Archives of Disease in Childhood最新文献

{"title":"Evolving landscape of paediatric sepsis: progress, gaps and the next generation of tools.","authors":"Pamela Jump Salcedo, Daniel R Owens","doi":"10.1136/archdischild-2026-331272","DOIUrl":"https://doi.org/10.1136/archdischild-2026-331272","url":null,"abstract":"<p><p>Paediatric sepsis remains a major cause of childhood mortality worldwide, despite substantial changes in its epidemiology, definitions and management over the past two decades. Progress has come from sharper criteria centred on organ dysfunction, prevention through vaccination and more nuanced bedside management. The Phoenix Sepsis Criteria have moved paediatric sepsis away from inflammation-based definitions towards life-threatening organ dysfunction, while conjugate vaccine programmes have reshaped the population of children presenting with invasive bacterial infection. Contemporary guidance also increasingly stratifies treatment by severity, reflecting a shift away from uniform bundles applied to all.Important gaps remain. Many paediatric sepsis deaths still occur within the first 24 hours of referral to intensive care, suggesting that outcomes are often determined before paediatric intensive care unit admission. Early recognition remains difficult: screening tools perform imperfectly in unselected febrile children, biomarkers remain adjuncts, and clinicians still rely on gestalt and parental concern. Sepsis is also heterogeneous, spanning children with different pathogens, host factors and immune responses.Future progress is likely to depend on risk stratification rather than universal screening. Machine learning may make early recognition more reproducible, while phenotype-informed approaches may support trials targeted to biologically meaningful subgroups. Both require prospective validation before routine use.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944179","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":"Survey of healthcare professionals, families and those with lived experience, exploring methodologies for identifying multiple long-term conditions in childhood.","authors":"Tim J van Hasselt, Janine Hart, Minakshi Patel","doi":"10.1136/archdischild-2026-331273","DOIUrl":"https://doi.org/10.1136/archdischild-2026-331273","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944204","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":"Association between sociodemographic factors, neighbourhood cigarette smoke exposure and critical illness due to respiratory condition among paediatric population in England, 2014-2023: a retrospective cohort study.","authors":"Subashan Vadibeler, Khurram Mustafa, Tatendashe Bernadette Dondo, Hannah K Mitchell, Sarah E Seaton, Richard Feltbower","doi":"10.1136/archdischild-2025-330159","DOIUrl":"https://doi.org/10.1136/archdischild-2025-330159","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the association between sociodemographic disparities and area-level smoking with paediatric intensive care unit (PICU) respiratory admission risk and outcomes.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>English PICUs.</p><p><strong>Patients: </strong>Children aged <16 years admitted with respiratory illness between January 2014 and December 2023.</p><p><strong>Main outcome measures: </strong>Crude incidence of PICU admission and incidence rate ratios (IRRs). ORs for in-PICU mortality.</p><p><strong>Results: </strong>Analysis included 41 859 admissions for 30 442 children. The respiratory admission IRRs were higher in children of Asian and Black ethnicity and in children from the most deprived areas compared with children of White ethnicity and those from the least deprived areas (IRR 1.5, 95% CI 1.3 to 1.7; IRR 1.7, 95% CI 1.4 to 1.9; adjusted IRR 1.7, 95% CI 1.4 to 2.2). Children living in areas with the highest cigarette smoke exposure had a higher respiratory admission IRR (adjusted IRR 1.3, 95% CI 1.1 to 1.5) compared with those in areas with the lowest exposure. Children of Asian ethnicity and those from the most deprived areas had a higher in-PICU mortality compared with children of White ethnicity and those from the least deprived areas (OR 2.1, 95% CI 1.8 to 2.5 and adjusted OR 1.6, 95% CI 1.2 to 2.0).</p><p><strong>Conclusions: </strong>Ethnicity and deprivation were associated with higher PICU respiratory admission incidence and poorer outcomes. Children from areas with higher cigarette smoke were more likely to require PICU admission for respiratory diseases. Community-focused tobacco control measures to reduce population-level smoking can benefit child respiratory health.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944193","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":"Methanol poisoning: be aware.","authors":"Margaret McKie","doi":"10.1136/archdischild-2026-330689","DOIUrl":"10.1136/archdischild-2026-330689","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890771","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":"Reframing research: a child-lens approach to health innovation.","authors":"Rhian Thomas-Turner, Mauricio Preciado Awad, Marc Ramis","doi":"10.1136/archdischild-2025-329686","DOIUrl":"https://doi.org/10.1136/archdischild-2025-329686","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944156","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":"Paediatric familial hypercholesterolaemia in Australia: a real-world registry study.","authors":"Andrew C Martin, Shubha Srinivasan, Robert N Justo, Kathryn E Waddell-Smith, David R Sullivan, Ari E Horton, Dick C Chan, Jing Pang, Gerald F Watts","doi":"10.1136/archdischild-2026-331003","DOIUrl":"https://doi.org/10.1136/archdischild-2026-331003","url":null,"abstract":"<p><strong>Objective: </strong>To describe the characteristics, detection and management of children and adolescents with familial hypercholesterolaemia (FH) enrolled in the Australian National FH Registry.</p><p><strong>Design: </strong>Cross-sectional registry analysis.</p><p><strong>Setting: </strong>17 specialist lipid clinics across Australia.</p><p><strong>Patients: </strong>341 children and adolescents under 18 years of age with FH, enrolled between February 2015 and March 2026.</p><p><strong>Interventions: </strong>None, observational study.</p><p><strong>Main outcome measures: </strong>Age at enrolment, mode of FH detection, uptake of genetic testing, lipid-lowering therapy patterns, attainment of low-density lipoprotein-cholesterol (LDL-C) goals and testing of lipoprotein(a) [Lp(a)].</p><p><strong>Results: </strong>The mean age at enrolment was 11.9 years; 51.4% were male and 53.5% were index cases. Only 52.6% had undergone genetic testing. The mean untreated LDL-C was 6.2 mmol/L. At follow-up, 85.4% were on lipid-lowering therapy, with 91.3% on a moderate-intensity or high-intensity statin but only 12.7% received combination therapy with ezetimibe. The mean treated LDL-C was 3.8 mmol/L and only 48.3% achieved the guideline-recommended goal. Factors associated with goal attainment included a lower pre-treatment LDL-C and use of lipid-lowering therapy. Lp(a) was tested in only 33.7% of children.</p><p><strong>Conclusions: </strong>This study reveals five critical gaps in the care of Australian children with FH: late diagnosis after the recommended age to commence therapy; non-attainment of LDL-C goals despite treatment; under-utilisation of genetic testing; infrequent cascade testing and infrequent testing of Lp(a). Addressing these gaps demands a coordinated multilevel response, including a universal childhood FH screening programme coupled with state-based cascade testing hubs and rigorous implementation of evidence-based paediatric guidelines.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918360","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":"Protected time for integration: reclaiming community as a professional obligation.","authors":"Guddi Singh, Mitch Blair","doi":"10.1136/archdischild-2026-330515","DOIUrl":"https://doi.org/10.1136/archdischild-2026-330515","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918448","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":"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}