BMJ Paediatrics Open最新文献

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.

Background: Breastmilk is the optimal source of nutrition for infants, particularly preterm infants. Preterm infants face unique feeding challenges and these change with the birth gestation of the infant. Preterm infants' feeding outcomes may have been affected differently than term infants by the SARS-CoV-2 pandemic. The objective of this study was to describe the feeding trajectories of preterm infants in the first 6 months of life compared with term infants and compare these across prepandemic and pandemic periods.

Methods: Data were extracted from the 2010 UK Infant Feeding Survey and the English National Maternity Surveys of 2018 and 2020. Original survey weights were used. Infants were divided by gestation into term (37+0 to 42+6 weeks' postmenstrual age), late preterm (34+0 to 36+6 weeks' postmenstrual age) and a lower gestation group (23+0 to 33+6 weeks' postmenstrual age). Modified Poisson regression, log-rank tests and survival curves were used to analyse feeding outcomes by gestational age.

Results: Late preterm infants had lower adjusted relative risk (aRR) of exclusive breastmilk at 6 weeks of age compared with term infants in 2010 and 2020 but not in 2018. In 2010, aRR was 0.47 (95% CI 0.29 to 0.74), in 2018 aRR was 0.86 (95% CI 0.67 to 1.10) and in 2020 aRR was 0.57 (95% CI 0.41 to 0.81). There was no evidence of differences in feeding outcomes between infants born less than 34 weeks' postmenstrual age and term infants.

Conclusion: Late preterm infants had worse breastfeeding outcomes than term infants in 2010, but the inequity was reduced or eliminated in 2018. In 2020, during the early SARS-CoV-2 pandemic, the inequity had re-emerged. Late preterm infants appear to be a particularly vulnerable population in relation to breast feeding. In future emergencies and natural disasters, late preterm infants should receive additional focus and resources to support breastfeeding establishment.

Background: Care for infants born at 22-24 weeks' gestation varies globally, with an increasing willingness to provide survival-focused ('active') care for infants born at 22 weeks' gestation in recent years. This study aims to report changes in care for infants born at 22-24 weeks before and after the introduction of a statewide guideline for extreme prematurity (EP).

Methods: A retrospective cohort study was conducted, including all live births at 22-24 weeks in tertiary perinatal centres from 1 January 2015 to 31 December 2022 in Victoria, Australia. Medical records were reviewed to obtain antenatal history and perinatal outcomes. Data on in utero referral and transfer to tertiary perinatal centres were sourced from the statewide perinatal emergency retrieval service (Paediatric Infant Perinatal Emergency Retrieval, PIPER) database. Changes in PIPER referrals and transfers, survival-focused care and survival at 28 days preguideline and postguideline were assessed using logistic regression.

Results: Following the guideline, at 22 weeks' gestation, there was an increase in referrals to PIPER and a 3.31 (95% CI 1.84 to 5.95) higher likelihood of in utero transfer to tertiary centres.Following the guideline, infants had a 6.67 (95% CI 1.40 to 31.72) higher likelihood of receiving survival-focused care at 22 weeks, and a 5.57 (95% CI 1.22 to 25.44) higher likelihood at 23 weeks. All 24-week live births received survival-focused care at birth. The 28-day survival for infants who received survival-focused care was unchanged preguideline and postguideline.

Conclusion: Following the publication of the EP guideline in Victoria, in utero referrals and transfers at 22 weeks' gestation have increased, as has survival-focused management of inborn live births at 22-24 weeks.

Introduction: The volumes of colostrum have been quantified as 5 mL and 25 mL per feed on days 1 and 3, respectively, as per the data described about 20 years ago. However, the use of commercial formula is on the rise and 'not enough milk' is a common complaint by postnatal mothers.

Objectives: To determine the average volume of colostrum in one sitting per day on first three postnatal days among healthy late preterm and term gestational mothers and to compare the same among late preterm, term gestation and modes of delivery.

Design: Retrospective study.

Setting: A tertiary care perinatal setting in South India.

Patients: Healthy late preterm and term gestational mothers whose babies were roomed in.

Interventions: A lactation consultant helped the mothers manually express breast milk.

Main outcome measures: Volumes of manually expressed colostrum on first three postnatal days.

Results: Of the 391 mothers analysed in the study, on first three postnatal days, the average volume of colostrum in one sitting each was 4.68 mL, 8.87 mL and 22.53 mL, respectively. There was no statistically significant difference in volumes of colostrum secreted among term and late preterm mothers and also among mothers with different modes of delivery. As anticipated, multiparous mothers expressed significantly higher volumes as compared with primiparous mothers, on all three postnatal days.

Conclusions: The volumes of colostrum on first three postnatal days among healthy mothers were comparable with traditional volumes described about two decades ago. Gestational age and mode of delivery did not affect the volumes of colostrum in the present cohort.

Background: Despite the regular occurrence of brought-in-dead (BID) phenomenon, little is known about their prevalence, pattern and prehospital contributors in rural settings in Nigeria. In addition, the impact of health insurance in this context has not been described in our locale. Our study aimed at identifying the characteristics and access to health insurance of paediatric BID cases.

Design: A cross-sectional, retrospective study in the paediatric emergency department of a rural tertiary hospital.

Methods: Data were obtained from the medical records of BID cases from January 2019 to December 2023. Their sociodemographic details, the nature and duration of preceding illnesses/complaints, prior treatment, referral and health insurance types were obtained.

Results: Sixty-seven (1.38%) of the 4872 admissions were BID. Their ages ranged between 12 hours and 14 years with a male:female ratio of 1.1:1. Forty-four (69.84%) were under 5s. Acute encephalitis syndrome, gastroenteritis and sepsis/severe malaria were the most prevalent presumed causes of death. Prior to arrival, 30.56% had obtained treatment outside the hospital setting (medicine vendors, herbal treatment, home nurse and religious centres). Almost half of the referrals were informal referrals by family and neighbours. None (0%) presented health insurance records nor was brought in by an ambulance.

Conclusion: Infectious diseases were the most common presumed causes of death and under 5s bore the greatest burden of BID. The healthcare choices were poor, but the informal sociocultural support system was strong. There was a dearth of health insurance enrolment, a poor patient referral and transfer system, and poor documentation of BID cases. We identify the need for concerted health education, improved patient referral and transfer, well-coordinated death registration and appropriate health insurance schemes in rural communities.

Introduction: Evidence shows that cancer treatment-related symptoms could be managed effectively in 8-18 years old children through Digital Health Interventions (DHIs), consequently improving their health-related quality of life (HRQOL). However, limited research is available about digitally mediated educative health interventions for children with cancer from lower-middle income countries like Pakistan. This study aims to develop a videogame intervention for children with cancer and test the clinical efficacy of the videogame concerning HRQOL and cancer treatment-related symptoms. Moreover, the following feasibility outcomes will be recorded: acceptability, appropriateness, cost, feasibility and intervention fidelity.

Methods and analysis: An exploratory sequential mixed methods design is used in this study. In the first phase of the study, we interviewed 28 participants (14 child-parent dyads) and assessed their symptom experiences affecting children's HRQOL. Moreover, their preferences for the development of the videogame were also elicited. Based on the findings from relevant literature and the interviews, we developed the videogame in collaboration with clinical and digital experts in the study's second phase. In the third phase of the study, a pilot randomised controlled trial will be conducted at a Tertiary Care Hospital in Karachi, Pakistan. There will be two groups: the intervention group and the control group. The intervention group children will receive the videogame application for 8 weeks, during which symptom management strategies will be taught to them. Children in the attention control group will receive weekly WhatsApp messages on healthy behaviours.The primary outcome will be the HRQOL of children, and the secondary outcome will be cancer symptoms frequency and distress. These outcomes will be assessed preintervention and 8 weeks post intervention. The feasibility outcomes will be assessed quantitatively and qualitatively through a questionnaire, videogame dashboard, interviews with a subset of intervention group child-parent dyads and a focus group discussion with nurses and doctors, post intervention, respectively.

Ethics and dissemination: The study has been approved by the Ethics Review Committee of the Aga Khan University (2022-6833-21251). Data are accessible only to the research team in a secure form. The findings will be disseminated through publications.

Trial registration number: ClinicalTrials.gov Identifier NCT05796895, registered in April 2023.