Paediatrics and Child Health (United Kingdom)最新文献

{"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":"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}

{"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":"Haematuria and proteinuria in childhood","authors":"Andrew Lunn,&nbsp;Thomas A. Forbes","doi":"10.1016/j.paed.2024.06.013","DOIUrl":"10.1016/j.paed.2024.06.013","url":null,"abstract":"<div><p>Haematuria and proteinuria are common findings on urinalysis in childhood. They usually occur in either children with specific symptoms e.g. macroscopic haematuria or nephrotic syndrome, or in those who have non-specific symptoms (usually when looking to exclude urinary tract infection) and sometimes in asymptomatic children. The majority of children fall into the latter two groups, the finding is temporary and not associated with long term renal disease. If the finding is persistent or patients have specific clinical features then renal abnormalities are more frequent and appropriate investigation is required. This review provides a rationale for an approach that allows reassurance to be given to children and their families in whom the finding is transient and benign, whilst identifying those in whom renal abnormalities are present and treatment required. It describes algorithms for macroscopic haematuria (MaH), asymptomatic microscopic haematuria (MiH) and proteinuria.</p></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 9","pages":"Pages 345-351"},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088487","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":"Polycystic kidney disease and other genetic kidney disorders","authors":"Larissa Kerecuk","doi":"10.1016/j.paed.2024.06.008","DOIUrl":"10.1016/j.paed.2024.06.008","url":null,"abstract":"<div><p>Cystic kidney diseases encompass a range of genetic disorders in which the primary cilia of the cells are affected and thereby cysts form as a result. There are an increasing range of cystic renal diseases recognized due to the advances in genomics. The most common genetic kidney condition is autosomal dominant polycystic kidney disease (ADPKD). ADPKD leads to renal failure in adulthood. In children, hypertension is common and if treated, may slow down renal decline. The most common cystic kidney disease causing renal failure in children is autosomal recessive polycystic kidney disease (ARPKD). ARPKD also affects the liver. These conditions often have extra-renal features which also need to be addressed. Until recently, treatments were mainly supportive but now it is possible to slow down development of cyst formation and renal decline in ADPKD. This raises hope for treatment for other cystic renal conditions as more genes are identified and underlying mechanisms defined.</p></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 9","pages":"Pages 311-316"},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088485","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":"Urinary tract infections in children","authors":"Hitesh Prajapati","doi":"10.1016/j.paed.2024.06.012","DOIUrl":"10.1016/j.paed.2024.06.012","url":null,"abstract":"<div><p>Urinary tract infections (UTI) are a common problem in childhood. The clinical presentation is variable depending on age and whether there is pyelonephritis or cystitis. UTI are diagnosed by culturing an appropriately collected urine sample. Most children with UTI can be managed safely with oral antibiotics irrespective of whether they have cystitis or pyelonephritis. Following a single UTI a significant proportion of children will develop recurrent UTI and many of these children will have identifiable risk factors. Treating children with recurrent UTI with repeated courses of antibiotics or long term prophylactic antibiotics puts patients at risk of infections with multi-resistant organisms. Furthermore recurrent UTI are also associated with the risk of renal parenchymal damage with long term health implications. It is therefore essential that management of children with UTI focuses not only on early diagnosis and treatment but also on UTI prevention.</p></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 9","pages":"Pages 340-344"},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088502","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 do children need kidney replacement therapy?","authors":"Jascharanpreet Bansal,&nbsp;Wesley Hayes","doi":"10.1016/j.paed.2024.06.009","DOIUrl":"10.1016/j.paed.2024.06.009","url":null,"abstract":"<div><p>Kidney replacement therapy (KRT) can provide lifesaving support for children with severely impaired kidney function. The decision about who needs KRT and when is often complex. Many acute kidney problems will resolve with conservative maanagemenent but some children with chronic or acute kidney impairment will find themselves in a position where KRT is required either as a bridge to recovery or kidney transplantation. Less commonly, children with metabolic disorders may find that the ability of their own kidneys is overwhelmed by excessive production of certain metabolites. These children may also benefit from short term KRT. This article aims to help paediatricians in training understand which children need kidney replacement therapy, the various types of treatment available, and when they are used.</p></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 9","pages":"Pages 317-322"},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142088486","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":"Fluid and electrolyte balance in children and young people","authors":"Michael Coffey,&nbsp;Mark Terris","doi":"10.1016/j.paed.2024.06.011","DOIUrl":"10.1016/j.paed.2024.06.011","url":null,"abstract":"<div><p><span>Intravenous fluids<span><span> are commonly prescribed to children in hospitals. However, there are risks associated with their use. In order to safely prescribe these clinicians should understand the indications for their use, the principles underpinning their use and know the likely complications associated with intravenous fluid administration in children. </span>Intravenous fluids should be prescribed depending on individual needs of each child and with careful monitoring and re-assessment. This review aims to provide a general approach to fluid prescription in children, providing some background of different physiological principles, different fluid composition, and the role of anti-diuretic hormone in fluid </span></span>homeostasis<span><span>. Fluid prescription is discussed, with an approach taking into consideration resuscitation boluses, dehydration, replacing ongoing losses and maintenance requirements. Case examples are provided to further facilitate readers’ comprehension. Electrolyte abnormalities and an approach to the management of deranged electrolytes is addressed. Complications associated with fluid administration are highlighted, in particular, emphasizing the assessment and emergency management of the child with suspected cerebral oedema or hyponatraemic encephalopathy. Special consideration and discussion is given to the differing approach to fluid management of children in the setting of burns or </span>diabetic ketoacidosis.</span></p></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 9","pages":"Pages 332-339"},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141709351","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":"How we use point-of-care ultrasound in a paediatric critical care unit: scanning everything, everywhere, all at once","authors":"Andras Husz,&nbsp;Andrea Wood,&nbsp;Amina Joarder,&nbsp;Zoltan Gyorgyi","doi":"10.1016/j.paed.2024.06.014","DOIUrl":"10.1016/j.paed.2024.06.014","url":null,"abstract":"<div><p>We would like the reader to consider the current paediatric<span> point-of-care ultrasound (POCUS) landscape. Even in the most developed European healthcare systems, paediatric POCUS programmes and users mostly operate in silos and are un-, or at best underrepresented by major professional bodies. While international societies focus on the extent and content of POCUS investigations, guidelines and associated evidence, there is little to no established framework for education and clinical governance<span> standards on this explosively advancing field. Borrowing from fluid dynamics, this rapid advancement generates cavitation, leaving providers and educators exposed in certain crucial areas of ongoing clinical practice covered contemporaneously, or worse, post hoc, allowing for clinical governance<span><span> or medico-legal scrutiny. We give a glimpse into our prospective local POCUS clinical practice initiative and how it complements, advances and affirms our clinical decision making on a daily basis. We'll guide the reader through ward rounds, procedural applications, specialist assessments with allied health professionals, referrals, remote consultations, new patient admissions, and grand rounds. As we are in the process of building a robust, reliable and accountable clinical governance structure around our daily practice, we would also like to demonstrate the need and utility for introductory courses, ongoing educational sessions, established mentorship and regular governance meetings ensuring optimal clinical outcomes. We hope to give insights to clinical practice, deployment, recruitment, education and potential future applications like </span>telemedicine.</span></span></span></p></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 9","pages":"Pages 352-357"},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141699405","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":"Empowering young people with additional needs to prepare for adulthood: an occupational therapist's view","authors":"Victoria King,&nbsp;Erin Killaspy,&nbsp;Rebecca Perks","doi":"10.1016/j.paed.2024.04.004","DOIUrl":"10.1016/j.paed.2024.04.004","url":null,"abstract":"<div><p>A smooth and coordinated handover to adult health services for young people with additional needs is important. Yet equally as important is preparing the young person for self-management of their health care and independence. A central goal of occupational therapy is to empower young people to lead a meaningful life, as independently as possible. Occupational therapists (OTs) therefore have an important role to play in helping young people with additional needs to prepare for their adult lives. However this article outlines suggestions, signposting and strategies that <em>all</em> professionals could consider which will empower young people with additional needs to prepare for their adulthood during every interaction. It provides a list of recommended materials that the authors have found particularly helpful. It is aimed at all health care professionals working with children and young people.</p></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 7","pages":"Pages 222-227"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140783267","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}