died, of which 70.6% (12/17) of the patients died within 1 week of hospitalisation. Thirty-two patients (69.6%) developed neurological symptoms within 1–2 days of fever onset. Common symptoms included fever (45/46, 97.8%), loss of consciousness (39/46, 84.8%), seizures (31/46, 67.4%), cough (19/46, 41.3%), and vomiting (16/46, 34.8%). Multivariate logistic regression analysis indicated that vomiting (odds ratio [OR], 11.005), loss of consciousness (AVPU score: P; OR, 15.871), lymphopenia (OR, 8.964), alanine aminotransferase (>80 IU/L; OR, 32.060) and serum sodium concentration (>145 mmol/L or <135 mmol/L; OR, 16.264) were related to mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The mortality in this study population was 37.0%. Children with IAE who have corresponding clinical manifestations and abnormal examination results in PICU should be warned of the high mortality rate.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633807","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}
Identifying abuse or neglect in one child (index) implicates risk to other children residing in the same home (contacts). While child protection investigators may interview and visually examine contacts, there is lack of consensus regarding when contacts should have a medical assessment. Our goal was to describe the prevalence, characteristics and predictors of abuse and neglect among contacts medically assessed by a child maltreatment evaluation centre over a 5-year period.
Methods
Records of 381 maltreated index children and their 588 contacts were reviewed. Abuse or neglect was diagnosed in 15% of contact children.
Results
When index children had more than one type of maltreatment or more than three risk factors, their contacts were more likely to be neglected or abused, respectively. Failure to thrive, patterned injuries, and unmet medical needs were the most common findings among maltreated contacts, and most were diagnosed with injuries or conditions that would not be evident to a child protection investigator.
Conclusions
Clinicians should consider evaluating contacts of maltreated children who have multiple risk factors or maltreatment types. These evaluations should include a careful assessment for injuries, growth and unmet medical needs.
{"title":"Medical assessments for abuse and neglect in contacts of maltreated children","authors":"Nancy D. Kellogg, James L. Lukefahr, Wouter Koek","doi":"10.1111/jpc.16618","DOIUrl":"10.1111/jpc.16618","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Identifying abuse or neglect in one child (index) implicates risk to other children residing in the same home (contacts). While child protection investigators may interview and visually examine contacts, there is lack of consensus regarding when contacts should have a medical assessment. Our goal was to describe the prevalence, characteristics and predictors of abuse and neglect among contacts medically assessed by a child maltreatment evaluation centre over a 5-year period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Records of 381 maltreated index children and their 588 contacts were reviewed. Abuse or neglect was diagnosed in 15% of contact children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>When index children had more than one type of maltreatment or more than three risk factors, their contacts were more likely to be neglected or abused, respectively. Failure to thrive, patterned injuries, and unmet medical needs were the most common findings among maltreated contacts, and most were diagnosed with injuries or conditions that would not be evident to a child protection investigator.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Clinicians should consider evaluating contacts of maltreated children who have multiple risk factors or maltreatment types. These evaluations should include a careful assessment for injuries, growth and unmet medical needs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627026","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}
Children and adolescents with autism spectrum disorder and/or intellectual disability often present to emergency departments with behaviours of concern: irritability, aggression and self-injurious behaviour. The objective of this study was to design, implement and evaluate a new model of care to support these patients and their families following presentation to reduce the need for re-presentation.
Methods
We designed and evaluated a new model of care for these patients, comprising consultations with a developmental paediatrician and a child psychiatrist, referral to a specialist behavioural service and 6 weeks of care coordination by a clinical nurse consultant. Using a quality improvement framework, iterative improvements were made to the model via a series of plan–do–study–act cycles. Re-presentation rates were compared with a control group of patients who presented with behaviours of concern but were not recruited into the study. Participating families and treating clinicians were surveyed at 2 and 6 weeks post-enrolment to gather qualitative feedback about their experience of the model.
Results
A total of 31 families participated in the study. Three- and 6-month re-presentation rates were 48.7% and 36.3% lower than the control group. Qualitative evaluation of the model by both families and clinicians was positive. The model was feasible and acceptable. Families reported feeling heard and understood, and that the intervention was helpful and provided a positive path forwards.
Conclusions
The findings suggest that a simple model of care can be successfully implemented and provide meaningful benefits for families of children with behaviours of concern, including reduced crisis-oriented help-seeking.
{"title":"A novel model of care for paediatric patients with developmental disabilities and associated behaviours of concern","authors":"Daryl Efron, James Fowler, Emily Cull, Kirsten Noakes, Claire Wilkin, Ric Haslam","doi":"10.1111/jpc.16615","DOIUrl":"10.1111/jpc.16615","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Children and adolescents with autism spectrum disorder and/or intellectual disability often present to emergency departments with behaviours of concern: irritability, aggression and self-injurious behaviour. The objective of this study was to design, implement and evaluate a new model of care to support these patients and their families following presentation to reduce the need for re-presentation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We designed and evaluated a new model of care for these patients, comprising consultations with a developmental paediatrician and a child psychiatrist, referral to a specialist behavioural service and 6 weeks of care coordination by a clinical nurse consultant. Using a quality improvement framework, iterative improvements were made to the model via a series of plan–do–study–act cycles. Re-presentation rates were compared with a control group of patients who presented with behaviours of concern but were not recruited into the study. Participating families and treating clinicians were surveyed at 2 and 6 weeks post-enrolment to gather qualitative feedback about their experience of the model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 31 families participated in the study. Three- and 6-month re-presentation rates were 48.7% and 36.3% lower than the control group. Qualitative evaluation of the model by both families and clinicians was positive. The model was feasible and acceptable. Families reported feeling heard and understood, and that the intervention was helpful and provided a positive path forwards.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings suggest that a simple model of care can be successfully implemented and provide meaningful benefits for families of children with behaviours of concern, including reduced crisis-oriented help-seeking.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627025","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}
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