BMJ Paediatrics Open最新文献

Introduction: Strong oral language and reading skills are important for child development. The response to intervention (RTI) framework supports schools to apply evidence-based practices and interventions to proactively meet the learning needs of all students and identify and support students at risk of learning difficulties. Getting it Right from the Start (GIRFTS) aims to implement a codesigned RTI framework in the first 2 years of formal schooling (foundation and grade 1) to improve oral language and reading skills. GIRFTS includes an implementation evaluation.

Methods and analysis: GIRFTS is a stepped-wedge cluster randomised trial conducted in Victoria, Australia, over 3 years. Clusters are primary schools. The intervention is to implement tiers 1 and 2 of the RTI framework into foundation and grade 1 according to RTI principles. The primary outcome is reading comprehension by the start of grade 2. Secondary outcomes include listening comprehension, word and non-word reading and phonological awareness. An implementation evaluation will also be conducted with the study to understand schools' RTI implementation process and enablers and barriers to implementation. Strategies used by schools to overcome implementation challenges will also be investigated.

Ethics and dissemination: This trial was approved by the Royal Children's Hospital Human Research Ethics Committee (HREC/58832/RCHM-2019). Investigators will communicate the results to stakeholders, collaborators and participating schools and teachers through presentations and publications.

Trial registration numbers: ISRCTN91164066, ACTRN12622000146796.

Objective: The objective of this study is to evaluate the impact of using International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) (IG-21) growth standards compared with Fenton growth charts on birthweight classification in a multiethnic newborn cohort in Singapore.

Design: Cross-sectional study.

Setting: KK Women's and Children's Hospital, Singapore.

Patients: Study population included 2541 babies born between 16 December 2019 and 16 March 2020.

Interventions: None.

Main outcome measures: Birthweight classifications of small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) were assessed using IG-21 and Fenton growth charts. The level of agreement between the two charts was measured using Cohen's kappa coefficient (K).

Results: Of 2541 neonates, 171 (6.7%) had discordant birthweight classifications. The kappa coefficient indicated moderate overall agreement (K=0.79) between the charts, with decreasing agreement from preterm (K=0.88) to full-term categories (K=0.71). The largest discordance was observed in 98 (60.5%) neonates classified as LGA by IG-21 but AGA by Fenton. In comparison, 60 (2.9%) neonates classified as AGA by IG-21 were SGA by Fenton, while 13 (4.6%) were SGA by IG-21 but AGA by Fenton.

Conclusions: The study found discrepancies in birthweight classification between IG-21 and Fenton growth charts, with Fenton charts overclassifying SGA and underclassifying LGA in our study population. These findings suggest the potential need to integrate IG-21 growth standards into local practice to improve accuracy in neonatal growth assessment. Further research is necessary to evaluate the clinical implications of these discordant classifications on neonatal outcomes.

Objective: The objective of this study is to assess the relationship between non-invasive ventilation (NIV) and the colonisation of oral and nasal microbiota in preterm infants within the neonatal intensive care unit (NICU).

Design: A prospective cohort study.

Setting: The NICU of Zhejiang University Children's Hospital.

Patients: Patients include preterm infants with a gestational age of 28-35 weeks, enrolled within the first 24 hours of life.

Interventions: Infants were categorised based on respiratory support: NIV, which included nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation or high-flow nasal cannula; and no respiratory support, defined as room air or low-flow nasal cannula at ≤2 L/min.

Main outcome measures: The primary outcome was the colonisation of oral and nasal microbiota at 5 days post birth, measured by colony-forming units per millilitre (CFU/mL), with colonisation defined as bacterial growth >10³ CFU/mL.

Results: The study included 100 preterm infants, with 50 in each group. Nasal microbial colonisation was observed in 56% (28/50) of the NIV group, significantly higher than the 28% in the no respiratory support group. No significant differences were found in oral colonisation. Adjusted binary logistic regression showed an association between NIV and increased risk of nasal colonisation (adjusted OR=2.91, 95% CI 1.12 to 7.58, p=0.028).

Conclusions: NIV in preterm infants was linked to a higher risk of nasal microbial colonisation. This finding suggests the need for further research and consideration of infection control strategies in the NICU.

Background: Sedation techniques can ease anxiety during medical procedures for children. Our previous report on Chinese sedation practices for non-invasive procedures in 2018 is outdated due to the rapid development of sedation services. This study provides an updated report on sedation practices for non-invasive procedures in China.

Methods: This is a cross-sectional study. Questionnaires were sent to tertiary maternity and children's hospitals nationwide through the WeChat Mini Program. The survey questioned the location and caseloads of hospitals providing sedation services, support facilities, contraindications, fasting practices, sedation regimens, monitoring practices, staff structure, certification requirements for sedation providers and quality control data.

Results: Procedural sedation for non-invasive procedures were provided in 88 of 114 hospitals. These hospitals are located across the country except Heilongjiang province and the Tibet Autonomous Region. Compared with previous reports, significant increases were found in the number of hospitals providing sedation services, dedicated sedation rooms and recovery rooms and full-time sedation providers. Most hospitals advocated the 2-4-6 rule for pre-sedation fasting. Dexmedetomidine was the most used first-choice sedative. Anaesthesiologists remain the primary sedation providers, but nurses are also important. The most mentioned qualification requirements for sedation providers were a professional title of attending doctor, ≥5 years of working experience in paediatric anaesthesia and paediatric advanced life support certification. Sedation service records were used in 83 hospitals, but only 42 and 39 recorded success rates and adverse events, respectively.

Conclusions: Sedation services for non-invasive procedures are available in most areas of China. More hospitals now provide sedation services and full-time sedation providers. Supporting facilities and sedation regimens have improved. Non-anaesthesiologist sedation providers are important at current stage, developing training programmes for them may be necessary. Attention should be focused on quality control and improvement of sedation services.

Background: Street-involved children and youth (SICY) face significant challenges, including structural and social exclusion, and multiple forms of abuse. Global estimates indicate there are 10-15 million SICY worldwide, with over 250 000 in Kenya alone. There is limited understanding of the timing of these abuse experiences, which may inform interventional efforts.

Methods: This study analysed relationships between the duration of street exposure, sleep location and experiences of abuse among formerly SICY (aged 6-19 years) in Kenya. Data were collected from participants in the Watoto wa Ahadi Rescue Center programme over a 6-year period (2016-2022). Abuse experiences were categorised into physical, emotional, economic and sexual abuse. Statistical analyses, including Lowess-curve plots and piecewise logit regression, were used to explore the relationships between street exposure duration, sleep location and reported abuse experiences.

Results: The sample consisted of 228 unique children, predominantly male, with a mean age of 13.2 years. Physical abuse (37%), emotional abuse (36%), economic abuse (28%) and any abuse (69%) were common, while sexual abuse (5.7%) was less frequently reported. The probability of experiencing abuse varied with the duration of street exposure, with significant increases observed for those on the street for 3 weeks or more. Sleeping under verandas was associated with higher odds of economic abuse and any type of abuse. Longer street exposure did not further increase the odds of physical, economic or any abuse beyond 10 months.

Conclusions: Children and youth living on the streets experience high levels of abuse, underscoring the need for data-informed, trauma-informed approaches to support their reintegration. The findings highlight the importance of early intervention and tailored strategies that address the specific timing and types of abuse experienced by SICY. Policy and funding should focus on preventing street migration, providing alternative living locations and supporting long-term reintegration efforts to protect and empower SICY.

Objective: To describe antibiotic prescribing practices using the WHO AWaRe (Access, Watch, Reserve) classification in West African children under 5 years of age attending public primary health centres (PHCs).

Design: Cross-sectional study.

Setting: The AIRE project implemented the systematic use of pulse oximetry into integrated management of childhood illness consultations in West African countries (Burkina Faso, Guinea, Mali and Niger). We described antibiotic prescriptions for outpatient children at 16 PHCs and for severe cases referred at district hospitals.

Patients: Between 14 June 2021 and 19 June 2022, 15 854 outpatients were included: 968 neonates and young infants (0-28 days) and 14 886 children (2-59 months). Among them, 78 (8.1%) neonates and young infants and 385 (2.6%) children were hospitalised. We evaluated 58 hospitalised neonates and young infants and 275 hospitalised children, respectively.

Main outcome measures: Frequency of antibiotic prescriptions according to the AWaRe classification recommended by WHO.

Results: At the PHC level, proportions of neonates and young infants with ≥1 antibiotic prescription were 83%, 62%, 71% and 59% in Burkina Faso, Guinea, Mali and Niger, respectively. A total of 805 antibiotics were prescribed (85% Access and 13% Watch). The proportions of children with ≥1 antibiotic prescription reached 71%, 66%, 63% and 36% in Burkina Faso, Guinea, Mali and Niger, respectively. Out of the 9630 antibiotics prescribed, 93% were Access (mainly amoxicillin), and 7% Watch. At the hospital level, Watch antibiotics were mainly prescribed for severe cases referred. No Reserve antibiotics were prescribed.

Conclusions: High proportions of antibiotics were prescribed to outpatient children included, the appropriateness of which needs further study. Nevertheless, in every country, the proportion prescribed in the Access group reached the minimum threshold of 60% of all antibiotic prescriptions, as recommended by WHO.

Trial registration number: PACTR202206525204526.

Objective: To examine the association between children's quality of life (QOL) and their experience of being heard by family and/or teachers during the COVID-19 pandemic.

Design: A cross-sectional study.

Settings: A randomly sampled postal survey of fifth or eighth grade children conducted in December 2020 in Japan.

Participants: Responses from child/caregiver dyads (n=700) were adjusted for complex sampling to ensure the sample's national representativeness, incorporating all regions.

Interventions: Based on the survey results, children were categorised as 'being heard' if they reported being frequently asked about their thoughts regarding the pandemic and having their thoughts and feelings considered by family, teachers or both.

Main outcome measures: Overall QOL and six QOL subscales measured through the Kid-KINDL Questionnaire (KINDL Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents).

Results: About half (52.9%) of children were heard by both family and teachers, with higher rates in fifth grade (59.9%) than in eighth grade (45.1%). The adjusted prevalence ratio for above median QOL was 4.40-fold (95% CI: 2.80 to 6.94) higher in children heard by both family and teachers than in unheard children. Associations remained significant but were lower in children heard only by family or teachers. QOL subscales showed similar associations, with family, self-esteem and friends being the strongest. Children asked for their thoughts or feelings without adult consideration did not exhibit higher QOL.

Conclusions: 'Being heard' during the pandemic was positively associated with higher QOL. Recognising children's right to be heard and promoting environments where they are heard at home and school may improve their well-being.

Background: Acute otitis media with discharge (AOMd) results from a tympanic membrane perforation secondary to a middle ear infection. Currently, the impact of AOMd on children and young people (CYP) and their families is not well understood. There is also a need to explore the experience of healthcare professionals in treating AOMd. Interviews with CYP and their parents, and focus groups with medical professionals, were conducted to explore these objectives.

Methods: A total of 26 parents of CYP (age range: 7 months to 15 years) with a history of AOMd (within the last year) and 28 medical professionals were recruited across the UK between August 2023 and March 2024. Healthcare professionals were from primary care (n=17), ear, nose and throat (ENT) (n=7) and emergency medicine (n=4) backgrounds. Thematic analysis was performed independently by three reviewers.

Results: The majority of CYP (n=25/26) (96.2%) had suffered from multiple episodes of AOMd. AOMd has a physical, psychological, educational, financial and social impact on CYP and their parents. Parents found accessing healthcare services and information difficult, which increased parental anxiety. Antibiotic overuse was also a concern among parents. The majority of general practitioners and emergency care staff described using oral amoxicillin, compared with ENT doctors who predominantly prescribed topical antibiotics.

Conclusions: AOMd has a significant impact on CYP and their parent's daily lives. Need for clear, easily accessible patient information was identified as a priority by the parents of CYP with AOMd. Evidence-based management guidelines should be developed once high-quality evidence is available.

Trial registration number: ISCTRN43760.