BMJ Paediatrics Open最新文献

{"title":"Clinical characteristics and burden of COVID-19 in children and adolescents in Colombia: a retrospective database analysis.","authors":"Jair Arciniegas, Juan Manuel Reyes, Jhon Bolaños-López, Carlos Fernando Mendoza, Julia Spinardi, Jingyan Yang, Farzaneh Maleki, Farley Johanna Gonzalez, Carlos Bello, Ana Catalina Herrera, Omar Escobar, Andrea Constanza Rubio, Mónica García, Luz Eugenia Pérez, Jorge La Rotta, Moe Kyaw","doi":"10.1136/bmjpo-2024-003243","DOIUrl":"10.1136/bmjpo-2024-003243","url":null,"abstract":"<p><strong>Background: </strong>The burden of COVID-19 infections has been extensively studied in some parts of the world. However, in emerging economies and particularly in Latin America and Colombia, research is still incomplete, especially in the paediatric population. This study aims to investigate the burden of COVID-19 infections in children and adolescents in Colombia to understand the burden and outcomes of COVID-19.</p><p><strong>Methods: </strong>This is a retrospective database analysis of 0-17-year-old persons diagnosed with COVID-19 and given inpatient or outpatient care at a large health maintenance organisation covering 10% of the entire population from March 2020 to January 2023. Cases were confirmed by International Classification of Diseases 10th Revision codes for COVID-19 and a lab test. The incidence rates of COVID-19 cases per 100 000 persons were calculated. With a multivariate logistic regression model adjusted for demographical and clinical characteristics, the factors related to developing severe or critical COVID-19 during the study period were identified.</p><p><strong>Results: </strong>Of the 76 376 COVID-19 cases included in the analysis, the mean age was 9.8 years, about 51.5% were male, 99.6% lived in urban areas and 98.9% were unvaccinated (76.9% of the cases occurred before the vaccination of this group began on 31 October 2021). Most cases (69 528, 91%) were classified as mild, 0.9% as moderate, 8% as severe and 0.1% as critical. The most prominent comorbidities were mental health-related conditions (18.9%), chronic lung disease (13.6%) and immunocompromised condition (10.6%). 28 deaths were observed, of which 22 had at least 1 comorbidity, the most frequent being chronic lung disease and mental health conditions.</p><p><strong>Conclusion: </strong>Nearly 1 in 5 cases of COVID-19 was documented in children with underlying medical conditions. Our findings underscore the need to target children with comorbidities.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742246","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":"Implementing a national Dutch PEWS system in 12 hospitals with different contexts: opportunities, challenges and implications.","authors":"Jikke Stevens, Tessa de Jong, Michèl A Willemsen, Joris Fuijkschot, Janke de Groot","doi":"10.1136/bmjpo-2025-003378","DOIUrl":"10.1136/bmjpo-2025-003378","url":null,"abstract":"<p><strong>Background: </strong>Worldwide, there is a large heterogeneity of Paediatric Early Warning Score (PEWS) systems to detect deterioration in hospitalised children timely. In the Netherlands, the Dutch PEWS was created to enhance national standardisation, incorporating a core set of vital signs and watcher signs with local adaptation strategies. The primary objective of this study was to determine factors for successful implementation. The secondary objectives were to assess the use and perceived value of local adaptation.</p><p><strong>Methods: </strong>In a multicentre study, the Dutch PEWS was implemented in 12 hospitals with different contexts ranging from University Medical Centers to general hospitals. This mixed-methods evaluation study prospectively collected data following the Plan-Do-Study-Act cycle. In preparation for implementation, local adaptation was executed, implementation strategies were formulated and baseline measurements were conducted. Post-implementation measures were performed 3, 6 and 9 months after implementation. In total, 1127 questionnaires and 171 interviews were completed with healthcare providers and 11 interviews and 3 member checks with project leaders. The protocol adherence percentage (PAP) was calculated for each hospital as an indicator for implementation.</p><p><strong>Results: </strong>The majority of the participants assessed the implementation and use of the Dutch PEWS positively. Important facilitators include reduced workload, increased confidence in achieving the objective and benefits related to utilisation on a national scale. Nationwide use facilitated further integration into training programmes and optimisation of electronic health record systems. At the same time, local adaptation was used in most hospitals and to varying extents. The overall PAP was 81% (±25%), ranging from 47% to 140%.</p><p><strong>Conclusion: </strong>This study demonstrates that successful implementation of PEWS systems is related to their design, adaptability to local contexts and nationwide utilisation. Moreover, nationwide use provides opportunities to evaluate the system across diverse contexts, thereby supporting broader implementation.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728379","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":"Health outcomes up to 5 years in children born as a second child after a previous caesarean section in a first pregnancy: a Swedish population-based register study between 1999 and 2015.","authors":"Anna Dencker, Huiqi Li, Ida Lyckestam Thelin, Valerie Smith, Christina Nilsson, Ingela Lundgren, Lars Ladfors, Anders Elfvin","doi":"10.1136/bmjpo-2024-003026","DOIUrl":"10.1136/bmjpo-2024-003026","url":null,"abstract":"<p><strong>Objective: </strong>To explore health outcomes up to 5 years of age, according to mode of birth, in a large cohort of Swedish children who were born as a second child to women who had a caesarean section (CS) in their first pregnancy.</p><p><strong>Design: </strong>Retrospective population-based register study.</p><p><strong>Population: </strong>All children (n=94 498) who were born as a second child (or children in cases of twins or higher-order multiple births) during 1999-2015 in Sweden in women who had a CS first birth. The children were followed up to 5 years of age. For inclusion, both births must have occurred in Sweden.</p><p><strong>Methods: </strong>A nationwide cohort study using follow-up data up to 5 years of age. Maternal factors, including age, smoking, diabetes, obesity (body mass index ≥30), mental illness, pre-eclampsia, education, income, country of birth and the neonatal factors of being a singleton and prematurity (up to week 36+6) were adjusted for in regression models.</p><p><strong>Main outcome measures: </strong>Developmental problems, asthma, allergy, hospital care and death within 5 years of age.</p><p><strong>Results: </strong>A total of 94 498 children were included in the study. Risk for developmental problems, asthma and allergy was increased after repeat CS but not after vaginal birth. The need for hospital care was increased in all other birth modes compared with spontaneous vaginal birth. The risk of death within 5 years increased after instrumental vaginal birth and emergency repeat CS.</p><p><strong>Conclusions: </strong>All repeat CS compared with spontaneous vaginal birth was related to increased risks for developmental problems, asthma, allergy and hospital stay, and emergency repeat CS was associated with an increased risk of death within 5 years. The results of the present study support vaginal birth as the optimal mode of birth after previous CS for longer-term child health outcomes.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708401","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":"Assessment of dietary, genetic and metabolic factors in South Indian adolescents with metabolic dysfunction-associated steatotic liver disease: a case-control study protocol.","authors":"Swathilakshmi Venu, Rajesh Gopalakrishna, Bhanu Vikraman Pillai, Lalitha Biswas, Rashmi Poojara, Manu Raj","doi":"10.1136/bmjpo-2024-003138","DOIUrl":"10.1136/bmjpo-2024-003138","url":null,"abstract":"<p><strong>Introduction: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of liver disease among adolescents. The objectives of this study are to investigate the associations of dietary, genetic and metabolic factors with MASLD in South Indian adolescents.</p><p><strong>Methods and analysis: </strong>The study will employ a case-control study design. We will recruit 280 adolescents (140 cases and 140 controls) from hospital and school settings. The hospital setting will be the paediatric gastroenterology outpatient department (OPD) at the study institution and the school setting will be selected urban schools from Ernakulam, Kerala. At the hospital, cases and controls will be selected from the patients who are attending the paediatric gastroenterology OPD with complaints of generalised abdominal pain or constipation with no other significant medical complaints or use of medications. A sensitisation programme on MASLD for parents of adolescents will be conducted in schools. All consenting parents along with their adolescent wards will be invited for study participation. Cases will be defined as adolescents having evidence of hepatic steatosis in ultrasound and meeting any one of the paediatric cardiometabolic criteria for MASLD. Those who fail to satisfy this criteria will be defined as controls. All participants will undergo nutritional and physical activity assessments using validated questionnaires along with blood sampling for biochemical analysis and genetic testing. We will examine the associations between MASLD and dietary parameters using Pearson's χ² tests after stratifying dietary variables into categorical groups. Logistic regression will be used to assess the impact of dietary parameters and single-nucleotide polymorphisms (SNPs) on the risk of MASLD.</p><p><strong>Ethics and dissemination: </strong>Ethics approval was obtained from the Ethics Committee of Amrita School of Medicine, Kochi. Informed consent will be obtained from participants and their legal guardians before enrolment. The study findings will provide valuable insights into the evolution of MASLD among adolescents in South India.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699599","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 and associated factors of admission hypothermia among neonates admitted to the premature baby unit of a secondary care hospital in Sri Lanka: a cross-sectional analytical study.","authors":"Savindi Kasturiarachchi, Inosha Alwis, Sanath Kumara, Buwanaka Rajapaksha","doi":"10.1136/bmjpo-2024-003233","DOIUrl":"10.1136/bmjpo-2024-003233","url":null,"abstract":"<p><strong>Background: </strong>Hypothermia is defined as core body temperature being below 36.5°C. This study aimed to identify the prevalence, associated factors and outcomes of hypothermia among neonates admitted to the premature baby unit (PBU) of a secondary care hospital in Nawalapitiya, Sri Lanka.</p><p><strong>Methods: </strong>In a cross-sectional analytical study, medical records of neonates admitted to the PBU were selected retrospectively from 31 March 2022 to 1 April 2021 using consecutive sampling. The recorded axillary temperatures on admission, sociodemographic and clinical data were extracted. Following bivariate analysis, multivariable logistic regression was performed.</p><p><strong>Results: </strong>Among 407 neonates, the median admission age was 1 day. The majority were male (52.6%), were term (59%) and had a normal birth weight (52.5%). The number of babies with hypothermia was 157 with a prevalence of 38.6% (95% CI: 33.9 to 43.4). Maternal factors like teenage pregnancy, multiple pregnancy, hypertension during pregnancy, premature rupture of membranes and lower-segment caesarean sections; neonatal factors like age on admission being less than 24 hours, prematurity, corrected gestational age on admission being less than 37 weeks, low birth weight, weight on admission being less than 2.5 kg and having been resuscitated at birth had statistically significant associations with hypothermia on the bivariate analysis. Hypothermia showed no significant association with the month of admission. Following multivariable analysis, age on admission being less than 24 hours (adjusted OR (aOR): 3.3, 95% CI: 1.9 to 5.8), teenage pregnancy (aOR: 8.2, 95% CI: 1.8 to 37.2), multiple pregnancy (aOR: 2.8, 95% CI: 1.1 to 7.1) and hypertension in pregnancy (aOR: 2.3, 95% CI: 1.2 to 4.7) remained statistically significant. Neonates with hypothermia had 5.2 times (95% CI: 1.8 to 14.6) odds of mortality and 4.9 times (95% CI: 2.8 to 8.5) odds of receiving ventilatory support compared with normothermic neonates. Hypothermia also showed statistically significant associations with infant respiratory distress syndrome, metabolic acidosis and neonatal jaundice.</p><p><strong>Conclusions: </strong>Nearly two out of five neonates admitted to the PBU were hypothermic. There were significant maternal and neonatal associations to be addressed. Hypothermia on admission may indicate serious neonatal morbidity and mortality.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691054","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":"Mortality in children and adolescents in Western Democratic Republic of Congo: retrospective analysis of verbal autopsy and demographic data from the Kimpese Health and Demographic Surveillance System.","authors":"Joël Kiniati Fumwakwau, Mattias Schedwin, Mireille Amba Ngale, Helena Hildenwall, Tobias Alfven, Mala Ali Mapatano, Carina King, Delphin Mavinga Phanzu","doi":"10.1136/bmjpo-2024-003224","DOIUrl":"10.1136/bmjpo-2024-003224","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of data on causes of death in children and adolescents that can be used for public health prioritisation in settings with the highest mortality burden. We aimed to estimate the causes and circumstances around deaths for the age group 1 month to 19 years in the Western Democratic Republic of Congo.</p><p><strong>Methods: </strong>Analysis of verbal autopsy and demographic data from the Kimpese Health and Demographic Surveillance System (rural setting 200 km west of Kinshasa) was collected between September 2018 and September 2021. About 66 000 individuals were surveyed yearly using structured questionnaires. Vital events were registered and identified deaths followed up with the World Health Organization 2012 or 2016 verbal autopsy questionnaire. Verbal autopsies were analysed using the InterVA-5 algorithm to generate cause of death and circumstances of mortality categories at the population level. Individual and household characteristics relevant to child survival were compared between deceased and surviving individuals using Fisher's exact test.</p><p><strong>Results: </strong>Overall, 166/273 (61%) of identified deaths had a complete verbal autopsy. 74% of deaths occurred in children 1-59 months of age, and 70% of all deaths were classified as due to infectious diseases. The top three causes were malaria (35%), lower respiratory infection (12%) and diarrhoeal disease (9%). 78% of deaths occurred at home, and <5% were considered inevitable. However, 70% of individuals sought healthcare in the days preceding death. Recognition (39%), emergencies (27%) and accessing care (20%) were the main contributing categories to fatal outcomes. Characteristics had low coverage (32-72% for the first dose of vaccinations and <10% for water, sanitation and hygiene).</p><p><strong>Conclusions: </strong>Results suggest a need to sensitise caregivers about care-seeking, home treatment and danger signs and improve access to health facilities, combined with improving the quality of care in facilities. Improvements in access to safe water, sanitation and vaccination coverage are also needed.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691050","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":"Funding the future: climate finance for youth.","authors":"Thomas Hardson Okinda","doi":"10.1136/bmjpo-2024-003164","DOIUrl":"10.1136/bmjpo-2024-003164","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691048","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":"Status epilepticus in the neonate.","authors":"Lakshmi Nagarajan, Soumya Ghosh","doi":"10.1136/bmjpo-2024-003202","DOIUrl":"10.1136/bmjpo-2024-003202","url":null,"abstract":"<p><p>Status epilepticus in the neonate (NSE) is a medical emergency that often results in dire consequences. Minimising injury from NSE is essential. The diagnosis of NSE can be challenging as neonates frequently have electrographic only seizures and an EEG is essential for recognition of seizures and seizure burden. The lack of a universally accepted definition of NSE, possible adverse effects from commonly used antiseizure medications, debate regarding the best treatment packages for NSE, limited access to EEG and investigations for aetiology of NSE add to the clinical conundrum. In this review, we aim to present what is known, highlight the importance of EEG monitoring for diagnosis and treatment, discuss what is not known and suggest a practical paradigm for the management of NSE.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690526","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":"Exploring the current usage of and attitudes towards transanastomotic tube (TAT) feeding in infants born with duodenal atresia: a survey of practice in the UK.","authors":"Alexandra Jager, Joanne Turnbull, Mark John Johnson, Nigel J Hall","doi":"10.1136/bmjpo-2024-003267","DOIUrl":"10.1136/bmjpo-2024-003267","url":null,"abstract":"<p><strong>Background: </strong>Despite evidence demonstrating clinical and cost benefits of transanastomotic tubes (TATs), following repair of congenital duodenal obstruction they are used in a minority of infants in the UK. Most infants are fed using parenteral nutrition (PN) (sometimes in combination with a TAT). This variation is unexplained by clinical or demographic factors. We aimed to understand why this is and the barriers to practice change.</p><p><strong>Methods: </strong>UK-based clinicians (surgeons, neonatologists, dietitians and specialist nurses) completed an online mixed methods survey. Open-ended replies were summarised thematically. Data were analysed using descriptive and inferential statistics.</p><p><strong>Results: </strong>109 clinicians (24 neonatologists, 7 nurses, 3 dietitians, 75 surgeons) from all 25 UK neonatal surgical units completed the survey. 88% (n=96/109) stated TAT use was decided solely by surgeons, driven primarily by considerations of providing appropriate nutrition and risks; 36% of surgeons felt TATs should always be used where possible. Decisions about central venous catheters (CVCs) were made by neonatologists (28%, n=31/109), surgeons (17%, n=18/109), jointly (48%, n=52/109) or 'other' (7%, n=8/109). Neonatologists and surgeons prioritised providing appropriate nutrition and risks when deciding whether to use CVCs/PN; surgeons rated a lack of supporting research and TATs' risks as key barriers to TAT usage. Costs and parents' preferences had limited influence on TAT and PN usage.</p><p><strong>Conclusions: </strong>Increased TAT usage requires surgeons to be persuaded of TATs' efficacy and safety, and neonatologist recognition that exclusive TAT feeding (ie, without CVCs/PN) can provide adequate nutrition. Further work is required to appreciate how best to achieve this.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655940","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":"Feasibility and acceptability of the Alarm Distress Baby Scale (ADBB) in universal health visiting practice in England: a mixed-methods study using Normalisation Process Theory.","authors":"Sharin Baldwin, Michael Fanner, Hilda Beauchamp, Vicky Gilroy, Alison Morton, Carl May, Jane Barlow","doi":"10.1136/bmjpo-2024-002997","DOIUrl":"10.1136/bmjpo-2024-002997","url":null,"abstract":"<p><strong>Background: </strong>The Alarm Distress Baby Scale (ADBB) is a validated observation tool, designed for use by healthcare practitioners to identify infant social withdrawal. A modified version (m-ADBB) was later developed as a clinically useful behavioural tool. However, neither version has been tested in the UK context. This study aimed to test the feasibility and acceptability of using the ADBB and m-ADBB within universal health visiting practice in England.</p><p><strong>Methods: </strong>A mixed methods convergent parallel design was used. Five health visitors were trained in the ADBB and 20 in the m-ADBB, from two National Health Service (NHS) community sites in England. Quantitative data were collected from health visitors, while qualitative semistructured interviews were conducted with health visitors and service managers, guided by Normalisation Process Theory (NPT). Thematic analysis was used to analyse the qualitative data and descriptive analysis for the quantitative data. NPT provided a framework for analysing the implementation process in routine health visitor practice.</p><p><strong>Results: </strong>The m-ADBB was used with 225 babies and behaviour concerns were identified in 23 babies (10%). Eleven themes were identified, aligned with the four NPT constructs: (1) Coherence: perceived uniqueness of the scale, new vocabulary for articulating baby behaviour, enrichment of existing knowledge and skills; (2) Cognitive participation: commitment to the use of the ADBB/m-ADBB, consolidation of new practice; (3) Collective action: implementation of the m-ADBB scale in routine practice, organisation and management support, existing systems and pathways for children and families and (4) Reflexive monitoring: perceived benefits of integrating the scales in practice, quality assurance for embedding the scales in practice, appraisal of the training and scales in practice.</p><p><strong>Conclusions: </strong>The ADBB/m-ADBB was perceived to have enhanced the health visitors' skills and knowledge in infant observation. The m-ADBB required minimal additional time and was highly acceptable to health visitors. These findings have significant implications for health visiting practice and future research.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655977","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}