95 reads in the past 30 days
New WHO guideline on the prevention and management of acute malnutrition in infants and young children: remaining challengesMay 2024
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1,015 Reads
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1 Citation
Published by BMJ Group and Royal College of Paediatrics and Child Health
Online ISSN: 2399-9772
95 reads in the past 30 days
New WHO guideline on the prevention and management of acute malnutrition in infants and young children: remaining challengesMay 2024
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1,015 Reads
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1 Citation
60 reads in the past 30 days
Adenoid hypertrophy in children: a narrative review of pathogenesis and clinical relevanceApril 2023
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2,210 Reads
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48 Citations
51 reads in the past 30 days
OP-004 To study prevalence and pattern of behavioral problems among adolescentsJuly 2024
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60 Reads
46 reads in the past 30 days
Parental detection of neonatal jaundice using a low-cost colour card: a multicentre prospective studyJune 2023
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878 Reads
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2 Citations
41 reads in the past 30 days
Risk of neuropsychiatric adverse events associated with montelukast use in children and adolescents: a population-based case-crossover studySeptember 2024
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88 Reads
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1 Citation
BMJ Paediatrics Open is an open-access journal publishing original research, clinical reviews and protocols dealing with all aspects of child health. The provision of child health is multidisciplinary and the journal welcomes papers from all health care professions. The journal publishes papers in paediatric surgery, paediatric specialties, public health, healthcare provision and qualitative research.
BMJ Paediatrics Open is a companion journal to Archives of Disease in Childhood co-owned by BMJ Group and Royal College of Paediatrics and Child Health (RCPCH).
February 2025
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6 Reads
Objective To assess the relationship between plasma ferritin concentrations and (1) antenatal factors and (2) requirement for red cell transfusion. Study design This single-site prospective study recruited infants in the first week of life who were born <32 weeks’ corrected gestational age and did not receive a red cell transfusion prior to sampling. Ferritin concentrations were assessed on discard plasma taken as part of routine neonatal investigations in the first week of life (median day of life=3, IQR 2–5 days). Reasons for delivery, placental histology and demographics were recorded. Results Plasma ferritin concentrations were not significantly associated with birth weight or gestational age in this cohort of extremely/very preterm neonates (n=114: n=26, <28 weeks’ corrected gestational age; n=88, 28–32 weeks’ corrected gestational age). Neonates exposed to chorioamnionitis had an increased ferritin concentration versus those who were not. Neonates exposed to pre-eclampsia had a significantly lower ferritin concentration than those who were not. Early ferritin concentration was not associated with time to transfusion in a time to event analysis. Conclusions Plasma ferritin concentrations in very/extremely preterm neonates are variable and associated with the intrauterine environment. Ferritin concentration was not predictive of time to transfusion in this cohort and was not significantly different at smaller birth weight or earlier gestation. This is important for considerations of iron storage in very preterm neonates and its developmental consequences.
February 2025
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7 Reads
Background It is essential to embed patient and public perspectives into every stage of the research journey, including setting the future research agenda. The substantial gaps in our understanding of prematurity-associated lung disease presented a timely opportunity to determine the community’s research priorities. Objective To conduct a priority setting partnership (PSP) to determine the top 10 research priorities for preterm lung health. Design We undertook a modified James Lind Alliance methodology comprising three main stages: (1) an idea generating survey with open questions to ascertain the community’s most important ideas for future preterm lung health research, (2) prioritisation survey to distill the main themes into a shortlist of 20 and (3) consensus workshop where participants were tasked with ranking their final top 10. This PSP is reflective of the view of preterm-born individuals, parents of preterm children and healthcare professionals in an Australian healthcare setting. Results We collated 144 submissions from the idea generating survey from which 27 prioritisation themes were developed. From the 150 prioritisation survey responses, the 20 themes receiving the most votes were taken to the consensus workshop . Participants identified the following top 10: (1) lifelong impacts; (2) interventions, treatments or supports; (3) ongoing lung health follow-up; (4) diagnostic tools, resources and education for primary healthcare providers; (5) resources to inform and empower families; (6) relationship to physical health and developmental issues; (7) preventing and/or treating lung infections; (8) additional supports, resources and research for minority groups; (9) impact on mental well-being; and (10) likelihood of asthma diagnosis. Conclusion Priorities identified through the PSP will be invaluable in informing future research into prematurity-associated lung disease.
February 2025
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Introduction Functional constipation is common in childhood, with chronicity leading to a significant impact on patients and their families. There is a significant range of therapies available to healthcare professionals for this condition, with many novel or recently studied. There is a need for an update to the joint European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)/North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) guidelines last released in 2014. We present the prospectively agreed operating procedure and technical review protocol in this manuscript. Methods ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE) will be used for all phases of this guideline development. The Guideline Development Group is formed by paediatric gastroenterologists from both the ESPGHAN as well as the NASPGHAN. A prospective exercise will agree on key outcomes, thresholds of magnitude that are significant at small, moderate and large levels. Systematic evidence searches, selection, extraction, appraisal and analysis will be performed following Cochrane guidance and GRADE guidance for objectively agreeing the certainty of findings. Additional use of network meta-analysis will identify areas of broad triangulation in the evidence. Summary of findings tables will be produced and inform evidence to decision frameworks. These will guide GRADE recommendations with voting to reach a consensus.
February 2025
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2 Reads
Background Human milk (HM) is considered a potential protective factor against bronchopulmonary dysplasia (BPD), but the specific volume needed for its protective effect in mixed feeding is unclear. This study aimed to investigate the impact of different HM volumes on BPD risk. Methods A retrospective cohort study examined the association between HM volume and BPD risk in very low birthweight (VLBW) infants. Dose-dependent analysis with spline smoothing curve and univariate, multivariate analyses and sensitivity analyses were conducted. Result The study included 339 VLBW infants. BPD incidence was 4.7% (6 infants) in the high HM group (HM volume≥1190 mL), 27.0% (48 infants) in the low HM group (HM volume<1190 mL) and 9.1% (3 infants) in the exclusive formula group, and the difference is statistically significant. Both univariate and multivariate logistic regression analyses showed significantly higher BPD incidence in the low HM group (OR 3.237, 95% CI 0.81 to 12.89) compared with the exclusive formula group. The sensitivity analysis showed that low HM remained a risk factor for BPD (model I OR 3.26, 95% CI 0.92 to 11.53; model II OR 3.28, 95% CI 0.81 to 13.1). Conclusion Higher HM volumes (≥1190 mL) were associated with decreased BPD risk compared with low HM and formula feeding. Although not statistically significant, the low HM group exhibited increased BPD incidence compared with the exclusive formula group. These findings emphasise the importance of considering HM quantity in mixed feeding practices.
January 2025
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9 Reads
Introduction Children with special healthcare needs (CSHCN) often experience vaccination delays or missed vaccines in China. The coverage rate of the age-appropriate National Immunisation Programme vaccine was suboptimal. This study aimed to explore attitudes, behaviours, and suggestions regarding the improvement of routine vaccination services for CSHCN among healthcare providers. Methods This study conducted local, cross-sectional interviews involving vaccination services for CSHCN. A purposive sampling strategy was used to recruit interviewees including primary care providers, paediatricians and immunisation programme administrators. The interview guide explored attitudes towards and suggestions for establishing immunisation advisory clinics and referral networks, updating immunisation guidance documents and vaccine package inserts and strengthening the education of vaccination providers. Results 21 representative healthcare providers were interviewed. 10 measures were proposed to promote routine immunisation for children with special needs: (1) using immunisation advisory clinics to provide vaccination services for CSHCN; (2) establishing a referral network and specifying which cases necessitate referral to advisory clinics; (3) using an interconnected information system to identify, document and follow-up the CSHCN; (4) supporting high-quality clinical research to update immunisation protocols; (5) providing clear and definite immunisation recommendations to parents of eligible CSHCN; (6) seeking immunisation advice from specialised professionals to enhance primary care capability; (7) creating quality improvement programmes; (8) considering immunisation status a mandatory assessment during specialist visits; (9) supporting off-label use of vaccines legally and (10) encouraging pharmaceutical companies to update vaccine package inserts. Conclusion Vaccine uptake among CSHCN in China is suboptimal, highlighting the need for a referral network and a standard immunisation protocol. The National Immunisation Programme should develop clear recommendations and an education programme for regional Centers for Disease Control and Prevention to train local providers. A quality assurance and improvement programme, along with regular feedback, is essential to ensure CSHCN receive necessary vaccinations and protection against infectious diseases.
January 2025
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7 Reads
Objective To investigate the associations between neonatal unit admission (NNU) and subsequent emotional and behavioural difficulties during childhood and adolescence. Design Longitudinal general population cohort study. Setting The Millennium Cohort Study: nationally representative UK-based cohort. Participants All children with exposure, outcome and confounding data. Exposure NNU admission was identified at 9 months by asking parents whether their baby was ‘taken to special care or neonatal or intensive care unit after birth’. Main outcome measures Emotional and behavioural problems were assessed using the Strengths and Difficulties Questionnaire when children were 3, 5, 7, 11, 14 and 17 years. We explored the association between NNU admission and trajectories of emotional and behavioural problems using multilevel models with growth curves for outcome data between 3–17 years and adjusted for a broad range of confounders. Results 14 013 participants (48.9% female, 13.7% ethnic minority) were included in the analytical sample. In the sample, mean gestational age was 275.81 (SD): 13.80) days, and mean birth weight was 3.36 kg (SD=0.58). 1273 (9.1%) participants had an NNU admission. The latter was associated with increased emotional difficulties (mean difference (MD) 0.13, 95% CI 0.045 to 0.22, p=0.003) and peer problems (MD 0.11, 95% CI 0.026 to 0.19, p=0.010) during childhood in fully adjusted models. There was no evidence that NNU admission was associated with conduct problems (MD 0.013, 95% CI −0.062 to 0.088, p=0.732) or hyperactivity symptoms (MD 0.042, 95% CI −0.070 to 0.15, p=0.452). Conclusions Children admitted to NNUs at birth are more likely to experience emotional difficulties and peer problems during childhood. These differences are apparent from early childhood continuing into adolescence and strengthen the case for a calm NNU environment with parental visits and mental health support, and early interventions for children admitted to NNUs.
January 2025
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1 Read
Objective To explore whether parents’ attendance at a commercial adult weight management programme (WMP) offers an opportunity to identify and signpost families to child weight management support, if appropriate to a child’s weight status. Design Mixed methods study including a cross-sectional online survey and semistructured telephone interviews. Setting and participants Parents attending Slimming World (UK-based adult commercial WMP), with one or more children aged 5–11 years, were invited to take part. There were 396 survey and 18 telephone interview participants. Results Most parents (78%) attending the adult WMP and worried about their child’s weight were receptive to being offered support for their child. Nearly all (98%) of these parents were happy for the adult WMP to signpost to this support. Nearly half of parents (47%, n=122/262) not worried about their child’s weight were still interested in a child height and weight check. The preferred intervention format and delivery possibilities differed among parents, with ‘no-one size fits all’, while recognising that change takes time, and weekly sessions may be too frequent. Parents were clear that the focus of support should be on healthy lifestyle not weight. Many parents felt a parent ‘peer support’ group would be helpful. Conclusions Parents actively addressing their own weight, through an adult WMP, are receptive to being offered and signposted to support for their child, where they have concerns about their child’s weight. These findings support a new referral pathway into child weight management services, through parents attending an adult WMP.
January 2025
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26 Reads
Introduction In Europe, disparities exist in having access to optimal neonatal care. With the European Standards of Care for Newborn Health (ESCNH), evidence-based reference standards are available which provide guidance to improve the care for preterm and ill newborns. To support healthcare professionals (HCPs) and hospital/clinic management in identifying the extent of ESCNH implementation, a feasible assessment tool is required. Such a tool should help identify areas in need of improvement and provide clear recommendations for action. We aim to develop a digital self-assessment tool for HCPs to detect the local level of ESCNH fulfilment and identify areas in need of improvement, and thus provide recommendations for action. Methods and analysis The self-assessment tool will have the form of a digital questionnaire with condensed ESCNH content. A Project Expert Group provides scientific input. With pretesting among HCPs, a template of a questionnaire section is evaluated and adapted accordingly. The subsequently developed full questionnaire will be appraised within a two-round eDelphi survey by at least 50 invited HCPs. Statements and formulations need to be accepted by at least 80% of participants. The remaining discrepancies will be solved in a final workshop. The resulting digital self-assessment tool (SAT) will be translated into several languages and evaluated in a pilot-testing among at least 20 hospitals/clinics across Europe. Conclusion With the self-reflection through the SAT, HCPs, hospital/clinic managers, policymakers and other stakeholders will receive feedback on the conformity with the ESCNH and guidance for improvement. Trial registration number NCT06379828 .
January 2025
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11 Reads
Background Ambulatory care sensitive conditions (ACSCs) are those for which hospital admission could be prevented by interventions in primary care. Children living in socioeconomic disadvantage have higher rates of emergency admissions for ACSCs than their more affluent counterparts. Emergency admissions for ACSCs have been increasing, but few studies have assessed how changing socioeconomic conditions (SECs) have impacted this. This study investigates the association between local SECs and emergency ACS hospital admissions in children in England. Methods We examined longitudinal trends in emergency admission rates for ACSCs and investigate the association between local SECs and these admissions in children over time in England, using time-varying neighbourhood unemployment as a proxy for SECs. Fixed-effect regression models assessed the relationship between changes in neighbourhood unemployment and admission rates, controlling for unmeasured time-invariant confounding of each neighbourhood. We also explore the extent to which this relationship differs by acute and chronic ACSCs and is explained by access to primary and secondary care. Results Between 2012 and 2017, paediatric emergency admissions for acute ACSCs increased, while admissions for chronic ACSCs decreased. At the neighbourhood level, each 1% point increase in unemployment was associated with a 3.9% and 2.7% increase in the rate of emergency admissions for acute ACSCs, for children aged 0–9 years and 10–19 years, respectively. A 2.6% increase in admission rates for chronic ACSCs was observed, driven by an association in 0–9 years old. Adjustment for primary and secondary care access did not meaningfully attenuate the magnitude of this association. Conclusions Increasing trends in neighbourhood unemployment were associated with increases in paediatric emergency admission rates for ACSCs in England. This was not explained by available measures of differential access to care, suggesting policy interventions should address the causes of unemployment and poverty in addition to health system factors to reduce emergency admissions for ACSCs.
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Editor-in-Chief
University of New South Wales, Sydney, Australia
Associate Editor
London School of Hygiene and Tropical Medicine, United Kingdom
Associate Editor
Oyster Woman and Child Hospital, Bengaluru, India