The Lancet. Child & adolescent health最新文献

{"title":"Procalcitonin-guided duration of antibiotic treatment in children hospitalised with confirmed or suspected bacterial infection in the UK (BATCH): a pragmatic, multicentre, open-label, two-arm, individually randomised, controlled trial.","authors":"Cherry-Ann Waldron, Philip Pallmann, Simon Schoenbuchner, Debbie Harris, Lucy Brookes-Howell, Céu Mateus, Jolanta Bernatoniene, Katrina Cathie, Saul N Faust, Lucy Hinds, Kerenza Hood, Chao Huang, Sarah Jones, Sarah Kotecha, Helen M Nabwera, Sanjay Patel, Stéphane C Paulus, Colin V E Powell, Jenny Preston, Huasheng Xiang, Emma Thomas-Jones, Enitan D Carrol","doi":"10.1016/S2352-4642(24)00306-7","DOIUrl":"10.1016/S2352-4642(24)00306-7","url":null,"abstract":"<p><strong>Background: </strong>Procalcitonin is a rapid response biomarker specific for bacterial infection, which is not routinely used in the UK National Health Service. We aimed to assess whether using a procalcitonin-guided algorithm would safely reduce the duration of antibiotic therapy compared with usual care, in which C-reactive protein is the commonly used biomarker.</p><p><strong>Methods: </strong>The BATCH trial was a pragmatic, multicentre, open-label, parallel, two-arm, individually randomised, controlled trial conducted in 15 hospitals in England and Wales. Children aged 72 h to 18 years who were admitted to hospital and were being treated with intravenous antibiotics for suspected or confirmed bacterial infection and who were expected to remain on intravenous antibiotics for more than 48 h were enrolled. Participants were randomly assigned (1:1) to receive either current clinical management alone (usual care group) or clinical management with the addition of a procalcitonin test guided algorithm (procalcitonin group). Participants were randomly assigned by minimisation, with site and age group (0-6 months, 6 months to 2 years, 2-5 years, and older than 5 years) as minimisation factors and a random element to reduce predictability. Participants were randomly assigned remotely using a secure 24 h web-based randomisation programme. The coprimary outcomes were duration of intravenous antibiotic use, assessed for superiority, and a composite safety measure, assessed for non-inferiority (non-inferiority margin 5%). The primary analysis sample for each coprimary endpoint included all randomly assigned participants with available outcome data. This trial is registered with the International Standard Randomised Controlled Trial Number registry, ISRCTN11369832.</p><p><strong>Findings: </strong>Between June 11, 2018, and Oct 12, 2022, 15 282 children were screened for eligibility, 1949 of whom were randomly assigned to receive procalcitonin-guided antibiotic therapy (n=977) or usual care (n=972). The median intravenous antibiotic duration was 96·0 h (IQR 59·5-155·5) in the procalcitonin group and 99·7 h (61·2-153·8) in the usual care group (hazard ratio 0·96 [95% CI 0·87-1·05]). 78 (9%) of 917 participants in the procalcitonin group and 85 (9%) of 904 participants in the usual care group had at least one event covered by the composite safety outcome measure (estimated adjusted risk difference -0·81% [95% CI upper bound 1·11]).</p><p><strong>Interpretation: </strong>In children with suspected or confirmed bacterial infection admitted to hospitals in England and Wales for intravenous antibiotic treatment of at least 48 h, the introduction of a procalcitonin-guided algorithm did not reduce duration of intravenous antibiotics treatment and is non-inferior to usual care for safety outcomes. Therefore, evidence does not support the use of procalcitonin-guided algorithms where robust effective paediatric antibiotic stewardship programmes are establ","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"121-130"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building global collaborative research networks in paediatric critical care: a roadmap.","authors":"Luregn J Schlapbach, Padmanabhan Ramnarayan, Kristen S Gibbons, Brenda M Morrow, Natalie Napolitano, Lyvonne N Tume, Andrew C Argent, Akash Deep, Jan Hau Lee, Mark J Peters, Michael S D Agus, John Adabie Appiah, Jennifer Armstrong, Tigist Bacha, Warwick Butt, Daniela Carla de Souza, Jaime Fernández-Sarmiento, Heidi R Flori, Patricia Fontela, Ben Gelbart, Sebastián González-Dambrauskas, Takanari Ikeyama, Roberto Jabornisky, Muralidharan Jayashree, Yasser M Kazzaz, Martin C J Kneyber, Debbie Long, Jenala Njirimmadzi, Rujipat Samransamruajkit, Roelie M Wösten-van Asperen, Quan Wang, Katie O'Hearn, Kusum Menon","doi":"10.1016/S2352-4642(24)00303-1","DOIUrl":"10.1016/S2352-4642(24)00303-1","url":null,"abstract":"<p><p>Paediatric critical care units are designed for children at a vulnerable stage of development, yet the evidence base for practice and policy in paediatric critical care remains scarce. In this Health Policy, we present a roadmap providing strategic guidance for international paediatric critical care trials. We convened a multidisciplinary group of 32 paediatric critical care experts from six continents representing paediatric critical care research networks and groups. The group identified key challenges to paediatric critical care research, including lower patient numbers than for adult critical care, heterogeneity related to cognitive development, comorbidities and illness or injury, consent challenges, disproportionately little research funding for paediatric critical care, and poor infrastructure in resource-limited settings. A seven-point roadmap was proposed: (1) formation of an international paediatric critical care research network; (2) development of a web-based toolkit library to support paediatric critical care trials; (3) establishment of a global paediatric critical care trial repository, including systematic prioritisation of topics and populations for interventional trials; (4) development of a harmonised trial minimum set of trial data elements and data dictionary; (5) building of infrastructure and capability to support platform trials; (6) funder advocacy; and (7) development of a collaborative implementation programme. Implementation of this roadmap will contribute to the successful design and conduct of trials that match the needs of globally diverse paediatric populations.</p>","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"138-150"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142884009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building policy around the built environment for adolescent mental health.","authors":"Amy Mizen, Richard Fry, Susan Williams, Ann John","doi":"10.1016/S2352-4642(24)00259-1","DOIUrl":"10.1016/S2352-4642(24)00259-1","url":null,"abstract":"","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"81-82"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight-loss medications: promoting health and not harm.","authors":"Lauren B Hartman, Abigail A Donaldson, Laura M K Prakash, Maya M Kumar","doi":"10.1016/S2352-4642(24)00354-7","DOIUrl":"https://doi.org/10.1016/S2352-4642(24)00354-7","url":null,"abstract":"","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence estimates and nature of online child sexual exploitation and abuse: a systematic review and meta-analysis.","authors":"Deborah Fry, Anna Krzeczkowska, Jungru Ren, Mengyao Lu, Xiangming Fang","doi":"10.1016/S2352-4642(24)00329-8","DOIUrl":"https://doi.org/10.1016/S2352-4642(24)00329-8","url":null,"abstract":"<p><strong>Background: </strong>Online child sexual exploitation and abuse (OCSEA) is a global health issue. The aim of this global systematic review and meta-analysis was to better understand the prevalence and nature of OCSEA on a global scale.</p><p><strong>Methods: </strong>Comprehensive literature searches were done in six UN languages (Arabic, Chinese, English, French, Russian, and Spanish) and multiple databases, for records published between Jan 1, 2010, and Sept 30, 2023. Studies were evaluated independently by two different authors for inclusion according to eligibility criteria. Eligible studies included children younger than 18 years or adults retrospectively reporting OCSEA. Studies used general population samples and were representative at the national and sub-national level. Risk of bias in prevalence studies was assessed and a synthesis of the findings produced. A random-effects model was conducted for meta-analysis of studies to calculate prevalence estimates with 95% CIs for past year recall and lifetime recall of four OCSEA subtypes and overall OCSEA (from studies that measured at least three different sub-types within the same sample). This study was pre-registered with Open Science Framework (osf.io/6vux2).</p><p><strong>Findings: </strong>Of the 47 097 records derived from literature searches, 86 records reporting on 123 studies were included in this systematic review and meta-analysis. Pooled mean prevalence for past year recall of OCSEA subtypes was estimated: online solicitation (12·5% [95% CI 10·5-14·7]); non-consensual taking, sharing, and exposure to sexual images and videos (12·6% [9·7-16·2]); online sexual exploitation (4·7% [2·9-7·3]); and sexual extortion (3·5% [1·9-6·4]). The mean prevalence of past-year recall for overall OCSEA was 8·1% (4·9-13·0). Heterogeneity of individual estimates was high, influenced by research design factors including the method of data collection and variability in definitions used.</p><p><strong>Interpretation: </strong>Heterogeneity in prevalence estimates identified across studies and regions indicates that more research is required to draw stronger conclusions about the scale of OCSEA. However, the findings of this study are of great relevance to policy makers, practitioners, and researchers to make informed decisions about allocating resources and designing effective prevention and response programmes to protect children worldwide.</p><p><strong>Funding: </strong>The Human Dignity Foundation.</p>","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From social media to artificial intelligence: improving research on digital harms in youth.","authors":"Karen L Mansfield, Sakshi Ghai, Thomas Hakman, Nick Ballou, Matti Vuorre, Andrew K Przybylski","doi":"10.1016/S2352-4642(24)00332-8","DOIUrl":"https://doi.org/10.1016/S2352-4642(24)00332-8","url":null,"abstract":"<p><p>In this Personal View, we critically evaluate the limitations and underlying challenges of existing research into the negative mental health consequences of internet-mediated technologies on young people. We argue that identifying and proactively addressing consistent shortcomings is the most effective method for building an accurate evidence base for the forthcoming influx of research on the effects of artificial intelligence (AI) on children and adolescents. Basic research, advice for caregivers, and evidence for policy makers should tackle the challenges that led to the misunderstanding of social media harms. The Personal View has four sections: first, we conducted a critical appraisal of recent reviews regarding effects of technology on children and adolescents' mental health, aimed at identifying limitations in the evidence base; second, we discuss what we think are the most pressing methodological challenges underlying those limitations; third, we propose effective ways to address these limitations, building on robust methodology, with reference to emerging applications in the study of AI and children and adolescents' wellbeing; and lastly, we articulate steps for conceptualising and rigorously studying the ever-shifting sociotechnological landscape of digital childhood and adolescence. We outline how the most effective approach to understanding how young people shape, and are shaped by, emerging technologies, is by identifying and directly addressing specific challenges. We present an approach grounded in interpreting findings through a coherent and collaborative evidence-based framework in a measured, incremental, and informative way.</p>","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Creating child-inclusive societies.","authors":"Helen Skouteris, Michael Marmot, Sharon Bessell","doi":"10.1016/S2352-4642(24)00254-2","DOIUrl":"10.1016/S2352-4642(24)00254-2","url":null,"abstract":"<p><p>In a global landscape defined by polycrisis, children are being failed. To address this failure, we ask an ambitious yet fundamental question: how do we create child-inclusive societies where every child thrives and has the best start in life, where intergenerational disadvantage is redressed, and where child poverty is ended? Building on the power of the social determinants of health in advancing equity and human wellbeing, we argue that child inclusiveness requires three foundational actions linked to the political, commercial, and social determinants of health: (1) prioritising implementation of transformative collaboration between policy makers, public bodies, and communities to improve outcomes for children; (2) reclaiming the public good through child-centred regulatory frameworks that aim to deliver health care and improve wellbeing; and (3) valuing the time to care for children and to build meaningful and responsive relationships with them. With innovative thinking about our societies and their core values, we can design child-inclusive interventions and derive relevant metrics and indicators to track progress.</p>","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"71-76"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a youth-led early childhood care and education programme on children's development and learning in rural Sindh, Pakistan (LEAPS): a stepped-wedge cluster-randomised implementation trial.","authors":"Aisha K Yousafzai, Saima Siyal, Emily E Franchett, Quanyi Dai, Karima Rehmani, Christopher R Sudfeld, Shelina Bhamani, Shahnaz Hakro, Chin R Reyes, Günther Fink, Liliana A Ponguta","doi":"10.1016/S2352-4642(24)00304-3","DOIUrl":"10.1016/S2352-4642(24)00304-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In low-income and middle-income countries, an estimated 181·9 million (74·6%) preschool-aged children do not receive adequate nurturing care in health, nutrition, protection, learning, and responsive care, thus jeopardising their healthy development across the life course. Working alongside the health sector, multisectoral actions including social protection and education are necessary to achieve child health and development outcomes. Innovations are needed to expand access to high-quality early childhood care and education (ECCE) for young children and opportunities for youth development. Youth Leaders for Early Childhood Assuring Children are Prepared for School (LEAPS) is a two-generation programme that trains female youth aged 18-24 years to deliver ECCE. We evaluated the effectiveness of LEAPS to improve children's school readiness when delivered at scale in rural Pakistan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We implemented a stepped-wedge cluster-randomised trial with three steps from Dec 3, 2018, to June 30, 2021. 99 villages (clusters) in four districts in rural Sindh, Pakistan, were randomly assigned (1:1:1) to introduce LEAPS across three steps. Eligible clusters were those that had a feeder primary school run by the National Commission for Human Development, a department of the Ministry of Federal Education and Professional Training; were safe; had space for a LEAPS preschool; could identify a female youth to deliver the ECCE service; and had not previously participated in the pilot study. Government partners trained female youth, aged 18-24 years, to provide community-based ECCE, enrolling up to 20 children, aged 3·5-5·0 years, per class. Population-based cross-sectional surveys were conducted at baseline and after each step for children who were eligible if they resided in the cluster, were aged 4·5-5·5 years at the time of the survey, and without any severe clinical health conditions or disability. The primary outcome was children's school readiness using the International Development and Early Learning Assessment (IDELA) composite score comprising emergent numeracy, emergent literacy, socio-emotional development, and motor skills. An intention-to-treat analysis was conducted, using linear mixed models accounting for clustering and the stepped-wedge design. The trial is registered with ClinicalTrials.gov (NCT03764436).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;LEAPS was implemented in 91 of 99 villages. In eight clusters, a LEAPS preschool could not be set up. For the intervention programme, the average enrolment of children in a LEAPS preschool was 19 (SD 3, range 12-20). A total of 3858 children (n=3852 with complete IDELA data) were assessed across the four survey rounds conducted between Jan 1, 2019, and March 31, 2021. LEAPS increased school readiness (standardised mean difference: 0·30 [95% CI 0·20-0·40]; p&lt;0·0001) as compared with the control condition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;LEAPS offers a ","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"25-36"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing multiple neurodivergent identities in clinical and research settings.","authors":"Sarah L Chellappa","doi":"10.1016/S2352-4642(24)00261-X","DOIUrl":"10.1016/S2352-4642(24)00261-X","url":null,"abstract":"","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":" ","pages":"5-6"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longer-term survival, quality of life, and cost-effectiveness of conservative versus liberal oxygenation targets in critically ill children: a pre-specified analysis from Oxy-PICU, a multicentre, open, parallel-group, randomised controlled trial.","authors":"Silvia Moler-Zapata, Mark J Peters, Doug W Gould, Elisa Giallongo, Marzena Orzol, Samiran Ray, Karen Thomas, Irene Chang, Lauran O'Neill, Rachel Agbeko, Carly Au, Elizabeth Draper, Lee Elliot-Major, Lamprini Lampro, Jon Pappachan, Sam Peters, Padmanabhan Ramnarayan, Kathryn M Rowan, David A Harrison, Paul R Mouncey, Zia Sadique","doi":"10.1016/S2352-4642(24)00294-3","DOIUrl":"10.1016/S2352-4642(24)00294-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Peripheral oxygen saturation (SpO&lt;sub&gt;2&lt;/sub&gt;) above 94% is typical in children in paediatric intensive critical care units (PICUs) who are receiving invasive ventilation and supplemental oxygen. In a previous report from the Oxy-PICU trial, we showed that lower (conservative) oxygenation targets (SpO&lt;sub&gt;2&lt;/sub&gt; 88-92%) are beneficial, showing small but statistically significant differences in duration of organ support and large but non-significant cost reductions at 30 days. In this pre-specified analysis of the Oxy-PICU trial, we compare longer-term outcomes and cost-effectiveness of conservative versus liberal (SpO&lt;sub&gt;2&lt;/sub&gt; &gt;94%) oxygenation targets in children with emergency PICU admission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Oxy-PICU was a pragmatic, multicentre, open-label, randomised controlled trial in England and Scotland. Eligible children were older than 38 weeks and younger than 16 years and had been admitted for emergency care in one of 15 participating PICUs, where they received invasive respiratory support for abnormal gas exchange. Participants were randomly assigned (1:1) to either a conservative oxygenation target (SpO&lt;sub&gt;2&lt;/sub&gt; 88-92%) or liberal oxygenation target (SpO&lt;sub&gt;2&lt;/sub&gt; &gt;94%). Survival status was assessed at 90 days and 1 year, and health-related quality of life (HRQoL), quality-adjusted life-years (QALYs), health-care costs, and incremental net monetary benefit were assessed at 1 year after the index hospital admission and randomisation. HRQoL was measured with age-appropriate Paediatric Quality of Life Generic Core Scales and mapped onto the Child Health Utility 9D index score. HRQoL and survival data were combined to construct QALYs. Costs at 1 year were derived from use of hospital, outpatient, and community health services. The trial was registered in the ISRCTN registry (ISRCTN92103439).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;2040 children were enrolled between Sept 1, 2020 and May 15, 2022. 1868 (91·6%) children were included in the 90-day survival analysis; of these 930 (49·8%) had been assigned liberal oxygen and 938 (50·2%) conservative oxygen. 1867 (91·5%) children were included in the 1-year survival analysis; 930 (49·8%) had been assigned liberal oxygenation and 937 (50·2%) conservative oxygen. At 90 days, 35 (3·7%) patients in the conservative oxygenation group and 45 (4·8%) patients in the liberal oxygenation group had died (adjusted hazard ratio [aHR] 0·75 [95% CI 0·48 to 1·17]). By 1 year, 52 (5·5%) patients in the conservative oxygenation group and 66 (7·1%) patients in the liberal oxygenation group had died (aHR 0·77 [95%CI 0·53 to 1·10]). Overall, mean HRQoL, life-years, and QALYs at 1 year were similar in the two groups. The adjusted incremental effect on cost of conservative oxygenation versus liberal oxygenation was -£879 (95% CI -9036 to 7278), whereas the incremental difference in QALYs was estimated at 0·001 (-0·010 to 0·011), leading to an incremental net moneta","PeriodicalId":94246,"journal":{"name":"The Lancet. Child & adolescent health","volume":"9 1","pages":"16-24"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}