Duchess of Kent Children's Hospital

Anti-CD20 monoclonal antibodies (mAbs), which act as B-cell-depleting therapies, are now regarded as important treatments for a range of paediatric kidney diseases. Despite their effectiveness in achieving B-cell depletion and consequent disease remission, concerns remain regarding their side effect profile. These include infusion reactions, hypogammaglobulinaemia, and neutropenia, as well as infections. At present, the evidence supporting preventive measures such as intravenous immunoglobulin (IVIG) replacement and antibiotic prophylaxis remains inconclusive. In this review, we summarise the existing data on infection-related risks following anti-CD20 therapy and propose practical strategies to mitigate infection risk tailored to this group of children.

ABSTRACTBackgroundSexual dysfunction is a well‐documented long‐term side effect of pediatric cancer treatment, which significantly impacts the overall health of childhood cancer survivors (CCSs). There is a relative lack of qualitative research on sexual dysfunction among CCSs.AimThis study aimed to explore sexual experience, psychological factors, and typical response strategies among CCSs with sexual dysfunction in China.MethodsA qualitative descriptive study employing semi‐structured interviews was conducted. Based on purposive sampling and data saturation principles, CCSs with sexual dysfunction from the previous cross‐sectional study were selected for semi‐structured interviews. Data relevant to the research question was analyzed and coded using thematic analysis.Results15 female and 15 male survivors provided written‐informed consent and were interviewed in this study. Four core themes were identified, including: common sexual problems, psychological factors associated with sexual dysfunction and their related pathways, and coping strategies for sexual and psychological challenges. These themes were further categorized into 15 sub‐themes.Clinical implicationsThe findings of this study are expected for health professionals to develop a culturally specific intervention to improve the sexual function in childhood cancer survivors.Strengths & Limitations: To our knowledge, this qualitative study is the first to provide in‐depth exploration on the sexual experience, how the identified psychological factors led to sexual dysfunction, and the coping strategies for sexual dysfunction in Chinese childhood cancer survivors. However, the findings may not be fully generalizable to older cancer survivors, and conducting interviews online may have influenced the richness of the data collected.ConclusionsThe present findings contribute to our understanding of sexual experience, psychological factors, and coping strategies to sexual problems among CCSs. The findings indicate that psychology is a significant factor for CCSs with sexual dysfunction and identify the mediating role of attention and self‐compassion. Future research should develop an appropriate intervention based on the underlying psychological mechanisms of sexual dysfunction to improve the overall sexual function in CCSs.

As post-mortem (PM) imaging in children becomes more common, there is a need to review the available evidence for its diagnostic yield in suspected child physical abuse. The aim of this review is to synthesise current evidence, assess study quality, and identify ongoing challenges. Following PRISMA guidelines, databases were searched until 31 December 2024. Original research articles reporting data on at least ten children with PM imaging in the context of physical abuse were included. Titles and abstracts were screened by two expert reviewers; full texts were assessed by a third, independent reviewer and one of the previous reviewers. Data was extracted by one of 12 experts and independently verified. The study risk of bias was evaluated with the ROBINS-I tool. Study heterogeneity precluded meta-analysis, resulting in descriptive synthesis. Eighteen out of 1687 potential papers were included. Seven described PM radiography, five post-mortem computed tomography (PMCT), four both PM radiography plus PMCT, and two post-mortem magnetic resonance imaging (PMMR). All but one were retrospective, and most (11/18, 61%) had a moderate-to-high risk of bias. Post-mortem skeletal survey (PMSS) detected subtle fractures, particularly corner metaphyseal fractures. PMCT provided a high-resolution assessment of injuries, particularly rib fractures. PMMR contributed soft-tissue and intracranial detail. All studies emphasised the importance of correlating autopsy findings. Technical variation and potential biases limited direct comparisons between studies. PM imaging can reveal important injury patterns that may be overlooked by autopsy. Nevertheless, standardised imaging methods and larger prospective trials are needed to reduce bias and establish best-practice guidelines. Question What is the evidence for PM radiologic imaging in suspected physical abuse of children? Findings PM imaging complements autopsy, but diagnostic accuracy varies by modality. Study heterogeneity and bias limit current evidence. Clinical relevance PM imaging can detect injuries missed at autopsy in child abuse cases. Standardised protocols and higher-quality studies are urgently needed.

BackgroundThe significant association between blood pressure (BP) in children and young adulthood and risks of cardiovascular diseases in adulthood highlights the critical need for early BP control. While lifestyle modifications such as increased physical exercise have proven effective, traditional exercise forms always suffer from low motivation and adherence. Active video games (AVGs), combining exercise with engaging gameplay, may present a promising alternative for managing BP in children and young adults.ObjectiveThis study aims to evaluate the effectiveness of AVGs in managing BP among the population aged 6 to 25 years.MethodsFollowing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline, this study retrieved and screened publications archived in the 4 databases (Web of Science, Cochrane Library, PubMed, and Embase) and the registration (ClinicalTrials.gov) up to December 30, 2024. Eligible studies were defined as interventional trials involving participants aged 6 to 25 years, using AVGs as one of the intervention protocols, and reporting BP outcomes. Studies were excluded if they involved participants with heart diseases, combined AVGs protocol with other intervention components, limited outcomes to immediate postgame BP, or included only control groups that received additional physical activity interventions. Depending on the heterogeneity among included trials, random-effects or fixed-effects models were selected to pool the effect sizes of individual trials, with 95% CIs. The risk of bias was assessed using the Cochrane Risk of Bias tool for controlled trials and the Methodological Index for Non-Randomized Studies for prepost design. Sensitivity analyses were performed to evaluate result robustness, while Egger tests investigated publication bias.ResultsA total of 17 trials from 16 studies, involving 503 participants who are normotensive, were included in this study. The analysis showed that AVGs significantly reduced systolic blood pressure (standardized mean difference=−0.50, P<.001, 95% CIs −0.80 to −0.20) and increased diastolic blood pressure (standardized mean difference=0.23, P=.03, 95% CIs 0.02 to 0.44) in children younger than 18 years, with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) indicating the certainties of evidence as low for systolic blood pressure and moderate for diastolic blood pressure.ConclusionsThese findings shed light on the cardiovascular benefits of AVGs in children younger than 18 years, underscoring their potential to improve vascular elasticity while maintaining organ perfusion. However, considering the limitations arising from small sample sizes, as well as inadequate allocation concealment and blinding in the included studies, these findings should be interpreted with caution.

22q11.2 deletion syndrome (22q11.2DS) is associated with palatal abnormalities. It remains controversial as to when and how children with palatal abnormalities should undergo specific diagnostic 22q11.2DS testing. There is also a lack of local data on the prevalence and clinical features associated with 22q11.2DS in children with cleft anomalies. We aimed to review the data on children diagnosed with 22q11.2DS who attended the cleft clinic at the Hong Kong Children's hospital. We retrospectively reviewed the medical records of children who attended the cleft clinic at the Hong Kong Children's Hospital from January 2020 to April 2024 and had been tested for or diagnosed with 22q11.2DS. The age at genetic diagnosis, clinical features and details of palatal operation were reviewed. Based on clinical suspicions, 31 children were tested for 22q11.2DS, and of these, eight (26%) children were confirmed to have the 22q11.2DS. The majority (75%) of those tested and diagnosed received their genetic diagnosis after their palatal operations. Additionally, ten other children with 22q11.2DS were identified from hospital records, having received their genetic diagnosis elsewhere. A notable number of children who attended the cleft clinic suffered from 22q11.2DS. Clinicians managing children with cleft anomalies should maintain a high index of suspicion and consider early specific 22q11.2DS genetic investigations in accordance with locally available resource and disease prevalence.

Retinoblastoma is the most common intra-ocular malignancy in children worldwide. Current treatment modalities include focal therapy such as laser or cryotherapy, intravenous chemotherapy, intra-arterial chemotherapy and surgical enucleation. According to the current retinoblastoma staging systems, there are a few common features indicating advanced disease stage, which can subsequently predict the prognosis and the necessity of surgical enucleation and adjuvant chemotherapy. This review uses annotated magnetic resonance (MR) images to illustrate these features, which include (1) retinal detachment, (2) vitreous and subretinal seeding, (3) choroidal invasion, (4) anterior segment invasion and increase in intra-ocular pressure, (5) iris neovascularization, (6) vitreous haemorrhage, (7) aseptic orbital cellulitis with lens dislocation, (8) post-laminar optic nerve invasion and (9) distant and systemic metastasis. Prompt identification of these features is important for paediatric radiologists to guide the clinical team for appropriate management.Graphical abstract

Uric acid is a major contributor to the total antioxidant capacity of human plasma. However, this endogenous substance's antioxidant and prooxidant properties have not yet been reported. In this study, the comet assay was employed in vitro to determine the effect of uric acid on DNA damage in human lymphocytes and leukocytic DNA damage in hyperuricemia patients with and without renal failure. DNA damage in lymphocytes occurred at uric acid concentrations of ≥600 μM. Adding catalase to the uric acid solution diminished the damaging effect, indicating that hydrogen peroxide mediated the prooxidant activity. Moreover, adding Fe2+ did not enhance the DNA damage, suggesting that the urate's prooxidant activity is independent of the Fenton reaction. The unstable nature of uric acid at nearly neutral and acidic pH levels resulted in autooxidation and the generation of hydrogen peroxide. Maintaining the stability of uric acid in vivo may lead to the consumption of antioxidants in the body and affect the antioxidant status. Hyperuricemia patients with and without renal failure had higher levels of leukocytic DNA damage compared to healthy individuals. However, there was no significant difference in leukocytic DNA damage between hyperuricemia patients with and without renal failure, which showed that the damaging effect was not due to renal failure. A correlation study suggested that serum uric acid level had a stronger correlation with DNA damage than the severity of renal failure as indicated by serum creatinine or urea. Uric acid demonstrated prooxidant activity in both in vitro and in vivo studies, which was mediated by the production of hydrogen peroxide and independent of both the Fenton reaction and renal failure.

Abstract Background: Since the commencement in 2019, the first specialised designated paediatric critical care transport (CCT) team with a standardised workflow was created to safely transport patients to and from our hospital and their respective neonatal intensive care unit (NICU) and paediatric intensive care unit. The aim was to review the first 3 years’ clinical outcomes of critically ill infants requiring interhospital transfer to and from our hospital’s NICU. Methods: This is a retrospective observational study of infants transported between NICUs of regional hospitals under the hospital authority retrieved and repatriated to our hospital’s NICU by the CCT team between July 1, 2019, and July 31, 2022. Results: A total of 283 infants with a mean gestational age at birth was 33.3 ± 5.1 weeks and a birth weight of 2060 ± 984 g were included. About 70% were classified as emergency transport (167/240), with a mean transport time of 34 ± 16 min and a dispatch time of 57 ± 43 minutes. A total of 84 (critical/serious) complications were documented in 71 patients (25.1%) and a total of 39 interventions were required from 36 patients (12.7%). The most common complications were mild acidosis (30.6%; 26/85) and hypothermia (8.1%; 23/283). Conclusions: This study provides a good benchmark for the introduction of a designated and standardised workflow for a CCT team at a centralised tertiary-level children’s hospital. This study also identifies areas of enhancement for subsequent quality improvement projects in the future.