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.