Paediatrics & child health最新文献

Le traumatisme crânien aigu responsable de lésions cérébrales traumatiques est une cause importante de morbidité et de mortalité en pédiatrie. La gravité des lésions dépend du mécanisme du traumatisme et de l'âge de l'enfant. Chez les enfants, la grande majorité de ces traumatismes sont légers, ne justifient pas de traitement et ne laissent aucunes séquelles à long terme. Il est toutefois important de déterminer les personnes qui courent un risque de lésions importantes et celles qui ont besoin d'une évaluation et d'une intervention particulières. Le présent document de principes, qui remplace les recommandations publiées en 2013 par la Société canadiennes de pédiatrie sur le sujet, décrit les enjeux liés aux traumatismes crâniens aigus chez les nourrissons, les enfants et les adolescents, y compris les manifestations cliniques, les priorités pour la prise en charge initiale, et les directives en vue de l'observation, de l'imagerie, puis du suivi et du traitement. L'évaluation initiale des patients victimes d'un traumatisme crânien aigu est également abordée.

Paediatric care is intrinsically rewarding. Preventing and mitigating disease while supporting patients and families means a better life for everyone. However, every paediatrician faces the frustration of appointment nonattendance and, especially tough, the dilemma of serial no-attendance-do we discharge the patient or impact our overflowing waitlist? Inequitable transportation compounds sociodemographic barriers to healthcare access. This article explores how 'transportation deserts', impact patients and what paediatricians can do to improve equitable access while decreasing 'no-shows.'

The incidence of newborns at risk for withdrawal due to antenatal substance exposure has increased rapidly, presenting significant health and early developmental concerns. Access to culturally safer, trauma-informed prenatal care and support for opioid consumption improves health outcomes for both the mother/birthing parent and the fetus. Newborns are at high risk for experiencing symptoms of abstinence or withdrawal that require assessment and non-pharmacological support in the early neonatal period and may go on to require pharmacological treatment. This position statement focuses specifically on women/persons with a substance-exposed pregnancy (SEP) who are taking opioids, their newborns, and the effects of withdrawal and management strategies on newborns. This statement is inclusive of all families, as defined and determined for themselves and representing many structures and identities. Health care team communication, language, and terminology must be culturally safer, trauma-informed, and individualized to meet each family's needs and expressed identity.

Introduction: Inborn errors of immunity (IEI) are a heterogenous group of disorders that lead to impairment and dysfunction of one or more parts of the immune system. Autoimmunity and autoimmune cytopenias have increasingly been recognized as early markers of IEI. This study describes the type, severity and range of cytopenias in children with IEI of varying immunophenotypes at a single Canadian centre.

Methods: A retrospective chart review was completed of children with IEI followed at the Stollery Children's Hospital in Edmonton, Alberta from January 2015 to December 2022. Patients were included if they received a diagnosis of an IEI and had single or multi-lineage cytopenia(s). The IEI diagnoses were grouped into immunophenotypic categories and cytopenias were compared using descriptive statistics.

Results: Immune cytopenias were common in all phenotypic categories, though there was variability in the type and severity. Thrombocytopenia was most likely to be seen in combined (53.8%), syndromic (59%) and immune regulatory disorders (63.6%). Neutropenia was most common in phagocytic (71.4%), immune regulatory (63.7%) and humoral disorders (52.6%). Multi-lineage cytopenias were present in 67.2% of cases and 10.4% had persistent cytopenias.

Conclusions: Immune cytopenias are common in varying types of IEI and are not isolated to a specific disease category. When seeing a patient with concerns for IEI, providers should investigate both for features of immunodeficiency and autoimmunity, in particular autoimmune cytopenias. The pattern of cytopenia may favour specific immunophenotypes and help prioritize further testing and timely referral.