Paediatrics & child health最新文献

Objective: This study aimed to address the overdiagnosis of penicillin allergies in the pediatric population, which leads to less effective antibiotic usage. We investigated the effectiveness of standardized oral amoxicillin challenges in the emergency departments (EDs) of pediatric patients with previous reactions but a low risk for serious reactions.

Methods: Children under 18 years of age who reported allergy to any penicillin presenting to the ED of the Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), Montreal, Quebec, Canada, with a clinical requirement for amoxicillin treatment were included if their risk of anaphylaxis was judged to be low. We evaluated immediate and delayed reactions, patient demographics, the impact on resource utilization, and the number of patients no longer considered to be allergic to penicillins at the 1-month follow-up.

Results: From August 2021 through April 2023, 100 children received an oral amoxicillin challenge in the ED. Among them, 93% safely received amoxicillin without an immediate reaction and were discharged with amoxicillin from the ED. Seven participants had immediate reactions which included skin rashes or vomiting, with one participant experiencing an anaphylactic reaction. Five of the seven subsequently had an amoxicillin challenge by an allergist and only the one with anaphylaxis in the ED reacted. Suspected delayed reactions were observed in 4 of the other 89 (4%) participants who could be contacted within 30 days of the challenge and consisted of skin rashes. Three of the four subsequently had an amoxicillin challenge by an allergist and one reacted. Then, two patients (2%) had confirmed allergies following suspected reactions: one patient with the anaphylactic reaction, and the other with the delayed reaction. Overall, 79/89 (89%) of patients with 30-day follow-up could have their allergy label removed without an allergist consultation.

Conclusions: Standardized oral amoxicillin challenges in low-risk pediatric ED patients allowed for the removal of penicillin allergy labels in 89% of patients reached for follow-up without an allergist consultation. This approach enhanced patient care, allowing 93% of participants to be discharged from the ED with an amoxicillin prescription. Only 2 of 100 children had proven amoxicillin allergy; another 3 had reactions but no assessment by an allergist.

Objectives: Kawasaki disease (KD) is the leading cause of acquired childhood coronary aneurysms (CAA). Males are more affected than females, with lower survival from cardiac events and normalization rates. This study aimed to determine the association between biological sex and CAA risk and evaluate the association with baseline biochemical inflammatory markers by biological sex.

Methods: This multicenter retrospective cohort study involved children ≤10 years old diagnosed with KD in five Canadian centres. Adjusted CAA risk differences between sexes were computed using binomial regression. Associations between inflammatory markers and CAA risk were analyzed using logistic regression with interaction terms between sex and inflammatory markers.

Results: From 2004 to 2015, 1382 patients were diagnosed with KD and 812 (59%) were males. Median age, fever total duration, and fever duration at therapy initiation were similar between the sexes. The cumulative incidence of medium to large (Z ≥ 5) CAA was higher in males [70/812 (8.6%)] compared to females [19/570 (3.3%)], with an adjusted risk difference of 4.6 % (95% confidence interval [CI] 2.1 to 7.1). Large (Z > 10) aneurysms were more prevalent in males (adjusted risk difference of 3.3%, 95% CI 1.7 to 5.0). Most inflammatory markers were positively associated with CAA risk, but the association was not statistically different between sexes.

Conclusion: Males with KD are at higher risk of developing CAA compared to females. The majority of patients were presumed to be prepubertal, suggesting that hormonal influences are unlikely to be a significant factor. Future KD research based on biological sex categorization should focus on patient risk stratification and long-term prognostic evaluation.

Objectives: Communimetric screening tools convey functional impairment and action required, helping clinicians identify and communicate patient's needs and actions within a measurement framework. We examined the feasibility of using the HEADS-ED Under 6, a communimetric mental health (MH) and developmental screening and triage tool for children under 6, within 1Call1Click.ca, a regional coordinated access and navigation program in Eastern Ontario. We explored utility validity to understand how the HEADS-ED Under 6 is used to help intake workers screen, inform their level of need decision, and establish a cut-off for recommending interventions targeting moderate levels of need or higher.

Methods: Using a prospective cohort design, intake workers at 1Call1Click.ca screened all children under 6 using the HEADS-ED Under 6 from June 2021 to August 2023. Correlations and an Analysis of variance examined how total scores were associated with the level of need, and Receiver Operator Curve analysis examined sensitivity and specificity for identifying moderate levels of need or higher.

Results: In total, 589 children under 6 were screened with the HEADS-ED Under 6. Utility validity was demonstrated by significant associations between level of need and HEADS-ED Under 6 domains and total scores. A total score of ≥6 supported decision-making for moderate levels of need or higher (Area Under Curve = 0.807).

Conclusions: The HEADS-ED Under 6 is a brief, easy, and valid screening tool, that can be used by clinicians to identify the level of action/impairment, communicate the severity of MH and developmental needs, and determine the level of need for services.

Introduction: Warfarin continues to be used in children for specific indications. Children must test their blood regularly and adherence to the medication routine can be highly challenging. Warfarin nonadherence has the potential for significant complications. Blister packaging (BP) is not commonly applied to warfarin therapy due to frequent dose titrations however BP may be useful in improving adherence.

Objective: To evaluate the efficacy of BP warfarin to determine its impact on outpatient management.

Methods: Retrospective chart review of children aged from 18 months to 18 years with suboptimal adherence transitioned to BP between 2021 and 2023. Data collected included international normalized ratio (INR) reminders, missed doses, bleeding or thrombotic events, and INRs for 6 months pre-/post-BP. Time in therapeutic range (TTR) analysis as a measure of safety and efficacy was used.

Results: Eleven charts were reviewed. Mean and median age were 11 and 9 years, respectively (4 to 17 range), nine female and two male. International normalized ratio reminders required decreased 30% pre-/post-BP initiation 84 (mean 7.6, range 0 to 18/child) and 59 (mean 5.4; range 1 to 15/child), respectively. Missed doses decreased by 20% pre-/post-BP 35 (mean 3.2; range 0 to 10) and 29 (mean 2.6; range 0 to 10), respectively. The TTR increased by a median of 11.61% from pre to post. This difference was not statistically significant (P-value from Wilcoxon signed rank test: 0.1602).

Conclusion: This study demonstrates that BP is a viable option that supports warfarin management. Caregivers described BP as beneficial with a trend to increased TTR and a decrease in healthcare provider workload.

Current health data reveal that children's voices often remain invisible in healthcare encounters. Incorporating voices of children and youth with chronic health conditions and/or disabilities in a systematic way will enhance and complement current health data. My Abilities First is an approach that invites children and youth with chronic health conditions and/or disabilities to describe themselves using their preferred way of communication. Importantly, including the preferences, opinions and abilities of children and youth in their clinical care promotes autonomy, dignity and respect in a human rights-based approach. My Abilities First facilitates participatory decision-making processes, ultimately expediting positive change in healthcare, bringing joy, shared purpose, empowerment and proximity in clinical care.