Archives of Disease in Childhood最新文献

{"title":"Definition, investigation and management of gastrointestinal dystonia in children and young people with neurodisability.","authors":"Andrew R Barclay, Susanna Meade, Catherine Richards, Timothy Warlow, Daniel E Lumsden, Charlie Fairhurst, Catherine Paxton, Katharine Forrest, Santosh R Mordekar, David Campbell, Julian Thomas, Michelle Brooks, Gregor M Walker, Osvaldo Borrelli, Helen Wells, Susie Holt, Shoana Quinn, Yi Fan Liang, Mohamed Mutalib, Elena Cernat, Alex C H Lee, Claire Teresa Lundy, Fiona McElligott, Jo Griffiths, Paul Eunson, Haidee Norton, Lisa Whyte, Mark A Samaan, Sue Protheroe","doi":"10.1136/archdischild-2024-327551","DOIUrl":"10.1136/archdischild-2024-327551","url":null,"abstract":"<p><strong>Background: </strong>Children and young people with severe neurodisabling conditions (CYPSND)experience severe functional gastrointestinal symptoms and dependence on artificial nutrition. 'Gastrointestinal dystonia' (GID) has been applied by clinicians when symptoms become debilitating and potentially life-limiting. Evidence is lacking regarding the definition and appropriate management of GID.</p><p><strong>Methods: </strong>We therefore assembled a RAND appropriateness panel. We performed a systematic review, created an online survey and distributed this to a panel of 27 experts from five stakeholder groups from 13 UK specialist centres across the British Isles (gastroenterology, neurology/neurodisability, surgery, palliative care and allied health professionals). A Disagreement Index ≥1 indicated disagreement.</p><p><strong>Findings: </strong>The panel rated the appropriateness of 250 statements covering the following in GID: definition, clinical evaluation, nutritional assessment/feeding strategies, investigations, medications and prescribing, surgical interventions, safeguarding, palliative care and ethics. Agreement was reached except in selected statements regarding uncommon diagnostic features. There was uncertainty in specific clinical scenarios regarding: investigation, the use of blenderised diet, certain pharmacological agents and surgical interventions. The only intervention deemed inappropriate was antireflux surgery in the context of GID and gastrointestinal dysmotility without reflux disease. The remaining statements (198) were considered appropriate.</p><p><strong>Interpretation: </strong>We present a comprehensive review, agreement on the definition of GID and recommendations on management pathways agreed by a selected panel of multidisciplinary experts. Clear diagnostic criteria will enable important epidemiological work to record outcomes for this complex patient group. Identifying the associated morbidity, burden of care and mortality will help advocate for appropriate health resources and support to carers and families.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"742-750"},"PeriodicalIF":3.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062037","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":"Screening parents of children with a chronic condition for mental health problems: a systematic review.","authors":"Nadia Coscini, Grace McMahon, Madison Schulz, Casey Hosking, Melissa Mulraney, Anneke Grobler, Harriet Hiscock, Rebecca Giallo","doi":"10.1136/archdischild-2024-328300","DOIUrl":"10.1136/archdischild-2024-328300","url":null,"abstract":"<p><strong>Objective: </strong>Parents of children with a chronic condition (CC) have a high prevalence of mental health (MH) difficulties. It is not known whether establishing screening programmes in paediatric clinics to identify parental MH difficulties increases detection or referrals to support services. We aimed to identify approaches to routine screening programmes for parents of children with a CC attending hospital outpatient clinics (aim 1); associated prevalence of MH symptoms (aim 2); and whether screening impacted referrals to, and uptake of, MH services (aim 3).</p><p><strong>Design: </strong>Medline, Embase, PsycINFO, CINAHL and PubMed databases were searched between January 2000 and December 2023. Studies were selected if they conducted routine screening of MH of parents of children with CCs (aged <18 years). Study characteristics, population demographics and information on screening tools, MH symptoms and referral pathways were extracted.</p><p><strong>Results: </strong>Eight articles met the inclusion criteria from 8673 screened. The prevalence of elevated parental MH symptoms ranged between 9.6% and 62.9% for anxiety and 7.7% and 57.0% for depression. Two studies using the Distress Thermometer for Parents found 3.3%-57.0% had elevated levels of 'clinical distress'. There was limited detail on referral pathways, referrals made and uptake.</p><p><strong>Conclusions: </strong>Elevated MH symptoms are common in parents of children with CCs, but there is wide variability in outcomes. More research is required to understand this and how best to identify and screen for and support parents with referrals to and uptake of services for their MH.</p><p><strong>Prospero registration number: </strong>CRD42023438720.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"722-728"},"PeriodicalIF":3.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric and perinatal deaths by the Office of the Irish State Pathologists: a 5-year retrospective cohort study.","authors":"Danielle Moran, Michael J Barrett, Heidi Okkers, Linda Mulligan","doi":"10.1136/archdischild-2024-328411","DOIUrl":"10.1136/archdischild-2024-328411","url":null,"abstract":"<p><strong>Introduction: </strong>The Irish Office of the State Pathologist (OSP) provides a forensic pathology service for cases of criminal, suspicious or unusual deaths as referred by the coroner. This study aims to review the paediatric and perinatal deaths referred to the OSP and compare them to existing standards and data.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on all paediatric and perinatal cases (<18 years) referred to the OSP from 2018 to 2022. Postmortem examination (PME) reports were reviewed in line with the Royal College of Pathologists guidance. Case data results were then analysed independently and alongside previously published data for 2012-2017.</p><p><strong>Results: </strong>65 cases were identified. Confirmed homicide accounted for the highest proportion of referred cases at 31% (n=20). Sudden infant death syndrome (SIDS) was the key cause under 1 years old (n=10/13). 91% of postmortem reports (2018-2022) met reporting standards. Paediatric and perinatal referrals remained consistent when comparing 2012-2017 to 2018-2022. Areas of inconsistency were in the area of SIDS and the inclusion of anthropometric reference values. PMEs involving forensic pathologists (FPs) and paediatric/perinatal pathologists (PPs) produced variations in reporting.</p><p><strong>Conclusion: </strong>Homicide was the leading cause of referred cases at 31% over 2018-2022 and 29% between 2012-2022. While the OSP provides a high standard service, key areas of improvement include the reporting of SIDS, the anthropometric reference values and the integration of PP and FP reports. Analysis of child mortality data and statistics in Ireland would be improved with the implementation of a single reporting database.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"706-711"},"PeriodicalIF":3.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contact with the National Health Service in the week after an acute medical paediatric admission.","authors":"Smita Dick, Richard Kyle, Philip Wilson, Lorna Aucott, Emma France, E King, Cari Malcolm, Pat Hoddinott, Stephen W Turner","doi":"10.1136/archdischild-2024-328208","DOIUrl":"10.1136/archdischild-2024-328208","url":null,"abstract":"<p><strong>Introduction: </strong>After a child is discharged home following an emergency admission to hospital, little is known about contact with emergency departments (ED) or out-of-hours (OOH) general practice. Here, we report the number of contacts with ED and OOH in the week after discharge from hospital in Scotland during 2015-2017, including the number of contacts which result in a readmission.</p><p><strong>Methods: </strong>Databases containing routinely collected details from hospital admissions for an acute medical condition and subsequent presentation to ED or OOH were linked using a unique personal identifier and the date of discharge.</p><p><strong>Results: </strong>Of 171 039 urgent admissions, the source of referral was identified for 97 177 (57%) including 92 148 referred by ED or OOH. In the week following discharge, 11 025 (11%) children had a total of 11 497 contacts with ED and/or OOH. The daily number of contacts with ED and/or OOH fell from 2560 on the day after discharge to 1008 1 week after discharge. There were 3892 (35%) children readmitted following contact with ED and/or OOH. An additional 7133 children had a total of 7605 contacts with ED and/or OOH in the week postdischarge but were not readmitted.</p><p><strong>Conclusion: </strong>Many families seek medical assistance for their child from ED and/or OOH in the week after discharge from hospital, and the majority are not managed by or referred back to paediatric services. Clearer discharge planning could reduce the burden on ED, OOH and parents.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":"712-716"},"PeriodicalIF":3.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565859","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":"Longitudinal modelling of growth in neonates exposed to antenatal steroids to quantify associations with final height: a cohort study.","authors":"Neil Richard Lawrence, Krish Panchigar, Simon J Clark, Tim J Cole, Gary S Collins, Jeremy F Dawson, Nils P Krone, Neil Wright","doi":"10.1136/archdischild-2025-329091","DOIUrl":"10.1136/archdischild-2025-329091","url":null,"abstract":"<p><strong>Objective: </strong>To assess the associations of antenatal steroids with child growth.</p><p><strong>Design: </strong>Longitudinal observational cohort study started in 1994.</p><p><strong>Setting: </strong>A single tertiary neonatal centre in Sheffield, UK.</p><p><strong>Participants: </strong>Of 254 individuals recruited, two were excluded, 48 born at term; 202 (57% boys, 87% white ethnicity) modelled had a median of 19 height measurements each (Q1:12 to Q3:21) up to median age 15.8 years (Q1:9.9 to Q3:16.9).</p><p><strong>Interventions: </strong>Data on administration of antenatal steroids were collected alongside gestational age and parental height.</p><p><strong>Main outcome measures: </strong>Height was modelled with SuperImposition by Translation and Rotation (SITAR) to extract each person's peak velocity and age at peak velocity via the SITAR random effects of 'size', 'timing' and 'intensity' and to predict height at 18 years. The association of each random effect and final height with exposure to antenatal steroids was assessed by multiple regression to adjust for covariates.</p><p><strong>Results: </strong>In girls with covariates available (n=59/87), exposure to antenatal steroids was positively associated with SITAR 'size' and 'intensity' of growth when adjusted for gestational age, maternal and paternal height, equating to a final height 2.8 cm (95% CI 0.3 to 5.3 cm) greater than for those not exposed to antenatal steroids. In boys (n=66/115), exposure to antenatal steroids had no association with final height.</p><p><strong>Conclusions: </strong>This observational cohort study showed greater height of girls exposed to antenatal steroids not seen in boys. Analysis of existing long-term follow-up data from neonates is indicated to increase understanding of the associations of neonatal interventions on growth.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688702","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 overnight oximetry in assessing the severity of obstructive sleep apnoea in children with Down syndrome: a dual-centre study.","authors":"Hannah Vennard, Anna Selby, Menaga Ananthamoorthy, Elise Buchan, Paul Burns, Thomas L Wilkinson, Rebecca Lennon, Jonathan James, Neil Gibson, David Young, Martin Samuels, Hazel J Evans, Ross Langley","doi":"10.1136/archdischild-2025-328767","DOIUrl":"https://doi.org/10.1136/archdischild-2025-328767","url":null,"abstract":"<p><strong>Background and objective: </strong>Cardiorespiratory polygraphy (CRP) is the predominant technology used to diagnose obstructive sleep apnoea (OSA) in tertiary centres in the UK. Nocturnal pulse oximetry (NPO) is cheaper and more accessible. This study evaluates NPO indices' ability to predict OSA in children with Down syndrome (DS).</p><p><strong>Methods: </strong>Indices from simultaneous NPO and CRP recordings were compared in children with DS (aged 2-16 years) referred to evaluate OSA in two tertiary centres across an 8-year period. Receiver operating characteristic curves assessed the diagnostic accuracy of NPO indices, including ODI3 (3% Oxygen Desaturation Index) and ODI4 (4% Oxygen Desaturation Index). Two-by-two tables determined the sensitivities and specificities of cut-off values for predicting OSA.</p><p><strong>Results: </strong>387 children with DS were included with stand-alone NPO; 177 female (46.7%), median age 6.1 years (range 2.02-15.97). There were 265 children (68.5%) with Obstructive Apnoea-Hypopnoea Index (OAHI) ≥1/hour, 164 with OAHI ≥1<5/hour (42.4%), 51 with OAHI ≥5<10/hour (13.2%) and 50 with OAHI ≥10/hour (12.9%). ODI3 and ODI4 demonstrated the best predictive value for predicting OSA. An ODI3 ≥19/hour and an ODI4 ≥8/hour were associated with the highest combined sensitivity (59.2%/63.8%) and specificity (74.6%/71.3%), respectively.</p><p><strong>Conclusion: </strong>Raised ODI3 and ODI4 predict moderate and severe OSA in children with DS with moderate specificity/sensitivity and have a low sensitivity for detecting mild OSA. The poor predictive performance of oximetry reflects the multifactorial nature of sleep disordered breathing in children with DS. We recommend oximetry is not used for diagnosis of OSA in DS and CRP/polysomnography should be used.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820429","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":"High Intensity Use paediatric clinics for children under 5 years old: a pilot.","authors":"Harry Abnett, Lucy Sahota, Hannah Jacob","doi":"10.1136/archdischild-2025-329166","DOIUrl":"10.1136/archdischild-2025-329166","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793329","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":"Hypoxaemia definition in childhood based on arterial oxygen saturation obtained with a pulse oximeter: a retrospective study.","authors":"Nicole Beydon, Bamodi Simaga, Hayat Hammiche, Benjamin Dudoignon, Jessica Taytard, Plamen Bokov, Christophe Delclaux","doi":"10.1136/archdischild-2025-328723","DOIUrl":"https://doi.org/10.1136/archdischild-2025-328723","url":null,"abstract":"<p><strong>Objective: </strong>Using normal pulse oximetry (SpO₂) values as basis, an oxygen saturation <98% could reflect hypoxaemia in childhood. The objectives were to define the level of SpO₂ associated with hypoxaemia, the prevalence of SpO₂ <98% in children suffering from chronic diseases referred to pulmonary function testing units.</p><p><strong>Setting: </strong>Two university paediatric hospitals.</p><p><strong>Design and patients: </strong>We retrospectively selected arterialised blood gas (ABG) analyses and SpO₂ recordings, and further recorded pulmonary function test (PFT) indices (z-scores of forced expiratory volume at 1 s (FEV₁), forced vital capacity (FVC), FEV₁/FVC and total lung capacity) of visits with SpO₂<98% (Radical-7 pulse oximeter, Masimo).</p><p><strong>Results: </strong>The Bland-Altman analysis of saturations (n=1188) showed that SpO₂ overestimated arterialised saturation (bias: +1.3%, precision: ±1.1%). The 20 ABGs with SpO₂≤95% showed hypoxaemia (z-score of arterialised pressure of O₂<-1.96), while 48/74 (65%) ABGs with SpO₂ of 96% or 97% showed hypoxaemia. Three thousand eight hundred twenty-four PFTs were recorded in 2641 children (1186 girls, 1455 boys) with a mean age (±SD) of 12.3±3.5 years. The prevalence of SpO₂<98% was 114/2641 children (4.3%, 95% CI 3.6 to 5.2), showing that hypoxaemia was mainly observed in chronic obstructive diseases (96 children). Twelve children had SpO₂≤95% and all had ventilatory defects (based on international definitions of PFT).</p><p><strong>Conclusions: </strong>An oxygen saturation ≤95%, using the Masimo oximeter, is indicative of hypoxaemia and PFT abnormalities, while oxygen saturation of 96% or 97% indicates possible hypoxaemia. Thus, chronic respiratory insufficiency can confidently be diagnosed if repeated SpO₂ is ≤95% using the Masimo oximeter.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752131","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":"Jaundiced views: neonatal ceftriaxone use, hype and hyperbilirubinaemia.","authors":"Doan Thuc Nguyen, Rachel Swanwick, Michal Bloch, Suzanne Boyce, Sarah McNab, Amanda Gwee, Joshua Osowicki","doi":"10.1136/archdischild-2025-329159","DOIUrl":"https://doi.org/10.1136/archdischild-2025-329159","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688701","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":"What can Martha's Rule learn from Ryan's Rule?","authors":"Nitin Kapur","doi":"10.1136/archdischild-2025-329080","DOIUrl":"https://doi.org/10.1136/archdischild-2025-329080","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688703","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}