Archives of Disease in Childhood最新文献

Background: The widespread use of pneumococcal conjugate vaccines (PCV) has changed the epidemiology of invasive pneumococcal disease (IPD) in children globally.

Methods: Multicentre prospective audit of IPD episodes from five paediatric hospitals in Australia over 5.5 years between 2016 and June 2021. Children (<18 years) with Streptococcus pneumoniae isolated from a sterile site were included.

Results: There were 377 IPD episodes in 375 children: 338 (90%) had received ≥3 PCV doses; 42 (11%) had IPD risk factors. The most common presentations were complicated pneumonia (254, 67%), bacteraemia (65, 17%) and meningitis (29, 8%). Five (1%) children died.Serotype information was available for 230 (61%) episodes; 140 (61%) were 13vPCV vaccine serotypes (VTs). The majority (85%) of episodes of complicated pneumonia were due to a VT; predominantly 3, 19A, 19F. Children with risk factors were more likely to present with bacteraemia ± sepsis (42% vs 12%) and to have a non-vaccine serotype (NVT) (74% vs 32%). Resistance to ceftriaxone (meningitis cut-off) occurred in 17% of 23B isolates (n=12) and accounted for 22% (5/23) of meningitis cases.

Conclusions: Complicated pneumonia is the most common IPD presentation. NVTs account for the majority of bacteraemia and meningitis episodes. High rates of ceftriaxone resistance for NVT 23B support the addition of vancomycin for empiric treatment of suspected meningitis.

Between July 2023 and June 2024, there were 540 publications from randomised controlled trials (RCTs) in child and adolescent health in low- and middle-income countries (LMICs), identified using a standardised process that has been in use for 21 years. This year, trials addressed a wide range of diseases and conditions impacting the health, development and well-being of children, newborns, adolescents and mothers. The RCTs reflected old, new and neglected problems, the rapidly changing epidemiology and the evolving social and economic circumstances in many countries. They also highlighted local and global priorities in LMICs, as well as environmental factors contributing to poor child health and inequities. The trials tested new and refined treatments, diagnostics, vaccines, holistic management and prevention approaches, and explored many outcomes, including mortality, nutrition, psychosocial measures and development. The studies were conducted in hospitals and primary healthcare clinics, schools and communities. Some studies are of the highest quality, while others fall short. The implications are many, including the need for greater capacity for discriminating synthesis and translation of evidence at a national and local level in many LMICs. This involves resourcing and educational components, with implications for healthcare worker training in research translation, quality improvement and learning health systems. Paediatricians and child health nurses everywhere have a role to play.

Objective: To systematically assess the modifiable risk factors for developing otitis media with effusion (OME) in children under 12 years.

Methods: We searched Embase, MEDLINE, INAHTA database, CENTRAL, CDSR and Epistemonikos for cohort studies with ≥40 children per arm/prognostic factor, published in English from 2000 to November 2022. We assessed risk of bias using the Quality in Prognosis Studies checklist, and overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Outcomes were analysed as risk ratio (RR), OR or Peto OR.

Results: Seven studies totalling 2 760 292 children were included. The evidence was very low quality. Fluid or pus discharge from ears (OR 2.1, 95% CI 1.01 to 4.35) and exposure to other children (RR 2.79, 95% CI 1.98 to 3.93) (OR 5.21, 95% CI 2.9 to 9.36) were strongly associated with development of OME. Coughs/colds ≥5 times (OR 1.91, 95% CI 1.22 to 2.99), breathing problems ≥5 times (RR 1.78, 95% CI 1.26 to 2.53) and ear infections (RR 1.95, 95% CI 1.39 to 2.72) in past year were associated with development of OME. Adenoid hypertrophy was strongly associated with development of fluctuating OME (recurrent OME) (OR 9.96, 95% CI 5.17 to 19.19). There was scare evidence for some potential modifiable risk factors, including breast feeding, household smoking, gastro-oesophageal reflux, dummy use and swimming.

Conclusions: Upper respiratory tract infection, ear infection, adenoid hypertrophy and exposure to other children could be the predictors for development of OME. Further observational studies are needed to investigate other potential modifiable risk factors.

Objective: IgA vasculitis (IgAV) is the most frequently experienced subtype of vasculitis seen in children. Most children fully recover, however, complications including chronic kidney disease are recognised. The aim of this project was to use a best available evidence, group agreement, based approach to develop national recommendations for the initial management of IgAV and its associated complications.

Methods: A fully representative multiprofessional guideline development group (GDG), consisting of 28 members, was formed and met monthly. Graded recommendations were generated using nationally accredited methods, which included a predefined scope, open consultation, systematic literature review, evidence appraisal, review of national or international guidelines and a period of open consultation. Audit measures and research priorities were incorporated.

Results: The IgAV GDG met over a 14-month period. A total of 82 papers were relevant for evidence synthesis. For the initial management, four topic areas were identified with five key questions generating six graded recommendations related to classification, specialist referral and musculoskeletal involvement. For the associated complications, five topic areas with 12 key questions generated 15 graded recommendations covering nephritis, gastrointestinal and testicular involvement, atypical disease and follow-up. Open consultation feedback was incorporated. The guidelines were endorsed by the UK Kidney Association and Royal College of Paediatrics and Child Health and are available online.

Conclusion: Despite IgAV being a rare disease with limited evidence, a national standardised approach to the clinical management for children and young people has been achieved. This should unite approaches to care and act as a foundation for improvement.