Archives of Disease in Childhood最新文献

{"title":"Clinically significant night-to-night variability in overnight oximetry screening for obstructive sleep apnoea in children with Down syndrome: a retrospective review of screening data.","authors":"Alison J B Garde, Jonathan Wen Yi Ong, Zara Howarth, Jonathan James, Thomas L Wilkinson, Ho Ming Yuen, Catherine M Hill, Hazel J Evans","doi":"10.1136/archdischild-2025-329937","DOIUrl":"https://doi.org/10.1136/archdischild-2025-329937","url":null,"abstract":"<p><strong>Aim: </strong>To understand the extent and implications of night-to-night variability (NTNV) in obstructive sleep apnoea (OSA) screening for children with Down syndrome (DS).</p><p><strong>Design: </strong>Retrospective review of outpatient OSA screening data, assessing NTNV across three consecutive nights of pulse oximetry (3NPO) studies and comparing results of screening oximetry and diagnostic polygraphy (PG). Two hundred and forty-six 3NPO studies in patients aged 1 to <18 years with DS at University Hospital Southampton NHS Foundation Trust between April 2020 and December 2024 were included. Clinically significant NTNV was defined as results above and below the published screening thresholds predictive of moderate-to-severe OSA in children with DS (3% oxygen desaturation index (ODI3) ≥6.15 and delta index (D12s) ≥0.555) on nights within the same 3NPO study. Receiver operating characteristic curve analysis was used to identify optimal lower reassurance threshold values to account for NTNV.</p><p><strong>Results: </strong>Fifty-three per cent of the 150 complete 3NPO studies showed clinically significant NTNV. Children with night 1 results below the reassurance thresholds ODI3 3.61 (n=19) and D12s 0.49 (n=64) had a low chance of abnormal result on subsequent nights (negative predictive value 79% and 81%, respectively). Eighty-seven per cent of night 1 oximetry data fell above these thresholds. Sixty per cent of PG studies showed OSA. Seventy-six per cent of moderate-to-severe OSA was in children aged >6 years.</p><p><strong>Conclusions: </strong>Clinically significant NTNV was seen in the majority of 3NPO studies. Single-night screening may miss children who would screen positive on multiple-night testing. UK screening recommendations may need revision to reflect NTNV and significant OSA prevalence in older children.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910564","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":"Quality and concordance of international paediatric sepsis guidelines: a cross-sectional appraisal from the SENTINEL International study.","authors":"Tom Solan, Amanda Williams, Shane George, Adin Breuer, Stephen Hearps, Adriana Yock-Corrales, Viviana Pavlicich, Kandamaran Krishnamurthy, Yashica Seymour-Hanna, Radhika Raman, Bharat Choudhary, Weda Kusuma, Victoria Ribaya, Nathan Forsyth, Nilanka Mudithakumara, Nichkamol Lertamornkitti, Antionette David, Suleiman Mohamed, Tigist Bacha, Jenala Njirammadzi-Maleta, John Appiah, Janvier Hitayezu, Mukami Kunga, Genevieve Po Gee Fung, Rahimi Abdrazak, Shu-Ling Chong, Jhong-Lin Wu, Jeong-Yong Lee, Damian Roland, Bressan Silvia, Ruth Logan, Yolanda Ballestero, Ozlem Teksam, Lina Jankauskaite, Graham Thompson, Vikram Sabhaney, Yasaman Shayan, Elysha Pifko, Julia Lloyd, Khalid Al Ansari, Franz E Babl, Elliot Long","doi":"10.1136/archdischild-2026-330907","DOIUrl":"https://doi.org/10.1136/archdischild-2026-330907","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the methodological quality of hospital-specific paediatric sepsis clinical practice guidelines (CPGs) from sites participating in an international study using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and to assess the consistency of treatment recommendations and concordance with the Surviving Sepsis Campaign 2020 (SSC 2020) international reference standard.</p><p><strong>Design: </strong>Cross-sectional appraisal of hospital-specific CPGs.</p><p><strong>Setting: </strong>Hospital sites participating in the Sepsis Epidemiology in Paediatric Acute Care International Study across five continents.</p><p><strong>Participants: </strong>Hospital-specific CPGs for the acute care management of paediatric sepsis.</p><p><strong>Interventions: </strong>Hospital-specific CPGs were appraised independently using the AGREE II tool and classified as high, moderate or low quality. Consistency across guidelines and concordance with SSC 2020 were assessed for 12 key treatment recommendations.</p><p><strong>Main outcome measures: </strong>AGREE II domain scores and overall quality rating; consistency of treatment recommendations across hospital-specific CPGs; concordance of individual CPGs with SSC 2020.</p><p><strong>Results: </strong>14 hospital-specific CPGs from 13 countries were included. All were rated as low methodological quality overall; the rigour of development (range: 0-50%) and editorial independence (0-58%) were the lowest scoring AGREE II domains. CPG concordance with SSC 2020 ranged from 42% to 100%; consistency across the 12 treatment recommendations ranged from 43% (steroid indications) to 93% (initial laboratory investigations, time to antibiotics and fluid bolus volume).</p><p><strong>Conclusions: </strong>Despite all hospital-specific CPGs across an international cohort being of low methodological quality, most aligned with SSC 2020 for key time-critical recommendations. Clinically important variations existed in fluid resuscitation composition and timing of steroid administration.</p><p><strong>Trial registration number: </strong>ACTRN12621000920097.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910557","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":"Secondary skeletal surveys yield significant additional injuries: a retrospective review.","authors":"Gregor MacDonald, Alison Evans, Katina Kontos, David Tuthill","doi":"10.1136/archdischild-2026-330344","DOIUrl":"https://doi.org/10.1136/archdischild-2026-330344","url":null,"abstract":"<p><strong>Objective: </strong>Skeletal surveys play an important role in detecting occult injury in young children at risk from non-accidental injury. Current UK safeguarding guidance (2018) advises two skeletal surveys within 2 weeks in children under 2 years old. The first is a full survey (plus a CT head scan if under 1 year), alongside a secondary survey using selected views of the chest and long bones. Recent work suggested the rarity of detected injury did not justify the second exposure to ionised radiation. We wished to explore this important issue further.</p><p><strong>Design: </strong>Retrospective audit of all skeletal surveys in infants aged under 2 years against these guidelines between 1 January 2018 and 18 February 2025.</p><p><strong>Setting: </strong>Children's Hospital for Wales.</p><p><strong>Patients: </strong>Local children having radiological examinations for safeguarding evaluation. Out-of-area children were excluded.</p><p><strong>Interventions: </strong>Two skeletal surveys.</p><p><strong>Main outcome measures: </strong>Adherence to guidelines in performing two surveys within 2 weeks, plus fracture rates found in first and second surveys.</p><p><strong>Results: </strong>Investigations performed in 186 children; 16 had only the primary survey and 2 were over 2 years leaving 168 for evaluation (90.3%). Secondary surveys carried out within 14 days in 161/168 (95.8%). Patients were classified in five presentation groups: bruise or skin lesion (n=106), fractures (n=43), domestic violence (n=15), fracture in sibling (n=2) and head injury (n=2). Skeletal surveys classified as normal, indeterminate or abnormal. 10/168 (6.0%) had fractures additional to the presenting injury on primary skeletal survey, 12/168 (7.1%) had additional fractures on secondary skeletal survey and 1/168 (0.6%) had a normal primary survey but fracture found solely on secondary survey.</p><p><strong>Conclusions: </strong>A clinically important number of additional injuries and occasional new ones are found on second skeletal surveys. Our work supports the ongoing use of the current radiological investigation protocol with two surveys for this vulnerable group.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886079","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":"Caring for children with functional neurological disorders in the emergency department.","authors":"Jordan Garris, Aarti Gaglani, Michael Malley, Dara Albert","doi":"10.1136/archdischild-2026-330914","DOIUrl":"https://doi.org/10.1136/archdischild-2026-330914","url":null,"abstract":"<p><p>Functional neurological disorder is a common reason for children to present to the emergency department, but education gaps contribute to delays in diagnosis. This can result in unnecessary diagnostic testing and interventions, which lead to increased healthcare costs and, at times, patient harm. In this narrative review, we provide practical recommendations regarding emergency department management of paediatric functional neurological disorder. We recommend that emergency physicians use the described rule-in signs rather than negative medical tests to make a positive diagnosis of functional neurological disorder. We advocate for timely communication of this diagnosis to the patient and family in a clear and validating way. We also discuss considerations for patient triage, outpatient referrals and special scenarios that emergency physicians may frequently encounter.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872665","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":"Bridging the gap between aspiration and reality in UK academic paediatrics.","authors":"Alice Jane Armitage, Sarah Clarke, A V Ramanan","doi":"10.1136/archdischild-2026-330506","DOIUrl":"https://doi.org/10.1136/archdischild-2026-330506","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872714","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":"Home truths: why housing matters for child health and development.","authors":"Helena Clements, Alison Firth","doi":"10.1136/archdischild-2026-330755","DOIUrl":"https://doi.org/10.1136/archdischild-2026-330755","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872673","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":"Bridging the gap between good intentions and action: building healthcare worker competence in supporting LGBTQ+ children and young people.","authors":"Julian Baudinet","doi":"10.1136/archdischild-2026-331351","DOIUrl":"https://doi.org/10.1136/archdischild-2026-331351","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872678","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":"CRP substitution in the PECARN rule: considerations for global generalisability.","authors":"Jingwen Xiao, Huibin Luo, Yanxia Chen","doi":"10.1136/archdischild-2026-331282","DOIUrl":"https://doi.org/10.1136/archdischild-2026-331282","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849707","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":"Difference-in-differences: an introduction and structured framework for paediatricians.","authors":"Alice Rhiannon Lee, Justus Simba, Daniel B Hawcutt, Ian P Sinha","doi":"10.1136/archdischild-2026-330341","DOIUrl":"https://doi.org/10.1136/archdischild-2026-330341","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824035","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":"Implementation of a novel community paediatric tone management clinic in south London: learning points and outcome measurements following interventions including botulinum toxin injection.","authors":"Kate Lydekker, Daniel Cromb, Lucy Shimwell, Michelle Huggins, Hemavathy Palanyiaya","doi":"10.1136/archdischild-2026-330772","DOIUrl":"https://doi.org/10.1136/archdischild-2026-330772","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817433","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}