Careers in paediatrics: Community paediatrics revisited

The concept of ‘community paediatrics’, as enunciated by Robert Haggerty in 1968, has informed and shaped many paediatric careers. The principle tenets of inclusiveness: attention to unmet needs; addressing common health problems of children and youth; using and applying preventive and harm-reduction strategies; and securing community input and control, were part of the Haggerty model. The present article revisits Haggerty’s model and describes how the concepts have shaped contemporary paediatrics in North America.     

Micronutrients

Micronutrients are essential dietary components and play a fundamental role in the prevention of disease. 30 are essential and cannot be synthesized by the body on a daily basis, making dietary sources critical. Micronutrients have an array of biochemical functions which are fundamental in the homoeostatic regulation of body function. It is at any point in a metabolic pathway that the chemical reaction may be unable to continue along its nature cascading pathway because the essential micronutrient is lacking. The normal metabolic regulation of the body will have been disturbed and ill health may occur due to the absence of a specific micronutrients. Several population groups with specific nutritional requirements, complex social, environmental and economic circumstances may be at risk of inadequate micronutrient intakes due to poor consumption or excessive losses, and hence maybe unable to meet their recommended requirements of micronutrients. This group may benefit from micronutrient supplements. Infants/children are a specific population group who are at risk of micronutrient deficiency states making adequate intakes essential to ensure normal growth and development. The paediatric group will be discussed here, with reference to current recommendations for their micronutrient and supplementation requirements based on current evidence available to advisory groups.     

Paediatric hereditary angioedema: a survey of UK service provision and patient experience

Hereditary angioedema (HAE) is a rare disease characterized by episodes of potentially life‐threatening angioedema. For affected children in the United Kingdom, there are relatively few data regarding disease prevalence, service organization and the humanistic burden of the disease. To improve knowledge in these areas, we surveyed major providers of care for children with HAE. A questionnaire was sent to major paediatric centres to determine patient numbers, symptoms, diagnostic difficulties, management and available services. In addition, all patients at a single centre were given a questionnaire to determine the experiences of children and their families. Sixteen of 28 centres responded, caring for a total of 111 UK children. Seven children had experienced life‐threatening crises. One‐third of patients were on long‐term prophylactic medication, including C1 inhibitor prophylaxis in four children. Eight centres reported patients who were initially misdiagnosed. Broad differences in management were noted, particularly regarding indications for long‐term prophylaxis and treatment monitoring. We also noted substantial variation in the organization of services between centres, including the number of consultants contributing to patient care, the availability of specialist nurses, the availability of home therapy training and the provision of patient information. Ten of 12 patient/carer questionnaires were returned, identifying three common themes: the need to access specialist knowledge, the importance of home therapy and concerns around the direct effect of angioedema on their life. To our knowledge, this study represents the first dedicated survey of paediatric HAE services in the United Kingdom and provides useful information to inform the optimization of services.     

Using electronic medical record data to report laboratory adverse events

Despite the importance of adverse event (AE) reporting, AEs are under‐reported on clinical trials. We hypothesized that electronic medical record (EMR) data can ascertain laboratory‐based AEs more accurately than those ascertained manually. EMR data on 12 AEs for patients enrolled on two Children's Oncology Group (COG) trials at one institution were extracted, processed and graded. When compared to gold standard chart data, COG AE report sensitivity and positive predictive values (PPV) were 0–21·1% and 20–100%, respectively. EMR sensitivity and PPV were >98·2% for all AEs. These results demonstrate that EMR‐based AE ascertainment and grading substantially improves laboratory AE reporting accuracy.     

An adapted walking intervention for a child with Pitt Hopkins syndrome*

Purpose: To investigate the effects of a community-based adapted walking intervention on a child with Pitt Hopkins syndrome (PTHS).

Methods: A four-year old boy with PTHS participated in a 12-week intervention comprising five one-hour long walking sessions per week at a local daycare. Walking sessions used the Upsee mobility device (Firefly by Leckey Ltd., Ireland). Outcome measures included Goal Attainment Scaling and the Mobility Ability Participation Assessment.

Results: Parental and caregiver goals for social interaction, physical activity and physical health surpassed expectations by post-testing. Gains were not sustained at three months follow-up. The participant’s ability and mobility may have increased following the intervention.

Conclusions: Participants with PTHS may benefit from regular physical activity and early intervention. The Upsee mobility device is a feasible and fun way to promote inclusive community-based physical activity and social engagement in a young child with PTHS. Further research into the health benefits of physical activity and the Upsee for children with PTHS may be warranted.

• Implications for Rehabilitation

• Physical activity may be beneficial for a child with Pitt Hopkins syndrome, a rare genetic disorder.

• New design, implementation of mobility intervention for a child with neurodevelopmental disabilities.

• The Upsee mobility device may offer physical benefits for a child with a neurodevelopmental disability.

• The Upsee mobility device may offer social benefits for a child with a neurodevelopmental disability.

     

Desired vancomycin trough concentration to achieve an AUC0‐24/MIC ≥400 in Chinese children with complicated infectious diseases

A vancomycin steady‐state trough concentration (C_min) of 15‐20 mg/L is recommended for achieving a ratio of the 24‐hour area under the curve to the minimum inhibitory concentration (AUC_0‐24/MIC) of ≥400 in adults. Since few paediatric data are available, our objectives were to (a) measure the pharmacokinetic indices of vancomycin and (b) determine the correlation between C_min and AUC_0‐24/MIC in paediatric patients. Population‐based pharmacokinetic modelling was performed for paediatric patients to estimate the individual parameters. The relationship between C_min and the calculated AUC_0‐24/MIC was explored using linear regression and a probabilistic framework. A sensitivity analysis was also conducted using Monte Carlo simulations. Body‐weight significantly influenced the pharmacokinetics of vancomycin. Based on real data and simulations, C_min ranges of 5.0‐5.9 and 9.0‐12.9 mg/L were associated with AUC_0‐24/MIC ≥400 for MIC values of ≤0.5 and ≤1 mg/L, respectively. Vancomycin regimens of 10 and 15 mg/kg every 6 hours achieved a C_min of 5.0‐5.9 mg/L and AUC_0‐24/MIC ≥400 in >90% of the children when MIC was ≤0.5 mg/L. At a MIC of ≤1 mg/L, vancomycin at 15 mg/kg every 6 hours achieved C_min of 9.0‐12.9 mg/L and AUC_0‐24/MIC ≥400 in 2.0‐ and 1.6‐fold as many children compared to a dose of 10 mg/kg every 6 hours, respectively. Vancomycin C_min values of 5.0‐12.9 mg/L were strongly predictive of achieving AUC_0‐24/MIC ≥400, and rational dosing regimens of 10‐15 mg/kg q6h were required in paediatric patients, depending on the pathogen.