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关键词： Resuscitation child   Infant   Paediatric   CPR   Basic life support   Advanced life support   Defibrillation   Pediatric   Respiratory failure   Circulatory failure   Shock   Oxygen   Cardiac arrest   Bag-mask ventilation  

摘要： These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.

关键词： Anaesthesia   Paediatrics   Dexmedetomidine   Pharmacology   Drug prescriptions   Off-label use  

摘要： Purpose The purpose of this international study was to investigate prescribing practices of dexmedetomidine by paediatric anaesthesiologists. Methods We performed an online survey on the prescription rate of dexmedetomidine, route of administration and dosage, adverse drug reactions, education on the drug and overall experience. Members of specialist paediatric anaesthesia societies of Europe (ESPA), New Zealand and Australia (SPANZA), Great Britain and Ireland (APAGBI) and the USA (SPA) were consulted. Responses were collected in July and August 2019. Results Data from 791 responders (17% of 5171 invitees) were included in the analyses. Dexmedetomidine was prescribed by 70% of the respondents (ESPA 53%;SPANZA 69%;APAGBI 34% and SPA 96%), mostly for procedural sedation (68%), premedication (46%) and/or ICU sedation (46%). Seventy-three percent had access to local or national protocols, although lack of education was the main reason cited by 26% of the respondents not to prescribe dexmedetomidine. The main difference in dexmedetomidine use concerned the age of patients (SPA primarily < 1 year, others primarily > 1 year). The dosage varied widely ranging from 0.2-5 mu g kg(-1) for nasal premedication, 0.2-8 mu g kg(-1) for nasal procedural sedation and 0-4 mu g kg(-1) intravenously as adjuvant for anaesthesia. Only ESPA members (61%) had noted an adverse drug reaction, namely bradycardia. Conclusion The majority of anaesthesiologists use dexmedetomidine in paediatrics for premedication, procedural sedation, ICU sedation and anaesthesia, despite the off-label use and sparse evidence. The large intercontinental differences in prescribing dexmedetomidine call for consensus and worldwide education on the optimal use in paediatric practice.

关键词： Children   Gastrointestinal   Hepatobiliary   Radiology   Subspecialisation  

摘要： We present the case for subspecialisation in paediatric gastrointestinal and hepato-pancreatico-biliary radiology. We frame the discussion around a number of questions: What is different about the paediatric patient and paediatric gastrointestinal system? What does the radiologist need to do differently? And finally, what can be translated from these subspecialty areas into everyday practice? We cover conditions that the sub-specialist might encounter, focusing on entities such as inflammatory bowel disease and hepatic vascular anomalies. We also highlight novel imaging techniques that are a focus of research in the subspecialties, including contrast-enhanced ultrasound, MRI motility, magnetisation transfer factor, and magnetic resonance elastography.

关键词： Craniofacial surgery   Craniofacial deformities   Craniomaxillofacial   Morbidity   Complications  

摘要： Paediatric craniomaxillofacial (CMF) surgery requires a multidisciplinary team approach to ensure the optimal and holistic management of children with craniofacial deformities. The aim of this retrospective study was to analyse the complications following functional interventions among 34 CMF deformity patients in a single multidisciplinary craniofacial centre. Electronic data including patient demographic characteristics and clinical entry were analysed. Inclusion criteria were all paediatric patients with CMF deformities who underwent various functional interventions. A total of 64 interventions (48 intermediate and 16 definitive) were conducted. Based on the Sharma classification of complications, 20.3% were type I, 4.7% were type II, 1.6% were type III, and 4.7% were type IV . Most complications were type I, which included local infection (3.1%) and premature opening of tarsorrhaphy (3.1%). More serious complications (types III and IV) included temporary visual loss (1.6%) and intraoperative haemorrhage (1.6%). Although a low complication rate was observed in intermediate interventions, a higher complication rate was observed in more complex definitive interventions such as monobloc distraction osteogenesis. Although most complications were manageable, effective prevention remains mandatory, as serious complications may lead to permanent damage and mortality. This analysis highlights the importance of a multidisciplinary team approach to optimize the outcomes in CMF patient management.

关键词： paediatric   pharmacist   prioritization  

摘要： What is known and objective Pharmacists play an integral role in paediatric patient care by ensuring the safe and optimal use of medications. There are increasing demands on pharmacists' time and challenges to meet them within allocated resources, and therefore, it is important to ensure that resources are used efficiently. Patient prioritization tools for clinical pharmacists have been proposed via many studies, but are generally adult-based and/or have not been validated to confirm their effectiveness. The aim of this study was to create, pilot and validate a patient prioritization tool to be used by pharmacists providing clinical pharmacy services to paediatric patients. Methods A two-phase (retrospective and prospective) observational audit of pharmacists' interventions collected via notes made on their ward handover information sheets and patient case notes was conducted over a 2-year period in a tertiary paediatric hospital. A patient prioritization tool was created based on pharmacists' interventions in real time. This tool could be used at the start of the working day (without the need to review the patient or their case notes) to identify patients who would benefit most from a clinical pharmacist review. The tool was validated for effectiveness and selectivity. Results and discussion The tool was easy to use and effective in identifying that 43% of paediatric inpatients did not require a routine clinical pharmacist review. It had 98% specificity in identifying patients who require a pharmacist intervention. It could be easily used at the start of the day to select patients for pharmacist review. What is new and conclusion A new patient prioritization tool has been developed and validated for identifying paediatric inpatients requiring clinical pharmacist review.

摘要： The Medical Research Council facilitated a survey of school medical officers in the late 1950s, which demonstrated not only extensive geographical variance in school-age children who had undergone tonsillectomy (between 0.5 and 25 per cent), but also significant variance with socioeconomic status (incidence ranged from 14.3 per cent in technical schools to 37.9 per cent in grammar schools).3 Later in the century, the Medical Research Council commissioned an investigation by medical sociologist MJ Bloor. In the UK, an increase in the medical surveillance of children (e.g. through the School Medical Service) occurred just as medical services were becoming more accessible with social programmes such as the National Health Insurance Act (1911).6 This facilitated greater identification of tonsil disease in children, while also making interventions available financially to a broader section of the population. Furthermore, it was during this period that otorhinolaryngology was formalised as a specialty, and this surgical procedure on the tonsils – where the ears, nose and throat meet – would anatomically represent this evolving discipline.7 As I have argued elsewhere, the focal theory played an important role in the popularity of tonsillectomy; however, there were also important structural, financial and political incentives for the growth of the procedure.8 Attention to the UK's historical experience allows us to gain an understanding of the factors implicated in the geographical variance of tonsillectomy rates, and helps explain why variance persists despite stricter indications and guidelines.

摘要： AIM: To investigate the feasibility of reducing the scan time of paediatric technetium 99m (Tc-99m) dimercaptosuccinic acid (DMSA) single-photon-emission computed tomographic (SPECT) using a deep learning (DL) method. MATERIAL AND METHODS: A total of 112 paediatric Tc-99m-DMSA renal SPECT scans were analysed retrospectively. Of the 112 examinations, 88 (84 for training and four for validation) were used to train a DL-based model that could generate full-acquisition-time reconstructed SPECT images from half-time acquisition. The remaining 24 examinations were used to evaluate the performance of the trained model. RESULTS: DL-based SPECT images obtained from half-time acquisition have image quality similar to the standard clinical SPECT images obtained from full-acquisition-time acquisition. Moreover, the accuracy, sensitivity and specificity of the DL-based SPECT images for detection of affected kidneys were 91.7%, 83.3%, and 100%, respectively. CONCLUSION: These preliminary results suggest that DL has the potential to reduce the scan time of paediatric Tc-99m-DMSA SPECT imaging while maintaining diagnostic accuracy. (C) 2020 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

关键词： Outcomes research   Physical examination  

摘要： Objectives Assessment of the impact of general anaesthetic agents on intraocular pressure (IOP) in children via systematic review. Methods Pubmed, Embase, and CENTRAL databases were systematically searched to identify randomised controlled trials, prospective, and interventional studies. The search included all studies through October 5, 2018 with no date or language restrictions. A linear mixed-effects regression analysis was performed to study the change in IOP after general anaesthesia (GA). Results The strategy identified 518 studies that met search criteria. Six studies (531 eyes) were included for quantitative synthesis. Seven categories of mixed and non-mixed induction and maintenance agents were compared. When assessing all agents utilising a model of mean IOP as a function of time, IOP decreased after induction phase at a rate of -0.59 +/- 0.19 mmHg/min (Pvalue = 0.006). Conclusions This systematic review showed that most anaesthetic agents significantly decrease IOP over time after the induction phase of general anaesthesia in children. An understanding of the effects of GA on IOP is critical for those performing paediatric ophthalmic examinations under anaesthesia.

关键词： Health care costs   Management   Paediatric radiology   Radiology  

摘要： Italy is the sixth most populous country in Europe and has the second highest average life expectancy, reaching 79.4 years for men and 84.5 for women. However, Italy has one of the lowest total fertility rates in the world: in 2018 it was 1.3 births per woman, with the population older than 65 comprising more than 30%, and those younger-than-19 less than 15%. Older people are the main concern of the Italian health system. Weighted coefficients for the allocation of funds favour older adults. As confirmed by our study, paediatric radiology is expensive, and the reimbursement based on Italian adult rates is not sufficient. The negative impact on the budget discourages the diffusion of paediatric radiology both in the private practices that provide services paid for by the state government and in the public hospitals. The 501 paediatric hospital units in Italy are not homogeneously distributed throughout the national territory. Furthermore, in Italy there are 12 highly specialised children's hospitals whose competences were defined in 2005 by the Ministry of Health. Paediatric radiology is not included among the highly qualified specialties. The quality gap in paediatric radiology between children's hospitals and general hospitals, the latter often without paediatric radiologists, is evident in daily practice with misdiagnoses and investigations not carried out.