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关键词： caesarean   childhood leukaemia   delivery   epidemiology  

摘要： Background Reports have suggested that children born by caesarean initiated before labour onset may be at increased risk of developing acute lymphoblastic leukaemia (ALL). However, with most data being derived from case-control study interviews, information on the underpinning reasons for caesarean section is sparse, and evidence is conflicting. Objectives Use clinical records compiled at the time of delivery to investigate the association between childhood ALL and caesarean delivery;examining timing in relation to labour onset, and reasons for the procedure. Methods Data are from the UK Childhood Cancer Study, a population-based case-control study conducted in the 1990s, when caesarean section rates were relatively low, in England, Scotland, and Wales. Children with ALL were individually matched to two controls on sex, date of birth, and region of residence. Information on mode of delivery and complications was abstracted from obstetric records. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression models adjusted for matching variables and relevant covariates. Results Around 75% of the 1034 cases and 1914 controls were born through unassisted vaginal delivery. Caesarean delivery was as frequent in cases and controls (OR 1.07, 95% CI 0.84, 1.36). No association was observed between ALL and caesarean delivery either during or before labour, with adjusted ORs of 1.08 (95% CI 0.78, 1.48) and 1.09 (95% CI 0.78, 1.53), respectively. For B-cell ALL, the ORs were 1.14 (95% CI 0.81, 1.59) for caesarean during labour and 1.21 (95% CI 0.85, 1.72) for prelabour. The underpinning reasons for caesarean delivery differed between cases and controls;with preeclampsia, although very rare, being more common amongst cases born by caesarean (OR 8.91, 95% CI 1.48, 53.42). Conclusions Our obstetric record-based study found no significant evidence that caesarean delivery increased the risk of childhood ALL, either overall or when carried out before

摘要： The article offers information on 'Peds Soup' podcast aimed to provide pediatrics residents with on-demand access to self-guided learning. Topics covered include the problems that were addressed by the podcast, how the topics for the podcast were chosen as well as the range of each episode, and the lessons that were learned from developing the podcast as well as the extent to which the project has achieved its goal based on residents' usage and opinions of the podcast.

关键词： Discitis   Spondylodiscitis   Paediatric   Biopsy  

摘要： Purpose Discitis in the paediatric population poses diagnostic challenges due to non-specific presenting symptoms and difficulty with expressing pain in non-communicating children. Discitis remains a relatively rare condition in the paediatric population and previous reports are limited to small cohorts. In this article, we report our experience in management of discitis over a 10-year period and review the literature on this topic. Methods We retrospectively reviewed cases of paediatric discitis/spondylodiscitis over a 10-year period between 2008 and 2018 managed in our regional paediatric neurosurgery unit. Relevant demographic information, microbiological data, blood investigation profile, antibiotic treatment duration and clinical outcomes were interrogated from clinical notes and electronic databases and further analysed. Results Overall, 21 cases of paediatric discitis were identified from year 2008 to 2018 with a female to male ratio of 1.3:1. The mean age at presentation was 4.3 years (range 1 to 15 years). Overall, there were 19 cases of lumbosacral/lumbar, 1 thoracic and 1 cervical discitis. The mean duration of follow-up was 20 months (range 6 to 69 months). The most common presenting features were back pain and refusal to walk/sit or weight bear. Erythrocyte sedimentation rate (ESR) was found to be more sensitive than C-reactive protein (CRP) (sensitivity 78% versus 38%) in our cohort. Computer tomography (CT)-guided biopsy was performed in five cases and only one of these was positive (20%). All patients were treated with intravenous antibiotics with resolution of discitis. Conclusions Presentation of discitis in children can be non-specific and requires high index of suspicion. CT-guided biopsy in our cohort revealed a low rate of positive cultures. Despite negative blood cultures and CT-guided biopsy results, empirical intravenous antibiotics were effective in treating discitis successfully. In our cohort, low yield of CT-guided biopsy does not suppor

关键词： busulfan   Fanconi anaemia   paediatrics   population pharmacokinetic modelling  

摘要： Aims Fanconi anaemia (FA) is a rare disorder characterized by progressive bone marrow failure that requires haematopoietic cell transplantation (HCT). Busulfan is used in conditioning regimens prior to HCT. Doses used in non-FA patients cause life-threatening toxicities in FA patients and data on busulfan pharmacokinetics (PK) in this population are limited. This study characterized busulfan PK in paediatric FA patients using population PK modelling and evaluated the effect of body composition on steady-state concentrations (C-ss). Methods A total of 200 busulfan plasma concentrations in 29 FA patients from a recent study (;NCT01082133) were available for population PK modelling. The effect of different body size-scaled doses and body compositions on C-ss was investigated using population PK modelling. Results Fat free mass (FFM) was identified as the best size descriptor in a two-compartment busulfan PK model in FA patients. Conventional dosing, based on an amount of busulfan per kilogram of total body mass, resulted in higher C-ss in FA patients with higher body mass index (BMI). A newly proposed FFM-based dosing strategy would eliminate the observed trend of higher concentrations in high BMI patients, and achieve consistent C-ss across a wide BMI spectrum. Conclusions This is the first study to describe the population PK of busulfan in paediatric FA patients. The proposed model will facilitate PK model-informed precision dosing. FFM-based dosing is expected to improve the probability of achieving target C-ss, particularly in obese patients, while minimizing the risk of overdosing.

摘要： The article offers information on Disaster Olympics, an asynchronous educational competition designed to assess the preparedness of pediatric emergency department (ED) staff in the event of a disaster. Topics covered include the problem that was addressed by the gamification strategy, the design of the curriculum that incorporated strategies from adult learning theory, and the lessons that were learned from developing and conducting the disaster drills.

关键词： cerebral palsy   information seeking behaviour   internet   online   paediatrics   rhizotomy  

摘要： Aim The aim of this research was to explore clinicians' experiences of parents' online health information seeking (OHIS) behaviour about selective dorsal rhizotomy for the management of cerebral palsy. Methods Using qualitative methodology, clinicians likely to have had experience with parents requesting selective dorsal rhizotomy were invited to participate in semi-structured interviews. Interviews with 13 clinicians were recorded, transcribed and inductive content analysis was used to identify, code and organise the data into themes. Results Participants highlighted how parental OHIS was changing clinical communication. Negative effects included a shift in clinicians' attention from giving advice and guidance to spending time discussing online findings, justifying how this information applies to a particular child and managing parents' judgments about clinical views. Positive effects included more collaboration and sharing of ideas. These results are presented in three main themes: (i) the informed parent;(ii) the clinicians' role;and (iii) a new clinical dynamic. Conclusion This research reinforces the notion that OHIS is changing the communication dynamic and clinicians' and parents' roles within the clinical encounter. Of significance was the number of challenges clinicians are facing as a result of online information, including managing parental understanding of non-evidenced information and responding to negative feedback about their practice. This research suggests a need for educational support and ongoing professional development for clinicians to assist them to adjust to new goals and expectations of clinical interactions with 'informed' parents.

关键词： Air pollution   Perinatal   Paediatric diabetes  

摘要： Background: Studies have reported increasing incidence rates of paediatric diabetes, especially among those aged 0-5 years. Epidemiological evidence linking ambient air pollution to paediatric diabetes remains mixed. Objective: This study investigated the association between maternal and early-life exposures to common air pollutants (NO2, PM2.5, O-3, and oxidant capacity [Ox;the redox-weighted average of O-3 and NO2]) and the incidence of paediatric diabetes in children up to 6 years of age. Methods: All registered singleton births in Ontario, Ca nada occurring between April 1st' 2006 and March 31st' 2012 were included through linkage from health administrative data. Monthly exposures to NO2, PM2.5, O-3, and O-x were estimated across trimesters, the entire pregnancy period and during childhood. Random effects Cox proportional hazards models were used to assess the relationships with paediatric diabetes incidence while controlling for important covariates. We also modelled the shape of concentration-response (CR) relationships. Results: There were 1094 children out of a cohort of 754,698 diagnosed with diabetes before the age of six. O-3 exposures during the first trimester of pregnancy were associated with paediatric diabetes incidence (hazard ratio (HR) per interquartile (IQR) increase = 2.00, 95% CI: 1.04-3.86). The CR relationship between O-3 during the first trimester and paediatric diabetes incidence appeared to have a risk threshold, in which there was littleto-no risk below 25 ppb of O-3, while above this level risk increased sigmoidally. No other associations were observed. Conclusion: O-3 exposures during a critical period of development were associated with an increased risk of paediatric diabetes incidence.

摘要： Adamantinoma-like Ewing's sarcoma is a rare tumor of the salivary gland seen in pediatric patients. It can mimic sialoblastoma and basal cell adenocarcinoma on cytomorphology and histopathology. FISH has to be performed to confirm the diagnosis.

关键词： Facial nerve palsy   Lyme disease   Bells palsy  

摘要： Introduction: Idiopathic facial nerve palsy (FNP) is an uncommon but important presentation in children, with Lyme disease known to be a common cause. The UK county of Hampshire is a high incidence area of Lyme disease. We conducted a retrospective review of the investigation and management of paediatric FNP at a large University hospital, including serologic testing and treatment of Lyme disease. Methods: We conducted a retrospective chart review of children under 18 presenting between January 1st 2010 and December 31st 2017 with a diagnosis of FNP. Patients with clear non-Lyme aetiology at presentation were excluded. Data was collected on demographics, initial presentation, investigations including Lyme serology, and management. Results: A total of 93 children were identified, with an even proportion of male to female and median age 9.3 years (IQR 4.6-12 years). A history of rash was present in 5.4%, tick bite in 14% and recent travel to, or residence in the New Forest in 22.6%. Lyme serology was performed in 81.7% of patients, of which 29% were positive. Antibiotics were prescribed for 73.1% of patients, oral steroids for 44% and aciclovir for 17.2%. Conclusion: Lyme disease is a significant cause of FNP in this endemic area of the UK, and there was a large degree of variability in management prior to national guideline publication. Areas with endemic Lyme disease should consider introducing local guidelines supporting routine investigation and management for FNP, including empiric treatment for Lyme disease in accordance with NICE guidelines to improve care and reduce variability.