Paediatrics and Child Health - Journal Articles

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    The use of cardiotonic drugs in neonates
    (W.B. Saunders, 2019) Dempsey, Eugene; Rabe, Heike; Seventh Framework Programme; Science Foundation Ireland
    There is a distinct lack of age-appropriate cardiotonic drugs, and adult derived formulations continue to be administered, without evidence-based knowledge on their dosing, safety, efficacy, and long-term effects. Dopamine remains the most commonly studied and prescribed cardiotonic drug in the neonatal intensive care unit (NICU), but evidence of its effect on endorgan perfusion still remains. Unlike adult and pediatric critical care, there are significant gaps in our knowledge on the use of various cardiotonic drugs in various forms of circulatory failure in the NICU. © 2019 Elsevier Inc.
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    Growth hormone treatment for non-GHD disorders: Excitement tempered by biology
    (Oxford University Press, 2023-07-14) Grimberg, Adda; Hawkes, Colin P.; National Institutes of Health
    The success of growth hormone (GH) replacement in children with classical GH deficiency has led to excitement that other causes of short stature may benefit similarly. However, clinical experience has shown less consistent and generally less dramatic effects on adult height, perhaps not surprising in light of increased understanding of GH and growth plate biology. Nonetheless, clinical demand for GH treatment continues to grow. Upon the 20th anniversary of the US Food and Drug Administration's approval of GH treatment for idiopathic short stature, this review will consider the factors underlying the expansion of GH treatment, the biological mechanisms of GH action, the non-GH–deficient uses of GH as a height-promoting agent, biological constraints to GH action, and future directions.
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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.