Paediatrics & child health最新文献

Objectives: Paediatric pressure injuries (PIs) are a serious constellation of wounds that can lead to additional suffering, lifelong scarring, increased risk of infection, and high costs to the healthcare system. The prevalence of paediatric PI in an inpatient setting is 1.4% and can be as high as 43% in critical care units. The most common causes of paediatric PIs are associated with pressure from prolonged immobility and medical devices.

Methods: A narrative literature review was conducted to survey the current state of paediatric PI management for the purpose of providing healthcare providers with updated insight into PI management.

Results: Compared to the adult population, there are unique differences in paediatric anatomy and physiology depending on age and weight that can affect the aetiology and location of PIs. There has also been a development of tools to assess paediatric PIs. Prompt risk assessment within 8 hours following admission with a structured risk assessment tool, such as the Braden QD, followed by thorough skin assessments at regularly spaced intervals, will aid in the detection and treatment of PIs. The optimization of skin health and the use of medical devices are also key to the prevention of PIs.

Conclusion: This article reviews the unique differences of PIs in children and provides recommendations on prevention, care, and treatment.

Objectives: Caregivers, children, and healthcare professionals (HCPs) should engage in shared decision-making (SDM) regarding a child's pain and comfort care plan in the emergency department (ED). A better understanding of caregivers' current knowledge and gaps regarding pain and comfort care in the ED could inform conversations to support such SDM.

Methods: This was a single-centre, cross-sectional survey with 341 participants recruited from April to July 2022. Survey questions included demographics, current knowledge and perceived gaps, as well as comfort (rated with a 4-point Likert scale) in advocating for pain management strategies.

Results: A total of 345 caregivers responded to the survey; 77.7% (265/341) were mothers, and 84.6% (286/338) spoke English at home. About 45.6% (113/248) knew that children could receive pain medication at triage, and 42.3% (105/248) knew that children could receive numbing cream before a skin-breaking procedure; 42.7% (106/248) knew about the availability of food/drink. Participants reported similar mean (SD) comfort asking for pharmacologic [3.0 (0.9)] and non-pharmacologic [2.9 (1.0)] pain management strategies. Qualitative feedback from caregivers demonstrated SDM could be best achieved through having knowledge mobilization tools readily available and improved approachability of HCPs.

Conclusions: While caregivers generally report feeling comfortable advocating for pain and comfort care for their children, many lacked knowledge of available options. Better educating caregivers in pain and comfort care options can support their agency to advocate for better care plans for their children.

Objectives: Recently, glyphosate has gained extensive utilization as a global herbicide. In vivo and in vitro studies suggest that glyphosate can affect kidney function, but the human evidence is scarce. The study seeks to assess the association between glyphosate exposure and kidney function within the general U.S. populace by analysing data from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2016.

Methods: Data derived from 1614 participants aged 12 to 40 years were employed. Estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) functioned as key markers for the assessment of kidney function. Multivariable linear regression models were established to assess associations of urinary glyphosate levels with UACR and eGFR. Log-binomial regression models were conducted to evaluate the risks of impaired kidney function in connection with urinary glyphosate concentrations.

Results: The study disclosed that approximately 74.6% of the examined population in U.S. manifested detectable glyphosate levels in urine. The geometric mean values and 95% confidence interval (CI) of traditional and novel creatinine-adjusted glyphosate were 0.33 ng/mg creatinine (95% CI: 0.32, 0.34) and 0.38 ng/mL creatinine (95% CI: 0.37, 0.40), respectively. Notably, individuals in the fourth quartile of glyphosate exposure displayed a decrement of 0.06 mL/min/1.73 m² (95% CI: -0.13, -0.00) in eGFR, compared with participants in the first quartile of exposure, after adjusting for confounding factors.

Conclusions: The study suggests a negative association between urinary glyphosate concentrations and eGFR. In contrast, individuals characterized by high levels of glyphosate exposure exhibited elevated UACR when compared with those with low glyphosate exposure.

Objectives: A significant proportion of children with severe neurodevelopmental disorders (NDD) are unable to access recommended medical evaluations due to behavioural complexity (aggression/self-injurious behaviours). Medical evaluations under anaesthesia (EUA) are often required for planned procedures; however, a lack of coordination results in missed opportunities and repeated, often traumatic sedations. We aim to describe the lived experiences of parents/caregivers of children with behavioural complexity undergoing EUA at a quaternary hospital in Canada.

Methods: Semi-structured interviews were conducted to explore families' experiences with EUAs. Data collection included demographics/diagnoses, experiences of previous EUA, and positive/negative contributors. An inductive thematic analysis was undertaken as part of an iterative process. Patient-oriented research principles embedded within a quality improvement framework were utilized throughout multiple phases of the study.

Results: Eleven families participated in the study. Five key themes were identified: (1) The cumulative physical and psychological trauma experienced by patients and families when accessing EUA, (2) Need for awareness/understanding of behavioural complexity in children with NDD, (3) Requirement of equitable and not equal care, tailored towards specific needs, (4) Communication being key, and (5) Providers being willing to undertake the role of care coordination. An infographic was developed to highlight these themes by our parent partner.

Conclusions: Our results highlight potential opportunities to increase care coordination of EUA for this population. Due to resource constraints and the lack of formalized pathways, there is ample room to create processes that are patient-centred and trauma-informed. Parental/caregiver voices are essential in guiding future service development.

Objectives: Listeria monocytogenes meningitis has traditionally been associated with specific vulnerable populations such as newborns, pregnant women, immunosuppressed transplant recipients, and older adults with compromised cell-mediated immunity. Instances involving otherwise healthy children without underlying immunological disorders are infrequently reported and considered unusual.

Methods: The medical records, clinical courses, laboratory findings, medical imaging, and responses to treatment of immunocompetent children diagnosed with Listeria monocytogenes meningitis were retrospectively analyzed.

Results: The study included seven previously healthy children aged 4 months to 15 years. Common onset symptoms included fever, seizures, vomiting, headache, and altered consciousness. Radiological evaluation revealed signs consistent with cerebral oedema in three patients, based on T2 and fluid-attenuated inversion recovery (FLAIR) hyperintensities and loss of grey-white differentiation, although brain oedema cannot be definitively confirmed without histopathological correlation. In addition, two patients exhibited clinical signs of cranial nerve involvement, specifically abducens nerve palsy. Magnetic resonance imaging demonstrated leptomeningeal contrast in four patients, with one showing brain stem involvement. None had recognized immunodeficiencies.

Conclusions: This study underscores the importance of considering Listeria monocytogenes meningitis even in the absence of underlying risk factors.

Background: Neonatal abstinence syndrome (NAS) is a set of withdrawal symptoms experienced in a newborn if they have been exposed to substances such as opioids prior to birth. The incidence of NAS in British Columbia as well as NAS-related healthcare burden, has been increasing within the last several years.

Aim: To determine whether the novel Eat, Sleep, Console (ESC) approach to NAS improves outcomes such as length of hospitalization compared to Finnegan Neonatal Abstinence Scoring System (FNASS) approach in the treatment of neonatal patients with NAS admitted to the Neonatal Intensive Care Unit (NICU).

Methods: Retrospective paper and electronic chart review of neonatal patients born at ≥35 weeks gestation and ≤28 days of life with prenatal exposure to opioids and admitted to Kelowna General Hospital (KGH) Neonatal Intensive Care Unit (NICU) between January 2018 and February 2023.

Results: The primary outcome of hospital length of stay was 19.5 days for the ESC group and 27.5 days for FNASS (p=0.039). Secondary outcomes of total weaning morphine doses (53 vs 147; p<0.001), percentage requiring maintenance dosing (43.8% vs 100%; p<0.001), and length of wean (8.2 vs 18.1 days; p=0.003) were significantly less with ESC. Percentage who received only as needed morphine was greater with ESC (37.5% vs 0%; p<0.001). Total morphine dose (11.2mg vs 22.5mg; p=0.09) and adverse events (6% vs 11.7%; p=0.54) were not statistically significantly different.

Conclusions: Compared to FNASS, ESC approach improves several outcomes for NAS patients admitted to the NICU including a reduction in length of hospitalization by 8 days.

Objectives: Evaluate clinical presentation, delays and outcome in management of children with malrotation with midgut volvulus to identify avenues for care improvement.

Methods: A retrospective cross-sectional observational study in a single tertiary care paediatric centre on patients with a final diagnosis of midgut volvulus presenting to the emergency department (ED)/neonatal intensive care unit (NICU) from January 2015 through August 2022. Data recorded included demographics, clinical presentation, imaging, surgical findings, and survival/complications. We recorded time from arrival to hospital to: (1) medical evaluation, (2) radiologic investigations, (3) surgery consultation, and (4) surgery. Outcomes included survival and major morbidity.

Results: Thirty children had a diagnosis of midgut volvulus (ED: 22, NICU: 8). Twenty-eight (93%) survived, including two with short bowel syndrome. Median age was 7 days (IQR 3-13), 70% were male. Bilious vomiting was green (13/27; 48%), yellow (9/27; 33%), or both (5/27;19%). All had an ultrasound performed, and it was diagnostic in 24 (80%). Seven (23%) had upper gastrointestinal series performed; all were diagnostic. Median time between arrival and ultrasound was 146 min (IQR 62-234), and between arrival and surgery (Ladd's procedure) was 297 minutes (IQR 206-368).

Conclusions: In our cohort, midgut volvulus had a mortality rate of 2/30 (7%). Bilious vomiting, which can be either green and/or yellow, is a reliable clinical sign of midgut volvulus in infants. Ultrasound has good diagnostic accuracy. Delay of definitive surgery was considered high with potential for improvement at different timepoints. These timepoints were targeted in the development of a clinical practice guideline to reduce delays in the management of infants with bilious vomiting.

Objectives: To evaluate the association between race and SARS-CoV-2 test positivity and outcomes in children.

Study design: Secondary analysis of a prospective cohort study recruiting children < 18 years, tested for SARS-CoV-2 between August 2020 and February 2022, in Canadian pediatric emergency departments. Race was self-reported by participants. The primary outcome was SARS-CoV-2 test positivity. Secondary outcomes were medical interventions and hospitalization within 14 days of index visit, and post-COVID condition (PCC) at 90-day follow-up. Associations were evaluated using multi-level logistic regression models.

Results: Seven thousand and two-thirty three children underwent SARS-CoV-2 testing; median age was 2.0 years (IQR: 1.0-5.0), and 3366 (46.5%) were female. 1440 (19.9%) children tested positive for SARS-CoV-2, 776 (10.7%) were hospitalized, and 153 (13.2%) test-positive children experienced PCC. Compared to White children, most racial minority groups were more likely to test positive for SARS-CoV-2 (Middle Eastern aOR [95% CI] 2.62 [2.07, 3.32], Black aOR 2.36 [1.85, 3.03], Latin American aOR 2.23 [1.58, 3.15], South Asian aOR 2.17 [1.67, 2.82], Indigenous aOR 2.09 [1.29, 3.37], Southeast Asian aOR 1.82 [1.27, 2.62], Multiracial aOR 1.35 [1.07, 1.69], and had lower odds of medical interventions. Only Indigenous children were at higher odds of hospitalization than White children (aOR [95% CI]: 2.48 [1.03, 5.95]). Black children were less likely to report PCCs than White children (aOR 0.44 [0.22-0.86]).

Conclusions: Racial disparities exist in SARS-CoV-2 test positivity and outcomes among Canadian children seeking emergency care. A better understanding of the factors contributing to these differences is needed to promote equitable health across the population.