BMJ Paediatrics Open最新文献

{"title":"Reduced hospitalisations for paediatric mild traumatic brain injury: a nationwide observational study.","authors":"Nora Bruns, Rayan Hojeij, Pia Brensing, Oliver Andres, Christian von Schnakenburg, Catharina Anna Neumann, Eric Waltersbacher, Hendrik Juenger, Martin Grieser, Sebastian Gaus, Thomas Lücke, Friedrich Reichert, Jan Beime, Vera Schellerer, Andreas Leutner, Anna-Lisa Oechsle, Johannes Meyer, Alexandra Fröba-Pohl, Johanna Wagner, Viviane Klingmann, Karl F Schettler, Matthias Keller, Ursula Felderhoff-Mueser, Christian Dohna-Schwake, Florian Heinen, Michaela Bonfert","doi":"10.1136/bmjpo-2025-003767","DOIUrl":"10.1136/bmjpo-2025-003767","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic brain injury (TBI) is common in childhood, with mild TBI (mTBI) predominating. Germany reports higher hospitalisation rates for paediatric TBI than any other country, suggesting overadmission of mild cases. The study objective was to determine TBI-related hospitalisations in patients <18 years from 2014 to 2020 and describe variability of TBI-related hospitalisations between emergency departments (EDs).</p><p><strong>Design: </strong>Retrospective observational study using the German hospital dataset (GHD) and controlling data from 18 paediatric EDs.</p><p><strong>Setting: </strong>Cases were identified from the GHD using International Classification of Diseases-10 codes and classified by severity using the Abbreviated Injury Scale for the head. Additionally, the proportion of inpatient versus outpatient TBI management from 18 paediatric EDs was assessed.</p><p><strong>Patients: </strong>Cases with TBI as discharge diagnosis hospitalised in Germany (GHD) or presenting at a participating ED.</p><p><strong>Interventions: </strong>N/A.</p><p><strong>Main outcome measures: </strong>Standardised morbidity ratios (SMRs) for 2020 with 2014-2019 as reference period (GHD); proportion of hospitalisations of TBI patients per ED.</p><p><strong>Results: </strong>Among 618 577 TBI cases, mean annual TBI hospitalisations declined from 91 299±1656 (mean±SD) cases in 2014-2019 to 70 783 in 2020. SMRs for all-cause admissions (0.83 (95% CI 0.81 to 0.85)) and mTBI (0.75 (95% CI 0.73 to 0.78)) decreased more strongly than for moderate and severe TBI (0.95 (95% CI 0.91 to 0.99) and 0.95 (95% CI 0.90 to 1.01)). Hospitalisation rates in EDs ranged from 19.1% to 93.0% (median: 75.0%).</p><p><strong>Conclusions and relevance: </strong>The disproportionate reduction of mTBI hospitalisations during the COVID-19 pandemic compared with moderate to severe cases suggests that there is potential for safely managing more mild cases in outpatient settings.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130004","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":"Clinical characteristics and pharmacotherapy choices in children newly diagnosed with tic disorders in China: a retrospective cohort study.","authors":"Yuxin Xiang, Chang Tong, Qing Lu, Dan Sun, Zhisheng Liu","doi":"10.1136/bmjpo-2025-003968","DOIUrl":"10.1136/bmjpo-2025-003968","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to characterise the clinical profiles and pharmacotherapeutic choices among children with newly diagnosed tic disorders (TDs) in China in order to improve clinical understanding and support decision-making for clinicians.</p><p><strong>Methods: </strong>This was a retrospective cohort study involving 15 182 paediatric patients aged 4-18 years newly diagnosed with TD at Wuhan Children's Hospital between January 2021 and October 2024. Demographic characteristics and initial pharmacotherapy choices were collected and analysed. Clinical characteristics were compared across age (<6 years, 6-12 years and ≥12 years) and gender groups using χ² tests/Wilcoxon rank-sum tests and trend analyses. A generalised linear model was applied to analyse the trend in the male-to-female ratio with increasing age. Pharmacotherapy choices were also analysed and divided into monotherapy and combination therapy for further evaluation.</p><p><strong>Results: </strong>Among the patients, 78.6%, 9.9% and 11.5% were diagnosed with provisional TD, chronic TD (CTD) and Tourette syndrome (TS), respectively. The median age at diagnosis was 7.3 years, with a male-to-female ratio of 3.7:1. The most common symptom was eye blinking/eye rolling. The rate of premonitory urge and the tic-related impact tended to increase with age. Male patients showed a higher prevalence of CTD and TS, as well as a greater comorbidity rate of attention-deficit/hyperactivity disorder. And the rate of male patients was slightly positively correlated with age at onset. Most patients chose the monotherapy for the first time. Among them, the clonidine patch and traditional Chinese medicine were the most common choices.</p><p><strong>Conclusions: </strong>We described the clinical phenotypes of paediatric patients with newly diagnosed TD in China. At the same time, we also explored the differences in TD subtypes, clinical characteristics and medication choices between patients in different age and gender groups, providing valuable real-world evidence for an early identification and individualised treatment in paediatric TD.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085027","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":"Prevalence of drug-drug interactions in children with cardiac disorders receiving off-label drugs in a single centre in Pakistan: a cross-sectional study.","authors":"Anam Fatima, Muhammad Aamir, Naila Shahbaz, Shehla Akbar, Adeel Aslam, Kashif Barkat, Samia Afaq","doi":"10.1136/bmjpo-2024-003293","DOIUrl":"10.1136/bmjpo-2024-003293","url":null,"abstract":"<p><strong>Objectives: </strong>This study evaluated the prevalence of clinically significant drug-drug interactions (CSDDIs), off-label (OL) drug use and the associated predictors in paediatric cardiology ward.</p><p><strong>Design: </strong>A cross-sectional study.</p><p><strong>Setting: </strong>Hayatabad Medical Complex, Tertiary care hospital in Peshawar, Pakistan.</p><p><strong>Patients: </strong>250 patients.</p><p><strong>Methodology: </strong>The Micromedex Drug-Reax tool was used to check the drug-drug interactions (DDI) and interactions of major severity were categorised as CSDDI. Association of various predictors including OL drug use with CSDDIs was evaluated using univariate and multivariate binary logistic regression.</p><p><strong>Main outcome measures: </strong>Rate of drug-drug interactions, types and classification of DDI, OL prescribing in paediatrics.</p><p><strong>Result: </strong>Of the total 250 paediatric patients, 127 (28.6%) patients were exposed to at least one clinically significant DDI, while 228 (91.20%) patients received at least one OL prescription. Furosemide was the most frequently prescribed drug involved in CSDDIs, while it was also one of the highly prescribed OL drugs. Multivariate analysis revealed that infant age group (OR 0.256; CI 0.080 to 0.814) with p value 0.02 and patients prescribed >5 drugs (OR 3.544; CI 1.906 to 6.589) were significantly more likely to experience CSDDIs in reference to their corresponding categories.</p><p><strong>Conclusion: </strong>A high prevalence of CSDDIs and OL prescriptions was observed. OL drug presence was also observed to be a significant predictor associated with an increased risk of CSDDIs. Thus, to improve paediatric pharmacotherapy, suitable medical interventions are required to decrease OL drug use and CSDDIs.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069022","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":"Association between heat and air pollution (PM_2.5 and black carbon) exposure in pregnancy and preterm birth in low- and middle-income countries: a systematic review and meta-analysis.","authors":"Sreevatsan Raghavan, Tanya Sarah Isaac, Divya Arya, Gabriela Cipriano Flores, Rekha Shanmugam, Ayushi Na, Bapu Koundinya Desiraju, Vidhya Venugopal, Ramachandran Thiruvengadam, Pallavi Kshetrapal, Nitya Wadhwa, Laura Downey, Jane E Hirst, Shinjini Bhatnagar","doi":"10.1136/bmjpo-2025-003428","DOIUrl":"10.1136/bmjpo-2025-003428","url":null,"abstract":"<p><strong>Background: </strong>Preterm birth (PTB) is a major global health issue, causing substantial newborn morbidity and mortality. Limited literature is available on the association between prenatal exposure to heat and air pollution (particularly, particulate matter 2.5 (PM_2.5) and black carbon) and the risk of PTB in low- and middle-income countries (LMICs). This review attempts to integrate existing information.</p><p><strong>Methods: </strong>A systematic search of numerous databases (Pubmed, Embase, Scopus and grey literature) for peer-reviewed articles published between 2010 and 2024 in LMIC was done using PM_2.5, black carbon and ambient heat as exposures with PTB as the outcome. After screening 4524 studies, 32 were included, focusing on various exposure windows throughout pregnancy. The risk of bias assessment was done using the Non-randomised Studies of Exposures tool. Random-effects meta-analyses using the DerSimonian and Laird method were done when three or more studies were available; otherwise, a fixed-effects model was used to estimate the pooled effect sizes.</p><p><strong>Results: </strong>Heat exposures were associated with elevated incidences of PTB, especially during the first and third trimesters (OR=1.29 and 1.39, respectively). PM_2.5 exposure was also similarly associated, but to a lower extent across all trimesters (OR=1.09). Black carbon exposure also depicted a similar trend, which was during the third trimester (OR=2.74).</p><p><strong>Conclusion: </strong>The results point towards a consistent adverse effect on the exposures studied (PM_2.5, black carbon, and heat). There is also a dearth of representative data from LMICs where vulnerabilities to climate change, specifically for maternal and child health, are more pronounced. Furthermore, few studies have investigated the impact of combined exposures, highlighting a critical gap in understanding the synergistic effects of these environmental factors. This emphasises the need for more geographically diverse and representative studies to permit policy framing aiming to reduce PTB incidence mediated by environmental factors.</p><p><strong>Prospero registration number: </strong>The study protocol for this review was registered with PROSPERO-CRD42024563329.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069048","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":"Adherence to infection mitigation strategies for facial dog bite wounds: a retrospective analysis of a level 1 paediatric trauma centre.","authors":"Elizabeth M Waltman, David M Mills, Isabella G Steidley, Michael C Monuteaux, Eric W Fleegler, Amir A Kimia","doi":"10.1136/bmjpo-2025-003616","DOIUrl":"10.1136/bmjpo-2025-003616","url":null,"abstract":"<p><p>Dog bites are a frequent cause of paediatric facial injuries and present a significant risk of infection. This retrospective study evaluated adherence to antibiotic and repair guidelines in facial dog bite cases at a level 1 paediatric trauma centre. Among 356 cases, 99.2% received antibiotics; however, only 90.4% received the recommended first-line agent and 12.6% missed the initial dose in the emergency department. Many prescriptions had an incorrect dose or prolonged duration. Paediatric emergency medicine clinicians used fewer layered repairs compared to plastic surgeons. These results highlight variation in both antibiotic prescribing and laceration repairs, suggesting the need for quality improvement in both areas.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051838","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":"Evaluating the impact of an indication-based, patient-specific prescribing tool on prescribing errors in paediatrics: a non-randomised, before-and-after study.","authors":"Calandra Feather, Nicholas Appelbaum, Jacqueline Le Geyt, Sharon Jheeta, Ian Maconochie, Bryony Dean Franklin","doi":"10.1136/bmjpo-2025-003662","DOIUrl":"10.1136/bmjpo-2025-003662","url":null,"abstract":"<p><strong>Background: </strong>Medication errors remain a major challenge in paediatric prescribing owing to the complexities of weight-based dosing, age-specific formulations and the need for precise calculations. This study examines the association of an indication-based, patient-specific prescribing tool with prescribing errors in paediatric emergency and inpatient settings.</p><p><strong>Methods: </strong>A non-randomised, before-and-after study was conducted at a London tertiary teaching hospital. Prescribing errors were assessed before and after implementing the intervention in the paediatric emergency department (PED) and a general paediatric ward. Errors were identified through manual review of medication orders against predefined criteria based on the British National Formulary for Children and local prescribing guidelines. Dose errors were defined as deviations of ±10% from recommended ranges, with deviations ≥25% categorised as major. Statistical analysis included descriptive comparisons, logistic regression and intention to treat analysis to assess the effect associated with the intervention.</p><p><strong>Results: </strong>A total of 1808 medication orders were reviewed, including 1567 standard practice orders and 241 intervention-supported orders. When the intervention was used, the overall prescribing error rate was 1.2%, compared with 7.14% in the control orders, representing an 83% reduction in the odds of error (OR 0.17). In the general paediatric ward, errors reduced from 9.1% to 1.1% (OR 0.11), while in PED, error rates declined from 4.9% to 1.4% (OR 0.27). Errors that occurred when using the intervention were attributed to prescriber deviation from system recommendations rather than inaccuracies within the tool itself.</p><p><strong>Conclusions: </strong>These findings suggest that use of the intervention is associated with significantly lower odds of a prescribing error occurring in paediatric settings. Future work should focus on optimising prescriber adherence, enhancing system integration into clinical workflows and exploring economic and user-experience outcomes to maximise impact.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051865","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":"Coming in hot: using emotional journey maps to examine parental perceptions associated with presentation of their child with fever to the emergency department in England.","authors":"Courtney Franklin, David Taylor-Robinson, Enitan D Carrol, Paul Moran, Bernie Carter","doi":"10.1136/bmjpo-2025-003640","DOIUrl":"10.1136/bmjpo-2025-003640","url":null,"abstract":"<p><strong>Introduction: </strong>Paediatric emergency department (ED) attendances and admissions in England for fever are extremely common and are increasing, despite little evidence of increased risk and severity of fever-related presentations. Fever is a cause of great concern and anxiety for parents and carers, and these factors have a strong influence on decision-making across every step of a child's journey through the healthcare system. There remains a gap in evidence investigating the emotional influences of parental health-seeking behaviours for fever.</p><p><strong>Objective: </strong>To explore the journeys taken by parents for children (0-18 years) with fever in England, from noticing a fever, to contacting primary care services, to ED attendance and subsequent discharge.</p><p><strong>Design: </strong>Qualitative design, using a novel emotional journey map approach.</p><p><strong>Participants: </strong>11 parents who had taken their febrile child to hospital (2015-2023).</p><p><strong>Methods: </strong>Emotional journey maps were co-produced with consenting parent participants during semi-structured Zoom interviews (2022-2023).</p><p><strong>Results: </strong>Parents' anxiety, fear and uncertainty strongly influenced decision-making throughout their child's healthcare journey. The use of the emotional component in the journey maps helped to clearly visualise the factors that influenced feelings of frustration and negative experiences. Lack of care continuity, unclear fever guidance and exclusion from decision-making led to mistrust and strained relationships with healthcare professionals. Attendance at the ED was driven by uncertainty about illness severity, conflicting medical advice, barriers to primary care and confusing safety-netting, highlighting key areas for intervention.</p><p><strong>Conclusions: </strong>Findings have significant potential to inform how and why parents seek support from different services and help to aid understanding of gaps in fever education and health services. These maps provide a powerful health service user experience tool and have significant potential to inform how and why parents seek different services and help aid understanding of gaps in fever education and health services.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051782","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":"Shifting tides: increased severity despite fewer visits for infant respiratory infections across two consecutive post-pandemic winters in Northern Italy.","authors":"Alessandra C F Ferrari, Andrea Scaramuzza, Giulia Chiopris, Chiara Massari, Elisa Giani, Claudio Cavalli","doi":"10.1136/bmjpo-2025-003695","DOIUrl":"10.1136/bmjpo-2025-003695","url":null,"abstract":"<p><p>This study compares infant (0-24 months) respiratory infection presentations to a Northern Italian paediatric emergency department across two post-pandemic winters (2022-2023 vs 2023-2024). Despite an approximate 44% reduction in visits in 2023-2024 (N=176 in 2023-2024 vs N=317 in 2022-2023), infants in the 2023-2024 season experienced significantly higher proportions of ventilatory support (51.1% vs 32.8%, p<0.001) and intensive care unit admission (15.9% vs 1.9%, p<0.001) than those presenting in 2022-2023, with a non-significant trend towards higher hospitalisation (88.1% vs 81.7%, p=0.052). Respiratory syncytial virus re-emerged as the dominant pathogen (43.2% vs 27.7%, p<0.001) in 2023-2024, alongside increased human metapneumovirus and influenza A H1N1. These findings highlight a concerning shift towards increased severity, underscoring the need for ongoing surveillance.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051820","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":"Clinically significant bradycardia in children with respiratory syncytial virus bronchiolitis receiving dexmedetomidine: effect modification by mechanical ventilation.","authors":"Rasha S Farag, Aditya S Kalluri, Geetha Iyer, Jennifer P Stevens, Carly E Milliren, James Brian McAlvin","doi":"10.1136/bmjpo-2025-003625","DOIUrl":"10.1136/bmjpo-2025-003625","url":null,"abstract":"<p><strong>Background: </strong>Limited evidence exists on the additive risk of bradycardia in children with respiratory syncytial virus (RSV) bronchiolitis receiving dexmedetomidine (DMED). We aim to study the association between RSV bronchiolitis and bradycardia during DMED administration.</p><p><strong>Methods: </strong>This retrospective cohort study included 273 children under 2 years old admitted to the intensive care units at Boston Children's Hospital with severe bronchiolitis and sedated with DMED from 2009 to 2022. Children were classified as RSV or non-RSV based on confirmed laboratory results. The primary outcome was a composite measure of clinically significant bradycardia, defined as either a heart rate <60 beats per minute or need for medical intervention(s). The secondary outcome was the minimum heart rate after DMED initiation. Subgroup analyses assessed potential effect modification by age, DMED doses, ventilation mode and pre- versus post-COVID-19.</p><p><strong>Results: </strong>The median (Q1, Q3) age was 8.0 (4.0, 13.7) months. Of the children studied, 85 (31.1%) had RSV bronchiolitis and 170 (62.3%) underwent invasive mechanical ventilation (IMV) at DMED initiation. Clinically significant bradycardia was observed in 71 (26.0%) patients with no significant difference between the RSV and non-RSV cohorts (OR: 1.80; 95% CI: 0.95 to 3.39; p = 0.07). Subgroup analyses showed effect modification with an increased likelihood of clinically significant bradycardia in the RSV group undergoing IMV (OR: 2.99 vs 0.45; Χ² ₁=3.6, p=0.04) or admitted before the COVID-19 pandemic (OR: 2.94 vs 0.51; Χ² ₁=4.7, p=0.03). The RSV cohort experienced a significantly greater heart rate reduction after DMED initiation (-8.07 bpm; 95% CI: -13.71 to -2.43; p = 0.005).</p><p><strong>Conclusions: </strong>Children with RSV bronchiolitis experienced greater heart rate reduction after DMED initiation, with a higher likelihood of clinically significant bradycardia if IMV is in use at DMED initiation or if admitted before the COVID-19 pandemic. Caution is warranted when treating RSV bronchiolitis patients with DMED.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022764","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":"Spot urinary copper/creatinine ratio: a non-invasive tool for diagnosis of Wilson's disease in children.","authors":"Fahmida Begum, Amit Kumar Datta, Khan Lamia Nahid, Tahmina Jesmin, Nadira Musabbir, Md Wahiduzzaman Mazumder, Kanij Fatema, Md Rukunuzzaman, Abu Sayd Mohammad Bazlul Karim, Faisal Chowdhury, Mohammad Azmain Iktidar","doi":"10.1136/bmjpo-2025-003718","DOIUrl":"10.1136/bmjpo-2025-003718","url":null,"abstract":"<p><p>Diagnosing Wilson's disease (WD) in children remains a significant challenge. This study evaluated spot urinary copper/creatinine (Cu/Cr) ratio for paediatric WD diagnosis in Bangladesh. 60 children (30 WD, 30 non-WD by Leipzig criteria) were enrolled, and the spot morning urinary Cu/Cr and 24-hour urinary copper were measured. The spot Cu/Cr ratio was significantly higher in patients with WD (median 0.2597 vs 0.0101, p<0.001) and correlated strongly with 24-hour urinary copper (r=0.697). A cut-off of 0.01604 yielded 90% sensitivity and specificity (AUC 0.920). Spot urinary Cu/Cr ratio is an accurate, non-invasive tool for paediatric WD diagnosis, particularly in resource-limited settings. These promising initial findings highlight its potential, though further comprehensive validation in larger and diverse populations is essential to confirm its reliability and generalisability.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999588","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}