Search Results (163)

Generative artificial intelligence (genAI) shows promising results in clinical practice. This study compared a GPT-4-turbo virtual assistant with physicians from Italy, France, Spain, and Portugal on medical knowledge derived from national exams while analysing knowledge retention over time and domain-specific performance. Via a digital platform, 17,144 physicians provided 221,574 answers to 600 exam questions between December 2022 and February 2024. Physicians were stratified by years since graduation and specialty, and the assistant answered the same questions in each native language. Differences in proportions of correct answers were tested with binomial logistic regression (odds ratios, 95% CI) or Fisher’s exact test (α = 0.05). The assistant outperformed physicians in all countries (72–96% vs. 46–62%; logistic regression, p < 0.001). Physicians also trailed the assistant across most knowledge domains (p < 0.001), except paediatrics (45% vs. 52%; Fisher, p = 0.60). Accuracy declined with seniority, falling 4–10% between the youngest and oldest cohorts (logistic regression, p < 0.001). Overall, genAI exceeds practising doctors on broad medical knowledge and may help counter knowledge attrition, though paediatrics remains a domain requiring targeted refinement. Full article

Background/Objectives: Allergen immunotherapy is the sole therapeutic option capable of modifying the natural course of allergic rhinitis and preventing the development of asthma. Results from paediatric patients are scarce. To evaluate the effectiveness and safety of a glutaraldehyde-modified extract of mites (Beltavac^®) administered for one year under clinical routine conditions in children between 3 and 11 years old. Methods: This was a multicentre, prospective, 13-month cohort study. Among 97 children diagnosed with immunoglobulin E-mediated house dust mite allergic rhinoconjunctivitis, 87 initiated the subcutaneous immunotherapy. The main outcomes included the Combined Symptoms and Medication Score (CSMS), assessed for 1 month at baseline and after 1, 6, and 12 months, and the number of adverse reactions according to the WAO adverse reaction grading system. The levels of serum-specific immunoglobulins were also assessed. Results: CSMS improved scores throughout therapy (adjusted mean change and 95% confidence interval: 0.55, 0.26–0.84 points; p < 0.001). Improvements occurred in both children with (n = 68) and without asthma (n = 19), as well as in children aged ≥6 years (n = 76) and <6 years (n = 11), although statistical significance was not reached in the smallest subgroups. Eight children (9.2%) developed a total of 15 adverse reactions. Most occurred after the initial dose (five out of eight children), and were local (six out of eight) and minor (five out of eight). Over 90% of patients completed the full regimen. Conclusions: This study supports the effectiveness and safety of allergen immunotherapy administered according to a rush schedule for one year for paediatric allergic rhinitis. Full article

Background: Forearm fractures are the most common fractures in children, accounting for 41% of all paediatric fractures. Most research focuses on distal forearm fractures, but studies encompassing the entire forearm are limited. Objective: This retrospective study describes the distribution and patterns of paediatric forearm fractures over a five-year period. Methods: We conducted a retrospective cohort study of children aged 0–15 years who received a radiograph of the forearm, wrist or elbow between March 2019 and December 2023 in the study region. Fractures were manually identified and registered from radiological reports. Fracture location, type (complete/incomplete), and epiphyseal involvement were analyzed across different age groups. Statistical analysis was performed using chi-square tests and descriptive statistics. Results: We identified 4547 forearm fractures from 4291 children. The median age was 10 years, and 57% of the patients were male. Fracture patterns varied significantly across age groups (p < 0.001), with older children experiencing more distal, complete, radial, and epiphyseal fractures. Younger children had a higher proportion of incomplete fractures and fewer distal or epiphyseal fractures. No significant differences in Salter–Harris classifications were found between age groups (p = 0.69). Conclusions: Fracture patterns in paediatric forearm fractures vary with age, with older children showing a higher incidence of complete, distal, and epiphyseal fractures. This study provides a detailed characterization of paediatric forearm fractures, which may inform clinical management and preventive strategies, particularly in tailoring age-specific care. Further research should explore the long-term outcomes of these fracture patterns. Full article

Background/Objectives: Adenotonsillectomy is common in paediatric otorhinolaryngology. Endotracheal intubation (ETT) has long been the preferred technique for securing the airway during anaesthesia, while the laryngeal mask airway (LMA) was introduced later as an alternative option. However, it is still unclear which of these airway management methods is associated with a lower risk of triggering laryngospasm. This systematic review compares incidences of laryngospasm between the LMA and ETT in paediatric adenotonsillectomy. Methods: This systematic review followed guidelines outlined by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). An extensive search of the literature was performed across three electronic databases, i.e. PubMed, Scopus, and Web of Science, covering all records available up to February 2024. Original studies comparing the use of LMAs and ETT in adenotonsillectomy among paediatric patients (aged 1 month–18 years) and reporting incidences of laryngospasm as the primary outcome were included in this review. Results: Five studies were included in the current review: three randomised controlled trials (RCTs) and two retrospective cohort studies. Incidences of laryngospasm during the use of LMAs and ETT in paediatric adenotonsillectomy were equivalent in most of these studies. Conclusions: The LMA does not reduce the incidence of laryngospasm as compared to ETT in paediatric adenotonsillectomy. More RCTs should be conducted to validate this observation. Full article

Tuberculous meningitis (TBM) is a very severe form of childhood tuberculosis (TB), requiring hospitalisation for diagnosis. We investigated trends in admission, disease spectrum, outcomes, and healthcare system factors in children with TBM managed at a tertiary referral hospital in Cape Town, South Africa. We conducted a retrospective cohort study of children (<13 years) with TBM admitted from 2017 to 2021. An innovative surveillance algorithm was used to identify all possible TBM episodes using integrated electronic health data. Episodes were clinically verified and data were extracted using medical records. A total of 263 children (median age 2.2 years; IQR: 1.1–5.1), 17 (6.5%) living with HIV were admitted with TBM during 2017 to 2021. There was a significant reduction in TBM admissions during the COVID-19 pandemic (IRR: 0.57, 95% CI:0.39–0.84), particularly in children < 2 years (IRR: 0.31, 95% CI: 0.15–0.62). BCG vaccination was documented in 137/263 (52.1%) and 10/87 (11.5%) eligible children who initiated TB preventive therapy. During the pandemic, children with TBM were significantly more likely to be living with HIV (aOR: 4.01, 95% CI: 1.39–11.62). COVID-19 was associated with a significant reduction in the number of young children admitted with TBM. Many missed opportunities to prevent TBM were identified regardless of COVID-19. Paediatric TBM surveillance is a useful marker to monitor epidemiological trends. Full article

Background/Objectives: The Tc-99m dimercaptosuccinic acid (DMSA) renal scan clearly images the renal cortex, highlighting functional tissue areas and indicating regions of renal scarring, infection, malformations, or other types of renal damage. To enhance the management of paediatric cases involving renal malformations and to reduce the incidence of chronic and progressive kidney diseases in “future adults”, our study aims to identify and categorise various renal anomalies. Methods: This has been achieved by analysing the Tc-99m DMSA renal scans of a large cohort of 931 children diagnosed with different renal pathologies. After interpreting the scans, we categorised the renal malformations and cortical modifications into four groups: kidney number anomalies, positional anomalies, structural anomalies, and shape anomalies. Results: There has been a notable increase in the demand for renal scintigraphy in recent years, rising from 82 cases in 2019 to 183 cases in 2024. Structural anomalies were the most common type of malformations (73% from all patients), featuring a significant variety of cortical modifications. In total, 98 cases (93% from kidney number anomalies and 10.5% from all children) were diagnosed with renal agenesis. Additionally, 30 children (3.2% from all patients) had positional anomalies, primarily ectopic kidneys, and 54 patients (5.8% from all cases) had shape malformations, especially fused kidneys. Conclusions: Combining the Tc-99m DMSA renal scan with ultrasound provides a more reliable diagnosis of paediatric renal progressive diseases. A more accurate diagnosis allows for quicker treatment and prevention of potential complications, ultimately improving the quality of life and decreasing hospital costs of paediatric patients becoming adults. Full article

Background/Objectives: The guideline on allergen-specific immunotherapy of the European Academy of Allergy and Clinical Immunology recommends subcutaneous allergen-specific immunotherapy for the treatment of allergic rhinitis in children and adults with moderate to severe symptoms. The five years cohort study described below was designed in 2020 to demonstrate non-inferiority in terms of safety, tolerability and efficacy in a paediatric population compared with adult patients treated with microcrystalline tyrosine-adsorbed allergoids for their tree and grass pollen allergy in a perennial setting. Here, we present the preliminary findings from the first year. Methods: The Combined Symptom and Medication Score was chosen as the primary endpoint of this therapy. Secondary endpoints include the Rhinoconjunctivitis Quality of Life Questionnaire, the retrospective Rhinoconjunctivitis score, the Asthma Control Test and the Rhinitis Control Test, as well as an analysis of adverse drug reactions. Results: A total number of 320 patients were enrolled into this study, with 129 of these patients in the age group between 5 and 17 years and 191 patients in the adult age group. Mean Combined Symptom and Medication Score values did not differ significantly between minors and adults in the first pollen season after treatment induction. The retrospective score showed a strong and significant reduction in rhinoconjunctivitis and asthma symptoms. Treatment was well tolerated, with more than 80% of patients reporting no adverse drug reactions. Conclusions: The validity of this study approach of a cohort study has been confirmed by this first interim analysis for the initial course of therapy in the first year. Full article

The possible association between COVID-19 and the development of complicated sinusitis in paediatric populations was noted during the COVID-19 pandemic, but understanding of this disease process is still developing. In Perth, Western Australia, a distinctive state of isolation, vaccination status and thorough screening methodology led to a unique experience of the pandemic. We conducted a retrospective cohort study of 129 patients admitted to Perth Children’s Hospital from May 2018 to September 2024. Disease factors were studied, including clinical severity, procedure, COVID status, length of stay and inflammatory markers. A surge in patients was noted during the COVID-19 pandemic, with at least 16 having a concurrent diagnosis of COVID-19 at the time of admission. The study demonstrates that whilst COVID-19 infection was associated with the development of complicated sinusitis, it was not associated with increased severity of disease or an increased likelihood of requiring surgical management. A unique subset of patients emerged with unusual presentations, possibly representing a new disease process of suppurative dacryoadenitis. Full article

Background: Acute lower respiratory tract conditions are highly prevalent in paediatrics. Many of these conditions present as consolidations on imaging studies. One of the most common causes is bacterial pneumonia (BP), which requires an accurate diagnosis to implement the best treatment plan. Despite the fact that major guidelines constrain the use of invasive tests, chest X-ray (CXR) or blood tests are still routinely used for the diagnosis. In this regard, the introduction of lung ultrasound (LUS) signified an advancement in reducing the invasiveness of diagnosis. However, there are still situations where distinguishing between different aetiologies remains challenging, especially in the case of atelectasis. Methods: This is a prospective cohort study to assess the diagnostic accuracy of new non-invasive, quantifiable, and reproducible imaging biomarkers (lung elastance and microvascularization ratio) for differentiating BP from another major entity that causes the appearance of consolidation in imaging tests, atelectasis. It will be conducted at Sant Joan de Déu Hospital in Spain from June 2025 to June 2027. Firstly, imaging biomarkers will be measured in well-aerated lung tissue without consolidation to establish their values in healthy lung tissue, according to a predefined imaging acquisition protocol. Subsequently, the imaging biomarkers will be assessed in patients with confirmed lung consolidation by LUS (Group 1: BP; Group 2: atelectasis). Results: The study aims to determine whether there are statistically significant differences in the biomarker values in relation to the normal values and between the different etiological groups. Conclusions: The demonstration of the reliable diagnostic accuracy of these biomarkers could significantly reduce the need for invasive techniques and improve the therapeutic management of many patients with BP and other pulmonary conditions presenting with consolidation in imaging tests. Full article

Background: Iatrogenic withdrawal syndrome (IWS) poses a significant clinical challenge in pediatric intensive care units (PICUs) within Japan. Despite the existing availability of tools to assess pain and delirium, a validated instrument specifically designed for IWS has been notably absent in Japanese clinical practice. The Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) scale is globally recognized as an effective tool for IWS evaluation. To bridge this gap, this study aimed to validate the Japanese version of the SOS-PD scale. Methods: A prospective, cohort, observational study was undertaken in a single-center PICU in Japan. Participants ranged from neonates to children aged 20 years, excluding those with pre-existing neurological conditions or coma. Criterion validity was evaluated by comparing Japanese SOS-PD scale scores between a Weaning Group (WEAN) undergoing sedative/opioid tapering and a Maintenance Group (MAIN) receiving stable medication. Correlation analysis was also conducted against pediatric intensivists’ observational NRS (NRSobs). Inter-rater reliability of the Japanese SOS-PD scale was assessed utilizing kappa statistics and intraclass correlation coefficient (ICC). Results: In support of criterion validity, the WEAN group demonstrated significantly higher scores in both NRSobs and the IWS component of the Japanese SOS-PD scale compared to the MAIN group (p < 0.001). A strong correlation was observed between the Japanese SOS-PD IWS component and NRSobs (r = 0.91, p < 0.001). Inter-rater reliability was also robust, with a kappa coefficient of 0.95 and an ICC of 0.98. Conclusions: The Japanese version of the SOS-PD scale exhibits strong validity and inter-rater reliability for IWS assessment within Japanese PICUs. This validated instrument can support the early detection and appropriate management of pediatric IWS in Japan, with the potential to enhance the quality of patient care. Full article

Background: Nirsevimab was indicated in a population level for all infants < 6 months during the 2023–2024 season in Andalusia (southern Spain). Our aim was to analyse the effect of nirsevimab in the reduction in complications in infants hospitalised for RSV bronchiolitis. Methods: A retrospective observational cohort study was conducted in nine relevant hospitals from all provinces of Andalusia, a region with over 9 million inhabitants. The study sample included 222 children, divided into two groups: infants administered with nirsevimab for passive immunisation (exposure) and infants not administered with nirsevimab. Clinical outcomes were analysed, including the use of respiratory support, the need for admission to paediatric intensive care unit (PICU), and duration of hospitalisation. Bivariate analyses were performed, and multivariable logistic regression models were designed to calculate adjusted odds ratios (ORa), and Cox regression models to calculate adjusted hazard ratios (HRa). Results: Bivariate analysis showed an association between passive immunisation with nirsevimab and a lower frequency of numerous outcomes. After adjustment for relevant covariates, multivariable models showed that the exposure (nirsevimab) reduced nasal cannula use by 64% (13–85%), invasive or non-invasive mechanical ventilation by 48% (1–73%), PICU admission by 54% (14–75%), length of hospitalisation by 30% (8–47%), and length of nasal cannula by 31% (7–49%). A higher risk of co-infection was observed in those immunised (aOR = 3.42, 95%CI: 1.52–7.68). Conclusions: Passive immunisation with nirsevimab may decrease the severity of RSV bronchiolitis in infants requiring hospitalisation, thus contributing tertiary prevention that extends beyond the prevention of RSV infection. Full article

Background: Analysing circulating miRNAs in paediatric plasma is challenging due to typically low sample volumes. The QIAseq miRNA UDI Library Kit (Qiagen, Hilden, Germany) was selected as it has a proven track record with a specific protocol for plasma and serum. The protocol, however, required optimisation for use with low-volume paediatric plasma samples before generating acceptable yields in our cohort. Methods: The miRNeasy Serum/Plasma kit (Qiagen) and the MagMAX miRVana Total Isolation kit (ThermoFisher Scientific, Waltham, MA, USA) were assessed following the manufacturer’s instructions with 100 µL and 200 µL of paediatric plasma. Libraries were prepared using the QIAseq miRNA UDI Library Kit (Qiagen). Optimisations were made for the QIAseq miRNA UDI Library Kit (Qiagen) using total RNA extracted with the miRNeasy Serum/Plasma kit (Qiagen) from 100 µL of plasma. Results: Prior to optimisation, both RNA extraction kits underperformed with the QIAseq miRNA UDI Library kit, producing low miRNA library yields ranging between 0 and 1.42 ng/µL. Plasma input volumes of 100 µL and 200 µL demonstrated no significant differences. Adjusting the QIAseq protocol for low RNA concentrations improved miRNA library yields, an average of 5.6 ng/µL and a maximum of 24.3 ng/µL across 92 samples. The optimised protocol showed no age or gender biases with the QIAseq kit. Conclusions: Failure rates in miRNA library preparations are rarely reported, making it hard to gauge whether the 8.7% failure rate observed here is typical. However, given the challenges of using low-concentration, low-volume paediatric plasma, this represents a significant improvement over previous attempts, supporting further research in the field. Full article

Monitoring infliximab (IFX) concentrations is crucial for optimizing IFX therapy in children with inflammatory bowel diseases (IBDs) who show low response rates due to inadequate drug exposure. Substantial variation occurs in IFX trough concentrations in paediatric patients. Objectives: This study aimed to investigate IFX pharmacokinetics (PK) in children with IBD during both the induction phase and maintenance phases and to identify covariates associated with IFX PK. Methods: This single-centre retrospective cohort study was conducted at an academic children’s hospital. Data was extracted from paediatric IBD patients receiving IFX between January 2018 and October 2023 and included demographic-, clinical- and laboratory parameters collected from electronic health records. Linear mixed model analysis was performed to investigate associations between these parameters and IFX trough concentrations. Target attainment [≥15 μg/mL in induction or 5–10 μg/mL in maintenance phase] of the IFX dosing regimens was evaluated. Results and Conclusions: A total of 115 children (417 unique IFX concentrations) were included. Multivariate analysis revealed significant positive associations between IFX and albumin concentrations (β = 0.388, p = 0.010) and IFX concentrations with dose (β = 6.534, p < 0.001), and an inversion association between IFX concentrations and treatment phase (β = −4.922, p < 0.001). During the induction and maintenance phases, 57.2% and 30.6% of IFX concentrations were subtherapeutic, respectively. A systematic search of studies investigating factors influencing IFX concentrations was concurrently performed. Our findings were critically compared against existing literature to assess relevant clinical and biochemical determinants of IFX PK in children with IBD. Our findings highlight the need for personalized dosing strategies in pediatric IBD patients, particularly during the induction phase. By implementing therapeutic drug monitoring (TDM) and considering clinical and biochemical factors, clinicians can implement more personalized strategies, potentially improving treatment efficacy and reducing the risk of treatment failure or adverse effects. This approach could lead to better target attainment, potentially enhancing clinical outcomes and minimizing premature switching to other therapies. Full article

Background: Paediatric Early Warning Scores (PEWS) are designed to detect the clinically unwell or deteriorating child within a hospital setting. There is a drive within the NHS to standardise this scoring system across various settings. According to the Royal College of Paediatrics and Child Health, there is currently a national review on triage tools used within emergency departments; however, evidence to date is scarce. Within the Chelsea and Westminster NHS Foundation Trust, we utilise both the Manchester Triage System (MTS) and the Children’s Observation and Severity tool (COAST), an adaption of PEWS, in our Paediatric Emergency Department (PED). Methods: This retrospective cohort study is the largest of its kind and was performed to validate COAST, compare it to MTS and determine if it is a good predictor of hospital admission. Demographic data, initial MTS scores, initial COAST scores and admission outcomes of 41,030 paediatric emergency department attendances were analysed, encompassing 27,196 unique patients. Results: Results demonstrated that high COAST scores on arrival are strongly correlated with hospital admission, with positive predictive values of 59.52% with COAST of ≥3 and 100% for with score threshold of ≥5. In comparison with the MTS, COAST is better at predicting admission. Conclusions: We conclude that COAST performs well in correlating to and thus predicting paediatric hospital admission outcome from the PED. Full article

Background/Objectives: There is a high prevalence of sleep behaviour disorders, as well as sleep disordered breathing (SDB), in individuals living with sickle cell disease (SCD). SDB has been systematically reviewed; therefore, this systematic review and meta-analysis focused on sleep behaviour. Methods: The comprehensive literature search, following PRISMA reporting guidelines, included all languages, conference proceedings and published theses from inception through February 2022. We identified 31 studies, with most of the research being conducted in North America, using polysomnography, actigraphy and questionnaires/diaries in paediatric SCD cohorts. Results: Total sleep time (TST) decreased, while sleep onset latency (SOL) increased with age. TST was higher on self-reported sleep diary measures and lower on polysomnography (PSG) and actigraphy assessments. SOL was lowest during PSG and highest in actigraphy. The discrepancy between sleep measures might be due to the overestimation of sleep behaviour by parents. In six studies, TST and SOL were compared between people living with SCD and healthy controls; in four, TST was longer in those living with SCD while it was shorter in two. Meta-analyses on the effect of TST and SOL were limited due to publication bias, with heterogeneity between the studies, in part related to measurement differences. No significant differences were found. Conclusions: The scarcity of case-control studies and significant heterogeneity in findings likely attributable to variations in sleep assessment methodologies. Gaps in the literature should be addressed. Full article