BMJ Paediatrics Open最新文献

For 2 years, the people of Gaza have been killed, maimed and displaced in a devastating war that is an affront to humanity. It is one of the ongoing wars, some of which have been going on for years, and many of which are submerged or ignored by the international community. Once again, and more than ever, the victims are civilians, especially children. In the Gaza Strip, 64 000 children have reportedly been killed or maimed, including at least 1000 babies. It is highly likely that the number of deaths is much higher, due to preventable illnesses or bodies remaining buried under rubble. What will happen to the surviving children once hostilities are suspended? What has happened under other circumstances? Every war is different in its motivations, methods, duration and (always dire) outcomes, but what can we expect for Gazan children?An analysis of three historical conflicts (Iraq, Democratic Republic of Congo and Haiti) indicates that, after the acute phase of an armed conflict, it takes approximately 10 years to restore, maintain and resume the trends in improvement in the under-5 mortality rate, in rates of vaccination coverage, wasted children and completion of primary education to preconflict levels. These results may be useful for monitoring future interventions to re-establish, or guarantee for the first time, the rights denied to children and the entire population. It would also be helpful to rewrite treaties and agreements for the suspension of conflict that go beyond the reconstruction of buildings and economic aid, but that also define specific objectives and timelines based on health determinants, which are nothing other than indicators of the implementation of human rights.

Objective: To evaluate caffeine prescribing practices in a tertiary neonatal unit, focusing on initiation, dose adjustment, discontinuation and recommencement, and to assess associations with gestational age and respiratory support.

Design: Retrospective observational study.

Setting: Neonatal unit, John Radcliffe Hospital, Oxford, United Kingdom.

Patients: Preterm infants born ≤32 weeks gestation and admitted between 1 February 2022 and 31 October 2023. Data extracted from paper patient records included daily caffeine dosing, initiation, discontinuation, recommencement, coadministration with doxapram, demographics and duration of respiratory support. Associations between caffeine administration and clinical factors such as gestational age were assessed using regression.

Results: 168 admissions were analysed from 163 infants. Caffeine was typically initiated with a loading dose of 20 mg/kg, and maintenance doses ranged from 5 mg/kg/day to 25 mg/kg/day. There were 1-8 dose adjustments per admission. Doxapram was administered to 19 infants. Caffeine was discontinued at a median (IQR) postmenstrual age of 34.0 (33.9-34.7) weeks and was recommenced in four infants. Gestational age at birth was negatively correlated with postmenstrual age at discontinuation (r(CI) -0.33 (-0.51 to -0.12), p=0.0029; R²=0.11) and infants born at lower gestational ages received higher doses.

Conclusion: Caffeine therapy in this unit showed marked variability in dosing, discontinuation and recommencement, highlighting the individualised nature of bedside decision-making, which may reflect clinical response to therapy.

Objective: To evaluate the prevalence of uncontrolled asthma in children and its association with parental knowledge.

Methods: This cross-sectional study was conducted at the paediatric clinic of the Aga Khan University Hospital, Karachi, Pakistan, from July 2024 to December 2024. Asthmatic children aged 4-16 years and their accompanying parents (at least one) were enrolled in the study with consent. Uncontrolled asthma was determined using the Childhood Asthma Control Test, with a score of less than 19. Parental asthma knowledge was assessed using the Asthma Knowledge Questionnaire. Multivariable logistic regression analysis was used to adjust for potential confounding factors and identify markers of suboptimal control among children with asthma.

Results: A total of 170 children were enrolled in the study, 99 (58.2%) were male, and the mean age was 8.00 ± 2.97 years. The mean age at the time of asthma diagnosis was 3.77 ± 2.59 years. There were 110 (64.7%) children who had controlled asthma, and 60 (35.3%) had uncontrolled asthma. Inhaler use was more frequent among children with uncontrolled asthma (76.7% vs 57.3%). Emergency department visits in the past year (75.0% vs 51.8%), intensive care unit (ICU) admissions (48.3% vs 27.2%) and pet exposure (28.3% vs 15.5%) were significantly higher in the uncontrolled group. The mean parental knowledge scores in both groups did not differ significantly (56.77±7.36 vs 55.00±7.43) and were inadequate in both groups. In multivariable analysis, children with good asthma control have fewer emergency department visits, while inhaler use (reliever or controller) is more common in poorer control.

Conclusion: This study concludes that parental asthma knowledge was inadequate and not associated with asthma control in children. Emergency department visits, ICU admissions and pet exposure were more common among children with poor asthma control.

Purpose: Visual impairment (VI) is a leading cause of disability in young people and profoundly affects their psychological well-being and that of their families. In Italy, Legislative Decree No. 62/2024 redefined disability according to the biopsychosocial model and focused on the individualised life project. Given the limited research in this field, this study explores the subjective experiences of disability among young people with VI and their close networks, within their social context.

Method: 36 semistructured interviews with 12 young people with VI (8-18 years old), 14 parents and 10 health professionals were conducted in four Italian centres participating in the EU project SeeMyLife. Data were analysed using a thematic approach aided by NVivo V.14 software. Representative quotations and emerging themes were identified and reported.

Results: Four major themes emerged from the analysis: (1) Understanding disability: medical vs social definitions; (2) Personal experiences and biopsychosocial perspectives; (3) Disability in social context: barriers and facilitators and (4) Interpersonal relationships and social dynamics. Although participants were familiar with the term 'disability', it was not always framed within a biopsychosocial perspective. Young people with VI described living similarly to their peers but with more limitations in autonomy and social participation. These limitations reflect individual functioning but also environmental and social barriers, consistent with the International Classification of Functioning, Disability and Health (ICF) framework.

Discussion: The findings, within the framework of the updated Italian legislative context, have significant implications for clinical practice, offering insights for practitioners and policymakers and supporting multidimensional decision-making in care planning and service delivery. These insights should be interpreted through the ICF lens to ensure person-centred and integrated care.

Background: In Ethiopia, despite national immunisation programmes, many children do not complete recommended vaccines. Identifying determinants of incomplete immunisation is crucial for designing interventions and guiding policy. This study explored factors associated with incomplete immunisation among children aged 12-23 months in Koore Zone, Southern Ethiopia.

Methods: A community-based unmatched case-control study was conducted from April to May 2025, including 279 children-93 incompletely immunised cases and 186 fully immunised controls randomly selected from 10 kebeles. Structured, interviewer-administered questionnaires adapted from WHO and United Nations Children's Fund tools collected data on sociodemographics, maternal healthcare utilisation and caregiver knowledge. Descriptive statistics summarised participant characteristics. Bivariable and multivariable logistic regression identified independent associated factors of incomplete immunisation, expressed as adjusted ORs (AORs) with 95% CIs.

Results: Overall, 42% of incompletely immunised children were born at home. Maternal illiteracy, rural residence and home delivery significantly increased the likelihood of incomplete immunisation (AOR 1.82, 4.0 and 2.30, respectively). Attendance at antenatal care (AOR 0.51), postnatal care (AOR 0.46) and adequate maternal knowledge of immunisation (AOR 0.30) were protective.

Conclusion: In Koore Zone, incomplete immunisation is driven by maternal education, rural residence, home delivery, maternal healthcare utilisation and caregiver knowledge. Strengthening maternal and child health services, improving community awareness and educating caregivers about vaccination schedules are vital strategies to enhance immunisation coverage and reduce vaccine-preventable diseases. These findings provide practical guidance for policy makers and public health practitioners in similar low-resource settings.

Background: Feeding practices during early childhood are critical to health and development. In low- and middle-income countries, many young children are exposed to sweetened beverages and processed foods, which may contribute to poor dietary quality. This study assessed the prevalence and correlates of unhealthy feeding practices (UFPs) among Bangladeshi children aged 6-23 months.

Methods: Data were derived from the 2022 Bangladesh Demographic and Health Survey. The analysis included 2608 children aged 6-23 months living with their mothers. Three infant and young child feeding indicators were considered: consumption of sweetened beverages, unhealthy foods and zero fruit or vegetable intake.Children having none of these three UFPs were considered as 'no UFP'; those who have at least one UFP are classified as '1 UFP' and subsequently having two is '2 UFP' and three is '3 UFP'.

Results: Among the 2608 children, 1239 (47.51%) reported having at least one UFP. In adjusted ordered logistic regression, older child age was associated with higher odds of having a higher UPF score. Maternal mass media exposure was also associated with increased UFP score (adjusted OR (aOR) 1.31; 95% CI 1.11 to 1.55). High women's empowerment was associated with lower odds of being in a higher UFP category (aOR 0.78; 95% CI 0.64 to 0.95) compared with low empowerment.

Conclusion: UFPs were common among Bangladeshi children aged 6-23 months. Higher child age and maternal media exposure were associated with higher UFP scores, while women's empowerment was associated with lower odds of higher UFP scores. These findings support integrating age-appropriate complementary feeding counselling, supporting women's decision-making and promoting marketing of healthy foods.

'A Better Start' was a 10-year (2015-2025), £215 million initiative funded by the National Lottery Community Fund, supporting five areas in England to address inequalities in the early years of life across socio-emotional development, language and communication, and nutrition outcomes. It aimed to provide a place-based, test-and-learn model, putting parents at the heart of design and delivery. As a result, each of the five sites developed and implemented distinct local programmes.The Better Start Bradford programme delivered multiple preventative interventions across the outcome domains. Bradford was the only site to embed a research partner, Born in Bradford, from the very beginning. This enabled the establishment of a fully resourced research hub-the Better Start Bradford Innovation Hub, which included the world's first interventional birth cohort, Born in Bradford's Better Start, designed to efficiently evaluate multiple interventions simultaneously. This evaluation has provided in-depth learning about the inequalities faced in contemporary urban populations and evidence of the implementation and impact of multiple early years interventions.In this review, we reflect on our 'decade of discovery': what worked well, what we have learnt about evaluating and delivering early years prevention at scale, and what we would do differently if we had the opportunity again. Examples of what worked well include the place-based model, the test-and-learn approach, a robust evaluation infrastructure and community empowerment. Our learning has evidenced important changes for future programmes and for commissioners, chief among them: complex inequalities cannot be resolved through the delivery of individual or scattered interventions. This collective learning points to a clear call for change to create a jointly commissioned, appropriately funded and continuously evaluated early years system, underpinned by a long-term commitment to prevent inequity in the early-years before it becomes entrenched.

Background: Eosinophilic esophagitis (EoE) is an immune-mediated disease characterised by oesophageal eosinophilic infiltration, leading to chronic inflammation and tissue remodelling.

Objectives: To describe the clinical, epidemiological and endoscopic characteristics of children with EoE in Colombia, and explore associations between symptoms, allergen sensitisation and endoscopic findings.

Methods: Observational, multicentre retrospective study with an analytical component, conducted on paediatric patients diagnosed with EoE across 10 tertiary referral centres in Colombia between 2015 and 2023. All cases had histological confirmation with ≥15 eosinophils per high-power field. Data were extracted from standardised medical records by trained investigators.

Results: A total of 143 cases were included, with a male predominance (66.4%) and median age at diagnosis of 92 months (IQR 56-144). Relevant early exposures included prematurity (11.2%), low birth weight (10.5%), caesarean delivery (50.3%), infant formula use (62.2%) and antibiotics in infancy (27.9%). Family history of atopy was present in 54.6%, and EoE in 4.9%. Food specific IgE was present, particularly to cow's milk (56.6%) and egg (38.1%). Most frequent symptoms included abdominal pain (67.1%), nausea (60.1%) and vomiting (46.2%). Endoscopic findings included longitudinal furrows (70.9%) and white exudates (67.4%). Statistically significant associations were found between dysphagia and oesophageal rings (p=0.003), vomiting and white exudates (p=0.018), abdominal pain and longitudinal furrows (p=0.025) and regurgitation and oedema (p=0.031).

Conclusions: Paediatric EoE in Colombia shows symptom and endoscopic heterogeneity. Identifying potential allergen triggers may contribute to understanding symptoms and endoscopic patterns in EoE.

Objective: To quantify patterns of emergency department (ED) use over two consecutive 12-month periods among children aged 15 and under, and to assess heterogeneity of reasons for attendance in high-frequency users.

Design: Population-based retrospective cohort study of routinely collected ED data.

Setting: EDs in the Yorkshire and Humber region, UK, from 31 March 2014 to 1 April 2017.

Patients: Children aged 15 and under with ≥1 ED attendance.

Main outcome measures: Proportion with ≥7 attendances over 2 years and heterogeneity of diagnostic reasons quantified by the Herfindahl index.

Results: The cohort included 71 143 individuals. Although only 13.6% were high-frequency attenders in the first year, over half (55.1%) of these made at least one attendance in the second year. A subset (14.1%) remained high-frequency attenders across both years and were more likely to belong to the most deprived deprivation category. Children aged 8-12 were more likely to attend for injury-related issues and showed lower heterogeneity in reasons for attendance, while infants under age 1 had more illness-related attendances and greater heterogeneity.

Conclusions: A notable proportion of children and young people frequently attend EDs over a 2-year period. This study introduces a method for quantifying heterogeneity in reasons for attendance, which may support future predictive modelling using electronic health records to identify and support high-frequency ED users.