{"title":"Revolutionizing paediatric neurorehabilitation: integrating innovation and contemporary practice","authors":"Vijay Palanivel, Tim Grove, Melanie Burrough","doi":"10.1016/j.paed.2025.02.002","DOIUrl":"10.1016/j.paed.2025.02.002","url":null,"abstract":"<div><div>The field of paediatric neurorehabilitation is undergoing significant transformation, driven by evolving care pathways, innovative technologies, and a growing emphasis on addressing health disparities. Children and young people (CYP) with acquired brain injuries (ABI) benefit from rehabilitation that optimizes their participation in daily life across home, school, and community settings. This paper explores the changing landscape of paediatric neurorehabilitation and changing patterns of causes of brain injury in children. The discussion extends to health inequalities that affect access to care, underscoring the need for system-wide reforms to bridge disparities linked to socioeconomic, geographic, and cultural factors. The development of seamless, end-to-end service pathways, from acute care to specialist tertiary neurorehabilitation and onward community services, demonstrates the potential for integrated care to improve outcomes for CYP transitioning from hospital to home. Central to effective rehabilitation is personalized goal setting and high-intensity treatments, which enhance physical, cognitive, and social outcomes. Technological advancements, including virtual reality, robotics, and electrical muscle stimulation, are reshaping therapeutic approaches, increasing engagement, and fostering neuroplasticity. Findings advocate for ongoing research, investment in community services, and equitable application of emerging technologies. By prioritizing personalized care and addressing systemic barriers, the future of paediatric neurorehabilitation holds promise for improved long-term functional outcomes for children with ABI.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 5","pages":"Pages 134-139"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute neurological deficit: is it demyelination? Review of demyelinating disorders of the central nervous system","authors":"Yoshua C. Collins-Sawaragi, Evangeline Wassmer","doi":"10.1016/j.paed.2025.02.004","DOIUrl":"10.1016/j.paed.2025.02.004","url":null,"abstract":"<div><div>Childhood demyelination is a condition that all paediatricians will see either presenting as encephalopathy from Acute Disseminated Encephalomyelitis (ADEM) or neurological deficits such as with optic neuritis (ON) or transverse myelitis (TM) amongst other presentations. We discuss the various types of demyelinating conditions including MOG antibody disease (MOGAD), NMO spectrum disorder (NMOSD) and Paediatric onset Multiple Sclerosis (POMS) and how these conditions present, how these should be investigated, the differentials to consider when faced with a patient with acute neurological deficit and the acute and long-term management for paediatric patients with demyelinating conditions.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 5","pages":"Pages 146-151"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Developmental and epileptic encephalopathies: the clinical approach to investigation and management","authors":"Ogechukwu Okpala, Manali Chitre","doi":"10.1016/j.paed.2025.02.007","DOIUrl":"10.1016/j.paed.2025.02.007","url":null,"abstract":"<div><div>Epileptic encephalopathies (EE) and developmental and epileptic encephalopathies (DEE) are a group of severe brain disorders in which epileptic electrical discharge contributes to progressive psychomotor dysfunction. These include rare but important conditions such as neonatal epileptic encephalopathy, West, Dravet, Lennox Gastaut and Landau Kleffner syndromes. These conditions result in a characteristic cluster of clinical, EEG and aetiological features which together, help us understand the condition, use more targeted therapies and prognosticate with regards to progression with age. Electroencephalography (EEG) is crucial in determining the causative epilepsy syndrome. Since the availability of next generation sequencing, genetic testing has assumed increasing importance in the diagnosis of specific syndromes. Multidisciplinary support from medical, nursing and therapy teams is essential in helping these children reach the best of their abilities, skills and to optimize their long-term outcomes. In this article we describe some of the more commonly seen EE/DEE and discuss management and prognosis of these.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 5","pages":"Pages 163-170"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Inherited white matter disorders in children","authors":"Nee Na Kim, Asthik Biswas, Cheryl Hemingway","doi":"10.1016/j.paed.2025.02.008","DOIUrl":"10.1016/j.paed.2025.02.008","url":null,"abstract":"<div><div>Inherited white matter disorders (IWMDs), otherwise known as leukodystrophies, represent a group of rare and heterogenous neurological conditions affecting the white matter of the central nervous system (CNS). With a wide range of differential diagnoses and associated medical complexities, they often pose a diagnostic challenge to clinicians. Rapid technological advancement including the availability of genetic investigations such as whole genome sequencing (WGS) is leading to an increasing number of patients with a confirmed genetic diagnosis. For the majority of IWMDs there is no specific treatment, and the focus of clinical management remains symptomatic and involves a multidisciplinary team and holistic approaches. Up until recently, only natural history trials were available, but now the focus is shifting to novel targeted therapies. Early diagnosis and prompt referral to specialized IWMD centers is crucial for optimum management of affected children or asymptomatic affected siblings. Collaborative efforts are needed to achieve two important goals 1) to establish international patient registries for long term natural history and recruitment to new treatment trials and 2) to encourage wider newborn screening programmes for early detection of these rare diseases at the asymptomatic stage. In this review, we aim to summarise the common clinical presentations, diagnostic investigations, management and prognosis of the more commonly encountered inherited white matter disorders in children.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 5","pages":"Pages 171-179"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hanna Richardson, Rachel Gwynn, Parisha Chadha, Penny Andreou, Karen Ray, Clare Rapier, Catherine Swales, Sarah Aylett
{"title":"Neurocutaneous syndromes: a multidisciplinary team approach","authors":"Hanna Richardson, Rachel Gwynn, Parisha Chadha, Penny Andreou, Karen Ray, Clare Rapier, Catherine Swales, Sarah Aylett","doi":"10.1016/j.paed.2025.02.006","DOIUrl":"10.1016/j.paed.2025.02.006","url":null,"abstract":"<div><div>Neurocutaneous syndromes are rare, genetically derived conditions which show characteristic dermatological and neurological features, the most common being Neurofibromatosis type 1, Tuberous Sclerosis Complex and Sturge Weber syndrome. These conditions are medically complex, often involving a number of bodily systems, but are also often associated with developmental differences. Medical and developmental care often involves a large number of professionals. Maintaining a holistic overview of care and ensuring clear communication between teams are essential to ensure that the needs of the child or young person are met in an appropriate and timely way. In this article, we present an approach to the multidisciplinary care of a child and young person with a neurocutaneous condition, taking into account both medical and developmental needs.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 5","pages":"Pages 155-162"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Treatable movement disorders in children","authors":"Gautam P Ambegaonkar","doi":"10.1016/j.paed.2025.02.003","DOIUrl":"10.1016/j.paed.2025.02.003","url":null,"abstract":"<div><div>Movement disorders are common in children but can be difficult to assess and diagnose as they are often mistaken for developmental disorders, may occur intermittently/ paroxysmally, and the child or their parents may not be able to describe them accurately. The aetiologies of paediatric movement disorders are significantly different to adults. Whilst many of the early onset paediatric movement disorders have a genetic basis and do not have a cure, there are some movement disorders which have a potentially reversible cause and treatable. This review provides an approach to the common, treatable, movement disorders in children.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 5","pages":"Pages 140-145"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neuroprotection in traumatic brain injury","authors":"Swathy Subhash, Shruti Agrawal","doi":"10.1016/j.paed.2025.04.001","DOIUrl":"10.1016/j.paed.2025.04.001","url":null,"abstract":"<div><div>Traumatic brain injury is the leading cause of trauma-related death and disability in children worldwide. To improve neuro-outcomes after injury, neuroprotective measures are implemented to limit secondary brain injury by providing adequate cerebral perfusion and oxygenation. In this article we review the general supportive and targeted neuroprotective measures that are outlined in the international paediatric guidelines and the physiological basis for these recommendations based on the underlying pathology. We also discuss multimodal neuro-monitoring in the PICU. We aim to provide a practical approach on how to respond to deteriorating patients, and manage complications arising during the course of their treatment.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 6","pages":"Pages 181-187"},"PeriodicalIF":0.0,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shana Irvine, Peter Logan, Michael D Shields, Paddy McCrossan
{"title":"Childhood pneumonia: an update in the post-COVID-19 era","authors":"Shana Irvine, Peter Logan, Michael D Shields, Paddy McCrossan","doi":"10.1016/j.paed.2025.04.005","DOIUrl":"10.1016/j.paed.2025.04.005","url":null,"abstract":"<div><div>Community acquired pneumonia is the leading global cause of death in childhood. Whilst COVID-19 infection does not typically cause severe illness in children the subsequent social isolation, along with changes in hygiene practices led to reduced levels of respiratory viruses and bacteria during the pandemic. This caused a significant change in the seasonality of community acquired pneumonia. Viruses are still the most common cause of community acquired pneumonia, however bacteria can cause more severe disease and it can be difficult to distinguish clinically between them. Generally, children with pneumonia can be managed at home with antipyretics, oral hydration and oral antibiotics, however a small subset need admission to hospital. Complications from pneumonia include pleural effusion, empyema, necrotizing pneumonia and pneumatocele. This article aims to direct physicians on the diagnosis and management of community acquired pneumonia and highlight the key changes since the COVID-19 pandemic.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 6","pages":"Pages 214-220"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Children with tracheostomies in the paediatric intensive care unit","authors":"Nicola Holt, Will Tremlett","doi":"10.1016/j.paed.2025.04.004","DOIUrl":"10.1016/j.paed.2025.04.004","url":null,"abstract":"<div><div>Tracheostomy has a long history, and is a procedure that is carried out in ever growing numbers of children. The main indications for tracheostomy can be divided into airway obstruction, rehabilitation, and long term ventilation. The decision to place a tracheostomy is not trivial, and should be made by the multi-disciplinary team working together with the family, as well as the child where possible. Artificial airways such as a tracheostomy can carry significant risks. The National Tracheostomy Safety Project provides guidelines and resources for their management, which aim to mitigate these risks. Standardization of practices across hospital sites supports this. Appropriate training for all individuals involved in the care of a child with a tracheostomy is essential to minimize the risk of problems.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 6","pages":"Pages 208-213"},"PeriodicalIF":0.0,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of extubation failure on the paediatric intensive care unit","authors":"Deepika Puthucode, Patrick Davies","doi":"10.1016/j.paed.2025.04.003","DOIUrl":"10.1016/j.paed.2025.04.003","url":null,"abstract":"<div><div>Extubation failure is common in PICU especially in the current era when patients with multiple complexities can be of a significant challenge. Extubation failure is defined as inability to sustain spontaneous breathing after removal of artificial airway leading to the need for re-intubation within 48 hours of a planned extubation. The pathophysiology of extubation failure can be grouped under four categories: airway, muscular power, respiratory drive, and lung parenchymal pathologies with cardiopulmonary interactions. To achieve success and maintain extubation, it is important to identify risk factors contributing for failure and fix them, wean ventilation using appropriate weaning strategies and by stepwise process, assess readiness and extubate at the optimum time. Repeated extubation failures can also be complications increasing the risk of mortality and length of stay. Causes are diverse with clinical complexity, needing multidisciplinary team approach for a comprehensive management of extubation failure. The paediatric intensivist needs to recognize children at risk of extubation failure, make a comprehensive plan and intervene at the earliest opportunity to prevent further morbidity.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 6","pages":"Pages 203-207"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}