BMJ Paediatrics Open最新文献

{"title":"<i>Correction for</i> 'Caregiver perspectives on the longlasting impact of the COVID-19 pandemic on children with cerebral palsy in Johannesburg, South Africa'.","authors":"","doi":"10.1136/bmjpo-2024-002617corr1","DOIUrl":"10.1136/bmjpo-2024-002617corr1","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101188","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":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/bmjpo-2025-003626","DOIUrl":"10.1136/bmjpo-2025-003626","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075893","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":"Predicting sepsis treatment decisions in the paediatric emergency department using machine learning: the AiSEPTRON study.","authors":"Sylvester Gomes, Harpreet Dhanoa, Phil Assheton, Ewan Carr, Damian Roland, Akash Deep","doi":"10.1136/bmjpo-2024-003273","DOIUrl":"10.1136/bmjpo-2024-003273","url":null,"abstract":"<p><strong>Background: </strong>Early identification of children at risk of sepsis in emergency departments (EDs) is crucial for timely treatment and improved outcomes. Existing risk scores and criteria for paediatric sepsis are not well-suited for early diagnosis in ED.</p><p><strong>Objective: </strong>To develop and evaluate machine learning models to predict clinical interventions and patient outcomes in children with suspected sepsis.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>ED of a tertiary care hospital, UK.</p><p><strong>Patients: </strong>Electronic health records of children <16 years of age attending between 1 January 2018 and 31 December 2019. Patients presenting with minor injuries were excluded.</p><p><strong>Methods: </strong>Prediction models were developed and validated, using 15 key predictors from triage and post-blood test data. XGBoost, the best-performing machine learning model, integrated these predictors with triage note information extracted via Natural Language Processing.</p><p><strong>Main outcomes: </strong>(1) Administration of antibiotics; (2) critical care: antibiotics with fluid resuscitation above 20 mL/kg or non-elective mechanical ventilation; (3) serious infection: hospital admission for antibiotics >48 hours.Model performance was evaluated using area under the receiver operating characteristic curve (AUC), likelihood ratios and positive and negative predictive values.</p><p><strong>Results: </strong>Triage model: predicted antibiotics at triage (n=35 795; 3.2% with outcome) with an AUC of 0.80 (95% CI 0.76 to 0.84).Antibiotic model: predicted antibiotics post-blood tests (n=4700; 24.2%) with an AUC of 0.78 (95% CI 0.73 to 0.81).Critical care model: predicted critical care (n=4700; 3.3%) with an AUC of 0.78 (95% CI 0.72 to 084).Serious infection model: predicted serious infection (n=4700; 9.4%) with an AUC of 0.76 (95% CI 0.71 to 0.81).Key predictors included triage category, temperature, capillary refill time and C reactive protein.</p><p><strong>Conclusion: </strong>Machine learning models demonstrated good accuracy in predicting antibiotic use following triage and moderate accuracy for critical care and serious infection. Further development and external validation are ongoing.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075903","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":"Automated oxygen control in preterm babies on respiratory support: protocol for a randomised crossover trial.","authors":"Hafiz Muhammad Aamir Yousuf, Ali Shabbir Hussain, Georg M Schmolzer, Zahra Hoodbhoy, Rabia Munir, Arjumand Rizvi, Uzma Khan","doi":"10.1136/bmjpo-2024-003210","DOIUrl":"10.1136/bmjpo-2024-003210","url":null,"abstract":"<p><strong>Introduction: </strong>Respiratory support is frequently needed for babies admitted to the neonatal intensive care unit. Among them, preterm babies are most likely to have issues of respiratory distress, and they may need invasive or non-invasive breathing support. Providing respiratory support, keeping the oxygen saturation (SpO2) in the target range (TR) and preventing abnormal high and low oxygen levels should be the aim of providing respiratory therapy. Usually, this control is achieved by manual adjustment of FiO2 (fraction of inspired oxygen) by bedside staff nurses to keep SpO2 in TR. However, the latest ventilators have automated oxygen control devices that adjust the FiO2 to keep SpO2 in TR. This study protocol is prepared to assess the effectiveness of automated versus manual oxygen control in keeping SpO2 in TR.</p><p><strong>Methods and analysis: </strong>This is a single-centre, non-blinded, randomised crossover trial that aims to recruit 26 preterm babies who may need invasive or non-invasive respiratory support. The 12-hour periods of automated oxygen control by ventilator will be compared with 12 hours of manual oxygen control by bedside staff nurse. The primary outcome will compare both interventions and will assess their efficacy to keep SpO2 in TR. Secondary outcomes will compare abnormal high and low SpO2 levels, and number and duration of fluctuations in both interventions. Median FiO2 values and median number of manual adjustments of FiO2 will also be compared. Secondary outcomes will also look for the impact of sedative and respiratory stimulant medications on target oxygen saturation.</p><p><strong>Ethics and dissemination: </strong>The ethics review committee at Aga Khan University Hospital Karachi has given ethical approval for this trial (approval number: 2024-10189-30775). Results from this trial will be published in journals.</p><p><strong>Trial registration number: </strong>NCT06622161.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075877","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":"Global analysis of tetanus incidence and mortality in children under 5 years: findings from the Global Burden of Disease Study 2021.","authors":"Li He, Cheng Liu, Xianli Nie, JiangShan He, Dachuan Deng, Wenlai Zhou, Xiangde Zheng","doi":"10.1136/bmjpo-2025-003326","DOIUrl":"10.1136/bmjpo-2025-003326","url":null,"abstract":"<p><strong>Background: </strong>Understanding trends in the incidence and mortality of tetanus in infants and young children is essential to develop prevention and intervention strategies.</p><p><strong>Methods: </strong>Data on tetanus incidence and mortality among children aged under 5 years from 1990 to 2021 were obtained from the Global Burden of Disease Study 2021. Estimated annual percentage changes were calculated to assess the trends in the change of children's tetanus incidence and mortality and the burden of disease. The relationship between disease burden and Sociodemographic Index (SDI) was also analysed.</p><p><strong>Results: </strong>Globally, the incidence of children's tetanus decreased from 308 931 cases in 1990 to 17 788 cases in 2021. Similarly, tetanus mortality among children has decreased significantly over the past 30 years, from 24.62 per 100 000 to 1.34 per 100 000, with little gender difference observed. The highest rates were seen in the Caribbean, Central Sub-Saharan Africa, Eastern Sub-Saharan Africa, North Africa and the Middle East, South Asia, Southeast Asia and Western Sub-Saharan Africa. The incidence and mortality of tetanus in children are significantly different in areas with different SDI levels. The incidence and mortality in areas with low SDI are higher than those in areas with high SDI.</p><p><strong>Conclusion: </strong>The incidence and mortality of tetanus in children have decreased to varying degrees worldwide, but they are still high in some regions, especially in countries with low SDI, which highlights the impact of socioeconomic factors on the outcome of the disease. More targeted supportive measures are imperative for mitigating the global burden posed by children's tetanus.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075900","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":"Less invasive surfactant administration for meconium aspiration syndrome.","authors":"Arun Prasath, Etze Chotzoglou, Asmahan Ahmad, Efren Diaz, Patti Burchfield, L Steven Brown, David B Nelson, Katherine Stumpf, Venkatakrishna Kakkilaya","doi":"10.1136/bmjpo-2025-003317","DOIUrl":"10.1136/bmjpo-2025-003317","url":null,"abstract":"<p><strong>Background: </strong>The role of less invasive surfactant administration (LISA) using a thin catheter in the management of meconium aspiration syndrome (MAS) is unclear.</p><p><strong>Study design: </strong>A retrospective study of infants with MAS admitted between January 2016 and December 2023. Relevant characteristics and outcomes were compared between a group of infants receiving surfactant in conjunction with mechanical ventilation (MV) via an endotracheal tube (ETT-surf) and receiving LISA. Infants intubated at birth were excluded.</p><p><strong>Results: </strong>Of the 113 infants admitted on continuous positive airway pressure (CPAP), 61 did not receive surfactant, 26 belonged to the ETT-surf group and 26 to the LISA group. Compared with the ETT-surf, a higher proportion of infants in the LISA group were exposed to chorioamnionitis and received a lower median fraction of inspired oxygen at birth and before surfactant therapy. Notably, infants in the LISA group had a lower need for MV (100 vs 23%, p<0.001), inhaled nitric oxide (iNO) (46% vs 12%, p=0.01) and a shorter median duration of hospital stay (14 vs 24 days, p=0.04). A subgroup analysis of infants with hypoxic respiratory failure on admission showed lower need for MV and duration of hospital stay with the LISA group compared with the ETT-surf group.</p><p><strong>Conclusions: </strong>LISA was associated with a lower need for MV, iNO and a shorter duration of hospital stay in a select group of infants with MAS. Further prospective studies are necessary to evaluate the role of LISA in MAS.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963919","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":"Meaningful youth engagement in children and youth major group of the United Nations Environment Programme (UNEP).","authors":"Teresia M Gitau","doi":"10.1136/bmjpo-2025-003503","DOIUrl":"https://doi.org/10.1136/bmjpo-2025-003503","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967549","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":"Smartphone-based screening of neonatal jaundice in three populations in low and middle-income countries: a cross-sectional study.","authors":"Anders Aune, Gabriela Jímenez-Díaz, Lobke Marijn Gierman, Gunnar Vartdal, Mónica Reyes Berlanga, Jorge Tusoy, Håkon Bergseng, Sunila Shakya, Elisabeth Darj","doi":"10.1136/bmjpo-2023-002242","DOIUrl":"https://doi.org/10.1136/bmjpo-2023-002242","url":null,"abstract":"<p><strong>Background: </strong>Neonatal hyperbilirubinemia (NHB) is a significant cause of morbidity and mortality, particularly in low and middle-income countries (LMICs). Transcutaneous bilirubinometers offer a non-invasive method for assessing NHB but have limited availability due to cost and maintenance requirements. Visual assessment of jaundice is shown to be inaccurate. Smartphone-based technologies have the potential to provide innovative and accessible healthcare solutions. This study aimed to evaluate the Picterus system, a smartphone-based tool for screening of NHB, in three non-Caucasian populations in LMICs.</p><p><strong>Methods: </strong>Between 2018 and 2022, cross-sectional studies were conducted in three countries: Mexico, Nepal and the Philippines. Newborns meeting the inclusion criteria were recruited, and data on demographic characteristics, skin type and visual assessment of jaundice were collected. Bilirubin levels were measured using both the Picterus system and total serum bilirubin (TSB) analysis. Correlation analyses, Bland-Altman plots and receiver operating characteristic (ROC) curves were used to evaluate the Picterus system.</p><p><strong>Results: </strong>A total of 416 infants were included in the analysis. The Picterus smartphone system demonstrated a significant positive correlation with TSB levels across all sites (r=0.76). The correlation coefficient was significantly higher in Mexico compared with Nepal and the Philippines. Bland-Altman plots showed limits of agreement ±89.2 µmol/L. Picterus values were underestimated in Mexico, whereas they were overestimated in Nepal and the Philippines. ROC analysis for detection of infants with TSB >225 µmol/L indicated that the Picterus system had higher sensitivity and specificity compared with visual assessment using the Kramer scale.</p><p><strong>Discussion: </strong>This study shows that the Picterus system can potentially be used in screening for neonatal jaundice in populations with moderate dark skin types. Further studies are needed before the system can be used in clinical practice.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982615","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":"Enhanced Recovery After Surgery (ERAS) consensus recommendations for non-pharmacological perioperative neonatal pain management.","authors":"Brandon Pentz, Kristin Short, Mercedes Pilkington, Tyara Marchand, Saffa Aziz, Jennifer Y Lam, Adam Spencer, Megan A Brockel, Scott Else, Duncan McLuckie, Andrew Franklin, David de Beer, Mehul V Raval, Michael Scott, Mary E Brindle","doi":"10.1136/bmjpo-2024-003280","DOIUrl":"10.1136/bmjpo-2024-003280","url":null,"abstract":"<p><p>Enhanced Recovery After Surgery (ERAS) recommendations for multi-modal, opioid-limiting analgesia have been shown to be effective in paediatric patients. However, neonatal-specific protocols are limited, and protocols that address non-pharmacological approaches are rare. Through systematic review and modified Delphi consensus with anaesthesiologists, paediatric surgeons and researchers, we developed non-pharmacological recommendations to improve perioperative neonatal pain management. Evidence from 37 articles of variable quality informed these recommendations. Our consensus resulted in four recommendations: (1) use of sweet-tasting solutions, (2) non-nutritive sucking, (3) skin-to-skin and (4) music therapy. These recommendations aim to reduce neonatal opioid usage alongside pharmacological therapies. PROSPERO registration number: CRD42021265273.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978856","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 cerebral oxygen saturation and neurological injury in asphyxiated neonates in a middle-income country: a retrospective cohort study.","authors":"Gloria Troncoso, Sergio Agudelo-Pérez, Daniel Botero-Rosas, Gisell Molina, Juan Botero","doi":"10.1136/bmjpo-2024-003081","DOIUrl":"https://doi.org/10.1136/bmjpo-2024-003081","url":null,"abstract":"<p><strong>Background: </strong>Neonatal outcomes following perinatal asphyxia vary significantly between low- and middle-income countries (LMICs) and high-income settings. Near-infrared spectroscopy is a non-invasive method for monitoring regional cerebral oxygen saturation (rScO₂), providing real-time insights into brain oxygenation. In LMICs, where healthcare resources are limited, early rScO₂ monitoring during therapeutic hypothermia (TH) may support neurological risk stratification. This study aimed to evaluate the association between early rScO₂ levels and brain MRI abnormalities in asphyxiated neonates during their first week of life.</p><p><strong>Methods: </strong>A retrospective longitudinal study was conducted on term neonates with moderate-to-severe perinatal asphyxia undergoing TH at a high-complexity healthcare institution in an LMIC. Continuous rScO₂ monitoring was performed for 72 hours during cooling and rewarming. Values were analysed at 6-hour intervals. The primary outcome was abnormal brain MRI findings during the first week, defined as radiological injury to the basal ganglia, thalami, cortical/watershed areas, white matter or vascular territories. Logistic regression was used to assess the association between rScO₂ and MRI abnormalities, and receiver operating characteristic analysis was used to evaluate predictive performance.</p><p><strong>Results: </strong>88 neonates were included, of which 29 had abnormal MRI findings. All patients were referred from lower-complexity centres. Elevated rScO₂ in the first 6 hours was significantly associated with abnormal MRI findings (adjusted OR, 1.10; 95% CI 1.02 to 1.18). The rScO₂ threshold showed limited sensitivity and moderate specificity.</p><p><strong>Conclusions: </strong>Higher rScO₂ values during the first 6 hours of TH were associated with abnormal brain MRI findings. Although not definitive, early rScO₂ monitoring may aid in identifying neonates at risk of neurological injury in LMICs.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966886","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}