BMJ Paediatrics Open最新文献

Objectives: To compare the INTERGROWTH-21st and the WHO fetal growth chart in detecting term small for gestational age (SGA) neonates and predicting short-term adverse perinatal outcomes.

Design: A retrospective cohort study.

Setting: Department of Obstetrics and Gynaecology at the Aga Khan University Hospital Karachi.

Subjects: Term singleton pregnancies between July and December 2018 with ultrasound growth scan done within 4 weeks of delivery. Pregnancies with structural and chromosomal abnormalities and multiple gestations were excluded.

Outcome: The estimated fetal weight (EFW) was calculated using the INTERGROWTH-21st and the WHO fetal growth chart based on ultrasound measurements. Fetuses with EFW below the 10th percentile were classified as SGA. Neonates were confirmed as SGA based on similar postnatal weight percentile. Short-term adverse perinatal outcomes were also analysed.

Results: A total of 932 records were screened, and 478 were included in the analysis. The sensitivity of the WHO fetal growth chart (70.2%; 95% CI: 60.4%, 78.8%) was higher than the INTERGROWTH-21st (45.2%; 95% CI: 35.4%, 55.3%) for predicting neonatal SGA. The WHO fetal growth chart predicted more SGA neonates when compared with the INTERGROWTH-21st (AUC=0.75, 95% CI: 0.71, 0.80 and AUC=0.63, 95% CI: 0.58, 0.68, respectively). Both charts were similar in predicting the short-term adverse perinatal outcomes; AUC (95% CI) was 0.77 (0.70, 0.83) for INTERGROWTH-21st and 0.78 (0.72, 0.85) for the WHO fetal growth chart.

Conclusion: The WHO fetal growth chart demonstrates significantly better accuracy in predicting term SGA neonates compared with INTERGROWTH-21st. Further, both charts have similar prediction abilities for short-term adverse perinatal outcomes.

Although appendectomy remains the standard treatment for acute appendicitis, non-operative management has gained interest as a safe and effective alternative. However, its implementation in resource-limited hospitals like ours is hindered by insufficient staffing, high bed occupancy, lack of digital records and limited specialist access. Despite these challenges, we present our centre's initial experience. Between July 2022 and December 2023, 24 children with uncomplicated acute appendicitis were treated non-surgically, with an equal gender distribution. The initial success rate was 100%, with only three cases (12.5%) of treatment failure during 12 months of follow-up.

Introduction: A growing number of paediatric core outcome sets (COS) have been developed in the past 20 years. Previous studies have provided many useful insights into the uptake of COS. In addition to the awareness of COS among clinical trialists, the COS development process (especially patient participation) and the actions of the developers can promote COS uptake. However, the uptake of COS in paediatric clinical trials needs to be further explored. The aim of this study is to provide information on the rationale and use of paediatric COS in clinical trials, and to analyse in depth the awareness and views of COS developers and clinical trialists about the development and use of COS.

Methods and analysis: We will include all paediatric COS identified in our previous systematic review and those subsequently included in the Core Outcome Measures in Effectiveness Trials (COMET) database. We will extract the target condition, population, intervention, list of core outcomes and the details of patient involvement. Next, we will search the Clinicaltrials.gov and WHO International Clinical Trials Registry Platform for trials on health conditions addressed by the identified COS. We will assess the comparability of the scopes in each COS-trial pair and determine for the outcomes in each clinical trial if they match exactly or generally, or if they do not match, with the outcomes of their respective COS. Finally, we will conduct a survey and semistructured interviews among COS developers and clinical trialists to examine their views.

Ethics and dissemination: Ethical approval for the study has been granted by the ethics committee of the Institute of Health Data Science, Lanzhou University (No. HDS-202405-01). This study was registered on COMET (https://www.comet-initiative.org/Studies/Details/3122).

Integrating Large Language Models like ChatGPT-4omni (ChatGPT-4o) into paediatric healthcare could revolutionise developmental screening. This study evaluated ChatGPT-4o's efficacy in paediatric developmental screening using Direct and Sequential Prompting methods compared with the Bayley Scales of Infant Development, Third Edition. Among 106 paediatric cases, Direct Prompting showed a sensitivity of 73.42% and overall accuracy of 69.81%, while Sequential Prompting had a specificity of 62.96% and overall accuracy of 67.92%. Both methods demonstrate potential for improving the efficiency and accessibility of paediatric developmental screening, with Direct Prompts being more sensitive and Sequential Prompts more specific.

Objective: To examine the distribution and time trends of admission temperature in very preterm infants, effects of temperature-preserving interventions and associations between hypothermia and outcomes.

Methods: Population-based cohort study of infants <32 gestational weeks without lethal malformations admitted to a neonatal intensive care unit within 2 hours of birth between 1 January 2012 and 31 December 2021. Hypothermia was defined as mild (36.0°C-36.4°C), moderate (34.5°C-35.9°C) or severe (<34.5°C). Associations between admission temperature and outcomes were investigated using multivariate logistic regression, adjusting for sex, weight Z-score, gestational age, antenatal steroids, surfactant and hospital.

Results: In total, 2457/4879 (50.4%) had normal admission temperatures between 36.5°C and 37.5℃, 1314 (26.9%) had mild hypothermia and 886 (18.2%) had moderate to severe hypothermia, with a significant interhospital variance of 7%-40%. Moderate to severe hypothermia decreased from 24% in 2012 to 16% in 2021 (p_trend<0.001). Measuring temperature before leaving the delivery unit correlated with lower incidence of moderate to severe hypothermia (42% vs 58%, p<0.001). Admission temperature was inversely associated with mortality (adjusted OR 1.5, 95% CI 1.1 to 2.0 for moderate and 2.4, 95% CI 1.1 to 4.9 for severe hypothermia) and with surgical necrotising enterocolitis or intestinal perforation (adjusted OR 1.7, 95% CI 1.1 to 2.7 for moderate and 3.1, 95% CI 1.3 to 7.7 for severe hypothermia).

Conclusions: Although the incidence of hypothermia decreased during the study period, it remains a concern due to significant associations with adverse outcomes. Areas for further improvement include addressing interhospital variance and enhancing temperature monitoring in the delivery unit.

Background: The 'Children's Assessment of Participation with Hands (CAP-H)' scale is a parent report questionnaire that can be used to measure participation in life situations that require hand use for children with disabilities. The aim of this study was to examine the reliability of a Turkish version of the CAP-H scale in order to evaluate the hand participation of children with physical disabilities and compare them with typically developing children.

Methods: Evaluation was made of a total of 182 physically disabled children (8.53±3.94 years) and 90 typically developing children (9.40±3.04 years). The CAP-H scale was used to evaluate children's hand participation, compare with typically developing children and to examine the reliability of the Turkish version. Cronbach's alpha and intraclass correlation coefficients (ICCs) were evaluated for internal consistency and test-retest reliability, respectively.

Results: Cronbach's alpha value used for all subscores was found to be excellent in all domains for internal consistency (Cronbach's α: 0.84-1). According to the test-retest reliability, it was found to be perfectly reliable in all domains (ICC: 0.81-1). There was a significant difference in all items of CAP-H (p=0.00) except for participation in self-care, frequency of recreational activities and frequency of educational domain in favour of typically developing children.

Conclusions: The results of this study demonstrated that the Turkish translation of CAP-H is a reliable evaluation for children's participation in life requiring hand use. In addition, hand participation of children with physical disabilities is lower compared with typically developing children.

Background: Siblings of children with disabilities or childhood-onset chronic conditions (eg, autism, cerebral palsy or congenital heart disease) often face challenges in mental health, quality of life and psychosocial adjustment. However, comprehensive knowledge of their participation in daily activities remains limited. Understanding their participation patterns and potential restrictions can help clarify their needs.

Aims and methods: This scoping review aims to summarise current research on the participation of siblings of children with childhood-onset chronic conditions. Following the Joanna Briggs Institute methodology, we systematically searched MEDLINE, CINAHL, AMED, PsycINFO and ERIC for peer-reviewed studies published in English between 2001 and 2024. Eligible studies focused on siblings of children with disabilities or early-onset chronic conditions (population) and their participation, including attendance and involvement in daily activities (concept) across children's homes, communities and schools (context). The review adheres to the Preferred Reporting Items for Scoping Reviews guidelines.

Results: A total of 62 articles met the inclusion criteria: 45 qualitative (73%) and 7 quantitative (11%) studies, 7 reviews (11%) and 3 meta-studies (5%). The studies covered various chronic conditions (eg, cancer, chronic kidney disease and Down syndrome), with autism being the most common (22 studies). Key participation themes identified include family life, home participation, school involvement, leisure activities, social interactions with peers, information-seeking and continuous meaning-making. Factors such as normalcy, advocacy, identity, gender, age, culture and socioeconomic status were found to intersect with participation.

Conclusions: This review provides a comprehensive overview of current research and contributes to our understanding of how participation in daily activities has been studied so far in the population of siblings of children with disabilities. It reveals a gap in research specifically measuring participation among siblings. The identified themes enhance our understanding of potential participation restrictions in this population.

Objectives: To investigate the differences in participation patterns, environmental barriers and supports across specific activities typically done at school between children with attention deficit hyperactivity disorder (ADHD) and without ADHD.

Design: Prospective cross-sectional study.

Setting: The children and adolescents with ADHD were selected from those routinely referred to the Health Sciences University Research and Training Hospital's child and adolescent psychiatry department, which is a reference centre for the region.

Participants: A total of 365 children (n _{children with ADHD} =175, n _{children without ADHD} =190, mean age 11.66 years, SD 2.96 years) and their primary caregivers were included in the study.

Primary outcome measures: Participation and Environment Measure for Children and Youth was used to evaluate children.

Results: The mean frequency of participation in five different school activities was significantly lower in children with ADHD than in children without ADHD, with moderate to large effect sizes. Children with ADHD were less likely to be involved in any activity type than children without ADHD, with moderate to large effect sizes. The characteristics of the school environment typically made it more challenging for children with ADHD to participate than for children without ADHD, with moderate effect sizes.

Conclusions: Children with ADHD have challenges in classroom activities and with socialising with peers outside class, cognitive demands, sensorial qualities and safety. Relationships with friends, cultural acceptance and support could improve the school participation of children with ADHD.

Background: To describe the characteristics of cardiac-related neonatal collapses referred to a critical care transport service and evaluate the diagnostic accuracy and management at referral and retrieval.

Methods: Retrospective cohort analysis of cardiac-related neonatal collapses who were referred to and transferred by a paediatric intensive care retrieval team based in London, UK between 2013 and 2021. Patients with antenatal diagnoses were excluded.

Results: There were 71 neonates identified of whom 49 (69%) had structural heart defect, 12 (17%) arrhythmia and 10 (14%) with cardiomyopathy/myocarditis. Among structural defects, left ventricular outflow tract (LVOT) obstruction (71%) and mixing of circulation (22%) were the predominant pathologies. Cardiac murmur was absent in 66% of the patients. The referring teams' diagnostic performance was suboptimal for LVOT obstruction and cardiomyopathy/myocarditis, with 63% and 30% recognised as cardiac cause of collapse at referral. Less than half of neonates with duct-dependent lesions received prostaglandin at referral, which later improved to 97% during retrieval. The number of patients requiring intubation and inotropic support also increased at various time points throughout the patient journey. 98% of patients with structural defects required cardiac interventions at a median of 1 day after admission.

Conclusions: Structural heart defect, particularly LVOT obstruction, was the leading cause of cardiac-related neonatal collapses. However, a significant portion were initially misdiagnosed leading to delay in prostaglandin administration. Our findings highlight the importance of a high index of suspicion for cardiac pathologies as a cause of neonatal collapse, which is essential for appropriate treatment and timely referral.