BMJ Paediatrics Open最新文献

{"title":"Correction for '<i>Factors influencing the natural history of non-IgE-mediated gastrointestinal food allergies in paediatric age: a prospective multicentre cohort study'</i>.","authors":"","doi":"10.1136/bmjpo-2024-003203corr1","DOIUrl":"10.1136/bmjpo-2024-003203corr1","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639568","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":"Comparing different administration methods of subanaesthetic propofol to mitigate emergence agitation in preschool children undergoing day surgery: a double-blind, randomised controlled study.","authors":"Jiaxiang Chen, Xiaoli Shi, Wei Hu, Rongmu Lin, Ligang Meng, Changsheng Liang, Xinggang Ma, Liang Xu","doi":"10.1136/bmjpo-2023-002376","DOIUrl":"10.1136/bmjpo-2023-002376","url":null,"abstract":"<p><strong>Background: </strong>Preschool children who received sevoflurane anaesthesia were associated with a high incidence of emergence agitation (EA). Studies have shown that a subanaesthetic dose of propofol (1 mg/kg) at the end of inhalational anaesthesia could reduce EA in paediatric patients, but the optimal administrations are still under investigation.</p><p><strong>Methods: </strong>In a double-blind trial, 160 preschool children (ASA I or II, 2-5 years old) undergoing day surgery of laparoscopic inguinal hernia repair with sevoflurane anaesthesia were randomly assigned into four groups: the control group, single bolus 3 min before the end of the surgery (bolus A), single bolus at the end of the surgery (bolus B) and continuous infusion for 3 min at the end of the surgery (continuous infusion). The dose of propofol in the bolus A group, bolus B group and continued infusion group is 1 mg/kg. The primary outcomes were the incidence and severity of EA assessed by the Paediatric Anaesthesia Emergence Delirium (PAED) scale and Watcha scales. The secondary outcomes included extubation time, emergence time, mean arterial pressure and heart rate.</p><p><strong>Results: </strong>The incidence of EA was as follows: 65.0% in the control group, 30.0% in the bolus A group, 32.5% in the bolus B group and 5.0% in the continuous infusion group (p<0.05). Furthermore, the peak PAED scores in the continuous infusion group were significantly lower than those in the other groups. However, extubation time and emergence time showed no differences among groups.</p><p><strong>Conclusions: </strong>Continuous infusion of subanaesthetic dose propofol (1 mg/kg) for 3 min at the end of sevoflurane anaesthesia seems to be more appropriate than other administration as it reduced EA and did not prolong the time to wake.</p><p><strong>Trail registration number: </strong>NCT05420402.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639460","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":"Predictors of successful Picture Exchange Communication System training in children with communication impairments: insights from a real-world intervention in a resource-limited setting.","authors":"Prakasit Wannapaschaiyong, Thitaporn Vivattanasinchai, Awassada Wongkwanmuang","doi":"10.1136/bmjpo-2024-003282","DOIUrl":"10.1136/bmjpo-2024-003282","url":null,"abstract":"<p><strong>Background: </strong>Children with communication impairments-such as autism spectrum disorder or global developmental delay-face significant challenges affecting their emotional and behavioural development. The Picture Exchange Communication System (PECS) is an augmentative communication tool designed to enhance their skills. However, its effectiveness can vary in resource-limited settings. This study aimed to identify predictors of successful PECS training among children with communication impairments in such environments.</p><p><strong>Methods: </strong>This retrospective study analysed records of 61 children with communication impairments who underwent PECS training at Siriraj Hospital in Bangkok, Thailand, from 2020 to 2023. Success was defined as achieving PECS phase 3 proficiency and a Clinical Global Impression-Improvement score of 1-3 after 1 year. Logistic regression identified predictors of successful outcomes based on demographic, clinical, family and training-related factors.</p><p><strong>Results: </strong>After 1 year, 46% (28 out of 61) of the children achieved successful PECS outcomes. Significant predictors of success were lower severity of communication impairment (Clinical Global Impression-Severity ≤4; adjusted OR= 15.24, p = 0.002), higher frequency of PECS sessions (>6 times per year; OR = 9.11, p = 0.010), higher family income (≥20,000 baht per month; OR = 9.83, p = 0.024) and frequent home practice (≥3 times per week; OR = 7.02, p = 0.066).</p><p><strong>Conclusions: </strong>In resource-limited settings, factors such as severity of impairment, intensity of intervention, socioeconomic status and caregiver involvement significantly influence the success of PECS training. Tailored interventions and strategic resource allocation are crucial to optimise communication outcomes for these children.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630012","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":"Artificial intelligence for weight estimation in paediatric emergency care.","authors":"Iraia Isasi, Elisabete Aramendi, Erik Alonso, Sendoa Ballesteros-Peña","doi":"10.1136/bmjpo-2024-002891","DOIUrl":"10.1136/bmjpo-2024-002891","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate a paediatric weight estimation model adapted to the characteristics of the Spanish population as an alternative to currently extended methods.</p><p><strong>Methods: </strong>Anthropometric data in a cohort of 11 287 children were used to develop machine learning models to predict weight using height and the body mass index (BMI) quartile (as surrogate for body habitus (BH)). The models were later validated in an independent cohort of 780 children admitted to paediatric emergencies in two other hospitals. The proportion of patients with a given absolute percent error (APE) was calculated for various APE thresholds and compared with the available weight estimation methods to date. The concordance between the BMI-based BH and the visual assessment was evaluated, and the effect of the visual estimation of the BH was assessed in the performance of the model.</p><p><strong>Results: </strong>The machine learning model with the highest accuracy was selected as the final algorithm. The model estimates weight from the child's height and BH (under-, normal- and overweight) based on a support vector machine with a Gaussian-kernel (SVM-G). The model presented an APE<i><</i>10% and <i><</i>20% for 74.7% and 96.7% of the children, outperforming other available predictive formulas by 3.2-37.5% and 1.3-29.1%, respectively. Low concordance was observed between the theoretical and visually assessed BH in 36.7% of the children, showing larger errors in children under 2 years.</p><p><strong>Conclusions: </strong>The proposed SVM-G is a valid and safe tool to estimate weight in paediatric emergencies, more accurate than other local and global proposals.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613221","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":"Identification of distinct clinical profiles of sepsis risk in paediatric emergency department patients using Bayesian profile regression.","authors":"Patricia Gilholm, Sainath Raman, Adam Irwin, Paula Lister, Amanda Harley, Luregn J Schlapbach, Kristen S Gibbons","doi":"10.1136/bmjpo-2024-003100","DOIUrl":"10.1136/bmjpo-2024-003100","url":null,"abstract":"<p><strong>Background: </strong>Sepsis affects 25 million children and neonates annually, causing significant mortality and morbidity. Early identification and treatment are crucial for improving outcomes. Identifying children at risk is challenging due to clinical heterogeneity and overlap with other conditions. Current evaluations of sepsis criteria adopt a variable-centred approach, evaluating each criterion independently. The objective of this study was to explore associations between patterns of sepsis screening criteria and sepsis risk in children screened in the emergency department (ED) to identify distinct profiles that describe the clinical heterogeneity of suspected sepsis.</p><p><strong>Methods: </strong>This secondary analysis involved 3473 children screened for sepsis across 12 EDs in Queensland, Australia. Bayesian profile regression was used to construct data-driven clinical profiles derived from sepsis screening criteria and their association with suspected sepsis, defined as senior medical officer diagnosis and antibiotic administration in the ED. Posterior risk probabilities (Prs) with 95% credible intervals (CIs) were calculated for each profile. Profiles were internally validated by assessing their association with sepsis, septic shock, organ dysfunction and infection sources, in both adjusted and unadjusted models.</p><p><strong>Results: </strong>Seven distinct clinical profiles were identified. Two profiles were labelled as high risk of suspected sepsis (profile 1, n=22: Pr 0.73, 95% CI 0.55, 0.89; profile 2, n=150: Pr 0.69, 95% CI 0.59, 0.80), four as moderate risk and one as low risk. High-risk profiles were characterised by severe illness indicators and elevated lactate levels. Moderate-risk profiles included criteria such as altered behaviour, young age (<3 months) and respiratory distress. High-risk profiles had strong associations with all clinical outcomes.</p><p><strong>Conclusions: </strong>Seven clinical profiles were identified that varied in their risk of suspected sepsis and associated outcomes. Validation of these profiles in diverse populations and identification of which profiles are likely to benefit from certain interventions is needed.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613238","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 the Patient-Specific Functional Scale for monitoring paediatric injury patients at a zonal referral hospital in Northern Tanzania.","authors":"Baraka Moshi, Michael J Mahande, Anna Tupetz, Elizabeth M Keating, João Ricardo Nickenig Vissoci, Winifrida C Mwita, William Nkenguye, Kajsa Vlasic, Francis Musa Sakita, Frida Shayo, Emily R Smith, Catherine A Staton, Blandina T Mmbaga, Haleluya Moshi","doi":"10.1136/bmjpo-2025-003348","DOIUrl":"10.1136/bmjpo-2025-003348","url":null,"abstract":"<p><strong>Background: </strong>Injuries are a major cause of morbidity and mortality among paediatric populations in low- and middle-income countries (LMICs). The Patient-Specific Functional Scale (PSFS) is a commonly used tool to assess functional recovery. This study aims to evaluate the psychometric properties of the PSFS for monitoring paediatric injury patients at a zonal referral hospital in Northern Tanzania.</p><p><strong>Methods: </strong>This retrospective cohort study used data from the Kilimanjaro Christian Medical Centre paediatric injury registry (November 2020 to June 2024) and included patients under 18 years treated for injuries at a zonal referral hospital in Northern Tanzania. Key outcomes were in-hospital mortality and injury-related morbidity, assessed using the PSFS and Glasgow Outcome Scale Extended Paediatric (GOS-E Ped). The PSFS's reliability was tested with Cronbach's alpha, its smallest meaningful change was calculated and its correlation with GOS-E Ped was analysed using Spearman's rank.</p><p><strong>Results: </strong>Among 1000 paediatric injury patients, the mortality rate was 6.6%. PSFS mean scores improved from 4.3 at discharge to 6.5 at 2 weeks and 9.0 at 3 months post hospital discharge. The PSFS showed good reliability (Cronbach's alpha: 0.90). A moderate negative correlation was found between PSFS and GOS-E Ped at 3 months (Spearman's ρ: -0.74). The minimally clinically important difference was 2.7, with a sensitivity of 0.73, specificity of 0.72 and an area under the curve of 0.83.</p><p><strong>Conclusion: </strong>The PSFS was found to be a valid, reliable and responsive tool for assessing functional changes in paediatric injury patients, demonstrating strong internal consistency. The findings support its use to measure morbidity in this population.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613234","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":"Disease burden and health-related quality of life among children with X-linked hypophosphataemia in China: a national cross-sectional survey.","authors":"Lin Zhu, Zhenqing Tang, Jiahao Hu, Dingguo Li, Aihua Zhang, Ying Chen, Li Liu, Feihong Luo, Qi Kang, Chunlin Jin","doi":"10.1136/bmjpo-2024-003165","DOIUrl":"10.1136/bmjpo-2024-003165","url":null,"abstract":"<p><strong>Background: </strong>X-linked hypophosphataemia (XLH) is a rare inherited disorder often misdiagnosed and lacking sufficient aetiological treatment. Previous studies have shown that XLH is associated with worse health-related quality of life (HRQoL) and greater economic burden for children and their families compared with the general population, but evidence from China is scarce. This study aimed to comprehensively explore the burden and HRQoL of XLH children in China.</p><p><strong>Methods: </strong>An online retrospective survey of paediatric patients with XLH and their caregivers was conducted nationwide during March to June 2021. A self-administered questionnaire was used to collect socio-demographic, clinical and economic data. The EQ-5D-Y-3L instrument was employed to assess HRQoL, and the health utility score was calculated. Direct medical, non-medical and indirect costs were determined. Multivariate regression analysis was performed to explore potential associations between HRQoL and identified influencing factors.</p><p><strong>Results: </strong>The study included 221 subjects with a mean age of 7.25 years, of whom 119 (53.8%) were girls. Most XLH children (63.8%) lived in rural areas, and 39.4% reported a family history. Over 70% experienced misdiagnosis. The average total annual cost per patient was found to be 34 657.85 CNY. Of direct medical costs, patients' out-of-pocket expenses were substantial. The incidence of catastrophic health expenditure was 19.9%. The means (SD) of EQ-5D-Y-3L health utility and EQ-5D VAS scores were 0.83 (0.14) and 56.07 (10.95). Both univariate and multivariate analyses found older age and lower economic affordability were associated with poorer HRQoL.</p><p><strong>Conclusions: </strong>The study underscores the significant burden of XLH on paediatric patients and their families in China, both in terms of HRQoL and economic costs. The findings emphasise the importance of early detection, accurate diagnosis, cost-effective targeted interventions and long-term multidisciplinary management strategies to improve the lives of XLH children and their families.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572001","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":"Analysis of early risk factors of death in preterm infants treated with iNO: a national multicentre retrospective study.","authors":"Liang Gao, Lian Wang, Yao Zhu, Guo-Bao Liang, Zhi Zheng, Xin-Zhu Lin, Sheng-Qian Huang, Ling Liu, Bao-Ying Feng, Qiu-Fen Wei, Mu-Lin Yao, Ma Li, Xu-Fang Fan, Wen-Li Duan, Fa-Lin Xu, Lu Zhu, Fan Wu, Jing Zhang, Jian Mao, Meng-Jiao Wang, Zhan-Kui Li","doi":"10.1136/bmjpo-2024-003204","DOIUrl":"10.1136/bmjpo-2024-003204","url":null,"abstract":"<p><strong>Objective: </strong>To analyse early risk factors for mortality in preterm infants treated with inhaled nitric oxide (iNO) in China.</p><p><strong>Design: </strong>A retrospective observational case-control study.</p><p><strong>Setting: </strong>8 tertiary hospitals in 5 regions of China.</p><p><strong>Patients: </strong>726 preterm infants treated with iNO for hypoxic respiratory failure or persistent pulmonary hypertension of newborns.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements: </strong>The primary outcome was survival status at discharge.</p><p><strong>Main results: </strong>(1) The mortality rate was 27.1% (197/726), and which significantly reduced with increasing gestational age (GA) and birth weight. (2) Compared with the survival group, the death group had significantly greater use of assisted reproductive technology, higher multiple pregnancy rates and lower caesarean section rates. Infants in the death group had a significantly higher incidence of small for GA (SGA), Apgar score ≤3 at 1 min after birth, pneumorrhagia, sepsis and shock. In the death group, the utilisation rate of a pulmonary surfactant (PS) was significantly lower, whereas the oxygenation index (OI) before iNO treatment was significantly higher. The maximum dose of iNO in the death group was significantly higher than that in the survival group. (3) The Cox proportional hazard model showed that SGA (HR 1.800, 95% CI (1.113 to 2.911)), sepsis (HR 1.488, 95% CI (1.093 to 2.027)), shock (HR 1.473, 95% CI (1.033 to 2.100)), OI before iNO treatment (HR 1.016, 95% CI (1.006 to 1.026)) and the maximum dose of iNO treatment (HR 1.070, 95% CI (1.035 to 1.105)) were risk factors for death in preterm infants treated with iNO. Furthermore, GA (HR 0.876, 95% CI (0.831 to 0.924)), PS (HR 0.433, 95% CI (0.296 to 0.633)) and a higher initial dose of iNO (HR 0.926, 95% CI (0.891 to 0.962)) were identified as protective factors. (4) Stratified analysis and sensitivity analysis determined the stability of the core results in preterm infants with GA between 28 and 36⁺⁶ weeks.</p><p><strong>Conclusion: </strong>Premature infants treated with iNO had a high mortality rate. SGA, sepsis, shock and higher OI before iNO treatment increased the mortality risk in infants with GA between 28 and 36⁺⁶ weeks. A higher GA the use of PS, and a higher initial iNO dose could improve the survival outcome of these babies.</p><p><strong>Trial registration number: </strong>The study was registered in the Chinese Clinical Trials Registry (http://www.chictr.org.cn; registration number: ChiCTR2200066935).</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571999","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":"Influence of time of birth in early neonatal mortality and morbidity: retrospective cohort study.","authors":"Ginna Cabra-Bautista, Andres F Pérez, Gissel V Ruiz, Daniel Camilo Aguirre-Acevedo, Ivan D Florez, Jose A Calvache","doi":"10.1136/bmjpo-2024-003236","DOIUrl":"10.1136/bmjpo-2024-003236","url":null,"abstract":"<p><strong>Background: </strong>A key target of the 2030 Sustainable Development Goals is to eliminate preventable deaths in newborns and children under 5. This study aimed to estimate the effect of time of birth on early neonatal mortality (ENM) and low Apgar scores at 5 min (LA5) in newborns.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using vital statistics data on live births, maternal morbidity, congenital defects and perinatal mortality in Cauca-Colombia (2017-2021) excluding out-of-hospital, multiple and major defect cases. A directed acyclic graph was constructed to define the confounder adjustment set. Multivariable logistic, linear and propensity score models evaluated the effect of birth timing on neonatal outcomes, estimating crude and adjusted incidence rate ratios (IRRa).</p><p><strong>Results: </strong>We assessed 65 182 live births, finding similar baseline characteristics for daytime and night-time births. ENM was 0.2% (95% CI 0.19% to 0.26%) at 7 days of follow-up, absolute mortality difference 0.1% (95% CI -0.01% to 0.12%). Night-time births increased the incidence of ENM in the primary analysis IRRa 1.27 (95% CI 0.90 to 1.82), in the secondary IRRa 1.45 (95% CI 0.94 to 2.20), and in the primary and secondary sensitivity analysis, respectively, IRRa 1.48 (95% CI 1.06 to 2.07) and 1.70 (95% CI 1.16 to 2.59). LA5 was present in 0.7% (95% CI 0.60% to 0.72%) of birth, with absolute LA5 difference 0.1% (95% CI -0.02% to 0.22%). Night-time births increased the incidence of LA5 in the primary analysis IRRa 1.31 (95% CI 1.00 to 1.49), in the secondary IRRa 1.44 (95% CI 1.13 to 1.83), and in the primary and secondary sensitivity analysis, respectively, IRRa 1.31 (95% CI 1.08 to 1.59) and IRRa 1.54 (95% CI 1.23 to 1.92).</p><p><strong>Conclusions: </strong>Birth at night-time is associated with worse neonatal outcomes, ENM and low Apgar scores in Colombia's diverse population, highlighting the need for optimised prenatal care, revised work schedules and improved referral systems in maternal health.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572002","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":"Carbon emissions from road transport on a national neonatal transport service: a retrospective observational study.","authors":"Carmel Maria Moore, Daniel O'Reilly, Nurul Aminudin, Jyosthsna R Purna, Jan Franta, Hana Fucikova","doi":"10.1136/bmjpo-2025-003320","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003320","url":null,"abstract":"<p><p>We conducted a retrospective observational study of all transports conducted by our national neonatal transport service to estimate direct carbon emissions produced by the service in a 1 year time period. We investigated all parts of the journey for 501 transports-from 27 referring units to 15 receiving units. These transports covered a total of 110 305.4 km. As our vehicles report carbon emissions of 293-327 g/km, over the study period between 32.3 and 36.1 metric tonnes of carbon were directly produced by our neonatal transport service. Our carbon impact could be mitigated by the utilisation of alternative fuels, including hydrotreated vegetable oil.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572000","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}