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) Free
    Ebiowei Samuel F Orubu, Jennifer Duncan, Catherine Tuleu, Mark A Turner, Anthony Nunn

    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)
    Karoliina Videman, Lotta Hallamaa, Otto Heimonen, Charles Mangani, Mari Luntamo, Kenneth Maleta, Per Ashorn, Ulla Ashorn

    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

Original research

  • Assessing the optimal time interval between growth measurements using a combined data set of weights and heights from 5948 infants (14 September, 2021)
    Charlotte Margaret Wright, Caroline Haig, Ulla Harjunmaa, Harshine Sivakanthan, Tim J Cole

    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)
    Nikita Punjabi, Kathryn Marszalek, Thomas Beaney, Rakhee Shah, Dasha Nicholls, Sarah Deeny, Dougal Hargreaves

    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)
    Sara Marie Larsson, Lena Hellström-Westas, Andreas Hillarp, Pia Karlsland Åkeson, Magnus Domellöf, Ulrica Askelöf, Cecilia Götherström, Ola Andersson

    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)
    Jeremy Anderson, Michelle Oeum, Eva Verkolf, Paul V Licciardi, Kim Mulholland, Cattram Nguyen, Kim Chow, Gregory Waller, Anna-Maria Costa, Andrew Daley, Nigel W Crawford, Franz E Babl, Trevor Duke, Lien Anh Ha Do, Danielle Wurzel

    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)
    Francisco Ribeiro-Mourão, Sophie Bertaud, Joe Brierley, Renee McCulloch, Jutta Köglmeier, Susan M Hill

    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)
    Ninna Brix, Mia Glerup, Steffen Thiel, Clara Elbæk Mistegaard, Regitze Gyldenholm Skals, Lillemor Berntson, Anders Fasth, Susan Mary Nielsen, Ellen Nordal, Marite Rygg, Henrik Hasle, Birgitte Klug Albertsen, Troels Herlin

    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.

Short report

Quality improvement

  • Impact of a standardised parenteral nutrition protocol: a quality improvement experience from a NICU of a developing country (13 July, 2021)
    Gul Ambreen, Vikram Kumar, Syed Rehan Ali, Uswa Jiwani, Waqar Khowaja, Ali Shabbir Hussain, Kashif Hussain, Syed Shamim Raza, Arjumand Rizvi, Uzair Ansari, Khalil Ahmad, Simon Demas, Shabina Ariff

    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.

Drug therapy