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关键词： Age-specific   Continuous   Reference intervals   Systematic review   Statistical methods  

摘要： Introduction: There is an emerging realisation that paediatric reference intervals (RIs) estimated using discrete age-groups may be misleading, especially close to age cut-off values. This limitation has been addressed by estimating RIs that vary continuously with age. This systematic review examines the range of statistical methods used over the past 25 years for estimation of age-specific RIs, and identifies trends in usage and reporting. Methods: Literature searches were conducted using predefined search criteria for original publications between 1993 and 2018 on the MEDLINE and Embase databases. Data related to sample size, treatment of age (as categorical or continuous), and statistical methods were extracted from the selected publications. Results: A total of 238 publications were reviewed. Not all publications reported the statistical methods used in different steps. Among the publications, 167 (70%) reported discrete age-group RIs, 54 (23%) reported continuous RIs and 17 (7%) reported both types of RIs. The nonparametric statistical method was commonly used for discrete age-group RIs (64%, n = 117), whereas a wide variety of curve-fitting approaches, including Cole's lambda-mu-sigma method (28%, n = 20), parametric curve-based methods (28%, n = 20), generalised additive model for location, scale and shape method (13%, n = 9) and quantile regression (11%, n = 8) were used for continuous RIs. Conclusions: Improvement in the reporting of statistical methods used for estimating age-specific paediatric RIs is required. There has been insufficient uptake of methods for producing continuous RIs, especially for biomarkers that display strong age-dependence.

关键词： antibiotic prophylaxis   Candida albicans   Candida auris   Candida tropicalis   candidemia   intensive care   neonates   paediatric  

摘要： Background The epidemiology, clinical profile and outcome of paediatric candidemia vary considerably by age, healthcare settings and prevalentCandidaspecies. Despite these differences, few comprehensive studies are undertaken. This nationwide study addresses this knowledge gap. Methods 487 children who contracted ICU-acquired candidemia at 23 Indian tertiary care centres were assessed for 398 variables spanning demography, clinical characteristics, microbiology, treatment and outcome. Results Both neonates (5.0 days;range = 3.0-9.5) and non-neonatal children (7.0 days;range = 3.0-13.0) developed candidemia early after ICU admission. Majority of neonates were premature (63.7%) with low birthweight (57.1%). Perinatal asphyxia (7.3%), pneumonia (8.2%), congenital heart disease (8.4%) and invasive procedures were common comorbidities, and antibiotic use (94.1%) was widespread.C tropicalis(24.7%) andC albicans(20.7%) dominated both age groups. Antifungal treatment (66.5%) and removal of central catheters (44.8%) lagged behind. Overall resistance was low;however, emergence of resistantC kruseiandC aurisneeds attention. The 30-day crude mortality was 27.8% (neonates) and 29.4% (non-neonates). Logistic regression identified admission to public sector ICUs (OR = 5.64), mechanical ventilation (OR = 2.82), corticosteroid therapy (OR = 8.89) and antifungal therapy (OR = 0.22) as independent predictors of 30-day crude mortality in neonates. Similarly, admission to public sector ICUs (OR = 3.62), mechanical ventilation (OR = 3.13), exposure to carbapenems (OR = 2.18) and azole antifungal therapy (OR = 0.48) were independent predictors for non-neonates. Conclusions Our findings reveal a distinct epidemiology, including early infection with a different spectrum ofCandidaspecies, calling for appropriate intervention strategies to reduce candidemia morbidity and mortality. Independent factors identified in our regression models can help tackle these challenges.

关键词： children   dental emergency   health services research   oral healthcare access  

摘要： Background Trends of paediatric emergency visits (ED) for dental conditions have been broadly discussed;however, little has been published in the Canadian context. Aim To describe the utilization of ED for dental conditions among children and to investigate demographic characteristics influencing its use. Design A comprehensive review of records of all children aged 1-17 years who attended the ED service of a paediatric hospital in Montreal, Canada, for dental conditions over a 10-year period (2004-2013) was completed. Information on the child's principal dental diagnosis, sociodemographic data, and source of referral was obtained. Results A total of 10 905 paediatric ED visits were seen during the study period. Among the children, 54.7% were male and the majority was younger than 6 years old. Dental caries constituted the most common reason for ED presentation comprising close to 43% of total visits for a dental complaint. Females, teenagers, and self-referred children were more likely to experience ED visits due to non-traumatic dental conditions. Conclusions The utilization of ED for dental conditions has increased among pre-school children in the last decade and was mostly due to caries-related dental problems. Effective preventive strategies are needed to improve the oral health condition of children.

关键词： Prematurity   Microlaryngobronchoscopy   Subglottic stenosis   Laryngeal cleft   Laryngomalacia   Paediatric airway  

摘要： Purpose Enhanced management of the pre-term patient has resulted in improved survival rates in increasingly premature patients. Although prematurity predisposes to congenital airway pathology, there is also increased risk of endotracheal intubation, and therefore acquired subglottic pathology. We sought to evaluate airway pathology in children outside the neonatal period with a history of prematurity to explore the relationship between prematurity and upper airway pathologies. Methods Data for patients undergoing elective microlaryngobronchoscopy (MLB) at our centre were collected prospectively over a 5-year period. Patients identified as premature were sub-classified by the grade of prematurity. Results 339 patients over 1 month of age underwent MLB, of which 56 (16.5%) were born prematurely. Of those with identified airway pathology, 49 (23.4%) were born prematurely, accounting for 32.6% of subglottic stenosis (n = 30), 24% of laryngomalacia (n = 13) and 19% of laryngeal cleft diagnoses (n = 16). 49 premature patients (87.5%) had one or more airway pathologies diagnosed. Multi-level airway pathology was seen in twelve premature infants (21.4%), demonstrating a statistically significant association (odds ratio 3.396;95% CI 1.697-6.842;pvalue < 0.0016). Incidence of airway pathology, the severity of airway disease and multi-level airway pathology were not related to the grade of prematurity. Conclusions Premature patients account for a significant proportion of the workload within our tertiary centre due to improving neonatal care and survival in pre-term infants. We suggest early paediatric ENT evaluation for ex-premature patients with symptoms of airway pathology, with a low threshold for MLB. Improving neonatal survival rates in ever-increasing prematurity will require the further provision of specialist paediatric ENT services to manage their ongoing care.

关键词： Australia and New Zealand   liver transplantation   paediatric  

摘要： Liver transplantation has become the standard of care for children with end-stage liver disease. In Australia and New Zealand, there are four paediatric liver transplant units, in Sydney, Melbourne, Brisbane and Auckland. Over the past 30 years, there have been significant changes to indications for transplant, as well as medical and surgical advances. In this paper, using retrospective data from the Australia and New Zealand Liver Transplant Registry, we review 977 children (less than 16 years of age) who underwent liver transplant from 1985 to 2018. The most common indication was biliary atresia (54%), although there has been an increase in other indications, including inborn errors of metabolism, fulminant hepatic failure and malignant liver tumours. Over the past 3 decades, areas of change and innovation include: the use of 'split grafts' to enable an adult and a child to receive the same donor liver, live donation, improvements in immunosuppressive regimens and infectious prophylaxis protocols and innovative surgical techniques allowing transplantation in smaller infants. The outcomes for children who undergo liver transplant in ANZ are excellent, with current 10-year patient survival rates of 95%, comparable to other larger centres around the world.

关键词： Children   Deoxyribonucleic acid   DNA   Exome   Genetics   Genomics   Heredity   Imaging   Radiology   Skeletal dysplasias  

摘要： An understanding of genetics and genomics is increasingly important for all clinicians. Next-generation genomic sequencing technologies enable sequencing of the entire human genome in short timescales, and are increasingly being implemented in health care systems. Clinicians across all medical specialties will increasingly use results generated from genomic testing to inform their clinical practice and provide the best quality of care for patients. These innovations are already transforming the diagnostic pathways for rare genetic diseases, including skeletal dysplasias, with an inevitable impact on the traditional roles of diagnosticians. This article covers the fundamentals of human genetics, mechanisms of genetic variation and the technologies used to investigate the genetic basis of disease, with a specific focus on skeletal dysplasias and the potential impact of genomics on paediatric radiology.

关键词： gastrointestinal tract   magnetic resonance imaging   Magnetic Resonance Imaging in Paediatric Constipation   TransiCap mini-capsules   x-ray radiopaque markers  

摘要： Objective: In England, 27,500 children are referred annually to hospital with constipation. An objective measure of whole gut transit time (WGTT) could aid management. The current standard WGTT assessment, the x-ray radiopaque marker (ROM) test, gives poor definition of colonic anatomy and the radiation dose required is undesirable in children. Our objective was to develop an alternative magnetic resonance imaging (MRI) WGTT measure to the x-ray ROM test and to demonstrate its initial feasibility in paediatric constipation. Methods: With the Nottingham Young Person's Advisory Group we developed a small (8 x 4 mm), inert polypropylene capsule shell filled with MRI-visible fat emulsion. The capsule can be imaged using MRI fat and water in-phase and out-of-phase imaging. Sixteen patients with constipation and 19 healthy participants aged 7 to 18 years old were recruited. Following a common ROM protocol, the participants swallowed 24 mini-capsules each day for 3 days and were imaged on days 4 and 7 using MRI. The number of successful studies (feasibility) and WGTT were assessed. Participants' EuroQoL Visual Analogue Scale were also collected and compared between the day before the taking the first set of mini-capsules to the day after the last MRI study day. Results: The mini-capsules were imaged successfully in the colon of all participants. The WGTT was 78 +/- 35 hours (mean +/- standard deviation) for patients, and 36 +/- 16 hours, P Conclusions: Magnetic Resonance Imaging in Paediatric Constipation was a first-in-child feasibility study of a new medical device to measure WGTT in paediatric constipation using MRI. The study showed that the new method is feasible and is well tolerated.