BMJ Paediatrics Open最新文献

{"title":"Tumours in children and adolescents with Turner syndrome and Klinefelter syndrome: a retrospective Chinese cohort study.","authors":"Gaowei Wang, Meiye Wang, Jin Wang, Zhenhua Zhang, Karel Allegaert, Yaodong Zhang, Shuying Luo, Yang Fang, Yongxing Chen, Haiyan Wei, Dongxiao Li","doi":"10.1136/bmjpo-2025-003741","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003741","url":null,"abstract":"<p><strong>Purpose: </strong>To analyse the incidence and characteristics of tumours diagnosed during childhood or adolescence in patients with Turner syndrome (TS) and Klinefelter syndrome (KS).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on clinical information of children diagnosed with TS and KS between 2010 and mid-2024. Meanwhile, the number of children with concomitant tumours was determined, and the incidence was analysed.</p><p><strong>Result: </strong>A total of 23 individuals (median age 10 years, range: after birth to 16 years) with tumours were identified among the 657 children with TS and KS (median age=9 years, range: birth to 18 years), resulting in a tumour incidence of 3.50%. Within a cohort of 560 TS cases (median age 9 years, range: birth to18 years), 20 (3.57 %) were diagnosed with tumours. In a cohort of 97 KS cases (median age 4.3 years, range: 1-16 years), three (3.09 %) cases were diagnosed with tumours. The most common tumours in TS were osteochondroma (n=7) and haemangioma (n=6), with an estimated incidence of 1.25% and 1.07%, followed by gonadoblastoma (n=2), with an incidence of 0.36% in all TS and 4.44% in TS presenting with Y-chromosome material. In patients with KS, haemangioma (n=1), acute lymphoblastic leukaemia (n=1) and germ cell tumours (n=1) were observed. The co-occurrence of hepatic haemangiomas, mixed-phenotype acute leukaemia in TS, and the karyotypes (48,XXY,+21) of patient with intracranial germ cell tumours have not been previously reported.</p><p><strong>Conclusion: </strong>Early-diagnosed TS and KS present with a variety of tumours in affected children, with osteochondromas representing the most prevalent in early diagnosed TS.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychosocial and contextual risk factors of adolescent deliberate poisoning: a multicentre case-control study in Sri Lanka.","authors":"Kavinda Dayasiri, Vijayakumary Thadchanamoorthy, Achila Ranasinghe, Nirosha Madhuwanthi Hettiarachchi, Nayani Suraweera, Tharuka Perera, Gihan Gunarathna","doi":"10.1136/bmjpo-2025-003949","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003949","url":null,"abstract":"<p><strong>Introduction: </strong>Deliberate self-poisoning is a leading method of self-harm among adolescents globally. This study aimed to identify psychosocial, familial and contextual risk factors associated with deliberate self-poisoning among Sri Lankan adolescents.</p><p><strong>Methods: </strong>A multicentre prospective case-control study was conducted across selected tertiary care hospitals in Sri Lanka over a 2-year period. Adolescents aged 10-17 years admitted with deliberate poisoning were recruited as cases. Age- and sex-matched controls were recruited from the same study settings. Structured interviews were conducted using a pretested tool assessing sociodemographic, psychological, family and school-related factors. Conditional logistic regression was used to estimate adjusted ORs (AORs) and 95% CIs.</p><p><strong>Results: </strong>A total of 326 case-control pairs (n=652) were included. The majority of cases were female (74.5%) and aged 15-17 years. The most frequently ingested agents were paracetamol (45.1%) and oleander (10.7%). In multivariable analysis, personal history of psychiatric illness (AOR 2.76, 95% CI 1.92 to 5.41), previous self-injury (AOR 4.17, 95% CI 1.92 to 10.77), previous deliberate poisoning (AOR 4.02, 95% CI 2.86 to 5.19), non-heterosexual orientation (AOR 26.9, 95% CI 12.18 to 75.45), school dropout (AOR 4.01, 95% CI 2.06 to 6.57), home violence (AOR 8.93, 95% CI 3.27 to 26.47) and feeling depressed (AOR 2.08, 95% CI 1.49 to 3.20) were independently associated with deliberate poisoning.</p><p><strong>Conclusion: </strong>Deliberate self-poisoning among Sri Lankan adolescents is strongly associated with psychiatric comorbidity, family adversity, sexual identity-related distress and school disengagement. These findings highlight the urgent need for integrated, adolescent-friendly mental health services, school-based screening and psychosocial support mechanisms.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between sleep duration at 12 and 18 months and epilepsy risk at 2-3 years: the Japan Environment and Children's Study.","authors":"Yuto Arai, Tohru Okanishi, Toshio Masumoto, Hisashi Noma, Yoshihiro Maegaki","doi":"10.1136/bmjpo-2025-003903","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003903","url":null,"abstract":"<p><strong>Background: </strong>Sleep deprivation has notable effects on neurobehavioural functioning in children. However, the link between sleep duration and the risk of developing epilepsy in early childhood remains uncertain. The aim of this study was to explore the association between sleep duration at 12 and 18 months and the risk of epilepsy at 2 and 3 years of age.</p><p><strong>Methods: </strong>Data from the Japan Environment and Children's Study (JECS), a largescale birth cohort, were analysed. We assessed the risk of epilepsy at 2 and 3 years of age among children sleeping under 11 hours per night, the minimum recommended by the American Academy of Sleep Medicine for 1-2 year olds.</p><p><strong>Results: </strong>Overall, 86 441 children were retrospectively analysed. Of these, 8786 (10.2%) and 12 850 (14.9%) slept for less than 11 hours at 12 months and 18 months, respectively. Multivariate logistic regression showed that a sleep duration of less than 11 hours at 12 months remained significantly associated with epilepsy incidence at 2 and 3 years (adjusted OR (aOR) 2.02, 95% CI 1.01 to 4.01, p=0.045; aOR 1.98, 95% CI 1.15 to 3.41, p=0.013). Furthermore, a sleep duration of less than 11 hours at 12 and 18 months was significantly associated with epilepsy incidence at 3 years (aOR 2.77, 95% CI 1.28 to 6.01, p=0.010).</p><p><strong>Conclusions: </strong>Insufficient sleep in infancy may be linked to epilepsy later in childhood. These findings highlight the importance of sleep interventions during early life to improve long-term neurological health.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolescents left behind: underrepresentation in asthma randomised controlled trials.","authors":"Amy G Nuttall, Catherine McNamara, William Bedson, Emma Wilkinson, Ian Sinha, Paul McNamara","doi":"10.1136/bmjpo-2025-003905","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003905","url":null,"abstract":"<p><p>To guide adolescent asthma management, evidence of treatment efficacy and safety is needed. We searched multiple databases for randomised control trials (RCTs) of pharmaceutical asthma therapies recruiting adolescents and adults between 2015 and 2023 to ascertain the proportion of adolescents recruited. 81 RCTs were identified, with 49 (60.5%) not reporting the number/proportion of adolescents recruited. Where the proportion of adolescents was reported, this ranged between 1% and 49% (median 6.1%). Only 7 (8.6%) trials reported adolescent subgroup data. In published asthma RCTs, it is frequently unclear whether adolescents have been recruited, with the proportion low when reported. Consideration is needed when using this data to manage adolescent asthma.CRD42021233497.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Impact of Early Childhood and Primary Education for Children with Neurodevelopmental Disabilities on Parents in Nigeria.","authors":"Basirat Razaq-Shuaib","doi":"10.1136/bmjpo-2025-003909","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003909","url":null,"abstract":"<p><strong>Background: </strong>Early childhood is a foundational period for children's development and readiness for primary education. Yet, children with neurodevelopmental disabilities (ND) in Nigeria, including autism and attention deficit hyperactivity disorder, face limited tailored support and interventions during this period. While the presence of ND is known to increase caregiver burden, this remains underexplored in Nigeria, especially in the context of education. This paper aims to discuss how mothers interpret their experiences of educating their children with ND, the multidimensional impact of these experiences on their personal and family lives, and what their experiences reveal about broader structural and systemic inequalities.</p><p><strong>Methods: </strong>A qualitative case study was conducted with mothers as they are the main caregivers. Twelve mothers of children aged 6-13 years diagnosed with ND and accessing primary education in Lagos, Nigeria, participated in the study. Data were collected through semi-structured interviews conducted in English language. Interviews were transcribed verbatim and thematically analysed individually and across cases.</p><p><strong>Results: </strong>The findings reveal that the experiences of mothers in caregiving and educating their children with ND have been challenging due to inadequate support and persistent systemic and attitudinal barriers. This lack of support commences in early childhood, from gaining a diagnosis through to finding a supportive educational setting for the child. While mothers navigate these barriers through resilience by developing adaptive measures such as re-educating themselves, this comes at interconnected and multidimensional costs which have a gendered dimension.</p><p><strong>Conclusion: </strong>The paper redirects attention to unsupportive systems, which continually draw on the resilience of mothers, thereby threatening their capacity to protect and support the development and education of their children. It also calls for the prioritisation of disabilities in education agendas, integration of voices of mothers into policy and practice, responsive systemic support for their significant caregiving and education responsibilities, and inclusion of fathers and other stakeholders into future research.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scaling success: parental perceptions of the benefits of a 20-week football living-lab approach for children living with cerebral palsy.","authors":"Ricardo Martins, Will Pattison, Lara Vella, Ruth Postlethwaite, David Broom, Eileen Africa, Michael Duncan","doi":"10.1136/bmjpo-2025-003895","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003895","url":null,"abstract":"<p><p>BackgroundLiving-lab approaches have effectively connected academic research with community needs but have not yet been applied to promote physical activity for children with cerebral palsy (CP). This study evaluated a 20-week football-based living-lab programme for children aged 5-10 years with CP, grounded in the principles of Football is Medicine and physical literacy.</p><p><strong>Methods: </strong>A qualitative design was employed, involving seven one-to-one semistructured interviews with parents or legal guardians of programme participants. A deductive thematic analysis was conducted, and pen profile diagrams were developed to represent key themes related to physical literacy outcomes.</p><p><strong>Results: </strong>Parents reported benefits across multiple dimensions of their children's physical literacy, including improved competence, confidence, motivation and enjoyment. All parents observed enhanced social interaction. Six described the sessions as inclusive and community-oriented, while five felt the programme was personalised to their child's needs. Three parents perceived the football activities as complementary to physical therapy, supporting physical rehabilitation. Participation also enabled parents to exchange strategies and engage more meaningfully in their child's well-being.</p><p><strong>Conclusion: </strong>The football-based living-lab supported the holistic development of children with CP, enhancing physical, psychological and social domains of physical literacy. Parental involvement further reinforced perceived therapeutic and community benefits.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring parent/caregiver perspectives post participation in WeCare programme for parents/caregivers post neurodevelopmental disability diagnosis.","authors":"Elena Hatzis, Anoo Bhopti, Helen Bourke-Taylor","doi":"10.1136/bmjpo-2025-003874","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003874","url":null,"abstract":"<p><strong>Background: </strong>Parents of children with neurodevelopmental disability face considerable challenges during the time of receiving their child's diagnosis, resulting in risks to their health, well-being and occupational participation. WeCare programme is a group-based, peer-supported parent programme delivered online, purposefully designed to support parents during the time of diagnosis. WeCare programme focuses on improving family well-being, family quality of life and engagement in meaningful parent occupations. This study aimed to investigate the experiences of parents who participated in the programme.</p><p><strong>Methods: </strong>WeCare programme was delivered over 2 years by two occupational therapists and two parent peer-facilitators. A qualitative study design was employed using semistructured interviews with participants who completed the WeCare programme. Interviews were recorded via Zoom. Data was analysed using Braun and Clarke's six-step method of reflexive thematic analysis.</p><p><strong>Findings: </strong>Seven parents (five mothers and two fathers) participated. Four major themes were identified: A Group for Me; Clearing the Fog; Positive Changes; and Reflections on Content and Delivery. The majority of parents described common experiences after attending the WeCare programme, including feeling less isolated by belonging in a group of parents facing similar challenges; being prompted to consider self-care and their own well-being; feeling more confident in their understanding of their child's diagnosis and ability to navigate services; and appreciating the support of professional and peer facilitators. Implementation of well-being strategies was influenced by structural and personal factors, highlighting systemic barriers to support. Valuable feedback highlighted suggestions for future WeCare programme including the need for ongoing support after the programmes' conclusion and face-to-face sessions.</p><p><strong>Conclusions: </strong>Parents' experiences confirm that the WeCare programme provides timely and effective support during the early days of receiving a disability diagnosis, complementing existing services rather than replacing them. Programmes like WeCare can enhance family-centred practice and parental capacity, though broader structural and policy reforms are needed to address service gaps. Occupational therapists can enhance parent support through specialised programmes such as the WeCare programme, tailored to meet the unique needs of each family. Continued development and dissemination of WeCare is warranted to enhance equitable access and improve family outcomes.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 with persistent post-COVID-19 condition over 24 months: a mixed-methods study.","authors":"Esther Ortega-Martin, Alvin Richards-Belle, Fiona Newlands, Roz Shafran, Terence Stephenson, Natalia Rojas, Neha Batura, Marta Buszewicz, Emma Dalrymple, Isobel Heyman, Snehal M Pinto Pereira","doi":"10.1136/bmjpo-2025-003634","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003634","url":null,"abstract":"<p><strong>Purpose: </strong>While most children and young people (CYP) recover from COVID-19, some develop 'post-COVID-19 condition' (PCC), affecting their health and well-being. We explored (1) whether distinct persistent PCC symptom subgroups exist in CYP and whether these subgroups remain stable up to 24 months postinfection; (2) whether impairments differ across subgroups and (3) how CYP with persistent PCC describe the evolving impact of the pandemic/lockdowns on their health and experiences up to 24 months postinfection.</p><p><strong>Methods: </strong>A cohort of CYP across England was recruited in 2020-2021 (the children and young people with Long COVID study). A subsample of 68 CYP meeting the PCC Delphi research definition at 3, 6, 12 and 24 months post-PCR-confirmed infection was analysed. Latent class analysis identified symptom subgroups (objective 1); associations with impairments (measured via EuroQol Five Dimensions Youth) were examined (objective 2). Free-text responses from six CYP at all four follow-up points (n=24) were thematically analysed to capture evolving experiences (objective 3).</p><p><strong>Results: </strong>Included CYP were older (72.1% were 15-17 years), female (82.4%) and white (80.9%). Two symptom groups emerged: a frequent symptom subgroup (median: 6.5-9 symptoms over time, mainly shortness of breath and tiredness); and a less frequent symptom subgroup (median: 4-5 symptoms, mostly tiredness). Generally, no association was found between symptom subgroups and impairments. Qualitative analysis indicated feelings of anxiety, respiratory problems and concerns around relaxation of lockdown restrictions persisted over follow-up. School-related worries were transient.</p><p><strong>Discussion: </strong>Even CYP with persistent PCC characterised by fewer symptoms experience long-term anxiety and impact, emphasising even few symptoms can be debilitating and underscoring the need for personalised PCC management for CYP.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145343178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leak during term neonatal CPAP stabilisation: does resuscitation device design affect delivered PEEP - a bench study.","authors":"Viktoria Gruber, Stephanie Morakeas, Murray Hinder, Thomas Drevhammar, Mithilesh Dronavalli, Mark Brian Tracy","doi":"10.1136/bmjpo-2025-003679","DOIUrl":"10.1136/bmjpo-2025-003679","url":null,"abstract":"<p><strong>Background: </strong>Mask leak is common during newborn resuscitation, impacting delivered ventilation. Less is known about the effect of leak during assisted spontaneous breathing with continuous positive airway pressure (CPAP).</p><p><strong>Aim: </strong>Compare CPAP performance in the presence of leak of two T-piece resuscitation devices, with differing design-imposed resistances: high resistance Neopuff and low resistance rPAP.</p><p><strong>Methods: </strong>Devices were tested on a term dynamic lung model (compliance 1.0 mL/cmH₂O, tidal volume (VT) 23 mL) at three incremental leak levels and set positive end expiratory pressure (PEEP) 5 cmH₂O, 7 cmH₂O and 9 cmH₂O. Continuous leaks were generated by differing-length tubes open to atmosphere. Measured parameters were mean pressure, fluctuations around set pressure (∆P), VT and leak flow.</p><p><strong>Results: </strong>2437 breaths were analysed (1216 rPAP, 1221 Neopuff). Leak reduced PEEP, with the largest reduction at the highest leak and 9 cmH₂O set PEEP (Neopuff 2.6 cmH₂O vs rPAP 7.0 cmH₂O). Higher delivered PEEP was associated with higher leak flows (Neopuff 4.4 L/min vs rPAP 8.2 L/min, 9 cmH₂O set PEEP). VT reduced with Neopuff compared with rPAP (Neopuff 18 mL vs rPAP 23.2 mL, no leak, 9 cmH₂O set PEEP) and was affected by delivered PEEP.</p><p><strong>Conclusion: </strong>The delivered support differed between devices in the presence of leaks. rPAP maintained pressures closer to the set PEEP value at all leak levels, and higher leak flows were seen with the maintained distending pressure. Neopuff's higher resistance led to reductions in VT that were more pronounced at low leak levels.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145306987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of intraoperative radiation exposure in paediatric orthopaedic and trauma patients: a comparative cohort study.","authors":"Philipp Kriechling, Fabian Luca Meichtry, Maria Anna Smolle, Helga Preiss, Michael Zellner, Yvonne Kaeser, Nadja A Farshad-Amacker, Thomas Dreher","doi":"10.1136/bmjpo-2025-003666","DOIUrl":"10.1136/bmjpo-2025-003666","url":null,"abstract":"<p><strong>Objective: </strong>To reliably analyse the intraoperative radiation exposure in paediatric orthopaedic trauma surgery (POTS).</p><p><strong>Design: </strong>Retrospective, comparative cohort study.</p><p><strong>Setting: </strong>Single-centre, academic tertiary referral hospital.</p><p><strong>Participants: </strong>2271 surgical cases of 1965 paediatric patients (median age 9 years (IQR, 6 to 12), 41% female) who underwent orthopaedic trauma surgery between 2016 and 2021.</p><p><strong>Main outcome measures: </strong>Radiation exposure was measured as dose area product (DAP, cGycm²) from intraoperative dose reports and categorised by anatomical region. Subsequently, factors in relation to one preoperative image of the region (rDAP) and in relation to a weight-corrected chest x-ray (rDAP chest) were calculated. Further, effective dose (µSv) was estimated.</p><p><strong>Results: </strong>A total of 195 667 x-rays were included in the analysis comprising 1584 (70%) trauma cases and 687 (30%) elective orthopaedic cases. The median DAP measured 30 cGycm² (IQR, 14 to 59) with a median of 62 (IQR, 34 to 107) exposure events per case. The applied DAP was comparable between trauma cases and elective cases (p=0.4). The rDAP reached 26 (IQR, 8 to 69), with the largest factors for multilevel surgery at the upper extremity, elbow and forearm with factors of 89, 56 and 55, respectively. The rDAP chest was highest for hip, multilevel upper extremity and shoulder with values of 27, 26 and 22. Analysis of effective dose revealed a median exposure of 13 µSv (IQR, 3 to 31) with highest values for spine, hip and shoulder reaching 98 µSv (IQR, 49 to 159), 73 µSv (IQR, 30 to 186) and 56 µSv (23 to 126), respectively.</p><p><strong>Conclusion: </strong>The data suggest that intraoperative radiation imaging during POTS exposes paediatric patients to a substantial amount of radiation in comparison to preoperative x-rays. In detail, analysis revealed higher effective doses for all procedures close to the trunk. Particularly concerning were the outliers reaching exponentially higher values. This study highlights the necessity for additional research on intraoperative radiation doses, emphasising the importance of minimising radiation exposure in this vulnerable patient cohort.</p><p><strong>Trial registration: </strong>Cantonal ethics committee of Zurich (BASEC 2022-01486).</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12542719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}