BMJ Paediatrics Open最新文献

{"title":"Codesign and knowledge translation of the Strength-based, Tiered, Accessible Resources and Supports (STARS) for Kids study to identify and support child development, parental mentalwell-being and family psychosocial needs: a mixed-methods research protocol.","authors":"James R John, Hayley Robinson, Sini Lambiase, Sophie Nicholls, Maite Diez, Karlen R Barr, Katarina Ostojic, Aunty Kerrie Doyle, Luana Kliendienst, Melissa Foster, Lynette Syron, Toni Carson, Jane Kohlhoff, Ann Dadich, Clare Brennan, Bree Katsamangos, Lynn Kemp, Amy Finlay-Jones, Grainne O'Loughlin, Katherine Boydell, Shanti Raman, Nicole Deen, Kenny Lawson, Virginia Schmied, Ilan Katz, Andrew Page, Rebekah Grace, Anna-Marie Kanaan, Rebecca Young, Erin Brandtman, Lee Bratel, Michael Hodgins, Raghu Lingam, Christa Lam-Cassettari, Sharon Goldfeld, Adam K Walker, Ping-I Lin, Susan Morton, Desiree Silva, Jenny Downs, Susan Woolfenden, Valsamma Eapen","doi":"10.1136/bmjpo-2025-004031","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-004031","url":null,"abstract":"<p><strong>Introduction: </strong>Many children and their families, especially those from priority populations, experience barriers to accessing high-quality early childhood health, education, social and legal services. Further, these families are often under-represented in service planning and research; hence innovations are not designed to meet their needs. Our aim is to codesign with families and the wider community, a Strength-based, Tiered, Accessible Resources and Supports for Kids (STARS for Kids) programme to optimise child development, parental mental well-being, and family psychosocial needs in the first 2000 days from pregnancy to start of school.</p><p><strong>Methods and analysis: </strong>This study will employ a mixed methods design at three sites: (1) Fairfield, urban multicultural site in South-Western Sydney New South Wales; (2) Taree, a regional town with a large Indigenous community; and (3) The City of Wanneroo, a low socioeconomic area of Western Australia. The codesign process will involve five phases of the design thinking methodology informed by culturally safe, strengths-based, and trauma-informed practices. Codesign will involve families, service providers, and community leaders from priority groups such as multicultural stakeholders from South-Western Sydney and an Aboriginal Community Consultation Group with Biripi Elders and other local Indigenous representatives at Taree. Data collection will include semi-structured interviews, workshops, or focus groups as well as 'yarning' for the Aboriginal community. Qualitative data will be thematically analysed using Braun and Clarke's six-phase method of thematic approach.</p><p><strong>Trial registration number: </strong>Australian New Zealand Clinical Trials Registry - ACTRN12624000806561 (This protocol pertains only to the initial codesign phase, during which the STARS for Kids tiered care model will be finalised for subsequent implementation and evaluation in the next trial phase which is outlined in the trial registry).</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833303","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":"Sensory processing differences and behavioural problems in children with autism: a retrospective study using statistical modelling and multi-output machine learning.","authors":"Chenyu Yan, Jialu Xu, Kexin Duan, Yifei Xiang, Haifeng Li","doi":"10.1136/bmjpo-2025-004343","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-004343","url":null,"abstract":"<p><strong>Background: </strong>Sensory processing differences (SPDs) are common in children with autism, yet their specific contributions to behavioural problems remain insufficiently explored. To examine how SPDs relate to behavioural problems in children with autism and to identify key sensory predictors and sensory-based subtypes associated with behavioural risk.</p><p><strong>Methods: </strong>The retrospective study included 127 children with autism (1-7 years) who received rehabilitation training at a tertiary children's hospital between 2020 and 2024. Fifteen SPD features across visual, auditory, tactile, gustatory/olfactory and vestibular/proprioceptive modalities (covering sensitivity, hyporesponsivity and seeking behaviours) and six behavioural problems were coded as binary variables based on parent-reported questionnaires. Associations were analysed using Phi correlations and logistic regression. A multi-output random forest with Shapley Additive Explanations (SHAP) evaluated the joint predictive value of SPDs. Hierarchical clustering using Jaccard distance was used to identify sensory subtypes and compare behavioural profiles.</p><p><strong>Results: </strong>Vestibular/proprioceptive seeking was positively associated with frequent tantrums (φ=0.30) and emerged as an independent predictor (OR=3.83, 95% CI 1.65 to 8.90). Visual seeking was negatively associated with difficulty adapting to routine changes (φ=-0.23; OR=0.34, 95% CI 0.15 to 0.78). The multi-output random forest showed moderate performance. SHAP analysis highlighted auditory sensitivity and multiple seeking behaviours as major contributors. Clustering revealed a 'multi-sensory seeking' subtype with higher rates of tantrums.</p><p><strong>Conclusions: </strong>SPDs are meaningfully linked to behavioural problems in autism. Vestibular/proprioceptive seeking and auditory sensitivity are key behavioural risk indicators, while visual seeking may support adaptability. Sensory-based profiling has the potential to identify children at elevated behavioural risk and guide personalised intervention planning.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833335","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":"Effect of probable neonatal sepsis on the development of infants in Eastern Uganda (ENON): a cohort study.","authors":"David Mukunya, Brendah Nambozo, Daphine Amanya, Faith Oguttu, Joel Okwir, Milton W Musaba, Martin Chebet, Sarah Mutonyi, Henry K Nabudere, George Okwakol, Kathy Burgoine, Dorcas N Magai, Pei-Yi Lin, Andrew D Weeks, Melissa Gladstone","doi":"10.1136/bmjpo-2025-003691","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003691","url":null,"abstract":"<p><strong>Background: </strong>Neonatal sepsis is a common cause of mortality and morbidity during the first 28 days of life, particularly in resource-limited settings. Of those infants who survive sepsis, there is a lack of clarity as to the likelihood of developmental difficulties in these children. This study aimed to understand the impact of probable neonatal sepsis on the development of 2-year-old children in Uganda.</p><p><strong>Methods: </strong>We assessed 404 infants aged between 18 and 36 months using the WHO's Global Scales for Early Development (GSED) Long Form (directly observed) and Short Form (parent report). This included 100 infants treated for probable neonatal sepsis and were part of a large community infection prevention trial (BabyGel). We then recruited 304 age-matched children from the same communities who took part in the parent trial but had no probable neonatal sepsis. We used linear regression and inverse probability of treatment weighting analyses to calculate measures of association and effect. We adjusted for the clustering effect, trial arm or other confounders.</p><p><strong>Results: </strong>The mean age (SD) of children in our cohort was 23.3 months (4.4) in both groups. GSED development for age Z-scores were significantly lower for the children with a probable sepsis diagnosis compared with those without for both the GSED Short Form -0.22, 95% CI -0.47 to -0.04 and the GSED Long Form -0.33, 95% CI -0.60 to -0.05 when adjusted. An additional model adjusting for HIV exposure as a confounder (only available 373/404) provided similar results with adjusted mean GSED Short Form developmental age Z-scores difference of -0.29, 95% CI -0.53 to -0.04 and -0.33, 95% CI -0.59 to -0.07 for GSED Long Form.</p><p><strong>Conclusion: </strong>Neonatal sepsis may be associated with poorer developmental outcomes in resource-limited settings such as Uganda. To ensure better outcomes for these children, it is vital to explore more effective strategies for follow-up, monitoring and early interventions in infants with probable neonatal sepsis.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833263","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":"Rheumatic heart disease in children and adolescents, part 1: epidemiology, pathogenesis and diagnosis.","authors":"Joselyn Rwebembera, Andrea Beaton, Joseph Kado, Raman Krishna Kumar","doi":"10.1136/bmjpo-2025-003435","DOIUrl":"10.1136/bmjpo-2025-003435","url":null,"abstract":"<p><p>Rheumatic heart disease (RHD) remains a leading cause of acquired cardiovascular disease in children and adolescents globally, despite dramatic declines in high-income settings. This review synthesises contemporary evidence on the epidemiology, pathogenesis, natural history and diagnosis of rheumatic fever (RF) and RHD in young populations, with a focus on regions with high disease burden.Over recent decades, improvements in socio-economic conditions and access to healthcare have led to marked reductions in RF and RHD across much of Europe, North America and parts of Asia. In contrast, the disease persists at high prevalence in sub-Saharan Africa, South Asia, the Pacific Islands and among Indigenous and marginalised populations within high-income countries. In these settings, RF often occurs at younger ages, disease progression is accelerated and access to timely diagnosis and care is limited, resulting in substantial morbidity and premature mortality.Pathogenetic models continue to support immune-mediated valvular injury following Group A streptococcal infection, with increasing evidence that both pharyngeal and skin infections contribute to disease initiation. However, determinants of individual susceptibility and the mechanisms underlying progression from infection to chronic valvular damage remain incompletely understood. Importantly, recent observational and trial data challenge the traditional linear paradigm in which clinically apparent RF precedes RHD, demonstrating that many children develop early valvular disease without recognised RF episodes.Echocardiography has transformed the diagnosis of RHD, revealing a substantial burden of clinically silent disease and enabling earlier identification along the disease spectrum. Updated World Heart Federation echocardiographic criteria and recent WHO guidelines now support screening in high-risk populations and a staged approach to disease classification. Evidence that secondary antibiotic prophylaxis can prevent progression of early RHD reinforces the importance of early detection.Together, these advances reframe RHD as a preventable chronic disease with a detectable early phase, providing a strong foundation for effective prevention, timely diagnosis and improved outcomes in children and adolescents living in endemic regions.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833311","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 enablers to antiseizure medication adherence in children with epilepsy: a systematic review using the theoretical domains framework (TDF).","authors":"Eric Amankona Abrefa Kyeremaa, Majed Alorabi, Charlotte Lawthom, Sion Scott, Caroline Smith, Andy Stewart, David Wright","doi":"10.1136/bmjpo-2026-004519","DOIUrl":"10.1136/bmjpo-2026-004519","url":null,"abstract":"<p><strong>Background: </strong>Antiseizure medications (ASMs) are the primary treatment for controlling seizures in children with epilepsy (CWE). Despite their proven effectiveness, non-adherence to ASMs remains a major challenge. The aim of this study is to synthesise qualitative data using the theoretical domains framework (TDF) to identify the behavioural mechanisms associated with ASM adherence in CWE. This will then inform the development of a theory-informed ASM adherence intervention.</p><p><strong>Methods: </strong>This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in CINAHL, PubMed, SCOPUS, EMBASE and PsycINFO databases. The Critical Appraisal Skills Programme was used to assess the quality of the included studies. Qualitative findings relating to barriers and enablers of ASMs were extracted, analysed and synthesised using NVivo V.14 and mapped to the TDF. Behaviour change techniques (BCTs) associated with identified TDF domains were identified using the Theory and Techniques Tool.</p><p><strong>Results: </strong>19 studies were included: 17 qualitative and two mixed-methods studies. A total of 83 factors were identified comprising 51 barriers and 32 enablers. Key factors included poor communication between prescribers and parents (<i>social influences</i>); unpleasant taste, large tablet size and access to ASMs (<i>environmental context and resources</i>); fear of addiction (<i>beliefs about consequences</i>); inferiority related to ASM use (<i>emotion</i>); parental prompting (<i>memory, attention and decision processes</i>); and understanding of treatment purpose (<i>knowledge</i>). Across different countries, there was contrasting evidence on belief about consequences.</p><p><strong>Conclusion: </strong>These findings provide broad descriptions of the determinants of non-adherence enabling direct linkage to evidence-based BCTs and therefore ultimate creation of theory-informed interventions.</p><p><strong>Prospero registration number: </strong>CRD42024600476.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833347","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":"Comparative accuracy of sleep disturbance questionnaires in children with autism spectrum disorder: a receiver operating characteristic study.","authors":"Batuhan Yüksel, Mert Dogan, Koray Kara, Ozgun Kaya Kara","doi":"10.1136/bmjpo-2025-004097","DOIUrl":"10.1136/bmjpo-2025-004097","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate the comparative effectiveness of various sleep and wakefulness scales used in children and their usefulness for children with autism spectrum disorder (ASD).</p><p><strong>Design: </strong>Cross-sectional observational study.</p><p><strong>Setting: </strong>The study was conducted at the Department of Child and Adolescent Psychiatry, University of Health Sciences Research and Training Hospital, Antalya, Türkiye, which serves as a regional referral centre for children and adolescents with developmental and behavioural disorders.</p><p><strong>Participants: </strong>A total of 230 children participated in the study, including 155 children diagnosed with ASD and 75 typically developing peers, aged between 4 and 18 years.</p><p><strong>Primary outcome measures: </strong>Sleep-wake disorders were assessed using five questionnaires: the Children's Sleep Habits Questionnaire (CSHQ), Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), Paediatric Daytime Sleepiness Scale (PDSS), Paediatric Sleep Questionnaire (PSQ) and Sleep Disturbance Scale for Children (SDSC). These tools evaluated sleep patterns, daytime sleepiness, and sleep-related behavioural problems based on caregiver reports.</p><p><strong>Results: </strong>The mean age of children with ASD and the typically developing peer group was 9.0±3.69 years and 9.07±4.25 years respectively. The CSHQ, ESS-CHAD, PDSS, PSQ and SDSC all demonstrated discriminant validity and internal consistency in the assessment of sleep-wake disorders in children with ASD (p<0.05, Cronbach's alpha >0.60). The CSHQ and SDSC showed similar levels of diagnostic accuracy in detecting sleep disorders. The PSQ had a high positive predictive value, the PDSS demonstrated a high negative predictive value and the ESS-CHAD showed a high level of agreement.</p><p><strong>Conclusions: </strong>A combination of tools such as the CSHQ, ESS-CHAD, PDSS, PSQ and SDSC may be useful for assessing sleep-wake disorders in children with ASD.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13150884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833317","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":"Multicentre cohort study on the course of paediatric familial Mediterranean fever in the aftermath of the 2023 earthquake.","authors":"Veysel Cam, Siddika Songul Yalcin, Ezgi Deniz Batu, Hatice Melisa Kacmaz, Nesibe Gökçe Kocamaz, Özge Günal, Eda Kayhan, Burcu Bozkaya, Semanur Taşkın, Vildan Gungorer, Elif Kılıç Konte, Gulsah Pirim, Dilara Ünal, Semanur Ozdel, Oya Koker, Aysenur Pac Kısaarslan, Rabia Miray Kisla Ekinci, Şeyda Dogantan, Selcan Demir, Kubra Ozturk, Hatice Adıgüzel Dundar, Ozge Basaran, Ayşe Balat, Betul Sozeri, Ozgur Kasapcopur, Yelda Bilginer, Seza Ozen","doi":"10.1136/bmjpo-2025-003818","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003818","url":null,"abstract":"<p><strong>Objectives: </strong>Türkiye was struck by earthquakes on 6 February 2023. Emerging evidence links psychosocial stress and environmental insults to inflammasome activation. This multicentre study investigated whether the earthquake was associated with changes in the disease course among paediatric patients with familial Mediterranean fever (FMF).</p><p><strong>Methods: </strong>Data were collected from 963 paediatric FMF patients (<18 years) across fifteen centres, including three located in the earthquake zone. Monthly attack counts were analysed over an 18-month period (February 2022-August 2023). Analyses were stratified by earthquake exposure and colchicine access (outside the earthquake area; earthquake area with sufficient access; earthquake area with limited access for the first 2 weeks). Primary analyses used multilevel interrupted time-series and difference-in-differences Poisson models for monthly attack counts, and secondary analyses used mixed-effects logistic regression for monthly attack presence (≥1 attack). Both models were stratified by colchicine access and adjusted for clinical covariates.</p><p><strong>Results: </strong>In the overall cohort, the February 2023 earthquake was associated with a 35% immediate rise in monthly FMF attack frequency (incidence rate ratio (IRR)=1.35, 95% CI 1.15 to 1.59). This effect was markedly amplified within the earthquake zone: attack frequency increased 2.16-fold in regions with adequate colchicine access (IRR=2.16, 95% CI 1.49 to 3.12) and 3.56-fold in regions with limited access (IRR=3.56, 95% CI 2.79 to 4.55). A significant post-earthquake decline in attacks followed (monthly trend IRR=0.93, 95% CI 0.89 to 0.98), with the fastest recovery in limited-access regions (IRR=0.83, 95% CI 0.78 to 0.89). Findings were consistent in the secondary logistic model.</p><p><strong>Conclusion: </strong>FMF patients in the earthquake zone experienced a marked but transient escalation in disease activity after the disaster, with the strongest impact in regions with limited medication access. These findings suggest that not just access to treatment but also psychosocial stress or possibly environmental factors may cause activation of such diseases through the trigger of pyrin-inflammasome.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833343","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":"Healthcare burden of bronchopulmonary dysplasia among very preterm infants in China: a cohort study.","authors":"Zhicheng Zhu, Lin Yuan, Jie Yang, Siyuan Jiang, Yun Cao, Jiao Yang, Yun Zhang, Yan Mo, Chao Chen, Huayan Zhang, Jianguo Zhou","doi":"10.1136/bmjpo-2025-004259","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-004259","url":null,"abstract":"<p><strong>Objective: </strong>To assess the healthcare burden of bronchopulmonary dysplasia (BPD) among very preterm infants in China.</p><p><strong>Design: </strong>A prospective cohort study between 2022 and 2023.</p><p><strong>Setting: </strong>Chinese Neonatal Network (CHNN) participating centres.</p><p><strong>Patients: </strong>Infants with gestational age <32 weeks admitted to CHNN neonatal intensive care units.</p><p><strong>Main outcome measures: </strong>A composite rate of BPD or mortality at 36 weeks' postmenstrual age (PMA), major comorbidities, clinical resources utilisation and outcome at discharge. BPD severity was classified by Jensen <i>et al</i>'s criteria.</p><p><strong>Results: </strong>Among 17 793 eligible infants, 568 (3.2%) infants died before 36 weeks' PMA, 1729 (9.7%) were discharged against medical advice before 36 weeks' PMA, 9895 (55.6%) were classified as no BPD, 2751 (15.5%) developed Grade 1 BPD, 2634 (14.8%) developed Grade 2 BPD and 216 (1.2%) developed Grade 3 BPD. Infants with BPD had significantly longer hospital stays than those without BPD (median (IQR), 67 (52-84) vs 44 (34-56) days) and incurred higher total hospitalisation charges (median (IQR), 127 (91-177) vs 73 (52-103) thousand CNY) and charge per day (median (IQR), 1975 (1638-2361) vs 1714 (1409-2048) CNY). Mortality at discharge increased with BPD severity, with rates of 0.2% (18/9895) for infants without BPD, 0.5% (15/2751) for Grade 1 BPD, 2.1% (56/2634) for Grade 2 and 26.9% (58/216) for Grade 3. Similarly, the rates of major comorbidities and the need for home oxygen therapy increased with BPD severity.</p><p><strong>Conclusions: </strong>Greater BPD severity was associated with increased comorbidities, higher in-hospital mortality and greater utilisation of healthcare resources. These findings emphasised the ongoing need to develop cost-saving strategies to reduce the risk and severity of BPD in this vulnerable population and improve overall care.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833290","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":"Future perspectives on the use of molecular assays for pathogen identification in neonatal sepsis: a survey study among members of the European Society for Paediatric Infectious Diseases.","authors":"Jip Groen, Martijn van der Kuip, Marc A Benninga, Tim de Meij, Hendrik J Niemarkt","doi":"10.1136/bmjpo-2026-004600","DOIUrl":"10.1136/bmjpo-2026-004600","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811097","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":"Challenges during clinical lactation studies investigating medicines exposure: experiences from the UmbrelLACT study - a contribution from the ConcePTION project.","authors":"Martje Van Neste, Nina Nauwelaerts, Michael Ceulemans, Kristel Van Calsteren, An Eerdekens, Pieter Annaert, Anne Smits, Karel Allegaert","doi":"10.1136/bmjpo-2026-004603","DOIUrl":"10.1136/bmjpo-2026-004603","url":null,"abstract":"<p><strong>Background: </strong>Clinical lactation studies are valuable to guide pharmacotherapy during breastfeeding, but are not easy to conduct. This paper reports on challenges and mitigation strategies while conducting the UmbrelLACT study, a prospective observational lactation study.</p><p><strong>Methods: </strong>The UmbrelLACT study includes breastfeeding women taking a relevant medicine (eg, absence of safety evidence during lactation) and after feasibility verification (eg, access to bioanalytical assay). Participants collect human milk samples at home over 24 hours. Optionally, maternal and infant blood samples are collected, together with self-reported questionnaires on clinical maternal and child variables. Medicine concentrations and estimated infant exposure (eg, daily and relative infant dose) are determined.</p><p><strong>Results: </strong>Regarding informed consent, study objectives should be carefully phrased to prevent pharmacotherapy avoidance due to a lack of safety information. On sample collection, the study team should provide all necessary materials if not available at home, including an electric breast pump. Due to the milk expressions over 24 hours, the infant might miss soothing moments. This can be mitigated by giving the breast after expressing the milk for study purposes, creating alternative soothing moments. Sample handling might be complicated by additional steps needed for certain compounds. A bioanalysis method should be available or developed for the milk matrix. Finding the assay might be challenging, but it can be facilitated by a network of specialised labs. In the UmbrelLACT study, pharmacokinetic values are collected fragmentarily. This results in the need for data pooling with data from the literature. In contrast, at-home sampling and multidisciplinary collaboration are clear strengths.</p><p><strong>Conclusions: </strong>It is feasible to tailor the approach to each participant and compound, to minimise the burden on the patient and their family. While there are limitations related to the pragmatic design, the opportunities of this lactation study outweigh the challenges to result in clinically significant scientific observations.</p><p><strong>Trial registration number: </strong>NCT06042803.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811088","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}