Publications by authors named "Nijman R"
Febrile infants often have self-limiting conditions. Differentiating them from infants with serious bacterial infections can be challenging. We aimed to understand how febrile infants are managed across London, by analysing the management steps from local clinical practical guidelines (CPGs) and comparing them to the national guideline 143 (NG143).
View Article and Find Full Text PDFImportance: Metformin and glyburide monotherapy are used as alternatives to insulin in managing gestational diabetes. Whether a sequential strategy of these oral agents results in noninferior perinatal outcomes compared with insulin alone is unknown.
Objective: To test whether a treatment strategy of oral glucose-lowering agents is noninferior to insulin for prevention of large-for-gestational-age infants.
Objective: To investigate a dose-response relationship between the magnitude of decrease in pediatric respiratory tract infections (RTI) during the 2020 implementation of non-pharmaceutical interventions (NPI) and the rise thereafter during NPI lifting.
Study Design: We conducted an interrupted, time-series analysis, based on a multinational surveillance system. All patients <16 years of age coming to medical attention with various symptoms and signs of RTI at 25 pediatric emergency departments from 13 European countries between January 2018 and June 2022 were included.
Article Synopsis
- The study assesses the effectiveness of white blood cell count (WBC) in predicting serious bacterial infections (SBI) in children compared to C reactive protein (CRP) and absolute neutrophil count (ANC).
- After analyzing data from over 17,000 febrile children across multiple European emergency departments, WBC showed poor predictive value with a sensitivity of 56% and specificity of 74% for WBC >15.
- The findings suggest that CRP is a better marker for identifying SBI in children, and WBC should only be used for specific cases rather than as a routine diagnostic tool.
Background: There is a need to empower parents and carers of young infants to recognise signs of serious illness and to act on these appropriately. Compiling the signs and symptoms of serious illness in infants found in clinical guidelines will support the evidence-based update of the 30+-year-old content of the Baby Check App to empower parents and carers.
Objective: To systematically review clinical guidelines for signs and symptoms related to serious illness in infants aged 6 months and below.
Background: The adoption of C-reactive protein point-of-care tests (CRP POCTs) in hospitals varies across Europe. We aimed to understand the factors that contribute to different levels of adoption of CRP POCTs for the management of acute childhood infections in two countries.
Methods: Comparative qualitative analysis of the implementation of CRP POCTs in the Netherlands and England.
Article Synopsis
- * Using data from 12 European EDs, researchers analyzed presenting symptoms and management of febrile children under 18, identifying those suitable for a fast track system based on simplicity and minimal resource use.
- * Findings revealed that respiratory symptoms were the most common, while neurological patients utilized more imaging and had higher admission rates, and gastrointestinal patients underwent more lab tests, indicating varying needs among the different symptom groups.
Results of simulation studies evaluating the performance of statistical methods can have a major impact on the way empirical research is implemented. However, so far there is limited evidence of the replicability of simulation studies. Eight highly cited statistical simulation studies were selected, and their replicability was assessed by teams of replicators with formal training in quantitative methodology.
View Article and Find Full Text PDFExternal validation of a multivariable prediction model for identification of pneumonia and other serious bacterial infections in febrile immunocompromised children.
Arch Dis Child
December 2023
Article Synopsis
- The study aimed to validate and update the Feverkids tool, a clinical prediction model designed to help differentiate between bacterial pneumonia, serious bacterial infections (SBIs), and non-SBI causes of fever in immunocompromised children.
- Conducted in 15 hospitals across nine European countries, the study involved observational data from febrile immunocompromised children aged 0-18 years.
- Results showed improved accuracy in predicting bacterial pneumonia and SBIs after model updates, indicating effective thresholds that can help minimize unnecessary medical interventions and antibiotic use.
Background: The PERFORM study aimed to understand causes of febrile childhood illness by comparing molecular pathogen detection with current clinical practice.
Methods: Febrile children and controls were recruited on presentation to hospital in 9 European countries 2016-2020. Each child was assigned a standardized diagnostic category based on retrospective review of local clinical and microbiological data.
Introduction: Several patients, who underwent major reconstruction under the care of an experienced pediatric urologist are now, as adults, several years later, appearing with long term problems and complications. This consensus process was undertaken to give an overview of long term consequences (and their management) of urological childhood surgery.
Material And Methods: Several known urologists with experience in life-long follow up and revisional surgery of patients with congenital conditions were asked to review literature and comment based on their experience about several complications of childhood surgery.
Children constitute 6-10% of all patients attending the emergency department (ED) by emergency medical services (EMS). However, discordant EMS use in children occurs in 37-61% with fever as an important risk factor. We aimed to describe EMS utilisation among febrile children attending European EDs.
View Article and Find Full Text PDFObjectives: To describe the incidence of new onset paediatric diabetes mellitus, clinical characteristics and patterns of presentation to emergency departments (ED) during the COVID-19 pandemic, and to assess whether this increase was associated with SARS-CoV-2 infection.
Design: Retrospective medical record review.
Setting: Forty nine paediatric EDs across the UK and Ireland.
Objectives: To describe the characteristics and clinical outcomes of children with fever ≥5 days presenting to emergency departments (EDs).
Design: Prospective observational study.
Setting: 12 European EDs.
Article Synopsis
- Clinical algorithms for assessing febrile children often rely on vital sign thresholds that may not accurately reflect serious bacterial infections (SBI) after antipyretics are given.
- A study involving 740 children demonstrated that persistent tachypnoea (fast breathing) after temperature reduction is a significant predictor of pneumonia but does not apply to other types of SBI.
- Tachypnoea showed high specificity and likelihood ratios for ruling in pneumonia, while tachycardia (fast heart rate) proved to be a poor diagnostic indicator, suggesting a need to reconsider its use in discharge decisions.
Aim: This study investigated febrile children with petechial rashes who presented to European emergency departments (EDs) and investigated the role that mechanical causes played in diagnoses.
Methods: Consecutive patients with fever presenting to EDs in 11 European emergency departments in 2017-2018 were enrolled. The cause and focus of infection were identified and a detailed analysis was performed on children with petechial rashes.
Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments.
Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort.
Article Synopsis
- The study investigates the factors influencing the adoption of CRP point of care (POC) tests in the Netherlands and England, noting significant differences in their availability despite similar healthcare systems.
- Researchers used qualitative case studies, analyzing documents and conducting interviews with stakeholders, guided by the NASSS framework.
- Results indicate that successful adoption in the Netherlands was driven by strong advocacy, evidence generation, support from health services, and mandatory reimbursement, while England faced challenges due to funding constraints and alternative priorities in healthcare.
Background: Point-of-care-tests (POCTs) have been advocated to optimise care in patients with infections but their actual use varies. This study aimed to estimate the variability in the adoption of current POCTs by paediatricians across Europe, and to explore the determinants of variability.
Methods And Findings: A cross-sectional survey was conducted of hospital and primary care paediatricians, recruited through professional networks.