Paediatrics & child health最新文献

Background: Epilepsy and systemic autoimmune disorders (SADs) are significant in pediatric populations, yet most research focuses on adults.

Methods: We conducted a retrospective analysis of the National Inpatient Sample (2016-2020) for pediatric patients (≤18 years) with SADs. Patients with and without epilepsy were compared by demographics and clinical factors. Multivariate logistic regression assessed associations. To account for multiple testing, a Bonferroni correction set the adjusted significance threshold at α = 0.002.

Results: Of 4,816,131 pediatric patients, 5371 had both SADs and epilepsy. Multivariate analysis confirmed a strong association between SADs and epilepsy (OR: 2.79, 95% CI: 2.71-2.87). Addison's disease (OR: 10.09, 95% CI: 8.12-12.55), hypothyroidism (OR: 9.14, 95% CI: 8.8-9.48), vitiligo (OR: 3.29, 95% CI: 2.26-4.87), and autoimmune thyroiditis (OR: 3.25, 95% CI: 2.8-3.77) were the strongest independent predictors (P < 0.0001).

Conclusion: Pediatric epilepsy is significantly associated with several SADs, highlighting the need for multidisciplinary approaches to manage these conditions.

Objectives: Thoracostomy and thoracocentesis are painful invasive procedures. Several professional organizations have recommended the combined use of non-pharmacological and pharmacological interventions to alleviate pain from these procedures in neonates. However, none of these recommendations are based on a systematic review of the literature. The primary objective of this systematic review and meta-analysis was to synthesize the literature on pain management strategies for thoracotomy and thoracocentesis.

Methods: Databases were searched for randomized trials evaluating pharmacological and non-pharmacological interventions for pain mitigation for thoracocentesis and thoracostomy in any age group from inception to March 2025. The literature search was updated in June 2025 and no additional eligible articles were identified for inclusion. Title and abstract screening, full-text screening, and data extraction were performed in duplicate. Risk of bias was assessed using Cochrane's risk of bias (RoB) tool version 2.0. The critically important outcome was pain measured using validated tools including unidimensional behaviours (comprising facial actions, body movements, and cry) tools and multidimensional (comprising combinations of contextual, behavioural, and/or physiological components) tools. Secondary outcomes included procedure success, procedure duration, ease of procedure, and adverse events. Pooled effect estimates were standardized mean difference and relative risk with 95% confidence intervals using random effects model. A GRADE assessment of the overall certainty of the evidence for each outcome was completed.

Results: One study with 36 adult participants assessing pain from thoracocentesis was included. The interventions compared were topical vs subcutaneous administration of local anaesthetics. There was no difference in the overall procedural pain, patient satisfaction, and the number of attempts between the two groups. There was very low evidence of certainty for the critical outcome of pain.

Conclusions: No recommendation for pain management for these procedures can be made from the single included study. Currently, professional guidelines recommend the use of subcutaneous lidocaine and intravenous opioids for thoracostomy. Future studies are recommended to evaluate the effectiveness of various pharmacological and non-pharmacological interventions (head-to-head comparison).

Objectives: To explore the pharmacokinetics of oral morphine and the potential effect of pharmacogenetics on efficacy and safety in children.

Methods: Serial blood samples were obtained from healthy children aged 5-17 years. We determined morphine, morphine-6-glucoronide (M6G) and morphine-3-glucoronide (M3G) concentrations and pharmacokinetic parameters. We performed genotyping and collected pain scores.

Results: A total of 13 children received a single dose of oral morphine 0.5 mg/kg. For morphine, M6G, and M3G, median T_max was 52.5, 90, and 90 min, respectively. Median C_max reached 14.07, 53.64, and 309.63 ng/mL, respectively. Median t_1/2 was 74.96, 170.73, and 149.45 min, respectively. Median area under the curve was 1757.71, 3290.83, and 43618.97 ng*h/mL, respectively. A single nucleotide polymorphism rs563649 on the OPRMI gene locus was associated with reduced receptor efficiency in one patient reporting an increase in pain.

Conclusions: Oral morphine's active metabolites have a longer t_1/2 and an OPMR1 SNP rs563649 may underlie variability in efficacy and safety. Clinical Trials Registration: clinicaltrials.gov NCT01690780.

Objective: To determine current practices, attitudes and barriers to pediatric lipid screening and management amongst family physicians and paediatricians in British Columbia (BC).

Design: Cross-sectional online survey.

Setting: Urban, suburban, and remote locations across BC.

Participants: Community-based or academic family physicians and paediatricians.

Main outcome measures: Self-reported lipid screening practices in children and diagnosis and management of dyslipidemia. Secondary outcomes were self-reported attitudes and barriers to screening and treatment.

Results: Most physicians are not screening their pediatric patients for dyslipidemias (85% of family physicians, 84% of paediatricians) and disagreed with screening children for elevated cholesterol both pre-puberty (67% of family physicians, 79% of paediatricians) and in adolescence (67% of family physicians and paediatricians). While 77% of paediatricians and 56% of family physicians agreed that statins are an appropriate treatment for children with Familial hypercholesterolaemia (FH), most respondents (89% of family physicians, 76% of paediatricians) reported they would not prescribe them. The most widely cited barrier to screening and management of paediatric dyslipidemias was a lack of Canadian guidelines (74% of family physicians, 53% of paediatricians).

Conclusions: Despite the recent release of a clinical practice update by the Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association, awareness of recommendations for the detection and management of pediatric dyslipidemias amongst family physicians and paediatricians is low, and practices remain at odds with these recommendations. Knowledge translation interventions are necessary to disseminate clinical practice recommendations to physicians and evoke practice change.

Objectives: There has been a growing emphasis on holistic approaches to assessing postoperative recovery by using self-reported health-related quality of life (HRQoL). Identifying groups of children at higher risk of poor recovery has become important. The aim of the study is to identify predictors of paediatric postoperative recovery assessed by self-reported HRQoL.

Methods: One hundred forty-eight children ages 4 to 12 years completed the Child Health Rating Inventories (CHRIS2.0) to measure overall, physical and mental health, preoperative anxiety, and postoperative pain. Four linear regressions were used to identify predictors of overall, physical and mental health and postoperative pain. Predictors included child gender, race/ethnicity and language, surgical severity, child and caregiver preoperative anxiety, and caregiver distress.

Results: Child male gender (p = 0.03, 95% confidence interval [CI] [-10.15, -0.65]) and identifying as English-speaking Latinx (p = 0.03, 95% CI [0.58, 13.25]) predicted poorer postoperative overall health. Higher child preoperative anxiety (p < 0.001, 95% CI [0.39, 1.50]) and higher caregiver preoperative distress (p = 0.003, 95% CI [-1.09, 0.28]) predicted poorer postoperative overall health.

Conclusions: The results of this self-reported study validated previously established predictors of recovery (preoperative anxiety and caregiver distress). Novel predictors, including child male gender and race/ethnicity and language, were identified, providing new insights into factors influencing recovery outcomes.