Archives of Disease in Childhood最新文献

Introduction: Childhood mortality in the emergency setting is disproportionately high in low-income and middle-income countries (LMIC), with limited research dedicated to improving timely interventions, especially for critically ill children during transport. To perform essential prehospital paediatric research, there is a need for a tailored consent process, which reflects the specific needs and concerns of participants in this challenging research context.

Objective: The objective is to prospectively investigate stakeholder perceptions and preferences regarding consent processes for a specific paediatric ambulance-based telemedicine trial.

Methods: Exploratory qualitative study design using face-to-face semistructured interviews and focus group discussions. Data were analysed using thematic analysis. Participants included healthcare providers (paediatric telemedicine physicians and emergency medical technicians) and parents of children who required emergency transportation in Karachi, Pakistan.

Results: 47 participants, ranging from 19 to 47 years old, were involved in in-depth interviews or focus group discussions. The participants comprised 29 healthcare workers and 18 parents. Among them, 9 were women and 38 were men. Expressing diverse attitudes towards different consent methods, the majority recommended a prospective written informed consent approach to build trust and provide legal protection. Participants understood the situational incapacity that occurs in emergency settings, emphasised the importance of keeping the consent brief and recommended a subsequent contact in 2-3 days after the emergency transport to reconfirm consent and answer any questions.

Conclusion: Our interpretation of the findings revealed that participants preferred a staged consent process for telemedicine trials in LMIC paediatric emergency settings.

Objective: To determine whether any children in the UK had variant Creutzfeldt-Jakob disease (vCJD).

Design: This active prospective epidemiological study used the British Paediatric Surveillance Unit, asking UK paediatricians to notify all childhood cases of progressive intellectual and neurological deterioration (PIND), a group that would include all cases of vCJD. Clinical data were obtained by questionnaire or via a site visit. An independent expert group classified the cases. If vCJD was suspected, referral to the National Creutzfeldt-Jakob Disease Research and Surveillance Unit was recommended.

Results: Between May 1997 and April 2024 (27 years), 5222 children were notified. There were four groups. (1) 2540 were 'not cases'-they did not meet the case definition or there were notification errors. (2) 2367 had a known underlying diagnosis other than vCJD; the group contained more than 220 different diseases. (3) 309 had no diagnosis to explain their deterioration; there was evidence that none of these cases had vCJD. (4) There were six cases of vCJD: two males and four females. They developed symptoms between 1998 and 2000, aged 12-15 years, and the last two died in 2003. Their clinical features were similar to those of adults. Four were classified as definite vCJD and two as probable vCJD.

Conclusions: This study has provided unique data about neurodegenerative diseases in UK children. There is no reliable vCJD screening test; so for 27 years, the PIND study has provided reassurance that childhood vCJD cases were not missed. New vCJD cases with the methionine/valine genotype could appear.

Objective: To determine if out-of-home care (OOHC) reduces the risk of death in children with prenatal drug exposure (PDE).

Design: Population-based cohort study.

Setting: New South Wales, Australia.

Patients: Children with PDE, born between 2001 and 2020 and discharged alive after birth.

Exposure: PDE was defined as intrauterine exposure to maternal use of drugs of addiction, categorised into (1) neonatal abstinence syndrome (NAS) (n=5978); (2) exposure to maternal drugs of addiction, but not meeting diagnostic criteria for NAS (n=12 162); and (3) exposure to maternal exclusive tobacco smoking (n=187 827). Subanalyses by type of maternal drug use (opioids, stimulants and cannabis) were conducted.

Main outcome measures: Multivariate regression analyses of linked administrative data were used to determine the primary outcome of death after birth hospital discharge. Causal mediation analyses assessed the mediating effect of OOHC between PDE and mortality.

Results: Compared with no exposure, PDE was associated with a higher risk of childhood death. Risks were highest for infants with NAS (HR=4.20, 95% CI=3.23 to 5.44), followed by infants with PDE but no NAS diagnosis (HR=2.53, 95% CI=2.01 to 3.18). Mediation analyses demonstrated a natural indirect protective effect of OOHC in reducing risk of death (NAS: OR=0.5, 95% CI=0.5 to 0.5; PDE but no NAS diagnosis: OR=0.8, 95% CI=0.8 to 0.8). Subanalyses demonstrated a protective effect of OOHC for three types of maternal drug use (opioids: OR=0.7; stimulants: OR=0.8; cannabis: OR=0.9).

Conclusions: Any OOHC intervention was associated with reduced risk of death for children with PDE, emphasising the importance of strengths-based, culturally-sensitive support for this vulnerable population.

Objective: To investigate real-life salbutamol use by children with asthma at home and compare it with their written asthma action plans (WAAPs).

Design: Multicentre, observational prospective study.

Setting: Five tertiary care hospitals in France.

Patients: 120 children aged 3-11 years with asthma.

Interventions: Parents used a smartphone application connected to a smart inhaler via Bluetooth to record salbutamol use and answer questionnaires about their child's asthma symptoms over 6 months.

Main outcome measures: The primary outcome was the median number of salbutamol puffs used in the first 2 hours after an asthma symptom occurred, depending on symptom type. Secondary outcomes included how families operationalised WAAP instructions and the proportion who administered more or less salbutamol than prescribed.

Results: 43 families used the smart inhaler for asthma symptoms, recording 124 episodes of salbutamol use. The median number of puffs used in the first 2 hours was 3 (IQR 2-4, range 1-26), varying between 2 and 4 depending on the initial symptom type. The number of puffs used did not differ significantly between episodes with and without symptom resolution. 18 (42%) families used a number of salbutamol puffs similar to that in their WAAP, while 21 (49%) used fewer and only 4 (9%) used more.

Conclusions: Families typically use 2-4 puffs of salbutamol in the first 2 hours after an asthma symptom. Adjusting WAAPs to start with 2-4 puffs of salbutamol, to be repeated if necessary, would be more in line with family practice, and effective in most situations.

Trial registration number: NCT04810169.

Introduction: Trauma is the leading cause of death in children over 1 year of age in the UK. However, individual prehospital clinicians only encounter paediatric trauma patients rarely. This study describes the frequency and type of paediatric trauma experienced by a mature prehospital trauma service in an urban environment to inform prehospital services about the type of injuries likely to be attended, and the key interventions that might be required on scene.

Study design: Retrospective review of patients 16 years of age and under attended by a physician-led prehospital trauma service between January 2017 and June 2022. Patients were divided into subgroups of 0-4 years, 5-11 years and 12-16 years.

Results: 782 paediatric patients were included, which comprised 8.3% of total patient workload. The median age was 15 years old (IQR 5-16 years) and the majority were male (n=597, 76.3%). The most common mechanism of injury for subgroups were falls from height (>2 m) in 0-4 year olds, road traffic collisions in 5-11 year olds and penetrating trauma in 12-16 year olds. 20.2% (n=158) of patients attended received critical care interventions. 9.8% (n=77) underwent prehospital emergency anaesthesia (PHEA) and 7.4% (n=58) received a blood transfusion.

Conclusion: Paediatric major trauma constitutes only a small minority of prehospital care workload. However, cases are attended regularly. Attending prehospital teams need to be trained to perform difficult resuscitations and perform high acuity, low frequency interventions. Educational and training strategies required to equip prehospital providers treating paediatrics may include checklists, algorithms, simulation training and mental health support.

Rationale: While there are numerous published paediatric asthma scores, it is unknown how commonly scores are recommended in asthma guidelines across different geographical regions globally, and what their validation status is.

Objectives: (1) To describe which clinical guidelines recommend asthma scores across different geographical regions. (2) To describe the initial and subsequent validation of the commonly recommended asthma scores.

Methods: Observational study of asthma scores recommended in guidelines for the management of acute paediatric asthma from institutions across the Pediatric Emergency Medicine Network; global paediatric emergency medicine research network comprising all eight local and regional paediatric emergency medicine research networks.

Main results: 158 guidelines were identified. Overall, 83/158 (53%) guidelines recommend a bedside clinical score for assessment of asthma severity. While a single country-specific clinical score was recommended in all guidelines from Spain and Canada, 27/28 (96%) of the USA guidelines recommend a wide variety of scores, and scores are rarely recommended in guidelines from other research networks (PERUKI, Paediatric Emergency Research in the UK and Ireland and PREDICT, Paediatric Research in Emergency Departments International Collaborative in Australia and New Zealand) and other countries (Costa Rica, South Africa, Nigeria, Singapore, India).The Pediatric Respiratory Assessment Measure (PRAM) and the pulmonary score (PS) were the most frequently used scoring instruments. While the PRAM has undergone the most extensive validation, including construct validity, validation studies for the PS are limited. Inter-rater reliability, as well as the criterion, responsiveness and discriminative validity aspects represent the most common limitations in many of the scores.

Conclusions: There are marked geographical differences in both the recommendation for and the type of clinical asthma score in clinical practice guidelines. While many asthma scores are recommended, most have insufficient validation.