首页期刊导航|Archives of disease in childhood.
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Archives of disease in childhood.
BMJ Pub. Group [etc.]
Archives of disease in childhood.

BMJ Pub. Group [etc.]

0003-6888

Archives of disease in childhood./Journal Archives of disease in childhood.
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    Atoms

    Nick Brown
    1页
    查看更多>>摘要：In the ‘old days’, textbooks were the source of information and wisdom. They were solid chunks of black and white knowledge painstakingly written over many years, each chapter compiled by an authority in the field, often one suspects a friend or collaborator of the editor. They were the final word in the respective fields, until... well, until the next revision appeared some 5-10 years later with an upholstered cover and extra lustre to the pages. only to be superseded again in due course. Key facts from each edition were pontificated over on ward rounds imbuing the consultant an air of (not always overtly specious) authority. They contained phrases like: ‘in my opinion’; ‘33% of children have a sweat chloride of >62mmol/L’; ‘the olfactory part of the examination is crucial in the differentiation between a primary and secondary amino aciduria’ and ‘dwarfism is a sine qua non of thanatophoric bone disease’. Time has moved on and authorial ego is now more fettered: well, perhaps not the ego itself, but the degree of certainty and dogma with which facts are represented. With the passage of time, we’ve been able to let go of a few old favourites (the secondhand bookshop, the departmental library, the house moving recycling cull) but some are simply immovable for emotional reasons, somehow etched in and adherent to our learning souls. While we can applaud the forward march of evidence rather than eminence-based medicine, it feels as if we’ve also lost something en route—the nous and passion of the clinical observer and the (quite touching) naivete in believing one’s own opinion to the exclusion of all others and the gall to assert it. As we fast forward to ever more online consumption, spare a thought for the real pioneers without whom we would not be here.
      原文链接:
    • NSTL

    Making the case for greater certainty in child protection

    Geoff DebelleAdam Oates
    2页
    查看更多>>摘要：Paediatricians, as with all healthcare professionals, have a duty to protect children from harm. They are called on to make the case for inflicted injury, often during a busy service week. If an inflicted injury to a child is not identified and acted on appropriately, the child or a sibling may present with further, serious or fatal injury, and, conversely, a decision in favour of inflicted injury that is not adjudicated as such may have serious human and societal consequences, including needless separation of the child from the family. This commentary and the related article by Arthurs et al~1 are book-ended by two such situations: the cases of two children removed from their respective parents on the basis of suspicious injuries, only to be returned to their parents following reappraisal of the radiological evidence by court-appointed experts, and the tragic cases of two children abused and murdered by their parents.
      原文链接:
    • NSTL
    • Bmj Publishing Group

    NICE and easy? Ensuring equitable access to NICE-approved treatments in children and young people

    Paul J TurnerNick MakwanaGraham RobertsAdam T Fox...
    2页
    查看更多>>摘要：The National Institute for Health and Care Excellence (NICE) recently approved Palforzia, an oral immunotherapy product for the treatment of peanut allergy in peanut-allergic children aged 4-17 years.~1 Palforzia contains precise amounts of defatted peanut powder and can be used to gradually increase the body’s ability to tolerate small amounts of peanut. It may also help reduce the severity of allergic reactions after being exposed to peanut.The approval of Palforzia represents a major step forward for the management of food-allergic patients in the National Health Service (NHS). There are approximately 140000 eligible patients with peanut allergy, but only a handful of specialist services able to provide the multiple visits needed to administer the treatment. These visits require significant space and staff resources, which many services lack. As a result, NHS England (NHSE) is limiting the number of eligible patients to 600 in the first year (and up to 2000 per annum thereafter).~2
      原文链接:
    • NSTL
    • Bmj Publishing Group

    Safeguarding children: are we getting it right?

    Owen J ArthursDavid WilliamsAlison Steele
    2页
    查看更多>>摘要：Safeguarding children is of paramount importance in modern society. Professionals work hard to identify potential problems in the community, and all National Health Service (NHS) workers, teachers and social workers undergo rigorous safeguarding training to detect and try to prevent child maltreatment. However, recent media coverage of two cases has highlighted the myriad challenges in this field, particularly the impact of clinical decision making in suspected physical abuse, and raises the question: are we getting it right?The Sunday Times recently covered two court cases in which children were removed from their parents following a provisional diagnosis of maltreatment. One child had bruising and a rib fracture diagnosed by local radiologists adhering to the Royal College of Paediatrics and Child Health (RCPCH) guidelines, but an expert radiologist appearing in the family court disagreed. In a different case of a child with more than one fracture, the court decided that the fractures had been caused accidentally.1 2 The children were returned to their parents. The implication in the media articles was that a different initial diagnosis would have spared these families from distress and the court process. This raises several overlapping issues in this field, including diagnostic uncertainty, when it is appropriate to remove a child following an initial diagnosis and the court’s overarching non-medical role in safeguarding our children.
      原文链接:
    • NSTL
    • Bmj Publishing Group

    Could conception, birth or life be 'wrong'?

    Robert Wheeler
    2页
    查看更多>>摘要：The thought of a person seeking compensation for being alive may cause bewilderment. Could this be a legitimate claim?There is a general assumption in English law that children can only make a claim for the effect of disabilities which they have suffered after some prenatal event, rather than for the very fact of being born with a disability. This latter ‘disallowed’ claim is known as one for 'wrongful life'. Parents, by contrast, might be able to claim for a wrongful conception or wrongful birth of a child born alive... who but for a clinician’s substandard care, would not have been born at all.Claims by parents of children born alive for wrongful conception can arise in various contexts, often related to imperfect sterilisation procedures, or flawed presterilisation counselling. By contrast, a wrongful birth claim is often founded on a failure to successfully terminate a pregnancy; or to screen for genetic abnormalities, or other relevant tests of the fetal health. In each case, the claim would relate to the mother continuing with an unwanted pregnancy or an initially planned pregnancy that the mother would have wished to terminate.
      原文链接:
    • NSTL
    • Bmj Publishing Group

    Microbiome and paediatric gut diseases

    Konstantinos GerasimidisKonstantinos GkikasChristopher StewartEsther Neelis...
    6页
    查看更多>>摘要：In the human gut resides a vast community of microorganisms which perform critical functions for the maintenance of whole body homeostasis. Changes in the composition and function of this community, termed microbiome, are believed to provoke disease onset, including non-communicable diseases. In this review, we debate the current evidence on the role of the gut microbiome in the pathogenesis, outcomes and management of paediatric gut disease. We conclude that even though the gut microbiome is altered in paediatric inflammatory bowel disease, coeliac disease, intestinal failure, necrotising enterocolitis and irritable bowel syndrome, there are currently very few implications for unravelling disease pathogenesis or guiding clinical practice. In the future, the gut microbiome may aid in disease differential diagnosis and prediction of clinical outcomes, and comprise a target for therapeutic interventions.
      原文链接:
    • NSTL
    • Bmj Publishing Group

    General population screening for childhood type 1 diabetes: is it time for a UK strategy?

    Rachel Elizabeth Jane BesserSze May NgJohn W GregoryColin M Dayan...
    6页
    查看更多>>摘要：Type 1 diabetes (T1D) is a chronic autoimmune disease of childhood affecting 1:500 children aged under 15 years, with around 25% presenting with life-threatening diabetic ketoacidosis (DKA). While first-degree relatives have the highest risk of T1D, more than 85% of children who develop T1D do not have a family history. Despite public health awareness campaigns, DKA rates have not fallen over the last decade. T1D has a long prodrome, and it is now possible to identify children who go on to develop T1D with a high degree of certainty. The reasons for identifying children presymptomatically include prevention of DKA and related morbidities and mortality, reducing the need for hospitalisation, time to provide emotional support and education to ensure a smooth transition to insulin treatment, and opportunities for new treatments to prevent or delay progression. Research studies of population-based screening strategies include using islet autoantibodies alone or in combination with genetic risk factors, both of which can be measured from a capillary sample. If found during screening, the presence of two or more islet autoantibodies has a high positive predictive value for future T1D in childhood (under 18 years), offering an opportunity for DKA prevention. However, a single time-point test will not identify all children who go on to develop T1D, and so combining with genetic risk factors for T1D may be an alternative approach. Here we discuss the pros and cons of T1D screening in the UK, the different strategies available, the knowledge gaps and why a T1D screening strategy is needed.
      原文链接:
    • NSTL
    • Bmj Publishing Group

    Immobilisation of torus fractures of the wrist in children

    1页
    查看更多>>摘要：A ‘torus’ (Greek for ‘bulge’ often seen at the base of Greek columns) fracture, or a ‘buckle’ fracture of the wrist, is one of the most common minor injuries seen in a Paediatric Emergency Department. Many centres will recommend cast immobilisation, discharge, follow-up, and repeat imaging. Is that the best way? Perry DC et al [Lancet 2022; 400: 39-47. DOI:https:// doi.org/10.1016/S0140-6736(22)01015-7] and the PERUKI research network have published a beautifully pragmatic, properly powered, randomised, open, equivalence study which compared pain and function in children with a distal radial torus fracture offered a soft bandage and immediate discharge and no follow-up with those receiving a more traditional management of rigid immobilisation and follow-up. They recruited 965 children (aged 4-15 years) presenting with a distal radius torus fracture (with or without associated ulnar fracture) from 23 hospitals in the UK. Children were randomly allocated in a 1:1 ratio to the offer of bandage group or rigid immobilisation group using a web-based randomisation software. Treating clinicians, participants, and their families could not be blinded to treatment allocation. Exclusion criteria included multiple injuries, greenstick fractures, diagnosis at more than 36 hours after injury, and inability to complete follow-up. The primary outcome was pain at 3 days post-randomisation measured using Wong-Baker FACES Pain Rating Scale. Secondary outcomes that were proxy reported for participants younger than 8 years and self-reported by participants aged 8 years and older were: functional recovery using Patient Report Outcomes Measurement System (PROMIS Bank version 2.0) Upper Extremity Score for Children Computer Adaptive Test, which was collected at baseline, 3, and 7 days, and 3 and 6 weeks and health-related quality of life using the EuroQol 3-level EQ-5DY (EQ-5DY-3L), which is a child-friendly version of the EQ-5D-3L. During the eighteen months recruitment period, 489 to the offer of a bandage group and 476 to the rigid immobilisation group, 586 (61%) were boys. Pain was equivalent at 3 days with 3·21 points (SD 2-08) in the offer of bandage group vs 3·14 points (2·11) in the rigid immobilisation group. With reference to a prespecified equivalence margin of 1·0, the adjusted difference in the intention-to-treat population was -0·10 (95% CI -0·37 to 0·17) and-0·06 (95% CI -0·34 to 0·21) in the per-protocol population. Essentially, this trial found equivalence in pain at 3 days in children with a torus fracture of the distal radius assigned to the offer of a bandage group or the rigid immobilisation group, with no between-group differences in pain or function during the 6 weeks of follow-up. There were no safety concerns. So, it appears that this form of de-escalation the treatment of children with a torus fracture of the distal radius is appropriate. These results will be incorporated into the next updated UK National Institute for Health and Care Excellence guideline with an aim to rationalise the overuse of healthcare resources. This is another example of how a well-organised research network delivers a simple answer to a simple question. Congratulations to the researchers for such a well-constructed study.
      原文链接:
    • NSTL
    • Bmj Publishing Group

    Acceptability of different oral dosage forms in paediatric patients in hospital setting

    Varsha PokharkarManjusha SajithThibault ValletShruti Akshantal...
    6页
    查看更多>>摘要：Objective The understanding of acceptability of existing dosage forms is limited in most of the world and hinders the development of acceptable, age-appropriate medicines. The attributes of paediatric medicine acceptability may differ from country to country based on culture, healthcare infrastructure and health policies. This study was designed to map the acceptability of oral medicines in paediatric patients treated in hospital in India.Methods An observational, cross-sectional study was conducted in patients aged below 18 years and taking any form of oral medication. Acceptability scores were obtained using CAST-ClinSearch Acceptability Score Test tool.Findings 490 patients were recruited and 193 evaluations of different pharmaceutical products available in 20 dosage forms and 7 routes of administration were studied. Oral liquids (50%) and tablets (35%) were the most commonly prescribed and administered forms. Regardless of the therapeutic class and age, the oral liquids were 'positively accepted’ in infants and toddlers. Acceptability of tablets improved with age and appeared to be generally good from the age of 6.Conclusion This study indicates the limited progress towards adoption of age-appropriate dosage forms in India and thus impact on the acceptability of existing oral dosage forms. The key challenges posed by the adoption of age-appropriate formulations in India are (1) awareness of importance of appropriate administration and acceptability of medicines to children in India, (2) availability of age-appropriate dosage forms and (3) lack of child-appropriate medicine policies.
      原文链接:
    • NSTL
    • Bmj Publishing Group

    Randomised controlled trial of fosfomycin in neonatal sepsis: pharmacokinetics and safety in relation to sodium overload

    Christina W ObieroPhoebe WilliamsSheila MurungaJohnstone Thitiri...
    9页
    查看更多>>摘要：Objective To assess pharmacokinetics and changes to sodium levels in addition to adverse events (AEs) associated with fosfomycin among neonates with clinical sepsis.Design A single-centre open-label randomised controlled trial.Setting Kilifi County Hospital, Kenya.Patients 120 neonates aged <28 days admitted being treated with standard-of-care (SOC) antibiotics for sepsis: ampicillin and gentamicin between March 2018 and February 2019.Intervention We randomly assigned half the participants to receive additional intravenous then oral fosfomycin at 100 mg/kg two times per day for up to 7 days (SOC-F) and followed up for 28 days.Main outcome(s) and measure(s) Serum sodium, AEs and fosfomycin pharmacokinetics.Results 61 and 59 infants aged 0-23 days were assigned to SOC-F and SOC, respectively. There was no evidence of impact of fosfomycin on serum sodium or gastrointestinal side effects. We observed 35 AEs among 25 SOC-F participants and 50 AEs among 34 SOC participants during 1560 and 1565 infant-days observation, respectively (2.2 vs 3.2 events/100 infant-days; incidence rate difference -0.95 events/100 infant-days (95% CI -2.1 to 0.20)). Four SOC-F and 3 SOC participants died. From 238 pharmacokinetic samples, modelling suggests an intravenous dose of 150 mg/kg two times per day is required for pharmacodynamic target attainment in most children, reduced to 100 mg/kg two times per day in neonates aged <7 days or weighing <1 500 g.Conclusion and relevance Fosfomycin offers potential as an affordable regimen with a simple dosing schedule for neonatal sepsis. Further research on its safety is needed in larger cohorts of hospitalised neonates, including very preterm neonates or those critically ill. Resistance suppression would only be achieved for the most sensitive of organisms so fosfomycin is recommended to be used in combination with another antimicrobial.Trial registration number NCT03453177.
      原文链接:
    • NSTL
    • Bmj Publishing Group