Paediatrics and Child Health (United Kingdom)最新文献

英文中文

Demystifying the TORCH screen: an approach to the newborn suspected of congenital infection 揭开TORCH筛查的神秘面纱：一种新生儿疑似先天性感染的方法

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2026-01-01 DOI: 10.1016/j.paed.2025.11.003

Lloyd Abood, Nitin Goel

Congenital infections are a significant cause of neonatal morbidity and mortality, often presenting with a diverse range of clinical features that pose diagnostic and management challenges. This review breaks down the TORCH screen, often referred to in neonatal and paediatric medicine as a generic congenital infection screen. We provide a comprehensive overview of the clinical approach to a neonate suspected of congenital infection, encompassing initial evaluation, diagnostic strategies, and therapeutic interventions. It outlines key clinical manifestations, such as intrauterine growth restriction, hepatosplenomegaly, rash, and neurologic signs, that may prompt investigation for congenital pathogens including cytomegalovirus, toxoplasmosis, syphilis, rubella, herpes simplex virus, and others. Diagnostic workup is guided by maternal history, antenatal screening, and targeted investigations, including laboratory testing, imaging, and specialist input. Management involves pathogen-specific therapy, supportive neonatal care, and addressing complications such as hearing loss or neurodevelopmental delay. The article emphasizes the importance of close monitoring and multidisciplinary follow-up to identify and manage long-term sequelae. In addition, it reviews strategies for prevention, including antenatal screening, maternal vaccination, and infection control practices. Finally, it discusses the broader public health implications, such as surveillance programs and the role of early diagnosis in mitigating the burden of disease. A structured, evidence-based clinical approach is essential to optimize outcomes for affected neonates and reduce the incidence of preventable congenital infections.

先天性感染是新生儿发病和死亡的重要原因，通常表现出各种临床特征，给诊断和管理带来挑战。这篇综述打破了TORCH筛查，通常在新生儿和儿科医学中被称为一般先天性感染筛查。我们提供了一个全面的概述临床方法的新生儿怀疑先天性感染，包括初步评估，诊断策略和治疗干预。它概述了关键的临床表现，如宫内生长受限、肝脾肿大、皮疹和神经系统体征，这些可能促使对先天性病原体进行调查，包括巨细胞病毒、弓形虫病、梅毒、风疹、单纯疱疹病毒等。诊断检查以产妇病史、产前筛查和有针对性的调查为指导，包括实验室检测、影像学检查和专家投入。管理包括病原体特异性治疗，支持性新生儿护理，并解决并发症，如听力损失或神经发育迟缓。文章强调了密切监测和多学科随访对识别和管理长期后遗症的重要性。此外，报告还审查了预防战略，包括产前筛查、孕产妇疫苗接种和感染控制做法。最后，它讨论了更广泛的公共卫生影响，如监测项目和早期诊断在减轻疾病负担中的作用。结构化的、基于证据的临床方法对于优化受影响新生儿的预后和减少可预防的先天性感染的发生率至关重要。

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引用次数: 0

Necrotizing enterocolitis: a review of current practice and current understanding of the pathophysiology 坏死性小肠结肠炎：当前的实践和当前的病理生理认识的回顾

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2026-01-01 DOI: 10.1016/j.paed.2025.11.001

Daniel Carroll

Necrotizing enterocolitis (NEC) is the commonest life-threatening surgical emergency in neonates. Despite decades of study the mortality and morbidity associated with this condition remain stubbornly high and the incidence has not decreased despite the introduction of multiple strategies to prevent NEC. The pathophysiology is incompletely understood, but what we do understand is that prematurity resulting in an immature and gut with impaired innate immunity renders the neonatal gastrointestinal tract susceptible to abnormal bacterial colonization and a subsequent pathological inflammatory response resulting in localized tissue damage and cell death. Recent advances in the understanding of the disease have led to a plethora of new potential treatments to both prevent and treat this condition. Here we review the most recent trends in contemporary practice and provide a simple summary of the underlying pathogenesis. We will discuss what is known about the risk factors, clinical presentation, diagnosis and treatment of the condition, before moving on to strategies for prevention and long-term outcomes.

坏死性小肠结肠炎（NEC）是新生儿最常见的危及生命的外科急诊。尽管经过几十年的研究，与这种疾病相关的死亡率和发病率仍然居高不下，尽管引入了多种预防NEC的策略，但发病率并未下降。病理生理学尚不完全清楚，但我们所知道的是，早产导致不成熟的肠道和先天免疫受损，使新生儿胃肠道容易受到异常细菌定植和随后的病理性炎症反应的影响，导致局部组织损伤和细胞死亡。最近对这种疾病的了解取得了进展，导致了大量新的潜在治疗方法来预防和治疗这种疾病。在这里，我们回顾了当代实践的最新趋势，并提供了一个简单的总结潜在的发病机制。我们将讨论已知的风险因素、临床表现、诊断和治疗，然后再讨论预防策略和长期结果。

引用次数: 0

Transitional respiratory care in medically complex infants: evidence-based strategies from NICU to PICU 医学复杂婴儿的过渡呼吸护理：从NICU到PICU的循证策略

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2026-01-01 DOI: 10.1016/j.paed.2025.11.002

Aravanan Anbu Chakkarapani, Rabindran Chandran, Manu Somasundaram Sundaram

The transition of critically ill infants from the Neonatal Intensive Care Unit (NICU) to the Paediatric Intensive Care Unit (PICU) presents a set of clinical, physiological, and logistical challenges. This period is particularly complex due to evolving respiratory demands, age-related changes in pulmonary mechanics, and variations in ventilatory practices between neonatal and paediatric teams. Individualized respiratory management is essential, especially for high-risk populations such as preterm infants with evolving or established bronchopulmonary dysplasia (BPD)/chronic lung disease (CLD), with or without associated pulmonary hypertension, infants with congenital diaphragmatic hernia (CDH), neuromuscular disorders, and those with tracheostomies or long-term ventilation needs. This review highlights the importance of tailored ventilatory strategies, including invasive and non-invasive modalities, the evolving role of Neurally Adjusted Ventilatory Assist (NAVA), a high-flow nasal cannula (HFNC), and other non-invasive ventilation (NIV) techniques. Pharmacologic adjuncts, such as pulmonary vasodilators and bronchodilators, are also discussed. Emerging evidence on negative pressure ventilation (NPV) is presented as a potential adjunct in select cases. Emphasis is placed on multidisciplinary coordination, continuity of respiratory care, and early planning to optimize outcomes during this critical transition.

危重婴儿从新生儿重症监护病房（NICU）过渡到儿科重症监护病房（PICU）提出了一系列临床、生理和后勤方面的挑战。由于不断变化的呼吸需求、与年龄相关的肺力学变化以及新生儿和儿科团队之间通气实践的差异，这一时期尤为复杂。个性化的呼吸管理是必要的，特别是对于高危人群，如发展或建立支气管肺发育不良(BPD)/慢性肺病（CLD）的早产儿，伴有或不伴有肺动脉高压，先天性膈疝（CDH）的婴儿，神经肌肉疾病，以及气管切开术或长期通气需要的婴儿。这篇综述强调了量身定制通气策略的重要性，包括有创和无创模式、神经调节通气辅助（NAVA）、高流量鼻插管（HFNC）和其他无创通气（NIV）技术的不断发展作用。药物辅助，如肺血管扩张剂和支气管扩张剂，也进行了讨论。在一些病例中，负压通气（NPV）作为一种潜在的辅助手段被提出。重点放在多学科协调，呼吸护理的连续性和早期规划，以优化这一关键过渡期间的结果。

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引用次数: 0

Maternal medications and drugs: what I should know as a paediatrician 产妇用药和药物：作为儿科医生我应该知道的

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2026-01-01 DOI: 10.1016/j.paed.2025.11.004

Arun Ramachandran, Avantika Arun

Prescribing in pregnancy sits at the intersection of paediatrics and obstetrics, with both specialties sharing responsibility for the health of not one, but two patients. Medicines and chemicals account for around 2–3% of birth defects. Maternal medications and substance abuse contribute to some avoidable admissions to neonatal intensive care units. Prescribing is often unavoidable, as pregnancy can worsen pre-existing conditions like diabetes and lead to new ones such as pre-eclampsia. The physiological changes of pregnancy alter the pharmacokinetics and pharmacodynamics of many drugs. Unfortunately, most drug trials exclude pregnant women, making evidence-based treatment difficult. The guiding principle is to use the lowest effective dose for the shortest necessary duration. We aim to raise awareness among paediatricians about commonly prescribed drugs in pregnancy, their potential adverse effects on the baby, and their impact on breastfeeding. Paediatricians should remain strong advocates for neonatal health, working closely with parents and obstetric teams to ensure appropriate use of medications and interventions that improve outcomes. This is especially important in cases like prematurity, where optimal use of antenatal corticosteroids and magnesium sulphate significantly affects outcomes and is monitored nationally via the National Neonatal Audit Programme.

怀孕期间的处方是儿科和产科的交汇处，这两个专业共同负责不是一个，而是两个病人的健康。药物和化学药品约占出生缺陷的2-3%。产妇用药和药物滥用导致一些本可避免的新生儿重症监护病房入院。处方通常是不可避免的，因为怀孕会使糖尿病等原有疾病恶化，并导致新的疾病，如先兆子痫。妊娠期的生理变化改变了许多药物的药代动力学和药效学。不幸的是，大多数药物试验将孕妇排除在外，使得循证治疗变得困难。指导原则是在最短的必要时间内使用最低的有效剂量。我们的目标是提高儿科医生对孕期常用处方药的认识，了解它们对婴儿的潜在不利影响，以及它们对母乳喂养的影响。儿科医生应继续大力倡导新生儿健康，与父母和产科小组密切合作，确保适当使用改善结果的药物和干预措施。这在早产等情况下尤其重要，在早产情况下，优化使用产前皮质类固醇和硫酸镁会显著影响结局，并通过国家新生儿审计规划在全国范围内进行监测。

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引用次数: 0

Social protection for children: global landscape and domestic provision in the UK 儿童的社会保护：英国的全球格局和国内规定

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-12-30 DOI: 10.1016/j.paed.2025.11.007

Kirsty Robertson, Alison McLuckie

Social protection programmes are suggested by UNICEF as being a key intervention in the battle against global child poverty. Unfortunately, the provision of social protection programmes, including benefit provision, is unequal across the globe with children living in low income countries least likely to receive social security. The provision of adequate income for families to ensure children's needs are met requires a rights-based approach. Children's rights are universal and include the right to social security (Article 26), healthcare (Article 24), access to education (Article 28) and an adequate standard of living (Article 27). This article will discuss the global importance of social protection in the context ongoing concerns about high levels of child poverty as well as taking a closer look at the United Kingdom's welfare system with an emphasis on children and families.

联合国儿童基金会建议，社会保护方案是对抗全球儿童贫困的关键干预措施。不幸的是，社会保护计划的提供，包括福利的提供，在全球范围内是不平等的，生活在低收入国家的儿童最不可能获得社会保障。为家庭提供足够的收入以确保满足儿童的需要需要一种基于权利的办法。儿童的权利是普遍的，包括社会保障权（第26条）、保健权（第24条）、受教育权（第28条）和适足生活水准权（第27条）。本文将讨论社会保护在全球范围内的重要性，当前人们对儿童贫困问题的高度关注，并仔细研究英国的福利制度，重点是儿童和家庭。

引用次数: 0

Climate change and child health: the importance of global citizenship 气候变化与儿童健康：全球公民的重要性

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-12-24 DOI: 10.1016/j.paed.2025.11.008

Emily Broadis, Euan Fisher

Viewing climate change through the lens of child health brings focus to the uncomfortable realities of the geographical, intergenerational, and healthcare system injustices of today's world. Children are disproportionately affected, their developing bodies are more susceptible to the negative health impacts, and they are ultimately suffering because of the actions of generations before them. Whilst the challenges of climate change may feel overwhelming, global citizenship offers the paediatrician an outlook of hope and encouragement through positive collaborative action. Global citizenship is an awareness of being connected to people from all around the world, recognizing that decisions made locally can impact on those who may live in other continents, bringing a sense of responsibility for individual actions and the implications they may have for all people and the planet. This concept of a global community fosters equity and social justice, energizing people to work collaboratively to address local and global challenges in the shared endeavour for a healthy planet and population. This paper positions global citizenship as a route through which paediatricians can utilize their knowledge, skills, global community networks, and agency to contribute to climate action from a global child health perspective within their roles alongside UK clinical practice.

从儿童健康的角度看待气候变化，使人们关注到当今世界的地理、代际和卫生保健系统不公正等令人不安的现实。儿童受到的影响尤为严重，他们发育中的身体更容易受到负面的健康影响，他们最终遭受的痛苦是由于他们之前几代人的行为。虽然气候变化的挑战可能令人难以承受，但全球公民身份通过积极的合作行动为儿科医生提供了希望和鼓励的前景。全球公民意识是一种与世界各地的人联系在一起的意识，认识到当地做出的决定可能会影响到生活在其他大洲的人，对个人行为及其可能对全人类和地球产生的影响产生责任感。这一全球共同体的概念促进公平和社会正义，激励人们齐心协力，共同努力，应对地方和全球挑战，共同维护地球和人类的健康。本文将全球公民定位为一种途径，通过这种途径，儿科医生可以利用他们的知识、技能、全球社区网络和机构，在他们与英国临床实践的同时，从全球儿童健康的角度为气候行动做出贡献。

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引用次数: 0

The impact of being a young carer and the support available 作为一个年轻的照顾者的影响和可用的支持

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-12-16 DOI: 10.1016/j.paed.2025.11.009

Joanna Coghill, Sharon Daniels, Denise Garner, Ruth Glenn

Young carers are children under the age of 18 who care for family members or friends. There are a significant number of young carers in the UK, with 2021 census data for England and Wales reporting at least 120,000 – however this is likely to be an under representation. Young carers are at higher risk of poor health, education and social outcomes. There is awareness of the challenges faced by young carers with clear legal frameworks, but access to services needs to be improved. A range of services and support mechanisms are available to young carers, including statutory assessments, localized support networks, and digital resources, though access and awareness remain inconsistent across regions.

青年照顾者是指照顾家庭成员或朋友的18岁以下儿童。英国有相当多的年轻看护人，2021年英格兰和威尔士的人口普查数据显示，至少有12万名年轻看护人，但这可能是不足的。年轻的照料者在健康、教育和社会结果方面面临更大的风险。在明确的法律框架下，人们意识到年轻照顾者面临的挑战，但需要改善获得服务的机会。青年照顾者可获得一系列服务和支持机制，包括法定评估、本地化支持网络和数字资源，但各地区的获取和认识仍然不一致。

引用次数: 0

Over one in four UK children face food insecurity: what can paediatricians do? 超过四分之一的英国儿童面临食品不安全：儿科医生能做些什么？

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-12-11 DOI: 10.1016/j.paed.2025.11.006

Rosalyn Arnold, Rosalie Cattermole, David Taylor-Robinson, Dougal Hargreaves, Rachel Loopstra

In 2023–24, over one in four children in the UK – at least 3.9 million – lived in households without reliable access to food each month, as reported by the Department for Work and Pensions. This rate of child food insecurity has been described as amongst the worst in Europe. The consequences are profound and long lasting. Food insecurity affects children's physical health, emotional wellbeing, social and cognitive development and academic performance. Often, hospitals and general practices are sites where these impacts are first recognized. Yet paediatricians and other health professionals frequently report feeling powerless to respond to problems rooted in poverty and inadequate welfare support. This article aims to help paediatricians and other health professionals better understand food insecurity, its impact on children, current rates in the UK and the approaches being taken to address it. There are several ways health professionals can respond to food insecurity, and we highlight two case studies showing how hospitals, community services and charities are working together to respond to rising rates. Our aim is to equip paediatricians and other health professionals with a clearer sense of what they can do in their everyday roles. An infographic summarizing the key messages of this article is available at the end of this article.

根据工作和养老金部的报告，在2023 - 2024年，英国超过四分之一的儿童（至少390万）生活在每月无法获得可靠食物的家庭中。这一儿童食品不安全率被认为是欧洲最严重的。其后果是深远而持久的。粮食不安全影响儿童的身体健康、情绪健康、社会和认知发展以及学业成绩。通常，医院和全科诊所是最先认识到这些影响的场所。然而，儿科医生和其他卫生专业人员经常报告说，他们感到无力应对源于贫困和福利支持不足的问题。本文旨在帮助儿科医生和其他卫生专业人员更好地了解食品不安全，其对儿童的影响，目前在英国的比率和正在采取的方法来解决这一问题。卫生专业人员可以通过多种方式应对粮食不安全问题，我们重点介绍了两个案例研究，展示了医院、社区服务和慈善机构如何共同努力应对不断上升的粮食不安全问题。我们的目标是使儿科医生和其他卫生专业人员更清楚地了解他们在日常工作中可以做些什么。在本文的末尾有一个信息图，总结了本文的主要信息。

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引用次数: 0

Violence: understanding the public health approach to violence prevention and implications for violence prevention work with children and young people 暴力：了解预防暴力的公共卫生方法及其对儿童和青少年预防暴力工作的影响

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-12-11 DOI: 10.1016/j.paed.2025.11.005

Christine A Goodall, Ryan McHenry, Michael Whelan

Our understanding of the causes and impact of violence has developed over the years to the point where we recognize the profound and long-lasting impact that violence can have on children and young people. In this article we explore some of the impacts violence has on children and young people and how taking a public health approach can help us to develop opportunities for prevention at the primary, secondary and tertiary levels.

多年来，我们对暴力的起因和影响的理解已经发展到认识到暴力可能对儿童和青年产生深远和持久的影响的程度。在本文中，我们探讨了暴力对儿童和年轻人的一些影响，以及采取公共卫生方法如何帮助我们在小学、中学和大学各级创造预防机会。

引用次数: 0

When should a child be referred for adenotonsillectomy? 儿童何时应接受腺扁桃体切除术？

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-12-01 DOI: 10.1016/j.paed.2025.09.001

Jacquline Chan, Kate Stephenson

Adenotonsillectomy is a frequently performed paediatric surgical procedure, primarily indicated for obstructive sleep-disordered breathing and recurrent tonsillitis. Accurate recognition of referral indications by primary and secondary care clinicians is essential to ensure timely and appropriate management. This article outlines a structured approach to assessment and referral, focusing on comprehensive history-taking, ENT examination, and the use of relevant investigations. Obstructive sleep apnoea, typically due to adenotonsillar hypertrophy, can have significant developmental and behavioural consequences. Recurrent tonsillitis is another key indication, with referral guided by Scottish Intercollegiate Guidelines Network (SIGN) criteria and supported by NHS England's decision aid. Adenoid hypertrophy also contributes to conditions such as nasal obstruction and otitis media with effusion, particularly in children requiring repeated grommet insertion. Additional indications for adenotonsillectomy include PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis) syndrome, peritonsillar abscess, and selected cases of PANDAS (paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections). Anatomical and physiological considerations, including craniofacial abnormalities and neuromuscular tone, can exacerbate upper airway obstruction and should prompt early specialist referral. While surgery is generally safe, risks include postoperative pain, haemorrhage, and symptom recurrence. A shared decision-making approach, incorporating clinical severity, comorbidities, and caregiver preferences, is vital to optimize outcomes and minimize risks.

腺扁桃体切除术是一种常见的儿科外科手术，主要用于阻塞性睡眠呼吸障碍和复发性扁桃体炎。初级和二级保健临床医生对转诊指征的准确识别对于确保及时和适当的管理至关重要。本文概述了一种结构化的评估和转诊方法，重点是全面的病史记录、耳鼻喉科检查和相关调查的使用。阻塞性睡眠呼吸暂停，通常是由腺扁桃体肥大引起的，会对发育和行为产生重大影响。复发性扁桃体炎是另一个关键指征，由苏格兰校际指导网络（SIGN）标准指导并由NHS英格兰决策援助支持。腺样体肥大也会导致鼻塞和积液性中耳炎等疾病，特别是在需要反复植入套管的儿童中。腺扁桃体切除术的其他适应症包括PFAPA（周期性发热、口疮性口炎、咽炎和腺炎）综合征、扁桃体周围脓肿和特定的PANDAS（与链球菌感染相关的儿童自身免疫性神经精神疾病）病例。解剖和生理方面的考虑，包括颅面异常和神经肌肉张力，可加剧上气道阻塞，应提示早期专科转诊。虽然手术通常是安全的，但风险包括术后疼痛、出血和症状复发。共同的决策方法，包括临床严重程度、合并症和护理人员偏好，对于优化结果和最小化风险至关重要。

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