Archives of Disease in Childhood最新文献

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.

Objectives: Describe clinical characteristics, treatment and outcomes of children treated for life-threatening pertussis in paediatric intensive care units during the 2023-2024 outbreak in Great Britain.

Design: National multi-centre audit.

Setting: All paediatric intensive care units (PICUs) in Great Britain.

Patients: Between November 2023 and June 2024, 54 children with a proven diagnosis of Bordetella pertussis as the primary reason for intensive care admission requiring invasive ventilation.

Interventions: None.

Main outcome measures: Mortality on PICU, length of stay and number of invasive ventilation days.

Results: Median admission age 43 days, with peak blood white cell count (WCC) from 6×10⁹/L to 149×10⁹/L. 23% of infants' mothers were vaccinated during pregnancy (national average 59%). Mortality was 11/54 (20%), with 10 in infants <3 months. The survivor with the highest WCC peaked at 82×10⁹/L prior to exchange transfusion (XT), and the highest peak WCC in a survivor without XT was 71×10⁹/L. Eighteen patients underwent 27 XTs for leucoreduction, initiated at median peak WCC of 54×10⁹/L (range 32-148). All who died had XT planned, with nine completing. None with a peak WCC of <51×10⁹/L died, although four patients underwent XTs. In patients with rising WCC, survivors' rise rate was lower than those who died (0.23×10⁹/L/hour vs 1.4×10⁹/L/hour).

Conclusions: In children invasively ventilated due to Bordetella pertussis, higher peak WCC, rapid WCC rise and a primary admission reason other than apnoeas are associated with mortality. XTs can be avoided in WCC <50×10⁹/L. Maternal vaccination rate was lower in this cohort than the general population.

Background: Women lacking social support during pregnancy often have worse mental health, but we know little about the influence of social support on child development, or the impact for migrant women. We aimed to investigate the association between maternal social support during pregnancy and child development using the Born in Bradford birth cohort.

Methods: Social support was evaluated using a composite score of items from the baseline pregnancy questionnaire. Outcomes were Communication and Language and Personal, Social and Emotional development school-readiness assessments from the Early Years Foundation Stage Profile (EYFSP, age 4-5 years) and the Strengths and Difficulties Questionnaire (SDQ, age 7-11 years), with associations tested using logistic and linear regression models. We explored the modifying effect of maternal migrant status.

Results: 3257 and 1413 cohort participants had EYFSP and SDQ outcomes, respectively. Higher levels of social support were associated with better EYFSP outcomes and SDQ scores. One SD higher social support score was associated with 13% lower odds of missing any EYFSP communication and language target (95% CI 0.79 to 0.95); 17% lower for EYFSP personal, social and emotional development (95% CI 0.75 to 0.92) and 0.65 (95% CI -0.98 to -0.32) lower overall SDQ scores, after adjustment for all variables. There was some evidence that maternal migrant status modified associations with SDQ, but not with EYFSP outcomes.

Conclusions: Greater attention to the role of social support in pregnancy, and its social and cultural context, may be helpful in developing and implementing interventions aiming to improve early childhood development.

Objective: To evaluate the efficacy and safety of early supplementation with insulin glargine (GI) during the acute management of paediatric diabetic ketoacidosis (DKA).

Design: Double-blinded randomised controlled trial conducted from July 2022 to June 2023.

Setting: Emergency department and paediatric intensive care unit of a tertiary care teaching hospital in North India.

Participants: Children between >1 month and ≤12 years presenting with DKA.

Intervention: Participants were randomised to receive a single subcutaneous dose of GI (0.3 U/kg) or volume-matched placebo within 1 hour of initiating intravenous regular insulin infusion.

Outcomes: The primary outcome was time to DKA resolution. Secondary outcomes included the rate of blood glucose decline, incidence of hypoglycaemia, hypokalaemia, rebound hyperglycaemia, treatment failure and total regular insulin dose received.

Results: 82 children were enrolled (glargine: n=42; control: n=40). The mean (SD) time to DKA resolution was 11 (6.4) hours in the glargine group versus 13.9 (7.4) hours in the control group (adjusted HR 1.05, 95% CI 0.65 to 1.69, p=0.84). Rebound hyperglycaemia (adjusted risk ratio (ARR) 0.57, 95% CI 0.35 to 0.92, p=0.02) and treatment failure (ARR 0.14, 95% CI 0.04 to 0.56, p=0.005) were significantly lower with glargine. Other secondary outcomes were similar across groups.

Conclusions: While early glargine supplementation did not accelerate DKA resolution, it was associated with reduced treatment failure and improved glycaemic stability post resolution. Its use was safe, feasible and not linked to increased adverse events.

Trial registration number: CTRI/2022/06/043076.