Archives of Disease in Childhood最新文献

Objective: Gastro-oesophageal reflux (GER) is often reported on barium swallow studies. Our aim was to investigate whether GER on barium oesophagography (GERB) correlates with GER on pH-impedance monitoring (GERpH).

Design: Children who underwent both pH-impedance monitoring and barium studies between 2018 and 2022 were retrospectively identified at a high-volume tertiary paediatric hospital. All pH-impedance studies were independently reanalysed to extract acid exposure time (AET), number of reflux episodes, proximal reflux episodes, reflux-symptom association and mean nocturnal baseline impedance (MNBI). GERpH was diagnosed based on the Lyon Consensus 2.0 criteria and compared with GERB.

Results: Within the study timeframe, 90 children (median age 10 years (IQR 4-15 years), 56.7% female, median body mass index 17.6 kg/m²) fulfilled inclusion criteria. Overall, GERpH was seen in 20 patients (22.2%) and GERB in 38 (42.2%) patients, with no differences whether testing was performed off (26.2% vs 38.1%, respectively, p=0.491) or on (18.8% vs 45.8%, respectively, p=0.716) acid suppressive therapy. Neither conclusive GERpH nor individual reflux metrics were associated with GERB (p≥0.157 vs no GERB). 10 patients had hiatal hernia (HH), of which nine (90%) had GERB (p=0.002 compared with no HH); four of these also had GERpH with 72 (IQR 37-92) reflux episodes compared with 68 (IQR 35-98) without HH (p=0.314). In fact, HH was associated with GERB only when GERpH was negative.

Conclusions: In a symptomatic paediatric cohort evaluated for reflux symptoms, GERB does not associate with objective pathological reflux. Barium studies cannot be substituted for oesophageal testing with endoscopy and/or ambulatory reflux monitoring for objective GERD diagnosis.

Aim: To understand whether the risk of complications following paediatric cardiac surgery differs according to a child's ethnicity or the degree of residential deprivation.

Methods: We conducted a retrospective cohort study using data from the National Congenital Heart Disease Audit, including children younger than 18 years who underwent cardiac surgery between April 2015 and March 2022 across 10 paediatric cardiac surgical centres in England and Wales. We examined the occurrence of six defined postoperative complications and used previously reported descriptive models to account for case complexity. Multivariable analysis was used to assess the association between complications and individual ethnicity and socioeconomic deprivation.

Results: There were 23 423 30-day postoperative episodes. Children of Asian ethnicity were more likely to have a functionally univentricular heart or congenital cardiac risk factors, while children of Black ethnicity were more likely to have Down syndrome and prematurity than children of the remaining ethnicities. Children from the most versus the least deprived areas had higher rates of congenital comorbidity, functionally univentricular heart, high illness severity and urgent operations. After adjusting for case complexity, children from high compared with low deprivation areas had greater odds of prolonged pleural effusion (p=0.05), extracorporeal life support (p=0.001) and unplanned reintervention within 30 days (p=0.04).

Conclusions: Greater area deprivation in England is associated with increased preoperative medical complexity and a higher incidence of certain postoperative complications among children with congenital heart disease (CHD). Further research is needed to explore the relationship between ethnic background and perioperative outcomes in CHD and to develop pathways to improvement based on social factors.

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.

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.