BMJ Paediatrics Open最新文献

{"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}

{"title":"Dexmedetomidine in neonates: utilisation trends and safety profile over time in a neonatal intensive care unit.","authors":"Gozdem Kayki, Nadir Yalcin, Hasan Tolga Celik, Sule Yigit","doi":"10.1136/bmjpo-2024-003004","DOIUrl":"10.1136/bmjpo-2024-003004","url":null,"abstract":"<p><strong>Background: </strong>Dexmedetomidine is an alpha-2 adrenergic agonist with sedative, anxiolytic and analgesic effects. Its use in neonatal intensive care units (NICUs) has been increasing in the last decade. The aim of this study was to assess the safety profile of dexmedetomidine and to identify specific trends in its use over time.</p><p><strong>Methods: </strong>In this retrospective observational study, data were collected on all patients who received continuous infusion of dexmedetomidine in a level IV NICU in Turkey between 2018 and 2023. Demographic characteristics were compared between preterm and term infants using the Mann-Whitney U test. Differences in adverse effects between term and preterm infants, as well as between lower and higher doses, were analysed using the χ² test. Regression analysis was conducted to identify factors influencing adverse effects.</p><p><strong>Results: </strong>A total of 383 patients were included. The participants had a median (IQR) gestational age of 37 (35-38) weeks with a median (IQR) birth weight of 2700 (2140-3270) grams and the median (IQR) postmenstrual age at the time of dexmedetomidine initiation was 38 (36-40) weeks. The most common indication for use was pain control following surgery and/or interventional procedures (81.5%). There was a statistically significant increase in initial doses (p<0.001) and treatment duration (p=0.009). Adverse drug reactions (ADRs) were observed in 5% of cases, mostly bradycardia (50%) and ADRs did not correlate with the dose (0.80), treatment duration (0.96) or gestational age (p=0.93).</p><p><strong>Conclusion: </strong>Our data and experiences demonstrated a significant increase in the dose and duration of dexmedetomidine use in the NICU over the years. Additionally, the findings have suggested that higher doses and treatment duration do not result in an increase in ADRs during the acute period.</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/PMC11927418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655809","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":"The impact of climate change on child nutrition in Indonesia: a conceptual framework and scoping review of the available evidence.","authors":"David Colozza, Isabella Guo, Sri Wahyuni Sukotjo, Astrid Citra Padmita, Rene Gerard Galera, Endang Sulastri, Inti Wikanestri, Mamadou Ndiaye","doi":"10.1136/bmjpo-2024-002980","DOIUrl":"10.1136/bmjpo-2024-002980","url":null,"abstract":"<p><strong>Background: </strong>Climate change is expected to significantly impact child nutrition, worsening global health inequities. Indonesia, a country highly vulnerable to climate change, also faces substantial child malnutrition challenges. However, comprehensive knowledge on climate change's impacts on child nutrition in Indonesia is limited. This study addresses this gap through a scoping review of the scientific evidence on the effects of climate change on child nutrition in Indonesia.</p><p><strong>Methods: </strong>We developed a conceptual framework based on global literature to guide our systematic search, linking climate change to child nutrition and its determinants in Indonesia. Systematic searches were conducted in English and Indonesian on Scopus, Web of Science and PubMed, supplemented by Google Scholar and citation screening. We included peer-reviewed, Scopus-indexed studies focused on Indonesia, examining either direct or indirect impacts of climate change on child nutrition. A narrative synthesis was performed, structured around outcomes identified in our framework: (1) nutrition-associated conditions, (2) diets and disease, (3) social dynamics and (4) food system shocks.</p><p><strong>Results: </strong>From 3025 records, 134 studies met the inclusion criteria. Studies were either multicountry including Indonesia (23%, n=31), Indonesia-specific across multiple regions (26%, n=35) or region-specific, mainly focused on Java (22%, n=29), Sumatra (11%, n=14), Kalimantan (7%, n=9) and Sulawesi (7%, n=9). Other regions were under-represented (5%, n=7). Most studies used quantitative methods (87%, n=116). Few studies assessed direct links between climate change and nutritional outcomes (n=5), food security or dietary quality (n=7); more focused on indirect pathways such as disease (n=49), social dynamics (n=18) and food system disruptions (n=55).</p><p><strong>Conclusions: </strong>Evidence suggests significant impacts of climate change on child nutrition in Indonesia, highlighting the need for urgent action. Further localised studies that consider contextual factors, and actions focused on strengthening health and nutrition systems, are critical, especially in regions most vulnerable to both climate change and child malnutrition.</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/PMC11927459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655951","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":"Correction for '<i>Factors influencing the natural history of non-IgE-mediated gastrointestinal food allergies in paediatric age: a prospective multicentre cohort study'</i>.","authors":"","doi":"10.1136/bmjpo-2024-003203corr1","DOIUrl":"10.1136/bmjpo-2024-003203corr1","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing different administration methods of subanaesthetic propofol to mitigate emergence agitation in preschool children undergoing day surgery: a double-blind, randomised controlled study.","authors":"Jiaxiang Chen, Xiaoli Shi, Wei Hu, Rongmu Lin, Ligang Meng, Changsheng Liang, Xinggang Ma, Liang Xu","doi":"10.1136/bmjpo-2023-002376","DOIUrl":"10.1136/bmjpo-2023-002376","url":null,"abstract":"<p><strong>Background: </strong>Preschool children who received sevoflurane anaesthesia were associated with a high incidence of emergence agitation (EA). Studies have shown that a subanaesthetic dose of propofol (1 mg/kg) at the end of inhalational anaesthesia could reduce EA in paediatric patients, but the optimal administrations are still under investigation.</p><p><strong>Methods: </strong>In a double-blind trial, 160 preschool children (ASA I or II, 2-5 years old) undergoing day surgery of laparoscopic inguinal hernia repair with sevoflurane anaesthesia were randomly assigned into four groups: the control group, single bolus 3 min before the end of the surgery (bolus A), single bolus at the end of the surgery (bolus B) and continuous infusion for 3 min at the end of the surgery (continuous infusion). The dose of propofol in the bolus A group, bolus B group and continued infusion group is 1 mg/kg. The primary outcomes were the incidence and severity of EA assessed by the Paediatric Anaesthesia Emergence Delirium (PAED) scale and Watcha scales. The secondary outcomes included extubation time, emergence time, mean arterial pressure and heart rate.</p><p><strong>Results: </strong>The incidence of EA was as follows: 65.0% in the control group, 30.0% in the bolus A group, 32.5% in the bolus B group and 5.0% in the continuous infusion group (p<0.05). Furthermore, the peak PAED scores in the continuous infusion group were significantly lower than those in the other groups. However, extubation time and emergence time showed no differences among groups.</p><p><strong>Conclusions: </strong>Continuous infusion of subanaesthetic dose propofol (1 mg/kg) for 3 min at the end of sevoflurane anaesthesia seems to be more appropriate than other administration as it reduced EA and did not prolong the time to wake.</p><p><strong>Trail registration number: </strong>NCT05420402.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of successful Picture Exchange Communication System training in children with communication impairments: insights from a real-world intervention in a resource-limited setting.","authors":"Prakasit Wannapaschaiyong, Thitaporn Vivattanasinchai, Awassada Wongkwanmuang","doi":"10.1136/bmjpo-2024-003282","DOIUrl":"10.1136/bmjpo-2024-003282","url":null,"abstract":"<p><strong>Background: </strong>Children with communication impairments-such as autism spectrum disorder or global developmental delay-face significant challenges affecting their emotional and behavioural development. The Picture Exchange Communication System (PECS) is an augmentative communication tool designed to enhance their skills. However, its effectiveness can vary in resource-limited settings. This study aimed to identify predictors of successful PECS training among children with communication impairments in such environments.</p><p><strong>Methods: </strong>This retrospective study analysed records of 61 children with communication impairments who underwent PECS training at Siriraj Hospital in Bangkok, Thailand, from 2020 to 2023. Success was defined as achieving PECS phase 3 proficiency and a Clinical Global Impression-Improvement score of 1-3 after 1 year. Logistic regression identified predictors of successful outcomes based on demographic, clinical, family and training-related factors.</p><p><strong>Results: </strong>After 1 year, 46% (28 out of 61) of the children achieved successful PECS outcomes. Significant predictors of success were lower severity of communication impairment (Clinical Global Impression-Severity ≤4; adjusted OR= 15.24, p = 0.002), higher frequency of PECS sessions (>6 times per year; OR = 9.11, p = 0.010), higher family income (≥20,000 baht per month; OR = 9.83, p = 0.024) and frequent home practice (≥3 times per week; OR = 7.02, p = 0.066).</p><p><strong>Conclusions: </strong>In resource-limited settings, factors such as severity of impairment, intensity of intervention, socioeconomic status and caregiver involvement significantly influence the success of PECS training. Tailored interventions and strategic resource allocation are crucial to optimise communication outcomes for these children.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence for weight estimation in paediatric emergency care.","authors":"Iraia Isasi, Elisabete Aramendi, Erik Alonso, Sendoa Ballesteros-Peña","doi":"10.1136/bmjpo-2024-002891","DOIUrl":"10.1136/bmjpo-2024-002891","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate a paediatric weight estimation model adapted to the characteristics of the Spanish population as an alternative to currently extended methods.</p><p><strong>Methods: </strong>Anthropometric data in a cohort of 11 287 children were used to develop machine learning models to predict weight using height and the body mass index (BMI) quartile (as surrogate for body habitus (BH)). The models were later validated in an independent cohort of 780 children admitted to paediatric emergencies in two other hospitals. The proportion of patients with a given absolute percent error (APE) was calculated for various APE thresholds and compared with the available weight estimation methods to date. The concordance between the BMI-based BH and the visual assessment was evaluated, and the effect of the visual estimation of the BH was assessed in the performance of the model.</p><p><strong>Results: </strong>The machine learning model with the highest accuracy was selected as the final algorithm. The model estimates weight from the child's height and BH (under-, normal- and overweight) based on a support vector machine with a Gaussian-kernel (SVM-G). The model presented an APE<i><</i>10% and <i><</i>20% for 74.7% and 96.7% of the children, outperforming other available predictive formulas by 3.2-37.5% and 1.3-29.1%, respectively. Low concordance was observed between the theoretical and visually assessed BH in 36.7% of the children, showing larger errors in children under 2 years.</p><p><strong>Conclusions: </strong>The proposed SVM-G is a valid and safe tool to estimate weight in paediatric emergencies, more accurate than other local and global proposals.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}