Journal of paediatrics and child health最新文献

{"title":"“Chemical Restraint” for Children and Adolescents in Victoria","authors":"Daryl Efron, Connie Wu, Chidambaram Prakash, Mandy Donley","doi":"10.1111/jpc.16800","DOIUrl":"10.1111/jpc.16800","url":null,"abstract":"<p>Children and adolescents with neurodevelopmental disorders such as autism spectrum disorder and intellectual disability commonly exhibit challenging behaviours, including agitation, irritability, aggression, and self-injurious behaviour [<span>1</span>]. Such behaviours are a major contributor to morbidity, functional impairments, and reduced quality of life in these individuals, and cause great distress for their families and carers. In severe cases carer burnout and relinquishment is a genuine risk.</p><p>Psychotropic medications including stimulants, antidepressants and anti-psychotics are prescribed for a high proportion of paediatric patients with neurodevelopmental disorders in Australia [<span>2</span>], for symptom management or the treatment of comorbid mental health conditions. These medications are often extremely helpful, enabling patients to function better, engage with allied health and behavioural interventions, and participate more fully in school and society. However they also carry a substantial risk of adverse effects, and patients with developmental disabilities may be at particularly high risk [<span>3</span>], as well as being less able to report their subjective experiences. Therefore medications need to be used judiciously and monitored closely.</p><p>The NDIS Quality and Safeguards Commission is responsible the National Quality and Safeguarding Framework, which is aimed at protecting and preventing harm to persons with disability. The intention is to ensure NDIS participants ‘live free from abuse, neglect, violence and exploitation’. The context for this policy framework is the historical practice of off-label use of medications for institutionalised people with disabilities, for the intentional purpose of sedation—often administered by support staff, with minimal oversight by the prescriber.</p><p>Restrictive practices include seclusion, mechanical restraint, physical restraint, environmental restraint, and “chemical restraint” (CR). According to the NDIS Rules 2018, CR is defined as ‘the use of medication for the primary purpose of influencing a person's behaviour, as opposed to treatment of a diagnosed mental disorder or physical condition’ [<span>4</span>]. The Disability Act [<span>5</span>] and NDIS Rules are based on the purpose for which the medication is used. The NDIS definition is different to that under the Victorian Mental Health and Wellbeing Act [<span>6</span>] which is much narrower: ‘the giving of a drug to a person for the primary purpose of controlling the person's behaviour by restricting their freedom of movement but does not include the giving of a drug to a person for the purpose of treatment or medical treatment’. In these definitions no distinction is made between which type of medical practitioner prescribes the medication.</p><p>Note that these definitions do not incorporate any evaluation of the clinical appropriateness of the medications, nor are the parent or guardian's wishes considered ","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 3","pages":"523-525"},"PeriodicalIF":1.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.16800","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No-Biopsy Diagnosis of Coeliac Disease in Children Without Anti-Endomysial IgA Antibody Testing: Combining Anti-Tissue Transglutaminase IgA and Anti-Deamidated Gliadin IgG Antibodies.","authors":"Marsus Pumar, Sharon Choo, Jeremy Rosenbaum, George Alex, Shaun S C Ho","doi":"10.1111/jpc.16801","DOIUrl":"https://doi.org/10.1111/jpc.16801","url":null,"abstract":"<p><strong>Aim: </strong>To determine the utility of anti-tissue transglutaminase IgA antibodies (tTG-IgA) and anti-deaminated gliadin peptide IgG antibodies (DGP-IgG) in detecting coeliac disease (CD) and whether DGP-IgG can replace anti-endomysial IgA antibody in the European Society for Paediatric Gastroenterology Hepatology and Nutrition no-biopsy approach in diagnosing CD.</p><p><strong>Methods: </strong>Children aged < 19 years who had paired tTG-IgA and DGP-IgG performed and had a gastroscopy with biopsies between 1 March 2016 and 31 October 2020 were retrospectively reviewed.</p><p><strong>Results: </strong>Of 1206 patients who fulfilled the study criteria, 298 (24.7%) patients were diagnosed with CD. Fifteen patients with IgA deficiency were excluded from any tTG-IgA analysis. tTG-IgA had sensitivity and specificity of 93.5% and 92.0%, respectively, in detecting CD, while DGP-IgG had sensitivity of 97.0% and specificity of 86.7%. tTG-IgA ≥ 10x upper limit of normal (ULN) alone had a specificity of 99.3% and a positive predictive value (PPV) of 96.8%. An optimal DGP-IgG threshold was identified to be 70 U/mL (3.5x ULN) based on > 99% specificity in detecting CD. When tTG-IgA ≥ 10x ULN was combined with DGP-IgG ≥ 3.5 ULN, the PPV in diagnosing CD was 98.5%. DGP-IgG performed well in detecting CD in 126 children aged < 3 years, with all patients with CD having an elevated DGP-IgG (sensitivity 100%).</p><p><strong>Conclusions: </strong>Combined tTG-IgA ≥ 10x ULN and DGP-IgG ≥ 3.5x ULN provided a high PPV (98.5%) in diagnosing CD. DGP-IgG testing can potentially replace EMA testing in those children with tTG-IgA ≥ 10x ULN. Future studies should evaluate DGP-IgG testing as a sequential test.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065786","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":"Surgery for Bronchiectasis: Experience and Outcomes at Starship Children's Hospital, Auckland, New Zealand","authors":"Clara Watson,&nbsp;Dug Yeo Han,&nbsp;Catherine A. Byrnes,&nbsp;James Hamill,&nbsp;Philip Morreau,&nbsp;Elizabeth Edwards","doi":"10.1111/jpc.16775","DOIUrl":"10.1111/jpc.16775","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Surgical management for bronchiectasis is uncommon. This study reviewed the experience of bronchiectasis surgery and subsequent outcomes at a tertiary paediatric centre over a 20 year period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective audit of children aged &lt; 18 years who underwent bronchiectasis surgery at Starship Children's Hospital between 2001 and 2021. Cases were identified from clinical coding, with demographics, pre-operative investigations and outcomes obtained from clinical records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nineteen children (11 females, 42% Pasifika, 26% Māori and 26% New Zealand European) were included. Mean age of bronchiectasis diagnosis was 6.3 years (range 2.1–13.9 years) and mean age of surgery was 8.5 years (range 2.6–15.9 years). Indications for surgery included localised bronchiectasis (<i>n</i> = 7), main burden of multilobar disease in one lobe (<i>n</i> = 5) and persistent lobar collapse (<i>n</i> = 3). Pre-operative investigations included chest computerised tomography scan (68%), bronchoscopy (37%) and overnight oximetry (42%). One child underwent documented pre-operative clinical optimisation. For children with bronchiectasis &lt; 5 years (<i>n</i> = 11), 81% demonstrated improved symptoms, 9% were unchanged and 9% deteriorated. All children with bronchiectasis &gt; 5 years had symptomatic improvement. The mean number of daily symptoms decreased by 2.4 (<i>p</i> &lt; 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lobectomy resulted in significant symptomatic improvement in 89% of children. However, pre-operative work-up was variable. The study highlights the importance of establishing a protocol for identification of children with bronchiectasis who would benefit from surgery and developing a consistent preparatory approach to ensure optimal and equitable outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 3","pages":"491-498"},"PeriodicalIF":1.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.16775","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excellent Outcomes of Biliary Atresia Over the Coronavirus-19 Disease Era in a Tertiary Referral Paediatric Liver Transplant Unit in Singapore","authors":"Nur Hafizah Mohamed Nor,&nbsp;Karthik Sivaramakrishnan Venkatesh,&nbsp;Lee Yang Yang,&nbsp;Loh Dale,&nbsp;Aw Marion,&nbsp;Mali Vidyadhar Padmakar","doi":"10.1111/jpc.16802","DOIUrl":"https://doi.org/10.1111/jpc.16802","url":null,"abstract":"&lt;p&gt;Groups from the United Kingdom and Europe observed decreased incidence of biliary atresia (BA) with an increased time to Kasai portoenterostomy (KPE) during the coronavirus disease-19 (COVID-19) pandemic [&lt;span&gt;1, 2&lt;/span&gt;]. This was attributed to changes in health behaviours resulting in delayed presentations and decreased sensitivity in detecting jaundice over teleconsultations. In contrast, our experience at the only paediatric liver transplantation (LT) unit in Singapore during the COVID-19 era showed a trend of steady incidence for BA, timely KPE, excellent jaundice clearance of 75% and comparable post-transplantation survival of 85.7%.&lt;/p&gt;&lt;p&gt;A retrospective analysis was conducted of children with BA who underwent KPE during COVID-19 era (2020–2023, Group 1), in comparison with a similar period prior (2016–2019, Group 2) and previously reported historical controls (1989–2015, Group 3) [&lt;span&gt;3&lt;/span&gt;] (Table 1).&lt;/p&gt;&lt;p&gt;BA incidence (&lt;i&gt;p&lt;/i&gt; = 0.222) and their median age at KPE (&lt;i&gt;p&lt;/i&gt; = 0.755) were similar across groups 1 and 2. Suspension of elective operations did not increase the time to KPE as compared to pre-COVID-19 periods. Superior jaundice clearance rate during COVID-19 era did not reach statistical significance as compared to other periods (&lt;i&gt;p&lt;/i&gt; = 0.638).&lt;/p&gt;&lt;p&gt;In response to the pandemic, the Singapore Healthcare Corps was formed by the Ministry of Health, recruiting additional clinical and non-clinical manpower to meet the needs of the pandemic, thus enabling specialists to continue delivering essential care [&lt;span&gt;4&lt;/span&gt;]. General paediatricians continued to have direct referral access for local resident patients to in-person consultations at our tertiary centre throughout the pandemic, possibly allowing timely assessment and intervention. Essential time-sensitive surgeries were approved on a case-by-case basis, adhering to strict protocols and airborne precautions with personal protective equipment. Suspected or confirmed COVID-19 patients were treated in dedicated isolation wards and negative-pressure operating theatres to minimise exposure to healthcare staff and other patients.&lt;/p&gt;&lt;p&gt;Paediatric LT numbers were lower during COVID-19 period. Organ transplantations were suspended in the early days of COVID-19 due to uncertainties surrounding its safety during a pandemic. As healthcare services gradually reopened, solid organ transplantations were resumed with strict screening protocols, achieving excellent outcomes [&lt;span&gt;5&lt;/span&gt;]. One patient developed hepatic artery thrombosis and demised in the immediate post-transplantation period due to factors unrelated to the pandemic. He tested negative for COVID-19 RT-PCR 7 days and 48 h before transplantation and post-transplantation.&lt;/p&gt;&lt;p&gt;Pandemics may continue to occur and influence our health behaviours and protocols. A well-managed healthcare delivery may include continued access and management of time-sensitive conditions during pandemic priorities; thereby allowing ","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 3","pages":"521-522"},"PeriodicalIF":1.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.16802","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioural Changes of Late Talkers During the Covid-19 Pandemic, One Year Follow-Up From a Community Sample.","authors":"Tuba Çelen Yoldaş","doi":"10.1111/jpc.16796","DOIUrl":"https://doi.org/10.1111/jpc.16796","url":null,"abstract":"<p><strong>Aim: </strong>Global threats to child health and well-being, compounded by the COVID-19 pandemic, have put child development at grave risk. This study aimed to observe the behavioural changes of children with isolated language delays from a paediatric outpatient clinic as a community sample during the pandemic with a 1-year follow-up.</p><p><strong>Methods: </strong>Patients admitted to the paediatrics outpatient clinic due to isolated language delays were included in the study. The Ages and Stages Questionnaire and Child Behaviour Checklist-1½-5 were implemented at baseline and 1 year later. All families were provided with information on developmental supportive strategies and called at 3-month intervals for follow-up.</p><p><strong>Results: </strong>Eighty-three children were initially included in this prospective study and completed with a 66.3% retention rate after 1 year. The mean initial age of the children was 30 ± 5.1 months. Internalising behaviour problems were high enough for concern at the baseline and all behavioural problem scores decreased after 1 year (p < 0.001). The initial proportion of children with borderline or clinical internalising problems also decreased from 69.1% to 5.5% after 1 year, and most children had normal language development.</p><p><strong>Conclusions: </strong>Late talkers experienced some behavioural problems during the pandemic, and the language and behaviour outcomes of these children who attended the paediatric clinic were better after the 1-year follow-up, even during the COVID-19 pandemic. The management of language delays in young children in crisis should include providing families with developmental support strategies consistently through the paediatric healthcare system to optimise child developmental and behavioural functioning.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059333","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":"School Attendance Among Autistic Students in Aotearoa/New Zealand: A Population Cross-Sectional Study Using the Integrated Data Infrastructure.","authors":"Nicholas Bowden, Francesca Anns, Hien Vu, Joanne Dacombe, Colette Muir, Jin Russell, Larah van der Meer, John Williams, Sally Clendon","doi":"10.1111/jpc.16795","DOIUrl":"https://doi.org/10.1111/jpc.16795","url":null,"abstract":"<p><strong>Background: </strong>Extant literature indicates autistic students have lower school attendance compared to the general population. However, there remains considerable heterogeneity between studies, a lack of large population-based studies beyond the UK and US, and insufficient consideration of age and sex differences in attendance rates. The aim of this study was to examine school attendance among autistic compared with non-autistic students including stratification by age and sex.</p><p><strong>Methods: </strong>This was a national retrospective cohort study using population-level data on students aged 5 to 16 years in 2018. Autism was identified using diagnostic information contained within multiple health datasets. Regular attendance was defined as attending 90% or more of school half days. The association between autism and attendance was estimated using complete-case 2-level random intercept modified Poisson regression.</p><p><strong>Results: </strong>Among 654 438 students, 8427 (1.3%) were autistic. In adjusted analyses, autism was associated with significantly decreased likelihood of regular attendance (incident rate ratio [IRR] 0.88; 95% CI, 0.86-0.90). Age and sex stratification revealed significant age differences with likelihood of regular school attendance lower for younger autistic students (5-11 years) (IRR 0.85; 95% CI, 0.83-0.87) while sex differences were marginal. The most frequent type of non-attendance among autistic students was justified (including medical) absence (8.2% of recorded attendance hours for autistic students vs. 5.0% for non-autistic students).</p><p><strong>Conclusion: </strong>This study provides further, whole-population evidence of the significant disparities experienced by Autistic students. To improve attendance of autistic students, comprehensive and targeted supports are required to help the student, family and school.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059351","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 Intravenous Caffeine Citrate Be Used for Severe Asthma Exacerbation in Children? A Retrospective Comparative Study.","authors":"Rebecca Brooks, Vladislav Babushkin, David Rekhtman, Malena Cohen-Cymberknoh, David Shoseyov, Itai Shavit","doi":"10.1111/jpc.16799","DOIUrl":"https://doi.org/10.1111/jpc.16799","url":null,"abstract":"<p><strong>Aim: </strong>To assess the effectiveness of intravenous caffeine citrate in paediatric asthma exacerbation unresponsive to beta2-agonists and steroids.</p><p><strong>Methods: </strong>A 10-year retrospective cohort study was conducted on asthmatic children unresponsive to beta2-agonists and steroids, who were treated with either intravenous caffeine citrate or magnesium sulphate. The study outcomes were changes in the Paediatric Respiratory Assessment Measure (PRAM) score, duration of oxygen therapy and paediatric intensive care unit (PICU) length-of-stay.</p><p><strong>Results: </strong>Overall, 296 children were treated in the PICU between January 1, 2011, and December 31, 2020. Fifteen and 26 children unresponsive to beta2-agonists and steroids (median ages 2.3 [0.7-11] and 3.0 [1.2-8.5] years), respectively, received caffeine citrate and magnesium sulphate. The two groups showed similar demographic characteristics and baseline parameters. At 24 and 48 h, the median (IQR) PRAM scores for the caffeine and magnesium groups were 4 (2-6) and 5 (4-6), respectively (p = 0.27), and 7 (6-8) and 8 (5-9), respectively (p = 0.57). The median (IQR) durations of PICU stay for the caffeine and magnesium groups were 36 (19-46) and 32 (23-45) h, respectively (p = 0.77). The median (IQR) durations of oxygen therapy for the caffeine and magnesium groups were 25 (10-30) and 20 (15-30) h, respectively (p = 0.29). No serious adverse events occurred in the caffeine group. One occurred in the magnesium group.</p><p><strong>Conclusions: </strong>Caffeine citrate and magnesium sulphate demonstrated comparable effectiveness in treating steroid- and beta2-agonist-resistant asthma. A multicentre prospective study is needed to validate these results.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059337","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":"Why the Delay? A Quality Improvement Initiative for Delayed Cord Clamping in Preterm Infants.","authors":"Ahmad Mohamad, Ana Navidad, Lindsay Edwards, Antonio DePaoli, Hamish Jackson, Joey Walsh, Naomi Spotswood","doi":"10.1111/jpc.16794","DOIUrl":"https://doi.org/10.1111/jpc.16794","url":null,"abstract":"<p><strong>Aim: </strong>To improve delayed cord clamping (DCC) rates for preterm infants (≤ 34 + 0 weeks' gestation) and establish DCC as standard practice using quality improvement (QI) methods.</p><p><strong>Methods: </strong>A multi-departmental initiative was undertaken. An audit of DCC for preterm infants born at or before 34 + 0 weeks was performed. Using this data and feedback from multidisciplinary staff meetings, barriers to DCC implementation were identified and targeted QI interventions were introduced. Ongoing data surveillance monitored the effects of these interventions.</p><p><strong>Results: </strong>DCC rates were evaluated for 862 preterm infants from January 2014 to August 2022. This QI project commenced in February 2018, with a detailed audit of 225 preterm infants across three time periods: epoch 1 (immediately prior to QI initiative), epoch 2 (QI implementation phase), and epoch 3 (immediate post-implementation surveillance). Inconsistent documentation of cord clamp time and admission hypothermia were identified as potential barriers to implementation of DCC. Over the course of the initiative, the documentation rate increased from 16% to 92.6%. Hypothermia at admission decreased from 76% in epoch 1 to 43.2% in epoch 3. The baseline rate of DCC was low in epoch 1 (12%), but improved to 70% in epoch 3, with this change sustained in ongoing DCC rate evaluation to August 2022.</p><p><strong>Conclusions: </strong>There has been a significant and sustained improvement in DCC for preterm infants at our centre. A structured approach to QI and collaboration between multiple departments were each integral in effecting this improvement in clinical care.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059396","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":"Ethical Dilemmas in Clinical Trials of Innovations in Bubble Continuous Positive Airway Pressure Models in Resource-Limited Neonatal Care","authors":"H. Shafeeq Ahmed","doi":"10.1111/jpc.16787","DOIUrl":"10.1111/jpc.16787","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Bubble Continuous Positive Airway Pressure (bCPAP) has become a crucial intervention in neonatal care, particularly in resource-limited settings where access to advanced respiratory support is scarce. While bCPAP offers a cost-effective solution for neonatal respiratory distress, conducting clinical trials in these settings presents significant ethical challenges. Issues of justice, beneficence, and autonomy arise due to disparities in healthcare infrastructure, complexities surrounding informed consent, and the potential exploitation of vulnerable populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this study, I examine the ethical principles essential to the design and implementation of bCPAP trials, focusing on justice, beneficence, and autonomy within the constraints of resource-limited settings. A normative analysis was conducted, drawing on key ethical frameworks to establish guiding principles for conducting ethically sound bCPAP trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Applying frameworks such as Rawls' theory of distributive justice and Sen's capability approach, I argue for prioritizing neonatal populations in low-resource settings while addressing the potential for exploitation. Autonomy underscores the need for informed consent processes that are culturally appropriate and accessible, empowering caregivers in decision-making. Beneficence and non-maleficence are evaluated through both utilitarian and deontological perspectives, balancing the potential benefits of innovation against the risks to participants. Structural inequities that complicate neonatal care and research are also critically examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>I advocate for the integration of ethical safeguards, including community-centered consent processes, rigorous trial protocols, and international collaboration to mitigate systemic inequities. By incorporating these ethical considerations, bCPAP research can better serve the interests of neonates and their families while ensuring their safety and dignity are upheld.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 3","pages":"306-315"},"PeriodicalIF":1.6,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046991","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":"Impact of COVID-19 on Antimicrobial Stewardship Activities in Hospitalised Children: A Scoping Review","authors":"Zabiuddin Ahad Mohammed,&nbsp;Gary Grant,&nbsp;Adam D. Irwin,&nbsp;Laetitia Hattingh,&nbsp;Vandana Kalwaje Eshwara,&nbsp;Rose I. Okonkwo,&nbsp;Sohil Khan","doi":"10.1111/jpc.16786","DOIUrl":"10.1111/jpc.16786","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>COVID-19 has brought unprecedented challenges to the healthcare system. The rapid spread of the virus, laboratory burn-out, exhausted staff, diagnostic uncertainty and lack of guidelines cumulatively disrupted hospital antimicrobial stewardship (AMS) programs. This scoping review evaluated how the COVID-19 pandemic has impacted the implementation of AMS, particularly within the context of clinical audits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An initial trend analysis was performed using a database search from 2000 to 2022. This review was developed following PRISMA-Scr guidelines. Databases such as Medline, Embase, Cochrane Library and CINAHL were searched using Medical Subject Headings and free text for ‘Children’, ‘antimicrobial stewardship’ and ‘COVID-19’. Primary studies that reported data on antimicrobial use among hospitalised children during COVID-19 from December 2019 to December 2022 were considered.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Paediatric AMS-related research output changed annually by −4.94% in 2022 compared to 14.44% in 2019. Of 677 articles, 15 were included, with 3 added through snowballing technique. All the studies were observational and from countries of all income levels. A quantitative measure of antibiotic use was the commonly assessed sub-category of AMS, while three studies performed the audit for a reason for antibiotic use, microbiological cultures, and surgical prophylaxis. Most studies reported antimicrobial use as prevalence, while two reported the days of therapy, and two used the AWaRe classification and the antibiotic spectrum index (ASI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Paediatric AMS activities were disrupted during the COVID-19 pandemic. A basic quantitative measure of antibiotic use was the only measure of assessment, with other AMS components unreported. A robust paediatric-focused AMS resilient to future pandemics and evidence-informed stewardship approach is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 3","pages":"333-343"},"PeriodicalIF":1.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.16786","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}