Archives of Disease in Childhood最新文献

Poor saliva control (sialorrhoea) represents a considerable burden to paediatric patients with neurodevelopmental disabilities, contributing significantly to both physical and psychological problems. Despite a significant proportion of paediatric patients with cerebral palsy (up to ~44%) and other neurological conditions suffering from sialorrhoea, no coordinated pathways for specialist clinics exist on a formal basis within the NHS.Several management strategies exist, ranging from conservative measures, enteral and transdermal medications, intraglandular botulinum toxin injections through to glandular and/or ductal surgery. Anti-cholinergic medications such as glycopyrronium bromide and transdermal hyoscine hydrobromide are effective but have frequent adverse effects, meaning they are unsuitable or contraindicated in some patients. More invasive procedures, such as intraglandular botulinum toxin injections and surgical interventions, are highly effective but require specialist clinics in a controlled setting.Therefore, a specialist interest group was set up to agree recommendations for equitable service delivery in line with current literature and recommendations from the National Institute for Health and Care Excellence and the American Academy for Cerebral Palsy and Developmental Medicine in order to address this current unmet need. The results of these recommendations are reported here.

Background: Bronchiolitis and its outcomes have strong socioeconomic determinants. In Liverpool, a city with high deprivation and above-average bronchiolitis hospitalisations, we implemented the Respiratory Parent Champions in the Community intervention. Parent Champions were provided with training from paediatricians and community organisations. They delivered peer support and education around bronchiolitis and modifiable risk factors in local children's centres.

Methods: Using anonymised linked electronic health records for children born in Cheshire and Merseyside 2016-2023, we used inverse probability of treatment weighted difference-in-differences methods to compare the change in monthly bronchiolitis admissions after the intervention was introduced in the intervention cohort to the change in admissions in children living in other wards in the region that had not received the intervention, adjusting for differences between populations.

Findings: Eight Respiratory Parent Champions conducted 18 050 family contacts across 16 wards in Liverpool over a 24-month period. The intervention was associated with a reduction in emergency admissions of 128 per 100 000 children per month (95% CI 43 to 214, p<0.01), in comparison to the non-intervention cohort. This equates to a 23.8% reduction in admissions or a total of 107 (95% CI 36 to 179) admissions saved per year in the intervention cohort. The preliminary estimated cost of yearly admissions saved was £219 243, with a net saving of £101 283 per annum (-£44 196 to +£248 811) after accounting for the cost of employing Parent Champions.

Interpretation: This study highlights the potential of a targeted community-led, co-produced intervention to alleviate healthcare burdens and address socioeconomic inequalities in infant respiratory illnesses.

Objective: For most children with kidney failure, a decision is made to commence kidney replacement therapies (KRT); however, little is known about children for whom a decision is made to manage their kidney condition conservatively, without the use of KRT. This study's aim was to determine the incidence of children<16 years reaching kidney failure who received conservative kidney care and to describe their characteristics, care and outcomes.

Setting and design: We conducted a prospective study in the UK and the Republic of Ireland (September 2020 to October 2022) through the British Paediatric Surveillance Unit.

Results: Over the surveillance period, 27 confirmed cases were reported (25 in the UK, 56% male). The median age at notification was 2.6 (IQR 0.3-8.7) years; 52% were white, 41% Asian and 7% of black ethnicity. The median number of comorbidities recorded was 5 (IQR 2-7). All children were referred to nephrology; 92% were referred to palliative care. Most (67%) were in kidney failure by the time treatment discussions commenced. Few (<5) received a trial of KRT. After 12 months, 18 children (73%) had died, 5 remained on conservative management and 2 started KRT.

Conclusion: Children receiving conservative kidney care account for approximately one-tenth of all incident paediatric kidney failure in the UK. While families receive specialist and palliative care support, further investigation is needed to understand whether treatment discussions could occur in a timelier fashion. As a vulnerable group of children, routine national data capture, as for the KRT-treated cohort, would support standardisation of care, audit and benchmarking.