BMJ Paediatrics Open最新文献

Introduction: Early childhood development (ECD) is a critical global and public health issue. Worldwide, paediatricians serve as the primary point of contact between children and the healthcare system, playing a key role in promoting healthy development through routine developmental surveillance (DS) and screening (DSc). However, there is limited research on paediatricians' perspectives regarding this matter, particularly in low-resource communities and countries such as Lebanon. This study aimed to explore the paediatricians' perspectives on the current routine DS and DSc practices for children under 5 years of age.

Methods: Paediatricians from all five Lebanese governorates were invited to participate using purpose and convenience sampling. A total of five academic and eleven non-academic paediatricians were included in the study. Semi-structured face-to-face or online interviews were conducted in Arabic between September 2018 and August 2021. Interviews were audio-recorded, then transcribed verbatim and translated into English and thematically analysed using Quirkos V.2.5.3 software.

Results: The study revealed significant variation regarding the understanding of concepts of routine DS and DSc. Most non-academic paediatricians primarily focused on physical development, while academic paediatricians were more attuned to cognitive and psychosocial development, with variation in practice. Factors influencing the practice were multi-layered: paediatricians, parents, paediatrician-parent interaction and system level.

Conclusion: DS and DSc practices in Lebanon are inconsistent, often incomplete and not systematically integrated into routine paediatric care. Efforts should be made to raise awareness about their importance, the appropriate methods for conducting them, and address the system-level factors by developing national guidelines for ECD. Data on paediatricians' practices in other similar low-resource countries or communities is needed to understand the common problems and have joint efforts to address them globally.

Children with autism spectrum disorder (ASD) often experience distress during medical procedures due to sensory sensitivities and communication challenges. We conducted a pilot study assessing whether a humanoid robot (NAO) could reduce distress during cardiology assessments. 24 children with ASD were evaluated during NAO-assisted visits. Distress levels were significantly lower compared with previous routine non-robot-assisted visits involving the same patients. Reduced motion artefacts and shorter diagnostic procedures were also observed. These results support the feasibility and potential benefit of integrating social robots into outpatient paediatric settings for patients with autism, paving the way for more inclusive and neurosensitive healthcare experiences.

Objective: To evaluate the factors affecting neonatal jaundice monitoring in primary care, specifically in normal-risk newborns, with the aim of optimising jaundice follow-up care through a risk-stratified approach.

Design: Cross-sectional study.

Setting: Seven primary care clinics in Singapore.

Patients: 5391 healthy newborns with jaundice at hospital discharge.

Main outcome measures: Jaundice visit rates within 90 days postdischarge.

Results: 5391 newborns attended 26 494 jaundice visits between 2022-2023, with 4593 (85.2%) determined to be normal-risk for severe hyperbilirubinaemia. compared with high-risk newborns, normal-risk newborns had significantly fewer visits (five visits, IQR 2-7 vs five visits, IQR 4-7), higher birth weight (3.13 kg, SD 0.47 vs 2.94 kg, SD 0.43), fewer newborns reaching phototherapy thresholds (8.4% vs 27.9%), and lower jaundice discharge rate (71.4% vs 75.6%). Chinese (compared with Malay) (incidence rate ratio (IRR) 1.15, 95% CI 1.11 to 1.19) and male (IRR 1.10, 95% CI 1.07 to 1.13) newborns had higher follow-up rates, while higher birth weight (IRR 0.752, 95% CI 0.728 to 0.778) and normal-risk (compared with high risk) (IRR 0.93, 95% CI 0.90 to 0.97) were associated with lower follow-up rates. Among normal-risk newborns >7 days old, none exceeded phototherapy thresholds; a risk-based approach could have safely avoided 3652 out of 22 053 follow-up visits (16.6%) in this group.

Conclusion: Our study provides insights into factors influencing jaundice follow-up visit rates. A risk-stratified approach to jaundice monitoring may optimise follow-up care. Further study is needed to implement and evaluate its effectiveness.

Background: Population-level research focused on major congenital abnormalities (MCAs) in sub-Saharan Africa is needed. The Tsepamo study estimated the prevalence of MCAs evaluable on neonatal surface examinations in Botswana.

Methods: Data were collected from up to 18 government hospitals throughout Botswana. Surface examinations were conducted by trained nurses after birth, and photographs and/or descriptions were used to identify and classify MCAs. Birth defects were categorised as MCAs if they were of clinical, surgical or cosmetic importance. We estimated MCA prevalence for all live and stillborn infants who were not exposed to HIV in utero. Variation by site, calendar year and season of MCAs (and, separately, of neural tube defects (NTDs)) was evaluated with the χ² and Benjamini-Hochberg methods.

Results: There were 1066 newborns with at least one MCA (59.3 (95% CI 55.8 to 62.9) per 10 000 births). NTDs accounted for 112 (10.5%) MCAs (6.2 (95% CI 5.2 to 7.5) per 10 000 births). Limb defects accounted for the majority of the birth defects (32.4 (95% CI 29.9 to 35.1) per 10 000 births), followed by major nervous system defects (16.7 (95% CI 14.9 to 18.7) per 10 000 births). The most common individual MCA was talipes (clubfoot) (18.5 (95% CI 16.6 to 20.6) per 10 000 births). While there was no meaningful variability of total MCAs by calendar year or season of conception, there was notable variation of NTDs by these factors.

Conclusions: The estimated prevalence of MCAs was 59.3 (95% CI 55.8 to 62.9) per 10 000 births. While NTD prevalence varied by calendar year and season of conception, overall MCA prevalence did not. Ongoing surveillance of MCAs is needed to monitor the occurrence of birth defects and support preventive interventions in Botswana and the region.

Objective: To summarise the direct and indirect cost incurred by the family and to evaluate the economic burden of caring for children with Down syndrome (DS).

Methods: A systematic review was carried out following the Joanna Briggs guidelines. The English language studies published between 2000 and August 2024 were searched in seven databases, grey literature sources and references of the included studies. The studies were included if they assessed the cost of caring for DS children (< 18 years) or described the perception of the parents regarding the financial burden. This review included observational, longitudinal, mixed-methods and qualitative studies. Two reviewers independently screened the studies, extracted the data using a custom-made form and assessed the critical appraisal using JBI checklists. The mean and/or median costs were inflated to January 2025 and reported in US$, and the data were narratively synthesised. Thematic analysis was performed for the qualitative data.

Results: The search retrieved 5652 records, of which 24 studies were included. A consistent higher cost was reported for DS children as compared with non-DS children, eg, cost associated with prescription drug claims was six times higher (US$2869 vs US$413, respectively). Additionally, there was a higher cost of caring for DS infants (eg, US$3453) as compared with the older (13-17 years: US$1157) DS children. Qualitative findings suggest that families incur additional medical, education and rehabilitation expenses, resulting in financial burden.

Conclusion: Considering the higher financial burden, the creation of an appropriate system of care and support mechanisms may alleviate the burden and reduce the cost of healthcare. Findings highlight the gap in research and need for standardised approaches to cost evaluation.

Prospero registration number: CRD42021265312.

Background: Low birth weight (LBW) and preterm birth significantly contribute to increased risks of neonatal mortality, particularly in sub-Saharan Africa. Early identification of and timely intervention for these vulnerable infants remains challenging. Simple anthropometric measurements, such as foot length (FL), have emerged as potential alternatives to identify small and vulnerable newborns. This study aims to assess the accuracy of FL as a screening tool to identify LBW and preterm babies and to establish appropriate cut-off points for the local context.

Methods: A facility-based cross-sectional study was conducted at Hawassa University Comprehensive Specialised Hospital and Bushulo Mother, Newborn and Child Health Specialty Centre and Primary healthcare from 15 May 2024 to 6 July 2024; 396 mother-newborn dyads were included using a consecutive sampling technique. Data were collected through interview, medical record review and FL measurement using digital calliper. Birth weight was measured using calibrated digital weight scales. Descriptive statistics, correlation analysis and receiver operating characteristic (ROC) curves were used to assess the distribution of measured characteristics and determine optimal FL cut-off points for identifying LBW and preterm babies.

Results: The study included 61 (15.4%) LBW and 48 (12.3%) preterm babies. FL showed a strong correlation with birth weight (r=0.79) and moderate correlation with gestational age (r=0.62). The optimal cut-off point for identifying LBW babies was 70.65 mm, yielding 93.4% sensitivity, 91.6% specificity and an area under receiver operator curve (AUC) of 0.97 (95% CI: 0.95 to 0.98). For preterm babies, the optimal cut-off was 69.95 mm, with 76.7% sensitivity, 91.1% specificity and an AUC of 0.91 (95% CI: 0.86 to 0.96).

Conclusion: FL has demonstrated excellent diagnostic accuracy to identify LBW and preterm newborns. Optimal accuracy of identifying LBW and preterm babies in similar populations can be achieved at 70.65 and 69.95 mm cut-off points, respectively. In designing FL-based screening tools, appropriate cut-off points for the required level of accuracy should be considered.

Background: Paediatric head injury is a common reason for emergency calls. While most cases are mild, a small proportion deteriorates rapidly. Paramedics are often the first point of clinical contact, yet the absence of paediatric-specific tools, infrequent exposure and emotionally charged environments contributes to uncertainty. Paramedic perspectives in this context remain under-represented in the literature.

Objective: To explore paramedics' experiences, challenges and decision-making in the prehospital assessment of children with suspected head injuries and explore perceptions of existing hospital-based clinical decision rules and their potential use in out-of-hospital care.

Methods: A qualitative study, guided by an interpretivist approach, was conducted with 37 paramedics from the North West Ambulance Service NHS Trust, United Kingdom. Purposive sampling captured a range of clinical grades and experience levels. Semistructured virtual interviews explored clinical assessment, decision-making, communication with families and views on current guidelines and clinical decision rules. The Paediatric Emergency Care Applied Research Network and the Children's Head Injury Algorithm for the Prediction of Important Clinical Events were presented after participants described their usual practice. Interviews were audio-recorded, transcribed verbatim, anonymised and analysed inductively using reflexive thematic analysis.

Results: Four inter-related themes captured the clinical, emotional and systemic realities of paediatric head injury assessment. Paramedics described the challenges in treating children, as developmental differences, limited communication and subtle or delayed symptoms required vigilance and adaptation. These were compounded by the paramedic's own challenges, including low confidence from limited exposure, training gaps and the emotional and ethical pressures of safeguarding. Participants showed frustration over adult-oriented tools, rigid guidelines and remote decision-making that undermined autonomy. The role of clinical decision rules was seen positively for structure and defensibility, but with caution about safeguarding, compensatory physiology, contextual risk and their limited relevance to non-conveyance decisions in out-of-hospital care.

Conclusions: Prehospital paediatric head injury assessment is shaped by intersecting clinical, emotional and systemic pressures. Improving care requires paediatric-specific decision tools, integrated training and system changes that support rather than professional judgement.

Introduction: Kenya's 2021 neonatal mortality rate was 18.42 per 1000 live births, far exceeding the Sustainable Development Goal of 12 per 1000 live births. Helping Babies Breathe (HBB) was developed to equip birth attendants with necessary skills for neonatal resuscitation in low-resource settings. This study aims to evaluate the implementation and impact of HBB training in Migori County, Kenya.

Methods: This single-group pretest-posttest study was conducted at 26 healthcare centres in Migori County, Kenya. Preimplementation neonatal health data were collected between January 2022 and June 2023. HBB training was conducted in June 2023, and postimplementation neonatal health data were collected from then until January 2024. To evaluate providers' retention of knowledge and skills, validated Knowledge Checks and Objective Structured Clinical Examination (OSCEs) were conducted immediately following training, at 4 months and at 9 months following training.

Results: The proportion of neonates not breathing and not receiving bag and mask ventilation within 1 min of birth decreased significantly following HBB training (12.73% pretraining vs 6.90% post-training, p=0.01). However, in-facility neonatal mortality did not decrease significantly when a trained HBB provider was present (86.73% survival without a provider vs 87.92% with, p=0.64). Providers' knowledge and hands-on skills deteriorated significantly within 9 months following initial training despite quarterly follow-up trainings (Knowledge Check score average 97.24% immediately post-training vs 92.67% at 9 months, p=0.01; OSCE B average 92.48% immediately post-training vs 87.10% at 9 months, p=0.04).

Conclusions: HBB training significantly improved providers' knowledge of HBB initially, but quarterly follow-up trainings were insufficient to sustain knowledge and resuscitation skills. No significant reduction in in-facility neonatal mortality was observed following implementation of HBB, although the study was not powered to detect this change. There was an increase in the appropriate use of bag and mask ventilation. As HBB training is expanded across Kenya, more frequent refresher trainings and provider engagement strategies are recommended to sustain providers' knowledge and skills.

Background: Failure to recognise and respond to early signs of critical illness contributes to preventable deaths in the UK, particularly among medically complex children. Critical care outreach teams (CCOTs) are multidisciplinary teams that manage deteriorating patients and support early care escalation. While well-established in adult services, Paediatric CCOTs (PCCOTs) remain under-researched. This study presents the first national evaluation of PCCOT provision and characteristics across tertiary paediatric centres in the UK and Ireland.

Methods: A cross-sectional questionnaire, developed from literature, patient and public involvement and peer-reviewed for validity, was distributed via Bristol Online Survey to healthcare professionals in 29 tertiary paediatric centres. Recruitment used convenience sampling through social media and professional networks. Eligible participants gave electronic consent. Data was collected over 7 weeks (August-October 2022) and used descriptive analysis. Ethical approval was obtained from the University of Birmingham.

Results: The response rate was 93% (27/29 centres). Of these, 41% reported having a PCCOT, predominantly nurse-led with notable growth since 2013. Team composition, size, funding models and training varied widely. Education and formal competencies were inconsistent, and many PCCOTs operated within incomplete governance systems often lacking process improvement functions. Commonly collected metrics included cardiorespiratory arrest rates, inpatient mortality and unplanned paediatric intensive care unit admissions.

Conclusions: PCCOTs remain underdeveloped, with limited 24/7 coverage, inconsistent training and fragmented governance in comparison with adult CCOTs. Despite their critical role, most lack sustainable funding and robust evaluation frameworks. Newly developed paediatric-specific education standards now require implementation and impact assessment. National leadership, investment and standardisation are needed to ensure PCCOTs can deliver safe, effective and equitable care across the UK and Ireland.