Paediatrics and Child Health (United Kingdom)最新文献

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Approach to the use of rescue medications in children for prolonged epileptic seizures in the community

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-04-01 DOI: 10.1016/j.paed.2025.01.004

Nermin Alashal, Nahin Hussain

Prolonged seizures including convulsive status epilepticus (CSE) in children are significant problems to manage in the community. Early treatment may shorten episodes and prevent subsequent mortality and long-term morbidity. It is likely that pre-hospital treatment is an important part of the optimal management of CSE as it helps to optimize the management in a hospital setting. Benzodiazepines were successfully used for many years with rectal diazepam was the mainstay of treatment. More recently buccal and intranasal midazolam have taken over its place due to their efficacy and ease of administration. Buccal midazolam is more acceptable to the careers and parents for the drug to be administered through mouth, rather than rectally in a tense and anxious situation. Intranasal midazolam has recently been approved for use in children in the USA. Although rectal paraldehyde is widely used in acute settings in the UK, there is relatively little evidence to support this practice. This short article outlines some of the more important studies that can help to guide clinical decision making and offers some practical advice for health professionals caring for children with seizures who may need rescue medication.

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引用次数: 0

Glucagon-like peptide-1 (GLP-1) receptor agonists: applications in childhood diabetes and obesity

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-04-01 DOI: 10.1016/j.paed.2025.01.003

Kun Hu, Timothy G Barrett

Glucagon-like 1 receptor agonists (GLP-1 RAs) are a class of synthetic incretin analogues that were originally developed to treat hyperglycaemia in adults with type 2 diabetes. Their mechanisms of action include effects on body weight through reducing appetite and slowing gastric emptying and these have been exploited in new indications for weight reduction in obesity. Most recently, convincing evidence has been published for their benefits in obstructive sleep apnoea, renal function in diabetes, and possibly anti-ageing. Studies in children have mainly focussed on childhood type 2 diabetes and obesity, and their efficacy has led to licensing for children from 10 years of age (type 2 diabetes) and 12 years (obesity). Early studies of these agents as add-on therapies in type 1 diabetes showed efficacy but significant risks of hypoglycaemia. This review will discuss the history and development of GLP-1 RAs in the context of the rising prevalence of childhood obesity and type 2 diabetes, the evidence for their effectiveness in children, and potential future applications such as in children with type 1 diabetes.

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引用次数: 0

Klinefelter syndrome: what every paediatrician needs to know

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-04-01 DOI: 10.1016/j.paed.2025.01.002

Gary Butler

Klinefelter syndrome (KS) is a common sex chromosome variation around one in 750 live male births. The karyotype is usually 47,XXY. However, three quarters of KS males are never identified. Lifespan is not reduced. There is no specific infant phenotype. Prepubertal growth is generally rapid and children may become taller than the mid-parental height. Adolescent growth is not increased, so extreme tall stature is unusual. Overweight and central obesity occur in some boys from mid-childhood. Infant development is usually within age related ranges, although one third may need speech support and two thirds reading and language support. IQ is within the population range.

Puberty onset is not delayed and testosterone levels increase typically at first but often fail to rise in late puberty and biochemical hypogonadism is diagnosed by a low morning testosterone concentration. Clinical hypogonadism is common with central obesity, gynaecomastia and low muscle development and strength. Testosterone supplementation with transdermal gel or injections may help to improve physical development and functioning. Sperm production is severely reduced resulting in azoospermia in the majority. Fertility counselling is important but assessment not needed until late adolescence when surgical testicular sperm extraction can be performed, with no advantage at younger ages.

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引用次数: 0

Prader Willi syndrome: an update on the multidisciplinary approach

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-04-01 DOI: 10.1016/j.paed.2025.01.005

Chamidri Randika Naotunna, Angela K Lucas-Herald, Malcolm DC Donaldson , M Guftar Shaikh

Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by hypotonia, hyperphagia, obesity, and a spectrum of cognitive and behavioural issues. Clinical manifestations differ according to the age of presentation and as such a multidisciplinary approach is important across the lifespan to improve outcomes. Often this may be led by paediatric endocrinology but should include input from dietetics, psychology, respiratory, speech and language and others according to clinical need. It is likely these needs will change as the child grows and, as such, the composition of the team should remain flexible. Overall, a comprehensive, multidisciplinary approach encompassing medical, nutritional, behavioural, and educational support is essential for managing individuals with PWS, significantly improving the quality of life and long-term outcomes for affected children and their families.

引用次数: 0

Making great occupational therapy referrals: how to get the right help, first time, for children, young people and families

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-03-01 DOI: 10.1016/j.paed.2024.12.004

Sally Payne

The demand for children's occupational therapy is rising, but resources and capacity are not following at the same pace. As a result, many children and young people are waiting too long to receive the occupational therapy they need and deserve. This article offers guidance for paediatricians to increase the chances of their referrals being accepted so children and young people can access the help they need, when they need it. The article begins by examining the reasons behind the growing demand, then explains how the universal, targeted, and individualized service model is being used to provide more timely access to occupational therapy expertise. Lastly, it offers guidance to help referrers make great referrals to enable children and young people to access the level and type of occupational therapy they need to fulfil their potential and live full and happy lives.

引用次数: 0

Effective vaccination for malaria and wider implications for future global child health

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-03-01 DOI: 10.1016/j.paed.2024.12.002

Rodney Ogwang, Jane Crawley

Malaria remains a major public health concern. Following decades of research and development, a significant milestone was recently achieved with the historic approval of the first-generation of malaria vaccines. Importantly, initial programmatic use is planned for children living in areas of Africa with high malaria transmission intensity. Although their protective efficacy is incomplete, it is anticipated that these vaccines will provide public health gains. Noteworthy is the fact that, in addition to the direct antimalarial benefit, a highly effective malaria vaccine would have broad implications for global child health. Here we summarize the potential broader public health benefits of an efficacious vaccine and the practical implications of vaccine rollout. We also briefly discuss the current state of malaria vaccine research and development.

引用次数: 0

The child with prolonged fever: when to think zebras

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-03-01 DOI: 10.1016/j.paed.2024.12.001

Sarah Reynolds, Seilesh Kadambari, Elizabeth Calton, Damian Roland

Fever is a very common paediatric presentation and usually has an identifiable infectious aetiology. However, for the child with prolonged fever it is sometimes necessary to look beyond the usual suspects and consider the ‘zebra’ diagnoses – that is, the unusual ones. This update of our 2020 article addresses when to consider rarer and potentially life-threatening infective, autoimmune or malignant causes of prolonged fever and their immediate management. The advent of the COVID-19 pandemic (and thus the need to consider paediatric inflammatory multisystem syndrome temporally associated with COVID-19), the increase in tuberculosis and the resurgence in measles have been considered in the re-working of this paper.

引用次数: 0

Managing a child with a possible vaccine allergy

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-03-01 DOI: 10.1016/j.paed.2024.12.003

Suzana Radulovic, Elizabeth Powell

Adverse reactions to vaccination are frequent, but true allergy to vaccines is rare. It is important to recognize symptoms which are common side effects of immunization and local reactions/benign rashes which are not a contraindication for future vaccination. Patients with a history of significant reactions to vaccines need to be referred for investigation of suspected allergy to the vaccine itself, or, more commonly excipients. Investigations involve allergy testing (skin testing and specific IgE) and ultimately risk – assessed challenge to either the same vaccine or an alternative vaccine without the offending allergen in case of reactions to excipients/adjuvants. In this article, we discuss how to identify children and young people who need further investigation, those who would benefit from onward referral and distinguish them from those who can continue with the immunization schedule in the community or local services.

引用次数: 0

Paediatric ECG made even easier

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-02-01 DOI: 10.1016/j.paed.2024.11.001

Rami Dhillon

All doctors need to be able to interpret an electrocardiogram (ECG). For a non-invasive test the ECG can deliver great rewards to those prepared to invest in its promise. It holds the potential of distinguishing normal from abnormal in the investigation of common presentations such as heart murmurs and palpitations. In more acute situations, correct interpretation offers a keen understanding of disturbances of rhythm and conduction. This article examines the utility of this modest but potent tool.

引用次数: 0

‘Let's pretend’ in paediatrics: in situ simulation in practice

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-02-01 DOI: 10.1016/j.paed.2024.11.004

Hannah Pool

In-situ simulation is simulation-based education which is integrated into the clinical environment rather than in a dedicated training venue. It is used to improve clinical care, team dynamics and leadership as well as evaluate system issues and identify latent threats in the environment.

Designing a simulation, whether impromptu or planned, is crucial to its success. Considering the scenario and learning outcomes, location, equipment required and ensuring the right facilitators are available is essential. A simulation proforma can help to structure and deliver a successful session. It is important to create a supportive educational environment where participants feel comfortable and there is open debrief which identifies key learning for individuals, the department and wider system.

Embedding simulation into a department can be challenging but equally rewarding and lead to improvements in team performance and communication.

引用次数: 0

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