Paediatrics and Child Health (United Kingdom)最新文献

{"title":"Chronic peritoneal dialysis in children","authors":"Iona Madden,&nbsp;Michelle Blaauw,&nbsp;Natasha Baugh,&nbsp;Lesley Rees,&nbsp;Rukshana Shroff","doi":"10.1016/j.paed.2024.06.010","DOIUrl":"10.1016/j.paed.2024.06.010","url":null,"abstract":"<div><p>End stage kidney disease is rare in children and adolescents. The availability and types of kidney replacement therapy (KRT) vary widely, with a global prevalence of 18–100 per million age-related population (pmarp). Chronic peritoneal dialysis (PD) is considered the dialysis modality of choice in younger children given its almost universal applicability, cost-effectiveness, and the possibility of a home-based treatment. This is most compatible with a child's schooling and social life. Advances in technology have improved outcomes even for the youngest children, but mortality remains high, and the morbidity and burden of care should not be underestimated. Optimal management of children on dialysis requires a multidisciplinary team and consideration of the child and family's expectations. With few high-quality randomised trials, clinicians are reliant on prospective cohort studies and international registries to inform and improve management strategies. Children on dialysis have a lifetime of KRT ahead of them. The selection of dialysis modality and management must consider the principles of dialysis access preservation. This review summarises current epidemiology, principles of dialysis, PD access, modalities, prescriptions, and complications of PD, as well as a brief discussion on PD in infants with their unique ethical and technical considerations.</p></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 9","pages":"Pages 323-331"},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142087431","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":"Complications of short bowel syndrome","authors":"Gautham Pai,&nbsp;Theodoric Wong,&nbsp;Girish Gupte","doi":"10.1016/j.paed.2024.07.004","DOIUrl":"10.1016/j.paed.2024.07.004","url":null,"abstract":"<div><div>Short bowel syndrome is the most common reversible cause of intestinal failure. Most of the children are started on parenteral nutrition (PN) after surgery to enable growth and allow time for intestinal adaptation. This is a process whereby the shorter length of bowel is able to achieve complete function as if the entire length of bowel is present. With management advances, most children with short bowel syndrome can discontinue PN and establish full enteral feeds. This article mainly focuses on the complications of short bowel syndrome that need to be avoided for the child to achieve intestinal adaptation, establish on enteral feeds/oral diet and achieve enteral autonomy.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 10","pages":"Pages 373-378"},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312385","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":"Paediatric inflammatory bowel disease: an update on current practice","authors":"Zachary Green,&nbsp;James J Ashton,&nbsp;R Mark Beattie","doi":"10.1016/j.paed.2024.07.005","DOIUrl":"10.1016/j.paed.2024.07.005","url":null,"abstract":"<div><div>Paediatric inflammatory bowel disease (PIBD), consisting of Crohn's disease, ulcerative colitis and inflammatory bowel disease unclassified, is a spectrum of chronic inflammatory conditions associated with significant morbidity. The incidence of PIBD continues to increase and disease phenotype is more severe than adult-onset disease. Referral to specialist services and diagnosis of PIBD can be slow; and faecal calprotectin is an invaluable tool for the prioritization of further investigation. Greater understanding of pre-existing treatments (such as anti-TNF monoclonal antibody therapy) and a growing arsenal of biologic and small molecule drugs have brought about significant changes in disease management. Whilst important challenges remain in the longer-term treatment of PIBD, including growth, nutrition and management of refractory disease, there remains a strong research focus on understanding underlying disease pathogenesis and a move towards personalized medicine. This review describes investigations, diagnosis and management of PIBD and presents contemporary evidence on nutritional and medical management.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 10","pages":"Pages 379-387"},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312386","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":"Paediatric major incident translational in-situ simulation: a how-to guide","authors":"Natalie Bee,&nbsp;Kirsty Kilpatrick","doi":"10.1016/j.paed.2024.06.006","DOIUrl":"10.1016/j.paed.2024.06.006","url":null,"abstract":"<div><p>Major incidents in paediatrics are rare in the western world but when they occur the morbidity and mortality can be devastating. We need to ensure our teams are prepared and trained to manage such events should they occur. Major incident planning has historically been through large group discussions away from the clinical environment. With the use of in-situ translational simulation we have the opportunity to strengthen major incident planning by testing organizational systems and responses whilst simultaneously training staff, developing both their technical and non-technical skills. This paper guides the multidisciplinary team through ten key steps to developing your own major incident simulation.</p></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 8","pages":"Pages 300-304"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141690608","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":"Upper limb function in children with cerebral palsy: a structured approach to assessment and management","authors":"Jo Lloyd,&nbsp;May Yip,&nbsp;Jill Cadwgan","doi":"10.1016/j.paed.2024.06.004","DOIUrl":"10.1016/j.paed.2024.06.004","url":null,"abstract":"<div><p>The cerebral palsies<span><span> (CP) have a UK prevalence of 1–2/1000. 60–80% of children with CP have upper-limb involvement. Physical movement difficulties including tone abnormalities, weakness and secondary musculoskeletal function are associated with sensory, cognitive difficulties and medical co-morbidities. Understanding the underlying </span>pathophysiology of CP and structured multidisciplinary assessment in the context of the International Classification of Functioning, Disability and Health (ICF) can guide management to improve activity and participation for children with CP. A range of therapy, medical and surgical interventions may be offered to a child and their family. The selection of treatment options should be focused on individualized and realistic goals. Clear outcomes should be evaluated. This review aims to summarize a structured approach to assessment and management of upper limb function in CP; and is illustrated by case examples.</span></p></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 8","pages":"Pages 279-289"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961962","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":"Self-assessment","authors":"Alexander Sutton,&nbsp;Peter Heinz","doi":"10.1016/j.paed.2024.06.007","DOIUrl":"10.1016/j.paed.2024.06.007","url":null,"abstract":"","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 8","pages":"Pages 305-309"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961963","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":"Lower-limb botulinum toxin A treatment in ambulant children with cerebral palsy","authors":"Lesley R Katchburian,&nbsp;Marcos V Katchburian","doi":"10.1016/j.paed.2024.06.005","DOIUrl":"10.1016/j.paed.2024.06.005","url":null,"abstract":"<div><p>Cerebral palsy<span><span> (CP) is frequently characterized by hypertonia<span>, impairing motor function and affecting the quality of life of children and young people with CP (CYPwCP). </span></span>Botulinum Toxin A<span><span> (BoNT-A) has emerged as a widely utilized treatment modality to manage lower limb hypertonia<span> in ambulant CYPwCP. This paper explores the current evidence base and clinical practice surrounding the use of BoNT-A in this population. BoNT-A injections are indicated for the management of focal lower limb hypertonia, targeting specific muscles that contribute to functional limitations. Clinical assessment plays a pivotal role in determining the suitability of BoNT-A treatment, with emphasis placed on evaluating tone, functional impairments, and individualized treatment goals. Timing of treatment is crucial, with interventions typically initiated when dynamic tone significantly impacts motor function and mobility. Optimal treatment age remains a topic of debate, with studies indicating benefits across various age groups. Close monitoring and regular follow-up evaluations are essential components of BoNT-A treatment, ensuring timely adjustments to address changing needs. BoNT-A represents a valuable therapeutic option for managing lower limb hypertonia in ambulant CYPwCP. Clinical decision-making should be guided by comprehensive assessments, utilization of appropriate outcome measures, and consideration of individualized treatment goals. Further research is warranted to elucidate optimal treatment strategies, long-term efficacy, and potential </span></span>adverse effects to optimize outcomes in this patient population.</span></span></p></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 8","pages":"Pages 290-299"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691418","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":"Effectiveness of postural interventions in cerebral palsy: umbrella systematic review","authors":"Monica Toohey,&nbsp;Remy Blatch-Williams,&nbsp;Kristian Budini,&nbsp;Astrid Ferreira,&nbsp;Alexandra Griffin,&nbsp;Ashleigh Hines,&nbsp;Michelle Jackman,&nbsp;Karin Lind,&nbsp;Jill Massey,&nbsp;Maria Mc Namara,&nbsp;Jenna Mitchell,&nbsp;Catherine Morgan,&nbsp;Esther Norfolk,&nbsp;Madison CB. Paton,&nbsp;Daniel Polyblank,&nbsp;Sarah Reedman,&nbsp;Iona Novak","doi":"10.1016/j.paed.2024.06.003","DOIUrl":"10.1016/j.paed.2024.06.003","url":null,"abstract":"<div><p>Cerebral palsy<span> is a disorder of posture and movement. Multiple postural management<span><span><span> interventions exist to prevent complications and improve outcomes. In this short review we followed a systematic approach to appraise the quality of evidence supporting each intervention and assessed the effectiveness across the International Classification of Functioning, Disability and Health (ICF) outcomes. Evidence-based recommendations are essential for assisting clinicians in selecting and implementing interventions aligned with the individual's goals. This review aims to summarize and evaluate the evidence supporting postural interventions for CP published after Gough's review in 2009. Additionally, it aims to provide clinical bottom lines according to GMFCS or MACS levels. We conducted our search for </span>systematic reviews or population register studies evaluating postural management interventions in people with cerebral palsy using an umbrella systematic review design. We assessed the quality of evidence for each intervention and made recommendations using GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) and the Evidence Alert Traffic Light approaches. From a total of 955 citations identified 33 unique studies met our inclusion criteria. The 33 studies included 41 interventions, measuring 22,835 participants, across 207 </span>RCTs and 1 population register study. Of the 41 interventions, 14 were postural control interventions to improve movement; 11 were tone management interventions to improve movement or prevent deformity; 2 were postural management interventions to support upright posture; and 14 were postural management interventions to prevent deformity. Several postural control interventions are effective for improving movement, and several postural management interventions may prevent deformity, with hip surveillance having the best evidence.</span></span></p></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 8","pages":"Pages 257-278"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961961","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":"‘Getting the tone right’: an approach to managing hypertonia in cerebral palsy","authors":"Rajib Lodh,&nbsp;Joanna Coghill","doi":"10.1016/j.paed.2024.06.001","DOIUrl":"10.1016/j.paed.2024.06.001","url":null,"abstract":"<div><p><span>Spasticity and dystonia are the commonest tonal abnormalities presenting in children and young people with </span>Cerebral Palsy<span><span> (CP). Hypertonia<span> can cause difficulties in a wide variety of areas and impact on quality of life. Secondary changes in muscle and bone can result in further disability. Management of hypertonia is facilitated by appropriate identification of goals, muscles involved and type of hypertonia present. Stretches, exercise programmes, </span></span>orthotic<span> and equipment interventions are important mainstays in management of hypertonia. Identifying and addressing possible triggers can avert need for escalation of treatments. Medication choice and suitability of surgical interventions are influenced by other individual factors such as acceptability, route of administration and perceived benefits versus risks of intervention. Multidisciplinary working is an important cornerstone of hypertonia management. There are several medications available for treatment of hypertonia, although evidence is limited in their use in childhood. Where children have not tolerated or benefitted from medical treatments, surgical interventions may be appropriate. This short article is aimed at everyone involved in the care of children with hypertonia as a result of CP. It discusses how to select the right treatment for right patient and offers practical advice to clinicians.</span></span></p></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 8","pages":"Pages 239-248"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711184","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":"When to use lower limb orthoses in cerebral palsy","authors":"Elaine Owen","doi":"10.1016/j.paed.2024.06.002","DOIUrl":"10.1016/j.paed.2024.06.002","url":null,"abstract":"<div><p><span><span>Healthcare practitioners will encounter children who use orthoses to improve or maintain body structures and functions, activities and participation. </span>Orthotic interventions involve complex science and the benefits need to outweigh the burden. Interdisciplinary collaborative family centred goal setting, from birth to adulthood is essential. An understanding of why and when orthoses are helpful allows a deeper discussion with families and can improve adherence. This article presents a systematic ‘Inside-Out Approach’ incorporating the International Classification of Functioning, Disability and Health and the International Organization for Standardization objectives for orthotic interventions. Pictorial and Table Tools identify potential goals for bones and </span>joints<span>, muscles, motor control of standing and walking, activities and participation, and prevention of pain which is an indicator of quality of life<span>. Achieving short and long term goals requires early intervention. The design, alignments and dosage, the duration and frequency the child needs to wear the orthosis, required to achieve goals will be determined by an understanding of natural history and prognosis, the agreed goals and the child's schedule of activities. A Dosage Tool is presented. Recent improved understanding of the contribution of the footwear, individualized and optimized joint and segment alignments and segment proportion is discussed.</span></span></p></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 8","pages":"Pages 249-256"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961964","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}