BMJ Paediatrics Open最新文献

Introduction: Our objective was to describe the population of infants <7 days of age admitted to the acute general paediatric services at Alder Hey Children's Hospital and ascertain the proportion with feeding difficulties amenable to community-based support.

Methods: Sequential retrospective audits of all infants <7 days of age admitted to acute paediatrics at Alder Hey Children's Hospital, Liverpool, England, from March to September 2019 (pre-COVID-19) and March to September 2020 (during COVID-19). All the infants were born and discharged from maternity units in Merseyside, Northwest England. Anonymised data were extracted from the electronic clinical records by three members of the clinical team.

Results: Pre-COVID-19, 38.6% (93) of the 241 admissions to acute general paediatric services had feeding difficulties. 31.2% (29) presented solely with feeding difficulties and 31.2% (29) were exclusively breastfed. However, during COVID-19, although there were fewer admissions (104), more than half (51%, 54) had feeding difficulties and for 54% (29), this was the only reason for admission. Over half (53.7%, 29) were exclusively breastfed.

Conclusion: Our audits showed that at least a third of infants <7 days of age admitted with feeding difficulties did not have any other features of severe illness. These admissions unnecessarily expose infants to hospital-acquired infections while disrupting the opportunity for families to build close and loving relationships that enhance the establishment of breastfeeding. Co-designing infant feeding strategies with the mothers and stakeholders will be a crucial next step to enhance infant feeding support, particularly in impoverished communities in the region.

Objective: To evaluate the impact of an asthma integrated care pathway (AICP) on adherence to evidence-based practices in the management of paediatric acute asthma (AA) across primary care (PC) and paediatric emergency department (PED) settings.

Methods: We conducted a 2-year quality improvement initiative (May 2023-April 2025) in two health districts and a regional PED in Spain. The AICP was developed using a design-thinking approach and included input from families and clinicians. Interventions included training, electronic decision support, family education and regular audit and feedback. The primary outcome was the proportion of AA cases treated with bronchodilator via metered-dose inhaler (MDI) with holding chamber. Secondary outcomes included documentation of severity (Pulmonary Score) and symptom control assessment (Paediatric Asthma Control Tool). Interrupted time series analyses (ITSA) were carried out.

Results: A total of 7241 AA episodes were recorded (4150 PED, 3091 PC). MDI with holding chamber use increased from 9.0% to 26.7% in PC and from 31.5% to 61.4% in PED. Pulmonary Score documentation improved from 16.3% to 45.1% in PC and from 48.4% to 78.7% in PED. Persistent symptom assessment increased from 8.0% to 23.4% and from 32.9% to 67.4% in the PC centres and the PED, respectively. ITSA showed differential patterns of change between PC and PED. No changes were observed in PED length of stay, hospitalisation or revisit rates.

Conclusions: Implementation of a structured, codesigned AICP significantly improved adherence to recommended asthma care practices. Integrated pathways can effectively bridge the gap between guidelines and practice in paediatric asthma care.

Objective: To determine the risk for behaviour and developmental problems and factors associated with excessive usage of screen time in children at 18 months of age.

Methods: A cross-sectional study was conducted among parents of children aged 18 months in four primary health clinics. Parents responded to questionnaires, including the Developmental Checklist and Baby Paediatric Symptom Checklist (BPSC), to screen risk for behaviour problems. Screen time of more than 1 hour is defined as excessive.

Results: A total of 254 study participants were included. Most participants were male (52.8%), the eldest child (39.8%) and of Malay ethnicity (91.3%). More than half (66.1%) had screen time of less than 1 hour. Children cared for in a mixed care environment were 3.10 times more likely to experience excessive screen time (p=0.048). No significant association was found between screen time and developmental risk. A higher proportion of participants who scored more than three on the BPSC had more than 1 hour of screen time, although this was not significant (p=0.475).

Conclusions: We found no significant association between screen time and the risk of developmental and behavioural problems. However, one-third of the study participants were engaged in excessive screen time. Children in mixed care environments were more likely to have excessive screen time, highlighting the need for targeted guidance for caregivers in these settings.

Background: Anterior cutaneous nerve entrapment syndrome (ACNES) is a chronic pain syndrome that also occurs in children. The European Pain Federation EFIC recommends the application of the biopsychosocial model of pain. In children with suspected ACNES, the use of this model in diagnosis and treatment appears underused. Most publications focus on invasive interventions. These are potentially harming patients due to this one-dimensional approach. We aimed to assess the use of the biopsychosocial model during the diagnosis and treatment of children with chronic abdominal pain and suspected ACNES before referral to a tertiary paediatric pain centre (PPC) and diagnosis and treatment outcomes in the PPC using the biopsychosocial model.

Design: Single-centre retrospective cohort study of patients referred to a tertiary PPC with (suspected) diagnosis of ACNES between November 2017 and March 2024.

Primary outcome: Use of the biopsychosocial model and treatments performed before referral to the PPC.

Secondary outcomes: Confirmation of the diagnosis of ACNES on assessment and results of therapeutic interventions performed in the PPC.

Results: 31 patients were included. In less than 25% of the patients, the biopsychosocial model was used before referral. The treatments performed were diverse. At the PCC, in none of the cases could the diagnosis of ACNES be solidly confirmed. After treatment using the biopsychosocial model in the PPC, 20 patients (64.5%) reported less or absence of pain.

Conclusion: Failure to use the biopsychosocial model in the treatment of suspected ACNES in children might lead to unnecessary invasive interventions with a risk of persistence of pain while the pain-maintaining factors are inadequately addressed. Therefore, a diagnostic-treatment algorithm is proposed.

Background: The secondary uses of routinely recorded data have become an important component of health research. The UK National Neonatal Research Database (NNRD), established in 2007 contains routinely recorded data from approximately 1.6 million babies who received care in NHS neonatal units in England, Wales and Scotland. The earliest included infants are now adults. We aimed to explore their perspectives on the existence and use of the NNRD METHODS: As part of a wider Public and Patient Involvement programme, we established a Young Persons' Advisory Group: "From Neonate to NOW". Fifteen young adults with lived experience of neonatal care were recruited to share their views and inform neonatal research priorities. We held online focus groups with 10 members to explore their views on the NNRD. Analysis was thematic and co-produced with two group members.

Results: Young people expressed a strong desire to know how their data have been used. Their wish to understand more about their start in life revealed that the NNRD carries meaning beyond data. Participants described pride in knowing their data contribute to improving neonatal care yet were surprised that they had never heard of the NNRD. They proposed ways to raise awareness of its existence and value. The main themes identified were knowledge and pride, early and clear communication, meaning and identity, and consent and clarity.

Conclusions: As the use of large datasets of routinely recorded health information becomes increasingly common, questions about awareness, consent and trust will become important, especially as the first waves of children represented in them reach adulthood. This study is among the first to explore how young adults with lived experience of neonatal care view the secondary uses of their data. Their perspectives highlight areas to address as we move toward a future shaped by big data in healthcare research.

Background: The social determinants of health contribute to health inequities experienced by children with neurodisability and pose barriers to engaging with healthcare systems. At an individual level, adverse social determinants of health are experienced as unmet social needs (USNs), for example, housing insecurity and financial hardship. Emerging evidence supports social prescribing interventions that systematically identify USNs and refer families to services to address these needs. This study aims to evaluate the effectiveness of a co-designed social prescribing programme to address the USNs of children with neurodisability and their parents/carers, its cost-effectiveness and cost-utility, and implementation and translation across the healthcare system.

Methods and analysis: The study will be conducted at the tertiary Paediatric Rehabilitation Services in New South Wales, Australia. A standardised screening tool will identify parents/carers experiencing USNs. Parents/carers who report one or more USN and consent will be eligible to participate in the randomised controlled trial. Participants will be randomised to an active control group or social prescribing intervention group (total sample size=392). The active control group will receive self-navigation via a resource pack containing information about services that can address USNs. The social prescribing intervention group will receive in-person Community Linker support, in addition to the resource pack. The screening tool, resource pack, and social prescribing intervention were co-designed with parents/carers of children with cerebral palsy and their healthcare professionals. The primary outcome is the effectiveness of interventions in reducing USNs. Secondary outcomes include parent/carer referrals to and engagement with support services, out-of-pocket expenses, child/young person and parent/carer health-related quality of life, parent/carer psychological distress, and child/young person hospital service use and emergency department presentations.

Trial registration number: ACTRN12625000324415.

Objective: This population-based cohort study in Kobe, Japan, investigated the impact of the COVID-19 pandemic on infant neurodevelopment by comparing children born before and during the pandemic.

Design: Retrospective population-based cohort study of 63 703 children born between 1 April 2014 and 31 October 2020, who underwent an 18-month health check-up.

Setting: Kobe, Japan.

Patient: Children born between April 2014 and March 2018 (pre-COVID-19 group) or April-October 2020 (during-COVID-19 group).

Intervention: None MAIN OUTCOME MEASURES: Neurodevelopmental outcomes assessed by trained paediatricians, including language, social and behavioural indicators.

Results: The abnormal neurodevelopment prevalence was higher in the during-COVID-19 group (12.8%) than in the pre-COVID-19 group (10.2%) (OR, 1.30; 99% CI 1.16 to 1.46). Similarly, the rate of children without meaningful words was higher during the pandemic (7.1% vs 4.8%; OR, 1.52; 99% CI 1.31 to 1.78), indicating delayed language development. Intergroup differences in other outcomes were minimal.

Conclusions: The COVID-19 pandemic may have negatively influenced early neurodevelopment, particularly language acquisition. These findings suggest that infant language development is affected by social changes, such as pandemics. Further research is required to explore the underlying causes and the long-term effects.

Background: We aimed to investigate the effects of overweight and obesity on bone age (BA), predicted adult height (PAH) and glucose metabolism in children and adolescents.

Methods: Chinese boys aged 5-15 years who were overweight or obese were recruited for the study. Clinical characteristics, including height, weight, body mass index (BMI), BA, PAH and homeostatic model assessment of insulin resistance (HOMA-IR), were recorded. Spearman's rank-order correlation was used to analyse associations between BA, PAH, HOMA-IR and BMI z-scores. Receiver-operating characteristic (ROC) curves were generated to evaluate the diagnostic value of the BMI z-score.

Results: Data from 130 males (n=43, overweight; n=87, obese) were collected. The median BA of the cohort was significantly higher than the chronological age: 12.00 (IQR: 11.00 to 13.00) versus 10.67 (IQR: 9.50 to 12.00; p=0.000). PAH was significantly lower than mid-parental height: -0.28±0.81 versus 0.10±0.60 (p=0.000). The prevalence of BA advancement, PAH impairment and insulin resistance was 52.3% (67/128), 22.6% (28/124) and 61.3% (49/80), respectively. BA advancement and HOMA-IR positively correlated with BMI z-score (Spearman's coefficients r_s =0.495, p=0.000 and r_s =0.343, p=0.002, respectively). No significant association was found between PAH impairment and BMI z-score (r_s =0.045, p=0.622). The ROC curves showed that the area under the curve for the BMI z-score of BA advancement and insulin resistance was 0.741 and 0.622, respectively. The sensitivity and specificity for BA advancement with a cut-off of 2.40 SD score (SDS) were 0.567 and 0.820, and for insulin resistance with a cut-off of 2.40 SDS, were 0.571 and 0.645.

Conclusions: Approximately half of the included children had advanced BA, one-fifth of them had PAH impairment and two-thirds exhibited insulin resistance. Advanced BA and HOMA-IR were positively correlated with the BMI z-score. A BMI z-score above 2.40 SDS may indicate BA advancement and insulin resistance.