BMJ Paediatrics Open最新文献

{"title":"Factors influencing the natural history of non-IgE-mediated gastrointestinal food allergies in paediatric age: a prospective multicentre cohort study.","authors":"Laura Carucci, Rita Nocerino, Serena Coppola, Giorgio Bedogni, Pasqualina Capasso, Veronica Giglio, Roberto Berni Canani","doi":"10.1136/bmjpo-2024-003203","DOIUrl":"10.1136/bmjpo-2024-003203","url":null,"abstract":"<p><strong>Background: </strong>We aimed at identifying the factors influencing the natural history of non-IgE-mediated gastrointestinal food allergies (non-IgE-GIFA), a group of common paediatric conditions including food protein-induced: enteropathy (FPE), allergic proctocolitis (FPIAP), enterocolitis syndrome (FPIES), and motility disorders (FPIMD).</p><p><strong>Methods: </strong>Prospective multicentre cohort study involving paediatric patients (both sexes, aged ≤14 y) with non-IgE-GIFA diagnosed and followed for 24 months at a Tertiary Centre for Paediatric Allergy, Gastroenterology and Nutrition. Anamnestic and clinical data were collected from all enrolled patients.</p><p><strong>Results: </strong>123 non-IgE-GIFA patients were enrolled (56% male, median age (IQR) 150 (60-300) days): FPE (39%), FPIES (17%), FPIAP (16%) and FPIMD (28%). 42% of patients had multiple food allergies (FAs) at baseline, and 64% had a positive family history of allergy. Male sex (OR = 2.24, 95% CI 1.07 to 4.71) and every 1 month of diagnostic delay (OR=1.09, 95% CI 1.01 to 1.18) were positively associated with the occurrence of multiple FAs. At 24-month follow-up, 54% of patients acquired immune tolerance. This rate was higher in FPIAP (75%), when compared with FPIMD (62%), FPE (54%) and FPIES (24%). The odds of 24-month immune tolerance acquisition rate was lower in children with family history of allergy (OR=0.41, 95% CI 0.19 to 0.89) and in those with multiple FAs at baseline (OR=0.24, 95% CI 0.11 to 0.51). At 24-month follow-up, the rate of patients with allergic march was 0.46 (95% CI 0.38 to 0.55, n=57/123), without differences comparing the four phenotypes. The presence of multiple FAs at baseline was associated with an increased risk of developing allergic march (OR=2.22, 95% CI 1.07 to 4.61) at 24-month follow-up.</p><p><strong>Conclusions: </strong>The results of the study suggest the potential role of modifiable and non-modifiable risk factors influencing the natural history of paediatric patients affected by non-IgE-GIFA.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373463","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":"Air pollution exposures in early life and brain development in children (ABC): protocol for a pregnancy cohort study.","authors":"Sarah Benki-Nugent, Faridah H Were, Anne M Riederer, Michael Gatari, C J Karr, Edmund Yw Seto, Beatrice C Mutai, Susan Wamithi, Brent R Collett, John Kinuthia, Priscilla Wanini Edemba, Barbra A Richardson, R Scott McClelland, Timothy V Larson, Julian D Marshall, Elizabeth Maleche-Obimbo","doi":"10.1136/bmjpo-2024-002758","DOIUrl":"10.1136/bmjpo-2024-002758","url":null,"abstract":"<p><strong>Introduction: </strong>Air pollution is linked with poor neurodevelopment in high-income countries. Comparable data are scant for low-income countries, where exposures are higher. Longitudinal pregnancy cohort studies are optimal for individual exposure assessment during critical windows of brain development and examination of neurodevelopment. This study aims to determine the association between prenatal ambient air pollutant exposure and neurodevelopment in children aged 12, 24 and 36 months through a collaborative, capacity-enriching research partnership.</p><p><strong>Methods and analysis: </strong>This observational cohort study is based in Nairobi, Kenya. Eligibility criteria are singleton pregnancy, no severe pregnancy complications and maternal age 18 to 40 years. At entry, mothers (n=400) are administered surveys to characterise air pollution exposures reflecting household features and occupational activities and provide blood (for lead analysis) and urine specimens (for polycyclic aromatic hydrocarbon (PAH) metabolites). Mothers attend up to two additional antenatal study visits, with urine collection, and infants are followed through age 36 months for annual neurodevelopment and caregiving behaviour assessment, and child urine and blood collection. Primary outcomes are child motor skills, language and cognition at 12, 24 and 36 months, and executive function at 36 months. The primary exposure is urinary PAH metabolite concentrations. Additional exposure assessment in a subset of the cohort includes residential indoor and outdoor air monitoring for fine particulate matter (PM2.5), carbon monoxide (CO), ultrafine particles (UFP) and black carbon (BC).</p><p><strong>Ethics and dissemination: </strong>This study was approved by the Kenyatta National Hospital - University of Nairobi Ethics and Research Committee, and the University of Washington Human Subjects Division. Results are shared at annual workshops.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early plasma ferritin concentrations are not associated with time to red cell transfusions in extremely and very preterm neonates: a prospective single-site observational study.","authors":"Daniel O'Reilly, Áine Fox, Lauren Murphy, Claire Murphy, Anna-Claire Glynn, Grainne Kelleher, Fionnuala Ni Ainle, Naomi McCallion","doi":"10.1136/bmjpo-2024-002967","DOIUrl":"10.1136/bmjpo-2024-002967","url":null,"abstract":"<p><strong>Objective: </strong>To assess the relationship between plasma ferritin concentrations and (1) antenatal factors and (2) requirement for red cell transfusion.</p><p><strong>Study design: </strong>This single-site prospective study recruited infants in the first week of life who were born <32 weeks' corrected gestational age and did not receive a red cell transfusion prior to sampling. Ferritin concentrations were assessed on discard plasma taken as part of routine neonatal investigations in the first week of life (median day of life=3, IQR 2-5 days). Reasons for delivery, placental histology and demographics were recorded.</p><p><strong>Results: </strong>Plasma ferritin concentrations were not significantly associated with birth weight or gestational age in this cohort of extremely/very preterm neonates (n=114: n=26, <28 weeks' corrected gestational age; n=88, 28-32 weeks' corrected gestational age). Neonates exposed to chorioamnionitis had an increased ferritin concentration versus those who were not. Neonates exposed to pre-eclampsia had a significantly lower ferritin concentration than those who were not. Early ferritin concentration was not associated with time to transfusion in a time to event analysis.</p><p><strong>Conclusions: </strong>Plasma ferritin concentrations in very/extremely preterm neonates are variable and associated with the intrauterine environment. Ferritin concentration was not predictive of time to transfusion in this cohort and was not significantly different at smaller birth weight or earlier gestation. This is important for considerations of iron storage in very preterm neonates and its developmental consequences.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143363627","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":"Human milk and bronchopulmonary dysplasia have a dose-dependent effect: a cohort study.","authors":"Jiaming Yang, Jiaxin Li, Huiyan Wang, Xueyu Chen, Chuanzhong Yang, Liga ChaoMu, Aifen Cao, Xiaoyun Xiong","doi":"10.1136/bmjpo-2024-002727","DOIUrl":"10.1136/bmjpo-2024-002727","url":null,"abstract":"<p><strong>Background: </strong>Human milk (HM) is considered a potential protective factor against bronchopulmonary dysplasia (BPD), but the specific volume needed for its protective effect in mixed feeding is unclear. This study aimed to investigate the impact of different HM volumes on BPD risk.</p><p><strong>Methods: </strong>A retrospective cohort study examined the association between HM volume and BPD risk in very low birthweight (VLBW) infants. Dose-dependent analysis with spline smoothing curve and univariate, multivariate analyses and sensitivity analyses were conducted.</p><p><strong>Result: </strong>The study included 339 VLBW infants. BPD incidence was 4.7% (6 infants) in the high HM group (HM volume≥1190 mL), 27.0% (48 infants) in the low HM group (HM volume<1190 mL) and 9.1% (3 infants) in the exclusive formula group, and the difference is statistically significant. Both univariate and multivariate logistic regression analyses showed significantly higher BPD incidence in the low HM group (OR 3.237, 95% CI 0.81 to 12.89) compared with the exclusive formula group. The sensitivity analysis showed that low HM remained a risk factor for BPD (model I OR 3.26, 95% CI 0.92 to 11.53; model II OR 3.28, 95% CI 0.81 to 13.1).</p><p><strong>Conclusion: </strong>Higher HM volumes (≥1190 mL) were associated with decreased BPD risk compared with low HM and formula feeding. Although not statistically significant, the low HM group exhibited increased BPD incidence compared with the exclusive formula group. These findings emphasise the importance of considering HM quantity in mixed feeding practices.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188282","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":"Research priorities for preterm lung health research across the lifespan: a community priority setting partnership.","authors":"Naomi R Hemy, Amber Bates, Belinda Frank, Anne McKenzie, Shannon J Simpson","doi":"10.1136/bmjpo-2024-003050","DOIUrl":"10.1136/bmjpo-2024-003050","url":null,"abstract":"<p><strong>Background: </strong>It is essential to embed patient and public perspectives into every stage of the research journey, including setting the future research agenda. The substantial gaps in our understanding of prematurity-associated lung disease presented a timely opportunity to determine the community's research priorities.</p><p><strong>Objective: </strong>To conduct a priority setting partnership (PSP) to determine the top 10 research priorities for preterm lung health.</p><p><strong>Design: </strong>We undertook a modified James Lind Alliance methodology comprising three main stages: (1) an <i>idea generating</i> survey with open questions to ascertain the community's most important ideas for future preterm lung health research, (2) <i>prioritisation</i> survey to distill the main themes into a shortlist of 20 and (3) <i>consensus workshop</i> where participants were tasked with ranking their final top 10. This PSP is reflective of the view of preterm-born individuals, parents of preterm children and healthcare professionals in an Australian healthcare setting.</p><p><strong>Results: </strong>We collated 144 submissions from the <i>idea generating</i> survey from which 27 <i>prioritisation</i> themes were developed. From the 150 prioritisation survey responses, the 20 themes receiving the most votes were taken to the <i>consensus workshop</i>. Participants identified the following top 10: (1) lifelong impacts; (2) interventions, treatments or supports; (3) ongoing lung health follow-up; (4) diagnostic tools, resources and education for primary healthcare providers; (5) resources to inform and empower families; (6) relationship to physical health and developmental issues; (7) preventing and/or treating lung infections; (8) additional supports, resources and research for minority groups; (9) impact on mental well-being; and (10) likelihood of asthma diagnosis.</p><p><strong>Conclusion: </strong>Priorities identified through the PSP will be invaluable in informing future research into prematurity-associated lung disease.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188283","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":"ESPGHAN and NASPGHAN 2024 protocol for paediatric functional constipation treatment guidelines (standard operating procedure).","authors":"Morris Gordon, Anna de Geus, Marcin Banasiuk, Marc A Benninga, Osvaldo Borrelli, Mary Boruta, Anil Darbari, Dawn Dore-Stites, Michelle Gould, Juliette Hawa, Kirsten Brooke Jones, Julie Khlevner, Alexandra Kilgore, Hayat Mousa, Samuel Nurko, Vassiliki Sinopoulou, Merit Tabbers, Nikhil Thapar","doi":"10.1136/bmjpo-2024-003161","DOIUrl":"10.1136/bmjpo-2024-003161","url":null,"abstract":"<p><strong>Introduction: </strong>Functional constipation is common in childhood, with chronicity leading to a significant impact on patients and their families. There is a significant range of therapies available to healthcare professionals for this condition, with many novel or recently studied. There is a need for an update to the joint European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines last released in 2014. We present the prospectively agreed operating procedure and technical review protocol in this manuscript.</p><p><strong>Methods: </strong>'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) will be used for all phases of this guideline development. The Guideline Development Group is formed by paediatric gastroenterologists from both the ESPGHAN as well as the NASPGHAN. A prospective exercise will agree on key outcomes, thresholds of magnitude that are significant at small, moderate and large levels. Systematic evidence searches, selection, extraction, appraisal and analysis will be performed following Cochrane guidance and GRADE guidance for objectively agreeing the certainty of findings. Additional use of network meta-analysis will identify areas of broad triangulation in the evidence. Summary of findings tables will be produced and inform evidence to decision frameworks. These will guide GRADE recommendations with voting to reach a consensus.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188280","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":"Ten proposed measures to improve vaccination: Health care providers' perspectives on promoting the vaccination intake of children with special healthcare needs in China.","authors":"Tianxing Feng, Meiyi Chen, Xuran Zhao, Xiangshi Wang, Yanling Ge, Zhonglin Wang, Xiang Guo, Zhuoying Huang, Mei Zeng","doi":"10.1136/bmjpo-2024-002797","DOIUrl":"10.1136/bmjpo-2024-002797","url":null,"abstract":"<p><strong>Introduction: </strong>Children with special healthcare needs (CSHCN) often experience vaccination delays or missed vaccines in China. The coverage rate of the age-appropriate National Immunisation Programme vaccine was suboptimal. This study aimed to explore attitudes, behaviours, and suggestions regarding the improvement of routine vaccination services for CSHCN among healthcare providers.</p><p><strong>Methods: </strong>This study conducted local, cross-sectional interviews involving vaccination services for CSHCN. A purposive sampling strategy was used to recruit interviewees including primary care providers, paediatricians and immunisation programme administrators. The interview guide explored attitudes towards and suggestions for establishing immunisation advisory clinics and referral networks, updating immunisation guidance documents and vaccine package inserts and strengthening the education of vaccination providers.</p><p><strong>Results: </strong>21 representative healthcare providers were interviewed. 10 measures were proposed to promote routine immunisation for children with special needs: (1) using immunisation advisory clinics to provide vaccination services for CSHCN; (2) establishing a referral network and specifying which cases necessitate referral to advisory clinics; (3) using an interconnected information system to identify, document and follow-up the CSHCN; (4) supporting high-quality clinical research to update immunisation protocols; (5) providing clear and definite immunisation recommendations to parents of eligible CSHCN; (6) seeking immunisation advice from specialised professionals to enhance primary care capability; (7) creating quality improvement programmes; (8) considering immunisation status a mandatory assessment during specialist visits; (9) supporting off-label use of vaccines legally and (10) encouraging pharmaceutical companies to update vaccine package inserts.</p><p><strong>Conclusion: </strong>Vaccine uptake among CSHCN in China is suboptimal, highlighting the need for a referral network and a standard immunisation protocol. The National Immunisation Programme should develop clear recommendations and an education programme for regional Centers for Disease Control and Prevention to train local providers. A quality assurance and improvement programme, along with regular feedback, is essential to ensure CSHCN receive necessary vaccinations and protection against infectious diseases.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063597","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":"Neonatal unit admission and offspring mental health trajectories across childhood and adolescence: a nationally representative UK cohort study.","authors":"Madura Nandakumar, Gemma Lewis, Glyn Lewis, Francesca Solmi, Ramya Srinivasan","doi":"10.1136/bmjpo-2024-003092","DOIUrl":"10.1136/bmjpo-2024-003092","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the associations between neonatal unit admission (NNU) and subsequent emotional and behavioural difficulties during childhood and adolescence.</p><p><strong>Design: </strong>Longitudinal general population cohort study.</p><p><strong>Setting: </strong>The Millennium Cohort Study: nationally representative UK-based cohort.</p><p><strong>Participants: </strong>All children with exposure, outcome and confounding data.</p><p><strong>Exposure: </strong>NNU admission was identified at 9 months by asking parents whether their baby was 'taken to special care or neonatal or intensive care unit after birth'.</p><p><strong>Main outcome measures: </strong>Emotional and behavioural problems were assessed using the Strengths and Difficulties Questionnaire when children were 3, 5, 7, 11, 14 and 17 years. We explored the association between NNU admission and trajectories of emotional and behavioural problems using multilevel models with growth curves for outcome data between 3-17 years and adjusted for a broad range of confounders.</p><p><strong>Results: </strong>14 013 participants (48.9% female, 13.7% ethnic minority) were included in the analytical sample. In the sample, mean gestational age was 275.81 (SD): 13.80) days, and mean birth weight was 3.36 kg (SD=0.58). 1273 (9.1%) participants had an NNU admission. The latter was associated with increased emotional difficulties (mean difference (MD) 0.13, 95% CI 0.045 to 0.22, p=0.003) and peer problems (MD 0.11, 95% CI 0.026 to 0.19, p=0.010) during childhood in fully adjusted models. There was no evidence that NNU admission was associated with conduct problems (MD 0.013, 95% CI -0.062 to 0.088, p=0.732) or hyperactivity symptoms (MD 0.042, 95% CI -0.070 to 0.15, p=0.452).</p><p><strong>Conclusions: </strong>Children admitted to NNUs at birth are more likely to experience emotional difficulties and peer problems during childhood. These differences are apparent from early childhood continuing into adolescence and strengthen the case for a calm NNU environment with parental visits and mental health support, and early interventions for children admitted to NNUs.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058023","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":"Randomised feasibility study of an intestinal adsorbent in acute diarrhoea in The Gambia.","authors":"Paul Rahden, Abdoulie Fatty, Momodou Lamin Jobarteh, Abdoulwahab Sallah, Ebrahim Jaiteh, Angela Allen, Doreen Umoh, Fanta Bass, Matthew Dodd, Carol Howell, Elena Markaryan, Radovan Hnatič, Stephen Allen","doi":"10.1136/bmjpo-2024-003133","DOIUrl":"10.1136/bmjpo-2024-003133","url":null,"abstract":"<p><strong>Background: </strong>Diarrhoea remains a leading cause of death in children. An intestinal adsorbent may reduce diarrhoea duration and severity.</p><p><strong>Methods: </strong>Randomised controlled feasibility trial with two phases: phase 1 (0-4 hours and double-blind) and phase 2 (up to 5 days and open-label). 50 children aged 6-59 months with acute diarrhoea presenting with no or some dehydration to the emergency paediatric unit and outpatient clinic at Edward Francis Small Teaching Hospital, Banjul, The Gambia were randomised to either standard treatment (oral rehydration fluid and zinc) or standard treatment with polymethylsiloxane polyhydrate for up to 5 days.</p><p><strong>Results: </strong>Recruitment was completed in 7 months. All but one child completed the study. There were no major protocol deviations although patient-held diaries did not collect reliable information. Time from randomisation to the last watery stool (primary outcome) was shorter in the intervention than control arm (mean difference -19.3 hours, 95% CI -30.9 to -7.8). Stool frequency was lower in the intervention arm on days 2 (95% CI -0.8 to -1.3 to -0.3) and 3 (95% CI -0.8; -1.3 to -0.3). One serious event (death) occurred in the control arm.</p><p><strong>Conclusions: </strong>A randomised, controlled trial is feasible. Further clinical trials are warranted to confirm the efficacy of polymethylsiloxane polyhydrate in acute diarrhoea and inform management guidelines.</p><p><strong>Trial registration number: </strong>PACTR202302683128875.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036407","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":"Exceeding the limits of paediatric heat stress tolerance: the risk of losing a generation to climate inaction.","authors":"Alexander Azan, Sulani Nyimbili, Oyinkansola O Babayode, Anna Bershteyn","doi":"10.1136/bmjpo-2024-002883","DOIUrl":"10.1136/bmjpo-2024-002883","url":null,"abstract":"<p><p>Greenhouse gas (GHG) emissions are creating unprecedented climate-driven extreme weather, with levels of heat and humidity surpassing human physiological tolerance for heat stress. These conditions create a risk of mass casualties, with some populations particularly vulnerable due to physiological, behavioural and socioeconomic conditions (eg, lack of adequate shelter, limited healthcare infrastructure, sparse air conditioning access and electrical grid vulnerabilities). Children, especially young children, are uniquely vulnerable to extreme heat-related morbidity and mortality due to factors including low body mass, high metabolism, suboptimal thermoregulatory mechanisms and behavioural vulnerabilities. Children are also uniquely vulnerable to non-fatal heat-related morbidities, including malnutrition due to agricultural disruptions and cardiometabolic, respiratory and mental illnesses from heat exposure and/or confinement during heat avoidance. Climate mitigation through GHG reductions is central to reducing harms to children and preventing the loss of a generation to climate change. In regions most predisposed to extreme heat-driven mass casualties under various GHG emission scenarios-particularly South Asian and Southwest Asian and North African regions-adaptation tools specific to children's needs are the most urgently needed. Existing public health interventions (eg, cooling infrastructure and preventative educational campaigns) to reduce acute heat mortality, and medical infrastructure capacity to treat heat-related illnesses are currently inadequate to meet children's growing heat resiliency needs. Paediatricians and other clinical and community child healthcare providers in these regions lack education about children's heat risks and adaptation tools. Paediatricians and other child healthcare providers have a crucial role in research, education, clinical practice and advocacy to protect children during extreme heat events. Paediatricians, other child healthcare providers and stakeholders of children's well-being are urged to act on young children's behalf and to elevate youth leadership in GHG mitigation and extreme heat adaptation policy-making.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021979","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}