BMJ Paediatrics Open最新文献

Wheeze is a common paediatric winter presentation, requiring bronchodilator therapy. Use of jet nebulisers (JN) is currently standard practice, but vibrating mesh nebulisers (VMN) have demonstrated quicker, quieter and more effective drug delivery, with reduced emergency department (ED) length of stay (LOS) in adults. A retrospective review of JN versus VMN use was conducted in a paediatric population (n=38 and n=19, respectively). An apparent reduction in ED LOS, nebuliser requirement and respiratory rate was seen with VMN use, indicating the potential for this device to improve the effectiveness of bronchodilator administration and warranting further investigation in paediatric patients.

Background: Despite the health benefits, just 3% of Gypsy and Traveller infants receive breastmilk.

Methods: This study took place in June-July 2024 and involved semistructured interviews with seven Gypsy and Traveller women. It presents a grounded theory interpretation of the barriers and facilitators to breastfeeding infants that they perceive and experience.

Results: Four main barriers are presented: breastfeeding in front of others is prohibited; an aversion to breastfeeding; reduced awareness of the health benefits; and limited skills to breastfeed and being overlooked. Four main facilitators are presented: breastmilk is thought to be healthier than formula; an awareness that attitudes to breastfeeding are outdated; determination and resourcefulness to breastfeed; and a new theoretical concept, that partners will support women to breastfeed.

Conclusion: Recommendations include ensuring that Gypsy and Traveller women and their partners are offered an antenatal contact with a midwife and health visitor to discuss the health benefits of breastfeeding and how to express breastmilk as well as breastfeed; collaboration with Gypsy and Traveller advocates to facilitate environmental change to enable breastfeeding; and further ethnographic research to understand the Gypsy and Traveller culture.

Objective: To assess the associations of early life exposures with school readiness.

Design, setting, main outcome measure and participants: Using data from the Born in Bradford (BiB) birth cohort, we investigated the association of early life exposures and the likelihood of children achieving a 'Good Level of Development' (GLD) as measured by the Early Years Foundation Stage Profile at the end of their first school year. Multivariable logistic regression modelling was used to estimate associations of early life exposures with school readiness.

Results: Outcome data were available for 10 589 of 13 858 BiB participants. 6272 (59%) children achieved a GLD. 17 variables were investigated, including child characteristics, maternal factors, family environment and socioeconomic exposures. In our multivariable model (n=7981), children with the following characteristics were significantly less likely to achieve a GLD: males (OR 0.43, 95% CI 0.39 to 0.47), Pakistani ethnicity (OR 0.76, 95% CI 0.66 to 0.89), younger children (OR 1.18 per month, 95% CI 1.16 to 1.19), preterm birth (gestational age<32 weeks OR 0.34, 95% CI 0.19 to 0.62; 32-36 weeks OR 0.64, 95% CI 0.51 to 0.80), younger maternal age (OR 1.01 per year of maternal age, 95% CI 1.00 to 1.02), lower maternal education (OR 0.27, 95% CI 0.20 to 0.37 with no qualifications, compared with higher degrees), never breastfed (OR 0.87, 95% CI 0.78 to 0.97), lower paternal employment status (OR 0.66, 95% CI 0.54 to 0.81, for unemployed, compared with non-manual employment), receiving benefits during pregnancy (OR 0.89, 95% CI 0.80 to 0.99) and eligible for free school meals (OR 0.71, 95% CI 0.62 to 0.81). A sensitivity analysis using multiple imputation (n=10 589) found consistent results.

Conclusions: The exposures most strongly associated with low school readiness were male sex, low maternal education and preterm birth (<32 weeks gestation). Greater understanding of the exposures associated with school readiness can inform a proportionate universal approach to policymaking to improve school readiness and subsequent life outcomes.

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.