Archives of Disease in Childhood最新文献

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.

Objective: To assess measles seroprevalence and testing practices in children with cancer in the UK.

Design: Multicentre evaluation of measles serology data for children on active treatment for cancer between January and March (Q1) 2024.

Setting: Eleven UK paediatric oncology centres (eight principal treatment centres and three shared care units).

Patients: Children aged <18 years on active cancer treatment with measles serology data at diagnosis and/or following revised UK Health Security Agency guidance in Q1 2024.

Results: A total of 695 eligible patients were included with a median age of 5.2 years (IQR 3.3-10.8 years). Baseline measles serology was tested in 545 patients with 89.0% positive for IgG antibodies. Cross-sectional testing of patients in Q1 2024 was undertaken in 289 patients with 78.5% measles seropositivity. Of the 121 patients tested at both time points who were measles seropositive at diagnosis, 23 (19.0%) were seronegative at retest. Most patients who lost pre-existing humoral immunity had an underlying diagnosis of leukaemia (n=16) followed by non-solid central nervous system (CNS) tumour (n=3), CNS tumour (n=2), lymphoma (n=1) and other (n=1). Although the odds of losing immunity were higher in haematological malignancy groups, this was not statistically significant (OR=1.44, 95% CI 0.52 to 3.99).

Conclusions: Children with cancer can lose pre-existing humoral immunity to measles during treatment. Variability in testing practices and rising measles cases nationally requires a standardised approach. Retesting measles serostatus during national outbreaks is important to identify susceptible patients who may require postexposure intravenous immunoglobulin.

Over the past 100 years, many important papers relating to growth and development have been published in Archives The aims of the study were to quantify time trends of such papers based on title keywords: to summarise them in terms of their citation counts and to highlight the top 10 most highly cited growth and development papers. Several patterns emerged: a rising then falling trend in papers referring to 'growth', the heyday being the 1960s to the 1990s, a rising trend in 'obesity', and many of the papers being highly cited. In the list of all Archives articles ranked by citations, growth and development topics fill the top five slots, and 10 of the top 16. This confirms the importance attached by the profession to research into growth and development.

Objective: To determine whether National Health Service (NHS) 111 advice regarding paediatric patients given by clinically trained health advisors (CHAs) is, as previously found for adult patients, less risk-averse, more accurate and complied with more than that given by non-clinically trained health advisors (NHAs) DESIGN: Retrospective observational study using routinely collected, linked NHS urgent care data.

Setting: NHS 111 triaging services in Yorkshire and the Humber, 2014-2017.

Patients: Children (<16 years) who were the subject of a call to NHS 111.

Main outcome measures: The recommendation given, whether the patient attended the emergency department (ED) within 48 hours and if so whether the patient was admitted to hospital, or considered 'non-urgent'. Adjusted logistic regressions were used for analysis.

Results: 972 221 calls were analysed (26.5% CHA; 73.5% NHA). CHAs were more likely than NHAs to recommend guardian/self-care (OR 45, 95% CI 44 to 46), and less likely to recommend ambulance dispatch (OR 0.5; 95% CI 0.48 to 0.51), ED attendance (OR 0.79; 95% CI 0.77 to 0.8) or primary care (OR 0.163; 95% CI 0.161 to 0.165). Patients were less likely to attend ED following guardian/self-care recommendations from CHAs versus NHAs (OR=0.64; 95% CI 0.56 to 0.74), but no more likely to be admitted if they did attend (OR 1.2; 95% CI 0.8 to 1.8). Callers were more likely to terminate a call before receiving a formal recommendation from a CHA (OR 2.02; 95% CI 2.0 to 2.1). Call-terminators were less likely to attend ED (OR 0.128; 95% CI 0.12 to 0.13) and more likely to be considered non-urgent if attending ED (OR 1.23; 95% CI 1.2 to 1.3) if advised by a CHA.

Conclusions: Paediatric patient journeys suggest triage by CHAs is less risk-averse and more accurate. Patients are more likely to avoid attending ED if advised to by a CHA. Callers who terminate a call early may typically represent the 'worried well'. CHAs may better identify these patients and discourage them from attending ED in prerecommendation conversation. This has implications for the cost-benefit balance of NHS 111 staffing.

Objective: To establish the incidence of adrenal crisis (AC) in patients treated with supraphysiological glucocorticoid (GC) for nephrotic syndrome (NS) or juvenile idiopathic arthritis (JIA) and hence at risk of adrenal suppression (AS).

Design: Retrospective observational single centre study.

Setting: Great North Children's Hospital, Newcastle upon Tyne.

Patients: Children aged 1 month-<16 years, who received supraphysiological GC for NS or JIA within a defined period.

Main outcome measures: Monthly GC regimen and incidence of AC identified by reviewing: (1) clinic letters and emergency department attendance, (2) region wide electrolyte results, (3) clinical coding and (4) proactive discussion with respective clinical teams.

Results: 97 patients were included, totalling 2363 patient months of follow-up. During GC weaning, all NS and 15% of JIA patients were switched to an alternate day GC regimen. A total of 974 patient months were observed following discontinuation of GC and no episodes of AC were identified. An assessment of AC events in other published cohorts indicated that the low incidence is not simply a reflection of poor sensitivity linked to sample size.

Conclusions: This study suggests that supraphysiological GC administered for several weeks can potentially be weaned and stopped safely without formal biochemical assessment in patients with NS and JIA. Specialist teams provide families with rapid access to advice which supports safe practice. An alternate day weaning regimen following a modest period of daily supraphysiological GC may have reduced the likelihood of AS at critical times.