BMJ Paediatrics Open最新文献

Background: The neonatal Sequential Organ Failure Assessment (nSOFA) score is an organ dysfunction score developed for predicting mortality risk in preterm neonates with proven late-onset neonatal sepsis (LONS) and necrotising enterocolitis. However, the utility of the nSOFA score in determining the risk of retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD) or mortality in patients with suspected LONS is unknown.

Methods: We performed a dual-centre retrospective cohort study of preterm (gestational age <32 weeks) neonates suspected of LONS, from 2016 to 2020 at two neonatal intensive care units. The nSOFA scores (range 0-15) were calculated for each suspected LONS episode at various time points around the sepsis evaluation. A nSOFA burden score was calculated, by counting each time point the nSOFA score was ≥4 during all sepsis episodes (in the time period -6 to 48 hours). The association with 10-day sepsis-related mortality and severe ROP and BPD was assessed.

Results: A total of 1157 episodes of suspected LONS in 706 neonates occurred. The nSOFA was significantly associated with 10-day mortality at various time points. The nSOFA score 6 hours after drawing a blood culture (T6) was associated with 10-day sepsis-related mortality (adjusted OR (aOR) 1.31; 95% CI (1.22 to 1.40; p<0.001)), in a model corrected for gestational age, sex, age at evaluation and gestational age-adjusted birth weight. The nSOFA burden scores were positively associated with the risk for ROP (aOR 1.24; 95% CI 1.09 to 1.41; p=0.001) and BPD (aOR 1.30; 95% CI 1.13 to 1.50; p<0.001).

Conclusion: Our findings show that the nSOFA score in preterm neonates suspected of LONS is associated with subsequent mortality, ROP and BPD. Incorporating nSOFA scores may help to identify sepsis survivors at the highest risk of adverse outcomes, who may require more intensive monitoring and adapted therapy.

This study explores the adaptation of a Positive Youth Development (PYD) programme for the Indigenous Quichua community in Guangaje, Ecuador, which faces chronic poverty and low educational attainment. In May, June 2023 we conducted focus groups with school teachers and indigenous community leaders, parents and middle school, high school and college students. We found a disconnect between students' aspirations for higher education and adults' emphasis on practical and vocational training. Findings highlight the need to strengthen youth internal assets and change adult perspectives to foster a supportive environment, empowering youth to be motivated and prioritise the long-term benefits of education beyond immediate economic challenges.

It is well reported that one of the main precipitants of abusive head trauma (AHT) is frequent and consistent periods of crying. The cornerstones in the management of excessive infant crying are reassurance and education. Our study showed a knowledge deficit in frontline healthcare workers (HCW) understanding of normal infant crying. We received 122 survey responses. 40% of respondents did not feel that 'walking away and leaving a baby for a limited time in a safe space' was a valid method of soothing. This highlights the need for better HCW education on normal infant crying to help prevent AHT.

This study aimed to describe the effectiveness of biofeedback (BFB) rehabilitation in children with retentive encopresis (RE). A retrospective, single-institution study was conducted in children with BFB sessions for RE between 2017 and 2020. Manometry data and associated envy scores were analysed. BFB was a success (recovery from RE or ≥50% reduction in faecal soiling) in 37/44 (84%) children at the last session and in 32/44 (73%) 6 months later. The median age of children was higher in the success group at 6 months (p=0.013). BFB could then be clinically effective in children with RE.

Introduction: Latin America and the Caribbean (LAC) is one of the regions most affected by the climate crisis, which is connected to international migration through a complex nexus. During the last years, migratory flows on the continent have increasingly included children and adolescents who are migrating through non-authorised crossing points. The existing literature shows how inequities negatively affect migrant children and the role that healthcare systems can play to mitigate them.

Objective: Based on a qualitative study, the paper aims to analyse the role of the climate crisis on the healthcare needs of migrant children from LAC who are currently living in Chile, from the point of view of parents from five main countries of immigration in Chile and healthcare professionals.

Method: An exploratory study was conducted in Arica, Antofagasta and Santiago. In-depth interviews with 20 migrant parents and 20 healthcare professionals were carried out. The interviews were transcribed verbatim and a thematic analysis was performed.

Results: Three findings emerged from this study: (1) food insecurity affects LAC migrant children in their country of origin and during their migratory trajectories to Chile, (2) natural disasters and environmental degradation in the countries of origin are not the only drivers of migration for LAC families but also prevent returns, even when they remain undocumented and (3) LAC migrant children are exposed to urban pollution and contaminants in informal settlements due to difficulties in accessing formal housing, among others.

Conclusions: The climate crisis must be integrated into the study of migrant health in LAC, considering the current context of multiple political, health and economic crises in the region. Healthcare professionals and communities play a central role in creating interventions to build sustainable and resilient universal healthcare systems.

Objective: To investigate the incidence and survival rates of paediatric patients receiving resuscitation for in-hospital cardiac arrest (IHCA) in a teaching hospital in Northern Jordan, comparing initial pulseless rhythms and bradycardia rhythm with poor perfusion.

Design: Retrospective observational study SETTING: An university-affiliated tertiary hospital in Northern Jordan, covering January 2015 to December 2022.

Patients: All hospitalised paediatric patients aged 1 month-18 years who received cardiopulmonary resuscitation (CPR) for cardiac arrest were included in the study. Resuscitation attempts were categorised into initial pulseless rhythm events and bradycardia with poor perfusion events.

Main outcome measures: Incidence rate of paediatric CPR and the survival to hospital discharge rate.

Results: A total of 504 paediatric patients received CPR during the study period, with an incidence rate of 6.26 per 1000 paediatric admissions. The annual incidence rate was significantly reduced by an average of 5.5% for the total sample but increased by 25.0% for bradycardia events (n=110, 21.8%). The percentage of patients who sustained return of spontaneous circulation (ROSC) was 25.0%. Survival to hospital discharge was low at 4.8% while showing an increasing trend by an average of 24.0% per year. Bradycardia events had a significantly higher ROSC rate (34.6% vs 22.3%); but an insignificant higher survival rate (6.4 vs 4.3). Patients with neurological or cardiovascular medical conditions, those in non-intensive care unit departments, and those with respiratory causes had higher odds of survival to discharge.

Conclusion: While the incidence rate of paediatric IHCA in Jordan is comparable to developed countries, the survival rate is much poorer. The study highlights the importance of strengthening healthcare infrastructure, establishing national legal and ethical frameworks around resuscitation policies and establishing robust data registries to monitor and optimise care practices.

Background: Post-transplantation diabetes mellitus and carbohydrate intolerance (PTDM/iCHO) are complications following solid organ transplantation, which significantly increases the risk of graft loss and mortality. However, data concerning long-term outcomes in paediatric kidney transplant recipients with PTDM/iCHO are scarce. This study aimed to evaluate the risk of graft loss in paediatric kidney transplant recipients with PTDM or iCHO compared with non-PTDM/iCHO.

Methods: The study cohort included patients aged <18 who underwent a kidney transplant in a transplant centre from 2005 to 2022. The primary outcome was graft survival loss; secondary outcomes were acute rejection, renal function and mortality. Cumulative incidence of graft loss and acute rejection was estimated, considering death a competing risk. Fine and Gray's proportional subdistribution hazard model was used to analyse the effect of PTDM/iCHO status on the event.

Results: Seventy-six paediatric kidney transplant recipients were included. The incidence of PTDM and iCHO was 6.6% and 9.2%, respectively. Patients with PTDM/iCHO had a significantly higher cumulative graft loss incidence than those without (34.4% vs 13.9% at 36 months, p<0.008). Multivariable analysis revealed a threefold increased risk of graft loss in patients with PTDM/iCHO (HR_adjusted 3.33, 95% CI 1.19 to 9.30, p=0.022). PTDM/iCHO was associated with a higher incidence of acute rejection (33.3% vs 14.5% at 1 year, p=0.025). Patients with PTDM/iCHO also exhibited significantly worse eGFR at all time points compared with patients without PTDM/iCHO (p=0.036) CONCLUSION: Patients with PTDM and iCHO had a higher risk of graft loss and lower renal function in paediatric kidney transplant recipients. This justifies close monitoring of metabolic complications in these patients.

Objective: To compare, through a systematic review and meta-analysis of observational accuracy studies, the main existing neonatal death prediction scores.

Method: Systematic review and meta-analysis of observational accuracy studies. The databases accessed were MEDLINE, ELSEVIER, LILACS, SciELO, OpenGrey, Open Access Thesis and Dissertations, EMBASE, Web of Science, SCOPUS and Cochrane Library. For qualitative analysis, Quality Assessment of Diagnostic Accuracy Studies 2 was used. For the quantitative analysis, the area under the curve and the SE were used, as well as the inverse of the variance as a weight measure, DerSimonian and Laird as a measure of random effects, Higgins' I² as an estimate of heterogeneity, Z as a final measure with a 95% confidence level.

Results: 55 studies were analysed, 8 scores were compared in a total of 193 849 newborns included. The most accurate neonatal death prediction score was Score for Neonatal Acute Physiology Perinatal Extension II (SNAPPE II) (0.89 (95% CI 0.86 to 0.92)) and the least accurate was gestational age (0.75 (95% CI 0.71 to 0.79)).

Conclusion: SNAPPE II was the most accurate score found in this study. Despite this, the choice of score depends on the situation and setting in which the newborn is inserted, and it is up to the researcher to analyse and decide which one to use based on practicality and the possibility of local implementation. Given this, it is interesting to carry out new prospective studies to improve the prediction of neonatal deaths around the world.

Prospero registration number: CRD42023462425.

Introduction: Paediatric emergency department (ED) attendances and admissions in England are increasing. Fever is a common presenting problem for these attendances. Anxiety and misperceptions surrounding appropriate management of fever persist among parents. Little evidence exists on the pathways to ED for fever, and doctors' perceptions of why parents present their child to the ED.

Objectives: To understand perceptions of parents and doctors of the reasons for ED presentation for children (0-18 years) with fever in England.

Design: This forms the first part of a qualitative study, using reflective thematic analysis.

Participants: 15 parents (12 mothers and 3 fathers) who had taken their febrile child to hospital (2015-2023), and 5 ED doctors (4 consultants and 1 resident doctor) who had experienced treating a febrile child in an ED in England.

Methods: Semistructured remote (Zoom) interviews were conducted (2022-2023).

Results: Reflexive thematic analysis facilitated investigation into current parental concerns regarding fever and decision-making leading to ED attendance. The overarching theme 'factors influencing unscheduled care' comprised four key themes that reflected the complex interplay between factors influencing parental decision-making to seek emergency care, at the individual and wider structural level. These were parental proficiency and experience; social networks and access to services; fever phobia, uncertainty and anxiety; and reassurance. Doctors also acknowledged the importance of these factors, such as reassurance and showing compassion and further indicated a persistent educational gap surrounding fever between doctors and parents.

Conclusions: We widen the evidence base of why parents attend ED for paediatric fever and their perceptions of other health services. Parents face challenges when seeking care and perceived ED as a last resort. Interventions to support parental decision-making and management of fever could help to alleviate these challenges, as well as potentially reducing the demand for emergency care.

Introduction: Maternal undernutrition and inflammation in utero may significantly impact the neurodevelopmental potential of offspring. However, few studies have investigated the effects of pregnancy interventions on long-term child growth and development. This study will examine the effects of prenatal nutrition and infection management interventions on long-term growth and neurodevelopmental outcomes of offspring.

Methods: The Enhancing Nutrition and Antenatal Infection Treatment ('ENAT') study (ISRCTN15116516) was a pragmatic, open-label, 2×2 factorial, randomised clinical effectiveness study implemented in 12 rural health centres in Amhara, Ethiopia. The study enrolled 2399 pregnant women who were randomised to receive routine care, an enhanced nutrition package (iron and folic acid, monthly household supply of iodised salt, and micronutrient-fortified balanced energy protein supplement for undernourished women), an enhanced infection management package (genitourinary tract infection screening and treatment, and enhanced deworming), or both packages. In the present Longitudinal Infant Development and Growth study, a subset of 480 children of mothers from ENAT will be recruited equally from each of the four study arms and visited at 12, 18, and 24 months of postnatal age. We will evaluate a range of domains and deploy multiple measures to assess child neurodevelopment, including resting electroencephalography and visual evoked potentials, Hammersmith Infant Neurological Examination, eye-tracking, Bayley Scales of Infant and Toddler Development (Bayley-III), and Magnetic Resonance Imaging (MRI).

Discussion: This study will advance understanding of the impact of nutrition and inflammation in pregnancy on long-term offspring neurodevelopment. This study aims to fill a critical knowledge gap on the benefits of prenatal interventions to promote the health of mothers and their offspring.

Ethics and dissemination: This study was approved by the Institutional Review Boards of Addis Continental Institute of Public Health (ACIPH/IRB/002/2022) and Mass General Brigham (2023P000461). Results will be disseminated to local and international stakeholders.

Trial registration number: NCT06296238.