Paediatrics & child health最新文献

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.

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.