Paediatrics (children and young people)

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Research outputs from the Paediatrics department at the RD&E.

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    Corrigendum to Persistence of immunogenicity after seven COVID-19 vaccines given as third dose boosters following two doses of ChAdOx1 nCov-19 or BNT162b2 in the UK: Three month analyses of the COV-BOOST trial" [J Infect 84(6) (2022) 795-813, 5511]"
    (Elsevier, 2023-05-01) Liu, X.; Munro, A. P.; Feng, S.; Janani, L.; Aley, P. K.; Babbage, G.; Baxter, D.; Bula, M.; Cathie, K.; Chatterjee, K.; Dejnirattisai, W.; Dodd, K.; Enever, Y.; Qureshi, E.; Goodman, A. L.; Green, C. A.; Harndahl, L.; Haughney, J.; Hicks, A.; van der Klaauw, A. A.; Kwok, J.; Libri, V.; Llewelyn, M. J.; McGregor, A. C.; Minassian, A. M.; Moore, P.; Mughal, M.; Mujadidi, Y. F.; Holliday, K.; Osanlou, O.; Osanlou, R.; Owens, D. R.; Pacurar, M.; Palfreeman, A.; Pan, D.; Rampling, T.; Regan, K.; Saich, S.; Serafimova, T.; Saralaya, D.; Screaton, G. R.; Sharma, S.; Sheridan, R.; Sturdy, A.; Supasa, P.; Thomson, E. C.; Todd, S.; Twelves, C.; Read, R. C.; Charlton, S.; Hallis, B.; Ramsay, M.; Andrews, N.; Lambe, T.; Nguyen-Van-Tam, J. S.; Cornelius, V.; Snape, M. D.; Faust, S. N.
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    Implementation of flash glucose monitoring in four pediatric diabetes clinics: controlled before and after study to produce real-world evidence of patient benefit
    (BMJ, 2023-08-01) Kandiyali, R.; Taylor, H.; Thomas, E.; Cullen, F.; Hollingworth, W.; Ingram, J.; Kenward, C.; West, N.; McGregor, D.; Smith, B.; Hamilton-Shield, J.
    AIMS: To assess the real-world evidence for flash glucose monitoring (Abbott FreeStyle Libre) for children with type 1 diabetes in terms of glucose control, secondary healthcare resources and costs. RESEARCH DESIGN AND METHODS: We conducted a controlled before and after study (approximately 12 months before and after) using routinely collected health record data on children who start using flash monitors and a control population of children with self-monitoring of blood glucose (SMBG). Our population-based sample of eligible individuals using flash monitoring (n=114) and controls (n=80) aged between 4 and 18 years was drawn from four paediatric diabetes clinics (secondary care) in the South West England. Outcome measures included: glycated hemoglobin (HbA1c), frequency of BG tests; frequency of sensor scans; time in recommended glucose range; short-term complications (hypoglycemia, diabetic ketoacidosis and related illness resulting in investigation) and secondary care costs. RESULTS: After adjustment for age, time since diagnosis, deprivation and the test modality (point of care or laboratory), the mean HbA1c reading for controls was 61.2 (mmol/mol) for the period before and 63.9 after. For individuals using flash monitoring, the adjusted mean HbA1c reading was 64.6 for the period before implementation and 63.8 after. Rates of short-term complications were low across all groups in the study. Whereas the 'after' flash monitoring group had substantially higher incremental costs (+£703 vs the flash monitoring 'before' comparison and +£841 vs contemporaneous SMBG controls), these cost differences were driven by primary care prescribing (sensor costs). CONCLUSIONS: There was some indication that flash monitoring might help young people improve the control of their diabetes but for our sample, the difference between finger-prick testing and flash monitoring was not clinically significant (HbA1c improvement <5 mmol/mol). Given the pace of technological change within diabetes, research efforts should now facilitate the real-time analysis of long-term routine data on flash and continuous glucose monitors.
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    Childhood/adolescent Sydenham's chorea in the UK and Ireland: a BPSU/CAPSS surveillance study
    (BMJ, 2023-09-01) Wooding, E. L.; Morton, M. J. S.; Lim, M.; Mitrofan, O.; Mushet, N.; Sie, A.; Knight, B.; Ford, T.; Newlove-Delgado, T.
    OBJECTIVE: To conduct the first prospective surveillance study of Sydenham's chorea (SC) in the UK and Ireland, and to describe the current paediatric and child psychiatric service-related incidence, presentation and management of SC in children and young people aged 0-16 years. DESIGN: Surveillance study of first presentations of SC reported by paediatricians via the British Paediatric Surveillance Unit (BPSU) and all presentations of SC reported by child and adolescent psychiatrists through the Child and Adolescent Psychiatry Surveillance System (CAPSS). RESULTS: Over 24 months from November 2018, 72 reports were made via BPSU, of which 43 met the surveillance case definition of being eligible cases of suspected or confirmed SC. This translates to an estimated paediatric service-related incidence rate of new SC cases of 0.16 per 100 000 children aged 0-16 per year in the UK. No reports were made via CAPSS over the 18-month reporting period, although over 75% of BPSU cases presented with emotional and/or behavioural symptoms. Almost all cases were prescribed courses of antibiotics of varying duration, and around a quarter of cases (22%) received immunomodulatory treatment. CONCLUSIONS: SC remains a rare condition in the UK and Ireland but has not disappeared. Our findings emphasise the impact that the condition can have on children's functioning and confirm that paediatricians and child psychiatrists should remain vigilant to its presenting features, which commonly include emotional and behavioural symptoms. There is a further need for development of consensus around identification, diagnosis and management across child health settings.
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    NICE guideline review: Epilepsies in children, young people and adults NG217
    (BMJ, 2023-06-01) Jones, K. E. A.; Howells, R.; Mallick, A. A.; Paul, S. P.; Dey, I.
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    Factors affecting the support for physical activity in children and adolescents with type 1 diabetes mellitus: a national survey of health care professionals' perceptions
    (BMC, 2023-03-22) Cockcroft, E. J.; Wooding, E. L.; Narendran, P.; Dias, R. P.; Barker, A. R.; Moudiotis, C.; Clarke, R.; Andrews, R. C.
    BACKGROUND: Many children and adolescents with Type 1 Diabetes Mellitus (T1DM) don't meet the recommended levels of physical activity. Healthcare professionals (HCPs) have a key role in supporting and encouraging children and adolescents with T1DM to be physically active. This study aims to understand the perspectives of HCPs in relation to supporting physical activity and implementing guidelines relating to physical activity. METHODS: An online mixed methods survey was circulated to HCPs in pediatric diabetes units in England and Wales. Participants were asked about how they support physical activity in their clinic and their perceptions of barriers/enablers of providing physical activity support to children and adolescents with T1DM. Quantitative data were analysed descriptively. An deductive thematic approach was applied to the free text responses using the Capability Opportunity Motivation model of Behaviour (COM-B) as a framework. RESULTS: Responses were received from 114 individuals at 77 different pediatric diabetes units (45% of pediatric diabetes units in England and Wales). HCPs surveyed felt that the promotion of physical activity is important (90%) and advised patients to increase levels of physical activity (88%). 19% of the respondents felt they did not have sufficient knowledge to provide support. HCPs reported limited knowledge and confidence, time and resources as barriers to providing support. They also felt the current guidance was too complicated with few practical solutions. CONCLUSION: Pediatric HCPs need training and support to be able to encourage and support children and adolescents with T1D to be a physical activity. In addition, resources that provide simple and practical advice to manage glucose around exercise are needed.