BMJ Paediatrics Open最新文献

{"title":"Child death review: understanding variations in practice using normalisation process theory.","authors":"Karen Shaw, Sara Kenyon, Anna Pease, Jenna Spry, Gayle Routledge, Joanna Jane Garstang","doi":"10.1136/bmjpo-2025-003432","DOIUrl":"10.1136/bmjpo-2025-003432","url":null,"abstract":"<p><strong>Background: </strong>In England, Child Death Review (CDR) is a statutory process designed to identify full reasons for death, support parents, improve care and save lives. At CDR meetings, professionals review care and identify learning. Although parents do not attend CDR meetings, they should be invited to contribute questions and feedback and be informed of outcomes. There is a lack of evidence to support implementation, particularly for families after an expected child death.</p><p><strong>Objective: </strong>To examine how parent involvement in CDR is operationalised currently, following expected child death, to support improvements in practice.</p><p><strong>Methods: </strong>A secure online questionnaire was developed to collect data on parental CDR involvement in hospitals and palliative care services in England. Semistructured interviews were undertaken during 2022-2023, with 21 professionals in five care settings, purposively sampled from the survey to include sites with different provision contexts. Quantitative data were analysed using basic descriptive statistics. Qualitative data were analysed using directed qualitative content analysis and through a conceptual lens of Normalisation Process Theory.</p><p><strong>Results: </strong>Questionnaires were completed by 13 Paediatric Intensive Care Units and 16 palliative care services. 25/29 (86%) held CDR meetings reflecting statutory guidance, 17/29 (59%) routinely informed parents about CDR and 10/29 (28%) shared outcomes with them. Interviews with 21 professionals revealed that despite valuing CDR, many struggled to implement the process and lacked confidence to involve parents. Professionals felt that parents need good bereavement support to be able to contribute and wanted resources to help inform parents about CDR and support their involvement. Enthusiastic leaders were important. Lack of funding, particularly for CDR and bereavement keyworkers, was a challenge.</p><p><strong>Conclusions: </strong></p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172624","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":"Late preterm as an often-overlooked group: the interplay of sleep, maternal mental health and sleep knowledge.","authors":"Ayse Mete Yesil, Buse Şencan Karakuş, Şeyma Kılınç, Nihal Yaman Artunç, Elif Nursel Özmert","doi":"10.1136/bmjpo-2024-003167","DOIUrl":"10.1136/bmjpo-2024-003167","url":null,"abstract":"<p><strong>Background: </strong>Late preterm infants (LPT) are often overlooked despite representing a significant proportion of preterm births. This study explores the sleep characteristics of LPT infants aged 3-6 months compared with their term-born peers and investigates the relationship between infant sleep patterns, maternal mental health and maternal knowledge about infant sleep.</p><p><strong>Methods: </strong>A total of 84 infant-mother dyads were included. Infant sleep characteristics were assessed using the Brief Infant Sleep Questionnaire (BISQ) with an additional norm-referenced scoring system to evaluate age-based sleep parameters. Maternal mental health was evaluated through the Depression, Anxiety and Stress Scale (DASS-21) and maternal knowledge of infant sleep was measured using a questionnaire based on the American Academy of Pediatrics' recommendations.</p><p><strong>Results: </strong>Sleep patterns between LPT and term infants were comparable, including nocturnal sleep duration (p=0.75) and nocturnal awakenings (p=0.33). However, maternal perceptions of sleep quality significantly differed, with LPT infants scoring higher on the Parent Perception subscale of the BISQ (median: 82.5 vs 70, p=0.04). Maternal DASS scores were negatively correlated with BISQ subscales in LPT infants. Anxiety scores were significantly associated with Parent Perception (r=-0.413, p<0.01) and total BISQ scores (r=-0.418, p<0.01). Depression was linked to lower Parent Perception (r=-0.346, p=0.03) and total BISQ scores (r=-0.319, p=0.04), while stress was associated with lower Parent Perception scores (p=0.03). In term infants, maternal knowledge of infant sleep was significantly higher in good sleepers (p=0.03), while maternal DASS scores showed no significant associations with sleep outcomes.</p><p><strong>Conclusions: </strong>Infant sleep should be considered within the maternal-infant dyad, with maternal factors playing a crucial role in shaping sleep outcomes, differing between LPT and term infants. The interplay between maternal mental health, parental sleep knowledge and sleep expectations warrants further investigation.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156345","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":"Short-term outcomes of treatment limitation discussions in neonatal care units of tertiary care hospital in Karachi, Pakistan: a cross-sectional study.","authors":"Rozina Iqbal, Ariba Siddiqui, Wajiha Khan, Aneela Pasha, Danish Abdul Aziz, Arshalooz Rahman","doi":"10.1136/bmjpo-2024-003154","DOIUrl":"10.1136/bmjpo-2024-003154","url":null,"abstract":"<p><strong>Objective: </strong>To determine the short-term outcomes of treatment limitation discussions (TLDs) in neonates with life-limiting conditions and life-threatening conditions.</p><p><strong>Design: </strong>Descriptive cross-sectional study.</p><p><strong>Settings: </strong>The study was conducted at the neonatal care units of a single tertiary care hospital in Karachi, Pakistan.</p><p><strong>Patients: </strong>Neonates for whom clinicians or parents considered TLDs were included in the study. The study duration was from May 2022 to May 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main outcome measures: </strong>Primary outcome was documented in the form of frequency of full code, withdrawal of life-sustaining support, and do not resuscitate (DNR) orders in neonates. The secondary outcome was categorised as discharge, death, transfer from the neonatal intensive care unit (NICU) to a step-down unit or leave against medical advice (LAMA).</p><p><strong>Results: </strong>A total of 115 patients were included. Full code was documented in 14 patients (12.2%), withdrawal of life-sustaining support in 54 cases (47.0%) and DNR in 47 patients (40.9%). Of the 115 cases, 11 (9.6%) were discharged, 90 (78.3%) died, 7 (6.1%) were shifted out of the NICU and 7 (6.1%) LAMA. We found that 14 out of 115 parents (12.2%) chose the full code option despite clinicians advising withdrawal or DNR. Of those, 13 (92.8%) did not survive, and 1 (7.1%) was shifted out of the NICU.</p><p><strong>Conclusions: </strong>The most frequent outcome after TLD was withdrawal of life-sustaining support. The majority of babies did not survive following TLD, irrespective of the code decided. Early transition out of the NICU was considered for babies with DNR orders.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156567","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":"A call for mixed-methods research on climate change, family systems and child mental health.","authors":"Alexandra Markwell, Paul De Luca, Heather Prime","doi":"10.1136/bmjpo-2024-003116","DOIUrl":"10.1136/bmjpo-2024-003116","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131874","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":"Delayed admission temperature normalisation in preterm infants <32 weeks: impact on mortality and neonatal morbidities.","authors":"Mohanned Alrahili, Shaimaa Halabi, Amenah Al Essa, Seham Alrsheedi, Rana Almuqati, Manal Althubaiti, Abdulaziz Homedi, Mohammed Almahdi, Abdulrahman Almehaid, Ibrahim Ali, Mohammed Khawaji, Saif Alsaif, Kamal Ali","doi":"10.1136/bmjpo-2025-003473","DOIUrl":"10.1136/bmjpo-2025-003473","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of delayed temperature normalisation on neonatal outcomes, including mortality and major morbidities, in preterm infants born at <32 weeks' gestation.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Neonatal Intensive Care Unit at King Abdulaziz Medical City, Riyadh, Saudi Arabia.</p><p><strong>Patients: </strong>Preterm infants born at <32 weeks' gestation between January 2022 and December 2024.</p><p><strong>Main outcome measures: </strong>Infants were categorised into three groups based on temperature normalisation: normothermia at admission, early recovery (<2 hours) and late recovery (>2 hours). Primary outcomes included mortality before discharge, major neonatal morbidities (intraventricular haemorrhage (IVH), necrotising enterocolitis (NEC), bronchopulmonary dysplasia (BPD) and culture-positive sepsis) and duration of mechanical ventilation and hospital stay.</p><p><strong>Results: </strong>Among 578 preterm infants, 75% achieved normothermia at admission, 16% recovered within 2 hours and 9% required >2 hours. Mortality was significantly higher in the late recovery group (42%) versus normothermia (7%) and early recovery (11%) (p<0.001). Late recovery was also associated with higher rates of major IVH (27% vs 5% normothermia, 11% early recovery, p<0.001), surgical NEC (10% vs 2% normothermia, 7% early recovery, p=0.001) and BPD (44% vs 16% normothermia, 42% early recovery, p<0.001). The need for mechanical ventilation was highest in the late recovery group (87%) (p<0.001). Kaplan-Meier analysis demonstrated prolonged ventilation and hospital stay (p<0.001).</p><p><strong>Conclusions: </strong>Delayed temperature recovery beyond 2 hours is associated with higher mortality and neonatal morbidities. These findings highlight the importance of early thermal stabilisation to improve outcomes in preterm infants.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126565","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":"A world without US support: WHO funding cuts and the future of childhood health.","authors":"Emma R Rashes, Donna Koller, Colleen Kraft, Nick Spencer, Jeffrey Goldhagen, Michael Weitzman","doi":"10.1136/bmjpo-2025-003533","DOIUrl":"10.1136/bmjpo-2025-003533","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126563","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":"Planetary health and Indigenous sovereignty: exploring the theory of change of the Healthy Environments and Lives (HEAL) network in Western Australia.","authors":"Lucie O'Sullivan, Theoni Whyman, Mara West, Noel Nannup, Jaime Yallup Farrant, Naomi Joy Godden, Emma-Leigh Synnott, Raewyn Mutch, Anita J Campbell, Kylie Wrigley, Brad Farrant","doi":"10.1136/bmjpo-2024-002894","DOIUrl":"10.1136/bmjpo-2024-002894","url":null,"abstract":"<p><p>This paper outlines the theory of change which underpins the Western Australian (WA) hub of the Healthy Environments and Lives (HEAL) network. HEAL is an Australian national research initiative that aims to address the health impacts of climate and environmental change. The WA hub's theory of change is focused on improving the health and well-being of the planet and people, including children, through centring Indigenous sovereignty, voices and ways of knowing and being in research, policy development and service provision. The WA hub also recognises it is essential for place-based, community-led solutions, which strengthens responses to climate and environmental change, grounding mitigation and adaptation efforts in local priorities, knowledges and relationships. To action its theory of change, the HEAL WA hub has embraced Community-Based Participatory Action Research (CBPAR), which positions Aboriginal elders, people with diverse lived experiences, young people, community organisations and policy makers as co-researchers. This weaving together of different ways of knowing, grounded in holistic, relational and multigenerational worldviews, enables community members to lead change and hold decision-making power at all stages of research. Through CBPAR, researchers, community members and organisations, policy-makers and service providers build and foster meaningful relationships and collaborate to co-design, implement and translate research. Young people and children are a vital part of the work, and their voices and priorities are integrated in all phases of the work to ensure intergenerational justice and vision also guides practice. This ensures HEAL WA can affect targeted, research-driven and equitable community-led change both now and for generations to come.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101189","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":"<i>Correction for</i> 'Caregiver perspectives on the longlasting impact of the COVID-19 pandemic on children with cerebral palsy in Johannesburg, South Africa'.","authors":"","doi":"10.1136/bmjpo-2024-002617corr1","DOIUrl":"10.1136/bmjpo-2024-002617corr1","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101188","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":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/bmjpo-2025-003626","DOIUrl":"10.1136/bmjpo-2025-003626","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075893","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 sepsis treatment decisions in the paediatric emergency department using machine learning: the AiSEPTRON study.","authors":"Sylvester Gomes, Harpreet Dhanoa, Phil Assheton, Ewan Carr, Damian Roland, Akash Deep","doi":"10.1136/bmjpo-2024-003273","DOIUrl":"10.1136/bmjpo-2024-003273","url":null,"abstract":"<p><strong>Background: </strong>Early identification of children at risk of sepsis in emergency departments (EDs) is crucial for timely treatment and improved outcomes. Existing risk scores and criteria for paediatric sepsis are not well-suited for early diagnosis in ED.</p><p><strong>Objective: </strong>To develop and evaluate machine learning models to predict clinical interventions and patient outcomes in children with suspected sepsis.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>ED of a tertiary care hospital, UK.</p><p><strong>Patients: </strong>Electronic health records of children <16 years of age attending between 1 January 2018 and 31 December 2019. Patients presenting with minor injuries were excluded.</p><p><strong>Methods: </strong>Prediction models were developed and validated, using 15 key predictors from triage and post-blood test data. XGBoost, the best-performing machine learning model, integrated these predictors with triage note information extracted via Natural Language Processing.</p><p><strong>Main outcomes: </strong>(1) Administration of antibiotics; (2) critical care: antibiotics with fluid resuscitation above 20 mL/kg or non-elective mechanical ventilation; (3) serious infection: hospital admission for antibiotics >48 hours.Model performance was evaluated using area under the receiver operating characteristic curve (AUC), likelihood ratios and positive and negative predictive values.</p><p><strong>Results: </strong>Triage model: predicted antibiotics at triage (n=35 795; 3.2% with outcome) with an AUC of 0.80 (95% CI 0.76 to 0.84).Antibiotic model: predicted antibiotics post-blood tests (n=4700; 24.2%) with an AUC of 0.78 (95% CI 0.73 to 0.81).Critical care model: predicted critical care (n=4700; 3.3%) with an AUC of 0.78 (95% CI 0.72 to 084).Serious infection model: predicted serious infection (n=4700; 9.4%) with an AUC of 0.76 (95% CI 0.71 to 0.81).Key predictors included triage category, temperature, capillary refill time and C reactive protein.</p><p><strong>Conclusion: </strong>Machine learning models demonstrated good accuracy in predicting antibiotic use following triage and moderate accuracy for critical care and serious infection. Further development and external validation are ongoing.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075903","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}