BMJ Paediatrics Open最新文献

{"title":"Prenatal urinary BTEX metabolite levels and length of gestation: preliminary results from a metropolitan Detroit birth cohort.","authors":"Homègnon A Ferréol Bah, Qiong Zhang, Yichu Wang, Emily Leydet, Mei Lu, Judy Westrick, Paul Stemmer, Christine Cole Johnson, Jennifer K Straughen, Andrea E Cassidy-Bushrow","doi":"10.1136/bmjpo-2026-004506","DOIUrl":"10.1136/bmjpo-2026-004506","url":null,"abstract":"<p><p>While the common volatile organic compound mixture benzene, toluene, ethylbenzene and xylene (BTEX) is associated with preterm birth (PTB), most evidence derives from estimated rather than direct measures of exposure. Metabolites of BTEX were measured in urine samples from pregnant participants (N=40) to conduct a preliminary association study of BTEX metabolites and length of gestation. Metabolites of ethylbenzene (phenylglyoxylic acid (PGA)) and xylene (methylhippuric acid (MHA)) were negatively correlated with gestational length; the Spearman correlation coefficient (ρ) for PGA and gestational length was ρ=-0.37 (p=0.018) and for MHA and gestational length was ρ=-0.35 (p=0.026). Preliminary findings suggest prenatal ethylbenzene and xylene exposure may be associated with shorter gestational length. Ongoing work in a larger sample is underway to examine associations between BTEX metabolites, measured longitudinally across pregnancy, and PTB.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007892","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":"Distribution, socioeconomic inequalities and contributing factors of anaemia prevalence across wealth index among Indian adolescent girls: multivariate decomposition analysis of nationally representative survey.","authors":"Pritam Halder, Kathirvel Srinath, Anamika Das, Sushanta Sarkar, Indra Shekhar Prasad, Ravneet Kaur, Shivani Rathor, Esha Das, Anshul Mamgai, Manish Chandra Prabhakar, Chandramohan Kumar, Arnab Ghorui","doi":"10.1136/bmjpo-2026-004903","DOIUrl":"10.1136/bmjpo-2026-004903","url":null,"abstract":"<p><strong>Background: </strong>Anaemia among adolescent girls aged 15-19 years can adversely affect educational, vocational and reproductive outcomes. Amid rapid urbanisation, understanding its prevalence, determinants and urban-rural inequities is essential. Using National Family Health Survey (NFHS)-5 data in India, this study comprehensively assessed anaemia epidemiology and quantified urban-rural disparities and their contributing factors through multivariate decomposition analysis.</p><p><strong>Methodology: </strong>NFHS-5 data from 113 606 adolescent girls aged 15-19 years were analysed. Socio-demographic, health, and behavioural factors were assessed through standardised interviews. Haemoglobin was measured using HemoCue Hb 201+, with anaemia defined as <12 g/dL. Decomposition and concentration indices assessed disparities inequities.</p><p><strong>Results: </strong>Anaemia was more prevalent among adolescent girls from rural areas (60.2%, 95% CI 59.9 to 60.5%) compared with those from urban areas (56.6%, 95% CI 56.0 to 57.3%). Multivariate decomposition analysis showed that the largest variable-level contribution to the explained urban-rural disparity in anaemia prevalence was from wealth index (52.4%; richest: -1.497, 95% CI-1.501 to -1.493), followed by region (21.7%; East: -0.750, 95% CI-0.753 to -0.748), caste (17.3%; schedule tribe: -0.406, 95% CI -0.408 to -0.403), accessibility of healthcare centre (12.6%; not accessible: -0.319, 95% CI -0.323 to -0.315) and fruit intake (8.2%; daily: -0.834, 95% CI -0.839 to -0.829). In contrast, media exposure showed a negative contribution (-13.1%; 0.452, 95% CI 0.450 to 0.455), indicating that differences in media exposure reduced the observed urban-rural disparity. The concentration indices were comparable between urban (-0.075, 95% CI -0.089 to -0.061) and rural (-0.071, 95% CI -0.078 to -0.064) populations, indicating modest wealth-related inequality in both settings.</p><p><strong>Conclusion: </strong>Anaemia burden was high among Indian adolescent girls, with urban-rural disparities driven by socioeconomic status, dietary patterns and media exposure, requiring comprehensive, multifaceted nationwide interventions.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007966","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":"Temporal changes in bronchopulmonary dysplasia severity distribution associated with evolving respiratory practices in very preterm infants.","authors":"Kamal Ali, Talal Aljarbou, Saleh Algarni, Mohanned Alrahili, Musab Alshareef, Saad Alshreedah, Moudhi Alhumaidi, Maather Almutairi, Nouf Alayyar, Abdulaziz Homedi, Ibrahim Ali, Saif Alsaif","doi":"10.1136/bmjpo-2026-005037","DOIUrl":"10.1136/bmjpo-2026-005037","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate temporal changes in respiratory management practices and bronchopulmonary dysplasia (BPD) severity in infants born before 32 weeks of gestation over a 9-year period.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Tertiary neonatal intensive care unit.</p><p><strong>Patients: </strong>Infants born before 32 weeks of gestation and admitted between January 2017 and December 2025.</p><p><strong>Exposure: </strong>Birth during one of three predefined clinical eras: pre-COVID (2017-2019), COVID (2020-2022) and post-COVID following relocation to an expanded neonatal intensive care unit (2023-2025).</p><p><strong>Main outcome measures: </strong>BPD severity at 36 weeks of postmenstrual age (PMA), mortality before hospital discharge, and the composite outcome of death before hospital discharge or BPD at 36 weeks of PMA. Associations between study era and respiratory outcomes were evaluated using multivariate logistic regression.</p><p><strong>Results: </strong>A total of 1259 infants were included. Respiratory management practices changed across study eras. High-flow nasal cannula exposure increased from 43.7% in era 1 to 70.6% in era 3 (p<0.001), while duration of non-invasive respiratory support increased from 4 to 11 days (p<0.001). Less invasive surfactant administration was introduced predominantly during era 3, and postnatal corticosteroid exposure increased from 16.5% to 36.4% (p<0.001). BPD incidence increased across eras (25.2%, 30.9% and 37.7%; p<0.001), primarily driven by grade 2 disease, whereas grade 3 BPD and mortality remained stable. Compared with era 1, infants in era 3 had higher adjusted odds of moderate-to-severe BPD (adjusted OR 3.29, 95% CI 2.15 to 5.05; p<0.001) and the composite outcome of death before hospital discharge or BPD at 36 weeks of PMA (adjusted OR 2.08, 95% CI 1.47 to 2.94; p<0.001).</p><p><strong>Conclusions: </strong>Respiratory management practices evolved over time and were accompanied by increased moderate BPD without corresponding increases in severe BPD or mortality. These findings suggest that evolving respiratory support practices and contemporary BPD definitions may influence the observed distribution of BPD severity.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical profile of gastro-oesophageal reflux disease and associated comorbidities in children aged 1-60 months: a prospective observational study.","authors":"Sandesh Kini, Sainath Ghali, Juanitha George, Praveen C Samuel, Ramesh Bhat, Shrikiran A Hebbar, Suneel Mundkur","doi":"10.1136/bmjpo-2026-005134","DOIUrl":"10.1136/bmjpo-2026-005134","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Gastro-oesophageal reflux disease (GERD) in young children causes troublesome symptoms and complications affecting growth, feeding and quality of life, but symptom-based diagnosis correlates poorly with objective reflux severity. Contemporary clinical-profile data from South Indian children under 5 years and the accompanying nutritional and comorbidity burden are sparse.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Prospective observational study at a tertiary-care paediatric centre in South India (June 2023 to March 2025). Children aged 1-60 months with clinically suspected GERD were enrolled consecutively. Clinical profile, radionuclide gastro-oesophageal reflux (GER) scintigraphy grade, Indian Academy of Paediatrics weight-for-age nutritional status and confirmed comorbidities were documented; physiological reflux was distinguished from pathological GERD by predefined operational criteria (troublesome symptoms beyond 8 weeks plus at least one ESPGHAN and NASPGHAN red flag plus a scintigraphy grade of mild or above). Univariable logistic regression identified predictors of severe reflux and of no clinical improvement at follow-up. A prespecified sensitivity analysis was restricted to the 128 children with a positive scintigraphy result.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 158 children, 40.5% (95% CI 33.2% to 48.3%) were aged 1-6 months and 62.0% (95% CI 54.3% to 69.2%) were male. Extraoesophageal respiratory symptoms predominated (cough 76.6%, 95% CI 69.4% to 82.5%; wheezing 67.1%), exceeding vomiting (48.7%). GER scintigraphy showed severe reflux in 35.4% (95% CI 28.4% to 43.2%), mild 29.7%, moderate 15.8% and normal 19.0%. Severe reflux clustered in younger infants (median age 4 vs 12 months in mild reflux; Kruskal-Wallis p&lt;0.05). Protein-energy malnutrition was present in 39.9% (95% CI 32.6% to 47.7%) and any comorbidity in 81.0% (95% CI 74.2% to 86.4%), predominantly respiratory (recurrent wheezing 45.3%, bronchiolitis 18.8%, recurrent pneumonia 10.9%, asthma 6.3%). Symptom severity did not correspond to scintigraphic grade (χ&lt;sup&gt;2&lt;/sup&gt; p=0.40). Among 78 children with follow-up, severe reflux independently predicted no clinical improvement compared with mild reflux (OR 4.00, 95% CI 1.01 to 15.77, Fisher exact p=0.047). Every principal finding was reproduced in the confirmed-GERD sensitivity analysis (n=128).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this tertiary-referral cohort of South Indian children under 5 years, GERD predominantly affected young infants with a respiratory-dominant symptom profile and a high burden of protein-energy malnutrition and respiratory comorbidity. Objective scintigraphy severity was independently prognostic of treatment non-response despite the absence of a symptom-severity correlation. The findings support structured nutritional and comorbidity screening, targeted objective diagnostic evaluation using the ESPGHAN and NASPGHAN red-flag criteria, and caution against reflexive empirical acid su","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987915","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":"Drawing and visual art interventions for anxiety in children aged 5-12: a systematic review and meta-analysis of randomised controlled trials.","authors":"Yu Jia, Shaojie Zhang, Diying Liao","doi":"10.1136/bmjpo-2026-004752","DOIUrl":"10.1136/bmjpo-2026-004752","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effects of drawing- and visual art-based interventions on anxiety in children aged 5-12 years and to examine variation across comparator structures and settings.</p><p><strong>Methods: </strong>PubMed, Web of Science, Cochrane Library, ERIC, DOAJ and China National Knowledge Infrastructure were searched for randomised controlled trials (RCTs). Postintervention anxiety was the primary outcome and was pooled as standardised mean differences. Trials using non-art or usual-care comparators and those using active art comparators were synthesised separately. Risk of bias was assessed using RoB 2.</p><p><strong>Results: </strong>10 RCTs involving 816 children were included. The primary meta-analysis included eight trials with non-art or usual-care comparators conducted in medical or procedure-related contexts. Drawing- and visual art-based interventions were associated with lower short-term anxiety compared with these controls (SMD=-2.70, 95% CI -3.73 to -1.68; I²=96%). Leave-one-out sensitivity analyses and exclusion of studies at high risk of bias did not materially change the direction of the effect although heterogeneity remained substantial. Two school-based trials used active art-based comparators and were synthesised separately.</p><p><strong>Conclusion: </strong>Drawing- and visual art-based interventions may reduce short-term anxiety mainly in acute medical or procedure-related contexts. Because heterogeneity was substantial and school-based evidence used different comparator structures, the current evidence does not support a single generalisable effect across paediatric settings.</p><p><strong>Prospero registration number: </strong>CRD420261288781.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148981928","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":"Communication, everyday life and technology from the perspectives of children with life-limiting or life-threatening conditions: a qualitative study.","authors":"Linda Johanne Martinsen, Heidi Holmen, Simen Alexander Steindal, Anette Winger","doi":"10.1136/bmjpo-2026-004998","DOIUrl":"10.1136/bmjpo-2026-004998","url":null,"abstract":"<p><strong>Background: </strong>Children with life-limiting or life-threatening conditions who are eligible for paediatric palliative care often have complex care needs. However, they prefer to live as normally as possible, which necessitates coordinated and multidisciplinary support that allows them to be at home rather than in a hospital. Advancements in technology have the potential to support home-based care, yet little is known about children's own communication needs, their views on home-based care and the possibilities of technology to support communication. Previous research has primarily focused on the views of parents and healthcare professionals. Consequently, this study aimed to explore what children with life-limiting or life-threatening conditions find important in communication with healthcare professionals and others and the role of technology in daily life.</p><p><strong>Methods: </strong>This qualitative study employed an exploratory design and used individual semi-structured interviews with children eligible for paediatric palliative care. Seven children aged 8-15 years with life-threatening or life-limiting conditions participated. The data were analysed using reflexive thematic analysis.</p><p><strong>Results: </strong>Three themes were developed: (1) understanding technology through daily life rather than in the frame of healthcare, (2) technology has the potential to be a digital bridge to normalcy and social belonging and (3) seeking information and safety through in-person meetings.</p><p><strong>Conclusion: </strong>Children with life-limiting or life-threatening conditions place a high value on in-person communication with healthcare professionals, emphasising the need for safety, predictability and clear information, particularly when medical procedures are involved. The findings highlight gaps in children's involvement in decision-making and underscore the importance of including children's perspectives when developing communication strategies and technologies to support home-based paediatric palliative care. These children primarily associated technology with gaming and everyday social interactions. They had little experience with technology in their healthcare follow-up and were unfamiliar with possibilities for use in the context of communication with healthcare professionals.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975616","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":"Impact of real-time respiratory function monitoring on neonatal mask ventilation training: a multicentre simulation-based crossover study.","authors":"Latifah Alrashed, Eliane Bodanese","doi":"10.1136/bmjpo-2026-004894","DOIUrl":"10.1136/bmjpo-2026-004894","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether visibility of respiratory function monitor (RFM) feedback improves mask ventilation performance and influences subsequent ventilation performance during neonatal resuscitation training.</p><p><strong>Design: </strong>multicentre randomised crossover simulation study.</p><p><strong>Participants: </strong>Healthcare professionals involved in neonatal resuscitation training across participating centres.</p><p><strong>Intervention: </strong>Participants performed positive pressure ventilation (PPV) on both term and premature manikins under two conditions: with visible RFM feedback and with the display masked. The order of feedback visibility was randomised. Each participant completed ventilation assessments in both conditions.</p><p><strong>Main outcome measures: </strong>Primary outcomes were expired tidal volume (Vte) and mask leak (%). The proportion of breaths within the target Vte range (4-8 mL/kg) was calculated as a performance indicator. Secondary outcomes included variability in Vte and mask leak to assess ventilation stability between conditions.</p><p><strong>Results: </strong>Visible RFM feedback was associated with lower mask leak and improved ventilation stability in the preterm manikin and with tidal volumes entering the target range in the term manikin. Participants initially ventilated with visible feedback maintained performance after feedback removal, suggesting a carry-over learning effect.</p><p><strong>Conclusion: </strong>In this multicentre crossover simulation study, visible RFM feedback was associated with changes in mask ventilation performance and evidence of a carry-over learning effect following feedback removal. Real-time visibility of respiratory parameters may strengthen neonatal resuscitation training.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975559","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":"Social programme receipt and child health, healthcare access and utilisation among low-income US households: a cross-sectional analysis of the National Survey for Child Health.","authors":"Sonia Taneja, Ji He, Lucy Marcil, Lawrence Chang, Edie Weller, Lois Lee","doi":"10.1136/bmjpo-2025-003890","DOIUrl":"10.1136/bmjpo-2025-003890","url":null,"abstract":"<p><strong>Background: </strong>Poverty is associated with poor health and increased healthcare utilisation. Social programmes may mitigate these effects by enhancing the ability to purchase direct inputs into health, improving access. We aimed to examine associations between receipt of cash assistance, Supplemental Nutrition Assistance Program, Special Supplemental Nutrition Program for Women, Infants and Children, and free/reduced cost school meals with child health measures among children from low-income US households.</p><p><strong>Methods: </strong>We conducted a retrospective, cross-sectional analysis of data from the 2019 National Survey for Child Health. Households with incomes <185% of the federal poverty level were included. Multivariable logistic regressions assessed associations, reporting OR with 95% CIs for the following outcomes: parent-reported child health; health access as defined by unmet healthcare need, inability to pay medical bills and experiencing frustrating access to care; and healthcare utilisation defined by the number of preventative healthcare visits and number of emergency visits in the past year.</p><p><strong>Results: </strong>The sample included 7279 children aged 0-17, representing 27 million children nationally. Among low-income households, 24.6% received none of the four programmes. Programme receipt was not associated with child health. Programme receipt was associated with frustrating healthcare access (OR 1.72, 95% CI 1.23 to 2.41) and increased emergency department utilisation (OR 1.63, 95% CI 1.16 to 2.29), with no association with preventative care.</p><p><strong>Conclusion: </strong>Social programme receipt was associated with frustrating healthcare access and greater emergency care utilisation. Policy efforts to facilitate access for low-income families may improve child health outcomes.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918504","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":"Shared principles, local practice: an international survey of child death review systems.","authors":"Merve Tosyali, Jeanine Young, Joanna Jane Garstang","doi":"10.1136/bmjpo-2026-005019","DOIUrl":"10.1136/bmjpo-2026-005019","url":null,"abstract":"<p><strong>Objective: </strong>Child death review (CDR) is the multiprofessional review of child deaths aiming to identify causes, risk factors and learning, with the aim of improving services and preventing future deaths.The objective of this study was to determine the range of current CDR practice internationally.</p><p><strong>Design: </strong>This study used a descriptive comparative survey design to determine similarities and differences between CDR practices in different countries. A secure online questionnaire was developed by the CDR working group of the International Society for the Study and Prevention of Perinatal and Infant Death and distributed via international professional networks.</p><p><strong>Setting: </strong>Professionals working in CDR in any country globally, contacted via email.</p><p><strong>Participants: </strong>27 professionals from 19 different countries participated in the study. To ensure data consistency, duplicate responses from the same region within countries were combined. A total of 20 responses from regions within 13 different countries were included.</p><p><strong>Outcomes: </strong>Key measures included legal status of CDR systems, family involvement in CDR, legal protection for professionals, multidisciplinary team structure and CDR inclusion criteria.</p><p><strong>Results: </strong>CDR was identified in 13 countries; 5 describing national CDR programmes and 8 with regional programmes. The aim of all CDR programmes was to prevent future deaths. Laws mandating CDR existed in 15 regions or countries; areas without legislative support reported challenges in conducting CDR. Parental involvement in CDR varied considerably between regions: six required parental consent for reviews, while nine did not inform parents about reviews. In 10 regions, all child deaths regardless of cause were included in CDR, while other programmes reviewed only selected deaths. In seven regions, professionals were provided with legal protection from malpractice claims to enable participation in the CDR.</p><p><strong>Conclusions: </strong>Common principles underpin effective CDR, providing a foundation for locally adapted approaches to improve systems and prevent future deaths.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918474","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":"Triggering modalities to synchronise non-invasive respiratory support in preterm infants: a systematic review and meta-analysis.","authors":"Fabio A Blom, Ruud W van Leuteren, Frans H de Jongh, Nerissa P Denswil, Ilaria Girimonte, Raffaele Dellaca, Anton H van Kaam, G Jeroen Hutten","doi":"10.1136/bmjpo-2026-005014","DOIUrl":"10.1136/bmjpo-2026-005014","url":null,"abstract":"<p><strong>Background: </strong>Increasing evidence suggests that synchronised nasal intermittent positive pressure ventilation (sNIPPV) may be the optimal mode of non-invasive respiratory support. However, no comprehensive review of sNIPPV modes is available. This review aims to describe different synchronisation methods for sNIPPV and compare their effectiveness in clinical, physiological and technical outcomes with other modes of non-invasive respiratory support.</p><p><strong>Methods: </strong>This review identified all clinical studies in preterm infants that compared sNIPPV to other non-invasive respiratory support modes or compared different trigger modalities between 1990 and 2026. A search was carried out in MEDLINE, Embase and the Cochrane Library. Main outcomes were categorised as clinical (eg, extubation failure (EF)), physiological (eg, breathing effort) and technical (eg, synchronisation rate).</p><p><strong>Results: </strong>49 studies (2864 infants) were included, with a low to moderate risk of bias. Meta-analysis showed a reduction in EF (risk ratio=0.38; 95% CI 0.17 to 0.85; p=0.03) in favour of sNIPPV compared with nasal continuous positive airway pressure (nCPAP). Physiological outcomes were significantly improved during sNIPPV compared with nCPAP and nasal intermittent positive pressure ventilation (NIPPV), especially breathing effort. When reviewing technical outcomes, non-invasive neurally adjusted ventilatory assist showed lower patient-ventilator asynchrony (PVA) (index ranging from 7% to 50%), a higher synchronisation rate (80%-99%) and a shorter trigger delay (35 ms) compared with other sNIPPV modes.</p><p><strong>Conclusions: </strong>This review shows that synchronising NIPPV results in consistent physiological (reduced patient effort) and technical benefits (reduced PVA). However, evidence on positive effects on (long-term) major clinical outcomes remains limited and requires further studies.</p><p><strong>Prospero registration number: </strong>CRD420251022479.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918528","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}