BMJ Paediatrics Open最新文献

Background: Grandmaternal caregiving is common in many countries and particularly prevalent in rural China, yet evidence on its early developmental implications across caregiving arrangements remains limited. We examined how three caregiving types-maternal caregiving, grandmother-mother cocaregiving and grandmaternal caregiving-relate to early child development, and whether associations are mediated by the parenting environment.

Methods: We analysed a two-wave longitudinal cohort of 1796 children under 3 years and their primary caregivers drawn from 118 randomly sampled villages in the Qin-ba mountain region of rural China. We estimated associations using multiple linear regression and assessed mediation by components of the parenting environment (parenting activities, home learning environment (HLE), parenting beliefs).

Results: Children receiving grandmother-mother cocaregiving had developmental scores comparable to those with maternal caregiving alone. In contrast, grandmaternal caregiving was associated with lower cognitive, language and social-emotional scores. Elements of the parenting environment partly mediated these associations. Negative associations with grandmaternal caregiving were more pronounced among boys, children with siblings and those whose primary caregiver had lower educational attainment.

Conclusion: In this rural Chinese context, grandmaternal caregiving was associated with less favourable early development scores, with the parenting environment acting as a pathway. Programmes may consider supporting grandparent caregivers-especially in grandmaternal caregiving settings-to enhance parenting activities, strengthen the HLE and foster positive parenting beliefs, with attention to families of boys, children with siblings and caregivers with lower education.

Aim: Children presenting with developmental regression are inconsistently investigated, leading to unacceptable delays to diagnosis for some children. This study sought global expert opinion to develop an agreed approach to investigate children presenting with developmental regression.

Method: A Delphi survey collected clinician participant choice of investigations in response to case scenarios of children presenting with developmental regression and differing presenting features. Participants responded to two surveys, and consensus was achieved at 70% agreement. Results were analysed using descriptive statistics (number of responses and percentage agreement). Fifty participants completed the first-round survey, and 31 completed round two. Forty-eight percent of participants who completed both rounds had over 20 years of experience in caring for children with developmental regression. They represented four different clinician specialties and worked across five countries.

Results: For each of the four scenarios, there was agreement to recommend haematological, biochemical and genetic investigations as first investigations. Endocrine, metabolic and neurophysiological investigations reached consensus for scenarios based on presentation differences.

Interpretation: Participants agreed on first investigations to recommend for children presenting with developmental regression. This is an important initial step towards an agreed approach to investigate children with developmental regression needed to reduce inconsistencies in current care.

Objective: To evaluate the predictive validity of best practice early detection tools for cerebral palsy (CP) in a high-risk cohort.

Study design: Prospective longitudinal cohort study.

Setting: Neonatal intensive care unit of a regional tertiary hospital in Bangladesh.

Participants: Neonates with risk factors for CP admitted to Mymensingh Medical College Hospital Neonatal Intensive Care Unit between November 2019 and March 2020.

Outcome measures: General Movements Assessment (GMA) at writhing and fidgety periods; Hammersmith Infant Neurological Examination (HINE) and Peabody Developmental Motor Scales Second Edition (PDMS-2) conducted in person at 3, 12 and 24 months. The Developmental Assessment of Young Children (DAYC-2), Ages and Stages Questionnaire (ASQ-3) and Developmental Milestones Chart (DMC) were administered remotely at 6, 9, 12, 18 and 24 months. Due to the impact of COVID-19, a proportion of the cohort was not able to have GMA fidgety videos completed and the first HINE assessment was delayed.

Results: A total of 227 infants were enrolled. Of the surviving infants assessed at 24 months, 36 (29%) had a confirmed diagnosis of CP. The most accurate combination of tools for early detection was GMA and HINE at 3 months (sensitivity 0.91; specificity 1.00). The PDMS-2 Total Motor Quotient, with an optimised cut-off of 59, showed high accuracy at 24 months (sensitivity 0.94; specificity 0.99). Among the tools administered remotely, the DAYC-2 PD, DMC (Gross and Fine Motor domains) and ASQ-3 (Gross and Fine Motor domains) demonstrated strong predictive validity-both individually and in combination-at 9, 12, 18 and 24 months, supporting their use as practical alternatives when in-person assessments are not feasible.

Conclusions: Despite pandemic-related disruptions, an accurate diagnosis was possible as early as 3 months of age using the best practice tools. Our findings support the practicability of scalable early detection models integrating in-person and remote assessments to improve access to timely diagnosis.

Background: The way childhood disability is understood and represented in various domains is evolving. The 'F-words for Child Development', derived from The International Classification of Functioning, Disability and Health, is a framework that is gaining increasing prominence. This paper reports on a quality improvement project in South Western Sydney, designed to encourage a more holistic, strengths-based approach to assessment, formulation and documentation in a child developmental assessment service. We implemented the 'F-words' framework (Function, Family, Fitness, Fun and Friends) into routine clinical practice.

Methods: The framework was incorporated into standardised clinic proformas, and regular team education and awareness building activities were conducted. We audited clinical reports pre-intervention and post-intervention to assess how well the 'F-words' framework was incorporated. We also assessed clinician and family perspectives and experiences with this tool using electronic surveys. Thematic analysis was performed on the open text responses.

Results: An audit was conducted on 88 reports completed pre-intervention and 112 reports post-intervention. There was an improvement in the reporting of strengths post-intervention. 95% (n=106) of reports clearly documented the child's strengths at the start of the report compared with 74% (n=65) pre-intervention and 85% (n=95) documented at least 4 of the 5 F-words domains, compared with 8% (n=7) pre-intervention. Multidisciplinary clinicians (n=21) and families (n=18) responded to the electronic surveys. The 'F-words' framework was very well received, with most clinicians and families finding it an effective, easy and helpful tool for enhancing clinical assessment, presenting a balanced, non-deficit focused reflection of the child, broadening understanding of the child's strengths and empowering families by fostering a more collaborative approach. None of the respondents rated the tool as unhelpful, although a minority were undecided.

Conclusion: The 'F-words' framework can be easily incorporated into clinical practice. Clinicians and families engaged with the service were positive about this approach.

Objective: To investigate whether perinatal care delivery in England and Wales varies by ethnicity and socio-economic deprivation, using National Neonatal Audit Programme (NNAP) measures.

Design: Retrospective observational study using NNAP (2017-2023) data.

Setting: Neonatal units in England and Wales participating in the NNAP.

Participants: Admitted infants born at ≥22 weeks with recorded data on ethnicity, deprivation and relevant NNAP measures.

Outcome measures: Fourteen NNAP measures covering perinatal optimisation, neonatal care, breastfeeding and parental partnership were explored by ethnicity (White, Black, Asian, Mixed and Other) and deprivation.

Results: Ethnicity and deprivation were associated with several measures of care. Compared with White infants, Black, Asian, Mixed and 'Other' ethnicity babies had lower odds of receiving deferred cord clamping (adjusted ORs (aOR) 0.76 (95% CI 0.70 to 0.84), 0.88 (95% CI 0.82 to 0.95), 0.79 (0.68 to 0.92) and 0.75 (0.64 to 0.88), respectively) and had higher odds of abnormal admission temperature. White infants had higher odds of receiving early breastmilk compared with infants from minority ethnic groups, but had lower odds of receiving it at 14 days or at discharge. Compared with the least deprived, the most deprived infants had lower odds of receiving breastmilk, within 48 hours (aOR: 0.58 (95% CI 0.54 to 0.63)) and at discharge (aOR: 0.39 (95% CI 0.36 to 0.43)). There were lower odds of early parental updates and involvement in ward rounds for minoritised ethnic groups (compared with White families) and most deprived (compared with least deprived) families.

Conclusions: Disparities exist in the delivery of perinatal care by ethnicity and deprivation. There are opportunities to improve equity, particularly around deferred cord clamping, breastfeeding support and parental partnership.

Background: Burnout syndrome is a significant issue among healthcare professionals, significantly affecting their mental well-being. Its prevalence has increased since the onset of the COVID-19 pandemic. In Colombia, data on burnout prevalence are limited, and no specific studies have been conducted in paediatrics. Therefore, this study aims to assess the risk of mental disorders and burnout syndrome among paediatricians working in various healthcare settings in Bogotá during 2023.

Methods: A cross-sectional survey was conducted among paediatricians in Bogotá, Colombia. The sample size was calculated at 179 participants based on the city's paediatrician population and previous studies on burnout prevalence in paediatric emergency services. The survey included the Maslach Burnout Inventory (MBI) for medical personnel, the Self-Report Questionnaire, the Patient Health Questionnaire-2 and the Generalised Anxiety Disorder-2.

Results: A total of 186 surveys were collected, revealing that 95% of paediatricians were at risk of burnout syndrome. This was indicated by impairments in at least one of the three MBI domains: depersonalisation, emotional exhaustion and reduced personal accomplishment. Furthermore, a relationship was identified between unfavourable working conditions and the risk of mental illness, highlighting the urgent need for intervention by health authorities and medical organisations.

Conclusion: There is a clear association between working conditions and mental health, highlighting the urgent need for action from health authorities and medical organisations.

Background: Less invasive surfactant administration (LISA) reduces the need for mechanical ventilation in preterm infants with respiratory distress syndrome. However, some LISA-treated infants require intubation within 72 hours due to continuous positive airway pressure (CPAP) failure (LISA failure, LISA-F). The long-term neurodevelopmental impact of LISA-F remains unclear.

Objective: To compare 2-year neurodevelopmental outcome in preterm infants with successful LISA (LISA-S) versus LISA-F and primary intubation for surfactant (PI).

Methods: Retrospective cohort study (2015-2023) including infants from 24 to 29 weeks gestational age (GA) with surfactant administration; categorised into three groups: LISA-S (n = 235), LISA-F (n = 117) and PI for surfactant (n = 102). Neurodevelopment was assessed at 2 years corrected age using Bayley Scales of Infant and Toddler Development, Third Edition. Multivariable linear regression adjusted for GA, birth weight and antenatal corticosteroid exposure. A multivariable logistic regression model was constructed to identify independent predictors of cognitive and motor delay.

Results: Adjusted composite motor scores were significantly higher in LISA-S compared with LISA-F infants (adjusted mean difference 6.4; 95% CI 2.0 to 19.0; p = 0.005). No differences were found between LISA-F and PI. Mechanical ventilation within the first 72 hours was the strongest independent predictor of motor delay (aOR (adjusted Odds Ratio) 3.9; 95% CI 1.3 to 11.6; p=0.012).

Conclusions: Preterm infants with LISA-F have significantly worse neurodevelopmental outcomes at 2 years corrected age, comparable to that of PI. Mechanical ventilation, rather than the initial surfactant strategy, emerged as the strongest predictor of developmental impairment, emphasising the importance of preventing CPAP failure after LISA.

Background: Neonatal sepsis is a major cause of morbidity and mortality in low-resource settings and accurate, context-appropriate diagnostic methods are urgently needed to improve clinical outcomes.

Methods: We used data collected using Neotree, an open source digital health intervention tool, from neonates admitted to Sally Mugabe Central Hospital in Harare between February 2021 and September 2024 to model a composite outcome variable comprised of senior clinician-assigned diagnosis at discharge or cause of death and blood culture test results. Three statistical and machine learning algorithms were developed, tuned where appropriate using cross-validation and evaluated.

Results: In total, 917 cases of early-onset neonatal sepsis were identified among the 18 345 neonates in our study sample, comprising 664 cases of clinician diagnosis and 253 positive blood culture results. With area under the receiver operating characteristic curve as a metric, LightGBM, a machine learning gradient-boosted tree classifier, performed marginally better (0.712; 95% CI 0.673 to 0.75) than logistic regression (0.687; 95% CI 0.646 to 0.728) on a held-out evaluation dataset. A simple and easily interpretable machine learning model, the k-neighbours classifier, offered comparable performance (0.699; 95% CI 0.662 to 0.736).

Conclusions: This study explored the potential advantages of using machine learning in the triage of neonates at risk of sepsis in low-resource settings where gold-standard blood culture test results are often unavailable. While the differences in performance metrics were not statistically significant, the machine learning approaches in our study offer other advantages including more intuitive predictions and the ability to handle missing data without imputation.

Background: Many parents struggle with infant crying and sleep, yet some needs remain unmet by current professional support. Soothing and Sleeping, an evidence-based practice (EBP) based on the Happiest Baby method, offers preventive support and parental education for these issues. The Dutch Youth Health Care (YHC) system, monitoring 95% of children, is well-positioned to implement it.

Method: This study explores YHC professionals' perceptions of EBPs and Soothing and Sleeping and identifies key implementation barriers and facilitators. YHC professionals (n=41) completed questionnaires and participated in focus groups. Quantitative data were analysed using descriptive statistics and qualitative data through thematic analysis guided by the Dynamic Adaptation Process framework.

Results: Professionals expressed positive attitudes towards EBPs and Soothing and Sleeping, with 81% adopting the method. Barriers and facilitators emerged at system, organisation, provider and client levels. Preimplementation, barriers spanned all levels, while postimplementation barriers were primarily systemic and organisational. Key barriers included resource limitations, inadequate training, organisational shifts and insufficient managerial support. Soothing and Sleeping-specific facilitators included its practicality, suitability and effectiveness.

Conclusions: Findings suggest Soothing and Sleeping strengthens YHC support for infant crying and sleep. Recommendations include proactive parental outreach, appointing an implementation facilitator, ongoing training and tailored approaches for families.