BMJ Paediatrics Open最新文献

Objective: Providing Kangaroo care (K-care) helps comfort infants through painful and stressful procedures including retinopathy screening examination (RSE) for retinopathy of prematurity. We examined the early pain-related and delayed inflammatory effects of K-care during the first RSE in preterm infants.

Design: Randomised clinical trial.

Setting: In a family-centred neonatal intensive care unit between 1 March 2023 and 31 August 2024.

Patients: Preterm infants (gestation <34+0 weeks and/or birth weight <2000 g) who required RSEs.

Interventions: Patients were randomly assigned to K-care provided by mother or father during RSE or control group on an examination table (n=50/group).

Main outcome measures: The Premature Infant Pain Profile (PIPP) score within the first minute of RSE was measured. Salivary samples (>110 uL) were collected before, at 1 and 6-8 hours after RSE for assays of cortisol, interleukin-1β, interleukin-6 and tumour necrosis factor-alpha (TNF-α) levels by ELISA methods in a blinded fashion.

Results: 100 infants (mean±SD gestational age: 31.1±2.4 weeks; birth weight: 1496±452 g, 58% males) were enrolled. Compared with controls (n=50), infants of the K-care group (n=50) had significantly lower PIPP score (11.0 vs 12.9; p=0.002); salivary cortisol levels (4.9 vs 6.9 ng/mL; p=0.001) at 1 hour after RSE, interleukin-6 (31.9 vs 34.7 pg/mL; p=0.01) and TNF-α (53.9 vs 58.6 pg/mL; p=0.02), but not interleukin-1β (50.4 vs 53.0 pg/mL; p=0.46), levels at 6-8 hour after RSE.

Conclusions: Providing K-care during RSE in preterm infants may potentially reduce pain-related stress, cortisol and inflammatory responses.

This article reviews current literature on early child development in Down syndrome (DS) to provide a summary for clinicians who deliver developmental care. Literature was reviewed on acquisition of developmental skills across domains including motor, language, vision and hearing skills, and evidence for interventions. We include current concepts on promotion of early developmental care and the importance of clinician-family collaboration. The perspective of a family is included which highlights their experience of the early years.Professionals including paediatricians and therapists have a role in monitoring development and proactively identifying and mitigating co-morbidities and barriers to progress. Families are best served by integrated therapeutic and educational input from specialists where required, with customised interventions when delays are apparent.The use of DS-specific developmental frameworks and monitoring for conditions which may impact development is suggested to enable realistic, meaningful and individualised goal setting, in partnership with families. Our review additionally provides a summary of potential actions for clinicians and carers to promote optimal child development across developmental domains.

Background: Respiratory rate is an important part of assessing the clinical state of children, and various methods exist to measure it. However, there is a lack of a universally accepted reference standard to validate the performance of these methods.

Aim: To identify different reference standards that have been used to evaluate respiratory rate measurement methods in children under 5 years of age and describe their perceived strengths and limitations.

Methods: MEDLINE and Web of Science were searched for studies in English. Studies of children under 5 years of age, published between 2013 and 2024, in which a method for measuring respiratory rate was compared against a reference standard, were included. Deductive content analysis was used to map perceived strengths and limitations of each standard, and a forest plot analysis was used to compare agreement between the reference standard and the index tests.

Results: From 992 retrieved studies, 56 were included. The most common reference standard was impedance pneumography (22/56), primarily used in high-income settings, followed by manual counting (19/56), mostly employed in low- and middle-income settings, and capnography (9/56). Child age, clinical condition, setting, training of personnel and the ease of implementation were all important factors in which the reference standard was used and how it performed.

Conclusion: Three different reference standards were used for most studies; however, their relative performance to each other is unclear. There is a need for research that directly compares the performance of these reference standards across different age strata and settings in order to confidently recommend a reference standard for respiratory rate measurement methods.

Wheeze is a common paediatric winter presentation, requiring bronchodilator therapy. Use of jet nebulisers (JN) is currently standard practice, but vibrating mesh nebulisers (VMN) have demonstrated quicker, quieter and more effective drug delivery, with reduced emergency department (ED) length of stay (LOS) in adults. A retrospective review of JN versus VMN use was conducted in a paediatric population (n=38 and n=19, respectively). An apparent reduction in ED LOS, nebuliser requirement and respiratory rate was seen with VMN use, indicating the potential for this device to improve the effectiveness of bronchodilator administration and warranting further investigation in paediatric patients.

Background: Despite the health benefits, just 3% of Gypsy and Traveller infants receive breastmilk.

Methods: This study took place in June-July 2024 and involved semistructured interviews with seven Gypsy and Traveller women. It presents a grounded theory interpretation of the barriers and facilitators to breastfeeding infants that they perceive and experience.

Results: Four main barriers are presented: breastfeeding in front of others is prohibited; an aversion to breastfeeding; reduced awareness of the health benefits; and limited skills to breastfeed and being overlooked. Four main facilitators are presented: breastmilk is thought to be healthier than formula; an awareness that attitudes to breastfeeding are outdated; determination and resourcefulness to breastfeed; and a new theoretical concept, that partners will support women to breastfeed.

Conclusion: Recommendations include ensuring that Gypsy and Traveller women and their partners are offered an antenatal contact with a midwife and health visitor to discuss the health benefits of breastfeeding and how to express breastmilk as well as breastfeed; collaboration with Gypsy and Traveller advocates to facilitate environmental change to enable breastfeeding; and further ethnographic research to understand the Gypsy and Traveller culture.

Objective: To assess the associations of early life exposures with school readiness.

Design, setting, main outcome measure and participants: Using data from the Born in Bradford (BiB) birth cohort, we investigated the association of early life exposures and the likelihood of children achieving a 'Good Level of Development' (GLD) as measured by the Early Years Foundation Stage Profile at the end of their first school year. Multivariable logistic regression modelling was used to estimate associations of early life exposures with school readiness.

Results: Outcome data were available for 10 589 of 13 858 BiB participants. 6272 (59%) children achieved a GLD. 17 variables were investigated, including child characteristics, maternal factors, family environment and socioeconomic exposures. In our multivariable model (n=7981), children with the following characteristics were significantly less likely to achieve a GLD: males (OR 0.43, 95% CI 0.39 to 0.47), Pakistani ethnicity (OR 0.76, 95% CI 0.66 to 0.89), younger children (OR 1.18 per month, 95% CI 1.16 to 1.19), preterm birth (gestational age<32 weeks OR 0.34, 95% CI 0.19 to 0.62; 32-36 weeks OR 0.64, 95% CI 0.51 to 0.80), younger maternal age (OR 1.01 per year of maternal age, 95% CI 1.00 to 1.02), lower maternal education (OR 0.27, 95% CI 0.20 to 0.37 with no qualifications, compared with higher degrees), never breastfed (OR 0.87, 95% CI 0.78 to 0.97), lower paternal employment status (OR 0.66, 95% CI 0.54 to 0.81, for unemployed, compared with non-manual employment), receiving benefits during pregnancy (OR 0.89, 95% CI 0.80 to 0.99) and eligible for free school meals (OR 0.71, 95% CI 0.62 to 0.81). A sensitivity analysis using multiple imputation (n=10 589) found consistent results.

Conclusions: The exposures most strongly associated with low school readiness were male sex, low maternal education and preterm birth (<32 weeks gestation). Greater understanding of the exposures associated with school readiness can inform a proportionate universal approach to policymaking to improve school readiness and subsequent life outcomes.

Children with autism spectrum disorder (ASD) often experience distress during medical procedures due to sensory sensitivities and communication challenges. We conducted a pilot study assessing whether a humanoid robot (NAO) could reduce distress during cardiology assessments. 24 children with ASD were evaluated during NAO-assisted visits. Distress levels were significantly lower compared with previous routine non-robot-assisted visits involving the same patients. Reduced motion artefacts and shorter diagnostic procedures were also observed. These results support the feasibility and potential benefit of integrating social robots into outpatient paediatric settings for patients with autism, paving the way for more inclusive and neurosensitive healthcare experiences.

Introduction: Early childhood development (ECD) is a critical global and public health issue. Worldwide, paediatricians serve as the primary point of contact between children and the healthcare system, playing a key role in promoting healthy development through routine developmental surveillance (DS) and screening (DSc). However, there is limited research on paediatricians' perspectives regarding this matter, particularly in low-resource communities and countries such as Lebanon. This study aimed to explore the paediatricians' perspectives on the current routine DS and DSc practices for children under 5 years of age.

Methods: Paediatricians from all five Lebanese governorates were invited to participate using purpose and convenience sampling. A total of five academic and eleven non-academic paediatricians were included in the study. Semi-structured face-to-face or online interviews were conducted in Arabic between September 2018 and August 2021. Interviews were audio-recorded, then transcribed verbatim and translated into English and thematically analysed using Quirkos V.2.5.3 software.

Results: The study revealed significant variation regarding the understanding of concepts of routine DS and DSc. Most non-academic paediatricians primarily focused on physical development, while academic paediatricians were more attuned to cognitive and psychosocial development, with variation in practice. Factors influencing the practice were multi-layered: paediatricians, parents, paediatrician-parent interaction and system level.

Conclusion: DS and DSc practices in Lebanon are inconsistent, often incomplete and not systematically integrated into routine paediatric care. Efforts should be made to raise awareness about their importance, the appropriate methods for conducting them, and address the system-level factors by developing national guidelines for ECD. Data on paediatricians' practices in other similar low-resource countries or communities is needed to understand the common problems and have joint efforts to address them globally.

Objective: To evaluate the factors affecting neonatal jaundice monitoring in primary care, specifically in normal-risk newborns, with the aim of optimising jaundice follow-up care through a risk-stratified approach.

Design: Cross-sectional study.

Setting: Seven primary care clinics in Singapore.

Patients: 5391 healthy newborns with jaundice at hospital discharge.

Main outcome measures: Jaundice visit rates within 90 days postdischarge.

Results: 5391 newborns attended 26 494 jaundice visits between 2022-2023, with 4593 (85.2%) determined to be normal-risk for severe hyperbilirubinaemia. compared with high-risk newborns, normal-risk newborns had significantly fewer visits (five visits, IQR 2-7 vs five visits, IQR 4-7), higher birth weight (3.13 kg, SD 0.47 vs 2.94 kg, SD 0.43), fewer newborns reaching phototherapy thresholds (8.4% vs 27.9%), and lower jaundice discharge rate (71.4% vs 75.6%). Chinese (compared with Malay) (incidence rate ratio (IRR) 1.15, 95% CI 1.11 to 1.19) and male (IRR 1.10, 95% CI 1.07 to 1.13) newborns had higher follow-up rates, while higher birth weight (IRR 0.752, 95% CI 0.728 to 0.778) and normal-risk (compared with high risk) (IRR 0.93, 95% CI 0.90 to 0.97) were associated with lower follow-up rates. Among normal-risk newborns >7 days old, none exceeded phototherapy thresholds; a risk-based approach could have safely avoided 3652 out of 22 053 follow-up visits (16.6%) in this group.

Conclusion: Our study provides insights into factors influencing jaundice follow-up visit rates. A risk-stratified approach to jaundice monitoring may optimise follow-up care. Further study is needed to implement and evaluate its effectiveness.