Institute of Child Health

Avoidant/restrictive food intake disorder (ARFID) involves restrictive eating driven by sensory sensitivity, low interest in food, or fear of negative consequences of eating. ARFID affects males and females equally and presents across the weight spectrum. Leptin, an anorexigenic hormone linked to adiposity, may contribute to low hunger and early satiety in ARFID. Prior findings indicate low leptin levels in low-weight females with ARFID; however, the role of leptin in ARFID across weight status and sex remains unknown. We hypothesized that youth with full/subthreshold ARFID, including a subgroup of low-weight males, would exhibit lower fasting leptin levels than healthy controls (HCs). We explored cross-sectional and longitudinal associations between leptin and clinical characteristics. Participants were youth aged 10-23 years (BMI percentile M [SD] = 41.4 (33.6)) with full/subthreshold ARFID (n = 95; 49.5% female) and HCs (n = 28; 50.0% female). At baseline, participants completed questionnaires, a fasted blood draw, and a diagnostic interview for ARFID, readministered at 1- and 2year follow-ups. Leptin levels did not differ between ARFID and HC groups. Low-weight ARFID males had significantly lower leptin than HC males (η 2 = 0.258); however, this difference was nonsignificant after adjusting for BMI percentile. Leptin showed medium-to-large positive associations with age, BMI, and anxiety but not appetite or ARFID severity. Baseline leptin did not predict symptom or weight changes longitudinally. Hypoleptinemia was only evident in low-weight ARIFD and strongly correlated with BMI percentile. However, relationships with anxiety may suggest additional roles of leptin in underlying ARFID psychopathology. Findings should be replicated in larger, more representative samples.

Hypogammaglobulinemia is a common side effect of rituximab that can result in life-threatening infections. The risk of hypogammaglobulinemia and infections should be weighed against the effectiveness of rituximab for nephrotic syndrome management. Prospero registration: CRD42024536465. •Rituximab, a chimeric anti-CD20 monoclonal antibody, is commonly used for complicated pediatric nephrotic syndrome. •Post-rituximab hypogammaglobulinemia is a recognized adverse effect that may predispose to severe, including fatal, infections; however, the magnitude of risk of poorly understood in pediatric population. •The pooled incidence of hypogammaglobulinemia in children with nephrotic syndrome receiving rituximab was 11.4%. Rituximab exposure was associated with a significantly higher risk of hypogammaglobulinemia compared with children not receiving rituximab (risk ratio 1.81). •In 517 episodes of hypogammaglobulinemia, 93 (18%) infections occurred, four of which were fatal.

The global population rise has increased surgeries to over 300 million annually. Operations on patients with multiple comorbidities contribute to postoperative complications affecting 15%-20% of surgical patients. Traditional pre-anaesthesia check-up (PAC) relies on snapshot assessments, potentially missing dynamic health changes. This review explored the integration of wearable technology in preoperative assessment to enhance monitoring through continuous data collection. This scoping review was conducted according to PRISMA ScR guidelines. Literature search performed across PubMed, Google Scholar, Embase and Scopus. Inductive thematic analysis, following Braun and Clarke, was used to synthesise findings. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A total of 17 full-text articles were included, and thematic analysis revealed: Benefits: Wearable devices enable continuous monitoring of physiological parameters and improve patient engagement. Challenges: Implementation barriers include data accuracy concerns and healthcare provider training needs. Future Directions: Advances in sensor technology may enhance personalised medicine. Most studies focused on limb-worn devices, showing correlations with functional tests. Risk of bias was low to moderate, with methodological rigour but limited sample sizes. Integrating wearable technology into PAC can improve surgical outcomes. Addressing implementation challenges is crucial for optimising perioperative care for surgical patients.

Depression remains a major global health burden, and conventional antidepressants, although effective, are limited by side effects and withdrawal symptoms. To map umbrella-level evidence on single-agent nutraceutical and herbal interventions for clinically diagnosed depression in adults. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and Joanna Briggs Institute guidance. PubMed, PsycINFO, Scopus, and Cochrane Library were searched (2015-2025) for umbrella reviews assessing oral nutraceuticals or herbal medicines for depression. Nine umbrella reviews met inclusion criteria, covering omega-3 fatty acids, vitamin D, probiotics, saffron, St John's wort, zinc, and folate. Umbrella reviews generally reported potential antidepressant benefits and acceptable safety profiles for several interventions, although trial overlap and heterogeneity limited certainty. Evidence indicates promising but inconsistent efficacy across several nutraceutical and herbal agents. Standardized reporting, consideration of baseline nutrient status, and economic evaluation are needed to clarify their role in depression care.

Children in contact with children's social care (CSC) services have high levels of hospital utilisation, but patterns before and after referral remain insufficiently understood. To evaluate healthcare utilisation two years before and after CSC referral. Retrospective cohort using ECHILD linked health and social care data, including children with a first CSC referral between 2009 and 2018 in England. We compared monthly planned and unplanned hospital contact rates for Children in Need, Children under Protection Plans, and Children Looked After with age-sex-matched cohorts. We used interrupted time series analysis to examine how healthcare utilisation changed following referral. We also explored reasons for hospital contacts. We analysed >12 million hospital contacts for 1,014,330 Children in Need, 204,240 Children under Protection Plan and 177,640 Children Looked After. Children Looked After had the highest average number of total contacts (11.8 per child over a 4year period), followed by Children in Need (8.8) and Children under Protection Plans (8.4). All CSC groups had about twice the contacts of matched peers. Healthcare utilisation increased sharply prior to referral, with a peak around referral. After referral, planned care increased and unplanned care decreased, with pre referral upward trends slowing or reversing. The most common reason for healthcare utilisation was mental health-related. At a population level, CSC referral marks a pivotal point in healthcare utilisation, with a shift from unplanned to planned care. This may reflect more structured engagement with health services and coordinated support for children and families.

Increased risk of infectious morbidity and hospitalization has been reported during infancy among children HIV-exposed uninfected (CHEU) compared to children HIV-unexposed uninfected (CHUU). However, data on risks beyond infancy are limited. We enrolled pregnant women with and without HIV from a primary healthcare facility in a lower income area in Cape Town, South Africa (2017-2018). We tracked their children's HIV test results and hospitalizations using routine electronic healthcare data. We previously reported increased rates of infectious-cause hospitalization among CHEU in the first year of life, and now extend the analysis to cover the period from age 1 to less than 5 years. Using random-effects Poisson regression, we calculated adjusted incidence rate ratios (aIRR) for infectious-cause hospitalization among CHEU vs. CHUU, clustered by infant and adjusted for child sex and vaccination status, maternal age and education, and housing type. Among 446 CHEU and 455 CHUU, 147 admissions occurred from age 1 to less than 5 years; with 59% ( n = 87) due to infections. All-cause hospitalization occurred in 9.2% of CHEU and 10.5% of CHUU; infectious-cause hospitalization occurred in 6.5% of CHEU and 7.3% of CHUU with crude incidence rates of 2.4 per 100 child-years for both groups [IRR = 1.0; 95% confidence interval (CI) 0.6-1.6]. Adjusted analyses showed no evidence of increased hospitalization among CHEU (aIRR = 0.71; 95% CI 0.36-1.41). Elevated risk of infectious-cause hospitalization among CHEU did not persist beyond the first year of life. These findings highlight infancy as a key window for targeted interventions, while providing reassurance regarding longer term infectious morbidity risk.