BMJ Paediatrics Open最新文献

{"title":"Global need for climate advocacy, education and evidence in paediatrics.","authors":"Haytham Ali, Georgia Bickerton, Praveen Sreekanthalal, Cinthu Vivehananthan, Alison Firth, Bernadette Anne-Marie O'Hare, Rebecca Rhodes, Alison Leaf, Dhurgshaarna Shanmugavadivel, Ekundayo Ajayi-Obe, Nancy Abdel Salam Ahmed Gomaa, Ramla Mohammed, Tony Waterston","doi":"10.1136/bmjpo-2025-003475","DOIUrl":"10.1136/bmjpo-2025-003475","url":null,"abstract":"<p><p>Climate change is the single greatest existential threat to children worldwide, adversely affecting the health and well-being of children and young people.The Royal College of Paediatrics and Child Health members living outside the UK (respondents) were invited to an online anonymised survey where opting-in participants answered 32 questions covering 6 domains.139 respondents from 50 countries responded to the survey. Respondents agreed that climate change influences the rising rates of children with heat-related (50%), infectious (64%) and mental health (36%).The climate crisis is a global emergency, and working together is paramount to safeguarding the planet for future generations.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144727830","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":"Resilience of Pediatric Healthcare Services in an Urban Hospital in China During the COVID-19 Pandemic in Late 2022.","authors":"Hongwei Chen, Mengyuan Hu, Huiyao Chen, Juan Yang, Fan Yang, Yahui Li, Zhenzhen Pan, Qiming Pan, Huili Ju, Lihong Zhu, Le Zhang, Haoyang Zhang","doi":"10.1136/bmjpo-2025-003654","DOIUrl":"10.1136/bmjpo-2025-003654","url":null,"abstract":"<p><p>The abrupt relaxation of COVID-19 control measures in China in December 2022 created acute pressures on paediatric healthcare services. We retrospectively evaluated patient visits, healthcare staffing and hospitalisation costs at Wuxi Children's Hospital, a tertiary paediatric centre. Despite over 40% staff absenteeism due to COVID-19, essential paediatric services remained operational through flexible staffing and workflow adaptations. Patient visits initially surged, particularly for respiratory diseases, but quickly stabilised. Hospitalisation expenses and inpatient stays significantly declined, highlighting the hospital's capacity for timely operational adaptation. These findings suggest that low-cost practical strategies increased healthcare resilience, without compromising patient care, during infectious disease surges in this urban Children's Hospital.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144727831","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":"\"Okay in theory\": a qualitative study of safer sleep advice in families with infants at risk and families reporting risky sleep practices.","authors":"Becky Lambert, Alice-Amber Keegan, Jenny Ingram, Peter S Blair, Peter J Fleming, Anna Pease","doi":"10.1136/bmjpo-2025-003620","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003620","url":null,"abstract":"<p><strong>Background: </strong>Safer sleep messages have reduced the rates of sudden unexpected deaths in infancy by 90% in England since 1990. However, deaths continue, mainly in deprived families or where unsafe sleep practices remain common. Understanding the factors influencing these decisions can help further reduce these deaths. This study explores what influences infant sleep-related care practices among caregivers of at-risk infants and those who report non-adherence to safer sleep advice.</p><p><strong>Methods: </strong>A previously collected survey of infant care practices allowed the identification of 'high scorers' based on a calculated risk score determined by background characteristics and those reporting risky behaviours as 'risky sleepers'. Semistructured telephone/online interviews took place from August to December 2022. Reflexive thematic analysis identified key themes.</p><p><strong>Results: </strong>Twenty-nine interviews were conducted with 28 families, with 14 'high scorers' and 15 'risky sleepers'. The key themes were trustworthy sources, interpretation of risk and desperate times call for desperate measures. Caregivers of high-risk infants generally understood and followed safer sleep guidance but described rare occasions of compromised safety, usually due to routine disruptions. Those engaging in risky sleep practices cited factors such as sleep deprivation, past experiences, self-identity and personal interpretations of safer sleep advice as influential.</p><p><strong>Conclusions: </strong>Safer sleep messages are reaching families, but targeted support is needed to prevent rare but fatal incidents. Health professionals should consistently discuss co-sleeping using improved communication strategies to enhance trust. Co-created, accessible and bitesize resources should support parents in problem-solving and planning for safer sleep during disruption to routines.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706308","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":"Description of probiotic use in preterm infants in England and Wales 2016-2022.","authors":"Alice Aveline, Lisa Szatkowski, Janet Berrington, Kate Costeloe, Alex Bottle, Shalini Ojha, Paul Fleming, Cheryl Battersby","doi":"10.1136/bmjpo-2025-003605","DOIUrl":"10.1136/bmjpo-2025-003605","url":null,"abstract":"<p><strong>Objective: </strong>To describe the use of probiotics among preterm infants in neonatal units and explore factors that influence exposure.</p><p><strong>Design: </strong>Observational study using prospectively recorded health data.</p><p><strong>Setting: </strong>England and Wales.</p><p><strong>Patients: </strong>48 048 infants born at <32 weeks gestational age (GA) and admitted to a neonatal unit between 1 January 2016 and 31 December 2022.</p><p><strong>Main outcome measures: </strong>Measures of probiotic use (number and proportion of infants exposed to probiotics, postnatal age of first probiotic exposure and discontinuation).</p><p><strong>Results: </strong>The proportion of infants who received probiotics increased from 9% to 54% over the study period. Median GA of infants given probiotics was 29⁺³ weeks (IQR 27⁺³-30⁺⁶). Probiotics were started on median day 5 (IQR 2-8), earlier for those born at >28 weeks GA (median day 4, IQR 2-7), most frequently after enteral feeds (66% of exposed infants) and were usually discontinued between 32 and 36 weeks postmenstrual age (PMA) (47% at 32⁺⁰-33⁺⁶ weeks PMA, 33% at 34⁺⁰-35⁺⁶ weeks PMA). Among infants cared for in probiotic neonatal intensive care units (defined as units where 50% or more infants born <32 weeks gestation were exposed to probiotics), 23% were never given probiotics. Infants from whom probiotics were withheld had a lower gestational age, lower birth weight z score and higher illness severity score or were more mature.</p><p><strong>Conclusions: </strong>By 2022, over half of infants born at <32 weeks GA were exposed to probiotics, but almost one quarter did not receive them despite being in a probiotic unit. Our findings help inform the interpretation of observational data and the design of future studies addressing the continued uncertainty around the safety and efficacy of probiotics.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706309","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":"Predictors and course of hypertension in Wilms tumour patients: a retrospective observational cohort study.","authors":"Yannick Braun, Florian Friedmacher, Anke Barnbrock, Henning C Fiegel, Udo Rolle, Till-Martin Theilen","doi":"10.1136/bmjpo-2025-003396","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003396","url":null,"abstract":"<p><strong>Introduction: </strong>Wilms tumour is the second most common extracranial solid tumour in paediatric patients. It is frequently associated with hypertension due to renal artery compression and activation of the renin-angiotensin-aldosterone system. This study aimed to identify predictors of hypertension, assess therapeutic factors and evaluate its impact on renal function.</p><p><strong>Methods: </strong>We retrospectively analysed 67 patients treated for Wilms tumour following International Society of Paediatric Oncology (SIOP) guidelines at our institution between 2005 and 2024. Clinical records, radiological reports and laboratory data were collected. Statistical analyses were performed to assess the relationship between hypertension, tumour characteristics, treatment and renal function.</p><p><strong>Results: </strong>Hypertension was strongly associated with central tumour localisation (p=0.0003) and younger patient age (p=0.024). Prolonged postoperative antihypertensive therapy correlated with the need for combination therapy before surgery (p=0.01136). Younger age (p=0.02994) and higher hypertension grade (p=0.03884) were linked to the requirement for multidrug antihypertensive therapy. Hypertension at presentation did not affect renal function at the end of follow-up.</p><p><strong>Conclusion: </strong>Central tumour localisation and younger age are significant predictors of hypertension in children with Wilms tumour. The need for combination antihypertensive therapy before surgery predicts prolonged postoperative treatment. These findings underline the importance of early identification and management of hypertension in affected patients.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706310","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":"When the bite is not the threat: non-venomous snakebites and their impact on rural child health.","authors":"Kavinda Dayasiri, Achila Ranasinghe, Nayani Suraweera, Priyanga Burhan","doi":"10.1136/bmjpo-2025-003583","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003583","url":null,"abstract":"<p><strong>Background: </strong>While the clinical management of venomous snakebites has been widely studied, little attention has been paid to paediatric bites from non-venomous or mildly venomous snakes in Sri Lanka. Although medically less severe, these bites frequently lead to healthcare visits and even hospital admissions, primarily due to caregiver anxiety and concern, and may result in minor complications.</p><p><strong>Methods: </strong>A multicentre descriptive cross-sectional study was conducted across four referral hospitals in Sri Lanka. Children aged 0-17 years with confirmed bites from snakes of low or no medical significance were included. Data were collected through medical records and caregiver interviews. A matched control group was used to explore environmental and behavioural risk factors. Multivariate logistic regression identified independent predictors of snakebites.</p><p><strong>Results: </strong>Among 183 children, the mean age was 10.5 years (SD=4.1), with 68.3% being male. Most lived in rural areas (86.9%), and rat snakes and water snakes were the most frequently implicated species. Bites primarily affected the feet (71%) and occurred during outdoor activities at home. Most children presented to healthcare facilities within 1 hour of the bite. Multivariate analysis showed that regular use of a torchlight (OR: 0.38, p<0.001) and home garden cleaning (OR: 0.35, p<0.001) were protective, while the presence of rats (OR: 2.01, p<0.001) and proximity to water bodies (OR: 1.92, p=0.04) were associated with increased risk.</p><p><strong>Conclusion: </strong>Non-venomous and mildly venomous snakebites in children are common in rural Sri Lanka and are influenced by modifiable behavioural and environmental factors. Targeted community education and preventive measures could reduce unnecessary health system burdens.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706311","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":"Enhancing parental health literacy through educational workshops: improving care for children with complex health needs.","authors":"Sarah Thomas, Kathryn Moore, Jin Khaw, Javairia Yakoob, May Yip, Hannah Zhu, Hemavathy Palanyiaya","doi":"10.1136/bmjpo-2025-003511","DOIUrl":"10.1136/bmjpo-2025-003511","url":null,"abstract":"<p><p>We conducted a workshop to enhance parental health literacy for managing children with complex health needs. Parents identified key areas requiring support, including puberty, toileting and seizure management. Specialist-led interactive sessions were held, with pre-event and post-event surveys assessing changes in parental confidence. Results showed significant improvements in understanding, with confidence scores rising across all topics, particularly in puberty (2.7 to 4.2) and feeding support (4 to 5). Over 90% of attendees reported the workshop met expectations. This study highlights the benefits of co-production in education and suggests further research into long-term impacts and larger-scale interventions.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673844","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":"Uncoupling investigation and diagnosis from management: at the heart of the art of paediatric clinical practice?","authors":"Gina Johnson, Sami Timimi, Rupal Shah, Liz Marder, Steve Turner","doi":"10.1136/bmjpo-2025-003539","DOIUrl":"10.1136/bmjpo-2025-003539","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673845","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":"Does early-targeted risk-based management of a patent ductus arteriosus improve outcomes in preterm infants? Insights from an observational study.","authors":"Rachel Mullaly, Aisling Smith, Claire Murphy, Sean Armstrong, Lyudmyla Zakharchenko, Orla Franklin, Naomi McCallion, Afif El-Khuffash","doi":"10.1136/bmjpo-2025-003347","DOIUrl":"10.1136/bmjpo-2025-003347","url":null,"abstract":"<p><strong>Background: </strong>This study evaluates the outcomes of an early-targeted patent ductus arteriosus (PDA) management strategy in preterm infants using the EL-Khuffash PDA Severity Score (PDAsc) for risk stratification. The objective was to compare outcomes between high- and low-risk infants from an early-targeted treatment epoch and a historical reference epoch who were risk stratified but did not undergo treatment.</p><p><strong>Methods: </strong>We conducted a single-centre, observational cohort study in a level III neonatal intensive care unit. Infants born <29 weeks gestation were stratified into high- and low-risk groups using the PDAsc. High-risk infants in the early-targeted treatment epoch received medical intervention, while low-risk infants did not. Outcomes from this epoch were compared with a historical reference epoch in which risk was assigned but treatment was not implemented. The primary outcomes included chronic lung disease (CLD), ventilation days and oxygen days.</p><p><strong>Results: </strong>A total of 110 high-risk and 74 low-risk infants were identified in the early-targeted epoch, compared with 84 high-risk and 51 low-risk infants in the reference epoch. High-risk infants in the early-targeted treatment epoch who achieved successful PDA closure demonstrated fewer ventilation days (median 5 vs 11), fewer oxygen days (median 45 vs 65) and a lower incidence of CLD (59% vs 76%) compared with high-risk infants in the reference epoch. However, high-risk infants in the early-targeted treatment epoch who failed treatment experienced outcomes similar to high-risk infants in the reference epoch. Low-risk infants in both epochs exhibited comparable favourable outcomes.</p><p><strong>Conclusions: </strong>The implementation of early-targeted risk-based PDA management may be associated with improved respiratory outcomes in high-risk infants who successfully responded to treatment. However, the observational nature of this study limits causal inferences. These findings underscore the need for further research, including randomised controlled trials with improved patient selection, to better understand the relationship between stratified treatment and important outcomes.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648479","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":"Partnership delivery of evidence-based therapy intervention to improve upper-limb function: a retrospective analysis.","authors":"Jill Massey, Leanne Claire Dreyer, Erika Molteni, Ben Siegle, Tomoki Arichi, Anne Gordon","doi":"10.1136/bmjpo-2025-003572","DOIUrl":"10.1136/bmjpo-2025-003572","url":null,"abstract":"<p><strong>Objective: </strong>To describe clinical characteristics and outcomes of children and young people with hemiplegia completing a novel dedicated therapy intervention, 'Evelina REACH'. This evidence-based upper-limb outpatient intervention is delivered in partnership with the child, caregivers, and occupational therapists at a tertiary hospital and community allied health professionals.</p><p><strong>Design: </strong>Retrospective audit of patients completing a 6-week protocolised therapy intervention with repeated standardised measures of spontaneous arm and hand use and of caregiver goal rating.</p><p><strong>Setting: </strong>A tertiary level children's hospital in London, UK.</p><p><strong>Patients: </strong>156 children (median age 26 months, range 4 months-16.5 years) completing a therapy intervention programme between 2012 and 2023.</p><p><strong>Interventions: </strong>An intensive, protocolised and individualised goal-directed therapy intervention programme, co-delivered by the patient, caregivers and hospital-based and community therapists.</p><p><strong>Main outcome measures: </strong>Assisting Hand Assessment (AHA), Goal Attainment Scaling (GAS)/Goal Attainment Scaling Light and Canadian Occupational Performance Measure (COPM).</p><p><strong>Results: </strong>Clinically significant gains were achieved with a mean AHA logit score change of 7 (n=69) which was maintained at 6 weeks post intervention (n=35). At least 1 GAS goal was met or exceeded by 99.2% participants, with measurable score change across three caregiver-mediated COPM goals, performance=90.17%, and satisfaction=83.58%. Of caregivers surveyed, 97.85% would repeat the programme, and 100% would recommend it to others.</p><p><strong>Conclusions: </strong>Evelina REACH is a clinically effective, goal-directed intensive activity-based therapy intervention that fosters lasting functional improvements in upper-limb use. Further research should explore optimal and scalable co-delivery models to enhance children's access to evidence-based therapy in statutory healthcare.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12273171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648482","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}