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Neonatal hyperbilirubinemia (NHB) is a significant cause of morbidity and mortality, particularly in low and middle-income countries (LMICs). Transcutaneous bilirubinometers offer a non-invasive method for assessing NHB but have limited availability due to cost and maintenance requirements. Visual assessment of jaundice is shown to be inaccurate. Smartphone-based technologies have the potential to provide innovative and accessible healthcare solutions. This study aimed to evaluate the Picterus system, a smartphone-based tool for screening of NHB, in three non-Caucasian populations in LMICs.
Between 2018 and 2022, cross-sectional studies were conducted in three countries: Mexico, Nepal and the Philippines. Newborns meeting the inclusion criteria were recruited, and data on demographic characteristics, skin type and visual assessment of jaundice were collected. Bilirubin levels were measured using both the Picterus system and total serum bilirubin (TSB) analysis. Correlation analyses, Bland-Altman plots and receiver operating characteristic (ROC) curves were used to evaluate the Picterus system.
A total of 416 infants were included in the analysis. The Picterus smartphone system demonstrated a significant positive correlation with TSB levels across all sites (r=0.76). The correlation coefficient was significantly higher in Mexico compared with Nepal and the Philippines. Bland-Altman plots showed limits of agreement ±89.2 µmol/L. Picterus values were underestimated in Mexico, whereas they were overestimated in Nepal and the Philippines. ROC analysis for detection of infants with TSB >225 µmol/L indicated that the Picterus system had higher sensitivity and specificity compared with visual assessment using the Kramer scale.
This study shows that the Picterus system can potentially be used in screening for neonatal jaundice in populations with moderate dark skin types. Further studies are needed before the system can be used in clinical practice.
This article explores the impact of ever-increasing volumes of traffic on paediatric health and wellbeing. It examines potential street design solutions that may hold the key to reversing this trend and better protecting the potential for children to engage in outdoor play and independent socialisation. Across the UK, people concerned by the gradual erosion of such opportunities are coming together to campaign for such changes to make their streets safer and therefore healthier places for both themselves and their children. The roots of this movement, its successes so far and onward political progress towards this objective are also described.
Preschool children who received sevoflurane anaesthesia were associated with a high incidence of emergence agitation (EA). Studies have shown that a subanaesthetic dose of propofol (1 mg/kg) at the end of inhalational anaesthesia could reduce EA in paediatric patients, but the optimal administrations are still under investigation.
In a double-blind trial, 160 preschool children (ASA I or II, 2–5 years old) undergoing day surgery of laparoscopic inguinal hernia repair with sevoflurane anaesthesia were randomly assigned into four groups: the control group, single bolus 3 min before the end of the surgery (bolus A), single bolus at the end of the surgery (bolus B) and continuous infusion for 3 min at the end of the surgery (continuous infusion). The dose of propofol in the bolus A group, bolus B group and continued infusion group is 1 mg/kg. The primary outcomes were the incidence and severity of EA assessed by the Paediatric Anaesthesia Emergence Delirium (PAED) scale and Watcha scales. The secondary outcomes included extubation time, emergence time, mean arterial pressure and heart rate.
The incidence of EA was as follows: 65.0% in the control group, 30.0% in the bolus A group, 32.5% in the bolus B group and 5.0% in the continuous infusion group (p<0.05). Furthermore, the peak PAED scores in the continuous infusion group were significantly lower than those in the other groups. However, extubation time and emergence time showed no differences among groups.
Continuous infusion of subanaesthetic dose propofol (1 mg/kg) for 3 min at the end of sevoflurane anaesthesia seems to be more appropriate than other administration as it reduced EA and did not prolong the time to wake.
Criticism of mainstream approaches to child labour is widespread and well-established. The Child Labour Action Research in South and Southeast Asia (CLARISSA) Cash Plus pilot sought to address these critiques through an innovative programme that prioritised the development of household resilience and well-being, and through increasing household capacity to make alternative choices around children’s work.
Funded by the UK’s Foreign, Commonwealth and Development Office, this pilot delivered unconditional cash transfers (UCTs) and needs-based case management and community mobilising across an entire slum neighbourhood in Dhaka, Bangladesh. Cash worth about 20% of household monthly income was delivered to all households for 7 months, with case work and community organising wrapped around for 21 months. The intended outcomes were that families would be able to increase their economic resilience and develop alternative capacities to meet their needs, with the intended goals of increasing well-being and the ability to make choices other than difficult or dangerous work for children. Research into impact was rooted in contribution analysis and combined bimonthly monitoring surveys administered by the community mobilisers; surveys at multiple time points; three rounds of targeted focus group discussions; three rounds of key informant interviews with case study households; community mobiliser diaries; and ethnographic observation.
The results strongly suggest that UCTs reduce poverty, increase economic resilience; improve well-being; and generate various household-level improvements that relate directly and indirectly to children’s work. They further suggest that case work and community organising act as a beneficial form of social protection and a tool for developing locally appropriate micro-responses to collective problems that commonly impact directly on well-being and indirectly on children’s work. These results point to the potential for this intervention to be scaled-up in efforts to achieve the eighth Sustainable Development Goal of ensuring decent work for all, including the elimination of child labour.
This is a short letter highlighting findings from a service evaluation of 16–17 year olds’ preferences of location of care following presentation to an Emergency Department. 95 young people were interviewed; 54.7% (52/95) of participants preferred to be seen in the Paediatric Emergency Department, with 16 year olds showing a higher preference (62.2%) compared with 17 year olds (48.0%). Additionally, 58.9% (56/95) desired a choice in treatment location, and 67.4% (64/95) expressed a preference for age-specific wards during admissions. Our findings highlight the importance of recognising the individual needs and preferences of young people within healthcare.