Archives of Disease in Childhood最新文献

The Archives of Disease in Childhood's centenary provides an opportunity to reflect on how our attitudes to child abuse have changed. Many are still reluctant to think the unthinkable and ask the awkward questions, but several high-profile cases have shown that recognition is still wanting, despite mandatory safeguarding training for all professionals working with children.A timeline of significant cases which have changed practice in the UK is given in the table and some of the most important will be discussed in this review.

Objective: To measure healthcare professional-reported conflict and tension across a 10-ward UK children's hospital before and after multimodal interventions.

Design and setting: Prospective pre-post single-centre study.

Patients: Inpatients with a length of stay ≥5 days.

Interventions: Five interventions were introduced between 2020 and 2023 centred around a framework to support families and staff: (1) training >400 staff in early recognition and intervention of conflict via the Medical Mediation Foundation, (2) enhancing the use of the Clinical Ethics Advisory Group, (3) introducing palliative care services for all children, (4) promoting safeguarding surgeries and ward-based safeguarding support for staff and (5) developing a senior multidisciplinary hub to advise teams when tension escalated.

Main outcome measures: Twice weekly on-ward surveys of nursing and medical teams over a 4-week period in 2019 and 2024 RESULTS: Post-intervention, prevalence of children with any reported tensions reduced from 65/153 (42%) to 42/138 (30%) (χ²=4.53, p=0.03) with staff-family conflict predominating. While all sources of tension numerically reduced, reduction in unresolved safeguarding concerns reached statistical significance (18%-3%, χ²=17.6, p<0.0001). Top cited reasons in 2024 for staff-family conflict remained: 'communication breakdown', 'treatment disagreements' and 'unrealistic expectations'; and for staff-staff conflict 'communication breakdown'. For children with ≥2 comorbidities, those with any tensions reduced from 42/76 (55%) in 2019 to 31/82 (38%) in 2024 (χ²=4.84, p=0.028).

Conclusions: We observed an association between multimodal hospital-wide interventions and a reduction in overall tensions. Further studies are needed to assess reproducibility and explore patient and family experience.

This review discusses the developments affecting research integrity over the past decade.

Background: Elastomeric devices (EDs) allow infusion of antibiotic via an intravenous catheter over 24 hours, supporting outpatient parenteral antimicrobial therapy. We conducted a systematic review of these devices in a paediatric population.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was used to review studies assessing antibiotic delivery through EDs in a paediatric population (0-21 years). Medline, Embase, CINAHL, PubMed, The Cochrane Clinical Trials Library, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched.

Results: After deduplication, 1789 titles and abstracts were screened; 45 underwent full-text review and nine were suitable for qualitative synthesis. 567 patients were treated in 657 episodes. 14 different antibiotics and aciclovir were delivered through EDs, primarily 24-hour infusions. Median treatment duration was 10 to 15 days. A variety of infections were treated (mostly infective exacerbations of cystic fibrosis (CF), bone/joint infection). Efficacy data were limited; two studies demonstrated non-inferiority of antibiotic therapy via ED for CF patients compared with conventional infusion pumps. In another study, only two patients (6%) experienced treatment failure. Few adverse events were reported: 1 of 34 patients (3%) experienced ED failure due to misplacement of the central line; one case of antibiotic crystallisation.

Conclusion: EDs have been used for a range of antimicrobial agents in children, in the treatment of a variety of infections, mostly in CF patients, and few adverse events were reported. Further studies should concentrate on new patient groups, and specific information about safety and cost effectiveness of ED in children is required.

Prospero registration number: CRD42021237146.

Background: High-flow nasal cannula (HFNC) therapy is increasingly used for lower respiratory tract infections (LRTIs) in infants and young children, but recommendations vary, and standardised practice is lacking.

Objective: To systematically review national or international guidelines on HFNC use in children aged 1-23 months with LRTIs, focusing on initiation, administration, monitoring, discontinuation and feeding.

Methods: We searched MEDLINE, EMBASE, CINAHL, Web of Science and professional society websites (2014-2025) for guidelines on HFNC use in this age group. Four reviewers independently screened, extracted data and assessed quality with the AGREE II tool. Interguideline concordance was calculated for all guidelines and separately for those addressing bronchiolitis and for evidence-based versus consensus-based guidelines. Recommendations were synthesised narratively.

Results: Fifteen guidelines were included, including nine bronchiolitis guidelines. All addressed HFNC initiation, with low oxygen saturation (73%) and respiratory distress (47%) as common indications. Initial flow recommendations varied; 2 L/kg/min was most frequent (57%), and all bronchiolitis guidelines reporting it advised weight-based settings. Only two guidelines included weaning or discontinuation protocols, and seven addressed failure criteria. Monitoring typically included pulse oximetry and clinical observation; pulse oximetry was endorsed by all bronchiolitis guidelines that reported it (8/9). Enteral feeding was supported by all reporting guidelines (6/15). Guideline quality was moderate to high, though applicability and updating were frequent gaps.

Conclusions: HFNC guideline recommendations for young children with LRTIs remain inconsistent, particularly regarding weaning, failure criteria and procedural details. Regular updates and greater standardisation are needed to improve care and optimise resource use.

Prospero registration number: CRD42024622544.