BMJ Paediatrics Open最新文献

{"title":"Multicentre study on nirsevimab: Bayesian analysis reveals persisting risk for preterm infants.","authors":"Enrico Cocchi, Silvia Bloise, Aurora Lorefice, Sara Zannoni, Benedetta Pellegrini, Francesco Saverio Morlupo, Beatrice Scarpellini, Melodie Olivia Loredana Rosa Aricò, Francesco Accomando, Gina Ancora, Gianluca Vergine, Enrico Valletta, Marcello Stella, Federico Marchetti","doi":"10.1136/bmjpo-2025-003665","DOIUrl":"10.1136/bmjpo-2025-003665","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether the timing and effectiveness of nirsevimab prophylaxis vary by gestational age.</p><p><strong>Design: </strong>Retrospective cohort study conducted during two identical epidemic seasons: 2023-2024 (before nirsevimab introduction) and 2024-2025 (after nirsevimab introduction).</p><p><strong>Setting: </strong>Multicentre study involving five hospitals in Italy.</p><p><strong>Patients: </strong>All infants under 1 year of age hospitalised for acute lower respiratory tract infection across two consecutive respiratory syncytial virus (RSV) seasons. We compared the number of RSV-positive hospitalisations (283 cases) and, among those admissions, clinical severity between the pre-nirsevimab and post-nirsevimab seasons, given live birth denominators at participating hospitals were stable. RSV-negative hospitalisations (79 cases) were analysed in parallel as a sensitivity analysis.</p><p><strong>Intervention: </strong>The study compared hospitalised infants eligible for RSV immunoprophylaxis during the 2024-2025 season who received nirsevimab, with those from the 2023-2024 season who did not receive nirsevimab (or received palivizumab, if indicated).</p><p><strong>Main outcome measures: </strong>The primary outcome was the count of RSV-associated hospitalisation, with nirsevimab prophylaxis as the primary exposure, considering live birth denominators at participating hospitals were stable. Particular attention was given to whether gestational age modified the effectiveness of the prophylaxis. Secondary outcomes included measures of disease severity (eg, high-flow nasal cannula use, neonatal intensive care unit admission), adjusted for the effect of gestational age and other relevant covariates. Bayesian hierarchical regression models were used, with sensitivity analyses performed both in negative cases and using frequentist bootstrapped hierarchical models.</p><p><strong>Results: </strong>Median gestational age at birth was 39.7 (38.7-40.7) weeks in the no-prophylaxis group versus 37.3 (35.3-39.0) weeks in the nirsevimab group. Despite prophylaxis, lower gestational age was associated with an increased risk of hospitalisation (Bayesian posterior probability, 98.68%; maximum a posteriori HR 0.63; 95% highest density interval: 0.41-0.95). No RSV hospitalisations occurred between 40 and 90 days post-prophylaxis, suggesting a window of maximal effectiveness. Nirsevimab significantly reduced RSV-related hospitalisations and the need for non-invasive respiratory support.</p><p><strong>Conclusions: </strong>Nirsevimab prophylaxis was associated with reduced hospitalisation and severity. However, protection waned in preterm infants, highlighting the need to investigate modified dosing strategies for this high-risk population.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290725","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":"Evaluating the introduction of workplace-based learning in a paediatric training programme: experience from Myanmar.","authors":"Marcus Wootton, Kyaw Linn, Kyaw Myo, Ian Maconochie, Tina Sajjanhar, Aye Han","doi":"10.1136/bmjpo-2025-003744","DOIUrl":"10.1136/bmjpo-2025-003744","url":null,"abstract":"<p><strong>Objective: </strong>Workplace-based learning (WPBL) for postgraduate paediatricians is well-established in advanced health systems but less so in low-resource settings. We evaluate the first WPBL pilot undertaken in paediatrics in Myanmar.</p><p><strong>Design: </strong>This cohort study assesses the implementation of WPBL among 85 postgraduate doctors from five medical universities in Myanmar.</p><p><strong>Setting: </strong>In 2018, Myanmar's paediatric medical leaders had outlined an ambitious plan to modernise learning at the postgraduate level through a multi-skilled <i>in-situ</i> approach. Supported by the Royal College of Paediatrics and Child Health (RCPCH, UK), a co-designed pilot programme of WPBL was trialled in a structured way.</p><p><strong>Interventions: </strong>This pilot was Myanmar-led, with UK experts providing support to Myanmar supervisors and to the 85 paediatric postgraduate doctors whom they mentored. Progress was documented through a co-designed, standardised 'portfolio of learning' that included well-established WPBL strategies.</p><p><strong>Main outcome measures: </strong>The quality of supervisor feedback in the portfolio to postgraduates was scored by independent assessors, as was the degree of completion of the portfolio, to determine adherence to the WPBL pilot objectives. Insights into the broader changes in practice resulting from the pilot were ascertained through a narrative commentary of moderated focus groups of both supervisors and postgraduates.</p><p><strong>Results: </strong>'Clinical' WPBL topics were more often chosen than 'softer' skill areas, for example, communication and leadership. Focus groups identified the benefits of a structured approach to learning, particularly in areas of weaker clinical performance. There were regional variations in how WPBL was delivered, with disparities between medical schools located in the north and those in the south, challenging WPBL standardisation.</p><p><strong>Conclusions: </strong>Evidence on the impact of formalising WPBL in low-resource settings is minimal. This pilot demonstrates that setting up a WPBL programme is feasible in a low-resource setting, but it also presents challenges.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12523726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290988","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":"Outcome of multiagency investigation for gonorrhoea and chlamydia in prepubertal children: a retrospective review.","authors":"Rebecca Corry, Scott Beard, Faiza Thompson, Patrick Kelly","doi":"10.1136/bmjpo-2025-003653","DOIUrl":"10.1136/bmjpo-2025-003653","url":null,"abstract":"<p><strong>Objective: </strong>To review the process and outcomes of multiagency investigation of gonorrhoea and chlamydia in prepubertal children.</p><p><strong>Design: </strong>Retrospective review of cases presenting to a hospital multidisciplinary child protection team (CPT).</p><p><strong>Setting: </strong>A multiagency centre adjacent to Starship Children's Hospital, in the city of Tāmaki Makaurau Auckland, Aotearoa New Zealand. The hospital CPT is colocated in this centre with statutory child protection services (CPS), police and forensic interviewers.</p><p><strong>Participants: </strong>All prepubertal children seen with gonorrhoea or chlamydia from 2009 to 2020.</p><p><strong>Results: </strong>There were 16 children aged 1 to 9 years: 10 with <i>Neisseria gonorrhoeae</i> (NG), 2 with NG and <i>Chlamydia trachomatis</i> (CT) and 4 with CT. Ten presented with vaginal discharge, and four with conjunctivitis. Aside from their infection, 14 had normal examinations. CPT practice varied with respect to history taking, medical tests and follow-up. Urine screening identified at least one positive household member in 14 children. Sexual abuse was substantiated by CPS in 2/4 children with conjunctivitis and 11/12 others. Five children disclosed in forensic interviews, contributing to four criminal convictions: three for rape (penile penetration of the genitalia) and one for indecent assault. None of these four children had anogenital injuries.</p><p><strong>Conclusions: </strong>Prompt, thorough and coordinated multiagency investigation of prepubertal NG and CT infection (including household screening and expert interviewing of children) will often identify the source of infection and almost always establish sexual transmission. However, even in a tertiary centre, cases are rare, leading to variability in practice. Conjunctivitis caused by NG or CT has a high risk of being sexually transmitted, so should be investigated with the same rigour as anogenital infection. Findings in this cohort, where penetrative sexual offences were confirmed by criminal convictions, support the international consensus that penetrative sexual abuse of children seldom causes anogenital injury.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249663","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":"Improving neonatal total parenteral nutrition (TPN) safety and standardisation in a tertiary NICU: a multicomponent QI initiative.","authors":"Priyadarshini Virupaxi Chougula, Pardha Ramineni, Vikrant Rajendra Deshmukh, Pradeep Suryawanshi, Suprabha Kumari Patnaik","doi":"10.1136/bmjpo-2025-003851","DOIUrl":"10.1136/bmjpo-2025-003851","url":null,"abstract":"<p><strong>Introduction: </strong>Total parenteral nutrition (TPN) is essential for newborns admitted to the neonatal intensive care unit (NICU) who are unable to meet their nutritional requirements through enteral feeding. However, practices often vary due to resource constraints, lack of standardisation and inadequate training-leading to contamination risks, suboptimal nutrition and increased infections. At our 60-bed tertiary NICU (≈1500 admissions/year), adherence to TPN standards was only 10%. This quality improvement project aimed to increase adherence to >80% through a structured, multidisciplinary protocol.</p><p><strong>Methods: </strong>A stepwise quality improvement initiative using planning, implementation, evaluation and action cycles was implemented. Interventions included shifting TPN preparation to trained residents, introducing a laminar flow surveillance system, deploying an Excel-based TPN calculator, modifying TPN composition to reduce contamination and establishing a rotation schedule. Ongoing training, competency checks and real-time monitoring were incorporated to support sustainability.</p><p><strong>Results: </strong>Adherence to standardised TPN practices improved from a baseline of ~10% to sustained levels, with an overall mean adherence of 84.2% . The Statistical Process Control (SPC) analysis demonstrated a centreline shift from 66.0% in the early unstable phase to 94.1% in the stable phase, confirming sustained process improvement. As a balancing outcome, the overall sepsis incidence among inborn neonates on TPN was 3.2%.</p><p><strong>Conclusion: </strong>This quality improvement initiative successfully enhanced adherence to standardised TPN protocols in the NICU through structured training, workflow optimisation and process surveillance. The structured, practical and team-based approach offers a scalable model for improving the quality and consistency of TPN practices in resource-limited settings, with sustained monitoring and regular training remaining essential for long-term success.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249660","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":"Correction: 'UK aid cuts threaten global child health: a call to rethink international assistance<i>'</i>.","authors":"","doi":"10.1136/bmjpo-2025-003602corr1","DOIUrl":"10.1136/bmjpo-2025-003602corr1","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249648","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":"Grandmaternal caregiving and early child development in rural China: the mediating role of parenting environment.","authors":"Qiannan Song, Ai Yue, Yuxin Jiang, Manlin Cui, Qiufeng Gao, Jing Ma","doi":"10.1136/bmjpo-2025-003434","DOIUrl":"10.1136/bmjpo-2025-003434","url":null,"abstract":"<p><strong>Background: </strong>Grandmaternal caregiving is common in many countries and particularly prevalent in rural China, yet evidence on its early developmental implications across caregiving arrangements remains limited. We examined how three caregiving types-maternal caregiving, grandmother-mother cocaregiving and grandmaternal caregiving-relate to early child development, and whether associations are mediated by the parenting environment.</p><p><strong>Methods: </strong>We analysed a two-wave longitudinal cohort of 1796 children under 3 years and their primary caregivers drawn from 118 randomly sampled villages in the Qin-ba mountain region of rural China. We estimated associations using multiple linear regression and assessed mediation by components of the parenting environment (parenting activities, home learning environment (HLE), parenting beliefs).</p><p><strong>Results: </strong>Children receiving grandmother-mother cocaregiving had developmental scores comparable to those with maternal caregiving alone. In contrast, grandmaternal caregiving was associated with lower cognitive, language and social-emotional scores. Elements of the parenting environment partly mediated these associations. Negative associations with grandmaternal caregiving were more pronounced among boys, children with siblings and those whose primary caregiver had lower educational attainment.</p><p><strong>Conclusion: </strong>In this rural Chinese context, grandmaternal caregiving was associated with less favourable early development scores, with the parenting environment acting as a pathway. Programmes may consider supporting grandparent caregivers-especially in grandmaternal caregiving settings-to enhance parenting activities, strengthen the HLE and foster positive parenting beliefs, with attention to families of boys, children with siblings and caregivers with lower education.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238190","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":"Towards an agreed approach to investigate children with developmental regression.","authors":"Kirsten Furley, Matthew Hunter, Gauravi Gawade, Michael Absoud, Chirag Mehra, Robin Kochel, Michael Collingwood Fahey, Katrina Williams","doi":"10.1136/bmjpo-2025-003594","DOIUrl":"10.1136/bmjpo-2025-003594","url":null,"abstract":"<p><strong>Aim: </strong>Children presenting with developmental regression are inconsistently investigated, leading to unacceptable delays to diagnosis for some children. This study sought global expert opinion to develop an agreed approach to investigate children presenting with developmental regression.</p><p><strong>Method: </strong>A Delphi survey collected clinician participant choice of investigations in response to case scenarios of children presenting with developmental regression and differing presenting features. Participants responded to two surveys, and consensus was achieved at 70% agreement. Results were analysed using descriptive statistics (number of responses and percentage agreement). Fifty participants completed the first-round survey, and 31 completed round two. Forty-eight percent of participants who completed both rounds had over 20 years of experience in caring for children with developmental regression. They represented four different clinician specialties and worked across five countries.</p><p><strong>Results: </strong>For each of the four scenarios, there was agreement to recommend haematological, biochemical and genetic investigations as first investigations. Endocrine, metabolic and neurophysiological investigations reached consensus for scenarios based on presentation differences.</p><p><strong>Interpretation: </strong>Participants agreed on first investigations to recommend for children presenting with developmental regression. This is an important initial step towards an agreed approach to investigate children with developmental regression needed to reduce inconsistencies in current care.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238130","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 detection of cerebral palsy among a high-risk cohort in Bangladesh.","authors":"Tasneem Karim, Anna Te Velde, Annabel Webb, Catherine Morgan, Nadia Badawi, Iona Novak, Saifuddin Ahmed, Shafiul Islam, Iskander Hossain, Nazrul Islam, Mohammad Muhit, Gulam Khandaker","doi":"10.1136/bmjpo-2025-003921","DOIUrl":"10.1136/bmjpo-2025-003921","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the predictive validity of best practice early detection tools for cerebral palsy (CP) in a high-risk cohort.</p><p><strong>Study design: </strong>Prospective longitudinal cohort study.</p><p><strong>Setting: </strong>Neonatal intensive care unit of a regional tertiary hospital in Bangladesh.</p><p><strong>Participants: </strong>Neonates with risk factors for CP admitted to Mymensingh Medical College Hospital Neonatal Intensive Care Unit between November 2019 and March 2020.</p><p><strong>Outcome measures: </strong>General Movements Assessment (GMA) at writhing and fidgety periods; Hammersmith Infant Neurological Examination (HINE) and Peabody Developmental Motor Scales Second Edition (PDMS-2) conducted in person at 3, 12 and 24 months. The Developmental Assessment of Young Children (DAYC-2), Ages and Stages Questionnaire (ASQ-3) and Developmental Milestones Chart (DMC) were administered remotely at 6, 9, 12, 18 and 24 months. Due to the impact of COVID-19, a proportion of the cohort was not able to have GMA fidgety videos completed and the first HINE assessment was delayed.</p><p><strong>Results: </strong>A total of 227 infants were enrolled. Of the surviving infants assessed at 24 months, 36 (29%) had a confirmed diagnosis of CP. The most accurate combination of tools for early detection was GMA and HINE at 3 months (sensitivity 0.91; specificity 1.00). The PDMS-2 Total Motor Quotient, with an optimised cut-off of 59, showed high accuracy at 24 months (sensitivity 0.94; specificity 0.99). Among the tools administered remotely, the DAYC-2 PD, DMC (Gross and Fine Motor domains) and ASQ-3 (Gross and Fine Motor domains) demonstrated strong predictive validity-both individually and in combination-at 9, 12, 18 and 24 months, supporting their use as practical alternatives when in-person assessments are not feasible.</p><p><strong>Conclusions: </strong>Despite pandemic-related disruptions, an accurate diagnosis was possible as early as 3 months of age using the best practice tools. Our findings support the practicability of scalable early detection models integrating in-person and remote assessments to improve access to timely diagnosis.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238182","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":"Using the 'F-words' to adopt a holistic and child rights promoting approach in developmental assessment clinics in Sydney: a quality improvement study.","authors":"Zien Vanessa Tan, Sinthu Vivekanandarajah, Jenna Ohlsen, Bronya Cruickshank, Lydia So","doi":"10.1136/bmjpo-2025-003933","DOIUrl":"10.1136/bmjpo-2025-003933","url":null,"abstract":"<p><strong>Background: </strong>The way childhood disability is understood and represented in various domains is evolving. The 'F-words for Child Development', derived from The International Classification of Functioning, Disability and Health, is a framework that is gaining increasing prominence. This paper reports on a quality improvement project in South Western Sydney, designed to encourage a more holistic, strengths-based approach to assessment, formulation and documentation in a child developmental assessment service. We implemented the 'F-words' framework (Function, Family, Fitness, Fun and Friends) into routine clinical practice.</p><p><strong>Methods: </strong>The framework was incorporated into standardised clinic proformas, and regular team education and awareness building activities were conducted. We audited clinical reports pre-intervention and post-intervention to assess how well the 'F-words' framework was incorporated. We also assessed clinician and family perspectives and experiences with this tool using electronic surveys. Thematic analysis was performed on the open text responses.</p><p><strong>Results: </strong>An audit was conducted on 88 reports completed pre-intervention and 112 reports post-intervention. There was an improvement in the reporting of strengths post-intervention. 95% (n=106) of reports clearly documented the child's strengths at the start of the report compared with 74% (n=65) pre-intervention and 85% (n=95) documented at least 4 of the 5 F-words domains, compared with 8% (n=7) pre-intervention. Multidisciplinary clinicians (n=21) and families (n=18) responded to the electronic surveys. The 'F-words' framework was very well received, with most clinicians and families finding it an effective, easy and helpful tool for enhancing clinical assessment, presenting a balanced, non-deficit focused reflection of the child, broadening understanding of the child's strengths and empowering families by fostering a more collaborative approach. None of the respondents rated the tool as unhelpful, although a minority were undecided.</p><p><strong>Conclusion: </strong>The 'F-words' framework can be easily incorporated into clinical practice. Clinicians and families engaged with the service were positive about this approach.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237839","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":"Does neonatal care delivery in England and Wales vary by deprivation and ethnicity: a retrospective cohort study.","authors":"Katherine Pettinger, Saira Pons Perez, Humfrey Legge, Shalini Ojha, David Odd, Sam Oddie","doi":"10.1136/bmjpo-2025-003585","DOIUrl":"10.1136/bmjpo-2025-003585","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether perinatal care delivery in England and Wales varies by ethnicity and socio-economic deprivation, using National Neonatal Audit Programme (NNAP) measures.</p><p><strong>Design: </strong>Retrospective observational study using NNAP (2017-2023) data.</p><p><strong>Setting: </strong>Neonatal units in England and Wales participating in the NNAP.</p><p><strong>Participants: </strong>Admitted infants born at ≥22 weeks with recorded data on ethnicity, deprivation and relevant NNAP measures.</p><p><strong>Outcome measures: </strong>Fourteen NNAP measures covering perinatal optimisation, neonatal care, breastfeeding and parental partnership were explored by ethnicity (White, Black, Asian, Mixed and Other) and deprivation.</p><p><strong>Results: </strong>Ethnicity and deprivation were associated with several measures of care. Compared with White infants, Black, Asian, Mixed and 'Other' ethnicity babies had lower odds of receiving deferred cord clamping (adjusted ORs (aOR) 0.76 (95% CI 0.70 to 0.84), 0.88 (95% CI 0.82 to 0.95), 0.79 (0.68 to 0.92) and 0.75 (0.64 to 0.88), respectively) and had higher odds of abnormal admission temperature. White infants had higher odds of receiving early breastmilk compared with infants from minority ethnic groups, but had lower odds of receiving it at 14 days or at discharge. Compared with the least deprived, the most deprived infants had lower odds of receiving breastmilk, within 48 hours (aOR: 0.58 (95% CI 0.54 to 0.63)) and at discharge (aOR: 0.39 (95% CI 0.36 to 0.43)). There were lower odds of early parental updates and involvement in ward rounds for minoritised ethnic groups (compared with White families) and most deprived (compared with least deprived) families.</p><p><strong>Conclusions: </strong>Disparities exist in the delivery of perinatal care by ethnicity and deprivation. There are opportunities to improve equity, particularly around deferred cord clamping, breastfeeding support and parental partnership.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12506196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238132","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}