BMJ Paediatrics Open最新文献

{"title":"National trends in neonatal diagnoses recorded at hospital discharge in Kazakhstan, 2014-2024.","authors":"Balzhan N Tatibekova, Adema K Sagatbaeva, Bauyrzhan N Tatibekov","doi":"10.1136/bmjpo-2026-005122","DOIUrl":"10.1136/bmjpo-2026-005122","url":null,"abstract":"<p><strong>Background: </strong>Declining neonatal mortality has increased the number of surviving newborns; however, in health systems without validated neonatal morbidity indicators, population-level patterns of diagnoses recorded at hospital discharge remain poorly characterised.</p><p><strong>Objective: </strong>To characterise national trends in neonatal mortality, survival among infants with extremely low and very low birth weight, and International Classification of Diseases 10th revision (ICD-10) diagnoses recorded at discharge among surviving newborns in Kazakhstan from 2014 to 2024.</p><p><strong>Methods: </strong>We conducted a nationwide retrospective population-based study using de-identified administrative health data covering all live births in Kazakhstan from 2014 to 2024. Temporal trends in neonatal mortality, survival among infants with extremely low and very low birth weight and recorded primary ICD-10 diagnoses at discharge were assessed.</p><p><strong>Results: </strong>Among 4 437 357 live births, neonatal mortality decreased from 6.2 to 4.0 per 1000 live births, whereas the proportion of surviving newborns with a recorded primary diagnosis at discharge increased from 4.9% to 16.7% (relative risk 3.41; 95% CI 3.36 to 3.46; p<0.001). By 2024, P91, P59 and P22 accounted for 88.4% of recorded primary diagnoses. The increase in P91 diagnoses occurred without a corresponding increase in the proportion of newborns weighing <2500 g.</p><p><strong>Conclusion: </strong>Declining neonatal mortality was accompanied by an increase and a changing distribution of recorded diagnoses among surviving newborns. These data cannot determine individual post-discharge follow-up needs but may provide an initial population-level basis for planning subsequent clinical risk stratification after discharge.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890919","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":"From fortification and foetal surgery to healthy ageing: mentoring leadership through global health partnerships in spina bifida care.","authors":"Jessica Stockman, Heidi Castillo, Viachaslau Bradko, Semhal Getachew Teka, Yakob Ahmed, Mahder Deju, Patricia O'Neill, Ann Inger Alriksson-Schmidt, Nienke Dosa, Jonathan Castillo","doi":"10.1136/bmjpo-2026-004584","DOIUrl":"10.1136/bmjpo-2026-004584","url":null,"abstract":"<p><p>Neural tube defects (NTDs) remain a significant global public health concern, affecting an estimated 300 000 live births annually. Spina bifida (SB), one of the most common NTDs, is associated with complex lifelong comorbidities including hydrocephalus, neurogenic bowel and bladder dysfunction, orthopaedic impairments and cognitive challenges that require coordinated multidisciplinary care across the lifespan. Although advances in prevention, foetal surgery, rehabilitation and assistive technology have improved outcomes, opportunities for sustained international professional learning remain limited.This review describes the development and activities of the Spina Bifida Global Learning Collaborative. This international community of practice was established following the 2023 Spina Bifida World Congress to promote knowledge exchange, mentorship, leadership development and professional capacity building. Drawing on documented collaborative activities and reflections from regular virtual meetings between 2023 and 2026, we describe three recurring learning modalities: practice-informed dialogue, educational and professional training initiative and collaborative writing and academic exchange. Through sustained, low-cost international collaboration, participants have shared experiences across diverse healthcare systems and translated learning into locally adapted initiatives, including rehabilitation capacity building and aftercare programmes in Ethiopia, hybrid professional education initiatives in Scandinavia, assistive technology training in the Americas and collaborative research and student engagement across institutions. Rather than implementing centrally coordinated programmes, the collaborative functions as a catalyst for locally led innovation by connecting clinicians, researchers and advocates across disciplines and countries. These experiences suggest that international communities of practice can strengthen professional networks, foster mentorship, support leadership development and contribute to educating the next generation of professionals working in SB care. Sustained global partnerships may therefore represent an important strategy for improving lifelong care for individuals with SB across diverse health systems.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890855","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":"RIGHTS principles for early intervention: right care at the right time for every infant, child and family in low and middle-income countries.","authors":"Álvaro Hidalgo-Robles, Daniel Cid-Cofré, María Lucía Mesa-Rubio, Antonio Rizzoli-Córdoba, Anahí Venzor Strader, Helia Molina-Milman","doi":"10.1136/bmjpo-2026-004467","DOIUrl":"10.1136/bmjpo-2026-004467","url":null,"abstract":"<p><strong>Background: </strong>Early intervention programmes for infants and young children at developmental risk are implemented inconsistently and inequitably worldwide. Variation in access, surveillance, referral, follow-up and service quality means that children and families may receive very different opportunities depending on where they live, system capacity and resources, laws, policy and local pathways. Practical, evidence-informed guidance is needed to translate 'what should be done' into 'how to implement it' across diverse settings.</p><p><strong>Methods: </strong>This conceptual, practice-oriented article used a narrative review and an evidence-informed iterative framework-development process. Sources included global frameworks, clinical guidelines and evidence syntheses, randomised and longitudinal studies relevant to low and middle-income contexts and implementation science frameworks.</p><p><strong>Results: </strong>We propose six Reach, Identify early, align Goals, Help families deliver, Track and improve and ensure Sustainability (RIGHTS) principles for early intervention programmes: (1) Reach underserved infants, children and families through proactive, equity-oriented and outreach-capable models; (2) Identify developmental risk early through standardised, feasible pathways with clear timepoints, tools, thresholds and referral circuits; (3) align Goals with family priorities, functioning and everyday routines through shared decision-making; (4) Help families deliver intervention using coaching, routines-based strategies and realistic doses of practice; (5) Track and improve systems through standards, service indicators, family experience measures and continuous learning cycles; and (6) ensure Sustainability by institutionalising governance, financing, workforce capacity and policy alignment for durable impact.</p><p><strong>Conclusions: </strong>Early intervention programmes should be designed to connect timely identification with family-centred, functionally meaningful and feasible support. Embedding standardisation, equity, caregiver partnership and data-informed improvement into service design may reduce unwarranted variation and strengthen continuity of care. Priority research areas include implementation-effectiveness studies, equity impacts, minimum data sets and the cost-effectiveness of scalable and sustainable early intervention programmes.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886281","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":"Circle of care model for strengthening newborn care through Kangaroo Mother Care integration in primary health systems in rural India.","authors":"Yogita Thakral, Ashmita Gulechha, Sanjana Brahmawar Mohan, Pavitra Mohan","doi":"10.1136/bmjpo-2026-004568","DOIUrl":"10.1136/bmjpo-2026-004568","url":null,"abstract":"<p><strong>Background: </strong>Kangaroo Mother Care (KMC) reduces morbidity and mortality among preterm and low birth weight infants, yet continuity between facility initiation and home practice remains weak in rural settings. This study examined a facility-community circle of care model in a primary care setting in southern Rajasthan, India.</p><p><strong>Methods: </strong>In a primary health centre (PHC) managed as a public-private partnership in rural south Rajasthan, India, we trained and supported the PHC facility-based team to initiate KMC for all low birth weight babies at birth, and the outreach team to continue KMC at household levels. Both teams educated and supported mothers and family members to provide and sustain KMC for the babies.We reviewed the programme and supervisory data of a 3-year period (2021-2024) following the KMC introduction to estimate key indicators of its coverage and effectiveness. We also conducted semi-structured interviews with the team members to understand and document the process of introduction.</p><p><strong>Results: </strong>Among 1188 live births, 34% were low birth weight. Facility KMC coverage rose from 60% to 88%, and 52% of dyads continued KMC at home. Exclusive breastfeeding reached 98%, mean skin-to-skin contact averaged 9 hours daily and infant survival was 99%. The circle of care strengthened continuity, trust and workforce capability.</p><p><strong>Conclusion: </strong>Embedding KMC within a coordinated, mentorship-supported circle of care provides a scalable systems approach to enhancing newborn outcomes and primary care in rural and tribal settings.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886273","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":"Growth and nutritional outcomes in children during the first year of cancer treatment: a scoping review with implications for child health care in low- and middle-income countries (LMICs).","authors":"Sashiha Manimohan, Padmasani Venkat Ramanan, Prathyusha Gopalakrishnan","doi":"10.1136/bmjpo-2026-004648","DOIUrl":"10.1136/bmjpo-2026-004648","url":null,"abstract":"<p><strong>Background: </strong>Improved survival among children with cancer has shifted attention towards quality of care and holistic child health outcomes during treatment. Growth faltering and undernutrition are common during cancer therapy, particularly in low- and middle-income countries (LMICs), where pre-existing nutritional vulnerability and health system constraints may exacerbate this effect. Evidence on growth patterns during the early phase of treatment remains fragmented.</p><p><strong>Objectives: </strong>To map available evidence on growth and nutritional outcomes in children with cancer during the first year after diagnosis and initiation of treatment, and to explore implications for child health care delivery in India and similar LMIC settings.</p><p><strong>Methods: </strong>A scoping review was conducted using PubMed and Google Scholar. Studies reporting growth or nutritional outcomes in children (≤18 years) with cancer during the first year of treatment were included. Evidence was charted and synthesised descriptively in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA) guidelines.</p><p><strong>Results and conclusions: </strong>The initial database search identified 493 titles. After title and abstract screening, 21 articles remained; a further 13 studies were identified through citation search. Four duplicates were removed, resulting in a total of 30 included studies. The literature demonstrates substantial heterogeneity in cancer types, treatment phases, growth indicators and timing of assessments. Most studies focus on weight, with limited reporting of height or growth velocity. Growth faltering is frequently observed during intensive treatment phases. Growth trajectories vary by cancer type and treatment phase, with acute lymphoblastic leukaemia demonstrating progressive adiposity gain and central nervous system tumours showing greater linear growth impairment. Data from LMICs on structured longitudinal growth monitoring and integrated nutritional interventions during treatment are sparse. Routine standardised growth monitoring remains inconsistent in LMIC settings. Integrating structured anthropometric assessment and early nutritional intervention into paediatric oncology care may represent a practical and potentially modifiable strategy to improve growth outcomes in these children.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886215","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":"Anaemia and its association with iron, vitamin B₁₂ and folate deficiency in school-age children and adolescents: a cross-sectional study of primary-care laboratory records (2019-2025).","authors":"Kevser Erdoğan, Hülya Doğan Tiryaki, Osman Kurt, Nefise Şeker, Osman Küçükkelepçe","doi":"10.1136/bmjpo-2026-005163","DOIUrl":"10.1136/bmjpo-2026-005163","url":null,"abstract":"<p><strong>Objective: </strong>To determine the frequency of anaemia and its association with iron, vitamin B₁₂ and folate deficiency in school-age children and adolescents.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Family health centres (primary care) in Antalya, Türkiye, 2019-2025.</p><p><strong>Participants: </strong>Children aged 6-18 years with a complete blood count; the first eligible record per child was analysed (n=240 613).</p><p><strong>Main outcome measures: </strong>Anaemia, defined by WHO age-specific and sex-specific haemoglobin thresholds; iron (ferritin <15 µg/L or transferrin saturation <16%), vitamin B₁₂ (<200 pg/mL) and folate (<3 ng/mL) deficiency; associations assessed by χ² test, ORs and multivariable logistic regression. Because total iron-binding capacity was not measured directly, transferrin saturation was derived as serum iron divided by the sum of serum iron and unsaturated iron-binding capacity, expressed as a percentage; iron deficiency was defined as ferritin <15 µg/L or transferrin saturation <16%, whichever was available.</p><p><strong>Results: </strong>Anaemia prevalence was 9.5% (95% CI 9.4% to 9.6%), higher in girls (13.6%) than boys (4.2%) and rising with age (6-11 years 4.8%; 15-18 years 12.9%; both p<0.001). Most anaemia was microcytic (76.0%). Iron deficiency was present in 50.4%, vitamin B₁₂ deficiency in 53.7% and folate deficiency in 0.8%. In multivariable analysis, iron deficiency (adjusted OR 4.15, 95% CI 3.99 to 4.31), female sex and older age were independently associated with anaemia (all p<0.001).</p><p><strong>Conclusions: </strong>Anaemia remains common and largely preventable in school-age children and adolescents, with iron deficiency as the principal correlate. Adolescent girls are the priority group for iron-status screening and intervention.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878842","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":"High-intensity treatment is common at the end of life among children and young people who died of cancer: a retrospective cohort study.","authors":"Stuart Jarvis, Pandell Damun, Sebastian Hinde, Helen Weatherly, Richard G Feltbower, Gayathri Subramanian, Bob Phillips, Lorna K Fraser","doi":"10.1136/bmjpo-2026-004575","DOIUrl":"10.1136/bmjpo-2026-004575","url":null,"abstract":"<p><strong>Background: </strong>Annually, approximately 500 children and young people (aged <25 years) with cancer die in England. Little is known about the intensity of their end-of-life care.</p><p><strong>Aim: </strong>The primary aim of this study was to establish the prevalence of high-intensity treatment at the end of life in England and assess the relationship between high-intensity treatment and palliative care integration in main cancer treatment centres. The secondary aim was to assess the relationship between palliative care integration and place of death.</p><p><strong>Design: </strong>Retrospective, national full-population cohort study.</p><p><strong>Setting/participants: </strong>English Cancer Registry data with linked hospitalisation, treatment and intensive care data were used to define a cohort aged <25 years who died in 2012-2020 and post-cancer diagnosis. High-intensity treatment was defined as any intravenous chemotherapy within 14 days of death or multiple hospitalisations, emergency department visits or any intensive care unit admission within 30 days of death. High-intensity treatment prevalence at the end of life and place of death were summarised by demographics, cancer type, main treatment centre and centre-level integration of palliative care. Logistic regression models explored associations with high-intensity treatment.</p><p><strong>Results: </strong>2208 (52%) of the cohort (n=4247) had high-intensity treatments at the end of life and 1911 (45%) died in hospital. High-intensity treatment prevalence varied by age at death and cancer type. There was no evidence of health inequalities in treatments, but minority ethnic groups and those living in more deprived areas had greater odds of dying in hospital.</p><p><strong>Conclusions: </strong>High-intensity treatment is common at the end of life among children and young people with cancer; however, its appropriateness is difficult to evaluate. Nevertheless, no evidence of health inequalities was noted, and hospital deaths remain most common.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873029","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":"Implementation and evaluation of a quality improvement initiative for central venous catheter management in neonates undergoing therapeutic hypothermia for perinatal asphyxia.","authors":"Margreet R Koolen-De Koninck, Tom Ouwehand, Florian Cassel, Sinno Hp Simons, Gerbrich E van den Bosch","doi":"10.1136/bmjpo-2026-004817","DOIUrl":"10.1136/bmjpo-2026-004817","url":null,"abstract":"<p><strong>Objectives: </strong>Therapeutic hypothermia (TH) is an effective treatment for hypoxic-ischaemic encephalopathy in infants following perinatal asphyxia, reducing mortality and morbidity when initiated within 6 hours after birth. Both perinatal asphyxia and TH require intensive management and therefore central venous access, such as umbilical venous catheters (UVC) or peripherally inserted central catheters (PICC). Placement of these catheters can lead to a delay in initiating TH. This study evaluated a potential quality improvement using subclavian vein catheters (SVCs) in TH patients, focusing on time to initiation, integration into routine practice and safety.</p><p><strong>Methods: </strong>We conducted a retrospective study including all neonates treated with TH between July 2017 and April 2025 at a level IV neonatal intensive care unit. Data included catheter type, placement success, adverse events and relation to TH initiation time.</p><p><strong>Results: </strong>A total of 219 patients were included: 160 prior and 59 after SVC implementation. Between 2017 and 2022, UVC was the most used (50.6%), followed by PICC (21.3%), while 12.5% had unsuccessful catheter placement. Catheter-related difficulties occurred in 51.6% overall and in 46/56 (82.1%) with delayed TH initiation beyond 6 hours. The introduction of the SVC led to an increase in its use up to 69.5% of patients and an overall 100% central catheter success rate. Mean time to initiate TH was 39.4 min shorter when SVC was chosen as the primary catheter (p=0.003), and delayed initiation decreased from 25.6% to 13.6%. No SVC-related adverse events were reported.</p><p><strong>Conclusions: </strong>Since introducing SVCs, catheter placement success improved and TH initiation was faster, indicating that SVCs are clinically feasible and safe. This quality improvement initiative represents a step forward toward optimising care for neonates undergoing TH. Further prospective studies are needed to confirm these findings and assess long-term outcomes.</p><p><strong>Implications for clinical practice: </strong>Implementing SVCs as primary central access in neonates undergoing TH can reduce delays and improve care without increasing adverse events.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872945","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":"Hospitalisations for respiratory tract infections in preterm and term born children aged 1-5 years before, during and after COVID-19 control measures: an interrupted time-series analysis.","authors":"Andreas Asheim, Kari Risnes, Isobel Todd, Henrik Døllner, Eero Kajantie, Signe Opdahl, Sara Marie Nilsen","doi":"10.1136/bmjpo-2025-004270","DOIUrl":"10.1136/bmjpo-2025-004270","url":null,"abstract":"<p><strong>Background: </strong>Preterm-born children are vulnerable to respiratory tract infections (RTIs), but we know little about how these were affected by COVID-19 pandemic control measures.</p><p><strong>Methods: </strong>We studied Norwegian population-wide registry data on 1-5-year olds born 2012-2021. RTI hospitalisations were identified from primary hospitalisation diagnosis codes. We modelled prepandemic hospitalisation rates, January 2017 to March 2020, using quasi-Poisson regression with harmonic seasonal terms. These were compared with monthly hospitalisation rates, March 2020 to December 2022. The calculations were performed separately for gestational age groups: 23-33, 34-36, 37-41 completed weeks.</p><p><strong>Results: </strong>We identified 9734 RTI hospitalisations among 449 105 children aged 1-5 years, with higher rates in the most preterm groups. Across gestational ages, we observed lower hospitalisation rates during control measures in 2020, followed by a surge after measures were lifted in 2021. For children born in weeks 23-33, the rate reduction with 95% CI during the first year of the pandemic compared with the prepandemic years was -21 per 1000 person-years (95% CI -30 to -13), whereas in April-December 2022, there was an increase of 22 (95% CI 12 to 31). For term born (week 37-41), the corresponding changes were -4.9 (95% CI -5.5 to -4.3) and 3.6 (95% CI 2.9 to 4.2).</p><p><strong>Conclusions: </strong>Compared with term born, preterm-born children of all gestational age groups were more distinctly protected by pandemic control measures. They were also more affected by the resurgence of infections when measures were lifted. These findings call for policies to protect preterm-born children better from RTIs, especially when viral spread is high.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873034","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":"Community-based paediatric eye care in low- and middle-income countries: bridging the gap between policy and practice.","authors":"Debabrata Tripathy, Payel Roy, Bhagabat Nayak, Manish Taywade","doi":"10.1136/bmjpo-2026-005155","DOIUrl":"10.1136/bmjpo-2026-005155","url":null,"abstract":"<p><p>Childhood visual impairment and blindness remain major public health concerns in low- and middle-income countries (LMICs), despite a substantial proportion being preventable or treatable. Delayed diagnosis, inadequate access to eye care services, fragmented referral systems, limited awareness and insufficient community-level interventions continue to contribute to the burden. In recent years, the epidemiological profile of paediatric ocular morbidity has shifted from infectious and nutritional causes towards refractive errors, myopia and developmental eye disorders, necessitating stronger community-oriented eye care models. This review examines the burden, determinants, policy frameworks, implementation gaps and future strategies related to community-based paediatric eye care in LMICs, with particular emphasis on bridging the gap between policy and practice. Evidence from global literature, WHO frameworks and national programmes such as India's Rashtriya Bal Swasthya Karyakram and National Programme for Control of Blindness and Visual Impairment highlights the importance of integrated life-course approaches involving neonatal, preschool and school-age screening. However, implementation remains constrained by workforce shortages, inadequate infrastructure, poor referral linkage, limited financing and disparities in access to specialised equipment. Community-based strategies including school vision screening, tele-ophthalmology, mobile eye clinics, digital surveillance systems and artificial intelligence-assisted diagnostics demonstrate considerable potential in improving access and continuity of care. Strengthening paediatric eye care in LMICs requires integration with primary healthcare systems, training of non-ophthalmic personnel, sustainable financing mechanisms, effective referral pathways and technology-supported service delivery to reduce avoidable childhood blindness and visual impairment.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849742","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}