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Background: The COVID-19 pandemic is the biggest worldwide health challenge in this century. Research concerning the role of children in the spread of SARS-CoV-2, and investigating the clinical effects of infection in children, has been vital. This paper describes the publication trend for pertinent scientific literature relating to COVID-19 in children during the first 6 months of the pandemic.Methods: A comprehensive search of preprint and published literature was conducted daily across four databases (PubMed, Scopus, Ovid-Embase and MedRXiv) between 1 January 2020 and 30 June 2020. Titles and abstracts were screened against predefined inclusion and exclusion criteria.Findings: Over the study period, a total of 45 453 papers were retrieved, of which 476 met our inclusion criteria. The cumulative number of children described in included publications totalled (at most) 41 396. The median number of children per paper was 6 (IQR 1-33). Nearly one-third of papers (30.2%) reported on a single child, and a further 28.3% reported on between 1 and 9 children. Half of all the publications originated from Asia.Interpretation: Our prospective bibliographic analysis of paediatric COVID-19 publications demonstrated a steady increase in the number of papers over time. Understanding and policy evolved with new information that was gathered over the course of the study period. However, over half of publications were individual case reports or small case series, which may have had a limited contribution to advancement of knowledge. During a pandemic, literature should be interpreted with great caution, and clinical/policy decisions should be continually reviewed in light of emerging evidence. [ABSTRACT FROM AUTHOR]

Background: Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a common illness with a major impact on quality of life. Recovery is poorly understood. Our aim was to describe definitions of recovery in paediatric CFS/ME, the rate of recovery and the time to recovery.Methods: This systematic review included a detailed search of MEDLINE, EMBASE, PsycInfo and Cochrane Library between 1994 and July 2018. Inclusion criteria were (1) clinical trials and observational studies, (2) participants aged <19 years with CFS/ME, (3) conducted in Western Healthcare systems and (4) studies including a measure of recovery and time taken to recover.Results: Twelve papers (10 studies) were identified, involving 826 patients (range 23-135). Recovery rates were highly varied, ranging between 4.5% and 83%.Eleven distinct definitions of recovery were used; six were composite outcomes while five used unidimensional outcomes. Outcome measures used to define recovery were highly heterogeneous. School attendance (n=8), fatigue (n=6) and physical functioning (n=4) were the most common outcomes included in definition of recovery. Only five definitions included a personal measure of recovery.Implications: Definitions of recovery are highly variable, likely secondary to differences in study design, outcomes used, follow-up and study populations. Heterogeneous definitions of recovery limit meaningful comparison between studies, highlighting the need for a consensus definition going forward. Recovery is probably best defined from the child's own perspective with a single self-reported measure. If composite measures are used for research, there should be agreement on the core outcome set used. [ABSTRACT FROM AUTHOR]

Background: Conflict in paediatric healthcare is becoming increasingly prevalent, in particular relation to paediatric end of life. This is damaging to patients, families, professionals and healthcare resources. Current research has begun to explore perspectives of healthcare professionals (HCPs), but the parental views on conflict are lacking.Objectives: This scoping review explores parental views on conflict during a child's end of life. In addition, parental views are mapped onto HCPs' views.Methods: A search was completed of the databases CINAHL, PubMed, Web of Science, Embase and Medline between 1997 and 2019, focused on parents of children with involvement with palliative or end-of-life care referring to conflict or disagreements.Results: The review found 10 papers that included parental views on conflict. Data on conflict were categorised into the following seven themes: communication breakdown, trust, suffering, different understanding of 'best interest', disagreements over treatment, spirituality and types of decision-making. In particular, parental expertise, perspectives on suffering and ways of making decisions were significant themes. A subset of themes mirror those of HCPs. However, parents identified views of conflict unique to their perspective.Conclusions: Parents identified important themes, in particular their perspective of what constitutes suffering and 'best interest'. In addition, parents highlight the importance of being recognised as an expert. [ABSTRACT FROM AUTHOR]

Objective: Assess the existing evidence base in order to synthesise the current qualitative findings for the impact of chronic health conditions on the school lives of young people.Design: Qualitative evidence synthesis using thematic synthesis.Patients: Young people aged 11-18 years with a chronic health condition from one of the following groups: oncology, cystic fibrosis, diabetes, asthma, rheumatology, neuromuscular, colorectal, chronic pain, allergies and dermatology.Outcome Measure: Qualitative findings and discussions present in included studies formed the data for the thematic synthesis.Results: From a search identifying 19 311 records, a sample of 35 papers were included. The included papers represented 15 countries and primarily employed interviews as part of data collection. Thematic synthesis resulted in six themes: 'keeping up/catching up/missing out/looking forward'; 'identity'; 'relationship with peers'; 'normality and difference'; 'autonomy'; 'relationships with staff'.Conclusions: Thematic synthesis highlighted the commonalities, rather than divergence, of issues for young people across different chronic conditions. Policies need to be based on the experiences of the people they aim to provide for, and while attendance and attainment remain important, there is clearly more that needs to be considered when gathering data, designing interventions and developing policies to support this population. It may also be advisable for clinical professionals to include the broader psychosocial aspects of school life in discussions and plans to support young people with long-term conditions.Prospero Registration Number: CRD42021278153. [ABSTRACT FROM AUTHOR]

Objective: Childhood obesity can affect drug disposition and efficacy of ibuprofen. The primary objective was to assess efficacy of ibuprofen in obese children.Design: A systematic review was undertaken following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Studies were identified from 12 databases. Two independent reviewers evaluated studies against the inclusion criteria and assessed for methodological quality.Setting: Any clinical setting.Patients: Patients under 18 years who were overweight/obese.Interventions: Patients taking ibuprofen for any indication, dose or regimen.Main Outcome Measures: The efficacy and tolerability of ibuprofen treatment in obese children and presence of any adverse drug reactions.Results: Searches identified 1305 studies. Four studies met inclusion criteria: three retrospective cohort studies (n=583, median age: 6 years, range: 1-18 years; n=200, median age: 11 years, range: 3-18 years; n=358 median age: 3.1 years, range: 1.2-8.5 years, respectively) and one case study. Each study differed in their method of dosing ibuprofen (weight-based, age-based and adjusted body weight dosing). Various doses were used: 5 mg/kg every 6 hours, 400 mg three times a day, 120 mg/dose and a dose calculated using adjusted body weight. One study reported efficacy (obese n=189, non-obese, n=394), where adequate pain control was achieved using 5 mg/kg. The other three studies did not determine if efficacy differed between obese and non-obese children.One study described adverse effects. An increased risk of bleeding with ibuprofen was noted but did not differentiate between obese and non-obese children.Conclusion: There are little published data to guide clinicians prescribing ibuprofen in obese children.Prospero Registration Number: CRD42021213500. [ABSTRACT FROM AUTHOR]

Background: The composition of the infant gastrointestinal (GI) microbiome has been linked to adverse long-term health outcomes and neonatal sepsis. Several factors are known to impact the composition of the microbiome, including mode of delivery, gestational age, feeding method and exposure to antibiotics. The impact of intrapartum antibiotics (IPAs) on the infant microbiome requires further research.Objective: We aimed to evaluate the impact of IPAs on the infant GI microbiome.Methods: We searched Ovid MEDLINE and Embase Classic+Embase for articles in English reporting on the microbiome of infants exposed to IPAs from the date of inception to 3 January 2021. Primary outcomes included abundance and colonisation of Bifidobacterium and Lactobacillus, as well as alpha and beta diversity.Results: 30 papers were included in this review. In the first year of life, following exposure to IPAs, 30% (6/20) of infant cohorts displayed significantly reduced Bifidobacterium, 89% (17/19) did not display any significant differences in Lactobacillus colonisation, 21% (7/34) displayed significantly reduced alpha diversity and 35% (12/34) displayed alterations in beta diversity. Results were further stratified by delivery, gestational age (preterm or full term) and feeding method.Conclusions: IPAs impact the composition of the infant GI microbiome, resulting in possible reductions Bifidobacterium and alpha diversity, and possible alterations in beta diversity. Our findings may have implications for maternal and neonatal health, including interventions to prevent reductions in health-promoting bacteria (eg, probiotics) and IPA class selection. [ABSTRACT FROM AUTHOR]

Background: For many children, visiting the hospital can lead to a state of increased anxiety. Social robots are being explored as a possible tool to reduce anxiety and distress in children attending a clinical or hospital environment. Social robots are designed to communicate and interact through movement, music and speech.Objective: This systematic review aims at assessing the current evidence on the types of social robots used and their impact on children's anxiety or distress levels when visiting the hospital for outpatient appointments or planned admissions.Methods: Databases such as MEDLINE, PubMed, IEEE Xplore, Web of Science, PsychINFO and Google Scholar were queried for papers published between January 2009 and August 2020 reporting the use of social robots interacting with children in hospital or clinical environments.Results: A total of 10 studies were located and included. Across these 10 studies, 7 different types of robots were used. Anxiety and distress were found to be reduced in the children who interacted with a social robot.Conclusions: Overall, the evidence suggests that social robots hold a promising role in reducing levels of anxiety or distress in children visiting the hospital. However, research on social robots is at an early stage and requires further studies to strengthen the evidence base. [ABSTRACT FROM AUTHOR]

Objective: Determine non-invasive ventilation with continuous positive airway pressure (CPAP) outcomes for paediatric respiratory distress in low-income and middle-income countries (LMICs).Design: Systematic review and meta-analysis.Setting: LMIC hospitals.Patients: One month to 15 year olds with respiratory distress.Interventions: We searched Medline, Embase, LILACS, Web of Science and Scopus on 7 April 2020. Included studies assessed CPAP safety, efficacy or effectiveness. All study types were included; neonatal only studies were excluded. Data were extracted by two reviewers and bias was assessed. Certainty of evidence was evaluated, and risk ratios (RR) were produced for meta-analyses. (PROSPERO protocol CRD42018084278).Results: 2174 papers were screened, 20 were included in the systematic review and 3 were included in two separate meta-analyses of mortality and adverse events. Studies suitable for meta-analysis were randomised controlled trials (RCTs) from Bangladesh, Ghana and Malawi. For meta-analyses comparing death or adverse events between CPAP and low-flow oxygen recipients, we found no clear CPAP effect on mortality (RR 0.75, 95% CI 0.33 to 1.72) or adverse events (RR 1.52, CI 0.71 to 3.26). We downgraded the certainty of evidence for both death and adverse events outcomes to 'low' due to design issues and results discrepancies across RCTs.Conclusions: Evidence for CPAP efficacy against mortality and adverse events has low certainty and is context dependent. Hospitals introducing CPAP need to have mechanisms in place to optimise safety in the context it is being used; this includes the location (a high dependency or intensive care area), adequate numbers of staff trained in CPAP use, close monitoring and mechanisms for escalation, daily direct physician supervision, equipment that is age appropriate and user-friendly and continuous monitoring of outcomes and quality of care. [ABSTRACT FROM AUTHOR]

Objective: Protracted international conflict has seen escalating numbers of displaced and resettled Syrian and Iraqi refugees, raising concerns for their health and well-being. This paper describes the demographic and clinical profiles of recently resettled Syrian and Iraqi refugee children and adolescents across physical, psychosocial, developmental and educational domains using standardised multidisciplinary assessments.Design: A cross-sectional observational study was undertaken of initial specialist paediatric multidisciplinary Refugee Health Service assessments completed at the tertiary paediatric hospital (Western Australia) between June 2015 and September 2019.Results: Three hundred and twenty-seven children and adolescents (264 Syrian, 63 Iraqi) were assessed following resettlement. Witnessed trauma (86%) and disclosed adversity (median Refugee Adverse Childhood Experiences score 3, range 1-14) were universally high. Almost all patients had health issues identified across physical (99%), psychosocial (76%) and developmental/educational (75%) domains. Interrupted education (65%) and death of a family member (16%) were significantly associated with psychological morbidities. Common comorbidities included dental caries (78%), non-infectious disease (76%), vitamin D deficiency (72%), malnutrition (46%; overweight/obesity 23%), and psychological (32%; post-traumatic stress disorder 4.3%) and developmental (9.5%) concerns. Emerging and alarming child protection concerns were prevalent (17%), with females demonstrating especially high risks.Conclusion: This is the largest comprehensive study demonstrating the complex and cross-dimensional health needs and specific vulnerabilities of resettled Syrian and Iraqi refugee children and adolescents. Early comprehensive standardised multidisciplinary paediatric assessments, and culturally safe, trauma-informed interventions and follow-up are required to optimise resettlement outcomes and promote well-being. [ABSTRACT FROM AUTHOR]

Objectives: To explore the impact of the COVID-19 pandemic on the experiences of caregivers of children with tracheostomies.Design: Qualitative semistructured interviews.Setting: All participants were currently, or had previously cared for, a tracheostomised child who had attended a tertiary care centre in the North of England. Health professionals were purposively sampled to include accounts from a range of professions from primary, community, secondary and tertiary care.Participants: Carers of children with tracheostomies (n=34), including health professionals (n=17) and parents (n=17).Interventions: Interviews were undertaken between July 2020 and February 2021 by telephone or video link.Main Outcome Measure: Qualitative reflexive thematic analysis with QSR NVivo V.12.Results: The pandemic has presented an additional and, for some, substantial challenge when caring for tracheostomised children, but this was not always felt to be the most overriding concern. Interviews demonstrated rapid adaptation, normalisation and varying degrees of stoicism and citizenship around constantly changing pandemic-related requirements, rules and regulations. This paper focuses on four key themes: 'reconceptualising safe care and safe places'; 'disrupted support and isolation'; 'relationships, trust and communication'; and 'coping with uncertainty and shifting boundaries of responsibility'. These are described within the context of the impact on the child, the emotional and physical well-being of carers and the challenges to maintaining the values of family-centred care.Conclusions: As we move to the next phase of the pandemic, we need to understand the impact on vulnerable groups so that their needs can be prioritised. [ABSTRACT FROM AUTHOR]

Background: A recent systematic review and meta-analysis identified a paucity of randomised-controlled trials (RCTs) investigating the use of probiotics to reduce or prevent mucositis and infection in children with cancer.Objective: This study evaluated the feasibility of undertaking an RCT and investigated the efficacy of probiotics for reducing or preventing mucositis and infection in children with cancers.Setting: The Paediatric Oncology and Haematology department at Leeds Teaching Hospital, UK.Patients: Children aged 1 year or older, receiving chemotherapies likely to cause mucositis.Interventions: Participants were randomised to receive the probiotic or placebo on day 1-14 of a chemotherapy cycle. Participants were also required to complete a patient diary for 21 days.Main Outcome Measures: To assess whether it is feasible to recruit children diagnosed with cancer who are at risk of developing mucositis to an adequately powered RCT.Results: Between May and November 2019, 34 out of 39 eligible participants were approached. Ten patients were recruited (4 probiotic and 6 placebo) of which 2 participants withdrew. Seven participants partially completed the diary but only two participants completed 80% or more. Eligible participants appeared to prefer giving informal verbal feedback when in direct contact with research and healthcare professionals.Conclusion: This study demonstrated that recruitment needs to be improved prior to undertaking an adequately powered RCT.Trial Registration Number: NCT03785938. [ABSTRACT FROM AUTHOR]

Background: Admission rates are rising despite no change to burden of illness, and interventions to reduce unscheduled admission to hospital safely may be justified.Objective: To systematically examine admission prevention strategies and report long-term follow-up of admission prevention initiatives.Data Sources: MEDLINE, Embase, OVID SP, PsychINFO, Science Citation Index Expanded/ISI Web of Science, The Cochrane Library from inception to time of writing. Reference lists were hand searched.Study Eligibility Criteria: Randomised controlled trials and before-and-after studies.Participants: Individuals aged <18 years.Study Appraisal and Synthesis Methods: Studies were independently screened by two reviewers with final screening by a third. Data extraction and the Critical Appraisals Skills Programme checklist completion (for risk of bias assessment) were performed by one reviewer and checked by a second.Results: Twenty-eight studies were included of whom 24 were before-and-after studies and 4 were studies comparing outcomes between non-randomised groups. Interventions included referral pathways, staff reconfiguration, new healthcare facilities and telemedicine. The strongest evidence for admission prevention was seen in asthma-specific referral pathways (n=6) showing 34% (95% CI 28 to 39) reduction, but with evidence of publication bias. Other pathways showed inconsistent results or were insufficient for wider interpretation. Staffing reconfiguration showed reduced admissions in two studies, and shorter length of stay in one. Short stay admission units reduced admissions in three studies.Conclusions and Implications: There is little robust evidence to support interventions aimed at preventing paediatric admissions and further research is needed. [ABSTRACT FROM AUTHOR]

Objective: To identify children and young people's preferences for effective healthcare communication.Design: A systematic review of qualitative studies was conducted to identify evidence from children and young people on effective healthcare communication. Electronic databases and reference lists of relevant articles were searched to July 2020.Results: A total of 13 studies were included. Five major themes were identified: medical information (timing, amount, coordination and futures), person not patient (creating relationships, time, nurse involvement, sensitivity), type of communication (creative and interactive, behavioural, talking and listening, written communication), consultations (first impressions, with and without parents, actively promoting involvement, open and honest, age appropriate) and communication with parents (using parental knowledge, support).Conclusions: Research in this area remains sparse and consistent implementation is debateable. Children and young people articulate a preference for two-way healthcare communication. General principles for effective communication are identified as well as the need to avoid making assumptions and to tailor approaches to individuals. Establishing and maintaining relationships is essential and requires time and resources. Parents and carers have a positive role in healthcare communication which needs to be balanced with the needs and rights of children. All these factors also apply to children with communication difficulties or from marginalised groups, but additional extra support may be required.Prospero Registration Number: CRD42019145539. [ABSTRACT FROM AUTHOR]

Objective: This systematic review aimed to establish the relative incidence of new postoperative brain MRI findings following paediatric congenital cardiac surgery.Design: To distinguish perioperative changes from pre-existing MR findings, our systematic search strategy focused on identifying original research studies reporting both presurgery and postsurgery brain MRI scans. Patient demographics, study methods and brain MR findings were extracted.Results: Twenty-one eligible publications, including two case-control and one randomised controlled trial, were identified. Pre-existing brain MRI findings were noted in 43% (513/1205) of neonates prior to surgery, mainly white matter injuries (WMI). Surgery was performed at a median age of 8 days with comparison of preoperative and postoperative MR scans revealing additional new postoperative findings in 51% (550/1075) of patients, mainly WMI. Four studies adopted a brain injury scoring system, but the majority did not indicate the severity or time course of findings. In a subgroup analysis, approximately 32% of patients with pre-existing lesions went on to develop additional new lesions postsurgery. Pre-existing findings were not found to confer a higher risk of acquiring brain lesions postoperatively. No evidence was identified linking new MR findings with later neurodevelopmental delay.Conclusion: This systematic review suggests that surgery approximately doubles the number of patients with new brain lesions. [ABSTRACT FROM AUTHOR]