CONTEXT: Preterm brain injuries are common; neurodevelopmental outcomes following contemporary neonatal care are continually evolving. OBJECTIVE: To systematically review and meta-analyze neurodevelopmental outcomes among preterm infants after intraventricular hemorrhage (IVH) and white matter injury (WMI). DATA SOURCES: Published and gray literature were searched across 10 databases between 2000 and 2021. STUDY SELECTION: Observational studies reporting 3-year neurodevelopmental outcomes for preterm infants with IVH or WMI compared with preterm infants without injury. DATA EXTRACTION: Study characteristics, population characteristics, and outcome data were extracted. RESULTS: Thirty eight studies were included. There was an increased adjusted risk of moderate-severe neurodevelopmental impairment after IVH grade 1 to 2 (adjusted odds ratio 1.35 [95% confidence interval 1.05–1.75]) and IVH grade 3 to 4 (adjusted odds ratio 4.26 [3.25–5.59]). Children with IVH grade 1 to 2 had higher risks of cerebral palsy (odds ratio [OR] 1.76 [1.39–2.24]), cognitive (OR 1.79 [1.09–2.95]), hearing (OR 1.83 [1.03–3.24]), and visual impairment (OR 1.77 [1.08–2.9]). Children with IVH grade 3 to 4 had markedly higher risks of cerebral palsy (OR 4.98 [4.13–6.00]), motor (OR 2.7 [1.52–4.8]), cognitive (OR 2.3 [1.67–3.15]), hearing (OR 2.44 [1.42–4.2]), and visual impairment (OR 5.42 [2.77–10.58]). Children with WMI had much higher risks of cerebral palsy (OR 14.91 [7.3–30.46]), motor (OR 5.3 [3–9.36]), and cognitive impairment (OR 3.48 [2.18–5.53]). LIMITATIONS: Heterogeneity of outcome data. CONCLUSIONS: Mild IVH, severe IVH, and WMI are associated with adverse neurodevelopmental outcomes. Utilization of core outcome sets and availability of open-access study data would improve our understanding of the nuances of these outcomes.

Urinary tract infection is a commonly occurring paediatric infection associated with significant morbidity. Diagnosis is challenging as symptoms are non-specific and definitive diagnosis requires an uncontaminated urine sample to be obtained. Common techniques for sampling in non-toilet-trained children include clean catch, bag, pad, in-out catheterisation and suprapubic aspiration. The pros and cons of each method are examined in detail in this review. They differ significantly in frequency of use, contamination rates and acceptability to parents and clinicians. National guidance of which to use differs significantly internationally. No method is clearly superior. For non-invasive testing, clean catch sampling has a lower likelihood of contamination and can be made more efficient through stimulation of voiding in younger children. In invasive testing, suprapubic aspiration gives a lower likelihood of contamination, a high success rate and a low complication rate, but is considered painful and is not preferred by parents. Urine dipstick testing is validated for ruling in or out UTI provided that leucocyte esterase (LE) and nitrite testing are used in combination.

The majority of children diagnosed with cancer present via acute services, with the route varying between tumour types. Only two cases in 10 years were referred via the 2-week pathway, thus challenging its relevance in the paediatric population.

Aims Time to diagnosis (TTD) in childhood cancer varies between tumour types. Most early diagnosis research in the United Kingdom has a predominant focus on brain tumours and tertiary centre populations. Few studies focus on the referral pathway and TTD of multiple cancer types within a defined geographical region. Methods This population based retrospective cohort study was set in a large level 2 Paediatric Oncology Shared Care Unit. Data was collected on 86 childhood cancer cases diagnosed during a 6 year period (January 2007 – December 2013). 13 cases were excluded and data was obtained from all other notes accessible to the authors with a total of 57 cases included for analysis. Different tumour types were compared to recent ADC case review data (May 2013). Time to presentation (TTP) was defined as time from initial symptoms to time seen by secondary paediatrics. Time to diagnosis (TTD) was defined as time from initial symptoms to diagnosis at primary treatment centre. Results The overall median TTD for all cancers was 33 days. Wilms’ tumour demonstrated the shortest median TTP and TTD, 4.5 days and 15.5 days respectively. Leukaemia also had a short median TTP and TTD of 14.5 days and 18 days respectively. Brain tumours, as described in previous studies, had longer median TTP and TTD of 21 and 32 days respectively. Solid tumours as a group had median TTP and TTD of 15 and 43.5 days respectively. Lymphoma had the longest delay in diagnosis with TTP 70.5 days and TTD 66.5 days respectively. Pathways to diagnosis via other specialities or private referral had longer delays. Conclusion TTP and TTD times in this study population are comparable to previous European and North American studies. However, this case set demonstrated a shorter median delay to brain tumour diagnosis and longer delay to lymphoma diagnosis. Most presentations were via immediate GP referral or self-referral to the emergency department. Only 2 cases in 6 years were referred via the 2 week pathway, challenging its relevance. Immediate referral without delay can improve service quality in the shared care setting and ultimately shortens the pathway to cancer diagnosis and treatment.

BackgroundOver 3000 children suffer a perinatal brain injury in England every year according to national surveillance. The childhood outcomes of infants with perinatal brain injury are however unknown.MethodsA systematic review and meta-analyses were undertaken of studies published between 2000 and September 2021 exploring school-aged neurodevelopmental outcomes of children after perinatal brain injury compared with those without perinatal brain injury. The primary outcome was neurodevelopmental impairment, which included cognitive, motor, speech and language, behavioural, hearing or visual impairment after 5 years of age.ResultsThis review included 42 studies. Preterm infants with intraventricular haemorrhage (IVH) grades 3–4 were found to have a threefold greater risk of moderate-to-severe neurodevelopmental impairment at school age OR 3.69 (95% CI 1.7 to 7.98) compared with preterm infants without IVH. Infants with perinatal stroke had an increased incidence of hemiplegia 61% (95% CI 39.2% to 82.9%) and an increased risk of cognitive impairment (difference in full scale IQ −24.2 (95% CI –30.73 to –17.67) . Perinatal stroke was also associated with poorer academic performance; and lower mean receptive −20.88 (95% CI –36.66 to –5.11) and expressive language scores −20.25 (95% CI –34.36 to –6.13) on the Clinical Evaluation of Language Fundamentals (CELF) assessment. Studies reported an increased risk of persisting neurodevelopmental impairment at school age after neonatal meningitis. Cognitive impairment and special educational needs were highlighted after moderate-to-severe hypoxic-ischaemic encephalopathy. However, there were limited comparative studies providing school-aged outcome data across neurodevelopmental domains and few provided adjusted data. Findings were further limited by the heterogeneity of studies.ConclusionsLongitudinal population studies exploring childhood outcomes after perinatal brain injury are urgently needed to better enable clinicians to prepare affected families, and to facilitate targeted developmental support to help affected children reach their full potential.

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The original version of the letter unfortunately contained a mistake. The catheterisation cost cited in the paper should be £49.39 instead of £25.98. The corrected paragraph is shown below. The original article was corrected. "The greatest determinant of the economic cost of testing a urine sample in secondary care is the time spent occupying a hospital bed rather than the equipment used [106]. The costs calculated in 2020 to obtain an uncontaminated sample are as follows: catheterisation £49.39, SPA £51.84, stimulated void £52.25, clean catch £64.82 and urine bag £112.28 [106]. This reflects a lower likelihood of contamination resulting in less repeated testing and more rapid sample collection requiring less time in the hospital." Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Aims To assess baseline paediatric career intentions and the impact of a student-led paediatric society (PS), which aims to increase student exposure and encourage recruitment to paediatrics. The PS was established in 2009 and runs career events, paediatric/neonatal resuscitation training days, Teddy Bear Hospital (TBH) sessions and provides information for electives. Methods Clinical students (2011) joining the PS completed a baseline career choice questionnaire during their introductory week. After attending PS events, students completed anonymous feedback questionnaires to assess changes in attitudes towards paediatrics. Participation in TBH, paediatric electives and student selected components (SSC) were used as other indicators of interest in paediatrics. Results The PS has 288 members, representing 64% of clinical students. 53 students responded to the baseline careers questionnaire; of these, 7 (13%) planned to specialise in paediatrics and mean certainty about their future career choice was 2.5 (5-point Likert scale). 30 students attended our careers event in November 2011 and 16 completed the feedback questionnaire; 8 were certain they wished to specialise in paediatrics and a further 8 considering paediatrics. The mean value for certainty about their future career was 3.2 (5-point Likert scale). Students (n=30) attending our Paediatric / Neonatal resuscitation training day rated it a mean of 100% for satisfaction and 97% for increased confidence in dealing with future emergency scenarios. The PS organised 8 TBH health education events for local primary schools, involving over 100 medical student volunteers and 250 children. Over the last 4 years the number of students undertaking paediatric electives has increased from 26 to 42 and SSCs from less than 10 in 2007 to 34 in 2011. Conclusions The majority of students entering clinical medicine are unsure about their future career choice, but many consider paediatrics as an option. Events run by the PS with supportive consultants are popular. Increasing student involvement in TBH, paediatric electives and SSCs has increased the profile of paediatrics at this medical school.