BMJ Paediatrics Open最新文献

Objective: Differentiating between functional and organic gastrointestinal disorders in infants and young children remains a diagnostic challenge. Faecal calprotectin (FC) has emerged as a non-invasive biomarker that can help to exclude organic pathology. This study aimed to establish age-specific reference ranges for FC in healthy Hungarian children aged 0-36 months, providing a practical tool for paediatric clinical decision-making.

Methods: A total of 282 stool samples were obtained from 245 healthy children (142 boys, 103 girls). Eligibility was determined using strict inclusion criteria based on parental interviews and questionnaires. FC concentrations were measured with a single-test ELISA assay (Orgentec Sebia Diagnostika). Data analysis employed Random Forest Regression and non-parametric statistical methods, following the Clinical and Laboratory Standards Institute EP28-A3c guideline.

Results: Median FC concentrations by age group were: 0-4 months, 181 µg/g (IQR 92.5-289.6); 4-12 months, 40.6 µg/g (IQR 14.2-100.3); and 12-36 months, 24.7 µg/g (IQR 4.62-59.27). FC levels peaked in the youngest age group (0-4 months) and declined steadily thereafter, showing a consistent downward shift in both median and upper percentile values with increasing age. No significant associations were found between FC and gender, birth weight, mode of delivery or type of nutrition.

Conclusions: This study provides age-specific reference values for FC in Hungarian children under 3 years of age. These results support the clinical use of FC testing to help exclude organic gastrointestinal disease, while emphasising the importance of appropriate test indication. The assay used proved to be reliable, minimally invasive, cost-effective and well suited for routine paediatric practice.

Background: Admission of preterm infants (PTIs) to neonatal care units (NCUs) is stressful for parents, potentially affecting infant-parent attachment, parents' mental health and parenting behaviour. Identifying stressors is essential for designing interventions that reduce this burden. However, evidence on parental stress among parents of PTIs in the Nepali context is limited. We aimed to assess parental stress and its associated factors among parents of NCU-admitted PTIs.

Methods: A descriptive cross-sectional study was conducted among 305 parents of PTIs admitted to NCUs in five randomly selected public hospitals in Nepal. Data were collected through in-person interviews using a 5-point Likert scale-based Parental Stress Questionnaire (1=not stressful to 5=extremely stressful). Stress levels were categorised as mild (<3), moderate (3-4) and severe (≥4) based on median scores. Descriptive and inferential statistics, including multivariable logistic regression, were applied.

Results: Parents had moderate levels of stress (median score and IQR: 3.0 (2.6-3.4)). Their most common stressor was separation and altered parental role 3.3 (2.6-3.6), which was significantly higher among mothers (p<0.001). Stress level showed significant associations with parental variables (age, education, family income and antenatal clinic check-up status) and infant variables (mode of birth, birth weight and hospitalisation duration) (p<0.050). Parents whose infants were hospitalised for ≥15 days were 2.4 times more likely to experience higher stress compared with those with ≤14 days of stay (adjusted OR 2.415; 95% CI 1.420 to 4.081; p<0.001).

Conclusions: NCU admission of PTIs imposes considerable stress on parents. Separation and altered parental roles are the main stressors, particularly among mothers. Longer hospitalisation significantly increases stress levels. Interventions that minimise parent-infant separation and promote parental involvement in care may help to mitigate parental stress.

Objectives: To evaluate the implementation and outcomes of the Layered Assessment of Neurodevelopmental Needs, Evaluation of Referrals and Navigation of support (LANTERN) triage system developed to improve referral quality, reduce unnecessary delays and enhance support for children referred for autism diagnostic assessment.

Design: Service improvement informed by action-based methodology and clinical audit, employing descriptive analysis of administrative and outcome data.

Setting: A UK National Health Service community paediatric service covering 59 000 children aged 4-16.

Participants: All referrals to the neurodevelopmental pathway for autism assessment from April 2019 to March 2025.

Intervention: The LANTERN system incorporates senior diagnostician-led triage, expanded evidence review and detailed guidance for families and referrers.

Main outcome measures: Referral volume and acceptance rates, rates per 1000 population, patient experience via friends and family test and cost-effectiveness.

Results: Referral rates fell 25% over 5 years, and acceptance rates dropped from 79.6% (2019-2020) to 61% (2024-2025), compared with 92% in the wider region. LANTERN achieved a local referral rate of 4 per 1000 versus 33 system-wide. 'Good' or 'very good' family satisfaction rose from 35% to 95%. The system incurred an annual cost of £58 695 but avoided £96 025 in assessments not indicated, yielding a net saving of ~£37 330.

Conclusions: The LANTERN system reduced assessments not indicated while improving family satisfaction and support for children, families and referrers. A senior-led, evidence-informed triage can enhance quality and efficiency in the autism diagnostic pathway.

Background: Schools play a crucial role in shaping children's growth and development. In Indonesia, however, school food environments face major challenges in promoting nutrition and healthy lifestyles. These environments are increasingly dominated by unhealthy ultra-processed products (UPPs), limited nutritious options and inadequate opportunities for physical activity-key contributors to rising childhood obesity rates.

Methods: We explored the drivers of childhood obesity and barriers to prevention in selected school food environments using qualitative data from in-depth interviews and focus group discussions with 165 purposefully selected participants across four study areas, field observations and a desk review of relevant regulations. Data were analysed through an iterative content analysis approach, using a predefined variable indicator matrix outlining key study themes.

Results: Findings show frequent consumption of unhealthy snacks and sweetened drinks in and around schools, driven by a lack of food environment regulations. Barriers to healthier diets include children's food preferences, limited parental time and the widespread availability of UPPs. While school-based physical activity was generally adequate, sedentary behaviours at home were common. Key gaps include limited teacher capacity, inadequate health education materials and weak data sharing and referral mechanisms for obesity between schools and community health services.

Conclusion: Strengthening school food environments regulations in Indonesia is urgently needed. Priorities include developing national canteen guidelines, restricting the sale and marketing of UPPs and high-fat, salt and sugar foods, adopting interpretative front-of-pack labelling schemes and promoting equitable physical activity opportunities. Improving knowledge, capacity and coordination among schools, parents and health workers is also critical.

Adolescents and young adults (AYAs) with leukaemia represent a unique population but face fragmented care between paediatric and adult systems. A retrospective study of AYA patients (≥14 years old) with leukaemia treated at Shanghai Children's Medical Center between September 2023 and March 2025 found acute lymphoblastic leukaemia (ALL) was predominant (152/189). AYA ALL patients showed a higher prevalence of high-risk subtypes like T-ALL and BCR::ABL1, while favourable ETV6::RUNX1 was rare. Paediatric protocols achieved a 5-year event-free survival of 75.2% and overall survival of 89.6%, comparable to young children. These findings show that paediatric-based therapy for AYA ALL can be effective, although prospective comparative studies are still needed.

Background: Autism spectrum disorder (ASD) is defined by persistent social communication difficulties and restricted, repetitive behaviours. Its increasing prevalence heightens the demand for earlier diagnosis and intervention. ASD can be diagnosed between 18 and 24 months, the typical kindergarten entry age, highlighting the vital role of kindergarten teachers in early detection. In Lebanon, the economic crisis has increased the demand for kindergarten services as both parents are working. This study aims to assess the knowledge of kindergarten teachers in Lebanon about ASD, emphasising their role in early detection and intervention referral.

Methods: A descriptive cross-sectional study was conducted between June 2023 and January 2024 using convenience sampling. Data were collected through a survey administered to 355 kindergarten teachers from all Lebanese governorates. The questionnaire assessed participants' sociodemographic characteristics, perceived knowledge of ASD and included the validated Autism Spectrum Knowledge Scale-General.

Results: Responses were obtained from 355 kindergarten teachers, aged 18 to 50 years, representing 57 kindergartens. Overall, Lebanese kindergarten teachers demonstrated moderate knowledge of ASD, with a mean score of 17.7/32 (55.3%). The level of knowledge regarding the symptoms and associated behaviours, assessment and diagnosis, treatment, outcomes and prognosis of the disease was moderate (59.9%, 58.2%, 54.3% and 52%, respectively). The lowest scores were observed in items related to the aetiology and prevalence of ASD (48.3%). Moreover, areas of residence, years of experience, sources of information and prior interactions with children with ASD were all statistically significant predictors of ASD knowledge (p=0.046, p=0.002, p=0.043 and p<0.001, respectively). Multivariate linear regression revealed that area of residence (p=0.009) and prior interaction with children with ASD (p<0.001) were significantly associated with knowledge scores.

Conclusions: Many teachers are unfamiliar with ASD and its implications for children, yet it is crucial to raise awareness of ASD and incorporate it into educational curricula.

Objective: To characterise quantitative glucose-6-phosphate dehydrogenase (G6PD) activity in term and preterm neonates, compare activity by gestational age (GA) and sex and derive neonatal screening cut-offs using percentile and WHO methods.

Design: Retrospective cross-sectional analysis of cord blood screening programme.

Setting: King Abdulaziz Medical City, Riyadh, Saudi Arabia, January 2016 to May 2022.

Participants: All live births with cord blood G6PD and GA. Of 59 465 births, 58 139 (97.8%) were screened. For reference range derivation only, results below the adult threshold (<5.7 U/g haemoglobin (Hb); n=1163) were excluded, yielding 56 976.

Main outcome measures: Distribution by GA and sex; prevalence under three definitions: adult cut-off (≤5.7 U/g Hb), neonatal percentile cut-off (2.5th percentile) and WHO bands (<30% deficient, 30-70% intermediate, >70% normal). Secondary measures were stratum medians and the male share among detected cases.

Results: Mean activity was 15.33±2.67 U/g Hb, higher in preterm than term. Sex differences were absent in preterm strata but present at term (males lower than females; p=0.002). The neonatal 2.5th percentile cut-off was 9.9 U/g Hb. Using the adult cut-off, 2.00% (1163/58 139) were deficient, 80.9% male. Using the neonatal cut-off, prevalence rose to 4.97% (2888/58 139), adding 1725 infants (+583 males, +1142 females) and reducing the male share to 52.8%. WHO bands identified a small <30% group and a female intermediate (30-70%) group across strata. Medians were 15.0 (≥37 weeks), 16.0 (33-36), 17.0 (29-32) and 17.6 (≤28) U/g Hb.

Conclusions: G6PD activity in neonates shows clear GA and sex effects. Adult cut-offs underestimate deficiency, especially in females. Neonatal thresholds (2.5th percentile plus GA-specific WHO bands) improve detection. Adoption within newborn screening, with reporting of a female intermediate band, should strengthen follow-up; external validation and linkage to bilirubin outcomes are needed.

Background: Sexual and reproductive health (SRH) education is crucial for adolescents aged 10-17 years, yet its effectiveness in this age group has not been quantified in prior meta-analyses. This study aims to address that gap.

Objective: The objectives of this systematic review and meta-analysis were to (1) evaluate the effectiveness of web-based SRH education for adolescents aged 10-17 years and (2) explore potential factors influencing intervention effectiveness by synthesising study characteristics, including study design, theoretical foundation, implementation approach and follow-up duration.

Data sources: We searched PubMed and Web of Science from database construction to October 2023.

Eligibility criteria: This review included randomised controlled trials of web-based SRH education for adolescents aged 10-17 years.

Study appraisal and synthesis methods: Data were extracted and examined by two researchers. The Cochrane risk-of-bias tool assessed the risk of bias. Analyses were divided into three groups, employing meta-analytic methodologies.

Results: 11 articles involving 7876 participants were analysed. This study revealed a moderate effect on knowledge (standardised mean difference (SMD) 0.59, 95% CI 0.60 to 0.94)), a low effect on attitudes (SMD 0.16, 95% CI 0.11 to 0.22) and a moderate effect on sexual behaviour (OR 0.75, 95% CI 0.60 to 0.94), with no significant effect on self-efficacy. Comparisons between web-based and traditional face-to-face SRH education were inconclusive due to limited studies and methodological heterogeneity.

Limitations: The overall certainty of evidence is limited by risk of bias, high heterogeneity and the use of only two databases, which suggests that the findings should be interpreted with caution.

Conclusions and implications of key findings: Web-based SRH education has potential in enhancing adolescents' knowledge, attitudes and behaviour. Future research must adhere to recognised reporting standards, thereby ensuring methodological consistency and enhancing the quality of evidence.

Prospero registration number: CRD42023400504.