BMJ Paediatrics Open最新文献

{"title":"Risk of burnout syndrome in paediatricians in Bogotá, Colombia: a cross-sectional survey.","authors":"Pedro Alexander Barrera López, Catalina Jaime, Fernanda Argote, Juan Carlos Molano, Andrés Sanmiguel, Jose De La Hoz, Martha Escobar","doi":"10.1136/bmjpo-2025-003525","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003525","url":null,"abstract":"<p><strong>Background: </strong>Burnout syndrome is a significant issue among healthcare professionals, significantly affecting their mental well-being. Its prevalence has increased since the onset of the COVID-19 pandemic. In Colombia, data on burnout prevalence are limited, and no specific studies have been conducted in paediatrics. Therefore, this study aims to assess the risk of mental disorders and burnout syndrome among paediatricians working in various healthcare settings in Bogotá during 2023.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among paediatricians in Bogotá, Colombia. The sample size was calculated at 179 participants based on the city's paediatrician population and previous studies on burnout prevalence in paediatric emergency services. The survey included the Maslach Burnout Inventory (MBI) for medical personnel, the Self-Report Questionnaire, the Patient Health Questionnaire-2 and the Generalised Anxiety Disorder-2.</p><p><strong>Results: </strong>A total of 186 surveys were collected, revealing that 95% of paediatricians were at risk of burnout syndrome. This was indicated by impairments in at least one of the three MBI domains: depersonalisation, emotional exhaustion and reduced personal accomplishment. Furthermore, a relationship was identified between unfavourable working conditions and the risk of mental illness, highlighting the urgent need for intervention by health authorities and medical organisations.</p><p><strong>Conclusion: </strong>There is a clear association between working conditions and mental health, highlighting the urgent need for action from health authorities and medical organisations.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211546","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":"Impact of LISA failure on 2-year neurodevelopmental outcomes in preterm infants: a retrospective cohort study.","authors":"Floor P M Swinkels, Mellanie Swanink, Jeroen Van Vonderen, Jeanne Dieleman, Brigitte Vugs, Carola Van Pul, Peter Andriessen, Hendrik J Niemarkt","doi":"10.1136/bmjpo-2025-003864","DOIUrl":"10.1136/bmjpo-2025-003864","url":null,"abstract":"<p><strong>Background: </strong>Less invasive surfactant administration (LISA) reduces the need for mechanical ventilation in preterm infants with respiratory distress syndrome. However, some LISA-treated infants require intubation within 72 hours due to continuous positive airway pressure (CPAP) failure (LISA failure, LISA-F). The long-term neurodevelopmental impact of LISA-F remains unclear.</p><p><strong>Objective: </strong>To compare 2-year neurodevelopmental outcome in preterm infants with successful LISA (LISA-S) versus LISA-F and primary intubation for surfactant (PI).</p><p><strong>Methods: </strong>Retrospective cohort study (2015-2023) including infants from 24 to 29 weeks gestational age (GA) with surfactant administration; categorised into three groups: LISA-S (n = 235), LISA-F (n = 117) and PI for surfactant (n = 102). Neurodevelopment was assessed at 2 years corrected age using Bayley Scales of Infant and Toddler Development, Third Edition. Multivariable linear regression adjusted for GA, birth weight and antenatal corticosteroid exposure. A multivariable logistic regression model was constructed to identify independent predictors of cognitive and motor delay.</p><p><strong>Results: </strong>Adjusted composite motor scores were significantly higher in LISA-S compared with LISA-F infants (adjusted mean difference 6.4; 95% CI 2.0 to 19.0; p = 0.005). No differences were found between LISA-F and PI. Mechanical ventilation within the first 72 hours was the strongest independent predictor of motor delay (aOR (adjusted Odds Ratio) 3.9; 95% CI 1.3 to 11.6; p=0.012).</p><p><strong>Conclusions: </strong>Preterm infants with LISA-F have significantly worse neurodevelopmental outcomes at 2 years corrected age, comparable to that of PI. Mechanical ventilation, rather than the initial surfactant strategy, emerged as the strongest predictor of developmental impairment, emphasising the importance of preventing CPAP failure after LISA.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190789","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":"Predicting risk of early-onset sepsis in low-resource neonatal units using routine healthcare data: development and evaluation of multivariable statistical and machine learning models.","authors":"Ed Lowther, Nushrat Khan, Mario Cortina-Borja, Gwendoline Lilly Chimhini, Samuel R Neal, Marcia Mangiza, Felicity Fitzgerald, Michelle Heys, Simbarashe Chimhuya","doi":"10.1136/bmjpo-2025-003617","DOIUrl":"10.1136/bmjpo-2025-003617","url":null,"abstract":"<p><strong>Background: </strong>Neonatal sepsis is a major cause of morbidity and mortality in low-resource settings and accurate, context-appropriate diagnostic methods are urgently needed to improve clinical outcomes.</p><p><strong>Methods: </strong>We used data collected using Neotree, an open source digital health intervention tool, from neonates admitted to Sally Mugabe Central Hospital in Harare between February 2021 and September 2024 to model a composite outcome variable comprised of senior clinician-assigned diagnosis at discharge or cause of death and blood culture test results. Three statistical and machine learning algorithms were developed, tuned where appropriate using cross-validation and evaluated.</p><p><strong>Results: </strong>In total, 917 cases of early-onset neonatal sepsis were identified among the 18 345 neonates in our study sample, comprising 664 cases of clinician diagnosis and 253 positive blood culture results. With area under the receiver operating characteristic curve as a metric, LightGBM, a machine learning gradient-boosted tree classifier, performed marginally better (0.712; 95% CI 0.673 to 0.75) than logistic regression (0.687; 95% CI 0.646 to 0.728) on a held-out evaluation dataset. A simple and easily interpretable machine learning model, the <i>k</i>-neighbours classifier, offered comparable performance (0.699; 95% CI 0.662 to 0.736).</p><p><strong>Conclusions: </strong>This study explored the potential advantages of using machine learning in the triage of neonates at risk of sepsis in low-resource settings where gold-standard blood culture test results are often unavailable. While the differences in performance metrics were not statistically significant, the machine learning approaches in our study offer other advantages including more intuitive predictions and the ability to handle missing data without imputation.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145190844","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":"Barriers and facilitators perceived by professionals while implementing Soothing and Sleeping in Dutch Healthcare: a mixed-methods study.","authors":"Jamie Lee van Someren, Eline Louise Möller, Hesther Rozemarijn Rodenburg, Annemieke E J Peters, Mariëtte H H Hoogsteder, Margreet W Harskamp-van Ginkel","doi":"10.1136/bmjpo-2025-003478","DOIUrl":"10.1136/bmjpo-2025-003478","url":null,"abstract":"<p><strong>Background: </strong>Many parents struggle with infant crying and sleep, yet some needs remain unmet by current professional support. Soothing and Sleeping, an evidence-based practice (EBP) based on the Happiest Baby method, offers preventive support and parental education for these issues. The Dutch Youth Health Care (YHC) system, monitoring 95% of children, is well-positioned to implement it.</p><p><strong>Method: </strong>This study explores YHC professionals' perceptions of EBPs and Soothing and Sleeping and identifies key implementation barriers and facilitators. YHC professionals (n=41) completed questionnaires and participated in focus groups. Quantitative data were analysed using descriptive statistics and qualitative data through thematic analysis guided by the Dynamic Adaptation Process framework.</p><p><strong>Results: </strong>Professionals expressed positive attitudes towards EBPs and Soothing and Sleeping, with 81% adopting the method. Barriers and facilitators emerged at system, organisation, provider and client levels. Preimplementation, barriers spanned all levels, while postimplementation barriers were primarily systemic and organisational. Key barriers included resource limitations, inadequate training, organisational shifts and insufficient managerial support. Soothing and Sleeping-specific facilitators included its practicality, suitability and effectiveness.</p><p><strong>Conclusions: </strong>Findings suggest Soothing and Sleeping strengthens YHC support for infant crying and sleep. Recommendations include proactive parental outreach, appointing an implementation facilitator, ongoing training and tailored approaches for families.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147828","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":"Body mass index-related participation limitations in daily life activities among survivors of childhood cancer: a cross-sectional study.","authors":"Müberra Tanrıverdi, Sedef Sahin, Kardelen Yıldırım, Guleser Guney Yılmaz, Ceren Davutoglu, Fatma Betul Cakir, Özgün Kaya Kara","doi":"10.1136/bmjpo-2025-003639","DOIUrl":"10.1136/bmjpo-2025-003639","url":null,"abstract":"<p><strong>Objectives: </strong>This study compared participation limitations in daily life activities among childhood cancer survivors across different Body Mass Index (BMI) categories.</p><p><strong>Design: </strong>Prospective cross-sectional study.</p><p><strong>Setting: </strong>The study data were collected from two separate oncology outpatient clinics.</p><p><strong>Participants: </strong>116 children with cancer aged 10.07±3.83 were included in the study. The mean follow-up time after cancer treatment turnover was 36.28±6.43 months.</p><p><strong>Primary outcome measures: </strong>Participation levels were assessed using the Pediatric Outcomes Data Collection Instrument (PODCI) as the primary outcome of this study, and they were categorised by BMI.</p><p><strong>Results: </strong>The mean z score was 0.64 ± 1.12, and the average BMI was 17.76±3.56. The PODCI global functioning score averaged 80.25±15.23. There were no significant associations between the global functioning score and age, chemotherapy, or surgery (p>0.05). However, significant relationships were found between the global functioning score and gender, BMI, and radiotherapy (p<0.05). Significant functional differences were observed in the upper extremity, basic mobility transfer, happiness and overall functioning (p<0.05). No significant differences were noted in sports and physical functioning or pain/comfort across different BMI categories (underweight, normal/healthy, overweight) (p>0.05).</p><p><strong>Conclusions: </strong>Survivors experience participation restrictions in daily living activities after completing treatment. Systematic evaluation of feedback received from patients/parents regarding physical function, sports, transfer and participation highlights the importance of BMI in childhood cancer survivors. Addressing these factors is key to achieving better health-related quality of life in functionality and participatory outcomes for survivors.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147768","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":"Food security, climate change and mental health problems in a Colombian Indigenous paediatric population.","authors":"Felipe Agudelo-Hernández, Marcela Guapacha-Montoya, María Camila Pinzón-Segura","doi":"10.1136/bmjpo-2024-003111","DOIUrl":"10.1136/bmjpo-2024-003111","url":null,"abstract":"<p><strong>Background: </strong>This study investigates the complex inter-relations among mental health, food security and climate anxiety in the Emberá-Dobidá paediatric Indigenous community in Caldas, Colombia. Although the community was displaced due to armed conflict, our focus is on the subsequent environmental changes driven by climate change that have emerged as independent stressors in the new territory. These stressors have compounded the community's vulnerabilities, with particular impacts on children and youth. By framing <i>territory</i> not merely as geographic space but as a sociocultural and symbolic construct, the study adopts a Latin American critical perspective to analyse health disparities.</p><p><strong>Methods: </strong>A mixed-methods study was conducted involving the paediatric population aged 6-16 years (n=40) from the Emberá-Dobidá Indigenous community, along with 65 caregivers representing 25 families. In-depth interviews explored community perceptions of environmental changes, food security and mental health. A cross-sectional correlational analysis used two culturally adapted instruments, the Pediatric Assessment of Community Emotional and Spiritual Health Scale and the Colombian Household Food Security Scale, to assess paediatric mental health and food security.</p><p><strong>Results: </strong>Qualitative findings revealed two key themes: 'Increased Heat in Recent Years' and 'Disconnection from Water and Cultural Identity'. Quantitative results showed significant correlations between food insecurity, spiritual disharmony and mental health problems, including emotional distress and suicide risk. Notably, 30% of children were at risk of suicide, and 50% exhibited emotional problems. The findings demonstrate that environmental degradation and disrupted territorial ties are not only ecological but also psychological and cultural stressors.</p><p><strong>Conclusions: </strong>Mental health in Indigenous communities, understood as spiritual harmony, must be addressed through culturally grounded approaches that integrate traditional ecological knowledge, food security and the recovery of territorial connection. From a Latin American perspective, territory is not a passive backdrop but an active determinant of health shaped by power, memory and resistance. Our findings call for climate-resilient, community-driven interventions that reterritorialise public health responses in Indigenous settings.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147794","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":"Association of caffeine with renal and other short-term outcomes in neonates with hypoxic-ischaemic encephalopathy undergoing therapeutic hypothermia.","authors":"Rakesh Lavu, Nicholas Nicoletti, Sarah Worley, Subhash Puthuraya, Hany Aly, Ceyda Acun","doi":"10.1136/bmjpo-2025-003720","DOIUrl":"10.1136/bmjpo-2025-003720","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association of caffeine with renal and other short-term clinical outcomes in neonates with moderate or severe hypoxic-ischaemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH).</p><p><strong>Study design: </strong>This retrospective cohort study included neonates born at ≥36 weeks gestational age with moderate or severe HIE treated with TH at our centre between January 2013 and December 2022. In 2019, there was a practice change to administer a single intravenous 20 mg/kg caffeine citrate dose for moderate/severe HIE, forming two cohorts (non-caffeine vs caffeine). The primary outcome was acute kidney injury (AKI), defined by modified Kidney Disease: Improving Global Outcomes criteria. Secondary outcomes included daily serum creatinine, blood-urea nitrogen (BUN), urine output, HIE-pattern lesion on brain-MRI, early EEG background grade, seizures, duration of mechanical ventilation, length of stay, tube-feeding at discharge and in-hospital mortality.</p><p><strong>Results: </strong>85 neonates met the inclusion criteria; 38 received caffeine, and 47 did not. AKI incidence was lower in the caffeine group (29% vs 47%), although not statistically significant (p=0.09). BUN levels and serum creatinine levels were significantly lower in the caffeine group on days 3-5 (p<0.05). MRI abnormalities consistent with HIE were more frequent in the caffeine group (60% vs 36%, p=0.028), particularly in infants with moderate HIE (p=0.004). EEG background profiles differed, with caffeine-exposed neonates displaying fewer severe (34% vs 65%) and more mild-to-moderate patterns. No significant differences were noted in other secondary outcomes.</p><p><strong>Conclusion: </strong>Caffeine during TH lowered serum creatinine and BUN but did not significantly reduce AKI and was associated with higher rates of MRI lesions. Prospective, dose-controlled trials with pharmacokinetic monitoring and long-term neurodevelopmental follow-up are needed to clarify caffeine's renal benefits and neurological safety in neonatal HIE.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129926","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":"Early activity and impact of a neighbourhood multidisciplinary team that integrates health and social support for underserved children and young people in Birmingham, UK: an observational study.","authors":"Christopher Bird, Frances Dutton, Simarjeet Kaur, Caroline Wolhuter, Ian Litchfield","doi":"10.1136/bmjpo-2025-003935","DOIUrl":"10.1136/bmjpo-2025-003935","url":null,"abstract":"<p><strong>Background: </strong>The Sparkbrook Children's Zone (SCZ) is an integrated health and social care offer for children and young people (CYP) in an economically marginalised area of Birmingham, UK. This study sought to measure: clinic reach to CYP living in deprivation; proportion of CYP receiving preventive health offers; referral rate to secondary care; proportion of CYP referred to a family support worker.</p><p><strong>Methods: </strong>Observational study using routinely collected data to evaluate activity and impact of the SCZ. SCZ weekly clinics, embedded in a partner primary care network, are located in Sparkbrook and Balsall Heath East, Birmingham's second most populous ward with a young population, high diversity and high infant mortality. The clinics provide preventive health, clinical care, mental health support and social support to CYP <16 years. UK Health Research Authority approval reference: 25/PR/0168.</p><p><strong>Results: </strong>From March 2022 to December 2024, 2265 CYP were booked into clinics (93.5% slots taken up); 89% of families were from the bottom Index of Multiple Deprivation quintile.<i>Preventive healthcare</i>: immunisation advice increased from 10.7% in 2023 to 40.2% in 2024; oral health promotion from 29.2% to 46.8%; smoking cessation advice from 1.8% to 12.5%; 97% eligible children received Healthy Start vitamins; 83% had body mass index measured.<i>Clinical care:</i> 73.8% of CYP discharged after seeing General Practitioner/paediatrician, 3.8% referred to secondary care, 14.7% patients were not brought to appointments.<i>Social support:</i> 28.2% of CYP referred to a family support worker. Five top reasons for referral: feeding, behaviour, activities, special educational needs and disabilities, parenting skills.</p><p><strong>Conclusion: </strong>Initial data suggest preventive health and social support can be successfully integrated in a neighbourhood health offer for CYP living in deprivation, with low referral rates to secondary care.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130001","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":"Application of the 2023 Italian guidelines for respiratory support management in acute viral bronchiolitis: a retrospective study.","authors":"Domenico Paolo La Regina, Brigitte Fauroux, Rocco Di Gioia, Simona Marra, Laura Petrarca, Enrica Mancino, Maria Giulia Conti, Luigi Matera, Greta Di Mattia, Antonella Frassanito, Enea Bonci, Benedetto D'Agostino, Raffaella Nenna, Paola Papoff, Fabio Midulla","doi":"10.1136/bmjpo-2025-003349","DOIUrl":"10.1136/bmjpo-2025-003349","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of the 2023 Italian guidelines on respiratory support management for acute viral bronchiolitis by comparing the use of low-flow oxygen (LFO) and high-flow nasal cannula (HFNC) therapies during the 2022-2023 and 2023-2024 epidemic seasons.</p><p><strong>Design: </strong>A retrospective, single-centre observational study.</p><p><strong>Setting: </strong>The paediatric emergency department of Policlinico Umberto I, Rome, Italy.</p><p><strong>Patients: </strong>A total of 202 infants (<12 months) with hypoxaemia due to acute viral bronchiolitis were hospitalised during the study periods. Eight patients were excluded due to chronic conditions or missing data.</p><p><strong>Interventions: </strong>The study compared LFO as a first-line therapy and HFNC as a second-line option in cases of LFO failure, before (2022-2023) and after (2023-2024) the guideline update.</p><p><strong>Main outcome measures: </strong>Rates of LFO and HFNC use, treatment failure, intubation, intensive care unit (ICU) admission, length of hospitalisation and oxygen therapy duration.</p><p><strong>Results: </strong>HFNC use as a first-line therapy decreased from 43.5% to 5.5%, while LFO use increased from 56.5% to 94.5%. LFO failure rates dropped significantly from 50% to 23%. No significant changes were observed in HFNC failure rates (12.5% vs 16.7%), ICU admissions or intubation rates. The average hospital stay decreased from 5.1±2.3 to 4.1±2.0 days, with a concomitant reduction in oxygen therapy duration.</p><p><strong>Conclusions: </strong>The 2023 Italian guidelines significantly reduced inappropriate HFNC use and hospital stay length without compromising patient outcomes. These findings support the step-up approach, emphasising LFO as the preferred first-line therapy.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129878","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":"Correction: 'Cost-utility analysis of MR imagingguided transurethral ultrasound ablation for the treatment of low- to intermediaterisk localised prostate cancer'.","authors":"","doi":"10.1136/bmjpo-2025-003577corr1","DOIUrl":"10.1136/bmjpo-2025-003577corr1","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129996","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}