Archives of Disease in Childhood最新文献

Objective: The objective is to determine the incidence of sudden unexplained death in childhood (SUDC) for children aged 1-14 years in England and Wales during 2001-2020.

Design: Observational study using official national statistics on death registrations and child population.

Setting: England and Wales.

Patients: Children dying of SUDC, aged 1-14 years, registered as International Classification of Disease version 10 codes R95-99.

Main outcome measures: Incidence of SUDC, proportion of child mortality due to SUDC.

Results: A total of 582 children aged 1-14 years died of SUDC, 450 (77.3%) deaths were in children aged 1-4 years, 55 (9.5%) in those aged 5-9 years and 77 (13.2%) in those aged 10-14 years. The number of SUDC was relatively stable with a mean of 29 cases per year (range 21-38, SD 4.2). Overall child mortality fell from 1482 deaths in 2001 to 826 in 2020. The incidence of SUDC for children aged 1-14 years ranged between 0.002 and 0.004 per 1000. The relative proportion of child mortality due to SUDC increased from 1.96% of all child deaths in 2001 to 3.03% in 2020 (p=0.103), SUDC accounted for 5.8% of deaths of children aged 1-4 years by 2020. At all ages, SUDC was more common in male children than female children.

Conclusion: The incidence of SUDC has remained static despite overall child mortality almost halving in the last two decades. SUDC is now more widely recognised due to improved investigation, but there has been limited research into SUDC; potential causes and associated risk factors remain unknown. As the relative proportion of child deaths due to SUDC increases, child health professionals must be aware of SUDC to support bereaved families.

Aims: To explore short-term weight variability in young children; (1) how it relates to expected weight gain and (2) how it is affected by age, time of day and dietary intakes and outputs.

Methods: Twenty healthy infants aged 2-10 months and 21 healthy toddlers aged 12-35 months were weighed at home by their parents six times over 3 days. The toddlers' parents also recorded whether they had eaten, drunk, urinated or passed stool in the previous 2 hours. The primary outcome was 'noise': the within-subject weight SD pooled separately for infants and toddlers, compared with their expected weight gain over 4 or 8 weeks. Analysis by successive pairs of weights was used to assess the extent of short-term weight gain and loss associated with time of day and eating, drinking and excretion.

Results: In infants, noise (117 g) was much less than the expected weight gain over 4 weeks (280-1040 g) but in toddlers, noise (313 g) was higher than the expected gain over 4 weeks (180-230 g) and around three-quarters the expected gain over 8 weeks (359-476 g). In toddlers, weight tended to fall overnight and rise by day, and recent eating and passage of stool were associated with increased weight gain, even after adjustment for time of day.

Conclusions: In toddlers, the recorded weight may be 300 g higher or lower than the underlying weight trajectory, so that their weight gain based on measurements collected fewer than 8 weeks apart will often be misleading.

Objective: Service evaluation of an urban 'Hospital at Home' service which provides care in patients' homes that would traditionally be delivered in the hospital setting.

Design: Retrospective longitudinal review of routinely collected data recorded contemporaneously for clinical use, analysed to elicit utilisation patterns and service impact.

Setting: A paediatric 'Hospital at Home' service delivered across two large acute hospitals, treating a total of 4427 patients across both primary and secondary care in South London from January 2018 to June 2022.

Patients: Children managed by the Hospital at Home service, aged 0-16 years MAIN OUTCOME MEASURES: We describe patient outcomes and service performance including data on demographics, diagnoses, referral sources, hospital reattendances and bed day savings.

Results: Over the evaluation period, 11 092 bed days were saved as a direct result of this service at a cost of 1.09-1.25 nursing contacts required per bed day. Reattendance to hospital was 11.1% over the study period, however, parent/carer-initiated reattendance resulting in hospital admission was only 2.7%.

Conclusion: Hospital at Home services are a policy priority for the English National Health Service because of their potential to reduce admissions to and enable early discharge from hospital. This evaluation provides insight into an urban population of children managed under Hospital at Home care and demonstrates its feasibility and effectiveness. Our novel approach to the analysis of hospital reattendance data may have the potential as a template for future performance analysis of similar services.

Objective: To investigate the moderating effects of socio-demographic social determinants of health (SDH) in the relationship between types of childhood hospitalisation (ie, none, injury, non-injury, injury+non-injury) and academic performance.

Design, setting and patients: Children residing in Wales 2009-2016 (N=369 310). Secure Anonymised Information Linkage databank linked Tagged Electronic Cohort Cymru (five data sources) from the Wales Electronic Cohort for Children.

Main outcome measure: Binary educational achievement (EA) measured across three key educational stage time points: grade 6 (mean age 11 years, SD 0.3), 9 (mean age 14 years, SD 0.3) and 11 (mean age 16 years, SD 0.3).

Results: Of the 369 310 children, 51% were males, 25.4% of children were born in the lowest two Townsend deciles. Females were more likely to meet EA than males (adjusted risk ratio (aRR) (95% CI): 1.047 (1.039, 1.055)). EA was lower for injury admissions in males and any admission type in females (interactions: female×non-injury 0.982 (0.975, 0.989); female×injury+non-injury 0.980 (0.966, 0.994)). Children born into a more deprived decile were less likely to achieve EA (0.979 (0.977, 0.980)) and worsened by an injury admission (interactions: townsend×injury 0.991 (0.988, 0.994); Townsend×injury+non-injury 0.997 (0.994, 1.000)). Children with special educational needs (SEN) were less likely to meet EA (0.471 (0.459, 0.484) especially for an injury admission (interactions: SEN×injury 0.932 (0.892, 0.974)).

Conclusion: SDH moderated the impact of hospital admission type on educational outcomes prompting future investigation into the viability of in-hospital routine screening of families for SDH and relevant post-hospital interventions to help reduce the impact of SDH on educational outcomes post-hospitalisation.

Objective: Sickle cell disease (SCD) has a high mortality during childhood in many low and middle-income countries (LMICs). Early diagnosis improves outcomes but newborn screening is not well established in LMICs. Cascade testing may be feasible and effective in identifying undiagnosed SCD and carriers of haemoglobin (Hb) S.

Design: Quality improvement project using existing clinic and laboratory resources.

Setting: The Haematology Clinic at the Edward Francis Small Teaching Hospital, Banjul, The Gambia.

Participants: Families of index cases with SCD.

Methods: Hb phenotype was determined in full or half-siblings of a SCD index case over a 6-week period using the HemoTypeSC test and confirmed by Hb electrophoresis.

Main outcome measure: Identifying undiagnosed SCD.

Results: Of 102 families invited, 31 (30%) attended during the study period and 53 siblings were tested. Except for one indeterminate test, HemoType SC agreed with Hb electrophoresis. Ten (19%; 95% CI 10 to 32) siblings were diagnosed with HbSS, 25 (47%; 34 to 60) as carriers (HbAS) and 18 (34%; 23 to 48) were unaffected (HbAA). Some symptoms and signs of SCD occurred significantly more frequently in HbSS than in HbAA and HbAS, but none was sufficiently common to help in identifying children for testing.

Conclusions: Cascade testing was effective in identifying undiagnosed HbSS as well as children carrying the sickle cell gene. In routine care settings in LMICs, cascade testing facilitated by point-of-care tests may be feasible and affordable in increasing the detection of SCD and improving outcomes through earlier diagnosis.

Background: Children and young people living with severe obesity experience a range of complications of excess weight (CEW); however the prevalence of complications is not well defined. We have evaluated baseline characteristics and CEW of patients from two UK tier 3 paediatric weight management services.

Methods: All new patients aged 2-17 years seen from March 2022 to February 2023 were included. Baseline demographic data was collected, and patients screened for CEW. PedsQL-4.0 questionnaires were used to assess health-related quality of life (HRQL).

Results: 185 patients were included, median age 14.3 years (range 3.3-18.0), 50.8% were girls. Of the patients, 73.8% were white British, with a significant excess of patients living in the most deprived decile (41.4%). Median body mass index SD score was +3.55 (IQR 3.11-3.90) and median body fat was 49.3% (IQR 42.3%-55.1%). Autistic spectrum disorder, attention deficit hyperactivity disorder and learning difficulties were vastly over-represented.Dyslipidaemia was the most common (51.6%) complication, followed by hypertension (28.9%), metabolic dysfunction-associated steatotic liver disease (17.8%), obstructive sleep apnoea (9.0%) and idiopathic intracranial hypertension (4.3%). Mean glycated haemoglobin was 35.0 mmol/mol (IQR 33-38). 8.1% had type 2 diabetes mellitus. Many of these complications were detected through screening in CEW clinics.Both child-reported (mean 51.9/100) and parented-reported (47.8/100) HRQL scores were low. Mental health problems were common: 26.2% with anxiety and 7.7% with depression.

Conclusions: This study demonstrates the significant and profound mental and organ-specific pathology resulting from severe obesity in childhood, highlighting the clinical necessity for CEW clinics. A rigorous approach to identify complications at an early stage is essential to improve long-term health outcomes.