Paediatrics and Child Health (United Kingdom)最新文献

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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

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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引用次数: 0

Recent advances in the management of retinoblastoma 视网膜母细胞瘤治疗的最新进展

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-12-01 DOI: 10.1016/j.paed.2025.09.004

Gerard Millen, Helen Jenkinson

Retinoblastoma is the most common intraocular malignancy in children, typically presenting before the age of 5, with around 50 new cases in the UK each year. Around 40% of affected children will carry a germline mutation of the RB1 tumour suppressor gene and will face not only the risk of retinoblastoma in early childhood, but a lifelong risk of second malignancy and challenging reproductive choices with a 1 in 2 chance of passing on the mutation to their offspring. Over the last 2 decades there have been significant developments in the management of retinoblastoma which have led to improved ocular survival, better visual outcomes and greater reproductive choices for affected individuals. This paper highlights some of these advances including: improvements in pre-natal and early neonatal diagnosis, new retinal imaging techniques which have revolutionized disease management, and innovative approaches to conservative management which have led to significant improvement in ocular salvage. There are exciting developments on the horizon as the increasing knowledge of the molecular genetics of retinoblastoma translates into the identification of high-risk subtypes and potential clinical and prognostic stratification which will guide treatment choices.

视网膜母细胞瘤是儿童中最常见的眼内恶性肿瘤，通常在5岁之前出现，在英国每年约有50例新病例。大约40%的患病儿童将携带RB1肿瘤抑制基因的种系突变，不仅在儿童早期面临视网膜母细胞瘤的风险，而且终身面临第二次恶性肿瘤的风险，并且有1 / 2的机会将突变遗传给后代，这对生殖选择构成挑战。在过去的二十年里，视网膜母细胞瘤的治疗取得了重大进展，这使得患者的眼部存活率得到了提高，视力得到了改善，并且有了更多的生殖选择。本文重点介绍了其中的一些进展，包括：产前和新生儿早期诊断的改进，新的视网膜成像技术已经彻底改变了疾病管理，以及创新的保守管理方法，这导致了眼部抢救的显着改善。随着对视网膜母细胞瘤分子遗传学知识的不断增加，对高风险亚型的识别和潜在的临床和预后分层将指导治疗选择，令人兴奋的进展即将出现。

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引用次数: 0

Barriers to ophthalmic care for children with autism spectrum disorder 自闭症谱系障碍儿童眼科护理的障碍

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-12-01 DOI: 10.1016/j.paed.2025.09.005

Iman Yahya, M Ashwin Reddy

This thematic literature review explores barriers to ophthalmic care for children with autism spectrum disorder (ASD), focusing on healthcare access, communication, sensory sensitivities, behavioural challenges, and adherence to eye care instructions. Relevant peer-reviewed literature published between January 2020 and March 2025 from high-income countries was reviewed, focusing on recurring themes and clinical implications. Key sources were selected to illustrate the most significant challenges and promising strategies. Case studies, non-peer-reviewed articles, and non-English publications were excluded. Common barriers identified included communication difficulties, sensory sensitivities, behavioural and emotional challenges, limited access to specialized services, and poor adherence to care routines. Effective strategies included sensory-friendly modifications in clinical environments, tailored communication techniques, and structured behavioural supports. Involvement of caregivers and pre-appointment preparation were also found to improve cooperation and outcomes. A multidisciplinary, person-centred approach is essential to improving ophthalmic care for children with ASD. Implementing sensory, communication, and behavioural strategies can enhance access and adherence. Further research should aim to standardize these practices across healthcare settings to ensure consistent, inclusive care.

本专题文献综述探讨了自闭症谱系障碍（ASD）儿童眼科护理的障碍，重点是医疗保健获取、沟通、感觉敏感性、行为挑战和遵守眼科护理指示。回顾了2020年1月至2025年3月期间来自高收入国家发表的相关同行评议文献，重点关注反复出现的主题和临床意义。选择了主要来源来说明最重大的挑战和有希望的战略。排除了案例研究、非同行评议文章和非英文出版物。确定的常见障碍包括沟通困难、感觉敏感、行为和情感挑战、获得专业服务的机会有限以及对护理程序的依从性差。有效的策略包括在临床环境中对感觉友好的修改，量身定制的沟通技术和结构化的行为支持。护理人员的参与和预约前的准备也可以改善合作和结果。多学科、以人为本的方法对于改善自闭症儿童的眼科护理至关重要。实施感官、沟通和行为策略可以提高获得性和依从性。进一步的研究应该致力于在医疗环境中标准化这些做法，以确保一致的、包容性的护理。

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引用次数: 0

Through the looking glass: managing ocular manifestations of autoimmune and autoinflammatory conditions 透过镜子：管理自身免疫和自身炎症条件的眼部表现

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-12-01 DOI: 10.1016/j.paed.2025.09.002

Smrithy Sadanandan, Mary Brennan, Conrad Schmoll

Autoimmune and autoinflammatory conditions may have ocular manifestations, which have potential to cause serious morbidity including vision loss. This article aims to provide the reader with a refresher about ocular anatomy, an update on immunopathogenesis and insight into the various ocular presentations. The commonest ocular manifestation namely uveitis is discussed in the context of idiopathic uveitis and juvenile idiopathic arthritis. Treatment approaches provide the reader a focus of discussion about the challenges that may be encountered by the child and their family.

自身免疫和自身炎症可能有眼部表现，有可能导致包括视力丧失在内的严重发病率。本文旨在为读者提供眼部解剖学的复习，免疫发病机制的更新和对各种眼部表现的见解。最常见的眼部表现即葡萄膜炎在特发性葡萄膜炎和青少年特发性关节炎的背景下进行了讨论。治疗方法为读者提供了一个关于儿童及其家庭可能遇到的挑战的讨论焦点。

引用次数: 0

Trends in the candidacy for cochlear implantation in children and young people 儿童和青少年人工耳蜗植入候选趋势

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-12-01 DOI: 10.1016/j.paed.2025.09.003

Sana Patel, Simone Schaefer, Lise Henderson, Iain Bruce, Jaya Nichani

Cochlear implantation has significantly improved outcomes for children with severe-to-profound sensorineural hearing loss. Children and young people (CYP) with residual hearing may benefit from advances in surgical technique and electrode design, which has made preserving remaining natural hearing more achievable. This enables combined electric-acoustic and electric-natural stimulation, supporting a more natural listening experience. This article reviews current candidacy criteria for cochlear implants (CI) in CYP, including the concept of ‘borderline’ candidacy, where CYP are not achieving anticipated benefit from their conventional hearing aids (age-appropriate speech, language and listening skills), despite receiving some measurable benefit. The role of cochlear implantation in children with complex needs and those with single-sided deafness is also discussed with practical considerations such as magnetic resonance imaging (MRI) safety and the presence of ventriculoperitoneal shunts. Timely identification and referral are essential to ensure all eligible CYP are given the opportunity to benefit from cochlear implantation.

人工耳蜗植入术显著改善了重度至重度感音神经性听力损失儿童的预后。残听儿童和青少年（CYP）可能受益于外科技术和电极设计的进步，这使得保留剩余的自然听力更容易实现。这使得电声和电自然刺激相结合，支持更自然的聆听体验。本文回顾了目前CYP中人工耳蜗植入（CI）的候选标准，包括“边缘”候选的概念，即CYP尽管获得了一些可测量的益处，但并未从传统助听器中获得预期的益处（与年龄相适应的言语、语言和听力技能）。本文还讨论了人工耳蜗植入在复杂需求儿童和单侧耳聋儿童中的作用，并结合磁共振成像（MRI）安全性和脑室-腹膜分流的存在等实际考虑进行了讨论。及时识别和转诊对于确保所有符合条件的CYP都有机会从人工耳蜗植入中获益至关重要。

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引用次数: 0

Paediatric ear, nose and throat (ENT) emergencies: more than ‘just’ things stuck up children's noses 儿科耳鼻喉科急诊：不仅仅是“仅仅”有东西卡在孩子的鼻子里

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-11-01 DOI: 10.1016/j.paed.2025.08.005

Sarah Reynolds, Harriet Cunniffe, Nicholas Richens, Jessica Bewick

Ear, nose and throat (ENT)-related presentations form a staple of the paediatric emergency department workloads. Although often minor, they have the potential to be life-threatening and require prompt and specific management. Examples of commoner problems include infections of the head and neck, epistaxis, nasal septum haematomas and airway foreign bodies. In this short article we briefly summarize the most significant emergencies affecting children and give advice about their emergency management.

耳鼻喉科（ENT）相关的介绍构成了儿科急诊科工作量的主要部分。虽然通常是轻微的，但它们有可能危及生命，需要迅速和具体的治疗。常见的问题包括头颈部感染、鼻出血、鼻中隔血肿和气道异物。在这篇短文中，我们简要地总结了影响儿童的最重要的紧急情况，并就他们的紧急情况管理提出建议。

引用次数: 0

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