Highlights from the literature
Guns In a sobering review paper, examining the deaths in the USA among children and young adults up to 20 years of age, Goldstick JE et al (New Eng J Med 2022;386:1955–1956. DOI: 10.1056/NEJMc2201761) have used data from The Centres for Disease Control and Prevention (CDC) which has recently released updated official mortality data. It showed that there were 45 222 firearm-related deaths in the United States in 2020 which is a new peak and establishes fire-arm related deaths as the top cause of deaths for children and adolescents in the USA. The figure published is astonishing and shows a marked decrease in deaths fr...
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Tags: Miscellanea Source Type: research

Does the measurement of fractional exhaled nitric oxide help asthma management?
In the search for an objective measure or biomarker of asthma control, fractional exhaled nitric oxide (FeNO) has looked a promising candidate. However, the benefit of using FeNO in addition to symptom-guided treatment is not clear. Turner S et al (Lancet Respiratory Medicine 2022;10:584–92 https://doi.org/10.1016/S2213-2600(21)00486-0) have successfully conducted and adequately powered study to evaluate the efficacy of adding FeNO to symptom-guided treatment in children with asthma vs only symptom-guided treatment. This is the first randomised clinical trial (RCT) to examine whether the addition of FeNO to symptom-g...
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Tags: Miscellanea Source Type: research

Narrowing the spectrum: development of a UK paediatric antimicrobial prescribing summary
Antimicrobial resistance (AMR) is predicted to kill 10 million people a year by 2050, costing the world up to $100 trillion.1 AMR threatens modern medicine as interventions such as surgery and chemotherapy cannot be provided safely without effective antibiotics. While AMR occurs naturally, modifiable factors contribute to its spread: inappropriate selection of agents and extended duration and spectrum of antimicrobial prescriptions.2 There is wide variation in inpatient paediatric antibiotic prescribing in the UK, with discrepancy between specialist groups, tertiary centres and even between clinicians within a hospital.3 T...
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Authors: Shears, A., Demirjian, A., McGarrity, O., Vergnano, S., Patel, S. V., McMaster, P. Tags: PostScript Source Type: research

Towards evidence-based medicine for paediatricians
Persuasive power of the P There is something beguiling about a result where p<0.05... Something in our inadequate medical statistics training makes us believe that this is a symbol for the truth. We have to resist. There is a whole branch of statistics that deals with knowing on the basis of things we have known before (Bayesian statistics). We have discussed this in Archimedes in the past1—the core of it we can all understand. A high potassium in a child with blocked dialysis tubing is much more likely to be real than a high potassium from a squeezed heel sample. While it is not quite as simple as that in reading...
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Authors: Phillips, B. Tags: ADC Archimedes Source Type: research

What information can we use to help determine futility in paediatric patients presenting in traumatic cardiac arrest?
Scenario A 2-year-old child presents to the emergency department (ED) after running into traffic. He chased a ball into the road and was struck by a car. An ambulance is dispatched to transport him to hospital, but he arrests en route. By the time he reaches your facility, he has been without a pulse for 10 min. He is in cardiac arrest. There is an endotracheal (ET) tube in situ and bilateral finger thoracostomies have been performed. The paramedics placed a pelvic binder prior to transportation. Tibial intraosseous (IO) access has been obtained and he is receiving 10 mL/kg of balanced crystalloid. No pre-hospital blood pr...
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Authors: Currie, V., Tagg, A., Kanaris, C. Tags: ADC Archimedes Source Type: research

Dexmedetomidine improves success of paediatric MRI sedation
Conclusions Intranasal dexmedetomidine is an effective alternative to oral midazolam for sedation for MRI and as a rescue medication where chloral hydrate has been ineffective. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Authors: Jackson, T. J., Dawes, D., Ahmad, S., Martin, D., Gyamtso, C. Tags: ADC Drug Therapy Source Type: research

Assessment of mitochondrial toxicity in newborns and infants with congenital cytomegalovirus infection treated with valganciclovir
Conclusions No evidence of mitochondrial toxicity was found in infants treated with valganciclovir for congenital CMV. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Authors: Ortiz-Gracia, A., Rios, M., Tobias, E., Noguera-Julian, A., Garcia-Garcia, F. J., Canto-Santos, J., Valls-Roca, L., Garrabou, G., Grau, J. M., Cardellach, F., Sanchez, E., Moren, C., Fortuny, C. Tags: Open access, ADC Drug Therapy Source Type: research

Information for children and young people about reporting suspected adverse drug reactions
Conclusion The new guide for CYP to inform them about how to report a suspected ADR to the MHRA was well received and increased the knowledge, and confidence to report, in those who responded. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Authors: Hawcutt, D. B., Jadeja, M., Bhoombla, N., Smith, S., McWilliam, S. J. Tags: ADC Drug Therapy Source Type: research

Long COVID (post-COVID-19 condition) in children: a modified Delphi process
Conclusions This is the first research definition of Long COVID (post-COVID-19 condition) in CYP and complements the clinical case definition in adults proposed by the WHO. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Authors: Stephenson, T., Allin, B., Nugawela, M. D., Rojas, N., Dalrymple, E., Pinto Pereira, S., Soni, M., Knight, M., Cheung, E. Y., Heyman, I., CLoCk Consortium, Shafran, R., Buszewicz, Chalder, Crawley, Stavola, Ford, Garg, Hargreaves, Harnden, Heyman, Ladhani Tags: Open access, COVID-19 Original research Source Type: research

Data handling practices and commercial features of apps related to children: a scoping review of content analyses
Conclusions Research related to the data handling and the commercial features of apps that may transmit children’s data is preliminary and has not kept pace with the rapid expansion and evolution of mobile app development. Critical examinations of these app aspects are needed to elucidate risks and inform regulations aimed at protecting children’s privacy and well-being. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Authors: Jibb, L., Amoako, E., Heisey, M., Ren, L., Grundy, Q. Tags: Open access Original research Source Type: research

Time to normalisation of tissue transglutaminase in paediatric coeliac disease is dependent on initial titre and half of patients will normalise within 12 months
Conclusions Normalisation of TTG levels occurs within 6–12 months for around half of patients. Higher TTG levels at diagnosis take longer to normalise. The role of compliance is unclear. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Authors: Ashton, J. J., Driscoll, K., Himsworth, J., Beattie, R. M., Batra, A. Tags: Original research Source Type: research

Self-management support for young people living with fluctuating chronic diseases
Fluctuating chronic diseases Unpredictable fluctuations, episodic deteriorations and flares are common in many paediatric chronic diseases, for example, asthma, type 1 diabetes mellitus, juvenile idiopathic arthritis (JIA), epilepsy, systemic sclerosis, cystic fibrosis, inflammatory bowel disease and sickle cell disease.1–4 For many children and adolescents, their chronic disease is not a steady state of illness. On the contrary, a continuous ebb and flow of symptoms interferes with functional and social daily life.1–4 These fluctuations constitute a difficult challenge to patients’ ability to self-manage...
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Authors: Schoemaker, C. G., van Geelen, S. M., Allewijn, M., Fernhout, M., van Vliet, R., Wulffraat, N. Tags: Open access Viewpoint Source Type: research

Race and ethnicity in clinical trials
Defining race and ethnicity has always been a challenge to clinical researchers and including subjects from all racial and ethnic backgrounds is difficult. Historically, many studies have excluded subjects who do not speak English or have only one or two language translations available for patient information and consent forms. Subjects from specific racial and ethnic groups, may well have problems accessing and inequalities in healthcare and will have poorer health outcomes in some countries. Rees CA et al (JAMA Pediatr 2022;176:e220142. doi:10.1001/jamapediatrics.2022.0142) have examined how race and ethnicity in paediat...
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Tags: Miscellanea Source Type: research

Revealing the identity of NHS staff: what is in a name?
For some years, judges have, during High Court proceedings relating to the end of a child’s life, made orders prohibiting the naming of clinicians who have been involved in the child’s care and treatment. The order, known as a Reporting Restriction Order (RRO, ‘freezing order’), may or may not extend for a short period following the child’s death. In June 2021, the High Court heard two joined cases1 where parents sought to question whether the court had the authority to keep in place the RROs made during the proceedings that had concerned their respective children. In both cases, their childre...
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Authors: Wheeler, R. Tags: Clinical law for clinical practice Source Type: research

Extra-axial haemorrhages in young children with skull fractures: abuse or accident?
Conclusions Simple contact EAHs were common among children with minor and major accidental skull fractures. Accidental EAHs were more localised with less neurological dysfunction than abusive. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - June 17, 2022 Category: Pediatrics Authors: Wallace, J., Metz, J. B., Otjen, J., Perez, F. A., Done, S., Brown, E. C. B., Wiester, R. T., Boos, S. C., Ganti, S., Feldman, K. W. Tags: ADC Paediatric Emergency Medicine Source Type: research