Archives of Disease in Childhood最新文献

{"title":"Severe accidental poisonings in children: a British Paediatric Surveillance Unit nationwide prospective study.","authors":"Charlotte King, Mark Anderson, Abhishek Agarwal, Apostolos Fakis, Christopher M Parry, Richard Michael Lynn, Daniel B Hawcutt, Elizabeth Sarah Starkey","doi":"10.1136/archdischild-2024-328196","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328196","url":null,"abstract":"<p><strong>Background: </strong>Poisoning in children and young people is common. Understanding the incidence, causes and circumstances of severe accidental poisonings, requiring admission and medical intervention, may help healthcare professionals and shape public health interventions.</p><p><strong>Methods: </strong>A prospective, population-based surveillance study using the British Paediatric Surveillance Unit (BPSU)'s active surveillance methodology (July 2018-July 2019) in the UK and Ireland. Inclusion criteria were as follows: all children aged <15 years; accidental poisoning requiring intervention; Poisoning Severity Score (PSS) score ≥2 (moderate or severe). Intentional poisonings were excluded.</p><p><strong>Results: </strong>116 cases of poisoning were reported, and 31 cases met the inclusion criteria. The overall incidence of reported severe accidental poisoning was 2.4 cases per million children (3.2 per million in male, 1.6 per million in female), with 7.3 cases per million in children under 2 years. On PSS scoring, 14 (45%) cases were classified as moderate, 16 (52%) cases severe and 1 (3%) case fatal. The frequency of fatal poisonings reported was 0.08 per million children. Prescription medications were the most common substance implicated (n=13, 42%), with opioids (n=6, 19%) being the most common medication group. Common non-medication causes were illicit drugs or alcohol (n=12, 39%), household or industrial products (n=5, 16%), and carbon monoxide (n=1, 3%). The most cited circumstance was 'the substance being left unattended' (n=8, 26%).</p><p><strong>Conclusion: </strong>Severe accidental poisoning remains a significant problem for children, but the most common causes have changed, underscoring the importance of updating public health initiatives.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405520","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":"Gender affirming hormone therapy for individuals with gender dysphoria aged <26 years: a systematic review and meta-analysis.","authors":"Anna Miroshnychenko, Sara Ibrahim, Yetiani Roldan, Chan Kulatunga-Moruzi, Steven Montante, Rachel Couban, Gordon Guyatt, Romina Brignardello-Petersen","doi":"10.1136/archdischild-2024-327921","DOIUrl":"10.1136/archdischild-2024-327921","url":null,"abstract":"<p><strong>Objective: </strong>In this systematic review and meta-analysis, we assessed and summarised the certainty of the evidence about the effects of gender affirming hormone therapy (GAHT) in individuals with gender dysphoria (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 studies comparing GAHT with no GAHT in individuals aged <26 years with GD. Outcomes of interest included psychological and physical effects. Pairs of reviewers independently screened articles, abstracted data and assessed the risk of bias in the included studies. We performed meta-analyses and assessed the certainty of the evidence using the grading of recommendations assessment, development and evaluation (GRADE) approach.</p><p><strong>Results: </strong>We included 24 studies. Comparative observational studies (n=9) provided mostly very low certainty evidence regarding GD, global function and depression. One comparative observational study reported that the odds of depression may be lower (OR 0.73 (95% CI 0.61 to 0.88), n (number of studies)=1, low certainty) in individuals who received GAHT compared with those who did not. Before-after studies (n=13) provided very low certainty evidence about GD, global function, depression and bone mineral density. Case series studies (n=2) provided high certainty evidence that the proportion of individuals with cardiovascular events 7-109 months after receiving GAHT was 0.04 (95% CI 0.03 to 0.05, n=1, high certainty).</p><p><strong>Conclusion: </strong>There is considerable uncertainty about the effects of GAHT and we cannot exclude the possibility of benefit or harm. Methodologically rigorous prospective studies are needed to produce higher certainty evidence.</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":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036177","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":"Blood folate level needed for fully effective fortification in the prevention of neural tube defects.","authors":"Nicholas J Wald, Stephen H Vale, Jonathan P Bestwick, Joan K Morris","doi":"10.1136/archdischild-2024-328115","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328115","url":null,"abstract":"<p><strong>Objective: </strong>Neural tube defects (NTDs) are a preventable folate deficiency disorder; increasing folic acid intake through food fortification increases serum and red blood cell folate and reduces the risk of an NTD pregnancy. There is controversy over the blood folate level needed to achieve the full preventive effect because of discrepant study conclusions.</p><p><strong>Methods: </strong>Results from two published studies were used to determine the relationship between serum folate and NTD risk which was compared with the observed result in a randomised trial of folic acid that increased serum folate from 5 ng/mL to 44 ng/mL among women who took a 4 mg daily periconceptional folic acid supplement.</p><p><strong>Results: </strong>Both studies showed a proportional (logarithmic) relationship between serum folate and NTD risk without evidence of a folate threshold above which there is no further NTD risk reduction. The suggestion of a threshold is due to the incorrect interpretation of the folate-NTD risk association when plotted on arithmetic scales, which conceals the proportional relationship between the two. Also, both studies accurately estimated the observed result from the randomised trial that achieved a median serum folate level of 44 ng/mL and an 83% preventive effect. This is much higher than has been achieved with current levels of folic acid fortification with serum folate between 10 and 16 ng/mL, resulting in an approximate 20% preventive effect.</p><p><strong>Conclusion: </strong>To achieve fully effective fortification, median population serum folate levels need to be about 44 ng/mL, which would globally prevent about 250 000 NTD cases every year.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405518","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":"Topical analgesia during needle-related procedures in children: a clinical practice guideline.","authors":"Debbie C Stavleu, Renée L Mulder, Demi M Kruimer, Maarten O Mensink, Leontien Cm Kremer, Wim Je Tissing, Erik Ah Loeffen","doi":"10.1136/archdischild-2024-326917","DOIUrl":"https://doi.org/10.1136/archdischild-2024-326917","url":null,"abstract":"<p><p>During intensive and long-lasting treatments, short-term or emergency care, children often undergo minor needle-related procedures (ie, venepuncture, venous cannulation and puncture of central venous access ports). The use of topical analgesia topical analgesia before these procedures can reduce needle-related pain. There is, however, uncertainty about the type of local anaesthetic (ie, eutectic mixture of topical analgesia (EMLA) or tetracaine-containing creams (eg, Rapydan) that should be used.Therefore, a clinical practice guideline (CPG) was developed to establish a comprehensive, evidence-based overview and provide recommendations for clinical practice.A comprehensive multidisciplinary panel was assembled, comprising 16 professionals and patient representatives in the Netherlands. A systematic literature review was performed, and after dual appraisal of all articles, results were extracted and meta-analyses were performed. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess, extract and summarise the evidence. An in-person meeting was held to discuss the evidence, complete an evidence-to-decision framework and formulate recommendations.In total, ten randomised controlled trials comprising 1808 children formed the evidence base for the recommendations. We recommend the use of EMLA in children who need to undergo a minor needle-related procedure, with minimal application duration of 60 min (strong recommendation, very low-quality evidence). We suggest the use of tetracaine-containing creams only when rapid cannulation/puncture (ie, within 30-60 min) is required (weak recommendation, very low-quality evidence).In this CPG, we provide recommendations regarding the choice of local anaesthetic for needle-induced pain during minor procedures in children. With these recommendations, we aim to reduce procedural pain and thereby contribute to improving care for children.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397775","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":"Dyskeratosis congenita mistaken for lichen planus.","authors":"Tanvi Dev, M Ramam","doi":"10.1136/archdischild-2024-328313","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328313","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397810","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":"Profiles of developmental disorder and associations with gestational age.","authors":"Katherine Jane Pettinger, Sarah Louise Blower, Elaine M Boyle, Catherine Elizabeth Hewitt, Lorna K Fraser","doi":"10.1136/archdischild-2024-327962","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327962","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to examine profiles of co-occurrence of developmental disorders and their association with birth before full term.</p><p><strong>Design: </strong>Latent class analysis of cohort data with linked health data.</p><p><strong>Setting: </strong>Bradford, England.</p><p><strong>Patients: </strong>13 172 children were included in the analysis.</p><p><strong>Outcome measures: </strong>Developmental disorder in medical records.</p><p><strong>Methods: </strong>Data were censored at each child's 12th birthday. The latent class analysis identified patterns of developmental disorders. Multinomial logistic regression explored the association with gestational age while adjusting for clinical and socio-factors.</p><p><strong>Results: </strong>The majority (12,536) had a low risk of developmental disorders; this group was named 'typical development'. The remaining children were classified into three groups: 'educational difficulties' (347 children); 'social, emotional, behavioural and communication difficulties' (189 children) and 'early developmental impairment, with physical and intellectual disabilities' (100 children).Compared with 'typical development', very preterm birth was associated with an increased likelihood of being in the 'early developmental impairment, with physical and intellectual disabilities' group, adjusted relative risk ratio (aRRR): 9.22 (95% CI 4.58 to 18.55). Birth before full term was associated with increased likelihood of being in the 'educational difficulties' group; risk was highest <34 weeks (aRRR: 2.64 (95% CI 1.44 to 4.83)) but persisted up to 37-38 weeks: aRRR: 1.41 (95% CI 1.10 to 1.81). There was no association between gestational age and the 'social, emotional, behavioural and communication difficulties'' group.</p><p><strong>Conclusion: </strong>Four distinct profiles of developmental disorders were identified; gestational age was associated with two of these. Understanding which disorders children are most at risk of and how these co-occur can help provide accurate information to families and contribute to prompt diagnosis.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389673","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":"The relevance of miracles in court decisions affecting children.","authors":"Robert Wheeler","doi":"10.1136/archdischild-2024-328461","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328461","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389680","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":"Impact of child socioemotional and cognitive development on exam results in adolescence: findings from the UK Millennium Cohort Study.","authors":"Michelle Black, Lateef Akanni, Nicholas Kofi Adjei, G J Melendez-Torres, Dougal Hargreaves, David Taylor-Robinson","doi":"10.1136/archdischild-2024-327963","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327963","url":null,"abstract":"<p><strong>Background: </strong>Cognitive ability and socioemotional behaviour during childhood have independently been shown to impact educational outcomes. The extent to which their co-development predicts these outcomes remains unclear. This study aimed to assess associations between concurrent cognitive and socioemotional development trajectories in childhood and exam results at age 16 years.</p><p><strong>Data and method: </strong>We analysed longitudinal data on 9084 children from the UK Millennium Cohort Study. Exposure trajectories of cognitive and socioemotional development from age 3 to 14 years were characterised using group-based multi-trajectory models. We used logistic regression to assess associations between these development trajectories and exam attainment, measured by passing five or more GCSE subjects at age 16, adjusting for confounders. Population-attributable fractions were calculated to quantify the contribution of cognitive and socioemotional problems to poor educational outcomes.</p><p><strong>Results: </strong>Compared with the 'no problem' trajectory group, the odds of not achieving a standard pass in GCSE was 2.5 times higher for the 'late socioemotional problems' trajectory group (adjusted OR 2.5, 95% CI 2.1 to 3.1) and four times higher for the 'early cognitive and socioemotional problems' trajectory group (adjusted OR 4.2, 95% CI 3.4 to 5.3). The OR was highest for the trajectory group with persistent cognitive and socioemotional problems (adjusted OR 4.4, 95% CI 3.3 to 5.8). Approximately 17% of poor exam results in adolescence were attributable to cognitive and socioemotional behaviour problems in childhood (adjusted population-attributable fraction 17%, 95% CI 15% to 19%).</p><p><strong>Conclusion: </strong>In a representative UK cohort, adverse development of cognitive and socioemotional behaviour in childhood was associated with a negative impact on exam results in adolescence, more so when the adverse development co-occurs or clusters early or persistently. Cross sector health and education policy that invests in reducing cognitive and socioemotional behaviour problems in children has the potential to improve educational outcomes in adolescence.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389668","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":"Current provision of point of care ultrasound in UK paediatric critical care: an online survey.","authors":"Charlotte G Morea, Christopher Beaves, Peter Shires, Antonia Hargadon-Lowe, Oliver Ross, Michael J Griksaitis","doi":"10.1136/archdischild-2024-327934","DOIUrl":"https://doi.org/10.1136/archdischild-2024-327934","url":null,"abstract":"","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389658","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":"Chimeric antigen receptor T cell therapy in childhood leukaemia.","authors":"Stacie Shiqi Wang, Rebecca C Abbott, Maddie Gilsenan, Trevor Duke, Seong Lin Khaw","doi":"10.1136/archdischild-2024-328263","DOIUrl":"https://doi.org/10.1136/archdischild-2024-328263","url":null,"abstract":"<p><p>Chimeric antigen receptor (CAR) T cell therapy is a promising form of adoptive cell therapy. This process re-engineers patient-derived T cells to express a hybrid receptor targeting a selected tumour-expressed antigen. CAR T cell therapy directed against the CD19 antigen has been highly successful in haematological malignancies that have failed other therapies, particularly relapsed B-cell acute lymphoblastic leukaemia (B-ALL). This review focuses on the numerous real-world aspects of treating children with B-ALL with CD19-targeted CAR T cell therapy. We discuss some of the considerations for clinicians including manufacturing time, administration and care of the patient receiving this novel therapy, toxicities and outcomes. We also discuss the therapeutic uncertainty many physicians now face of when to use CAR T cell therapy in the patient journey, especially when haematopoietic stem cell transplant is being considered.</p>","PeriodicalId":8150,"journal":{"name":"Archives of Disease in Childhood","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363346","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}