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Article ; Online: COVID-19 interventions in children: a balancing act.

Emonts, Marieke

2021 Volume 107, Issue 3, Page(s) e12

MeSH term(s)	Adolescent ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19/virology ; COVID-19 Vaccines/adverse effects ; Child ; Drug Approval ; Evidence-Based Medicine ; Humans ; Pandemics/prevention & control ; Risk Assessment ; SARS-CoV-2 ; United States/epidemiology ; United States Food and Drug Administration
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2021-10-21
Publishing country	England
Document type	Journal Article
ZDB-ID	524-1
ISSN	1468-2044 ; 0003-9888 ; 1359-2998
ISSN (online)	1468-2044
ISSN	0003-9888 ; 1359-2998
DOI	10.1136/archdischild-2021-323042
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Article: Recurrent or unusual infections in children - when to worry about inborn errors of immunity.

Reilly, Liam / Emonts, Marieke

Therapeutic advances in infectious disease

2023 Volume 10, Page(s) 20499361231162978

Abstract: Recurrent infections are a common presenting feature in paediatrics and, while most times considered part of normal growing up, they are also a classical hallmark of inborn errors of immunity (IEI). We aimed to outline the value of currently used signs ... ...

Abstract	Recurrent infections are a common presenting feature in paediatrics and, while most times considered part of normal growing up, they are also a classical hallmark of inborn errors of immunity (IEI). We aimed to outline the value of currently used signs for IEI and the influence of the changing epidemiology of infectious diseases due to implementation of new vaccines and the effect of the COVID-19 pandemic on the assessment of children with recurrent infections. Warning signs for IEI have been developed, but the supporting evidence for their effectiveness is limited, and immune dysregulation is more commonly recognised as a feature for IEI, making reliable identification of children who should be screened for IEI on clinical grounds difficult. In addition, the epidemiology of infectious diseases is changing due to restrictions related to Covid-19 as well as immunisations, which may change the threshold to screen children for IEI. Treatments for IEI are evolving and are often more effective and less complicated when started early. Screening for IEI can be initiated by the non-immunologist and should be considered early to ensure optimal treatment outcomes.
Language	English
Publishing date	2023-04-17
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2728410-4
ISSN	2049-937X ; 2049-9361
ISSN (online)	2049-937X
ISSN	2049-9361
DOI	10.1177/20499361231162978
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Article: Biomarkers for Diagnosing Febrile Illness in Immunocompromised Children: A Systematic Review of the Literature.

van der Velden, Fabian J S / Gennery, Andrew R / Emonts, Marieke

Frontiers in pediatrics

2022 Volume 10, Page(s) 828569

Abstract: Objective: This study aims to assess the performance of biomarkers used for the prediction of bacterial, viral, and fungal infection in immunocompromised children upon presentation with fever.: Methods: We performed a literature search using PubMed ... ...

Abstract	Objective: This study aims to assess the performance of biomarkers used for the prediction of bacterial, viral, and fungal infection in immunocompromised children upon presentation with fever. Methods: We performed a literature search using PubMed and MEDLINE and In-Process & Other Non-indexed Citations databases. Cohort and case-control studies assessing biomarkers for the prediction of bacterial, viral, or fungal infection in immunocompromised children vs. conventional microbiological investigations were eligible. Studies including adult patients were eligible if pediatric data were separately assessable. Data on definitions used for infections, fever, and neutropenia and predictive values were collected. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results: Fifty-two studies involving 13,939 febrile episodes in 7,059 children were included. In total, 92.2% were in cancer patients ( Discussion: There is great heterogeneity in the biomarkers studied and cutoff values and definitions used, thus complicating the analysis. Literature for immunocompromised children with non-malignant disease and for non-bacterial infection is sparse. Literature on novel diagnostics was not available. We illustrated the challenges of diagnosing fever adequately in this study population and the need for improved biomarkers and clinical decision-making tools.
Language	English
Publishing date	2022-03-10
Publishing country	Switzerland
Document type	Systematic Review
ZDB-ID	2711999-3
ISSN	2296-2360
ISSN	2296-2360
DOI	10.3389/fped.2022.828569
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Article ; Online: Atypical juvenile dermatomyositis complicated by systemic capillary leak syndrome: case report and review of the literature.

Martin, Alexander J / Sen, Ethan S / Emonts, Marieke

Rheumatology (Oxford, England)

2020 Volume 60, Issue 1, Page(s) e1–e2

MeSH term(s)	Antirheumatic Agents/therapeutic use ; Capillary Leak Syndrome/etiology ; Capillary Leak Syndrome/therapy ; Cyclophosphamide/therapeutic use ; Dermatomyositis/complications ; Dermatomyositis/therapy ; Female ; Glucocorticoids/administration & dosage ; Humans ; Infant ; Methylprednisolone/administration & dosage ; Plasma Exchange ; Treatment Failure
Chemical Substances	Antirheumatic Agents ; Glucocorticoids ; Cyclophosphamide (8N3DW7272P) ; Methylprednisolone (X4W7ZR7023)
Language	English
Publishing date	2020-08-06
Publishing country	England
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	1464822-2
ISSN	1462-0332 ; 1462-0324
ISSN (online)	1462-0332
ISSN	1462-0324
DOI	10.1093/rheumatology/keaa406
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Article ; Online: Adoption of C-reactive protein rapid tests for the management of acute childhood infections in hospitals in the Netherlands and England: a comparative health systems analysis.

Dewez, Juan Emmanuel / Nijman, Ruud G / Fitchett, Elizabeth J A / Li, Edmond C / Luu, Queena F / Lynch, Rebecca / Emonts, Marieke / de Groot, Ronald / van der Flier, Michiel / Philipsen, Ria / Ettelt, Stefanie / Yeung, Shunmay

BMC health services research

2024 Volume 24, Issue 1, Page(s) 351

Abstract: 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 ... ...

Abstract	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. The study was informed by the non-adoption, abandonment, spread, scale-up, and sustainability (NASSS) framework. Data were collected through document analysis and qualitative interviews with stakeholders. Documents were identified by a scoping literature review, search of websites, and through the stakeholders. Stakeholders were sampled purposively initially, and then by snowballing. Data were analysed thematically. Results: Forty-one documents resulted from the search and 46 interviews were conducted. Most hospital healthcare workers in the Netherlands were familiar with CRP POCTs as the tests were widely used and trusted in primary care. Moreover, although diagnostics were funded through similar Diagnosis Related Group reimbursement mechanisms in both countries, the actual funding for each hospital was more constrained in England. Compared to primary care, laboratory-based CRP tests were usually available in hospitals and their use was encouraged in both countries because they were cheaper. However, CRP POCTs were perceived as useful in some hospitals of the two countries in which the laboratory could not provide CRP measures 24/7 or within a short timeframe, and/or in emergency departments where expediting patient care was important. Conclusions: CRP POCTs are more available in hospitals in the Netherlands because of the greater familiarity of Dutch healthcare workers with the tests which are widely used in primary care in their country and because there are more funding constraints in England. However, most hospitals in the Netherlands and England have not adopted CRP POCTs because the alternative CRP measurements from the hospital laboratory are available in a few hours and at a lower cost.
MeSH term(s)	Child ; Humans ; Netherlands ; C-Reactive Protein/analysis ; Point-of-Care Testing ; Hospitals ; Systems Analysis
Chemical Substances	C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2024-03-19
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-024-10698-6
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Article ; Online: Biobanking and consenting to research: a qualitative thematic analysis of young people's perspectives in the North East of England.

van der Velden, Fabian J S / Lim, Emma / Gills, Lily / Broadey, Jasmin / Hayes, Louise / Roberts, Eve / Courtney, Jack / Ball, Joanne / Herberg, Jethro / Galassini, Rachel / Emonts, Marieke

BMC medical ethics

2023 Volume 24, Issue 1, Page(s) 47

Abstract: Background: Biobanking biospecimens and consent are common practice in paediatric research. We need to explore children and young people's (CYP) knowledge and perspectives around the use of and consent to biobanking. This will ensure meaningful informed ...

Abstract	Background: Biobanking biospecimens and consent are common practice in paediatric research. We need to explore children and young people's (CYP) knowledge and perspectives around the use of and consent to biobanking. This will ensure meaningful informed consent can be obtained and improve current consent procedures. Methods: We designed a survey, in co-production with CYP, collecting demographic data, views on biobanking, and consent using three scenarios: 1) prospective consent, 2) deferred consent, and 3) reconsent and assent at age of capacity. The survey was disseminated via the Young Person's Advisory Group North England (YPAGne) and participating CYP's secondary schools. Data were analysed using a qualitative thematic approach by three independent reviewers (including CYP) to identify common themes. Data triangulation occurred independently by a fourth reviewer. Results: One hundred two CYP completed the survey. Most were between 16-18 years (63.7%, N = 65) and female (66.7%, N = 68). 72.3% had no prior knowledge of biobanking (N = 73). Acceptability of prospective consent for biobanking was high (91.2%, N = 93) with common themes: 'altruism', 'potential benefits outweigh individual risk', 'frugality', and '(in)convenience'. Deferred consent was also deemed acceptable in the large majority (84.3%, N = 86), with common themes: 'altruism', 'body integrity' and 'sample frugality'. 76.5% preferred to reconsent when cognitively mature enough to give assent (N = 78), even if parental consent was previously in place. 79.2% wanted to be informed if their biobanked biospecimen is reused (N = 80). Conclusion: Prospective and deferred consent acceptability for biobanking is high among CYP in the UK. Altruism, frugality, body integrity, and privacy are the most important themes. Clear communication and justification are paramount to obtain consent. Any CYP with capacity should be part of the consenting procedure, if possible.
MeSH term(s)	Child ; Humans ; Female ; Adolescent ; Biological Specimen Banks ; Prospective Studies ; Informed Consent ; Parental Consent ; Qualitative Research ; England
Language	English
Publishing date	2023-07-05
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041552-7
ISSN	1472-6939 ; 1472-6939
ISSN (online)	1472-6939
ISSN	1472-6939
DOI	10.1186/s12910-023-00925-w
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Article ; Online: First reported use of zidovudine for prevention of perinatal HIV transmission in a premature neonate on extra corporal membrane oxygenation.

Emonts, Marieke / Waalewijn, Hylke / Colbers, Angela / Pickering, Ailsa / Burger, David

AIDS (London, England)

2018 Volume 32, Issue 14, Page(s) 2084–2085

MeSH term(s)	Administration, Intravenous ; Anti-HIV Agents/administration & dosage ; Anti-HIV Agents/pharmacokinetics ; Chemoprevention/methods ; Disease Transmission, Infectious/prevention & control ; Extracorporeal Membrane Oxygenation ; HIV Infections/prevention & control ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases/prevention & control ; Infant, Premature ; Plasma/chemistry ; Zidovudine/administration & dosage ; Zidovudine/pharmacokinetics
Chemical Substances	Anti-HIV Agents ; Zidovudine (4B9XT59T7S)
Language	English
Publishing date	2018-10-03
Publishing country	England
Document type	Letter
ZDB-ID	639076-6
ISSN	1473-5571 ; 0269-9370 ; 1350-2840
ISSN (online)	1473-5571
ISSN	0269-9370 ; 1350-2840
DOI	10.1097/QAD.0000000000001940
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Article ; Online: Role of point-of-care tests in the management of febrile children: a qualitative study of hospital-based doctors and nurses in England.

Li, Edmond / Dewez, Juan Emmanuel / Luu, Queena / Emonts, Marieke / Maconochie, Ian / Nijman, Ruud / Yeung, Shunmay

BMJ open

2021 Volume 11, Issue 5, Page(s) e044510

Abstract: Objectives: The use of rapid point-of-care tests (POCTs) has been advocated for improving patient management and outcomes and for optimising antibiotic prescribing. However, few studies have explored healthcare workers' views about their use in febrile ... ...

Abstract	Objectives: The use of rapid point-of-care tests (POCTs) has been advocated for improving patient management and outcomes and for optimising antibiotic prescribing. However, few studies have explored healthcare workers' views about their use in febrile children. The aim of this study was to explore the perceptions of hospital-based doctors and nurses regarding the use of POCTs in England. Study design: Qualitative in-depth interviews with purposively selected hospital doctors and nurses. Data were analysed thematically. Setting: Two university teaching hospitals in London and Newcastle. Participants: 24 participants (paediatricians, emergency department doctors, trainee paediatricians and nurses). Results: There were diverse views about the use of POCTs in febrile children. The reported advantages included their ease of use and the rapid availability of results. They were seen to contribute to faster clinical decision-making; the targeting of antibiotic use; improvements in patient care, flow and monitoring; cohorting (ie, the physical clustering of hospitalised patients with the same infection to limit spread) and enhancing communication with parents. These advantages were less evident when the turnaround for results of laboratory tests was 1-2 hours. Factors such as clinical experience and specialty, as well as the availability of guidelines recommending POCT use, were also perceived as influential. However, in addition to their perceived inaccuracy, participants were concerned about POCTs not resolving diagnostic uncertainty or altering clinical management, leading to a commonly expressed preference for relying on clinical skills rather than test results solely. Conclusion: In this study conducted at two university teaching hospitals in England, participants expressed mixed opinions about the utility of current POCTs in the management of febrile children. Understanding the current clinical decision-making process and the specific needs and preferences of clinicians in different settings will be critical in ensuring the optimal design and deployment of current and future tests.
MeSH term(s)	Child ; England ; Hospitals ; Humans ; London ; Nurses ; Point-of-Care Testing ; Qualitative Research
Language	English
Publishing date	2021-05-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-044510
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Article ; Online: Which low urgent triaged febrile children are suitable for a fast track? An observational European study.

Emergency medicine journal : EMJ

2024 Volume 41, Issue 4, Page(s) 236–241

Abstract: Background: The number of paediatric patients visiting the ED with non-urgent problems is increasing, leading to poor patient flow and ED crowding. Fast track aims to improve the efficiency of evaluation and discharge of low acuity patients. We aimed to ...

Abstract	Background: The number of paediatric patients visiting the ED with non-urgent problems is increasing, leading to poor patient flow and ED crowding. Fast track aims to improve the efficiency of evaluation and discharge of low acuity patients. We aimed to identify which febrile children are suitable for a fast track based on presenting symptoms and management. Methods: This study is part of the Management and Outcome of Fever in children in Europe study, which is an observational study including routine data of febrile children <18 years attending 12 European EDs. We included febrile, low urgent children (those assigned a triage acuity of either 'standard' or 'non-urgent' using the Manchester Triage System) and defined children as suitable for fast track when they have minimal resource use and are discharged home. Presenting symptoms consisted of neurological (n=237), respiratory (n=8476), gastrointestinal (n=1953) and others (n=3473, reference group). Multivariable logistic regression analyses regarding presenting symptoms and management (laboratory blood testing, imaging and admission) were performed with adjustment for covariates: patient characteristics, referral status, previous medical care, previous antibiotic use, visiting hours and ED setting. Results: We included 14 139 children with a median age of 2.7 years (IQR 1.3-5.2). The majority had respiratory symptoms (60%), viral infections (50%) and consisted of self-referrals (69%). The neurological group received imaging more often (adjusted OR (aOR) 1.8, 95% CI 1.1 to 2.9) and were admitted more frequently (aOR 1.9, 95% CI 1.4 to 2.7). The respiratory group had fewer laboratory blood tests performed (aOR 0.6, 95% CI 0.5 to 0.7), were less frequently admitted (aOR 0.6, 95% CI 0.5 to 0.7), but received imaging more often (aOR 1.8, 95% CI 1.6 to 2.0). Lastly, the gastrointestinal group had more laboratory blood tests performed (aOR 1.2. 95% CI 1.1 to 1.4) and were admitted more frequently (aOR 1.4, 95% CI 1.2 to 1.6). Conclusion: We determined that febrile children triaged as low urgent with respiratory symptoms were most suitable for a fast track. This study provides evidence for which children could be triaged to a fast track, potentially improving overall patient flow at the ED.
MeSH term(s)	Child, Preschool ; Humans ; Infant ; Emergency Service, Hospital ; Europe ; Fever/diagnosis ; Fever/etiology ; Hospitalization ; Referral and Consultation ; Triage/methods
Language	English
Publishing date	2024-03-21
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	2040124-3
ISSN	1472-0213 ; 1472-0205
ISSN (online)	1472-0213
ISSN	1472-0205
DOI	10.1136/emermed-2023-213375
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Article ; Online: Oral Valganciclovir Initiated Beyond 1 Month of Age as Treatment of Sensorineural Hearing Loss Caused by Congenital Cytomegalovirus Infection: A Randomized Clinical Trial.

Kimberlin, David W / Aban, Inmaculada / Peri, Kalyani / Nishikawa, Javier K / Bernatoniene, Jolanta / Emonts, Marieke / Klein, Nigel / Bamford, Alasdair / DeBiasi, Roberta L / Faust, Saul N / Jones, Christine E / McMaster, Paddy / Caserta, Mary / Ahmed, Amina / Sharland, Mike / Demmler-Harrison, Gail / Hackett, Scott / Sánchez, Pablo J / Shackley, Fiona /

Kelly, Dominic / Dennehy, Penelope H / Storch, Gregory A / Whitley, Richard J / Griffiths, Paul

The Journal of pediatrics

2024 Volume 268, Page(s) 113934

Abstract: Objective: The objective of this study was to determine if valganciclovir initiated after 1 month of age improves congenital cytomegalovirus-associated sensorineural hearing loss.: Study design: We conducted a randomized, double-blind, placebo- ... ...

Abstract	Objective: The objective of this study was to determine if valganciclovir initiated after 1 month of age improves congenital cytomegalovirus-associated sensorineural hearing loss. Study design: We conducted a randomized, double-blind, placebo-controlled phase 2 trial of 6 weeks of oral valganciclovir at US (n = 12) and UK (n = 9) sites. Patients of ages 1 month through 3 years with baseline sensorineural hearing loss were enrolled. The primary outcome was change in total ear hearing between baseline and study month 6. Secondary outcome measures included change in best ear hearing and reduction in cytomegalovirus viral load in blood, saliva, and urine. Results: Of 54 participants enrolled, 35 were documented to have congenital cytomegalovirus infection and were randomized (active group: 17; placebo group: 18). Mean age at enrollment was 17.8 ± 15.8 months (valganciclovir) vs 19.5 ± 13.1 months (placebo). Twenty (76.9%) of the 26 ears from subjects in the active treatment group did not have worsening of hearing, compared with 27 (96.4%) of 28 ears from subjects in the placebo group (P = .09). All other comparisons of total ear or best ear hearing outcomes were also not statistically significant. Saliva and urine viral loads decreased significantly in the valganciclovir group but did not correlate with change in hearing outcome. Conclusions: In this randomized controlled trial, initiation of antiviral therapy beyond the first month of age did not improve hearing outcomes in children with congenital cytomegalovirus-associated sensorineural hearing loss. Clinical trial registration: ClinicalTrials.gov identifier NCT01649869.
MeSH term(s)	Humans ; Cytomegalovirus Infections/drug therapy ; Cytomegalovirus Infections/congenital ; Cytomegalovirus Infections/complications ; Valganciclovir/therapeutic use ; Valganciclovir/administration & dosage ; Hearing Loss, Sensorineural/drug therapy ; Hearing Loss, Sensorineural/virology ; Hearing Loss, Sensorineural/etiology ; Antiviral Agents/therapeutic use ; Antiviral Agents/administration & dosage ; Male ; Female ; Double-Blind Method ; Infant ; Administration, Oral ; Ganciclovir/analogs & derivatives ; Ganciclovir/therapeutic use ; Ganciclovir/administration & dosage ; Child, Preschool ; Treatment Outcome ; Viral Load ; Infant, Newborn
Chemical Substances	Valganciclovir (GCU97FKN3R) ; Antiviral Agents ; Ganciclovir (P9G3CKZ4P5)
Language	English
Publishing date	2024-02-02
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Clinical Trial, Phase II ; Multicenter Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2024.113934
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