Archives of Disease in Childhood最新文献

Objective: The aim of this systematic review was to assess the effect of metformin on anthropometric indices, hormones and adipocytokine concentrations in children with overweight or obesity.

Methods: Eligible studies were searched via PubMed, Scopus, Cochrane Central Register of Controlled Trials, alongside clinical trial registries and the reference lists of included studies, from inception to October 2024. Screening was carried out independently by two reviewers, involving title-abstract screening for relevance, followed by full-text review for eligibility confirmation. Data extraction was performed by two independent investigators using an identical Excel spreadsheet. A meta-analysis was conducted using the random-effects model.

Results: A total of 19 original studies were deemed eligible for this systematic review. Metformin was more effective than placebo in improving Body Mass Index (BMI), BMI-Z score, body weight, fasting insulin and leptin concentrations (mean difference (MD) -1.07 kg/m², 95% CI -1.62 to -0.52; MD -0.09, 95% CI -0.13 to -0.05; MD -3.20 kg, 95% CI -4.21 to -2.19; MD -3.38 μU/mL, 95% CI -6.00 to -0.75; MD -3.73 ng/mL, 95% CI -6.28 to -1.18, respectively). There was no difference between metformin and placebo on adiponectin and resistin concentrations, as well as adiponectin to leptin ratio.

Conclusion: Metformin may have a role as an adjuvant therapy in managing overweight and obesity among the paediatric population. Regarding the concentrations of adipokines and hormones, the results are inconclusive. More randomised controlled trials with rigorous methodology and homogeneity in population and intervention characteristics are needed to shed light on this topic.

Trial registration number: PROSPERO CRD42023401732.

2026 marks not only 100 years since the first edition of Archives of Disease in Childhood, but also 50 years since the Court Report which marked the beginning of a process to extend the practice of paediatrics from the hospital to the community. I've spent much of my life staring out of windows, wondering what was on the other side. As a junior doctor, from the hospital windows, I wondered where the children came from, where they went back to after discharge and why some ill, and some not so ill, children seemed to be admitted again and again. The hospital toolkit did not seem to have a remedy for poor parenting or the excess morbidity from disadvantaged areas. Starting in the 1970s, a number of articles caught my attention-these papers, written by paediatricians, expressed similar questions, concerns and frustrations to those that preoccupied me as I gazed out the window. What's more, these papers went on to suggest possible answers to these problems. In this article, I have selected three seminal papers published at the time when the first consultant community paediatric services were being planned. The three studies highlight the identification and the need to respond to those factors in the family and environment that have such a powerful influence on morbidity and mortality in childhood.

The existence of international agencies dedicated to the health and well-being of children has spanned only the last 100 years, and has coincided with unprecedented progress in child health. A brief history of these agencies is reviewed, the strategies they supported and the challenges they faced, in the context of the last turbulent century, and the current State of the World's children. Ultimately, these agencies are as effective as the people who support them, and this is a role for paediatricians and child health workers everywhere.

Objective: To describe causes of death in children with congenital or acquired heart disease (CAHD) and provide updated mortality data across CAHD groups.

Design: Prospective observational cohort study (2010-2024).

Setting: Tertiary paediatric cardiac care centre.

Patients: All children with CAHD who died during the study period were classified into congenital heart diseases (CHD), cardiomyopathies (CM) and pulmonary hypertension (PH).

Main outcome measures: Causes of death and demographic characteristics were reported for the entire cohort and by the CAHD group.

Results: Among 1137 deaths, 244 (21.5%) occurred under compassionate care. The main cohort consisted of 868 (76.3%) children with CHD, 170 (14.9%) with CM and 50 (4.4%) with PH. The median age at death was 2.6 (IQR 14.2) months. Comorbidities and prematurity were observed in 438 (38.6%) and 348 (30.6%) cases, respectively, with no difference among groups. After excluding compassionate care, heart failure was the leading cause of death affecting 359 (40.2%) children, followed by PH crisis in 105 (11.8%) and infections in 101 (11.4%). In the CHD group, severe complexity was predominant in 516 (59.5%) cases, with functionally univentricular heart (172 (33.3%) cases) being the most common subtype. Surgical deaths constituted 625 (72%) cases, with 64 (7.4%) requiring extracorporeal membrane oxygenation (ECMO) and 69 (0.8%) listed for heart transplant. In the CM group, the dilated CM subtype was predominant, accounting for 78 (45.9%) cases, with 12 (7.1%) requiring ECMO. For the PH group, pulmonary arterial hypertension was observed in 34 (68%) cases, with 9 (18%) requiring ECMO.

Conclusions: Heart failure is the leading cause of death in CAHD, followed by PH, with most deaths occurring within the first year of life, particularly in complex CHD and premature infants.

Hepatitis B virus (HBV) is a potentially chronic infection that can be transmitted from mother to child with the risk of developing cirrhosis, liver failure and hepatocellular carcinoma. There is a safe and effective vaccine to prevent vertical transmission that is recommended to be given as soon as possible after birth and within 24 hours.When a woman with HBV refuses the birth dose of HBV vaccine for her baby, infectious diseases and safeguarding teams are asked to provide urgent opinions on whether this crosses the threshold for triggering child protection mechanisms.We consider a low-infectivity HBV vertical transmission scenario where there is parental refusal of HBV vaccination and focus on ethical arguments for and against overruling parental refusal in the child's best interests. As an additional resource for clinical and safeguarding teams, we also include the anonymised transcript of the only available UK court judgement to our knowledge that addresses the issue of decline of HBV vaccine to prevent vertical transmission.We propose a dialogue process for managing scenarios where a pregnant woman with HBV has concerns about vaccinating her baby when born, which is the basis of the current UK Health Security Agency guidance.