Journal of paediatrics and child health最新文献

{"title":"Evaluation of Risk Factors of Coronary Artery Abnormalities in Incomplete Kawasaki Disease: An Analysis of Post RAISE.","authors":"Serena Hamanaka, Shogo Akahoshi, Takahiro Matsushima, Yoshihiko Morikawa, Koichi Miyata, Masahiro Misawa, Hiroyuki Yamagishi, Masaru Miura","doi":"10.1111/jpc.70120","DOIUrl":"10.1111/jpc.70120","url":null,"abstract":"<p><strong>Aim: </strong>The American Heart Association provides an algorithm for managing suspected incomplete Kawasaki disease (iKD), but the evidence remains limited. This study aimed to investigate the risk factors of coronary artery abnormalities (CAA) in iKD patients.</p><p><strong>Methods: </strong>This study was a secondary analysis of Post RAISE, a prospective cohort study of Japanese KD patients. The primary analysis included patients treated within 10 days of onset. CAA was defined by a Z score of the coronary artery diameter ≥ 2.5. Multiple logistic regression analysis was used to identify independent risk factors of CAA 1 month after treatment commencement.</p><p><strong>Results: </strong>Post RAISE enrolled 2628 KD patients, of whom 565 with iKD were included in the main analysis. Of the latter, 32 (5.7%; 95% confidence interval [CI]: 3.9-7.7) developed CAA 1 month after treatment commencement. The baseline factors significantly associated with CAA development on univariate analysis were young age (median: 10.8 vs. 20.8 months; p = 0.002), high platelet count (39.6 × 10⁴ vs. 33.5 × 10⁴/μL; p = 0.008), and pre-treatment presence of CAA (38 vs. 11%; p < 0.001). Multivariate analysis of the independent variables, including age ≤ 12 months, platelet count > 45 × 10⁴/μL, prednisolone use, and the pre-treatment presence of CAA, revealed a significant association of platelet count > 45 × 10⁴/μL (odds ratio: 3.46; 95% CI: 1.43-8.13) and the pre-treatment presence of CAA (4.62; 1.93-10.85) with the primary outcome.</p><p><strong>Conclusions: </strong>A high platelet count and pre-treatment presence of CAA were risk factors of CAA development in iKD patients 1 month after treatment commencement.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pericardial Tamponade and Myocardial Fibrosis-Uncommon Features of Rheumatic Fever.","authors":"Ryan Palfreyman, Jonathan Robert Skinner, Ganesh Gnanappa","doi":"10.1111/jpc.70114","DOIUrl":"10.1111/jpc.70114","url":null,"abstract":"","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deprivation, Ethnicity and Eczema: Understanding Associations for Childhood Bone and Joint Infection.","authors":"Sarah Hunter, Elsie Brown, John Mutu-Grigg, Haemish Crawford, Vanessa Selak, Cameron Grant","doi":"10.1111/jpc.70113","DOIUrl":"10.1111/jpc.70113","url":null,"abstract":"<p><strong>Background: </strong>Rates of childhood bone and joint infection (BJI) in New Zealand (NZ) are among the highest in the world, with a disproportionate burden experienced by Māori and Pacific children. Eczema, also inequitably distributed by ethnicity, is a potential risk factor for BJI. This study describes the recent incidence of BJI and investigates disease risk secondary to eczema.</p><p><strong>Methods: </strong>BJI cases were children aged </= 15 years admitted with acute haematogenous osteomyelitis (AHO) or septic arthritis (SA) between 2018 and 2023 in the Auckland region. Data were obtained on eczema status, ethnicity and area-based socioeconomic deprivation. BJI incidence was estimated using the 2018 Census. A retrospective case-control study was undertaken to determine the association between eczema and BJI. Ethnicity-matched controls were identified from the nationally representative NZ Health Survey.</p><p><strong>Results: </strong>This study identified 563 cases and 8840 ethnicity-matched controls. Incidence of AHO remains higher for Māori (26.7/100 000) and Pacific (38.5/100 000) compared with European children (17/100 000). Eczema was seen more frequently in BJI cases (30% of BJI cases vs. 24% of NZHS controls (p = 0.0007)). For NZ Māori and Pacific children, a diagnosis of eczema increased the odds of developing BJI (Pacific aOR = 1.6, 95% CI: 1.1-2.3, Māori aOR = 1.6, 1.1-2.4). Pacific children with BJI were more likely than controls to reside in areas of greater socioeconomic deprivation (aOR 1.88, 95% CI: 1.3-2.5). European children were more likely to reside in areas of least socioeconomic deprivation (OR 2.3, 95% CI: 1.7-3.1).</p><p><strong>Conclusions: </strong>Childhood BJI remains inequitably distributed by ethnicity. Eczema may be a suitable focus for strategies to lower disease risk.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suboptimal Immunisations in Children With a Ventriculoperitoneal Shunt-Can We Do Better?","authors":"Emily Elliott, Tamasine McGeown, Sonya Stacey, Robert Campbell, Sophie Wen","doi":"10.1111/jpc.70118","DOIUrl":"https://doi.org/10.1111/jpc.70118","url":null,"abstract":"<p><strong>Aim: </strong>To assess the immunisation status of children with a ventriculoperitoneal (VP) shunt as recommended per the Australian National Immunisation Program (NIP), including additional recommended pneumococcal immunisations. The secondary aim assessed the prevalence of invasive pneumococcal disease (IPD) in this cohort.</p><p><strong>Methods: </strong>Patients were identified via surgical codes utilising electronic medical records (EMR) over a 5-year period. Patients' EMR and Australian Immunisation Record were accessed to identify immunisation status and prevalence of IPD (as of 30 June 2022).</p><p><strong>Results: </strong>A total of 245 children were identified, and after exclusion criteria, 207 remained. Of the cohort (n = 207), 86% were up to date with standard NIP immunisations, however only 40% received an additional dose of 13-valent pneumococcal conjugate vaccine (13vPCV). For eligible children, 55% received the first dose of 23-valent pneumococcal polysaccharide vaccine (23vPPV), and only 25% received the second dose of 23vPPV. Overall, 25% of children received all eligible additional pneumococcal immunisations. Only two children were diagnosed with IPD, of which one received all eligible additional pneumococcal immunisations. Both were immunocompromised and neither strain was preventable with current immunisations.</p><p><strong>Conclusion: </strong>Coverage with routine immunisations in children with a VP shunt is suboptimal compared to Australian national immunisation rates. The rates of additional pneumococcal immunisation for at-risk children are less optimal, placing them at increased risk of vaccine-preventable infections. Strategies should be implemented to increase immunisation completeness in this cohort.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes and Nursing Strategies for Paediatric Tracheostomy Children: A Prospective Observational Study of 150 Cases.","authors":"Yanan Wang, Shifen Zhai, Lili Liu, Bin Qu, Ziqian Wang","doi":"10.1111/jpc.70116","DOIUrl":"https://doi.org/10.1111/jpc.70116","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to analyse clinical outcomes of children post-tracheostomy and to explore effective nursing strategies.</p><p><strong>Methods: </strong>A prospective observational study was conducted from January 2020 to December 2022, including 150 children who underwent tracheostomy. They were further divided into airway obstruction and lung support groups based on the tracheostomy indication. Post-discharge, preferably children requiring prolonged mechanical ventilation (PMV) received either respiratory therapist-led or home-based continuity care, with outcomes compared between the two.</p><p><strong>Results: </strong>A total of 150 children were categorised into PMV (n = 91) and non-PMV (n = 59) based on the duration of mechanical ventilation. The PMV group had more patients under 5 years old and fewer cases of airway obstruction (p = 0.001). Preferably children requiring PMV had higher mortality in the first month post-discharge and higher adverse reaction rates during hospitalisation (p = 0.004), with longer hospital stays (p < 0.001). No significant difference in one-month post-discharge mortality was found between the two indication groups, but airway obstruction patients had lower one-year post-discharge mortality (p = 0.008) and shorter hospital stays (p = 0.034). Respiratory therapist-led continuity care significantly reduced re-admission and rehospitalization rates (p = 0.002).</p><p><strong>Conclusion: </strong>PMV is prevalent among tracheostomized children and is linked to higher adverse reactions and mortality. Effective nursing strategies, particularly respiratory therapist-led continuity care, are vital for improving long-term outcomes and reducing rehospitalisation rates in preferably children requiring PMV.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Early Echocardiography in Low-Risk Patients With Kawasaki Disease.","authors":"William D Renton, Jake Carmody, Emma Mactaggart, Jonathan D Akikusa","doi":"10.1111/jpc.70115","DOIUrl":"https://doi.org/10.1111/jpc.70115","url":null,"abstract":"<p><strong>Aim: </strong>Anecdotally, in some centres in Australia and New Zealand, there is difficulty in obtaining early echocardiograms in patients with Kawasaki disease (KD) considered at low risk of coronary artery (CA) involvement, justified by the argument that the risk of coronary artery aneurysm (CAA) is low and that results will not change management. We sought to determine how often in practice the results of early echocardiography alter management in patients with KD, particularly in those at low risk of medium-giant aneurysms.</p><p><strong>Methods: </strong>A retrospective chart review of patients with KD at a large paediatric tertiary referral centre was performed. Data collected included demographic features, echocardiography results, and treatments. Analysis of data was stratified by risk of coronary involvement using criteria prospectively defined by the study authors.</p><p><strong>Results: </strong>Of the 147 included patients, 53 (36.1%) were female and the mean age was 3.4 years (range 0.3-11.4 years). 13 (8.8%) had aneurysms on baseline echocardiogram; 4/86 'low-risk' (4.7%) and 9/61 (14.7%) 'high-risk' patients (odds ratio 3.55; 95% confidence interval 1.04-12.11). Baseline echocardiogram findings changed management in three 'low-risk' patients who had primary treatment intensification. Seven 'high-risk' patients had changes in management including primary treatment intensification, additional anti-platelet treatment, and anticoagulation.</p><p><strong>Conclusions: </strong>These data support recommendations for baseline echocardiography in all patients with KD regardless of perceived risk of CAA. Further research into risk stratification in KD is required.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Checkup.","authors":"Mick O'Keeffe","doi":"10.1111/jpc.70112","DOIUrl":"https://doi.org/10.1111/jpc.70112","url":null,"abstract":"","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Serum Lactate on Admission to Intensive Care Predict Length of Stay? A Retrospective Analysis of Critically Ill Paediatric Oncology Patients.","authors":"Megan B Sim, Patricia Gilholm, Endrias Ergetu, Trisha Soosay Raj, Kristen Gibbons, Sainath Raman","doi":"10.1111/jpc.70110","DOIUrl":"https://doi.org/10.1111/jpc.70110","url":null,"abstract":"<p><strong>Introduction: </strong>Nearly 40% of hospitalised oncology patients are admitted to the paediatric intensive care unit (PICU). Clinicians utilise serum lactate as a biomarker to guide resuscitation and ongoing management of critically ill children. The significance of raised serum lactate remains unknown in oncology patients. Those who require an admission to the PICU have relatively poorer outcomes compared to those only managed on hospital wards, where there may be an increased tendency to apply additional interventions to normalise lactate. We assessed the association between serum lactate and the length of stay in PICU in paediatric oncology patients.</p><p><strong>Patients and methods: </strong>We conducted a retrospective observational study of patients admitted to the oncology service, who had at least one PICU admission, at a tertiary children's hospital between 2015 and 2020. The outcome was PICU length of stay (LOS). Multilevel regression modelling assessed the association between lactate measured at PICU admission and PICU LOS, controlling for patient demographic and clinical covariates.</p><p><strong>Results: </strong>There were 633 admissions to PICU from 426 children. Of these 633 admissions, 197 (31.1%) had hyperlactatemia (serum lactate ≥ 2 mmol/L) on admission, 229 (36.2%) had normal lactate levels (< 2 mmol/L) and the remaining 207 (32.7%) did not have lactate measured on admission. Of the 426 patients, 292 (68.5%) were diagnosed with solid tumour, 82 (19.2%) hematologic malignancy, and 52 (12.2%) had received a bone marrow transplant (BMT). The median PICU length of stay was 29 h (interquartile range 21, 68). Hyperlactatemia was associated with an average 1.25-fold (95% CI [1.04, 1.51]) increase in PICU LOS when we assumed that missing lactate indicated absence of hyperlactatemia. Interaction effects revealed that this association was only present in the solid tumour group. In sensitivity analyses including only admissions with measured lactate, this effect was reduced and no longer significant (β 1.20, 95% CI [0.99, 1.46]).</p><p><strong>Conclusion: </strong>After adjusting for clinical and demographic covariates, increased lactate at PICU admission was associated with PICU LOS in paediatric solid tumour patients. While further larger prospective studies are required, serum lactate levels may serve as a predictive biomarker for PICU length of stay in children with solid tumours.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Cardiac Causes of Low SpO₂ in Newborns: A Case Series of Fetal Haemoglobin Variants.","authors":"Mariana M Anjos, Ana Rita Rodrigues Matos, Raquel Monteiro Costa, Ana Ferraz, João Martins","doi":"10.1111/jpc.70105","DOIUrl":"https://doi.org/10.1111/jpc.70105","url":null,"abstract":"","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid Tuberculosis Masquerading as Malignancy.","authors":"Anagha Nair, Punnet Kumar Choudhary, Pratap Kumar Patra, Aravind Reddy","doi":"10.1111/jpc.70108","DOIUrl":"https://doi.org/10.1111/jpc.70108","url":null,"abstract":"","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}