BMJ Paediatrics Open最新文献

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.

Background: Before 2016, no Laotian child was known to have survived type 1 diabetes (T1D) into adulthood. There is an ongoing need for action. Our study explored, in supported youth, the impact of transitioning from a twice to multiple daily injection (MDI) regimen on glycaemic control, and their views/perceptions around how the switch affected their T1D management/quality of life.

Methods: Data were obtained from medical records/semi-structured interviews; participants recruited as they switched to an MDI regimen. Quantitative data were stratified into glycated haemoglobin (HbA1c) 6/12 months before/after the switch, and male/female sex; associations examined using t-tests. Qualitative data were analysed using Gibb's framework.

Results: Overall, 24 youth (62.5% female) changed regimens. Mean±SD HbA1c 6/12-month periods before the switch were 8.8±2.3% (73.0 mmol/mol)/8.3±2.2% (67.0 mmol/mol), respectively. In the same periods after the switch, HbA1c improved to 7.6±2.7% (60.0 mmol/mol)/7.7±2.1% (61.0 mmol/mol), respectively. No differences were observed between sexes.Interviews were conducted with 15 youth (73.3% female); mean ages at T1D diagnosis/the switch time were 10.6 and 14.3 years, respectively. Describing how transitioning to an MDI regimen affected T1D management/quality of life, three themes emerged: pragmatism; empowerment and agency; and foundations of success.

Conclusions: The study provides valuable insights that will guide future work in supporting youth with T1D.

Background: Post-traumatic stress disorder (PTSD) is a prevalent psychiatric disorder that frequently arises following exposure to armed conflict. However, evidence on the pooled prevalence of PTSD and associated factors among children and adolescents in East Africa remains limited. This systematic review and meta-analysis aimed to estimate the pooled prevalence of PTSD and identify associated factors among children and adolescents exposed to armed conflict in East Africa.

Methods: A systematic search was conducted in PubMed, HINARI, Web of Science, PsycINFO, PsychiatryOnline, ScienceDirect and Google Scholar. Cross-sectional studies conducted in East Africa that reported the prevalence of PTSD and/or associated factors among children and adolescents affected by armed conflict were included. Only full-text articles published in English were considered. The methodological quality of included studies was assessed using the Joanna Briggs Institute critical appraisal checklist. Statistical heterogeneity was assessed using the I² statistic. Publication bias was evaluated through visual inspection of funnel plots and Egger's test. Results were presented using forest plots and summary tables.

Results: Of the 933 records identified, 10 studies met the inclusion criteria and were included in the analysis. The pooled prevalence of PTSD among children and adolescents in East Africa was 47.8% (95% CI 34.8% to 61.0%). Witnessing the killing of family members or friends (adjusted OR (AOR)=2.11, 95% CI 1.38 to 3.22), experiencing war-related trauma (AOR=2.49, 95% CI 1.54 to 4.03) and female sex (AOR=1.52, 95% CI 1.29 to 1.78) were identified as significantly associated with PTSD.

Conclusion: The prevalence of PTSD among children and adolescents in East Africa is high. Exposure to traumatic events and female sex are significantly associated with increased risk of PTSD. Interventions should be context-specific, risk-targeted and gender-sensitive to effectively address the mental health needs of this population.

Prospero registration number: CRD420251075395.

Background: Recent studies have expanded the evidence on novel and existing non-pharmacological treatments for paediatric functional constipation (FC). This study aimed to systematically review the efficacy and safety of non-pharmacological therapies for FC in children.

Methods: PubMed, MEDLINE, Embase, PsycINFO, Cochrane Library and trial registries were searched from inception to March 2025. Randomised controlled trials (RCTs), including children (0-18 years) with FC treated with non-pharmacological interventions compared with placebo, no treatment or other interventions, were included. Primary outcomes were treatment success, defecation frequency and withdrawals due to adverse events. Dual data extraction and appraisal was conducted. Certainty was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Results: 93 RCTs comprising 7787 children (50.4% female) were included investigating dietary, psycho-educational, physiotherapeutic interventions, various complementary and complementary medicine interventions, and electrical stimulation. A substantial part of the therapies provided evidence that was of very low certainty, meaning no conclusions could be drawn. Abdominal transcutaneous electrical stimulation plus pelvic floor muscle exercises (PFME) may improve treatment success and defecation frequency compared with PFME alone (risk ratio (RR): 1.75 (95%CI 1.25 to 2.44) and mean differences (MD): 1.85 (95%CI 1.28 to 2.43), moderate certainty). Percutaneous tibial nerve stimulation plus PFME leads to more treatment success (RR: 1.73 (95%CI 1.08 to 2.77), low certainty) and greater defecation frequency (MD: 1.82 (95%CI 0.82 to 2.82), moderate certainty). Behavioural therapy plus polyethylene glycol may not improve treatment success (RR: 0.83 (95%CI 0.62 to 1.12), low certainty) and probably reduces defecation frequency (MD: -1.80 (95%CI -2.88 to -0.72), moderate certainty).

Conclusions: Imprecise data, poor reporting and substantial heterogeneity led to downgrading in GRADE assessments. Some non-pharmacological treatment options for children with FC show beneficial effects, and these may be considered in the management of children. Future trials should aim to improve methodological rigour.

Prospero registration number: CRD42023416891.

Background: Persistent pulmonary hypertension of newborns (PPHN) is an acute neonatal disorder with a high mortality rate despite several advances in its management.

Design: This was a prospective cross-sectional study.

Setting: 84 asphyxiated neonates were included. All the participants underwent complete transthoracic echocardiography to assess the parameters for the diagnosis of PPHN.

Patient: Newborns with PPHN diagnosed via echocardiography with perinatal asphyxia who were admitted to the newborn unit.

Interventions: Echocardiography was performed within 72 hours of life. The mean age at echocardiography was 38.4±0.71 hours.

Main outcome measures: The severity of asphyxia, gestational age and place of birth (inborn), delivery at the study centre or 'out-born' and delivery at another facility or location away from the study centre were significantly associated with the development of PPHN.

Results: The prevalence of PPHN in the study was 52.4%. The severity of asphyxia, gestational age and place of birth (inborn), delivery at the study centre or 'out-born' and delivery at another facility or location away from the study centre were significantly associated with the development of PPHN (p<0.05). Severe asphyxia was approximately nine times more likely to be associated with the development of PPHN than mild asphyxia (AOR=9.89; 95% CI 1.92 to 50.94, p=0.006) and was the single most significant predictor of PPHN in the present study. However, the severity of asphyxia was not associated with the severity of PPHN.

Conclusion and relevance: Severe asphyxia was the single most significant predictor of the development of PPHN among asphyxiated neonates. The prevalence of PPHN among asphyxiated neonates was high. A high index of suspicion and the routine use of echocardiography and sildenafil to diagnose and treat PPHN in asphyxiated neonates are recommended.

Background: Socioeconomic inequalities in child development are pervasive; however, less is known regarding the impacts of socioeconomic factors within and across ethnically diverse and socioeconomically disadvantaged populations. This study (1) describes the prevalence of children at risk of poor overall early child development; (2) investigates the relationship between individual indicators of socioeconomic position and early child development; and (3) investigates if the relationship between indicators of socioeconomic position and early child development varies by ethnic group.

Methods: This study uses data from a prospective birth cohort study, Born in Bradford's Better Start (BiBBS). Child development was measured with the Ages and Stages Questionnaire (ASQ) during routine health visiting appointments at age 2-years-old. Binary logistic regression investigated child development by key maternal socioeconomic indicators: maternal education, financial security, social status (measured via the MacArthur Scale of Subjective Social Status), and social support (measured via number of people to count on).

Results: 22% of the 2003 children with a valid developmental assessment were at risk of poor child development. Mothers who had a degree (OR=1.95, 95% CI 1.28 to 2.99), reported 'living comfortably' in financial security (OR=1.78, 95% CI 1.03 to 3.07) and had higher social status (OR=1.11, 1.02 to 1.22); all had higher odds of their child having a good development. Though socioeconomic gradients in maternal education and financial security were consistent across White British, South Asian and Other ethnic groups, both social support and social status had weaker relationships with child development for South Asian parents.

Conclusion: A high proportion of children are at risk of poor development in this diverse, socioeconomically disadvantaged population. Higher socioeconomic position may protect against poor early development, and the mechanisms underlying this may differ by ethnicity. The findings underline the need for proportionate universal strategies to improve child development in such communities.

Background: Sepsis is a leading cause of neonatal mortality in sub-Saharan Africa (SSA), where microbiological diagnostic capacity and antibiotic access are limited. High antimicrobial resistance (AMR) rates limit the effectiveness of current treatment guidelines, with concern that available antibiotics are rarely adequate treatment for neonatal sepsis in the region.

Methods: A cross-sectional online survey was electronically distributed in English, French and Portuguese to neonatal clinicians across SSA between April and June 2025. Questions focused on the management of neonatal sepsis including diagnostic, antibiotic and guideline use. Responses were analysed descriptively and presented as percentages of the total number of responses.

Results: Of 169 responses (40/48 countries; 83.3%) from SSA, 71.6% were senior doctors, 88.8% managed neonatal sepsis at least weekly and 58.0% worked in central healthcare facilities.14.9% (95% CI 10.3% to 21.0%) of respondents never and 28.6% (CI 22.3% to 35.8%) less than half of the time received blood culture results in time to impact patient care. Guidelines were almost universally used (97.6% (CI 94.0% to 99.1%)). The most common guideline for early-onset neonatal sepsis advised amoxicillin/ampicillin plus aminoglycosides (46.4% of responses (CI 39.1% to 54.0%)). 50.3% (CI 42.8% to 57.7%) of respondents had difficulties accessing antibiotics, with carbapenems and piperacillin-tazobactam least accessible. 45.4% (CI 38.0% to 53.1%) had attempted to author local guidelines with insufficient local AMR data (45.6% (CI 35.7% to 55.8%)) the most common barrier to guideline development.

Conclusions: This large survey highlighted widespread challenges in diagnostic and antibiotic access for neonatal sepsis in SSA. We find that clinicians rely on guidelines to guide starting antibiotics and to guide agent choice. Their practices reflect advice in global guidelines. Attempts to author locally applicable guidelines are hindered by insufficient AMR data. These findings strengthen calls to improve microbiological diagnostic access and support data sharing to generate evidence-based, locally appropriate guidelines.

Objective: We compared bone structure and body composition in adolescents with a challenge-confirmed cow's milk allergy (CMA) during infancy to peers with refuted CMA and to controls.

Design: An observational clinical cohort study.

Setting: A tertiary allergy clinic at Helsinki University Hospital.

Patients: From a randomised controlled trial from 1999 to 2001 evaluating the effect of probiotics on atopic eczema, we followed up participants (n=81) at 15-18 years' age and recruited age-matched controls (n=49). Original study participants all had atopic eczema, and CMA confirmed (n=43) or refuted (n=38) by double-blind placebo-controlled cow's milk challenge in infancy.

Main outcome measures: The primary outcome was differences in volumetric bone mineral density (vBMD) measured with peripheral quantitative CT. Secondary outcomes were differences in body composition by a bioelectric impedance analysis.

Results: Participant's median age was 17.3 years, 62% were females. After adjusting for sex, age-adjusted body mass index, past 5 years' mean daily supervised physical activity, daily vitamin D intake from food and supplements and mean daily intake of dairy products, the CMA-confirmed group had, compared with the CMA-refuted group, lower median total vBMD at the distal radius (Z-scores -1.49 vs -0.78). The CMA-confirmed group had lower median total vBMD (Z-scores -0.05 vs +0.01) and lower median trabecular vBMD (Z-scores +0.20 vs +0.51) at the distal tibia compared with controls. No group differences in body composition were found.

Conclusion: An early childhood history of CMA may be associated with lower adolescent radial and tibial vBMD. Further studies are needed to assess this potential association.

Background: Acute kidney injury (AKI) is a common and severe complication in paediatric intensive care units (PICUs), particularly among children with bacterial sepsis. Although the epidemiology of sepsis-associated AKI is well described, reliable biomarkers to predict both its onset and associated mortality are still lacking, limiting their integration into routine clinical practice.

Objective: To characterise the incidence, clinical phenotype and modifiable risk factors of bacterial sepsis-related AKI in a single-centre PICU cohort and to evaluate the utility of novel biomarkers in refining early risk-stratification.

Methods: In this single-centre retrospective cohort study, data from 475 children admitted to the PICU with severe bacterial infections were analysed. Least absolute shrinkage and selection operator regression and logistic regression analyses were employed to identify biomarkers associated with the occurrence and prognosis of AKI. A nomogram model was developed to facilitate clinical application. The predictive utility of these biomarkers was further validated using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA).

Results: Among the 475 children with bacterial infections, 50 (10.53%) developed AKI. Of these, 20 children died, resulting in a mortality rate of 40%. Regression analysis, model construction and validation through ROC and DCA revealed that elevated cystatin C levels were significantly associated with both AKI occurrence and AKI-related mortality in children with bacterial infections.

Conclusions: This study confirms that elevated cystatin C is a robust predictor of both AKI onset and AKI-related mortality in critically ill children with severe bacterial infections. The nomogram incorporating cystatin C enables early identification of high-risk patients and may support clinical decision-making to improve outcomes.

Introduction: Acute kidney injury (AKI) is a major health concern, disproportionately affecting children in low- and lower-middle-income countries (LLMICs). Diarrhoeal diseases, a leading cause of paediatric morbidity and mortality, are significant contributors to AKI.

Methods: This study systematically reviewed literature published post-2000 on three groups of children: those hospitalised with diarrhoea who developed AKI (Diarrhoea/AKI), those hospitalised with AKI attributable to diarrhoea (AKI/Diarrhoea), and those with diarrhoea-associated haemolytic uraemic syndrome (D⁺-HUS).

Results: After screening 1895 titles and abstracts, 92 studies were included. Most focused on D⁺-HUS (76%), with fewer addressing AKI/Diarrhoea (15%) and Diarrhoea/AKI (9%). Studies were predominantly retrospective and high-income country (HIC)-based. In children hospitalised with diarrhoea, mean AKI prevalence was higher in LLMICs than in HICs (43.2±30.5% vs 10.1±12.7%). Similarly in children hospitalized with AKI, diarrhoea was more frequent in LLMICs compared with HICs (23.8±12.3% vs . 16.1±5.9%). Among children with D⁺-HUS, 60% required dialysis, and mortality was substantially higher in LLMICs compared with HICs (28.5±17.43% vs . 3.7±3.6%).

Conclusion: Diarrhoea is a common yet underreported associated clinical finding among children with AKI, particularly in resource-limited settings. Enhanced monitoring of kidney outcomes in children with diarrhoea is essential to address the overlapping burden of these conditions and improve outcomes globally.