Archives of Disease in Childhood最新文献

Objective: To evaluate the diagnostic accuracy of point-of-care ultrasound (POCUS) performed by paediatric emergency medicine (PEM) clinicians for suspected paediatric appendicitis.

Design: Prospective observational study.

Setting: Two paediatric emergency departments in the UK.

Patients: Patients aged 1-16 years presenting with abdominal pain and right lower quadrant tenderness on examination.

Primary outcome measures: Sensitivity, specificity, positive predictive value and negative predictive value of POCUS.

Secondary outcome measure: Comparison to radiology-performed ultrasound in terms of agreement of findings.

Results: 226 patients were included in our study, of which 130 (58%) were boys. The mean age of patients was 9.7 years. 28 patients had appendicitis confirmed on histological examination, giving a prevalence of 12.4%. Compared with our reference standard, POCUS demonstrated a sensitivity of 0.89 (0.71-0.97), specificity 0.96 (0.92-0.98) positive predictive value 0.76 (0.57-0.88) and negative predictive value 0.98 (0.95-1.00). The appendix was visualised in 82/226 patients (36%). There was a very high degree of agreement between POCUS and radiology-performed ultrasound with a Cohen's kappa (k) of 0.87 (95% CI 0.70 to 1.00).

Conclusion: POCUS performed by PEM clinicians has a high degree of accuracy in detecting paediatric appendicitis. There was a high level of agreement between POCUS and radiology-performed ultrasound.

Background: Teduglutide is a glucagon-like peptide 2 analogue with demonstrated efficacy in reducing parenteral solution (PS) requirements to facilitate enteral autonomy in children with short bowel syndrome-associated intestinal failure (SBS-IF). There is currently no clear consensus on how to wean PS and monitor children once treatment is commenced, with variable regimens utilised in published paediatric and adult studies. We aimed to develop a practical algorithm for PS weaning in children with SBS-IF responding to teduglutide for use in the real-world setting.

Methods: A modified Delphi approach was adopted to achieve consensus with input from a multidisciplinary group of paediatric clinicians with intestinal rehabilitation expertise.

Results: We describe the resulting PS-weaning algorithm, which is easy to use, pragmatic and paediatric focused.

Conclusion: Future studies will be required to validate the algorithm.

Objectives: To describe trends in demographic and clinical characteristics of children with a life-limiting condition (LLC) who died in Wales.

Methods: Linked full population cohort observational study of all children and young people (CYP) aged 0-25 years old with an LLC, resident in Wales from 2003 to 2020. Deaths were identified using four data sources: death registries, congenital anomaly, inpatient and day case activity, and accident/emergency attendances.

Results: Of the 6828 recorded deaths, 39% (N=2633) had an LLC-related diagnosis. The proportion of LLC deaths increased from 36% to 42% from 2003 to 2008 to 2015to 2020, with 43% (1135/2633) of LLC-related deaths occurring among children aged up to a year old. Among 5-11 years old, 68% (276/406) had an LLC diagnosis on their death certificate. Of all deaths with an LLC-related diagnosis, 28% (738/2633) occurred in the most deprived quintile areas. Neurological conditions were the most common LLC diagnostic group (22%, 570/2633). Among those with an LLC, 63% (1654/2633) had the condition reported as cause of death (Underlying: 39% (1017/2633); Related: 24% (637/2633)).

Conclusions: The proportion of LLC-related deaths in Wales increased 6% from 2003 to 2020. LLC-related deaths accounted for nearly 40% of total deaths in CYP up to 25 years. One-third of these deaths did not mention a life-limiting diagnosis on the death certificate. Seventy per cent of deaths among the 5-11 age group had a life-limiting diagnosis present.

Objective: To describe and understand relationships between paediatricians and industry in Colombia.

Methods: Mixed methods study composed of three phases: quantitative (cross-sectional study, e-survey to paediatricians) describing interaction patterns and evaluating the factors that explain the perceived need for industry visits to health services and their influence through multivariate analyses; qualitative (grounded theory study, semistructured interviews) to create an explanatory theory; and an integrative phase (mixed methods explanatory study).

Results: We surveyed 218 paediatricians (mean age, 45.2 years), nearly all of whom interacted with industry monthly, mainly with the commercial milk- formula industry (CMFI). Sponsored trips to attend conferences and not having teaching activities were associated with a perception of the potential effects of the trips on prescribing practices. Moreover, being sponsored for an international trip was associated with the perception of indispensability of industry visits for maintaining continuing medical education (CME). In the qualitative phase, four phenomena emerged; two related to the quantitative findings: 'Paediatrician's dependence on industry for CME', and 'Colombian health context facilitates a closer relationship between paediatricians and industry'. Two emerged as explaining factors: 'Normalisation of paediatrician-industry interaction' and 'Paediatrician's prescriptive power: mediator between their conflict of interest with industry and patients'. The integration showed how the qualitative phase explained the quantitative findings.

Conclusions: Most paediatricians frequently interact with industry, mainly with the CMFI, and this is perceived as necessary for CME. The normalisation of the paediatrician-industry interaction leads to the underestimation and invisibility of its effects, which fosters the notion of its necessity for the paediatric field.

Background: Outdoor play promotes healthy development in children, fostering physical, social and cognitive growth. Play involving age-appropriate challenges is an important aspect of child development. Physical activity injuries from play are a frequent reason for paediatric emergency department (ED) presentation. Balancing injury prevention with the developmental benefits of risky play is essential for promoting child health and safety.

Aim: The aim of this study was to describe the circumstances of injury (risky or dangerous play), injuries sustained while playing outdoors and attendance at a large regional paediatric ED service.

Methods: The electronic medical record system was searched to identify cases of outdoor play-related injuries in children aged ≤16 years over a 2-year time frame, from 1 May 2020 to 30 April 2022. A hazard is a danger in the environment that could seriously injure or endanger the child and is beyond the child's capacity to recognise.

Results: A total of 6470 attendances met the inclusion criteria. Outdoor play was responsible for 3.5% of the total ED presentations. The majority of injuries involved children aged between 4-7 and 8-12 years. Dangerous play was implicated in 613 (9.5%) preschool (0-3 years) children. The play equipment implicated most frequently was wheeled equipment and trampolines. Regression analysis of trampolining injuries related to age suggested that the risk of injury decreases with increasing age. 298 (0.16%) of total presentations required admission.

Conclusions: Opportunity lies in the screening of trauma data from a regional service to inform future public health measures and targeting local department measures in young families to avoid situations in which dangerous play is a factor in an injury resulting from outdoor play.

The field of genetics has evolved rapidly in recent years, however early understanding of inheritance patterns began much earlier. Ancient cave paintings depicted selective breeding of animals 20,000 years ago, and Plato was one of the first to record a written theory of heredity. Genetic discovery has expanded over the past 100 years: from Gregor Mendel's experiments on pea plants, through identification of chromosomes, and the discovery of the double-helix structure of DNA. Genetic advancements have brought accompanying ethical challenges, including the controversial field of eugenics. This paper narrates the history of genetics, prominent scientific breakthroughs, examples of ethical issues, and the importance of genetics for paediatric care.