BMJ Paediatrics Open最新文献

Objective: We aimed to assess health-related quality of life (HRQOL) in a cohort of very preterm born children and adolescents (aged 5-16), and to compare it with their fullterm born siblings and the general population. We also explored correlates of HRQOL among the very preterm born.

Design: Cross-sectional survey.

Patients: Children born <32 weeks gestation (N=442) as well as their fullterm born siblings (N=145).

Main outcome measures: Primary outcome was KINDL total score (0 worst to 100 best), a validated multidimensional measure of HRQOL in children and adolescents.

Methods: Linear mixed models accounted for family unit. Secondary analysis compared very preterm born children to another cohort of healthy children from the same time period. A classification tree analysis explored potential correlates of HRQOL.

Results: On average, preterm children, both <28 and 28-31 weeks gestational age, had similar KINDL total score to fullterm sibling controls (-2.3, 95% CI -3.6 to -0.6), and to population controls (+1.4, 95% CI 0.2 to 2.5). Chronic non-respiratory health conditions (such as attention deficit hyperactivity disorder or heart conditions, but not including cerebral palsy), age and respiratory symptoms affecting daily life were key correlates of HRQOL among very preterm born children.

Conclusions: Very preterm birth in children and adolescents was not associated with a relevant reduction in HRQOL compared with their fullterm born peers. However, lower HRQOL was explained by other factors, such as older age, and the presence of chronic non-respiratory health conditions, but also by possibly modifiable current respiratory symptoms. The influence of respiratory symptom amelioration and its potential influence on HRQOL needs to be investigated further.

Trial registration number: NCT04448717.

Objective: Enhanced recovery after surgery (ERAS) guidelines have been successfully applied to children and neonates. There is a need to provide evidence-based consensus recommendations to manage neonatal pain perioperatively to ensure adequate analgesia while minimising harmful side effects.

Methods: Following a stakeholder needs assessment, an international guideline development committee (GDC) was established. A modified Delphi consensus iteratively defined the scope of patient and procedure inclusion, topic selection and recommendation content regarding the pharmacologic management of neonatal pain. Critical appraisal tools assessed the relevance and quality of full-text studies. Each recommendation underwent a formal Grades of Recommendation, Assessment, Development and Evaluation (GRADE) assessment of the quality of evidence and expert consensus was used to determine the strength of recommendations.

Results: The GDC included paediatric anaesthesiologists, surgeons, and ERAS methodology experts. The population was defined as neonates at >32 weeks gestational age within 30 days of life undergoing surgery or painful procedures associated with surgery. Topic selection targeted pharmacologic opioid-minimising strategies. A total of 4249 abstracts were screened for non-opioid analgesia and 738 abstracts for the use of locoregional analgesia. Full-text review of 18 and 9 articles, respectively, resulted in two final recommendations with a moderate quality of evidence to use regular acetaminophen and to consider the use of locoregional analgesia. There was inadequate evidence to guide the use of other non-opioid adjuncts in this population.

Conclusions: Evidence-based, ERAS-driven consensus recommendations were developed to minimise opioid usage in neonates. Further research is required in this population to optimize multimodal strategies for pain control.

Background: Breastfeeding within the first hour of birth is critical for newborn survival. However, in Papua New Guinea (PNG), about 40% of newborns are not breastfed within the first hour of birth. This study aimed to determine the prevalence and factors associated with delayed initiation of breastfeeding in PNG.

Methods: This study used secondary data from the 2016-2018 PNG Demographic and Health Survey, a nationally representative cross-sectional study. A total weighted sample of 4748 women aged 15-49 were included. Complex samples analysis was performed to determine the direction of association between the independent variables and delayed initiation of breastfeeding.

Results: About a quarter (24.6%) of women delayed initiation of breastfeeding. Women with an unplanned pregnancy (adjusted OR (AOR) 1.32; 95% CI 1.03 to 1.68), those who had a caesarean section (AOR 3.16; 95% CI 1.39 to 7.17), those who did not initiate newborn skin-to-skin contact immediately after birth (AOR 1.83; 95% CI 1.41 to 2.38) and those who watched television (AOR 1.39; 95% CI 1.11 to 1.75), and were from the Momase region (AOR 1.31; 95% CI 1.00 to 1.93) had higher odds of delayed breastfeeding initiation. Conversely, the odds of delayed initiation of breastfeeding was lower among women who read a newspaper or magazine (AOR 0.76; 95% CI 0.61 to 0.95), were from the Southern (AOR 0.81; 95% CI 0.56 to 1.15) and Highlands (AOR 0.86; 95% CI 0.58 to 1.29) regions, and gave birth at home or in the village (AOR 0.69; 95% CI 0.49 to 0.96).

Conclusion: One in four women in this study delayed initiation of breastfeeding until after 1 hour after birth. Interventions to promote optimal breastfeeding require a multi-sectoral approach, as well as bolstering health workers' capacity to encourage and support early initiation of breastfeeding during the antenatal and early postnatal periods.

Background: Street and working children (SWC) and young people (YP) are highly vulnerable to violence, exploitation, hazardous environments and human rights violations. While the UN Committee on the Rights of the Child and the International Labour Organisation provide some guidance, there is limited information on their right to healthcare. This study aims to identify enablers and barriers to healthcare access for SWC and document associated rights violations.

Methods: From 2000 to the present, we conducted systematic searches for SWC (0-18 years) in databases including MEDLINE, PsycINFO, EBSCO, PUBMED and PROQUEST, using broad search terms related to street children, working children, healthcare access and rights. The searches were supplemented by grey literature and hand searches. Two independent reviewers finalised the included studies, and data were analysed using a rights-based framework with narrative analysis and thematisation.

Results: The initial search yielded 7346 articles (5972 for street children and 1374 for working children), with 35 studies (18 for street children and 17 for working children) included in the review. Most studies on working children (13/17) focused on trafficking/commercial exploitation. Studies were predominantly from Africa, followed by the USA, Asia, the UK and Canada, with only two employing a rights framework. SWC face barriers such as cost, distance, visibility/accessibility of services, stigma, seclusion, threats of violence, lack of legal documents, crisis-oriented healthcare use and self-medication. Enablers included agency, self-efficacy, positive relationships with adults and proactive healthcare use when accessible. Emergency departments are frequently accessed by SWC, indicating a need for healthcare professionals to be trained and sensitised. Holistic and comprehensive healthcare is essential.

Conclusion: Significant research gaps exist, with many SWC populations under-represented. SWC share healthcare access barriers with other marginalised groups. Healthcare for SWC must be tailored to their unique needs and strengths and be holistic and trauma-informed.

Objective: The incidence of bronchopulmonary dysplasia (BPD) is increasing, but data on its prevalence and management variations remain insufficient in China. The study aims to investigate its point prevalence and variations in BPD care.

Setting, patients and interventions: A multicentre cross-sectional study was conducted in 37 NICUs. 'Snapshot' clinical data on 18 June 2021 for individual patients born at <32 weeks gestation age (GA) were collected. BPD was defined based on the National Institute of Child Health and Human Development (NICHD) 2001 criteria and two newer criteria (NICHD 2018 and Jensen 2019).

Results: A total of 1044 infants born at <32 weeks GA were included, of which 72% were born at ≥28 weeks GA and 95.8% were born at ≥750 g. At the time of 'snapshot', 563 were ≥28 days old and 281 were ≥36 weeks postmenstrual age (PMA). The prevalence of BPD was 78.2% per NICHD 2001 definition. Infants with BPD were more likely to be born earlier with a lower birth weight and to have complications. Among infants who reached 36 weeks PMA, the point prevalence and severity of BPD differed across BPD definitions. Respiratory support and treatments for BPD also significantly varied.

Conclusion: Point prevalence of BPD is remarkably high in China. The prevalence of BPD was lowest according to the NICHD 2018 definition, whereas the NICHD 2001 definition classified most patients with severe BPD. We found infants with BPD have more complications and significant differences in BPD treatments between centres. Efforts to prevent BPD and standardise care are warranted in China.

Introduction: Febrile infants under 3 months of age are at risk of invasive bacterial infection (IBI). It is currently unclear if testing for respiratory viruses may have a role in IBI risk stratification. If found to be associated with the likelihood of IBI, respiratory viral point-of-care testing may improve patient and caregiver experience, reduce costs and enhance antimicrobial stewardship.

Methods and analysis: This is a study protocol for a systematic review and meta-analysis that aims to answer the following question: In young febrile infants presenting to emergency care settings does a positive respiratory viral test for RSV, Influenza or SARS-CoV2 (relative to a negative test) add value to current risk stratification pathways for the exclusion of invasive bacterial infection, subsequently enabling safe de-escalation of investigation and treatment?A search strategy will include MEDLINE, EMBASE, Web of Science, The Cochrane Library and grey literature. Abstracts and then full texts will be independently screened for selection. Data extraction and quality assessment will be completed by two independent authors.The primary objective is to analyse the ability of a positive respiratory viral test to identify the overall risk of IBI. The secondary objective is to perform a subgroup analysis to investigate how the risk stratification alters based on other variables including virus type, patient characteristics and the presence of an identified source of fever.Bivariate random-effects meta-analysis will be undertaken. Diagnostic odds ratios (OR), sensitivity, specificity and positive and negative likelihood ratios will be calculated. The degree of heterogeneity and publication bias will be investigated and presented.

Ethics and dissemination: Ethical approval is not required. We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to disseminate the study results through publication and conference presentations.

Prospero registration number: This protocol is registered in PROSPERO-ID number: CRD42023433716.

Background: Intestinal dysbiosis is implicated in the pathogenesis of necrotising enterocolitis and late-onset sepsis in preterm babies. The provision of non-invasive positive pressure ventilation is a common clinical intervention in preterm babies, and may be hypothesised to adversely affect intestinal bacterial growth, through increased aerophagia and induction of a hyperoxic intestinal environment; however this relationship has not been previously well characterised.

Methodology: In this prospectively recruited cohort study, high-throughput 16S rRNA gene sequencing was combined with contemporaneous clinical data collection, to assess within-subject changes in microbiome development around the time of transitioning from non-invasive positive pressure respiratory support to unsupported spontaneous breathing.

Results: In a group of 14 preterm infants, bacterial diversity was seen to increase by 0.34 units/week (inverse Simpson index) at the point of transitioning off non-invasive positive pressure respiratory support. Correspondingly, a significant increase in anaerobic genera (Bifidobacteria spp, Veillonella spp), and a non-significant fall in Enterobacteriaceae was also seen at this time.

Conclusions: Provision of non-invasive positive pressure ventilation is associated with suppression of both diversity accrual and obligate anaerobic growth in the preterm intestine. This has clinical implications in view of the widespread use of non-invasive positive pressure ventilation in preterm neonatal care (and wider adult use), and demonstrates the need for potential strategies (eg, probiotic support; reduced aerophagia) to support the development of a healthy gut microbiome during this time.

Objective: There is limited evidence on how the physical health of children and young people (CYP) who are care experienced (eg, in foster or out-of-home care) compares to the general population. UK research suggests that the prevalence of some chronic conditions may be similar for these groups.

Design: We undertook longitudinal population-wide data linkage of social care, prescription and hospitalisation records for care experienced and general population CYP born 1990-2004, followed from birth to August 2016. We compared prevalence estimates for asthma, diabetes (type 1) and epilepsy between the cohorts and used Poisson and survival models to estimate the association between social care and hospitalisations for these conditions.

Results: Care experience was not associated with a higher prevalence of asthma and diabetes, but epilepsy was more prevalent. Care was associated with increased hospitalisation rates for all three conditions, particularly for males. HRs for hospitalisations were highest before and after care and lower while the child was in care, for diabetes these were, respectively 1.88 (95% CI 1.28 to 2.77), 2.40 (95% CI 1.55 to 3.71) and 1.31 (95% CI 0.91 to 1.88) for care experienced CYP compared with general population.

Conclusions: Hospitalisations for chronic conditions are higher among care experienced CYP, particularly for males, and outside care episodes. Families with children with chronic conditions should be offered support to manage these conditions and help keep families together. Higher hospitalisations after care suggest that care leavers should be provided more support to help manage their health.

Background: Neonatal sepsis remains a primary cause of morbidity and mortality among newborns. Rapid and accurate diagnosis poses a significant challenge-the non-specific clinical presentation of neonatal sepsis relies heavily on various laboratory indices for early detection and subsequent management. One such indicator under investigation is the mean platelet volume (MPV), which may serve as a predictive marker. This study aims to evaluate the association between the MPV and late-onset sepsis in preterm infants.

Methods: This retrospective study included 63 newborns born at Sheba Medical Center from 2016 to 2020 with late-onset sepsis as evidenced by positive blood cultures, and 63 newborns in the control group. We analysed blood count data at three intervals: preinfection, intrainfection and postinfection. Electronic medical records provided supplemental data. Each septic neonate was paired with a non-septic control.

Results: Our results revealed a significant elevation of MPV in septic newborns compared with non-septic controls during the days prior to the infection (9.323 and 8.876, respectively, p=0.043) and persisted up to 2 weeks postinfection (9.39 vs 8.714, p=0.025).The MPV and the MPV-to-total platelet (PLT) count ratio exhibited significant predictive capabilities in receiver operating characteristics analysis (-0.60 and -0.57, respectively).

Conclusions: High MPV in combination with PLT decrement might be predictive for the diagnosis of late-onset sepsis. Future studies should be conducted in order to better understand the underlying pathophysiology and the potential clinical applications of these findings.

Background and objectives: Neonatal mortality due to severe bacterial infections is a pressing global issue, especially in low-middle-income countries (LMICs) with constrained healthcare resources. This study aims to validate the Neonatal Healthcare-associated infectiOn Prediction (NeoHoP) score, designed for LMICs, across diverse neonatal populations.

Methods: Prospective data from three South African neonatal units in the Neonatal Sepsis Observational (NeoOBS) study were analysed. The NeoHoP score, initially developed and validated internally in a South African hospital, was assessed using an external cohort of 573 sepsis episodes in 346 infants, focusing on different birth weight categories. Diagnostic metrics were evaluated, including sensitivity, specificity, positive predictive value and area under the receiver operating characteristic curve.

Results: The external validation cohort displayed higher median birth weight and gestational age compared with the internal validation cohort. A significant proportion were born before reaching healthcare facilities, resulting in increased sepsis evaluation, and diagnosed healthcare-associated infections (HAIs). Gram-negative infections predominated, with fungal infections more common in the external validation cohort.The NeoHoP score demonstrated robust diagnostic performance, with 92% specificity, 65% sensitivity and a positive likelihood ratio of 7.73. Subgroup analysis for very low birth weight infants produced similar results. The score's generalisability across diverse neonatal populations was evident, showing comparable performance across different birth weight categories.

Conclusion: This multicentre validation confirms the NeoHoP score as a reliable 'rule-in' test for HAI in neonates, regardless of birth weight. Its potential as a valuable diagnostic tool in LMIC neonatal units addresses a critical gap in neonatal care in low-resource settings.