BMJ Paediatrics Open
EISSN : 2399-9772
Published by: BMJ (10.1136)
Total articles ≅ 523
Latest articles in this journal
BMJ Paediatrics Open, Volume 5; https://doi.org/10.1136/bmjpo-2021-001193
Background Neonatal transmission of SARS-CoV-2 from positive mothers to their babies has been a real concern, opening the arena of research in this area. Objective To detect the possibility of vertical transmission of SARS-CoV-2 from COVID-19-positive mothers to their neonates and the clinicopathological outcome in them. Design A single-centre, prospective, observational study involving 47 COVID-19-positive mothers and their neonates. Setting A tertiary care hospital in Eastern India. Participants Neonates born to SARS-CoV-2-infected mothers. Main outcome measures We investigated the SARS-CoV-2 positivity rate by real-time reverse transcriptase-PCR (RT-PCR) done twice (on admission and after 24 hours of admission) in neonates born to SARS-CoV-2-positive mothers, who tested RT-PCR positive for this virus in their nasopharyngeal swab. Clinical outcome was also assessed in these neonates during their hospital stay. Results Out of 47 neonates born to SARS-CoV-2-positive mothers, four were SARS-CoV-2 positive by RT-PCR. All the neonates in our study were discharged home in stable condition after management of acute complications. None of them required readmission. Conclusion Vertical transmission occurs in neonates born to COVID-19-positive mothers; however, the risk is small. Majority of the neonates remain asymptomatic with good clinical outcome.
BMJ Paediatrics Open, Volume 5; https://doi.org/10.1136/bmjpo-2021-001195
Objectives To study (1) epidemiological factors, clinical profile and outcomes of COVID-19 related multisystem inflammatory syndrome in children (MIS-C), (2) clinical profile across age groups, (3) medium-term outcomes and (4) parameters associated with disease severity. Design Hospital-based prospective cohort study. Setting Two tertiary care centres in Kerala, India. Participants Diagnosed patients of MIS-C using the case definition of Centres for Disease Control and Prevention. Statistical analysis Pearson χ2 test or Fisher’s exact test was used to compare the categorical variables and independent sample t-test or Mann-Whitney test was used to compare the continuous variables between the subgroups categorised by the requirement of mechanical ventilation. Bonferroni’s correction was used for multiple comparisons. Results We report 41 patients with MIS-C, mean age was 6.2 (4.0) years, and 33 (80%) were previously healthy. Echocardiogram was abnormal in 23 (56%), and coronary abnormalities were noted in 15 (37%) patients. Immunomodulatory therapy was administered to 39 (95%), steroids and IVIg both were used in 35 (85%) and only steroids in 3 (7%) patients. Intensive care was required in 36 (88%), mechanical ventilation in 8 (20%), inotropic support in 21 (51%), and 2 (5%) patients died. Mechanical ventilation requirement in MIS-C was associated with hyperferritinaemia (p=0.001). Thirty-seven patients completed 3 months follow-up by April 2021, of whom 6 (16%) patients had some residual echocardiographic changes. Conclusions Patients with MIS-C in our cohort had varied clinical manifestations ranging from fever with mild gastrointestinal and mucocutaneous involvement to fatal multiorgan dysfunction. Immediate and medium-term outcomes remain largely excellent except for the echocardiographic sequelae in a few patients which are also showing a resolving trend. Hyperferritinaemia was associated with the requirement of mechanical ventilation.
BMJ Paediatrics Open, Volume 5; https://doi.org/10.1136/bmjpo-2021-001224
Introduction The I-KID study aims to determine the clinical efficacy, outcomes and safety of a novel non-CE-marked infant haemodialysis machine, the Newcastle Infant Dialysis Ultrafiltration System (NIDUS), compared with currently available therapy in the UK. NIDUS is specifically designed for renal replacement therapy in small babies between 0.8 and 8 kg. Methods and analysis The clinical investigation is taking place in six UK centres. This is a randomised clinical investigation using a cluster stepped-wedge design. The study aims to recruit 95 babies requiring renal replacement therapy in paediatric intensive care units over 20 months. Ethics and dissemination The study has high parent and public involvement at all stages in its design and parents will be involved in dissemination of results to parents and professionals via publications, conference proceedings and newsletters. The study has has ethics permissions from Tyne and Wear South Research Ethics Committee. Trial registration numbers IRAS ID number: 170 481 MHRA Reference: CI/2017/0066 ISRCT Number: 13 787 486 CPMS ID number: 36 558 NHS REC reference: 16/NE/0008 Eudamed number: CIV-GB-18-02-023105 Link to full protocol v6.0: https://fundingawards.nihr.ac.uk/award/14/23/26
BMJ Paediatrics Open, Volume 5; https://doi.org/10.1136/bmjpo-2021-001168
Objective Hypothermia is believed to affect more than half of Ethiopian neonates. The goal of this study is to determine risk factors for newborn hypothermia in neonates admitted to public hospitals in the east Wollega zone of western Ethiopia’s neonatal intensive care unit. Design Unmatched case–control study using neonates admitted to the intensive care unit. Setting Neonatal intensive care units at public hospitals in western Ethiopia. Patients Neonates admitted to intensive care units. Main outcomes The cases were all neonates with hypothermia (less than 36.5°C) and the controls were all neonates with a body temperature of greater or equal to 36.5°C when admitted to the neonatal intensive care unit for other reasons. Results The study involved the participation of 73 cases and 146 controls. The study found that delayed breastfeeding initiation after 1 hour (adjusted OR (AOR)=3.72; 95% CI: 1.39 to 10.00), admission weight less than 2500 g (AOR=3.43; 95% CI: 1.18 to 9.97), cardiopulmonary resuscitation at birth (AOR=3.42; 95% CI: 1.16 to 10.10.08), lack of immediate skin-to-skin contact with their mother (AOR=4.54; 95% CI: 1.75 to 11.81), night-time delivery (AOR=6.63; 95% CI: 2.23 to 19.77) and not wearing a cap (AOR=2.98; 95% CI: 1.09 to 8.15) were all associated with newborn hypothermia. Conclusions Neonatal hypothermia was associated with obstetric, neonatal and healthcare provider factors. As a result, special consideration should be given to the thermal care of low birthweight neonates and the implementation of warm-chain principles with low-cost thermal protection in Ethiopian public health facilities.
BMJ Paediatrics Open, Volume 5; https://doi.org/10.1136/bmjpo-2021-001206
Background Asthma is the most common chronic condition of childhood. Leukotriene receptor antagonists (LTRAs) are included in international guidelines for children and young people (CYP), but there have been highly publicised concerns about potential adverse effects. The aim was to identify and understand the reported frequency of adverse drug reactions (ADRs) attributed to LTRAs in CYP with asthma. Methods Embase, MEDLINE, PubMed and CINAHL were searched up to October 2020. Reference lists of eligible papers were manually screened. Eligible studies identified adverse events attributed to an LTRA in individuals aged between 0 and 18 years diagnosed with asthma. Four different tools were used to assess risk of bias or quality of data to accommodate the papers assessed. Results The search identified 427 papers after deduplication; 15 were included (7 case reports, 7 case–controlled or cohort studies and 1 randomised control trial (RCT)). 7012 patients were recorded, of which 6853 received an LTRA. 13 papers examined the ADRs attributed to montelukast, one to pranlukast and one to unspecified LTRAs. After language standardisation, 48 ADRs were found, 20 of which were psychiatric disorders. Across all studies, the most commonly reported ADRs were ‘anxiety’, ‘sleep disorders’ and ‘mood disorders’. The frequency of ADRs could be calculated in seven of the eight studies. Applying standardised frequency terms to the prospective studies and RCT, there were 14 ‘common’ and ‘uncommon’ ADRs. ‘Common’ ADRs included ‘agitation/hyperactivity/irritability/nervousness’, ‘aggression’ and ‘headache’. The case reports showed a similar pattern, describing 46 different ADRs experienced by a total of eight patients. Conclusions LTRAs have a wide range of suspected ADRs in CYP, predominantly gastrointestinal and neuropsychiatric disorders. Careful monitoring of CYP with asthma is required, both to assess and manage ADRs and to step treatment down when clinically stable. PROSPERO registration number CRD42020209627.
BMJ Paediatrics Open, Volume 5; https://doi.org/10.1136/bmjpo-2021-001116
Direct risk from infection from COVID-19 for children and young people (CYP) is low, but impact on services, education and mental health (so-called collateral damage) appears to have been more significant. In North Central London (NCL) during the first wave of the pandemic, in response to the needs and demands for adults with COVID-19, general paediatric wards in acute hospitals and some paediatric emergency departments were closed. Paediatric mental health services in NCL mental health services were reconfigured. Here we describe process and lessons learnt from a collaboration between physical and mental health services to provide care for CYP presenting in mental health crisis. Two new ‘hubs’ were created to coordinate crisis presentations in the region and to link community mental health teams with emergency departments. All CYP requiring a paediatric admission in the first wave were diverted to Great Ormond Street Hospital, a specialist children’s hospital in NCL, and a new ward for CYP mental health crisis admissions was created. This brought together a multidisciplinary team of mental health and physical health professionals. The most common reason for admission to the ward was following a suicide attempt (n=17, 43%). Patients were of higher acute mental health complexity than usually admitted to the hospital, with some CYP needing an extended period of assessment. In this review, we describe the challenges and key lessons learnt for the development of this new ward setting that involved such factors as leadership, training and also new governance processes. We also report some personal perspectives from the professionals involved. Our review provides perspective and experience that can inform how CYP with mental health admissions can be managed in paediatric medical settings.
BMJ Paediatrics Open, Volume 5; https://doi.org/10.1136/bmjpo-2021-001207
Background Stimulation of non-crying neonates after birth can help transition to spontaneous breathing. In this study, we aim to assess the impact of intact versus clamped umbilical cord on spontaneous breathing after stimulation of non-crying neonates. Methods This is an observational study among non-crying neonates (n=3073) born in hospitals of Nepal. Non-crying neonates born vaginally at gestational age ≥34 weeks were observed for their response to stimulation with the cord intact or clamped. Obstetric characteristics of the neonates were analysed. Association of spontaneous breathing with cord management was assessed using logistic regression. Results Among non-crying neonates, 2563 received stimulation. Of these, a higher proportion of the neonates were breathing in the group with cord intact as compared with the group cord clamped (81.1% vs 68.9%, p<0.0001). The use of bag-and-mask ventilation was lower among those who were stimulated with the cord intact than those who were stimulated with cord clamped (18.0% vs 32.4%, p<0.0001). The proportion of neonates with Apgar Score ≤3 at 1 min was lower with the cord intact than with cord clamped (7.6% vs 11.5%, p=0.001). In multivariate analysis, neonates with intact cord had 84% increased odds of spontaneous breathing (adjusted OR, 1.84; 95% CI: 1.48 to 2.29) compared with those with cord clamped. Conclusions Stimulation of non-crying neonates with intact cord was associated with more spontaneous breathing than among infants who were stimulated with cord clamped. Intact cord stimulation may help establish spontaneous breathing in apnoeic neonates, but residual confounding variables may be contributing to the findings. This study provides evidence for further controlled research to evaluate the effect of initial steps of resuscitation with cord intact.
BMJ Paediatrics Open, Volume 5; https://doi.org/10.1136/bmjpo-2021-001139
Background Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is disabling and relatively common. Although evidenced-based treatments are available, at least 15% of children remain symptomatic after one year of treatment. Acceptance and commitment therapy (ACT) is an alternative therapy option; however, little is known about whether it is an acceptable treatment approach. Our aim was to find out if adolescents who remain symptomatic with CFS/ME after 12 months of treatment would find ACT acceptable, to inform a randomised controlled trial (RCT) of ACT. Methods We recruited adolescents (diagnosed with CFS/ME; not recovered after one year of treatment; aged 11–17 years), their parent/carer and healthcare professionals (HCPs) from one specialist UK paediatric CFS/ME service. We conducted semi-structured interviews to explore barriers to recovery; views on current treatments; acceptability of ACT; and feasibility of an effectiveness RCT. Thematic analysis was used to identify patterns in data. Results Twelve adolescents, eleven parents and seven HCPs were interviewed. All participants thought ACT was acceptable. Participants identified reasons why ACT might be efficacious: pragmatism, acceptance and compassion are valued in chronic illness; values-focussed treatment provides motivation and direction; psychological and physical needs are addressed; normalising difficulties is a useful life-skill. Some adolescents preferred ACT to cognitive behavioural therapy as it encouraged accepting (rather than challenging) thoughts. Most adolescents would consent to an RCT of ACT but a barrier to recruitment was reluctance to randomisation. All HCPs deemed ACT feasible to deliver. Some were concerned patients might confuse ‘acceptance’ with ‘giving up’ and called for clear explanations. All participants thought the timing of ACT should be individualised. Conclusions All adolescents with CFS/ME, parents and HCPs thought ACT was acceptable, and most adolescents were willing to try ACT. An RCT needs to solve issues around randomisation and timing of the intervention.
BMJ Paediatrics Open, Volume 5; https://doi.org/10.1136/bmjpo-2020-001014
Background On 23 March 2020, schools closed to most children in England in response to COVID-19 until September 2020. Schools were kept open to children of key workers and vulnerable children on a voluntary basis. Starting 1 June 2020, children in reception (4–5 years old), year 1 (5–6 years old) and year 6 (10–11 years old) also became eligible to attend school. Methods 1373 parents or guardians of children eligible to attend school completed a cross-sectional survey between 8 and 11 June 2020. We investigated factors associated with whether children attended school or not. Results 46% (n=370/803) of children in year groups eligible to attend school and 13% (n=72/570) of children of key workers had attended school in the past 7 days. The most common reasons for sending children to school were that the child’s education would benefit, the child wanted to go to school and the parent needed to work. A child was significantly more likely to attend if the parent believed the child had already had COVID-19, they had special educational needs or a person in the household had COVID-19 symptoms. Conclusions Following any future school closure, helping parents to feel comfortable returning their child to school will require policy makers and school leaders to communicate about the adequacy of their policies to: (A) ensure that the risk to children in school is minimised; (B) ensure that the educational potential within schools is maximised; and (C) ensure that the benefits of school for the psychological well-being of children are prioritised.
BMJ Paediatrics Open, Volume 5; https://doi.org/10.1136/bmjpo-2021-001156
Around the world, one in four children live in a country affected by conflict, political insecurity and disaster. Healthcare in humanitarian and fragile settings is challenging and complex to provide, particularly for children. Furthermore, there is a distinct lack of medical literature from humanitarian settings to guide best practice in such specific and resource-limited contexts. In light of these challenges, Médecins Sans Frontières (MSF), an international medical humanitarian organisation, created the MSF Paediatric Days with the aim of uniting field staff, policymakers and academia to exchange ideas, align efforts, inspire and share frontline research and experiences to advance humanitarian paediatric and neonatal care. This 2-day event takes place regularly since 2016. The fourth edition of the MSF Paediatric Days in April 2021 covered five main topics: essential newborn care, community-based models of care, paediatric tuberculosis, antimicrobial resistance in neonatal and paediatric care and the collateral damage of COVID-19 on child health. In addition, eight virtual stands from internal MSF initiatives and external MSF collaborating partners were available, and 49 poster communications and five inspiring short talks referred to as ‘PAEDTalks’ were presented. In conclusion, the MSF Paediatric Days serves as a unique forum to advance knowledge on humanitarian paediatrics and creates opportunities for individual and collective learning, as well as networking spaces for interaction and exchange of ideas.