BMJ Paediatrics Open最新文献

Background: Digital peer support apps can assist with mental ill health. We present an early economic evaluation of Tellmi, a related and novel app for children and young people (CYP).

Methods: Tellmi users were surveyed; healthcare resource use over 3 months was captured. Data informed the development of an early cost-comparison model, capturing cost and resource use differences (CYP using Tellmi vs standard care). A 1-year time horizon was used, and the model was built from a National Health Service (NHS) perspective. Deterministic sensitivity analysis highlighted key driving parameters.

Results: There were 283 responses. Tellmi use for more than 1 month resulted in significantly fewer accident and emergency, general practitioner and school nurses/counsellor visits (vs standard care). An early cost calculator model estimated that Tellmi use led to an NHS cost saving of £214 per person (excluding service cost).

Conclusions: Tellmi has the potential to be cost saving to the NHS. Further evidence is needed.

Background: Burnout is increasingly identified as a factor affecting physician welfare, and subsequently patient care. Surgeons are known to experience higher rates of burnout compared with the general population. No review has focused exclusively on burnout prevalence among paediatric surgeons. This systematic review and meta-analysis aims to determine the prevalence of burnout among paediatric surgeons, alongside identifying and analysing potential influences.

Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines, following our published PROSPERO protocol (CRD42025640570), 719 records were identified from inception through 13 January 2025. Included studies produced primary data reporting paediatric surgeon burnout prevalence, using validated burnout metrics. Main exclusion criteria were: study or population irrelevance, study type and duplicates. All available data were extracted; authors were contacted for original data. Random-effects meta-analysis with restricted maximum likelihood estimation estimation was conducted to estimate a pooled burnout prevalence, further subgroup analyses and meta-regressions were performed.

Results: Meta-analysis of 15 studies (2757 paediatric surgeons) revealed a pooled burnout prevalence of 29.4% (95% CI 20.3% to 40.5%), with substantial heterogeneity (I²=96.4%). Burnout rates ranged from 7.8% to 73.7%. Studies using the Maslach Burnout Inventory (MBI) reported significantly lower burnout (22.4%) compared with non-MBI tools (44.9%; p=0.025). No publication bias was detected. Study quality and measurement tool choice explained 35.3% and 24·5% of heterogeneity, respectively.

Conclusions: This study establishes that nearly one in three paediatric surgeons experience burnout, with a pooled prevalence of 29.4% (95% CI 20.3% to 40.5%). This rate, while concerning, is notably lower than other surgical disciplines. Strong personal accomplishment, resulting from emotionally rewarding work with children, appears protective, alongside structurally embedded practices such as family-centred care and multidisciplinary collaboration. Personality traits associated with increased agreeableness, conscientiousness and emotional stability may further reduce susceptibility to burnout. Specialty-specific interventions, supported by structured mentorship, are critical to sustainable well-being throughout paediatric surgical practice.

Background: The first thousand days, the period from the conception to the second year of life, play a fundamental role in establishing the foundation of a newborn's health, growth and neurological development, finally impacting its entire life. Reading interventions during this period produce numerous positive outcomes for the infants, such as their language skills and development, as well as enhancing the relationship between caregivers and children, supporting the importance of studying the effectiveness of shared reading groups in this period among children without pathologies and their caregivers. This research aims to systematically review evidence on shared group activity in the first thousand days, including also their caregivers, exploring the following outcomes: children's language skills, cognitive development, prosocial behaviour, parent-child relationship, reading habits, health literacy, quality of life and empowerment.

Methods: We conducted a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight experimental studies met the inclusion criteria: shared group reading intervention involving children up to 24 months with their caregivers (especially parents, but also other caregivers). These interventions typically consisted of 6-12 group sessions led by trained facilitators in community settings.

Results: The results showed no clear conclusions. Both the narrative synthesis and meta-analysis suggested improvements on children's language skills (comprehension), only the narrative analysis suggested positive changes in cognitive development and prosocial behaviour, alongside improved parent-child relationship and enhanced parental skills following the intervention. However, evidence was limited and inconsistent.

Conclusions: These findings highlighted the importance of evidence-based interventions in supporting infant development, particularly in disadvantaged contexts addressing inequalities, and the promising role of shared reading as an integral part of such interventions. However, further studies are needed to confirm the effectiveness of these early interventions in fostering optimal developmental outcomes during the critical first thousand days.

Objective: We aimed to examine the associations between family adversity in infancy and subsequent daytime soiling at primary school age. We also examined factors on the causal pathway between family adversity and soiling, specifically the child's emotional/behaviour problems and constipation.

Design: This prospective cohort study included children from the Avon Longitudinal Study of Parents and Children (N=10 033) with data on the Family Adversity Index (FAI; birth to age 2), daytime soiling at age 7.5, emotional/behaviour problems at age 4, and constipation at age 6. We examined the relationships between the FAI, soiling, emotional/behaviour problems and constipation. We then evaluated the mediating effects of emotional/behaviour problems and constipation. All analyses were adjusted for child and family-related confounders.

Results: Daytime soiling occurred in 7% of children. A one-unit increase in infancy FAI was associated with increased odds of 12% for daytime soiling at age 7.5 (OR 1.12, 95% CI 1.07 to 1.17), emotional/behaviour problems score at age 4 (beta 0.52, 95% CI 0.47 to 0.58) and increased odds of constipation at age 6 (OR 1.07, 95% CI 1.03 to 1.11). The presence of constipation at age 6 was strongly associated with increased odds of soiling at age 7.5 (OR 3.34, 95% CI 2.68 to 4.16). There was weak evidence that the associations between FAI and daytime soiling were mediated by emotional/behaviour problems and constipation (OR_{natural_indirect_effect} 1.03, 95% CI 0.99 to 1.07).

Conclusions: Clinicians should be aware that exposure to family adversity in the early years places children at greater risk of subsequent constipation and soiling.

Background: The AVENIR cluster-randomised trial evaluated whether biannual mass drug administration (MDA) of azithromycin improved childhood mortality among infants in Niger, a high-mortality, high-malnutrition setting.

Methods: Weight-for-age z-score (WAZ) was a prespecified secondary outcome of the trial. In this analysis, 2880 communities in the Dosso and Tahoua regions and 51 687 infants with two sequential weight measurements were included. Weight was assessed at baseline and 6 months post treatment, and WAZ was calculated using WHO standards. To include two subsequent measures of WAZ, infants at baseline were 1-5 months old. Linear mixed-effects models compared mean WAZ between azithromycin and placebo arms, with additional analyses examining community-level means, categorical underweight outcomes and predefined subgroups.

Results: At follow-up, mean WAZ was -1.39 in the azithromycin arm and -1.38 in the placebo arm, with no detectable difference (mean difference 0.00, 95% CI -0.05 to 0.04, p=0.94). Odds of moderate-to-severe or severe underweight also did not differ between groups. Subgroup analyses by baseline nutritional status, age, sex, community size and distance to health centres showed consistent null effects, though a small, non-significant improvement in WAZ was observed in infants treated during the rainy season compared with the dry season.

Conclusion: These findings align with prior large-scale trials that demonstrated mortality benefits but no sustained effects of azithromycin on growth. Taken together, the results suggest that while azithromycin MDA reduces childhood mortality, it is unlikely to provide medium-term improvements in weight gain, highlighting the need for complementary nutritional interventions to address undernutrition in similar settings.

Objectives: To evaluate the association between corticosteroid use and clinical outcomes in children hospitalised with severe orbital infections, and to describe practice patterns of systemic corticosteroid use.

Design: Multi-site observational cohort study using hospital data from 2009 to 2018.

Setting: Canadian children's hospitals (7) and community hospitals (3).

Patients: Children 2 months and 18 years hospitalised with severe orbital infections.

Interventions: Systemic corticosteroids at any time MAIN OUTCOME MEASURES: Length of hospital stay and surgical intervention using time-to-event Cox proportional hazards multivariable regression models to account for potential differences in timing of corticosteroid use (early, ≤24 hours or late, >24 hours after admission), with adjustment for covariates.

Results: Of the 1479 hospitalised children, 876 (59.2%) were male and median age was 5.3 years (IQR 2.2 to 9.8). Of the 65 (4.4%) who received corticosteroids, over half (53.8%) received them early. Median length of stay was 75.9 hours (IQR 47.1 to 130.4) and 98 (6.6%) underwent surgical intervention. Corticosteroid use was associated with delayed discharge and prolonged hospitalisation, as reflected by a HR of 0.73 (95% CI 0.55 to 0.96) in adjusted analyses. However, systemic corticosteroids had no association with surgical intervention (HR 0.82, 95% CI 0.36 to 1.88).

Conclusion: In a large cohort of hospitalised children with severe orbital infections, corticosteroids were used infrequently, and when used, were not associated with improved clinical outcomes. Further high-quality trial evidence is needed to determine if routine corticosteroids are safe and effective.

Introduction: Delayed cord clamping (DCC) is an evidence-based intervention that reduces mortality, anaemia and disability in infants born <37 weeks' gestation who do not require immediate resuscitation. However, it is neither reliably recorded nor routinely implemented in Australia. The Wait a Minute or More (WAMM) study aims to reduce this gap between the evidence and practice by integrating timely sharing of cord clamping data with Evidence-based Practice for Improving Quality methods to increase the proportion of preterm infants receiving DCC for 60 s or longer (DCC60).

Methods: The WAMM study is a pragmatic stepped wedge cluster randomised trial (SW-CRT), informed by the Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Up to 20 Australian maternity hospitals will participate in this pragmatic SW-CRT to evaluate if in (Population) infants <37 weeks' gestation who do not need resuscitation, does (Intervention) the WAMM intervention (sharing of anonymised data on DCC60, together with a locally adapted quality improvement (QI) programme), compared with (Control) sharing of anonymised data on DCC60 alone, increase (primary Outcome) the proportion of infants receiving DCC60? At the end of 72 weeks, all sites will complete an 8-week period without the WAMM intervention to evaluate if implementation of DCC is sustained. Alongside the SW-CRT, an embedded process evaluation will assess the fidelity, acceptability, mechanisms of action and contextual barriers and enablers of the WAMM intervention.

Discussion: Using the stepped wedged design and guided by an explicit implementation framework (i-PARIHS), WAMM will provide information on the effectiveness and transferability of a locally adapted QI method to improve DCC60. If proven effective, ultimately scaling up the WAMM intervention globally will greatly improve childhood anaemia, death, disability and long-term costs.

Trial registration number: ACTRN12624000035527.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe mucocutaneous reactions in children, often triggered by medications such as antibiotics, anticonvulsants and non-steroidal anti-inflammatory drugs (NSAIDs). Treatment guidelines in paediatric populations remain unclear, particularly in South Asia, where data are scarce. This study aims to describe the clinical profile, triggers, management and outcomes of paediatric SJS/TEN cases from a tertiary care centre in Pakistan.

Methods: A retrospective cross-sectional study was conducted at Aga Khan University Hospital, Karachi, Pakistan. Medical records of children aged 1 month to 15 years diagnosed with SJS or TEN between June 2008 and December 2020 were reviewed. Data on demographics, drug exposure, clinical features, treatment modalities and outcomes were extracted and analysed using Stata V.14.

Results: Among 124 identified cases, 98 children (79.0%) had TEN with >30% body surface area involvement. Mucosal involvement was seen in 85 (68.5%) cases. Prior drug exposure was documented in 98 (79.0%) patients, with antibiotics (52.0%) and NSAIDs (48.0%) being the most common triggers. Supportive care was the mainstay of treatment. Age was associated with poorer outcomes.

Conclusion: Paediatric drug-induced SJS/TEN remains a critical concern, particularly due to commonly prescribed antibiotics and NSAIDs. High mortality in TEN cases and predominant use of supportive therapy highlight the need for clear paediatric treatment protocols. Local data on the role of early immunomodulatory therapy are limited, indicating a need for further research on optimal early interventions to improve outcomes.

Background: Cochlear implantation (CI) is a critical intervention for restoring auditory function in individuals with severe to profound hearing impairment; however, the relationship between CIs and social development in hearing-impaired children has not been fully elucidated. This study examined disparities in child-parent relationship, teacher-student relationship and peer relationship between hearing-impaired children with CIs and their typically hearing (TH) peers in China, focusing on the dimensions of social relationships in social development.

Methods: Samples were selected from one primary special school and two primary mainstream schools in Xi'an, Shaanxi Province, China, in August 2024. According to the inclusion criteria, 35 CI recipients and 209 TH children in grades 3-5 were enrolled in the experimental and control groups, respectively. Self-reported data were used. Propensity score matching was employed to control demographic covariates, and the Hodges-Lehmann aligned rank test was used for the postmatching analysis.

Results: This study revealed that CI recipients reported higher teacher-student closeness (ATE=2.55, d=0.61, p<0.05) yet experienced more teacher-student conflict (ATE=5.25, d=1.78, p<0.001). CI recipients exhibited significantly elevated peer-related loneliness (ATE=18.03, d=1.62, p<0.001). The two groups have no significant differences in child-parent closeness, teacher-student dependency and teacher-student satisfaction.

Discussion: These multifaceted outcomes highlight that while hearing-impaired children with CIs achieved positive relationships with peers and adults comparable to their normal-hearing peers in specific domains, the auditory restoration provided by CIs does not automatically ensure social ease. This underscores the need for targeted language rehabilitation and inclusive educational environments to enhance their socioemotional well-being.