Lancet Child & Adolescent Health最新文献

{"title":"How long is prolonged mechanical ventilation in children, and does it matter?","authors":"Brenda M Morrow","doi":"10.1016/S2352-4642(24)00307-9","DOIUrl":"10.1016/S2352-4642(24)00307-9","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 1","pages":"Pages 2-3"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866941","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":"Serum GFAP and UCH-L1 for the identification of clinically important traumatic brain injury in children in France: a diagnostic accuracy substudy","authors":"Antoine Puravet PharmD ,&nbsp;Charlotte Oris PharmD PhD ,&nbsp;Bruno Pereira PhD ,&nbsp;Samy Kahouadji PharmD ,&nbsp;Prof Philippe Gonzalo PharmD PhD ,&nbsp;Prof Damien Masson PharmD PhD ,&nbsp;Julie Durif MSc ,&nbsp;Prof Catherine Sarret MD PhD ,&nbsp;Prof Vincent Sapin PharmD PhD ,&nbsp;Prof Damien Bouvier MD PhD","doi":"10.1016/S2352-4642(24)00295-5","DOIUrl":"10.1016/S2352-4642(24)00295-5","url":null,"abstract":"<div><h3>Background</h3><div>Many children with mild traumatic brain injury (mTBI), defined by a Glasgow Coma Scale (GCS) score between 13 and 15, undergo hospitalisation or cranial CT (CCT) scans despite the absence of clinically important traumatic brain injury (ciTBI; ie, hospitalisation &gt;2 days associated with intracranial lesions on CCT, neurosurgical intervention, intensive care admission, or death). Clinical algorithms have reduced CCT scans and hospitalisations by 10%. We aimed to established age-appropriate reference values for GFAP and UCH-L1 and evaluate their diagnostic test performance in identifying ciTBI in children.</div></div><div><h3>Methods</h3><div>This study was a diagnostic test accuracy substudy within the PROS100B stepped wedge cluster randomised trial that included children aged 16 years or younger, clinically managed within 3 h of mTBI, with a GCS score of 15 requiring hospitalisation or CCT scan according to French Pediatric Society guidelines (equivalent to the intermediate risk group of the PECARN algorithm). Enrolment for PROS100B occurred from Nov 1, 2016, to Oct 31, 2021, at 11 hospital emergency departments in France. Stored blood samples collected from March 1, 2015, to Oct 31, 2015, from children aged 16 years or younger who were outpatients for allergic conditions unrelated to mTBI and free of neurological disease were used as a control group to calculate reference values of GFAP and UCH-L1 across four age groups (&lt;6 months, 6 months to &lt;2 years, 2 years to &lt;4 years, and 4 years to &lt;16 years). The diagnostic test performance of GFAP and UCH-L1, both above the reference range to identify ciTBI, was evaluated in the children with mTBI. GFAP and UCH-L1 were measured with the Alinity analyser (Abbott, Chicago, IL, USA).</div></div><div><h3>Findings</h3><div>Reference values were calculated from GFAP and UCH-L1 measured in samples from 718 control children (378 [53%] boys and 340 [47%] girls). 531 children (334 [63%] boys and 197 [37%] girls) aged 0–16 years with mTBI were included. By applying our reference values for GFAP and UCH-L1 across four age groups the biomarker combination (both biomarkers above reference ranges) had a sensitivity of 100% (95% CI 69–100), a negative predictive value of 100% (99–100), a specificity of 67% (63–71), a positive likelihood ratio of 3·01 (2·67–3·40), a negative likelihood ratio of 0, and an area under the curve of 0·83 (0·81–0·85) in identifying ciTBI.</div></div><div><h3>Interpretation</h3><div>Serum GFAP and UCH-L1 identify ciTBI in children with 100% sensitivity and 67% specificity, which could potentially reduce unnecessary CCT scans and hospitalisations in children with mTBI if implemented.</div></div><div><h3>Funding</h3><div>French Ministry of Health.</div></div>","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 1","pages":"Pages 47-56"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788350","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":"Addressing multiple neurodivergent identities in clinical and research settings","authors":"Sarah L Chellappa","doi":"10.1016/S2352-4642(24)00261-X","DOIUrl":"10.1016/S2352-4642(24)00261-X","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 1","pages":"Pages 5-6"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690202","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":"Longer-term survival, quality of life, and cost-effectiveness of conservative versus liberal oxygenation targets in critically ill children: a pre-specified analysis from Oxy-PICU, a multicentre, open, parallel-group, randomised controlled trial","authors":"Silvia Moler-Zapata PhD ,&nbsp;Prof Mark J Peters PhD ,&nbsp;Doug W Gould PhD ,&nbsp;Elisa Giallongo MSc ,&nbsp;Marzena Orzol MSc ,&nbsp;Samiran Ray PhD ,&nbsp;Karen Thomas MSc ,&nbsp;Irene Chang MSc ,&nbsp;Lauran O'Neill BSc ,&nbsp;Rachel Agbeko PhD ,&nbsp;Carly Au BSc ,&nbsp;Prof Elizabeth Draper PhD ,&nbsp;Prof Lee Elliot-Major PhD ,&nbsp;Lamprini Lampro MSc ,&nbsp;Jon Pappachan MD ,&nbsp;Sam Peters BSc ,&nbsp;Padmanabhan Ramnarayan MD ,&nbsp;Prof Kathryn M Rowan PhD ,&nbsp;Prof David A Harrison PhD ,&nbsp;Paul R Mouncey MSc ,&nbsp;Andrew Davies","doi":"10.1016/S2352-4642(24)00294-3","DOIUrl":"10.1016/S2352-4642(24)00294-3","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Peripheral oxygen saturation (SpO&lt;sub&gt;2&lt;/sub&gt;) above 94% is typical in children in paediatric intensive critical care units (PICUs) who are receiving invasive ventilation and supplemental oxygen. In a previous report from the Oxy-PICU trial, we showed that lower (conservative) oxygenation targets (SpO&lt;sub&gt;2&lt;/sub&gt; 88–92%) are beneficial, showing small but statistically significant differences in duration of organ support and large but non-significant cost reductions at 30 days. In this pre-specified analysis of the Oxy-PICU trial, we compare longer-term outcomes and cost-effectiveness of conservative versus liberal (SpO&lt;sub&gt;2&lt;/sub&gt; &gt;94%) oxygenation targets in children with emergency PICU admission.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Oxy-PICU was a pragmatic, multicentre, open-label, randomised controlled trial in England and Scotland. Eligible children were older than 38 weeks and younger than 16 years and had been admitted for emergency care in one of 15 participating PICUs, where they received invasive respiratory support for abnormal gas exchange. Participants were randomly assigned (1:1) to either a conservative oxygenation target (SpO&lt;sub&gt;2&lt;/sub&gt; 88–92%) or liberal oxygenation target (SpO&lt;sub&gt;2&lt;/sub&gt; &gt;94%). Survival status was assessed at 90 days and 1 year, and health-related quality of life (HRQoL), quality-adjusted life-years (QALYs), health-care costs, and incremental net monetary benefit were assessed at 1 year after the index hospital admission and randomisation. HRQoL was measured with age-appropriate Paediatric Quality of Life Generic Core Scales and mapped onto the Child Health Utility 9D index score. HRQoL and survival data were combined to construct QALYs. Costs at 1 year were derived from use of hospital, outpatient, and community health services. The trial was registered in the ISRCTN registry (ISRCTN92103439).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;2040 children were enrolled between Sept 1, 2020 and May 15, 2022. 1868 (91·6%) children were included in the 90-day survival analysis; of these 930 (49·8%) had been assigned liberal oxygen and 938 (50·2%) conservative oxygen. 1867 (91·5%) children were included in the 1-year survival analysis; 930 (49·8%) had been assigned liberal oxygenation and 937 (50·2%) conservative oxygen. At 90 days, 35 (3·7%) patients in the conservative oxygenation group and 45 (4·8%) patients in the liberal oxygenation group had died (adjusted hazard ratio [aHR] 0·75 [95% CI 0·48 to 1·17]). By 1 year, 52 (5·5%) patients in the conservative oxygenation group and 66 (7·1%) patients in the liberal oxygenation group had died (aHR 0·77 [95%CI 0·53 to 1·10]). Overall, mean HRQoL, life-years, and QALYs at 1 year were similar in the two groups. The adjusted incremental effect on cost of conservative oxygenation versus liberal oxygenation was –£879 (95% CI –9036 to 7278), whereas the incremental difference in QALYs was estimated at 0·001 (–0·010 to 0·011), leading to an increment","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 1","pages":"Pages 16-24"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, management, health-care burden, and 90-day outcomes of prolonged mechanical ventilation in the paediatric intensive care unit (LongVentKids): an international, prospective, cross-sectional cohort study","authors":"Prof Atsushi Kawaguchi MD ,&nbsp;Analia Fernandez MD ,&nbsp;Florent Baudin MD ,&nbsp;Fabrizio Chiusolo MD ,&nbsp;Jan Hau Lee MBBS ,&nbsp;Joe Brierley MBBS ,&nbsp;José Colleti Jr MD ,&nbsp;Karl Reiter MD ,&nbsp;Prof Kyung Won Kim MD ,&nbsp;Yolanda Lopez Fernandez MD ,&nbsp;Prof Martin Kneyber MD ,&nbsp;Marti Pons-Òdena PhD ,&nbsp;Natalie Napolitano PhD ,&nbsp;Robert J Graham MD ,&nbsp;Tatsuya Kawasaki MD ,&nbsp;Daniel Garros MD ,&nbsp;Gonzalo Garcia Guerra MD ,&nbsp;Prof Philippe Jouvet MD","doi":"10.1016/S2352-4642(24)00296-7","DOIUrl":"10.1016/S2352-4642(24)00296-7","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;The number of children requiring prolonged mechanical ventilation (PMV) has increased with the advancement of medical care. We aimed to estimate the prevalence of PMV worldwide, document demographic and clinical characteristics of children requiring PMV in paediatric intensive care units (PICUs), and to understand variation in clinical practice and health-care burden.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This international, multicentre, cross-sectional cohort study screened participating PICUs in 28 countries for children aged &gt;37 postgestational weeks to 17 years who had been receiving mechanical ventilation (MV; invasive or non-invasive) for at least 14 consecutive days. Screening days took place every 90 days for 3 years. Patients were eligible for inclusion in the analysis if they had been receiving MV (invasive or non-invasive) for at least 14 consecutive days by their first day of screening. Eligible patients were followed up on the subsequent screening day 90 days later or at time of hospital discharge, whichever came first. Outcome data were recorded in a validated web-based case report file. The primary outcome was the prevalence of PMV. Secondary outcomes were mortality, duration of MV, tracheostomy, and number of complications. All outcomes were assessed at 90 days post-screening. The study was registered with &lt;span&gt;&lt;span&gt;ClinicalTrials.gov&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;, &lt;span&gt;&lt;span&gt;NCT04112459&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt;.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Between Sept 4, 2019 and Dec 7, 2022, 14 595 children were screened on four separate screening days in 158 PICUs, and 2773 patients had been receiving MV for at least 14 days and were included in the analysis. The point prevalence of PMV was 25·8% (IQR 24·1–28·5). Median age was 0·4 years (IQR 0·2–5·3) and median weight was 8·1 kg (IQR 4·7–19·1). 625 (24·0%) of 2610 patients had a history of prematurity (&lt;37 weeks gestational age at birth). 90-day outcome data were collected for 2430 patients. 441 (18·2%) of 2430 patients had died within 90 days. 649 (29·8%) of 2176 patients who initiated ventilation support upon hospital admission had a tracheostomy placed after the first 14 days of MV. The median time to tracheostomy placement after MV initiation was 26 days (IQR 18–52). 462 (21·2%) of 2176 patients had at least one failed extubation between MV initiation and their first screening date. 556 (25·6%) of 2174 patients who started MV upon hospital admission required MV for 21 days or less, whereas 1618 (74·4%) patients required MV for 22 days or more; 90-day mortality did not differ between these groups (18·2% &lt;em&gt;vs&lt;/em&gt; 20·30%, p=0·288). Complications were recorded for 810 (38·4%) 2109 patients who initiated MV upon hospital admission; of these 539 (67%) had ventilator-associated pneumonia, and 212 (39%) of 539 patients had multiple episodes of ventilator-associated pneumonia.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Timing ","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 1","pages":"Pages 37-46"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866943","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":"Child-first societies are safe societies for all","authors":"The Lancet Child & Adolescent Health","doi":"10.1016/S2352-4642(24)00334-1","DOIUrl":"10.1016/S2352-4642(24)00334-1","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 1","pages":"Page 1"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866933","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":"Handle with care: contains dreams","authors":"Josefine Gibson","doi":"10.1016/S2352-4642(24)00335-3","DOIUrl":"10.1016/S2352-4642(24)00335-3","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 1","pages":"Page 10"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866940","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":"Refreshing our International Advisory Board and Youth Advisory Panel","authors":"Allison Landman ,&nbsp;Amy L Slogrove ,&nbsp;Josefine Gibson","doi":"10.1016/S2352-4642(24)00337-7","DOIUrl":"10.1016/S2352-4642(24)00337-7","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 1","pages":"Page 9"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866944","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":"A profound portrait of a life online","authors":"Aaron Van Dorn","doi":"10.1016/S2352-4642(24)00310-9","DOIUrl":"10.1016/S2352-4642(24)00310-9","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 1","pages":"Pages 14-15"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873791","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":"A new Youth Advisory Panel for 2024–27","authors":"Jules Morgan","doi":"10.1016/S2352-4642(24)00336-5","DOIUrl":"10.1016/S2352-4642(24)00336-5","url":null,"abstract":"","PeriodicalId":54238,"journal":{"name":"Lancet Child & Adolescent Health","volume":"9 1","pages":"Pages 10-14"},"PeriodicalIF":19.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866918","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}