BMJ Paediatrics Open最新文献

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.

Background: Extemporaneously compounded medicines are widely used in paediatric patients. However, the associated extent and nature of adverse drug events from these products remained unclear.

Aims: To summarise the characteristics of adverse drug events reported from the use of compounded medicines in children and determine the types of adverse drug events, medications most frequently involved, and reasons for medication errors.

Methods: A search was performed in Medline via Ovid, CINAHL, Embase, Scopus and the ISMP Canada Safety Bulletins to identify studies that described adverse drug events associated with community pharmacy compounded medicines. There were no restrictions based on country or publication date. Two authors independently screened titles, abstracts and full texts of studies of the studies found and extracted data with a standardised extraction table. Information extracted included study characteristics, details regarding the compounded medicine and clinical characteristics.

Results: We identified 37 cases across 25 studies. There were 31 cases of compounding errors, 5 cases of administration errors and 1 case of dispensing error. The most common compounding error types were incorrect concentration in the formulation, substitution or addition of an active ingredient that was not prescribed. The most commonly reported medicines were clonidine (n=7) and flecainide (n=5). The median age of children involved was 2 years (IQR 0.9-5.5 years). Two deaths were reported, following exposures to baclofen and tacrolimus.

Conclusions: This review highlights the importance of thoroughly verifying active ingredients and their concentrations when compounding paediatric formulations in community pharmacies.

Objectives: Recent advances in inflammatory bowel disease (IBD) therapies have provided patients with a variety of medications administered via different routes. We aimed to assess parental preferences regarding medication administration routes and to identify the factors influencing these preferences.

Design: This cross-sectional study surveyed the parents of children with IBD using a comprehensive questionnaire focusing on treatment experiences, preferences and attitudes towards switching from intravenous (IV) to subcutaneous (SC) administration. The questionnaire explored various regimens, including oral pills, SC injections at different intervals and IV infusions.

Results: Of the 147 participants, daily oral administration and SC administration every 8 weeks were the most preferred options. IV and SC administration every 2 weeks was less favoured. Prior treatment experience significantly influenced the parents' preferences regarding administration routes and schedules. Despite new options allowing for SC administration, 67% of parents preferred not to switch from IV, citing concerns about self-injection, desire for nurse presence and longer intervals between infusions. No significant correlation was found between treatment preferences and disease-related factors such as disease type or activity.

Conclusion: These findings highlight the complexities of transitioning paediatric patients with IBD to alternative treatment methods, emphasising the importance of individualised care and parental perspectives in clinical decision-making.

Objective: To estimate the incidence rates (IRs) of outcomes of interest in paediatric patients (aged 1 to <2 years) treated with intravenous pantoprazole.

Methods: This real-world, non-interventional, retrospective study was conducted using Optum's longitudinal electronic health records database between 1 January 2007 and 31 December 2020. Eligible patients receiving ≥1 dose of intravenous pantoprazole were included. Premature patients and those with birth weight <2.36 kg were excluded. Patients were divided into three subgroups based on diagnosis of gastro-oesophageal reflux disease (GORD) and erosive oesophagitis (EO): subgroup 1 (GORD and EO), subgroup 2 (GORD and no EO) and subgroup 3 (absence of both GORD and EO). The IRs (per 1000 person-years) of outcomes of interest were estimated in the overall and subgroups and stratified by duration of intravenous pantoprazole treatment (<4 days vs ≥4 days).

Results: Of 981 patients, none were identified in subgroup 1, while subgroup 2 and subgroup 3 comprised 462 (47.1%) and 519 (52.9%) patients, respectively. The highest IRs in the overall cohort were observed for vomiting (711.8), diarrhoea (412.4), abdominal distension (234.9), hypokalaemia (195.4) and hyponatraemia (182.5) with comparable IRs between subgroups 2 and 3. The IRs were higher for vomiting, diarrhoea, hypokalaemia, abdominal distension, hyponatraemia and thrombocytopenia in patients receiving ≥4 days of pantoprazole treatment versus <4 days.

Conclusion: The real-world incidence of the outcomes of interest is consistent with the established safety profile of pantoprazole and may provide key insights for use of intravenous pantoprazole in paediatric patients excluding those born preterm or with low birth weight.

Background: Medication-related problems are a significant global public health concern, with children being particularly vulnerable due to factors like weight-based dosing and immature organ function. In low-resource settings like Ethiopia, the burden is suspected to be high, but a comprehensive national estimate has been lacking.

Objective: This systematic review and meta-analysis aimed to determine the pooled prevalence of medication-related problems and their associated factors among paediatric patients in Ethiopia.

Method: A comprehensive search was conducted across PubMed, Google Scholar, Science Direct and Hinari-Research4Life and manual reference search from 1 to 10 September 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting data on medication-related problems (including medication errors, adverse drug reactions and drug therapy problems) in Ethiopian children were included. Data extraction and quality assessment were performed by independent reviewers. Heterogeneity was assessed using I² statistics; moderate heterogeneity (I²=39.4%) was observed and a random-effect model was used. Subgroup analysis and meta-regression were applied to explore the source of heterogeneity.

Result: Out of 3435 initially identified articles, 21 hospital-based studies involving 5969 paediatric patients were included. The pooled prevalence of medication-related problems across these studies was 53% (95% CI 45% to 61%) with a pooled incidence rate of 1.17 medication-related problems per child and a moderate level of heterogeneity. The pooled prevalence of dosing error was 37.4%. Additionally, 51% of children had comorbid conditions and 42% were exposed to polypharmacy. Both polypharmacy (≥5 medications: pooled OR=1.32; 95% CI 1.13 to 1.52) and the presence of comorbidity (pooled OR=1.32; 95% CI 1.02 to 1.61) were significantly associated factors of medication-related problems.

Conclusion: More than half of the paediatric patients in Ethiopia experience medication-related problems. Polypharmacy and comorbidities are major contributing factors. Therefore, comprehensive medication review and monitoring are needed to mitigate this substantial burden.

Background: Child undernutrition remains a leading contributor to mortality, morbidity and impaired development in low-income and middle-income countries, particularly in India where rates of stunting and underweight persist despite broad policy and programme investments. The critical window for intervention is the first 1000 days, from conception to age 2, when both maternal and child factors influence lifelong outcomes.

Objectives: To map the review level evidence on interventions to prevent and reduce child and maternal malnutrition across health, education, environment and engineering sectors in India, and assess the degree of alignment with current policy strategies targeting the first 1000 days.

Eligibility criteria: Included sources were systematic reviews, meta-analyses and WHO guidelines published in English, addressing interventions for pregnant women, mothers of infants and children under 5 in India or other low-income/middle-income country settings.

Sources of evidence: Evidence was identified via searches of MEDLINE, Cochrane Library, CINAHL, ERIC, GEOBASE, Engineering Village, and relevant policy reports and guidelines, up to July 2025.

Charting methods: Reviews were screened, and data were extracted on intervention design, implementation context, sectoral focus, population, outcomes, strength of evidence and evidence gaps.

Results: A total of 155 reviews met eligibility. Multisectoral approaches integrating nutrition, Water, Sanitation and Hygiene(WASH), education and social support showed the strongest impact for preventing stunting and improving child growth, particularly when targeted early. Intervention coverage and effectiveness were limited by gaps in cross-sector coordination, infrastructural constraints, poor supervision and exclusion of the youngest and poorest populations. Prevention in the first 1000 days yielded greatest benefits, but implementation challenges persist.

Conclusions: India's efforts against childhood malnutrition require integrated, context-specific and prevention-focused strategies. Mapping review evidence to policy reveals strengths and gaps, with lessons relevant for improving child and maternal nutrition in other high-burden regions.

Introduction: Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality among neonates requiring life-saving mechanical ventilation in neonatal intensive care units (NICUs), particularly those who are born prematurely and/or with very-low-birth-weight (VLBW), or critically ill. Despite its clinical significance, neonatal VAP lacks standardised diagnostic criteria, resulting in variability in incidence reporting, over or under diagnosis and inappropriate antimicrobial use which further exacerbates the emergence of antibiotic-resistant organisms. Current diagnostic criteria and prevention strategies, often adapted from paediatric populations and adults, fail to address the unique anatomical and clinical characteristics of neonates. Building on a pilot investigation across Canadian NICUs, the goal of this study is to establish standardised, neonatal-specific VAP diagnostic criteria and prevention strategies to improve diagnostic accuracy, promote antimicrobial stewardship and enhance clinical outcomes.

Methods and analysis: Beginning in 2025, a 4-year, multicentre, prospectively-designed retrospective cohort study will be conducted across tertiary NICUs in Canada. All VLBW (birth weight <1500 g) neonates admitted to participating NICUs will be included. Our first aim is to use the Canadian Neonatal Network (CNN) platform, integrated with advanced data screening tools, to collect standardised demographic, clinical, ventilatory and microbiological data to assess VAP incidence and outcomes based on existing definitions. Next, we will develop a neonatal-specific VAP diagnostic criteria, by combining statistical analyses, including univariate analysis, multivariable logistic regression and receiver operating characteristic analyses, with expert consensus building through the Delphi method. Concurrently, we will focus on implementing evidence-based VAP prevention strategies and evaluate outcome measures, such as VAP incidence, adherence to prevention bundles and antimicrobial stewardship practices.

Ethics and dissemination: This study has received ethics approval from the University of Alberta Health Research Ethics Board-Health Panel (Pro00149177). Findings will be disseminated through open-access publications, conference presentations and online platforms to promote widespread adoption.

Trial registration number: NCT07109791.