BMJ Paediatrics Open最新文献

{"title":"Establishing consensus on defining the physically vulnerable child with cancer: a protocol for an international Delphi approach.","authors":"Sarah L Grimshaw, Rachel Conyers, Elvira C van Dalen, Kirsten Ness, Emma J Verwaaijen","doi":"10.1136/bmjpo-2025-003401","DOIUrl":"10.1136/bmjpo-2025-003401","url":null,"abstract":"<p><strong>Introduction: </strong>Childhood cancer survivors have an increased risk of lifetime morbidity and mortality. To improve outcomes, the physical impact of treatment toxicity must be minimised in the acute phase. Using a framework to identify early signs of physical vulnerability could provide an avenue for early intervention. Yet, existing models of physical vulnerability (sarcopenia and frailty) are adult-based definitions and require adaptation as they do not reflect the unique pathophysiology of paediatric cancer. Using phenotypes of sarcopenia and frailty as base, this study aims to establish a consensus definition of the physically vulnerable child with cancer.</p><p><strong>Methods and analysis: </strong>A Delphi consensus approach is guided by a project team of four specialised oncology healthcare professionals. Five stages include defining the problem area, selecting panel members, conducting four Delphi rounds, establishing closing criteria and validation of results. A focus group of international experts will meet to define the problem area, in addition to a scoping review to collate existing definitions and assessments of sarcopenia and frailty within paediatric contexts. Delphi panel members will include multinational clinicians with >5 years' experience in the acute paediatric setting, and researchers specialising in sarcopenia and/or frailty in paediatric cancer. Delphi rounds will aim to achieve consensus on how to define physical vulnerability in children with cancer. Consensus will be considered achieved when 80% or more of panellists agree. A series of focus groups with select members of the Delphi panel, and families, children, and adolescents affected by paediatric cancer will be held to validate results.</p><p><strong>Ethics and dissemination: </strong>The study has ethics approval through the Royal Children's Hospital Human Ethics Committee (number 3707). Results from this study will be published in peer-reviewed academic journals and disseminated via scientific conference(s) and key stakeholders.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336212","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":"Machine learning approaches to identify neonates and young children at risk for postdischarge mortality in Dar es Salaam, Tanzania and Monrovia, Liberia.","authors":"Chris A Rees, Rodrick Kisenge, Evance Godfrey, Readon C Ideh, Julia Kamara, Ye-Jeung G Coleman-Nekar, Abraham Samma, Hussein K Manji, Christopher R Sudfeld, Adrianna L Westbrook, Michelle Niescierenko, Claudia R Morris, Todd A Florin, Cynthia G Whitney, Karim P Manji, Christopher P Duggan, Rishikesan Kamaleswaran","doi":"10.1136/bmjpo-2025-003547","DOIUrl":"10.1136/bmjpo-2025-003547","url":null,"abstract":"<p><strong>Background: </strong>The time after hospital discharge carries high rates of mortality in neonates and young children in sub-Saharan Africa. Previous work using logistic regression to develop risk assessment tools to identify those at risk for postdischarge mortality has yielded fair discriminatory value. Our objective was to determine if machine learning models would have greater discriminatory value to identify neonates and young children at risk for postdischarge mortality.</p><p><strong>Methods: </strong>We conducted a planned secondary analysis of a prospective observational cohort at Muhimbili National Hospital in Dar es Salaam, Tanzania and John F. Kennedy Medical Center in Monrovia, Liberia. We enrolled neonates and young children near the time of discharge. The outcome was 60-day postdischarge mortality. We collected socioeconomic, demographic, clinical, and anthropometric data during hospital admission and used machine learning (ie, eXtreme Gradient Boosting (XGBoost), Hist-Gradient Boost, Support Vector Machine, Neural Network, and Random Forest) to develop risk assessment tools to identify: (1) neonates and (2) young children at risk for postdischarge mortality.</p><p><strong>Results: </strong>A total of 2310 neonates and 1933 young children enrolled. Of these, 71 (3.1%) neonates and 67 (3.5%) young children died after hospital discharge. XGBoost, Hist Gradient Boost, and Neural Network models yielded the greatest discriminatory value (area under the receiver operating characteristic curves range: 0.94-0.99) and fewest features, which included six features for neonates and five for young children. Discharge against medical advice, low birth weight, and supplemental oxygen requirement during hospitalisation were predictive of postdischarge mortality in neonates. For young children, discharge against medical advice, pallor, and chronic medical problems were predictive of postdischarge mortality.</p><p><strong>Conclusions: </strong>Our parsimonious machine learning-based models had excellent discriminatory value to predict postdischarge mortality among neonates and young children. External validation of these tools is warranted to assist in the design of interventions to reduce postdischarge mortality in these vulnerable populations.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336213","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":"Evaluation of primary healthcare worker training to screen children under 5 years of age with a low-cost alternative to the direct ophthalmoscope, the 'Arclight', as part of the Integrated Management of Newborn and Childhood Illness (IMNCI) programme in Tanzania.","authors":"A N J Malik, Godfrey Furhini Mnedeme, Nemes Iriya, Philip Bahati, Henry Marealle, Andrew Blaikie, Mlika Mafwiri","doi":"10.1136/bmjpo-2025-003520","DOIUrl":"10.1136/bmjpo-2025-003520","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the integration of childhood eye screening with the Arclight direct ophthalmoscope into an already existing WHO/UNICEF Integrated Management of Newborn and Childhood Illness (IMNCI) programme in Tanzania.</p><p><strong>Design: </strong>Prospective interventional study.</p><p><strong>Setting: </strong>Primary healthcare facilities in a semirural district, central Tanzania.</p><p><strong>Participants: </strong>Two IMNCI (Integrated Management of Newborn and Childhood Illness) facilitators received training enhanced with four newly developed videos on using the Arclight. These facilitators then trained 378 primary healthcare workers (PHCWs) who were already familiar with the IMNCI 'Eye Module'. The training covered how to perform red reflex testing with the Arclight device, interpret the results and appropriately refer children who failed the screening.</p><p><strong>Intervention: </strong>'Arclight' direct ophthalmoscope and training of primary healthcare workers.</p><p><strong>Main outcome measures: </strong>Number of children screened and diagnosed with eye conditions.</p><p><strong>Results: </strong>Over 4 months, 2 trained IMNCI facilitators trained 378 PHCWs on how to use the Arclight direct ophthalmoscope to screen children's eyes. Over a 6-month period, 36 000 children were screened in primary care settings with 136 seen at district level facilities and 105 referred to regional and tertiary facilities. The most common diagnoses of children referred were allergic conjunctivitis (37.4%), bacterial conjunctivitis (31.2%) and cataract (7.1%). There were six cases of ophthalmia neonatorum (3.9%) and two cases of retinoblastoma (1.3%). The incidence rate per 10 000 children of cataract was 3.05, ophthalmia neonatorum 1.67 and retinoblastoma 0.55.</p><p><strong>Conclusion: </strong>Primary healthcare workers in Tanzania can be trained to screen for eye disease in babies and children using the Arclight direct ophthalmoscope as part of an ongoing child health programme leading to the detection of treatable and serious eye diseases. Training all PHCWs would allow every child under 5 years old to be screened for eye disease, detecting serious eye conditions such as cataract and retinoblastoma earlier preventing avoidable childhood blindness and mortality.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324460","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":"Exploring hygiene practices, prenatal recommendations and parental attitudes towards congenital cytomegalovirus prevention and screening in Sweden.","authors":"Allison Mackey, Ulrika Löfkvist","doi":"10.1136/bmjpo-2025-003524","DOIUrl":"10.1136/bmjpo-2025-003524","url":null,"abstract":"<p><strong>Objective: </strong>The aims of the study were to explore the attitudes of parents of young children towards prevention and screening for congenital cytomegalovirus infection, and to map the practices and recommendations in prenatal care regarding the prevention of fetal infection.</p><p><strong>Methods: </strong>A survey was distributed across Sweden to parents of children under 2 years. Information about congenital cytomegalovirus infection was provided. Questions followed, pertaining to attitudes towards screening and prevention, hygiene behaviours during pregnancy, and recommendations from midwives.</p><p><strong>Results: </strong>4405 parents completed the survey; 4263 were pregnant less than 2 years prior. Parents were positive towards screening, with 85% agreeing that screening should be offered. A predicted increase in stress was positively associated with positive attitudes towards screening. Attitudes towards prevention were positive (90%). Most did not regularly perform hygiene measures to prevent cytomegalovirus infection during pregnancy, though behaviours preventing other infections were common. Recommendations by midwives rarely included cytomegalovirus prevention.</p><p><strong>Conclusion: </strong>Parents have positive attitudes toward screening and prevention of congenital cytomegalovirus infection, despite a predicted increase in stress. Information is not being conveyed by prenatal providers about how to protect oneself against cytomegalovirus infection, which reflects a lack of hygiene routines during pregnancy related to its prevention.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315872","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":"Preventive practices and parental attitudes towards snakebites in children in snakebite hotspots of rural Sri Lanka.","authors":"Kavinda Dayasiri, Gihan Gunarathna, Indika Gawarammana, Shaluka Jayamanne","doi":"10.1136/bmjpo-2025-003543","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003543","url":null,"abstract":"<p><strong>Background: </strong>Snakebites remain a major public health issue in rural Sri Lanka, particularly among children under 5. Parental attitudes, knowledge and preventive practices significantly influence the risk of snakebites and the effectiveness of first aid responses. This study aimed to assess parental attitudes, knowledge sources and preventive practices related to snakebite prevention and management in children living in snakebite-endemic rural regions of Sri Lanka.</p><p><strong>Methods: </strong>A descriptive cross-sectional study was conducted in the Ampara and Polonnaruwa Districts, two snakebite-endemic regions in Sri Lanka. The study targeted parents with at least one child under 5 years old, who were selected through cluster sampling facilitated by Public Health Midwives. A structured, self-administered questionnaire was used to collect data on demographic characteristics, parental attitudes towards snakes and snakebites, knowledge sources and preventive practices.</p><p><strong>Results: </strong>A total of 518 parents participated, with the majority being mothers (94.2%). Extreme fear of snakes was reported by 92.7% of participants. Parental beliefs varied, with 23.7% believing that a snake should always be killed after biting a person and 18.0% holding the belief that snakes take revenge. Significant associations were found between extreme fear of snakes and the absence of prior training in snakebite first aid (p=0.035) as well as being a mother (p=0.001). Major challenges in snakebite care included transportation difficulties (90.5%), lack of proximity to hospitals with emergency treatment (81.5%) and reliance on traditional healing practices (32.6%). Traditional healing practices (32.6%) were significantly associated with low socioeconomic status (p=0.001) and low parental education (p=0.001). Social media (42.1%) was the most common source of knowledge on snakebite care. Storing paddy at home was significantly associated with a family history of snakebites (p=0.004) CONCLUSIONS: Parental fear, cultural beliefs and limited access to training programmes significantly influence snakebite prevention and management practices. Enhancing community-based education, improving healthcare accessibility and incorporating snakebite first-aid training into public health programmes could mitigate the risks and improve outcomes for paediatric snakebite cases in rural Sri Lanka.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293294","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":"Environment and admission preferences of 16-17 year olds.","authors":"Hannah Siu-Yu Ha, Samantha Jones, Damian Roland","doi":"10.1136/bmjpo-2023-002451","DOIUrl":"10.1136/bmjpo-2023-002451","url":null,"abstract":"<p><p>This is a short letter highlighting findings from a service evaluation of 16-17 year olds' preferences of location of care following presentation to an Emergency Department. 95 young people were interviewed; 54.7% (52/95) of participants preferred to be seen in the Paediatric Emergency Department, with 16 year olds showing a higher preference (62.2%) compared with 17 year olds (48.0%). Additionally, 58.9% (56/95) desired a choice in treatment location, and 67.4% (64/95) expressed a preference for age-specific wards during admissions. Our findings highlight the importance of recognising the individual needs and preferences of young people within healthcare.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12314816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293293","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":"Caught between fear and tradition: parental knowledge, beliefs and emergency responses to paediatric snakebites in rural Sri Lanka.","authors":"Kavinda Dayasiri, Tharuka Perera, Indika Gawarammana, Shaluka Jayamanne","doi":"10.1136/bmjpo-2025-003658","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003658","url":null,"abstract":"<p><strong>Background: </strong>Paediatric snakebite remains a critical yet underexplored public health issue in rural Sri Lanka, where children are particularly vulnerable due to ecological exposure, limited access to timely care and entrenched traditional beliefs. While biomedical advancements exist, parental knowledge, cultural practices and systemic barriers significantly shape prehospital responses and outcomes.</p><p><strong>Methods: </strong>This qualitative exploratory study employed 10 focus group discussions with 70 parents (45 mothers, 25 fathers) from snakebite-endemic rural communities in the Ampara and Polonnaruwa Districts. Participants were purposively selected, including those with direct or indirect exposure to snakebite incidents. Data were collected using a semistructured guide and analysed thematically, following Braun and Clarke's six-phase framework. Themes were validated through member checking and intercoder agreement.</p><p><strong>Results: </strong>Five interrelated themes emerged: (1) pervasive fear and psychological burden associated with snakebite risk, (2) fragmented and inconsistent knowledge of envenomation symptoms and first-aid, (3) environmental and structural vulnerabilities such as unsafe housing and proximity to snake habitats, (4) strong adherence to traditional beliefs and ritual practices and (5) a high demand for culturally tailored education and systemic support. Many parents employed harmful first-aid methods due to inherited practices and a lack of formal training. Despite challenges, participants expressed strong willingness to learn and adopt evidence-based strategies.</p><p><strong>Conclusions: </strong>Effective paediatric snakebite prevention and management require context-specific, culturally sensitive interventions that address both knowledge gaps and structural barriers. Engaging with local belief systems and improving healthcare accessibility are essential for reducing snakebite-related morbidity and mortality among children in rural Sri Lanka.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293292","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":"Environmental factors and clinical markers of stress during neonatal transport: a systematic literature review .","authors":"Tone Solvik-Olsen, Marit Bekkevold, Fridtjof Heyerdahl, Astri Maria Lang, Jostein S Hagemo, Marius Rehn","doi":"10.1136/bmjpo-2025-003568","DOIUrl":"10.1136/bmjpo-2025-003568","url":null,"abstract":"<p><strong>Background: </strong>Neonatal transport is an essential component of modern neonatal intensive care globally, providing access to advanced treatment while exposing vulnerable neonates to environmental conditions that may increase the risk of physiological instability.</p><p><strong>Objective: </strong>To systematically review studies measuring environmental exposures, specifically vibration, sound and temperature fluctuations during neonatal transport and to evaluate their impact on clinical parameters in neonates.</p><p><strong>Methods: </strong>A systematic literature review identified studies reporting environmental factors or clinical data during transport via ground, rotor or fixed-wing air ambulances. The medical databases searched included MEDLINE/PubMed, Embase, the Cochrane database of systematic reviews, Nursing Reference Center Plus, UpToDate and SveMed covering the period from November 2020 to January 2025.</p><p><strong>Results: </strong>15 observational studies, 13 prospective and 2 retrospective covering publications from 1992 to 2025 were included. The studies included data on vibration, sound, ambient temperature and a wide range of clinical parameters such as heart rate and heart rate variability, change in clinical behaviour scales and cortisol in saliva reflecting the neonatal condition. Only four articles reported the effect of environmental factors on neonatal physiology.</p><p><strong>Conclusions: </strong>This review highlights the presence of environmental factors, particularly noise and vibration, during transport and raises concerns about their impact on neonates. Although diverse clinical parameters were documented, the small sample sizes and variability in measurement methods across studies limit the ability to draw definitive conclusions. These observations emphasise the need for standardised monitoring protocols and further research to optimise neonatal transport practices.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282312","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":"Epidemiological insights and clinical management of paediatric kala-azar in Shanxi Province (2014-2023): retrospective analysis of case characteristics and therapeutic strategies.","authors":"Jie Zhao, Ihsan Ullah, Huixia Fan, Xinghua Li","doi":"10.1136/bmjpo-2024-003131","DOIUrl":"10.1136/bmjpo-2024-003131","url":null,"abstract":"<p><strong>Background: </strong>From 2019 to 2020, Shanxi Province reported the highest incidence of kala-azar (visceral leishmaniasis) in China. Despite this, research on the disease in paediatric populations, particularly in the Shanxi region, remains limited. No comprehensive data have been published on the occurrence and clinical characteristics of kala-azar in children within this region. This study seeks to address this gap by investigating the epidemiological features, clinical manifestations and therapeutic strategies for paediatric visceral leishmaniasis in Shanxi Province, providing critical insights for improving prevention and management efforts.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on medical records of 89 paediatric patients diagnosed with kala-azar at Shanxi Children's Hospital between January 2014 and December 2023. This study examined epidemiological data, clinical manifestations, therapeutic interventions and patient outcomes.</p><p><strong>Results: </strong>(1) Among the 89 kala-azar cases, the male-to-female ratio was 1.34:1, indicating a higher prevalence among males. Infants aged (0-3 years) constituted the largest proportion of cases, accounting for 58.43% (52/89). The seasonal peak occurred during summer (May-July), with 46.07% (41/89) of cases identified during this period. Geographically, the cases were distributed across seven districts and cities in Shanxi Province, with the majority being reported in Yangquan city. (2) The most common clinical symptoms observed were irregular fever and hepatosplenomegaly. Laboratory findings revealed leucopenia in 73 cases, decreased platelets in 69, decreased haemoglobin in 79, elevated erythrocyte sedimentation rate in 16 and elevated C reactive protein in 78. Additionally, respiratory infections were noted in 31 cases, haemophagocytic syndrome in 24, gastrointestinal infections in 15 and sepsis in 7. (3) The treatment regimen using sodium stibogluconate achieved a cure rate of 96.63% (86/89).</p><p><strong>Conclusions: </strong>To improve diagnostic accuracy and patient outcomes, clinicians are advised to thoroughly investigate the medical and travel history of paediatric patients. For suspected cases, enhanced diagnostic methods, including serum antibody testing and bone marrow aspiration smear examinations, should be employed to minimise misdiagnoses and missed cases. Sodium stibogluconate or amphotericin B is recommended for confirmed cases to optimise prognosis.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282313","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":"Respiratory distress in late-preterm neonates: from controversy to consensus - a survey of regional advisory boards and neonatologists in France.","authors":"Jean Michel Hascoet, Delphine Mitanchez, Elie Saliba, Yoni Athea","doi":"10.1136/bmjpo-2025-003557","DOIUrl":"10.1136/bmjpo-2025-003557","url":null,"abstract":"<p><strong>Objective: </strong>Late-preterm neonates present with more complications at birth than full-term neonates. The care of these infants is sometimes controversial. Our study aims at examining the practices of French neonatologists and compares them to the literature.</p><p><strong>Design: </strong>Regional advisory boards discussed a clinical case with four categories of questions: the risk of term-related respiratory distress (RD), the indication for antenatal corticosteroid therapy, neonatal care at delivery and the use of surfactant. An anonymous survey covering the same question categories was also sent to French neonatology departments.</p><p><strong>Results: </strong>For the risk of RD, the boards' responses were somewhat unclear. Conversely, the survey highlighted the association between high risk of RD and low term of birth, which is in agreement with the literature. The boards noted that, in the absence of official recommendations, they would not advise using antenatal corticosteroids. However, the survey recommended their use in cases of threatened prematurity (32%). For neonatal care at delivery, the boards and survey recommended the standard use of continuous positive airway pressure (CPAP) as advised in the literature. Lastly, the boards and survey agreed that surfactant therapy is part of usual care. Published recommendations do not support its systematic use except when RD is present.</p><p><strong>Conclusion: </strong>This study confirms that late-preterm infants have an often-underestimated vulnerability. Morbidity is inversely correlated with gestational age, and caution is required over the place of birth. Antenatal steroid treatment remains controversial. There is consensus over the use of CPAP at delivery and of surfactant as early curative therapy.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12161312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282343","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}