BMJ Paediatrics Open最新文献

Background: The secondary uses of routinely recorded data have become an important component of health research. The UK National Neonatal Research Database (NNRD), established in 2007 contains routinely recorded data from approximately 1.6 million babies who received care in NHS neonatal units in England, Wales and Scotland. The earliest included infants are now adults. We aimed to explore their perspectives on the existence and use of the NNRD METHODS: As part of a wider Public and Patient Involvement programme, we established a Young Persons' Advisory Group: "From Neonate to NOW". Fifteen young adults with lived experience of neonatal care were recruited to share their views and inform neonatal research priorities. We held online focus groups with 10 members to explore their views on the NNRD. Analysis was thematic and co-produced with two group members.

Results: Young people expressed a strong desire to know how their data have been used. Their wish to understand more about their start in life revealed that the NNRD carries meaning beyond data. Participants described pride in knowing their data contribute to improving neonatal care yet were surprised that they had never heard of the NNRD. They proposed ways to raise awareness of its existence and value. The main themes identified were knowledge and pride, early and clear communication, meaning and identity, and consent and clarity.

Conclusions: As the use of large datasets of routinely recorded health information becomes increasingly common, questions about awareness, consent and trust will become important, especially as the first waves of children represented in them reach adulthood. This study is among the first to explore how young adults with lived experience of neonatal care view the secondary uses of their data. Their perspectives highlight areas to address as we move toward a future shaped by big data in healthcare research.

Background: The social determinants of health contribute to health inequities experienced by children with neurodisability and pose barriers to engaging with healthcare systems. At an individual level, adverse social determinants of health are experienced as unmet social needs (USNs), for example, housing insecurity and financial hardship. Emerging evidence supports social prescribing interventions that systematically identify USNs and refer families to services to address these needs. This study aims to evaluate the effectiveness of a co-designed social prescribing programme to address the USNs of children with neurodisability and their parents/carers, its cost-effectiveness and cost-utility, and implementation and translation across the healthcare system.

Methods and analysis: The study will be conducted at the tertiary Paediatric Rehabilitation Services in New South Wales, Australia. A standardised screening tool will identify parents/carers experiencing USNs. Parents/carers who report one or more USN and consent will be eligible to participate in the randomised controlled trial. Participants will be randomised to an active control group or social prescribing intervention group (total sample size=392). The active control group will receive self-navigation via a resource pack containing information about services that can address USNs. The social prescribing intervention group will receive in-person Community Linker support, in addition to the resource pack. The screening tool, resource pack, and social prescribing intervention were co-designed with parents/carers of children with cerebral palsy and their healthcare professionals. The primary outcome is the effectiveness of interventions in reducing USNs. Secondary outcomes include parent/carer referrals to and engagement with support services, out-of-pocket expenses, child/young person and parent/carer health-related quality of life, parent/carer psychological distress, and child/young person hospital service use and emergency department presentations.

Trial registration number: ACTRN12625000324415.

Objective: This population-based cohort study in Kobe, Japan, investigated the impact of the COVID-19 pandemic on infant neurodevelopment by comparing children born before and during the pandemic.

Design: Retrospective population-based cohort study of 63 703 children born between 1 April 2014 and 31 October 2020, who underwent an 18-month health check-up.

Setting: Kobe, Japan.

Patient: Children born between April 2014 and March 2018 (pre-COVID-19 group) or April-October 2020 (during-COVID-19 group).

Intervention: None MAIN OUTCOME MEASURES: Neurodevelopmental outcomes assessed by trained paediatricians, including language, social and behavioural indicators.

Results: The abnormal neurodevelopment prevalence was higher in the during-COVID-19 group (12.8%) than in the pre-COVID-19 group (10.2%) (OR, 1.30; 99% CI 1.16 to 1.46). Similarly, the rate of children without meaningful words was higher during the pandemic (7.1% vs 4.8%; OR, 1.52; 99% CI 1.31 to 1.78), indicating delayed language development. Intergroup differences in other outcomes were minimal.

Conclusions: The COVID-19 pandemic may have negatively influenced early neurodevelopment, particularly language acquisition. These findings suggest that infant language development is affected by social changes, such as pandemics. Further research is required to explore the underlying causes and the long-term effects.

Background: We aimed to investigate the effects of overweight and obesity on bone age (BA), predicted adult height (PAH) and glucose metabolism in children and adolescents.

Methods: Chinese boys aged 5-15 years who were overweight or obese were recruited for the study. Clinical characteristics, including height, weight, body mass index (BMI), BA, PAH and homeostatic model assessment of insulin resistance (HOMA-IR), were recorded. Spearman's rank-order correlation was used to analyse associations between BA, PAH, HOMA-IR and BMI z-scores. Receiver-operating characteristic (ROC) curves were generated to evaluate the diagnostic value of the BMI z-score.

Results: Data from 130 males (n=43, overweight; n=87, obese) were collected. The median BA of the cohort was significantly higher than the chronological age: 12.00 (IQR: 11.00 to 13.00) versus 10.67 (IQR: 9.50 to 12.00; p=0.000). PAH was significantly lower than mid-parental height: -0.28±0.81 versus 0.10±0.60 (p=0.000). The prevalence of BA advancement, PAH impairment and insulin resistance was 52.3% (67/128), 22.6% (28/124) and 61.3% (49/80), respectively. BA advancement and HOMA-IR positively correlated with BMI z-score (Spearman's coefficients r_s =0.495, p=0.000 and r_s =0.343, p=0.002, respectively). No significant association was found between PAH impairment and BMI z-score (r_s =0.045, p=0.622). The ROC curves showed that the area under the curve for the BMI z-score of BA advancement and insulin resistance was 0.741 and 0.622, respectively. The sensitivity and specificity for BA advancement with a cut-off of 2.40 SD score (SDS) were 0.567 and 0.820, and for insulin resistance with a cut-off of 2.40 SDS, were 0.571 and 0.645.

Conclusions: Approximately half of the included children had advanced BA, one-fifth of them had PAH impairment and two-thirds exhibited insulin resistance. Advanced BA and HOMA-IR were positively correlated with the BMI z-score. A BMI z-score above 2.40 SDS may indicate BA advancement and insulin resistance.

Background: Before 2016, no Laotian child was known to have survived type 1 diabetes (T1D) into adulthood. There is an ongoing need for action. Our study explored, in supported youth, the impact of transitioning from a twice to multiple daily injection (MDI) regimen on glycaemic control, and their views/perceptions around how the switch affected their T1D management/quality of life.

Methods: Data were obtained from medical records/semi-structured interviews; participants recruited as they switched to an MDI regimen. Quantitative data were stratified into glycated haemoglobin (HbA1c) 6/12 months before/after the switch, and male/female sex; associations examined using t-tests. Qualitative data were analysed using Gibb's framework.

Results: Overall, 24 youth (62.5% female) changed regimens. Mean±SD HbA1c 6/12-month periods before the switch were 8.8±2.3% (73.0 mmol/mol)/8.3±2.2% (67.0 mmol/mol), respectively. In the same periods after the switch, HbA1c improved to 7.6±2.7% (60.0 mmol/mol)/7.7±2.1% (61.0 mmol/mol), respectively. No differences were observed between sexes.Interviews were conducted with 15 youth (73.3% female); mean ages at T1D diagnosis/the switch time were 10.6 and 14.3 years, respectively. Describing how transitioning to an MDI regimen affected T1D management/quality of life, three themes emerged: pragmatism; empowerment and agency; and foundations of success.

Conclusions: The study provides valuable insights that will guide future work in supporting youth with T1D.

Background: Post-traumatic stress disorder (PTSD) is a prevalent psychiatric disorder that frequently arises following exposure to armed conflict. However, evidence on the pooled prevalence of PTSD and associated factors among children and adolescents in East Africa remains limited. This systematic review and meta-analysis aimed to estimate the pooled prevalence of PTSD and identify associated factors among children and adolescents exposed to armed conflict in East Africa.

Methods: A systematic search was conducted in PubMed, HINARI, Web of Science, PsycINFO, PsychiatryOnline, ScienceDirect and Google Scholar. Cross-sectional studies conducted in East Africa that reported the prevalence of PTSD and/or associated factors among children and adolescents affected by armed conflict were included. Only full-text articles published in English were considered. The methodological quality of included studies was assessed using the Joanna Briggs Institute critical appraisal checklist. Statistical heterogeneity was assessed using the I² statistic. Publication bias was evaluated through visual inspection of funnel plots and Egger's test. Results were presented using forest plots and summary tables.

Results: Of the 933 records identified, 10 studies met the inclusion criteria and were included in the analysis. The pooled prevalence of PTSD among children and adolescents in East Africa was 47.8% (95% CI 34.8% to 61.0%). Witnessing the killing of family members or friends (adjusted OR (AOR)=2.11, 95% CI 1.38 to 3.22), experiencing war-related trauma (AOR=2.49, 95% CI 1.54 to 4.03) and female sex (AOR=1.52, 95% CI 1.29 to 1.78) were identified as significantly associated with PTSD.

Conclusion: The prevalence of PTSD among children and adolescents in East Africa is high. Exposure to traumatic events and female sex are significantly associated with increased risk of PTSD. Interventions should be context-specific, risk-targeted and gender-sensitive to effectively address the mental health needs of this population.

Prospero registration number: CRD420251075395.

Background: Recent studies have expanded the evidence on novel and existing non-pharmacological treatments for paediatric functional constipation (FC). This study aimed to systematically review the efficacy and safety of non-pharmacological therapies for FC in children.

Methods: PubMed, MEDLINE, Embase, PsycINFO, Cochrane Library and trial registries were searched from inception to March 2025. Randomised controlled trials (RCTs), including children (0-18 years) with FC treated with non-pharmacological interventions compared with placebo, no treatment or other interventions, were included. Primary outcomes were treatment success, defecation frequency and withdrawals due to adverse events. Dual data extraction and appraisal was conducted. Certainty was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Results: 93 RCTs comprising 7787 children (50.4% female) were included investigating dietary, psycho-educational, physiotherapeutic interventions, various complementary and complementary medicine interventions, and electrical stimulation. A substantial part of the therapies provided evidence that was of very low certainty, meaning no conclusions could be drawn. Abdominal transcutaneous electrical stimulation plus pelvic floor muscle exercises (PFME) may improve treatment success and defecation frequency compared with PFME alone (risk ratio (RR): 1.75 (95%CI 1.25 to 2.44) and mean differences (MD): 1.85 (95%CI 1.28 to 2.43), moderate certainty). Percutaneous tibial nerve stimulation plus PFME leads to more treatment success (RR: 1.73 (95%CI 1.08 to 2.77), low certainty) and greater defecation frequency (MD: 1.82 (95%CI 0.82 to 2.82), moderate certainty). Behavioural therapy plus polyethylene glycol may not improve treatment success (RR: 0.83 (95%CI 0.62 to 1.12), low certainty) and probably reduces defecation frequency (MD: -1.80 (95%CI -2.88 to -0.72), moderate certainty).

Conclusions: Imprecise data, poor reporting and substantial heterogeneity led to downgrading in GRADE assessments. Some non-pharmacological treatment options for children with FC show beneficial effects, and these may be considered in the management of children. Future trials should aim to improve methodological rigour.

Prospero registration number: CRD42023416891.

Background: Persistent pulmonary hypertension of newborns (PPHN) is an acute neonatal disorder with a high mortality rate despite several advances in its management.

Design: This was a prospective cross-sectional study.

Setting: 84 asphyxiated neonates were included. All the participants underwent complete transthoracic echocardiography to assess the parameters for the diagnosis of PPHN.

Patient: Newborns with PPHN diagnosed via echocardiography with perinatal asphyxia who were admitted to the newborn unit.

Interventions: Echocardiography was performed within 72 hours of life. The mean age at echocardiography was 38.4±0.71 hours.

Main outcome measures: The severity of asphyxia, gestational age and place of birth (inborn), delivery at the study centre or 'out-born' and delivery at another facility or location away from the study centre were significantly associated with the development of PPHN.

Results: The prevalence of PPHN in the study was 52.4%. The severity of asphyxia, gestational age and place of birth (inborn), delivery at the study centre or 'out-born' and delivery at another facility or location away from the study centre were significantly associated with the development of PPHN (p<0.05). Severe asphyxia was approximately nine times more likely to be associated with the development of PPHN than mild asphyxia (AOR=9.89; 95% CI 1.92 to 50.94, p=0.006) and was the single most significant predictor of PPHN in the present study. However, the severity of asphyxia was not associated with the severity of PPHN.

Conclusion and relevance: Severe asphyxia was the single most significant predictor of the development of PPHN among asphyxiated neonates. The prevalence of PPHN among asphyxiated neonates was high. A high index of suspicion and the routine use of echocardiography and sildenafil to diagnose and treat PPHN in asphyxiated neonates are recommended.

Background: Socioeconomic inequalities in child development are pervasive; however, less is known regarding the impacts of socioeconomic factors within and across ethnically diverse and socioeconomically disadvantaged populations. This study (1) describes the prevalence of children at risk of poor overall early child development; (2) investigates the relationship between individual indicators of socioeconomic position and early child development; and (3) investigates if the relationship between indicators of socioeconomic position and early child development varies by ethnic group.

Methods: This study uses data from a prospective birth cohort study, Born in Bradford's Better Start (BiBBS). Child development was measured with the Ages and Stages Questionnaire (ASQ) during routine health visiting appointments at age 2-years-old. Binary logistic regression investigated child development by key maternal socioeconomic indicators: maternal education, financial security, social status (measured via the MacArthur Scale of Subjective Social Status), and social support (measured via number of people to count on).

Results: 22% of the 2003 children with a valid developmental assessment were at risk of poor child development. Mothers who had a degree (OR=1.95, 95% CI 1.28 to 2.99), reported 'living comfortably' in financial security (OR=1.78, 95% CI 1.03 to 3.07) and had higher social status (OR=1.11, 1.02 to 1.22); all had higher odds of their child having a good development. Though socioeconomic gradients in maternal education and financial security were consistent across White British, South Asian and Other ethnic groups, both social support and social status had weaker relationships with child development for South Asian parents.

Conclusion: A high proportion of children are at risk of poor development in this diverse, socioeconomically disadvantaged population. Higher socioeconomic position may protect against poor early development, and the mechanisms underlying this may differ by ethnicity. The findings underline the need for proportionate universal strategies to improve child development in such communities.

Background: Sepsis is a leading cause of neonatal mortality in sub-Saharan Africa (SSA), where microbiological diagnostic capacity and antibiotic access are limited. High antimicrobial resistance (AMR) rates limit the effectiveness of current treatment guidelines, with concern that available antibiotics are rarely adequate treatment for neonatal sepsis in the region.

Methods: A cross-sectional online survey was electronically distributed in English, French and Portuguese to neonatal clinicians across SSA between April and June 2025. Questions focused on the management of neonatal sepsis including diagnostic, antibiotic and guideline use. Responses were analysed descriptively and presented as percentages of the total number of responses.

Results: Of 169 responses (40/48 countries; 83.3%) from SSA, 71.6% were senior doctors, 88.8% managed neonatal sepsis at least weekly and 58.0% worked in central healthcare facilities.14.9% (95% CI 10.3% to 21.0%) of respondents never and 28.6% (CI 22.3% to 35.8%) less than half of the time received blood culture results in time to impact patient care. Guidelines were almost universally used (97.6% (CI 94.0% to 99.1%)). The most common guideline for early-onset neonatal sepsis advised amoxicillin/ampicillin plus aminoglycosides (46.4% of responses (CI 39.1% to 54.0%)). 50.3% (CI 42.8% to 57.7%) of respondents had difficulties accessing antibiotics, with carbapenems and piperacillin-tazobactam least accessible. 45.4% (CI 38.0% to 53.1%) had attempted to author local guidelines with insufficient local AMR data (45.6% (CI 35.7% to 55.8%)) the most common barrier to guideline development.

Conclusions: This large survey highlighted widespread challenges in diagnostic and antibiotic access for neonatal sepsis in SSA. We find that clinicians rely on guidelines to guide starting antibiotics and to guide agent choice. Their practices reflect advice in global guidelines. Attempts to author locally applicable guidelines are hindered by insufficient AMR data. These findings strengthen calls to improve microbiological diagnostic access and support data sharing to generate evidence-based, locally appropriate guidelines.