Archives of Disease in Childhood

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ISSN / EISSN : 0003-9888 / 1468-2044
Published by: BMJ (10.1136)
Total articles ≅ 32,240
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, Mark D Lyttle, Charlotte Munday, Steven Foster, Marc McNulty, Rebecca Platt, Michael Barrett, Emma Rogers, Sheena Durnin, Nida Jameel, et al.
Published: 16 September 2021
by BMJ
Archives of Disease in Childhood; https://doi.org/10.1136/archdischild-2021-322586

Abstract:
Objective To report the performance of clinical practice guidelines (CPG) in the diagnosis of serious/invasive bacterial infections (SBI/IBI) in infants presenting with a fever to emergency care in the UK and Ireland. Two CPGs were from the National Institutes for Health and Care Excellence (NICE guidelines NG51 and NG143) and one was from the British Society for Antimicrobial Chemotherapy (BSAC). Design Retrospective multicentre cohort study. Patients Febrile infants aged 90 days or less attending between the 31 August 2018 to 1 September 2019. Main outcome measures The sensitivity, specificity and predictive values of CPGs in identifying SBI and IBI. Setting Six paediatric Emergency Departments in the UK/Ireland. Results 555 participants were included in the analysis. The median age was 53 days (IQR 32 to 70), 447 (81%) underwent blood testing and 421 (76%) received parenteral antibiotics. There were five participants with bacterial meningitis (1%), seven with bacteraemia (1%) and 66 (12%) with urinary tract infections. The NICE NG51 CPG was the most sensitive: 1.00 (95% CI 0.95 to 1.00). This was significantly more sensitive than NICE NG143: 0.91 (95% CI 0.82 to 0.96, p=0.0233) and BSAC: 0.82 (95% 0.72 to 0.90, p=0.0005). NICE NG51 was the least specific 0.0 (95% CI 0.0 to 0.01), and this was significantly lower than the NICE NG143: 0.09 (95% CI 0.07 to 0.12, p<0.0001) and BSAC: 0.14 (95% CI 0.1 to 0.17, p<0.0001). Conclusion None of the studied CPGs demonstrated ideal performance characteristics. CPGs should be improved to guide initial clinical decision making. Trial registration number NCT04196192.
Kate Parmenter, Andrew Brookes, Sarah Burn, Emma Gamwell, Peter Jenkins, Maria McPhee, Sarah Webb, Rajeeva Singh, Sal Uka, Beki James
Published: 14 September 2021
by BMJ
Archives of Disease in Childhood; https://doi.org/10.1136/archdischild-2021-322217

, Simon Chapman, Karen Nicola Street, Dasha Nicholls, , Bernadka Dubicka, Faith Gibson, Gabrielle Mathews,
Published: 14 September 2021
by BMJ
Archives of Disease in Childhood; https://doi.org/10.1136/archdischild-2021-322700

Abstract:
This is an anonymous online survey, circulated in April 2021, to an established network of 62 paediatricians from 62 paediatric units in England. We asked for estimates of numbers, proportions and clinical care required for patients admitted with primary …
, Caroline Haig, Ulla Harjunmaa, Harshine Sivakanthan,
Published: 14 September 2021
by BMJ
Archives of Disease in Childhood; https://doi.org/10.1136/archdischild-2021-322479

Abstract:
Background Current guidance on the optimum interval between measurements in infancy is not evidence based. We used routine data to explore how measurement error and short-term variation (‘noise’) might affect interpretation of infant weight and length gain (‘signal’) over different time intervals. Method Using a database of weights and lengths from 5948 infants aged 0–12 months, all pairs of measurements per child 2, 4 and 8 weeks apart were extracted. Separately, 20 babies aged 2–10 months were weighed on six occasions over 3 days to estimate the SD of the weight difference between adjacent measurements (=116 g). Values of 116 g and 0.5 cm for ‘noise’ were then used to model its impact on (a) the estimated velocity centile and (b) the chance of seeing no growth during the interval, in individuals. Results The average gain in weight and length was much larger than the corresponding SD over 8-week and 4-week time intervals, but not over 2 weeks. Noise tended to make apparent velocity less extreme; after age 6 months, a 2-week velocity that appeared to be on to the ninth centile, would truly be on the second–third centile if measured with no noise. For 2-week intervals, there was a 16% risk of no apparent growth by age 10 months. Conclusions Growth in infancy is so rapid that the change in measurements 4–8 weeks apart is unlikely ever to be obscured by noise, but after age 6 months, measurements 2 weeks or less apart should be treated with caution when assessing growth faltering.
, Jennifer Duncan, Catherine Tuleu, , Anthony Nunn
Published: 3 September 2021
by BMJ
Archives of Disease in Childhood; https://doi.org/10.1136/archdischild-2021-321831

Abstract:
Introduction The WHO Essential Medicine List for children (EMLc) is used for promoting access to medicines. The age-appropriateness of enteral (oral and rectal) formulations for children depend on their adaptability/flexibility to allow age-related or weight-related doses to be administered/prescribed and the child’s ability to swallow, as appropriate. There is scant information on the age-appropriateness of essential enteral medicines for children. Objective To evaluate the age-appropriateness of enteral essential medicines. Materials and methods Age-appropriateness of all enteral formulations indicated and recommended in the EMLc 3rd to 7th (2011–2019) editions were determined by assessing swallowability and/or dose adaptability for children under 12 years, stratified into five age groups. Results Enteral formulations in the EMLc were more age-appropriate for older children aged 6–11 years than for younger children. In the 3rd edition, for older children, 77%, n=342, of formulations were age-appropriate. For younger children, age-appropriateness decreased with age group: 34% in those aged 3–5 years, 30% in those aged 1–2 years, 22% among those aged 28 days to 11 months and 15% in those aged 0–27 days. Overall, similar proportions were found for the 7th edition. In contrast, the majority of medicines in the 7th list were age-appropriate in targeted diseases like HIV and tuberculosis. Conclusion Most recommended enteral essential medicines in EMLc 2011 and 2019 were not age-appropriate for children <6 years. Medicines which are not age-appropriate must be manipulated before administration, leading to potential issues of safety and efficacy. Evaluation of the age-appropriateness of formulations for medicines to be included in EMLc could improve access to better medicines for children in the future.
, Roberta Evans, Michelle Fernandes, Barbara Landon, Trevor Noel, Calum Macpherson, Nikita Cudjoe, Kemi S Burgen, Bianca Punch, Amy Krystosik, et al.
Published: 3 September 2021
by BMJ
Archives of Disease in Childhood; https://doi.org/10.1136/archdischild-2020-321031

Abstract:
Objective Zika virus (ZIKV) targets neural stem cells in the developing brain. However, the majority of ZIKV-exposed children are born without apparent neurological manifestations. It remains unclear if these children were protected from ZIKV neurotropism or if they harbour subtle pathology that is disruptive to brain development. We assess this by comparing neurodevelopmental outcomes in normocephalic ZIKV-exposed children relative to a parallel control group of unexposed controls. Design Cohort study. Setting Public health centres in Grenada, West Indies. Patients 384 mother–child pairs were enrolled during a period of active ZIKV transmission (April 2016–March 2017) and prospectively followed up to 30 months. Child exposure status was based on laboratory assessment of prenatal and postnatal maternal serum. Main outcome measures The INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) package and Cardiff Vision Tests, administered and scored by research staff masked to child’s exposure status. Results A total of 131 normocephalic ZIKV exposed (n=68) and unexposed (n=63) children were assessed between 22 and 30 months of age. Approximately half of these children completed vision testing. There were no group differences in sociodemographics. Deficits in visual acuity (31%) and contrast sensitivity (23%) were apparent in the ZIKV-exposed infants in the absence of cognitive, motor, language or behavioural delays. Conclusions Overall neurodevelopment is likely to be unaffected in ZIKV-exposed children with normal head circumference at birth and normal head growth in the first 2 years of life. However, the visual system may be selectively vulnerable, which indicates the need for vision testing by 3 years of age.
Karoliina Videman, Lotta Hallamaa, Otto Heimonen, Charles Mangani, Mari Luntamo, Kenneth Maleta, Per Ashorn, Ulla Ashorn
Published: 3 September 2021
by BMJ
Archives of Disease in Childhood; https://doi.org/10.1136/archdischild-2021-322043

Abstract:
Objective To assess whether intermittent preventive treatment of pregnant women (IPTp) with sulfadoxine-pyrimethamine (SP) and azithromycin (AZI) in a malaria-endemic area leads to sustained gains in linear growth and development in their offspring. Design Follow-up study of a randomised trial. Setting Mangochi District in rural southern Malawi. Participants 1320 pregnant women and their offspring. Interventions IPTp monthly with SP and twice with AZI (AZI-SP group), monthly with SP but no AZI (monthly SP), or twice with SP (control). No intervention was given to children. Main outcome measures Cognitive performance using Raven’s Coloured Progressive Matrices (CPM) at 13 years of age; mean height and height-for-age Z-score (HAZ), cumulative incidence and prevalence of stunting (HAZ <−2); weight, body mass index, mid-upper-arm circumference and head circumference. Results At approximately 13 years of age, the mean CPM score was 14.3 (SD 3.8, range 6–29, maximum 36), with no differences between groups. Children in the AZI-SP group were on average 0.4 cm (95% CI −0.9 to 1.7, p=0.6) taller than those in the control group. For cumulative incidence of stunting, the HR in the AZI-SP group was 0.72 (95% CI 0.61 to 0.84, p<0.001) compared with the control and 0.76 (95% CI 0.65 to 0.90, p<0.001) compared with the monthly SP groups. There was no intergroup difference in stunting prevalence or anthropometric measurements. Conclusions In rural Malawi, maternal intensified infection control during pregnancy reduces offspring’s cumulative incidence of ever being stunted by 13 years of age. In this study, there was no evidence of a positive impact on cognitive performance. Trial registration number NCT00131235.
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