Paediatrics and Child Health - Journal Articles

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    Adolescents’ experiences of transition to self-management of type 1 diabetes: systematic review and future directions
    (Sage, 2023-11-05) Leocadio, Paula; Kelleher, Carol; Fernández, Eluska; Hawkes, Colin P.
    Purpose: The purpose of this systematic literature review was to explore studies that report the experiences of adolescents, their families, and health care professionals of adolescents’ transition to self-management of type 1 diabetes (T1DM). Methods: SocINDEX, PsycInfo, APA PsycArticles, and MEDLINE electronic databases were searched. Studies reporting on experiences of transition to self-management of T1DM for adolescents, their parents, siblings, and health care professionals published between January 2010 amd December 2021 were included. The Mixed Methods Appraisal Tool guided trustworthiness and relevance of selected studies. Results: A total of 29 studies met the inclusion criteria. Findings indicate that adolescents’ experiences of transitioning to self-management of T1DM are interconnected with the supports provided by others (eg, family, teachers, friends). Considering interdependence and collective lived experiences is essential to developing effective and personalized family, peer, and social interventions to facilitate transition and to avoid negative outcomes in later life. The renegotiation of roles within the network of supports that impact adolescents’ transition and adolescents’ self-negotiation have been neglected. Conclusion: Transition to self-management of T1DM is a dynamic and iterative process comprising of continuous shifts between interdependence and independence, making it challenging for all involved. A number of research gaps and avenues for future research are outlined.
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    Neonatal hypoxic-ischemic encephalopathy grading from multi-channel EEG time-series data using a fully convolutional neural network
    (MDPI, 2023-10-25) Yu, Shuwen; Marnane, William P.; Boylan, Geraldine B.; Lightbody, Gordon; Science Foundation Ireland; Wellcome Trust
    A deep learning classifier is proposed for grading hypoxic-ischemic encephalopathy (HIE) in neonates. Rather than using handcrafted features, this architecture can be fed with raw EEG. Fully convolutional layers were adopted both in the feature extraction and classification blocks, which makes this architecture simpler, and deeper, but with fewer parameters. Here, two large (335 h and 338 h, respectively) multi-center neonatal continuous EEG datasets were used for training and testing. The model was trained based on weak labels and channel independence. A majority vote method was used for the post-processing of the classifier results (across time and channels) to increase the robustness of the prediction. A dimension reduction tool, UMAP, was used to visualize the model classification effect. The proposed system achieved an accuracy of 86.09% (95% confidence interval: 82.41–89.78%), an MCC of 0.7691, and an AUC of 86.23% on the large unseen test set. Two convolutional neural network architectures which utilized time-frequency distribution features were selected as the baseline as they had been developed or tested on the same datasets. A relative improvement of 23.65% in test accuracy was obtained as compared with the best baseline. In addition, if only one channel was available, the test accuracy was only reduced by 2.63–5.91% compared with making decisions based on the eight channels.
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    Growth hormone stimulation testing patterns contribute to sex differences in pediatric growth hormone treatment
    (Karger, 2021-10-18) Kamoun, Camilia; Hawkes, Colin P.; Gunturi, Hareesh; Dauber, Andrew; Hirschhorn, Joel N.; Grimberg, Adda; National Institute of Diabetes and Digestive and Kidney Diseases; Pfizer; Eunice Kennedy Shriver National Institute of Child Health and Human Development
    Introduction: Males are twice as likely as females to receive pediatric growth hormone (GH) treatment in the USA, despite similar distributions of height z (HtZ)-scores in both sexes. Male predominance in evaluation and subspecialty referral for short stature contributes to this observation. This study investigates whether sex differences in GH stimulation testing and subsequent GH prescription further contribute to male predominance in GH treatment. Methods: Retrospective chart review was conducted of all individuals, aged 2–16 years, evaluated for short stature or poor growth at a single large tertiary referral center between 2012 and 2019. Multiple logistic regression models were constructed to analyze sex differences. Results: Of 10,125 children referred for evaluation, a smaller proportion were female (35%). More males (13.1%) than females (10.6%) underwent GH stimulation testing (p < 0.001) and did so at heights closer to average (median HtZ-score −2.2 [interquartile range, IQR −2.6, −1.8] vs. −2.5 [IQR −3.0, −2.0], respectively; p < 0.001). The proportion of GH prescriptions by sex was similar by stimulated peak GH level. Predictor variables in regression modeling differed by sex: commercial insurance predicted GH stimulation testing and GH prescription for males only, whereas lower HtZ-score predicted GH prescription for females only. Conclusions: Sex differences in rates of GH stimulation testing but not subsequent GH prescription based on response to GH stimulation testing seem to contribute to male predominance in pediatric GH treatment. That HtZ-score predicted GH prescription in females but not males raises questions about the extent to which sex bias – from children, parents, and/or physicians – as opposed to objective growth data, influence medical decision-making in the evaluation and treatment of short stature.
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    Reference centiles for infant sleep parameters from 4 to 16 weeks of age: findings from an Irish cohort
    (BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health, 2023-03-21) O'Sullivan, Marc Paul; Livingstone, Vicki; Korotchikova, Irina; Dempsey, Eugene M.; Murray, Deirdre M.; Boylan, Geraldine B.; Science Foundation Ireland; Johnson and Johnson
    Objectives: To establish unconditional reference centiles for sleep parameters in infants 4–16 weeks of age. Design and setting: Secondary data analysis of sleep parameters recorded at 4–16 weeks of age in a longitudinal randomised controlled trial (RCT) (BabySMART). Patients: Healthy term infants assigned to the non-intervention arm of the RCT. Main outcome measures: Infants’ sleep duration was recorded by parents/guardians daily, from week 2–16 of age using a sleep diary. Reference centiles for total, daytime, night-time and longest sleep episode duration were estimated using multilevel modelling. Results: One hundred and six infants, mean (SD) gestational age of 39.9 (1.2) weeks and mean (SD) birth weight of 3.6 (0.5) kg had sleep recorded contributing 1264 measurements for each sleep parameter. Between 4 and 16 weeks of age total sleep duration in a 24-hour period, night-time sleep duration in a 12-hour period and infant’s longest sleep episode duration increased, while daytime sleep duration in a 12-hour period decreased. Conclusions: Reference centiles up to 4 months of age in infants highlight the gradual decrease in daytime sleep and large increases in night-time sleep, which occur in tandem with increasing lengths of sleep episodes. These reference centiles provide useful sleep values for infant sleep trajectory occurring in early life and may be helpful for parents and clinicians.
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    All Island Congenital Heart Network brings diagnosis closer to home
    (Irish Medical Organisation, 2022-12) Finn, Daragh; Allawendy, S.A.A.; Dempsey, Eugene M.; McMahon, C. J.
    Aim: The All-Island congenital heart network appointed paediatricians with expertise in cardiology in regional centres. Prior to these appointments children with suspected congenital heart disease were referred to the national children’s heart centre for investigation. The aim of this study is to quantify paediatric cardiology activity in a regional Irish centre over the first year of service provision. Methods: Data was collected retrospectively on all inpatient neonatal referrals over a 12-month period (January 2019 to January 2020). Results: There were 268 neonatal referrals. Premature infants (< 37 weeks gestation) accounted for 26% (n= 69) of total neonatal referrals. Congenital cardiac disease was identified in 58.5% (n= 113) of referrals. Cardiac intervention in the first year of life was required in 24 infants, 12.2% of referrals (5.6% catheter and 6.6% surgery). Discussion: Our report displays how clinical networks of care can reduce hospital transfers from regional neonatal centres for non-invasive cardiology investigations.