Lancet Child & Adolescent Health最新文献

{"title":"WHO's global roadmap to tackle adolescent hypertension","authors":"Prerna Banati , Maria Vedechkina , Ashish Krishna , Rauell J Santos , Anshu Banerjee , Valentina Baltag","doi":"10.1016/S2352-4642(25)00121-X","DOIUrl":"10.1016/S2352-4642(25)00121-X","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 6","pages":"Pages 367-368"},"PeriodicalIF":19.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International expert consensus statement on PICU admission and early critical care management for paediatric patients following haematopoietic cell transplant and immune effector cell therapy","authors":"Prof Matteo Di Nardo MD ,&nbsp;Prof Saad Ghafoor MD ,&nbsp;Prof Zofia Szmit MD ,&nbsp;Prof Lama Elbahlawan MD ,&nbsp;Prof Courtney M Rowan MD ,&nbsp;Prof Asya Agulnik MD ,&nbsp;Prof Roelie Wosten-Van Asperen MD ,&nbsp;Prof Matthew S Zinter MD ,&nbsp;Prof Marianne E Nellis MD ,&nbsp;Prof Karen Moody MD ,&nbsp;Prof Orsola Gawronski PhD ,&nbsp;Prof Daniele G Biasucci MD ,&nbsp;Beatrice Baldelli MD ,&nbsp;Prof Krzysztof Kalwak MD ,&nbsp;Fabiana Cacace MD ,&nbsp;Manuela Moncada MSc ,&nbsp;Prof Kris M Mahadeo MD","doi":"10.1016/S2352-4642(25)00091-4","DOIUrl":"10.1016/S2352-4642(25)00091-4","url":null,"abstract":"<div><div>Advances in paediatric haematopoietic cell transplantation strategies using immune-effector cells (HCT-IEC) and in intensive care management have improved survival expectations for patients with malignant and non-malignant diseases. However, critical illness still complicates the clinical course for 10–35% of patients undergoing HCT-IEC because of disease-related complications or treatment-related toxicities. Given the improvement in survival for these patients in paediatric intensive care units (PICU), the European Society of Paediatric and Neonatal Intensive Care (ESPNIC), the HCT-Cancer Immunotherapy Subgroup of the Paediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, and the Paediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation (EBMT) derived expert consensus statements to guide PICU admission and early critical care management of patients following HCT-IEC. 27 statements were drafted by the steering committee and subsequently voted on by 20 expert panel members with expertise in HCT and IEC. 20 statements received strong agreement and seven received weak agreement. This consensus statement serves as a guide for intensivists, haematologists, and oncologists during the challenging process of PICU admission and critical care management of patients who have undergone HCT-IEC and can serve as a basis for prioritising future research in the field.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 6","pages":"Pages 426-438"},"PeriodicalIF":19.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insulin for early glycaemic abnormality in children with cystic fibrosis without cystic fibrosis-related diabetes (CF-IDEA): a randomised controlled trial","authors":"Shihab Hameed PhD ,&nbsp;Elizabeth H Barnes MStat ,&nbsp;Julie Briody MBioMedEng ,&nbsp;Prof Claire E Wainwright MD ,&nbsp;Jodi Hilton MD ,&nbsp;Penny I Field MD ,&nbsp;Andrew Tai PhD ,&nbsp;Yvonne Belessis PhD ,&nbsp;Christine L Chan MD ,&nbsp;Hiran Selvadurai PhD ,&nbsp;Bernadette Prentice PhD ,&nbsp;Tamarah Katz ,&nbsp;Sarah K McMahon PhD ,&nbsp;Michelle Neylan MN ,&nbsp;Alexia Pena PhD ,&nbsp;Prof Adam Jaffe MD ,&nbsp;Charles F Verge PhD","doi":"10.1016/S2352-4642(25)00099-9","DOIUrl":"10.1016/S2352-4642(25)00099-9","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;People with cystic fibrosis can have impaired insulin secretion and hyperglycaemia before meeting the diagnostic criteria for cystic fibrosis-related diabetes during an oral glucose tolerance test (OGTT). Insulin therapy given to such patients was associated with improved weight and lung function in several small, uncontrolled trials but might increase treatment burden and cause hypoglycaemia. We aimed to assess whether insulin treatment improves weight and lung function when given to patients with cystic fibrosis with early glycaemic abnormality.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;CF-IDEA was a multicentre, randomised controlled trial conducted at five children's hospitals in Australia and one in the USA. Eligible participants were children with cystic fibrosis aged 5–18 years without cystic fibrosis-related diabetes and with peak glucose concentration on a five-point OGTT of 8·2–11·0 mmol/L (cystic fibrosis insulin deficiency stage 1) or ≥11·1 mmol/L (cystic fibrosis insulin deficiency stage 2). Participants were randomly assigned (1:1) to insulin or observation. Randomisation was done using the biased coin method, followed by minimisation when the study groups became imbalanced by chance. Randomisation was stratified by glycaemic category (cystic fibrosis insulin deficiency stage 1 or 2), weight Z score (more than or equal to –0·61 or less than –0·61), and study centre. Participants in the insulin group received once-daily, long-acting insulin detemir by subcutaneous injection before breakfast, commencing at 0·1 units per kg per day, adjusted in 0·5-unit increments to achieve all fingerstick blood glucose concentrations between 4 mmol/L and 8 mmol/L. The primary outcomes were absolute changes in weight Z score, percentage predicted forced expiratory volume in 1 s (ppFEV&lt;sub&gt;1&lt;/sub&gt;), and percentage predicted forced vital capacity (ppFVC), derived with generalised estimating equations and presented with two-sided 95% CIs. Severe hypoglycaemic events (defined as requiring outside assistance or causing reduced level of consciousness or seizure), insulin-related adverse events, and continuous glucose monitoring (CGM) percentage time with blood glucose below 3·9 mmol/L were recorded as safety outcomes. This study is registered with ClinicalTrials.gov, NCT01100892, and is completed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Between Dec 6, 2010, and Feb 25, 2022, 109 participants were randomly assigned to observation (n=54) or insulin (n=55). Five participants withdrew after the baseline visit, and the analysis therefore included 104 participants (53 observation and 51 insulin); 95 participants completed the 12-month protocol and nine completed only 6 months. Baseline characteristics were similar between the groups; however, the observation group included 30 (57%) boys and 23 (43%) girls, whereas the insulin group included 23 (45%) boys and 28 (55%) girls. The median daily insulin dose at 12 months was 0·12 units per kg per","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 6","pages":"Pages 371-382"},"PeriodicalIF":19.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Child Adolesc Health 2024; 8: 571–79","authors":"","doi":"10.1016/S2352-4642(25)00136-1","DOIUrl":"10.1016/S2352-4642(25)00136-1","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 6","pages":"Page e14"},"PeriodicalIF":19.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"180-day efficacy of nirsevimab against hospitalisation for respiratory syncytial virus lower respiratory tract infections in infants (HARMONIE): a randomised, controlled, phase 3b trial","authors":"Alasdair P S Munro PhD ,&nbsp;Simon B Drysdale PhD FRCPCH ,&nbsp;Katrina Cathie MD FRCPCH ,&nbsp;Florence Flamein MD PhD ,&nbsp;Prof Markus Knuf PhD ,&nbsp;Andrea M Collins MD PhD ,&nbsp;Helen C Hill PhD ,&nbsp;Friedrich Kaiser MD ,&nbsp;Robert Cohen MD ,&nbsp;Didier Pinquier MD ,&nbsp;Natalya C Vassilouthis MD ,&nbsp;Mariana Carreno MD ,&nbsp;Catherine Moreau MSc ,&nbsp;Pierre Bourron PharmD ,&nbsp;Lydie Marcelon PhD ,&nbsp;Karine Mari PhD ,&nbsp;Michelle Roberts MD ,&nbsp;Prof Pierre Tissières MD DSc ,&nbsp;Simon Royal MPH MRCGP ,&nbsp;Prof Saul N Faust PhD FRCPCH ,&nbsp;Richard Burkimsher","doi":"10.1016/S2352-4642(25)00102-6","DOIUrl":"10.1016/S2352-4642(25)00102-6","url":null,"abstract":"<div><h3>Background</h3><div>Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection and hospitalisations in infants worldwide. The primary analyses of HARMONIE showed that nirsevimab reduced infant hospitalisations due to RSV-associated lower respiratory tract infection through the RSV season. This analysis aims to evaluate nirsevimab's efficacy at 180 days after dosing, a period exceeding the typical 5-month RSV season.</div></div><div><h3>Methods</h3><div>HARMONIE is an ongoing, open-label, parallel arm, randomised, controlled, phase 3b study conducted in France, Germany, and the UK. Infants aged 12 months or younger, born at a gestational age of at least 29 weeks, were randomly assigned (1:1) to receive either a single intramuscular dose of nirsevimab (50 mg for children &lt;5 kg or 100 mg for children ≥5 kg) or standard care (without RSV prophylaxis) before or during their first RSV season. Randomisation was electronically done, stratified by country and age-group. The primary efficacy endpoint for this analysis was the incidence of hospitalisations due to RSV-associated lower respiratory tract infection up to 180 days after nirsevimab administration or randomisation in all randomised participants. Safety up to 365 days following nirsevimab administration was also assessed. This trial is ongoing and registered with ClinicalTrials.gov, number NCT05437510.</div></div><div><h3>Findings</h3><div>Between Aug 8, 2022, and Feb 28, 2023, 8057 infants were randomly assigned to either the nirsevimab group (n=4038) or the standard care group (n=4019). The median age at randomisation was 4·00 months (IQR 1·0–7·0; range 0·0–12·0, and 4195 (52·1%) were male and 3862 (47·9%) were female. Up to 180 days, 12 (0·3%) of 4038 infants in the nirsevimab group and 68 (1·7%) of 4019 infants in the standard care group had been hospitalised for RSV-associated lower respiratory tract infection, corresponding to a nirsevimab efficacy of 82·7% (95% CI 67·8–91·5; p&lt;0·0001). Most participants experienced grade 1 (2759 [68·7%] of 4016 in the nirsevimab group; 2696 [67·1%] of 4018 in the standard care group) or grade 2 (1447 [36·0%] of 4016 in the nirsevimab group; 1436 [35·7%] of 4018 in the standard care group) treatment-emergent adverse events, and no apparent safety concerns were raised up to 365 days after dosing.</div></div><div><h3>Interpretation</h3><div>Nirsevimab offers consistent and sustained protection against hospitalisation due to RSV-associated lower respiratory tract infection for at least 6 months. This finding provides global health systems greater flexibility when implementing nirsevimab, providing substantial benefit in the ongoing effort to reduce the burden of infant RSV and the potential wider public health value.</div></div><div><h3>Funding</h3><div>Sanofi and AstraZeneca.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 6","pages":"Pages 404-412"},"PeriodicalIF":19.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus recommendations for early critical care management of paediatric HCT and IEC recipients: what comes next?","authors":"Kevin O McNerney ,&nbsp;Daniela C de Souza ,&nbsp;L Nelson Sanchez-Pinto","doi":"10.1016/S2352-4642(25)00129-4","DOIUrl":"10.1016/S2352-4642(25)00129-4","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 6","pages":"Pages 363-365"},"PeriodicalIF":19.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Child Adolesc Health 2025; 9: 325–36","authors":"","doi":"10.1016/S2352-4642(25)00135-X","DOIUrl":"10.1016/S2352-4642(25)00135-X","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 6","pages":"Page e14"},"PeriodicalIF":19.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Keeping families stable, secure, and together","authors":"The Lancet Child & Adolescent Health","doi":"10.1016/S2352-4642(25)00137-3","DOIUrl":"10.1016/S2352-4642(25)00137-3","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 6","pages":"Page 361"},"PeriodicalIF":19.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting paediatric pneumonia severity in the emergency department: a multinational prospective cohort study of the Pediatric Emergency Research Network","authors":"Todd A Florin MD ,&nbsp;Prof Daniel J Tancredi PhD ,&nbsp;Lilliam Ambroggio PhD ,&nbsp;Prof Franz E Babl MD ,&nbsp;Prof Stuart R Dalziel PhD ,&nbsp;Michelle Eckerle MD ,&nbsp;Prof Santiago Mintegi PhD ,&nbsp;Prof Mark I Neuman MD ,&nbsp;Prof Amy C Plint MD ,&nbsp;Norma-Jean Simon MPH ,&nbsp;Prof Nathan Kuppermann MD","doi":"10.1016/S2352-4642(25)00094-X","DOIUrl":"10.1016/S2352-4642(25)00094-X","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Risk stratification tools for paediatric community-acquired pneumonia (CAP) in well-resourced settings are scarce. We prospectively developed models to predict CAP severity within a multinational cohort of paediatric emergency departments (EDs). Our primary objective was to develop a risk prediction model to discriminate between mild CAP and moderate or severe CAP to assist clinicians in determining the need for hospitalisation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This prospective cohort study was conducted from Feb 6, 2019, to June 30, 2021, at 73 EDs in 14 countries. Children aged 3 months to &lt;14 years with clinical diagnoses of CAP were included. Children were excluded if they were recently hospitalised or had a chronic complex condition (eg, immunodeficiency). The primary outcome was severity, defined as mild (CAP treated in the outpatient setting or hospitalisation &lt;24 h with no use of oxygen or intravenous fluids during that time), moderate (hospitalisation &lt;24 h with oxygen or fluids, or hospitalisation ≥24 h regardless of interventions but without an outcome qualifying as severe CAP), or severe (chest drainage, intensive care unit admission &gt;24 h, positive-pressure ventilation, septic shock, vasoactive infusions, extracorporeal membrane oxygenation, or death) occurring within 7 days of the ED visit. Models were developed using logistic regression with bootstrap validation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Of 2222 children in the overall study population (1103 [49·7%] female, 1119 [50·3%] male; median age 3 years [IQR 1–5]), 1290 (58·1%) had mild CAP, 812 (36·5%) moderate, and 120 (5·4%) severe. Primary analyses were performed in 1901 patients with complete data: 1011 (53·2%) mild, 772 (40·6%) moderate, and 118 (6·2%) severe CAP. Congestion or rhinorrhoea was negatively associated with moderate or severe CAP (adjusted odds ratio 0·59 [95% CI 0·46–0·76]), while abdominal pain (1·52 [1·17–1·97]), refusal to drink (1·57 [1·24–2·00]), antibiotics before ED visit (1·64 [1·29–2·10]), chest retractions (2·86 [2·24–3·65]), respiratory rate above the 95th percentile for age (1·63 [1·29–2·06]), heart rate above the 95th percentile for age (1·64 [1·27–2·12]), and hypoxaemia (oxygen saturation 90–92%, 3·24 [2·46–4·27]; &lt;90%, 13·39 [8·64–20·73]) were positively associated. The model accurately discriminated between mild CAP and moderate or severe CAP (c-statistic 0·82 [95% CI 0·80–0·84]). Similar results were found in those with radiographic CAP, with decreased breath sounds and multifocal opacities on radiography as additional predictors (c-statistic 0·82 [0·80–0·85]).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;We developed accurate, pragmatic severity risk prediction models among children with CAP. After future external validation, these models have the potential to provide individualised risk assessments that can be incorporated into clinical judgement in well-resourced health systems to improve man","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 6","pages":"Pages 383-392"},"PeriodicalIF":19.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empowering young voices in clinical research: co-creation of an educational video to support informed assent","authors":"Anne E M Kamphuis,&nbsp;Lungile P Jafta,&nbsp;Tom G Jacobs,&nbsp;Penta Youth Trials Board","doi":"10.1016/S2352-4642(25)00138-5","DOIUrl":"10.1016/S2352-4642(25)00138-5","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 6","pages":"Pages 369-370"},"PeriodicalIF":19.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143948936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}