Archives of Disease in Childhood最新文献

{"title":"Treatment options for preventing autoimmune-mediated congenital heart block: a systematic review.","authors":"Abhishek Agarwal, Nikolaos Skoutelis, Yufeng Zhou, Reina Kawanami, Amandine Charras, Felice Occhigrossi, Umber Agarwal, Sophia Khan, Sarah Donegan, Daniel Hawcutt","doi":"10.1136/archdischild-2024-327570","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327570","url":null,"abstract":"<p><strong>Objective: </strong>Complete congenital heart block (CHB) due to anti-Ro/La antibodies in pregnancy can lead to adverse fetal outcomes and neonatal death. National and international guidelines do not recommend specific treatment for women identified with anti-Ro antibodies while pregnant.</p><p><strong>Design: </strong>Systematic review of studies of pregnant women with anti-Ro/La antibodies undertaking treatment(s) to prevent CHB. Studies solely focused on treating developing or established CHB were excluded.</p><p><strong>Main outcome measure: </strong>CHB incidence.</p><p><strong>Results: </strong>Of 1049 articles, 20 studies were eligible, of which 13 were retrospective. Sixteen studies contained usable data comparing various treatments (seven hydroxychloroquine (HCQ), six corticosteroids, two intravenous immunoglobulin (IVIG) and one each on combined HCQ and corticosteroids and plasmapheresis), including 2134 women and 2915 pregnancies. Meta-analysis was not possible due to heterogeneity. HCQ as primary prophylaxis showed protective effect on CHB incidence in four of five studies, whereas for preventing recurrence, only one study had a comparator arm, which showed a protective effect. Corticosteroids showed protective effect on CHB incidence as primary prophylaxis in two of three studies, whereas in recurrence, only one study showed protective effect. The IVIG study with a comparator showed no protective effect on CHB recurrence. Two studies (IVIG and plasmapheresis) had no comparator. The long-term toxicity of treatments was poorly investigated.</p><p><strong>Conclusion: </strong>HCQ showed the most evidence among various treatment options to prevent CHB in babies of women with anti-Ro/La antibodies. However, included studies had high risk of bias and imprecision. Future studies should be prospective, compare existing treatments and capture adverse effects.PROSPERO registration number CRD42023492934.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Puberty blockers for gender dysphoria in youth: A systematic review and meta-analysis.","authors":"Anna Miroshnychenko, Yetiani Roldan, Sara Ibrahim, Chan Kulatunga-Moruzi, Steven Montante, Rachel Couban, Gordon Guyatt, Romina Brignardello-Petersen","doi":"10.1136/archdischild-2024-327909","DOIUrl":"10.1136/archdischild-2024-327909","url":null,"abstract":"<p><strong>Aim: </strong>Gender dysphoria (GD) refers to the psychological distress associated with the incongruence between one's sex and one's gender identity. To manage GD, individuals may delay the development of primary and secondary sex characteristics with the use of puberty blockers. In this systematic review, we assess and summarise the certainty of the evidence about the effects of puberty blockers in individuals experiencing GD.</p><p><strong>Methods: </strong>We searched Medline, Embase, PsychINFO, Social Sciences Abstracts, LGBTQ+ Source and Sociological Abstracts from inception to September 2023. We included observational studies comparing puberty blockers with no puberty blockers in individuals aged <26 years experiencing GD, as well as before-after and case series studies. Outcomes of interest included psychological and physical outcomes. Pairs of reviewers independently screened articles, abstracted data and assessed risk of bias. We performed a meta-analysis and assessed the certainty of a non-zero effect using the grading of recommendations assessment, development and evaluation (GRADE) approach.</p><p><strong>Results: </strong>We included 10 studies. Comparative observational studies (n=3), comparing puberty blockers versus no puberty blockers, provided very low certainty of evidence on the outcomes of global function and depression. Before-after studies (n=7) provided very low certainty of evidence addressing gender dysphoria, global function, depression, and bone mineral density.</p><p><strong>Conclusions: </strong>There remains considerable uncertainty regarding the effects of puberty blockers in individuals experiencing GD. Methodologically rigorous prospective studies are needed to understand the effects of this intervention.</p><p><strong>Trial registration number: </strong>PROSPERO CRD42023452171.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Fighting every day': exploring caregiver quality of life and perspectives on healthcare services for children with dementia - a cross-sectional, mixed-methods study.","authors":"Jason Djafar, Suzanne Nevin, Nicholas Smith, Simone Ardern-Holmes, Kaustuv Bhattacharya, Russell Dale, Carolyn Ellaway, Sarah Grattan, Alexandra Johnson, Tejaswi Kandula, Didu S Kariyawasam, Katherine Lewis, Christian Elias Meagher, Shekeeb Mohammad, Michelle Anne Farrar","doi":"10.1136/archdischild-2024-328011","DOIUrl":"10.1136/archdischild-2024-328011","url":null,"abstract":"<p><strong>Objective: </strong>To explore quality of life outcomes for caregivers of children with childhood dementia including the positive and negative impact of caregiving. The secondary aim was to explore caregivers' perspectives on healthcare services for children with dementia.</p><p><strong>Design: </strong>Cross-sectional, mixed-methods study with analyses of quantitative and qualitative data collected via online survey.</p><p><strong>Setting: </strong>Australian tertiary referral children's hospitals, clinics and community advocacy groups.</p><p><strong>Patients: </strong>40 caregivers of children with dementia.</p><p><strong>Interventions: </strong>The survey was developed by a multidisciplinary team of clinicians including paediatric neurologists and behavioural scientists with experience in caring for families with childhood dementias and mixed-methods research.</p><p><strong>Main outcome measures: </strong>Surveys assessed caregiver-reported health-related quality of life, psychological distress, the impacts of caregiving and perspectives on healthcare services and how they may be improved for children with dementia.</p><p><strong>Results: </strong>Psychological distress was reported by 72.5%, caregiver stress by 67%, chronic pain or discomfort by 43% and for 87.5% their child's condition had a moderate or severe impact on their ability to do regular daily activities. Caregivers voiced a desire for more integrated care, increased general awareness and education around childhood dementia and a greater need for more trained support services.</p><p><strong>Conclusions: </strong>Caregivers of children with dementia experience high levels of psychological distress, physical and social consequences. This study highlights the need for integrated care and psychosocial support to efficiently connect children and families with appropriate healthcare services and resources.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and outcomes associated with fidelity in the Family-Nurse Partnership in England: a data linkage cohort study.","authors":"Amanda Clery, Francesca Cavallaro, Eilis Kennedy, Ruth Gilbert, Katie L Harron","doi":"10.1136/archdischild-2024-327654","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327654","url":null,"abstract":"<p><strong>Objectives: </strong>To determine (1) which maternal and area characteristics are associated with reaching fidelity targets (the expected number of visits mothers should receive at each stage of the programme) in the Family-Nurse Partnership (FNP), and (2) whether achieving these fidelity targets affects outcomes.</p><p><strong>Design, setting and population: </strong>Cohort study of mothers enrolled in the FNP, aged 13-19 years, giving birth between April 2010 and January 2018 in England. Mothers were linked to their Hospital Episode Statistics and National Pupil Database records.</p><p><strong>Outcomes: </strong>We described whether mothers reached fidelity targets for each programme stage (pregnancy, infancy and toddlerhood) and explored the characteristics associated with reaching targets. We used generalised linear models to compare child and maternal outcomes between mothers who did and did not reach fidelity targets.</p><p><strong>Results: </strong>Of the 28 155 mothers enrolled, 58% completed the programme. Fidelity targets were met by 59% of mothers in pregnancy, 65% in infancy and 61% in toddlerhood. The median number of visits was 38 (median 43 hours contact time). Younger mothers, those with a history of unplanned hospital admissions for adversity and those with social care involvement received a greater number of visits. Meeting fidelity targets was associated with a reduction in subsequent births within 18 months and an increase in the number of children with unplanned hospital admissions for maltreatment or injury up to age 2.</p><p><strong>Conclusions: </strong>Achieving fidelity to the FNP is challenging, but family nurses are able to engage the most vulnerable mothers in the programme. More research is needed to understand whether fidelity to programme targets is a useful measure of mothers' experiences of intensive home visiting.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Listening to the voices of adolescents with inflammatory bowel disease after returning to school: a qualitative study.","authors":"Keyuan Peng, Pingting Zhu, Xinyue Gu, Chenglei Hu, Yi Teng, Zhie Gu","doi":"10.1136/archdischild-2024-328010","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328010","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of inflammatory bowel disease (IBD) among Chinese adolescents has continued to increase in recent years. Adolescents with IBD interrupted their schooling due to the diagnosis and treatment of the disease. And when the condition stabilises, they will return to school. However, as a lifelong and recurrent disease, the instability of the disease after returning to school affects normal school participation.</p><p><strong>Objective: </strong>This study aims to explore the psychological and life challenges of adolescents with IBD in the complex and intertwined situations of disease management, adolescent development and school social interactions.</p><p><strong>Methods: </strong>A qualitative descriptive study was conducted. Qualitative data were collected from adolescents aged 11-19 (n=21; 7 males and 14 females) through in-depth, semistructured interviews. Reflexive thematic analysis was employed to ensure rigour.</p><p><strong>Results: </strong>The results highlight the challenges of returning to school for adolescents with IBD. There are three emerging themes and nine subthemes (in parentheses). (1) Problems of continued disease management (occasional uncontrollable flare-ups of symptoms, regular medical checkups disrupting daily school programming and shame from medication management). (2) Difficulties of impaired school functioning (difficulty keeping up with academic study and participating in high-intensity sports activities). (3) Challenges of maintaining friendship (burden of disease disclosure, difficulty in sharing food with friends, common topics of conversation decreasing and absence of group activities).</p><p><strong>Conclusion: </strong>We call on medical institutions and schools to strengthen cooperation and further optimise support measures for this group through the intermediary role of school health clinics.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of functional tics in adolescents: a single-centre tertiary study.","authors":"Alexandra Ducroizet, Claire Eccles, Rebecca Lancaster, Aleksandra Kowalczyk, Tamsin Owen, Sara Sopena, Osman Malik, Tammy Hedderly","doi":"10.1136/archdischild-2024-327408","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327408","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the prognosis and co-occurring disorders, including functional neurological symptoms, in adolescents diagnosed with functional tic-like behaviour (FTLB).</p><p><strong>Design: </strong>This was a single-centre tertiary study in the UK. A structured clinical interview was administered to 43 parents or carers of adolescents assessed with FTLB at their previous outpatient clinic appointment. Data collected included demographic variables, co-occurring psychiatric and neurodevelopmental diagnoses and additional functional neurological symptoms.</p><p><strong>Setting: </strong>A tertiary UK paediatric tics and neurodevelopmental movement disorder service.</p><p><strong>Patients: </strong>adolescents diagnosed with FTLB during the COVID-19 pandemic.</p><p><strong>Outcome measures: </strong>the primary outcome was whether FTLB had resolved, improved, remained constant or worsened. Secondary outcomes were Children's Global Assessment Scale scores, impact on school attendance and parent or carer work absence.</p><p><strong>Results: </strong>Patient demographics support the European Society for the Study of Tourette Syndrome diagnostic criteria for FTLB, with a 100% female sex bias, adolescent onset and high levels of co-occurring disorders. Anxiety disorders were especially common (70%), as were other functional neurological symptoms. While the majority (65%) of parents reported that the young people had resolution or improvement in the severity of FTLB symptoms at follow-up, a significant minority (16%) saw no change and a fifth reported worsening symptoms.</p><p><strong>Conclusions: </strong>FTLB show high co-occurrence with psychiatric and neurodevelopmental disorders, along with other functional neurological symptoms. In this study, the prognosis was poor for a fifth of patients diagnosed with FTLB.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of fetal and infant growth with pubertal timing.","authors":"Sophia Blaauwendraad, Romy Gaillard, Romy Gonçalves, Fernando Rivadeneira, Gert Dohle, Edwin Oei, Annemarie Mulders, Pauline Jansen, Vincent Jaddoe","doi":"10.1136/archdischild-2024-327060","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327060","url":null,"abstract":"<p><strong>Objective: </strong>Impaired fetal and infant growth may cause alterations in developmental programming of the hypothalamic-pituitary-gonadal axis and subsequently pubertal development. We aimed to assess associations between fetal and infant growth and pubertal development.</p><p><strong>Design: </strong>Population-based prospective birth cohort.</p><p><strong>Setting: </strong>Rotterdam, the Netherlands.</p><p><strong>Patients: </strong>5830 singleton born children.</p><p><strong>Interventions: </strong>We estimated fetal weight in second and third trimester by ultrasound. Infant growth measures were gestational age and weight at birth and infant weight at 6, 12 and 24 months.</p><p><strong>Main outcome measures: </strong>Pubertal timing outcomes included difference between chronological and skeletal age assessed using dual-energy X-ray absorptiometry, testicular or ovarian volumes assessed using MRI at 10 years, age at menarche and Tanner staging at 13 years.</p><p><strong>Results: </strong>Among girls, 1-SD scores birth weight increase was associated with larger ovarian volume at 10 years (0.07 SD (95% CI 0.02 to 0.12) and later age at menarche (0.06 (0.02 to 0.11)). Among girls, increased infant growth was associated with an older skeletal age at 10 years (difference 2.67 (95% CI 2.26 to 3.08) months), earlier menarche (difference 0.10 (95% CI -0.14 to -0.06) years) and more advance breast and pubic hair development at 13 years (difference in Tanner stages 0.09 (0.05 to 0.13) and 0.07 (0.03 to 0.12)). In boys, increased infant growth was associated with an older skeletal age (3.13 (95% CI 2.58 to 3.69) months) and a larger testicular volume (0.07 (95% 0.02 to 0.12) SD) at 10 years, and with more advance pubic hair development (0.09 (95% CI 0.05 to 0.14) at 13 years).</p><p><strong>Conclusion: </strong>Birth anthropometrics and early-life growth patterns are associated with altered pubertal development in a sex-specific manner.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards evidence-based medicine for paediatricians.","authors":"Bob Phillips","doi":"10.1136/archdischild-2024-328388","DOIUrl":"10.1136/archdischild-2024-328388","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"170"},"PeriodicalIF":4.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highlights from the literature.","authors":"","doi":"10.1136/archdischild-2024-328422","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328422","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":"110 2","pages":"176"},"PeriodicalIF":4.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of the medical examiner service in children and young people's deaths.","authors":"Stephen Playfor","doi":"10.1136/archdischild-2024-327944","DOIUrl":"10.1136/archdischild-2024-327944","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"87-88"},"PeriodicalIF":4.3,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}