Table of contents
April 2022 - Volume 107 - 4
Clinical law for clinical practice
Global child health
- WHO essential medicines for children 2011–2019: age-appropriateness of enteral formulations (3 September, 2021)
This study of enteral medicines in the World Health Organization Essential Medicines List for Children from 2011 and 2019 found many were not age-appropriate for children less than 6-years. Medicines which are not age-appropriate must be manipulated before administration, leading to potential issues of safety and efficacy. the majority of medicines in the 2019 list for some diseases, including HIV and tuberculosis were age-appropriate.
- Child growth and neurodevelopment after maternal antenatal antibiotic treatment (3 September, 2021)
Studying anti-infective therapy during pregnancy is an active stream of child nutrition research. In this study, the authors longitudinally follow a cohort of children of mothers involved in such a study and find that stunting rates decreased in the long-term.
Paediatric emergency medicine
- Validating clinical practice guidelines for the management of febrile infants presenting to the emergency department in the UK and Ireland (16 September, 2021)
This retrospective cohort study assessed the performance of Clinical Practice Guidelines (CPG) in the diagnosis of serious bacterial infections in infants with fever in the UK /Ireland and found that no CPG performed in an ideal manner, suggesting the need for further study.
- Assessing the optimal time interval between growth measurements using a combined data set of weights and heights from 5948 infants (14 September, 2021)
Using routinely collected weight and length measurements of young infants, authors report measurement intervals 4 to 8 weeks apart likely reflect true growth, rather than noise from measurement error or short-term variation. After 6 months of age, measurements two weeks or less apart should be treated with caution when assessing growth faltering.
- Categorising high-cost high-need children and young people (17 September, 2021)
A retrospective observational clinical database study shows the top 5% of CYP (high-cost high-need patients) account for more than half of our annual spending for CYP, largely driven by inpatients. The most common diagnoses are mental health, metabolic, respiratory, neurological conditions.
- Haemoglobin and red blood cell reference intervals during infancy (21 October, 2021)
Anaemia in childhood is a global health problem, however the WHO thresholds for haemoglobin levels & definition of anaemia during infancy are based on data from over 60 years ago and an update is long overdue. This review, by Larsson et al, of haemoglobin levels and reference intervals in Swedish infants reveals much narrower red blood cell reference intervals during infancy, highlighting the necessity of age definitions when presenting reference intervals.
- Factors associated with severe respiratory syncytial virus disease in hospitalised children: a retrospective analysis (15 September, 2021)
Respiratory syncytial virus (RSV) disease places a large burden on healthcare systems. Early recognition of children at risk of severe RSV disease may be useful. This study finds younger age (<2 months) and prematurity are associated with increased severity of RSV disease. An association between Para-influenza virus type 3/RSV co-detection and severe disease may warrant further investigation.
- Use of home parenteral nutrition in severely neurologically impaired children (22 September, 2021)
This case series explores the decision making around home parenteral nutrition (HPN) for a group of five children with a combination of severe neurodisability and intestinal failure, the involvement of a clinical ethics team and subsequent outcomes. The authors conclude that HPN can help relieve difficult symptoms and be justified as part of good palliative care. The importance of thorough assessment before committing to long term treatment is emphasised.
- M-ficolin: a valuable biomarker to identify leukaemia from juvenile idiopathic arthritis (22 October, 2021)
It is well recognised that ALL can present in a proportion as inflammatory arthritis.The authors present the role of a potential biomarker which may help in discriminating between leukemia and juvenile idiopathic arthritis.
- Prevalence of neurological problems in a community-based sample of paediatric coeliac disease: a cross-sectional study (28 September, 2021)
In a community based sample of children with coeliac disease a lower prevalence of neurological problems was identified than has been described in adult populations.
- Impact of a standardised parenteral nutrition protocol: a quality improvement experience from a NICU of a developing country (13 July, 2021)
Standardised parenteral nutrition formulations are widely used in neonatal intensive care for convenience and safety. This retrospective investigation compares individualised versus standardised feeds in a LMIC setting, in the context of a a quality improvement study. Use of standardised feeds made on site was a feasible alternative to individualised prescription.
- Dosing of enteral acetaminophen in critically ill children: a cohort study (27 September, 2021)
Prescribing paracetamol is one of the most common therapeutic interventions in hospitals. This large retrospective study review when under- and over-dosing occurs in children in PICU, and finds age, cardiac admission are significant risk factors.
- Pharmacogenomics and asthma treatment: acceptability to children, families and healthcare professionals (24 January, 2022)
Pharmacogenetics offers the possibility of personalised medicine for asthma. This pilot study suggests that such an approach would be acceptable to children, young people and their carers as well as healthcare professionals.