Paediatrics & child health最新文献

Objectives: Arterial puncture/cannulation is considered to be a severely painful procedure. Both non-pharmacological and pharmacological interventions are recommended by professional organizations to alleviate pain in neonates undergoing arterial puncture/cannulation, but these recommendations are not based on systematic review of the literature. The primary objective of this systematic review and meta-analysis was to synthesize the literature on pain management strategies in this setting.

Methods: Databases were searched for randomized trials evaluating pharmacological and non-pharmacological interventions for pain mitigation for arterial puncture/cannulation from inception to July 2024. 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. The risk of bias was assessed using Cochrane's risk of bias (RoB) 2.0 tool. The critically important outcome was pain measured using validated tools including unidimensional behaviour and multidimensional (comprising combinations of contextual, behavioural, and/or physiological components) tools. Secondary outcomes included procedure success and adverse events. Pooled effect estimates were standardized mean difference (SMD) and relative risk (RR) with 95% confidence intervals (CI) using random effects models. A GRADE assessment of the overall certainty of the evidence for each outcome was completed.

Results: Five studies including a total of 358 neonates were included. All assessed pain from arterial puncture rather than cannulation. The interventions evaluated in the included studies were: 1) white noise (50 dB) compared to control (0 dB), 2) expressed breast milk compared to 25% oral dextrose, 3) music, 25% oral dextrose or both, 4) familiar scent compared to unfamiliar scent or control, and 5) 24% oral sucrose compared to no intervention. Expressed breast milk was effective in reducing procedural pain compared to 25% oral dextrose (SMD -0.95 [95% CI -1.64, -0.24]; n = 36). The familiar scent was effective in reducing the duration of cry when compared to unfamiliar scent (MD -22.96 [95% CI -33.20, -12.72]; n = 90) and control (MD -25.22 [95% CI -35.22, -15.22]; n = 90) respectively. There was low certainty of evidence for all critical outcomes. No statistically significant difference was demonstrated for other comparisons. Conclusion: Expressed breast milk and familiar scent may be effective in reducing pain during arterial puncture based on single studies, however, there is low confidence in the estimates of effect. There is a need for further research on pharmacological interventions for this procedure.

Background: Lumbar puncture (LP) is a painful procedure performed in infants. Both national and international organizations recommend the use of local anesthetics for LP pain management. However, recommendations are not based on systematic review of the literature. The primary objective of this systematic review and meta-analysis was to synthesize the literature on local anesthetics and opioids for pain management in infants undergoing LP.

Methods: Databases were searched for randomized trials from inception to March 2024. 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) 2.0 tool. The critically important outcome was pain measured using validated tools including unidimensional behaviour and multidimensional (comprising combinations of contextual, behavioural and/or physiological components) tools. Secondary outcomes included procedure success and adverse events. Pooled effect estimates were standardized mean difference (SMD) and relative risk (RR) with 95% confidence intervals (CI) using random effects models. A GRADE assessment of the overall certainty of the evidence for each outcome was completed.

Results: Five studies with 292 infants were included. The interventions evaluated include local anesthetics (subcutaneous injection of lidocaine, needle-free jet injection of lidocaine using J-Tip and topical administration of lidocaine-prilocaine) and opioids (intravenous fentanyl). Local anesthetics were effective in reducing acute pain compared to placebo/control (SMD -0.70 [95% CI -0.89, -0.51]; I² = 0, n = 215). Fentanyl was effective in reducing acute pain compared to placebo (SMD -1.93 [95% CI -2.64, -1.21]). Across all comparisons, there was no difference in procedure success and number of attempts in studies including local anesthetics. No serious adverse events were attributed to local anesthetics or opioids. There was moderate to low certainty of evidence for all critical and important outcomes.

Discussion: Both local anesthetics and opioids are effective in reducing pain associated with LP based on limited evidence and can be incorporated in clinical practice. Future studies should evaluate the effectiveness and safety of combined analgesia and alternative routes of administration for opioids.

Objectives: Genome-wide sequencing (GWS) is now used across the breadth of pediatric research. There is a greater potential to identify unexpected, clinically relevant findings with GWS than with the targeted genetic techniques used in prior decades. Individual research teams may not have the expertise to evaluate and manage these findings. The Hospital for Sick Children (SickKids) Genome Board is a no-cost consultation service for researchers with questions arising from genetic aspects of their studies.

Methods: We reviewed all submissions to and recommendations from the Genome Board over the first 4 years, to identify common questions, themes, and trends.

Results: There were 67 submissions and a year-over-year increase in volumes. The most common request (60%) was to assess variants identified by GWS for pathogenicity, clinical actionability, and returnability to a study participant. Overall, 23 of 48 reviewed variants were recommended for clinical confirmation and return with genetic counselling. Other categories of submissions included requests to researchers from study participants to release their "raw" genomic data and for input on protocols related to clinical translation of findings.

Conclusion: The Genome Board provides a generalizable model for centralized triage of clinical questions arising from genomic research at a pediatric centre. Clinicians should be aware that patient participation in genetic research studies can have downstream consequences for their healthcare.

Objectives: Children from Nunavik, a Northern Quebec region with a predominantly Inuit population, must travel by air for surgical care at urban paediatric centres. Telemedicine offers an opportunity for virtual postoperative visits for low-risk patients, though its feasibility remains unclear. This study aimed to assess the feasibility of paediatric postoperative telemedicine in Nunavik.

Methods: This qualitative study (August 2022-June 2023) included a rapid literature review on telemedicine use in rural and postoperative care, which informed the interview process. Eleven healthcare providers with experience caring for Inuit children from Nunavik were interviewed on telemedicine viability. Data was thematically analyzed. Technical and operational feasibility was evaluated using data on Nunavik's resources from the regional health board. The primary outcome was healthcare providers' perspectives on feasibility, and the secondary outcome assessed technical and operational viability through community resources.

Results: The literature review yielded few sources. All participants agreed on the feasibility of paediatric postoperative telemedicine but identified key conditions for its success. The thematic analysis highlighted seven themes, including benefits, challenges, patient suitability, and resource requirements. While two regional hospitals and three health centres were equipped to support postoperative telemedicine, nine health centres had only partial capability, primarily due to limited high-speed internet access. Imaging and laboratory services were available solely at regional hospitals.

Conclusions: Postoperative telemedicine was deemed feasible from both provider and resource perspectives, with optimal utilization dependent on appropriate support to centres. Family and community involvement is crucial to expanding its use in Nunavik and respecting patient autonomy.

Background: Children with suspected appendicitis are often transferred from community emergency departments (EDs) across the Greater Toronto Area (GTA) to a Toronto paediatric tertiary-care ED due to inconsistent access to, and experience with, paediatric ultrasound, surgery, and anaesthesia. Literature on transfer practices and outcomes is sparse.

Objective: To investigate transfer patterns and outcomes in children with suspected appendicitis transferred from community EDs to a paediatric tertiary ED.

Methods: A retrospective chart review was conducted for children with suspected appendicitis transferred from 19 GTA community EDs to a Toronto paediatric tertiary-care ED from October 1, 2021, to September 30, 2022. Primary outcome was the proportion of children with appendicitis. Secondary outcomes included rates of ultrasound repetition and surgical consultation post-transfer. All transferred children were included; descriptive statistics were performed.

Results: Of the 282 children (mean age 7 years, 60% male), 164 (58%) were diagnosed with appendicitis, while 118 (42%) children were discharged without. Among those without appendicitis, 100 (85%) had a community ultrasound; 77 (77%) were read as positive for appendicitis, and 89 (89%) of the community-imaged patients had repeat ultrasound after transfer. Among the 164 children diagnosed with appendicitis, 144 (88%) had a community ultrasound, with 78 (54%) undergoing repeat ultrasound after transfer. Surgical consultation in the paediatric ED occurred for all children with appendicitis and for 26/118 (22%) of those without.

Conclusions: Nearly half of the children transferred for suspected appendicitis were discharged without appendicitis, and most community ultrasounds required re-imaging. Opportunities exist to optimize transfer pathways and ultrasound resources.

Objectives: Genomic sequencing (GS) is increasingly recommended as a diagnostic test for patients with suspected genetic disorders, but access often remains limited to those referred to medical geneticists. Enabling paediatric subspecialists to access GS can expedite diagnosis for families and reduce burdens on the geneticist-led model of care. Targeted implementation strategies are needed to empower paediatric subspecialists to access GS; however, data to inform these strategies are lacking.

Methods: Semi-structured interviews were conducted with 13 paediatric subspecialists (6 paediatric neurologists, 7 developmental paediatricians) and 9 genetics practitioners in Ontario, Canada, exploring barriers and facilitators to expanding access to GS amongst paediatric subspecialists. Interview guide development was informed by the Consolidated Framework for Implementation Research. Interviews were transcribed verbatim, coded inductively, and analyzed thematically.

Results: Facilitators identified by interviewees included a tension for change, clinician motivation, and the presence of analogous infrastructure. The barriers to be addressed included logistical (requiring increased resource investment), cognitive (requiring upskilling and improved support for non-geneticist clinicians from genetics services), and cultural (requiring role clarification and trust-building between groups).

Conclusions: To maximize readiness of paediatric subspecialists to access GS, implementation strategies must be designed to capitalize on facilitators and reduce barriers. Evaluation of such models will be essential to ensure they meet the needs of paediatric subspecialist end-users while delivering on the expected value of GS for patients.

Objectives: Acute respiratory infections(ARIs) represent a major global public health concern and affect all age groups. Children are infected approximately two to three times more frequently than adults. This study aimed to evaluate the prevalence and seasonality of viral pathogens associated with respiratory tract infections in children in our region.

Materials and methods: Between January 2019 and December 2024, respiratory viral pathogens were analyzed using the Rotor-GeneQ MDxdevice (Qiagen, Germany) with the FastTrack Diagnostics "FTD Respiratory Pathogens 21 Assay" multiplex real-time PCR kit.

Results: The most frequently detected viral pathogen was RSV A/B (25.18%), while the least detected was PIV1 (0.54%). The most common pathogens were RSV A/B in 2019 and 2023, RSV A/B in 2020, PIV3 in 2021, RSVA/B in 2022, and Rhinovirus in 2024. RSV A/B was the most frequently detected virus in both girls and boys. HMPV A/B was significantly more common in males (p<0.05). Viral pathogens were detected in 73.60% of individuals aged ≤1 year, with RSV A/B being the most frequently identified. ARIs peaked during the winter months and were lowest in the summer. ARIs reached their highest level in December and dropped significantly in August. RSV A/B predominated in December, January, February, and March; Rhinovirus in April, May, and June; Adenovirus in July, August, September, and October; and Bocavirus in November.

Conclusion: Monitoring the annual and seasonal distribution of respiratory viruses is critical for predicting and identifying epidemics and pandemics. This approach can help ensure accurate pathogen identification and prevent inappropriate antimicrobial treatments.