Archives of Disease in Childhood最新文献

{"title":"Associations of waist circumference to height ratio and body mass index through childhood and adolescence on blood pressure and risk of young adult hepatic steatosis: a cohort study.","authors":"Sumona Mandal, Sam D Leary, Nic Timpson, Kushala Abeysekera, Julian P H Shield","doi":"10.1136/archdischild-2024-328140","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328140","url":null,"abstract":"<p><strong>Objective: </strong>Body mass index (BMI), and its adjustment for age and sex as a z-score, is a common measure of excess weight but performs poorly in children. Waist circumference to height ratio (WHtR), which reflects excess adiposity, may be a useful alternative. We explored the associations between WHtR and BMI from childhood through adulthood and hepatic steatosis and systolic blood pressure (SBP).</p><p><strong>Design: </strong>Participants (n=2193) from the Avon Longitudinal Study of Parents and Children were categorised into eight groups based on criteria for assessing excess adiposity at 7, 15 and 24 years using WHtR≥0.5, and excess weight using established age-specific BMI cut-off values. Regression models were fitted assessing associations between the groups and hepatic steatosis and SBP at age 24.</p><p><strong>Results: </strong>Adult excess adiposity (WHtR) and excess weight (BMI) both associate with increased risk of hepatic steatosis: risk ratios (RR) 9.3 (95% CI 6.4 to 13.6) and 8.8 (95% CI 5.8 to 13.5), respectively, compared with always having healthy parameters. Excess adiposity in childhood and adulthood increases the associated risk (RR 11.4 (95% CI 6.2 to 20.9)), but not for excess weight, compared with adulthood alone (RR 7.6 (95% CI 3.9 to 15.1)). Both excess adiposity (RR 14.8 (95% CI 10.0 to 21.7)) and weight (RR 11.6 (95% CI 7.1 to 19.0)) in adolescence and adulthood associate with greater risk than adulthood alone. Positive associations with SBP were observed for excess adiposity or weight in adulthood only, childhood and adulthood, and adolescence and adulthood, and for persistent adiposity/weight, using both measures.</p><p><strong>Implications: </strong>Excess adiposity or weight in early life, continuing to adulthood, elevates hepatic steatosis risk and associates with increased SBP in adulthood. These findings highlight the impact of youth adiposity and weight on later health outcomes. The strong association of WHtR and hepatic steatosis risk suggests it may be an alternative to BMI, with potential use in paediatric risk stratification.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148986","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":"Evaluating intravascular hypovolaemia by manually assessing peripheral limb coolness compared with the capillary refill time in children aged <5 years in a tropical environment: a prospective cohort study of diagnostic accuracy.","authors":"Rafiuk Cosmos Yakubu, Rashida Gomda, Francis Agyei Frimpong, Sampson Antwi, Macolm G Coulthard, Alhassan Abdul-Mumin, Augustine Kwame Afful, Haruna Mahama, Kingsley Aseye Hattoh, Justice Sylverken, Uni Wariyar","doi":"10.1136/archdischild-2024-328067","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328067","url":null,"abstract":"<p><strong>Objective: </strong>It is important to detect reduced peripheral perfusion due to hypovolaemia early before it progresses to shock. Capillary refill time (CRT) and manual palpation for peripheral coolness are used widely to detect this, while the central-peripheral temperature gradient is used as a measure of peripheral perfusion in intensive care settings. Here, our aim was to compare the precision of these three clinical signs to detect hypovolaemia in the tropics.</p><p><strong>Design, setting and patients: </strong>Trainee paediatricians measured the CRT, graded the coolness of the toes manually and measured temperature gradients with inexpensive infrared thermometers in healthy control children and in sick children admitted to two hospitals in Ghana over 1 year, and compared these data to the intravascular volume status measured by the inferior vena cava diameter to height ratio (IVCd/ht) Z-scores.</p><p><strong>Results: </strong>We studied 1383 well and 787 hospitalised children aged 2 months to 5 years, of which 99 had hypovolaemia. The hospitalised children had a median age of 1.63 years and weight of 8.7 kg. The most useful method to predict hypovolaemia was to detect mild peripheral coolness (sensitivity 44%, specificity 88.8%). The measured temperature gradient was less sensitive at 26%, perhaps because the ambient temperature (average 30.2°C) was close to body temperature. The CRT also had low sensitivity at all values (best 29% at ≥2 s).</p><p><strong>Conclusions: </strong>Manual palpation for detecting mild coolness predicts hypovolaemia more effectively than the CRT in small children, and measuring temperature gradients with a thermometer is relatively ineffective in a tropical setting.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149063","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":"Trends in neural tube defects in Scotland in 2000-2021 prior to the introduction of mandatory folic acid fortification of non-wholemeal wheat flour: a population-based study.","authors":"Amir Kirolos, Rute Vieira, Clara Calvert, Emily Griffiths, Rachael Wood","doi":"10.1136/archdischild-2024-328295","DOIUrl":"10.1136/archdischild-2024-328295","url":null,"abstract":"<p><strong>Objective: </strong>To describe the total birth prevalence of neural tube defects (NTDs) in Scotland in 2000-2021.</p><p><strong>Design: </strong>National, population-based study.</p><p><strong>Setting: </strong>Scotland, UK.</p><p><strong>Participants: </strong>Babies with an NTD and pregnancy outcome of live birth, stillbirth (≥20 weeks' gestation) or termination of pregnancy (any gestation), as recorded in the Scottish Linked Congenital Condition Dataset.</p><p><strong>Exposures: </strong>Year, maternal age group and maternal area-level deprivation quintile.</p><p><strong>Main outcome measures: </strong>The main outcome measure was the total birth prevalence of all NTDs and separately anencephaly and spina bifida (per 10 000 total births). The association between exposures and outcomes was investigated using Poisson regression.</p><p><strong>Results: </strong>In Scotland in 2000-2021, there were 1178 babies with a recorded NTD (436 anencephaly, 577 spina bifida) and 1 203 491 total births. The total birth prevalence of NTDs was 9.8 (95% CI 9.2, 10.4) per 10 000 total births. The prevalence was lower among babies born to mothers aged 30-39 years (compared with younger or older mothers) and those from less (compared with more) deprived areas. There was no evidence of change in the prevalence of NTDs (prevalence rate ratio (PRR) 1.01 (95% CI 0.997, 1.02), p=0.16) or spina bifida (PRR 0.99 (95% CI 0.98, 1.01), p=0.35) over the study period. The prevalence of anencephaly showed no change in 2000-2012, but increased in 2013-2021 (PRR 1.12 (95% CI 1.06, 1.19), p<0.001).</p><p><strong>Conclusions: </strong>The observed trends in anencephaly likely reflect increasing detection in early pregnancy. Current strategies are failing to equitably reduce NTDs in Scotland. Monitoring of future trends is needed to assess the impact of mandatory folic acid fortification.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646819","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":"Gamma-glutamyltransferase testing in paediatric inflammatory bowel disease to screen for primary sclerosing cholangitis: a diagnostic study based on routinely collected electronic healthcare data.","authors":"Besrat Berhane, Wouter Sjoerd van de Put, Patrick Ferry van Rheenen","doi":"10.1136/archdischild-2024-327998","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327998","url":null,"abstract":"<p><strong>Objective: </strong>To investigate, among children with inflammatory bowel disease (IBD) and elevated liver enzymes, what threshold of gamma-glutamyltransferase (GGT) best distinguishes those with and without primary sclerosing cholangitis (PSC).</p><p><strong>Method: </strong>Delayed-type diagnostic study with a paired design. Children with IBD were regularly screened with GGT (index test). Confirmation of PSC was based on magnetic resonance cholangiopancreatography (MRCP) and/or liver histology (preferred reference standard). Children at low risk of PSC continued regular GGT testing for latent PSC to become visible (alternative reference test). The primary outcome was the negative predictive value (NPV) using three predefined test thresholds, respectively, 1, 2 and 5× the upper limit of normal (ULN). The secondary outcome was the GGT threshold based on receiver operating characteristic analysis.</p><p><strong>Results: </strong>132 of 469 children (28.1%) had elevated GGT levels at their first colonoscopy or during follow-up. Eventually, 34 children (7.2%) were diagnosed with PSC. Median GGT (IQR) for children with and without PSC was 227 (127-345) and 77 (59-138) U/L, respectively. Of the predefined GGT thresholds, 2× ULN (ie, 100 U/L) had the best test characteristics, including an NPV of 98% and a negative likelihood ratio of 0.04 (95% CI 0.01 to 0.31). The area under the curve was 0.83 (95% CI: 0.75 to 0.90) and the optimal GGT threshold was 103.5 U/L.</p><p><strong>Conclusion: </strong>In children with IBD who have GGT elevations less than 2× ULN, the likelihood of PSC is extremely low. In such cases, MRCP and liver biopsy can be omitted. Regular GGT monitoring is advised, as PSC may develop over time.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141208","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 complete blood count in the diagnosis of culture-proven neonatal sepsis: a systematic review and meta-analysis.","authors":"Emily Hyde, Mark Anthony, Stephen Kennedy, Manu Vatish","doi":"10.1136/archdischild-2025-328523","DOIUrl":"https://doi.org/10.1136/archdischild-2025-328523","url":null,"abstract":"<p><strong>Objective: </strong>Neonatal sepsis is a significant cause of morbidity and mortality, particularly in preterm infants. Despite its routine use in adults, the diagnostic utility of complete blood count (CBC) in neonatal sepsis remains debated. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of CBC parameters for neonatal sepsis.</p><p><strong>Methods: </strong>This review was registered at PROSPERO (CRD42023476510). MEDLINE, Embase, CINAHL and the Cochrane Library were searched from database inception to 28 October 2024. Observational studies of neonates with sepsis, published in English, were included. Pooled diagnostic accuracy metrics were calculated for CBC parameters, including the white cell count (WCC), neutrophil count and immature-to-total neutrophil ratio (ITR). Bias was assessed using a modified QUADAS-2 tool.</p><p><strong>Results: </strong>Functional CBC parameters like ITR and mean neutrophil volume (MNV) showed moderate diagnostic accuracy. Pooled analysis revealed that an ITR >0.20 had 66.3% sensitivity and 85.4% specificity for neonatal sepsis. MNV also showed promising diagnostic utility, but substantial heterogeneity across studies (I²>0.80) limited its generalisability. Traditional parameters like the WCC and platelet count had lower diagnostic accuracy.</p><p><strong>Conclusions: </strong>The CBC is a rapid, cost-effective test requiring minimal blood volume, making it a practical adjunct in neonatal diagnostics. Functional parameters like ITR and MNV show the potential to complement existing approaches but are insufficient as stand-alone diagnostic tools. Further research is needed to validate their clinical utility and address heterogeneity in study designs.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141214","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":"Eat, sleep and console model of care for managing infants with neonatal abstinence syndrome: a meta-analysis of observational studies.","authors":"Zoe Wei, Mohamed E Abdel-Latif, James Cope, Ju-Lee Oei","doi":"10.1136/archdischild-2025-328549","DOIUrl":"https://doi.org/10.1136/archdischild-2025-328549","url":null,"abstract":"<p><strong>Importance: </strong>Vigilant clinical assessment is the key to preventing complications, including death, in infants at risk of neonatal withdrawal syndrome. The eat, sleep and console (ESC) is proposed as an alternative to usual care with Finnegan's Neonatal Abstinence Scoring System (FNASS), but whether ESC improves infant outcomes is uncertain.</p><p><strong>Objective: </strong>To conduct a meta-analysis and systematic review of outcomes of studies comparing ESC to FNASS.</p><p><strong>Data sources: </strong>PubMed, Embase, CINAHL and Cochrane were searched. There was no date restriction.</p><p><strong>Study selection: </strong>Published data from observational studies published in English were included. Randomised controlled trials, reviews and abstracts were excluded. Data was required to be converted to mean and SD to be included.</p><p><strong>Data extraction and synthesis: </strong>Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were used, and data were independently extracted by multiple observers. Data was pooled using a random-effects model.</p><p><strong>Main outcome and measures: </strong>Length of stay (LOS) in days, number of days medicated and proportion of infants medicated were the primary outcomes assessed. It was hypothesised prior to data collection that ESC would be associated with shorter LOS and a lower proportion of infants medicated, given key differences in infant assessment compared with the FNASS.</p><p><strong>Results: </strong>12 studies, all from the USA, were published between 2018 and 2024. 10 quality improvement studies and two cohort studies compared ESC (n=1877) with historical controls using FNASS (n=2199). ESC decreased hospitalisation days (MD -4.11 days, 95% CI -6.04 to -2.19 days; p<0.0001; I²=95%; 10 studies; 3703 participants) and the proportion treated with withdrawal medications (OR 0.36, 95% CI 0.22 to 0.60; I²=89%; RD -0.22; 95% CI -0.34 to -0.10; p<0.0001; I²=93%; 12 studies; 4076 participants). One study assessed physical health up to 1 week after discharge (n=1), three assessed weight loss (n=3) and one assessed cost (n=1).</p><p><strong>Conclusions and relevance: </strong>The majority of evidence for a reduction in hospitalisation and need for withdrawal medication with ESC compared with FNASS is derived from quality improvement and cohort studies with almost no health information beyond 1 week after discharge. High-quality trials incorporating physiological measurements of infant stress and longer-term outcomes are needed.</p><p><strong>Review prospective registration: </strong>CRD42024532169.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109554","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":"Correction: Variant Creutzfeldt-Jakob disease in UK children after 27 years of active prospective surveillance.","authors":"","doi":"10.1136/archdischild-2025-328472corr1","DOIUrl":"https://doi.org/10.1136/archdischild-2025-328472corr1","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109553","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":"A step ahead of Martha's Rule: evaluation of a parent initiated paediatric escalation pathway.","authors":"Abigail Kiely, Leanne George, Davinder Singh, Ramesh Kumar, Elizabeth Evans","doi":"10.1136/archdischild-2024-328331","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328331","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109551","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":"Children and young people attending the paediatric emergency department with the police: a 5-year retrospective case series.","authors":"Joseph Anthony, Marnie Bruce, Hannah Jacob, Tulsi Patel, Yasmin Baki","doi":"10.1136/archdischild-2024-327889","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327889","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109552","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":"Children and adolescents attending for a forensic medical examination at a regional centre in Ireland: a 5-year retrospective cohort study of patients, alleged perpetrators and service provision.","authors":"Naomi Bergin, Abrar Alzaabi, Michael Barrett, Susan Roe, Aideen Walsh, Aisling R Geoghegan, Sinead Harty","doi":"10.1136/archdischild-2025-328561","DOIUrl":"https://doi.org/10.1136/archdischild-2025-328561","url":null,"abstract":"<p><strong>Objective: </strong>This study examines the forensic medical examination (FME) service provided to children in a regional centre in Dublin, Ireland, over 5 years. It reports on patient characteristics, alleged perpetrators and service provision. The goal is to inform future service provision and prevention strategies.</p><p><strong>Design: </strong>The retrospective cohort study included all children and adolescents who underwent FME from January 2018 to December 2022. Data was collected from encrypted child protection reports and analysed with descriptive statistics SETTING: The study was undertaken in the Laurels Clinic, one of the three regional Irish centres for FME.</p><p><strong>Results: </strong>Of 448 patients, 79% were female, with 37.3% aged 5-11 years. Vaginal penetration occurred in 46% of cases, with digital penetration (vaginal or anal) being the most common method. Anal penetration was reported in 26%, and 6.3% had anogenital findings suggestive of child sexual abuse (CSA). CSA was most often perpetrated in the home, with nearly half of patients showing behavioural changes. About 18% had developmental concerns, and 30% lived in blended families. Alleged perpetrators were mainly male (90.1%), with over 20% being teenagers and 12.8% under 13. Over half of cases involved repeated abuse. Disclosure rates were higher with age, with 69% of disclosures made to a parent.</p><p><strong>Conclusion: </strong>This study highlights CSA risk factors, including blended families and developmental concerns. A worrying finding was that many perpetrators were adolescents or children. Prevention programmes must address risks related to smartphone use and exposure to pornography. These findings can guide clinicians, policymakers and institutions in strengthening CSA prevention and response efforts.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101004","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}