Over the past 20 years, there has been a growing interest in the psychosocial outcomes of children and adolescents born with a congenital heart defect (CHD). This systematic review and meta-analysis aims to appraise and synthesize current literature on the psychosocial outcomes of children and adolescents with severe CHD.
A search of studies examining psychosocial outcomes in children and adolescents with severe CHD was performed. Meta-analyses were used to calculate the prevalence of psychosocial impairments and the standardized mean differences between cases and controls. Results that were not included in the meta-analysis were collated using descriptive statistics.
A total of 16 studies were included in this review, and results were summarized according to three domains: behavior, social cognition, and self-esteem. Results from a meta-analysis identified that 25% of children and adolescents with CHD presented behavioral problems. Children and adolescents with CHD had more problematic behavior than healthy peers (standardized mean difference; g = 0.71). Young people with CHD had significantly more difficulties inferring on the mental states of others (standardized mean difference; g = 0.72). In contrast, identifying the emotions of others and self-esteem was not statistically different from healthy controls.
This review and meta-analysis provides evidence to support the presence of psychosocial difficulties in children and adolescents born with a severe CHD giving grounds for the systematic assessment of behavior and social cognition during their clinical follow-up.
Young people newly diagnosed with type 1 diabetes achieve similar blood glucose control by 12 months if they are treated with multiple daily insulin injections or continuously via an insulin pump. Adverse events are rare and occur at similar rates. Pumps are more expensive with no clear benefit to quality of life.
Both regimens are used in the management of type 1 diabetes, and the number of children using insulin pumps is rising. This NIHR-funded trial suggests that at an additional cost of £1,863 per patient annually with equivalent outcomes, the high costs of insulin pumps seem unjustified at this stage of the condition.
However, continuous insulin may be more convenient for some, particularly younger children, or later in their diabetes, so insulin pumps are still likely to have a place in treatment. Current guidelines recommend that multiple injections are considered first, with a switch to an insulin pump if these injections are inappropriate.
Recruitment was challenging. Many families declined to join the study because they had a treatment option preference (66% preferring multiple injection therapy). Pump usage in the UK is still at relatively low levels (30%). Would greater confidence in pump therapy improve the outcome? – I doubt it!
The reasons for wide variation in children’s diabetes outcomes across Europe are probably more complex.
About 50% of participants achieved HbA1c less than 58 mmol/mol – better than the 2016-2017 UK Audit data (28.9%), but we still have a long way to go. As the investigators suggest, we should be putting more resources into understanding why the outcomes during the first year remain poor.
David Dunger, Professor of Paediatrics, University of Cambridge
Anne Longfield, the Children’s Commissioner for England, is today (Thursday) publishing new analysis by her office looking at the provision of children’s mental health services in England. The research comes ahead of the publication today (Thursday) by NHS Digital of the first prevalence survey of children’s mental health since 2004.
The Commissioner’s briefing finds that Child and Adolescent Mental Health Services (CAMHS) are improving in most areas in the country, yet with the exception of eating disorder services, the provision of services in the youth justice system and in perinatal mental health care, the rate of progress is slow. A vast gap remains between what is provided and what children need. As a result, the current rate of progress is still not good enough for the majority of children who require help but are not receiving it.
Our main findings include:
Of more than 338,000 children referred to CAMHS last year, less than a third (31%) received treatment within the year.
Another 37% were not accepted into treatment or discharged after an assessment appointment, and 32% were still on waiting lists at the end of the year.
Less than 3% of children in England accessed CAMHS last year, a small fraction of those who need help. This is partly because many children who seek help are not accepted into treatment, but also because many children do not know they have a problem or do not seek help.
Of those children who did enter treatment, around half did so within six weeks.
However, nearly 80% of children entering eating disorders treatment are seen within four weeks.
Most areas are increasing funding for CAMHS, but parity with spending on adult mental health services remains a distant prospect. Nearly fifteen times as much is spent on adult mental health as on child mental health.
In cash terms this means children’s mental health services require an additional £1.7bn a year to achieve equivalent funding to that provided to adult mental health
Some areas are already far exceeding the existing NHS target to be treating a third of children with significant need (based on 2004 levels of prevalence) by 2021. Yet for every area exceeding what NHS England expects of them, there is an area failing to deliver.
The report does show areas of progress. In the last two years the NHS has delivered 70 new community eating disorder services for children, with a waiting time standard of one week for urgent referrals and four weeks for routine. There have also been welcome improvements in mental health care support in the youth justice system and in perinatal mental health.
Oral steroids do not improve hearing, symptoms, or quality of life in children with glue ear. This NIHR-funded trial compared oral steroids with placebo for 389 children with glue ear, also called otitis media with effusion, and found no significant effect on those outcomes.
Glue ear is when the middle ear fills with fluid, often following an ear or respiratory infection. The fluid makes hearing more difficult. It usually resolves within three months without treatment, but if it lasts longer, the hearing loss may cause delayed language development or difficulties with communicating, for instance at school.
This study shows that many children will improve spontaneously, even after three months of glue ear and confirms that steroids are not useful, even though they are well tolerated. Surgery to place ventilation tubes known as grommets is an option for children with persistent glue ear in and hearing loss in both ears. This evidence supports more informed discussions with parents about watchful waiting and the surgical options available.
The stimulant methylphenidate has the best balance of effectiveness against side effects in children and young people with attention deficit hyperactivity disorder. Amphetamines are more effective, but also more likely to be stopped for a reason other than side effects.
This large, NIHR-funded systematic review compared a range of drugs against each other through a network meta-analysis. Effectiveness and tolerability were assessed at about 12 weeks of treatment. Other second-line drug treatments were also effective and well-tolerated, including modafinil which is currently not licensed for children in the UK.
There were some quality issues due to risk of bias. But this study supports NICE guidance on the range of potential drug options to consider in conjunction with behavioural and support strategies for children and young people with attention deficit hyperactivity disorder.
Treatment with sodium thiosulfate alongside cisplatin chemotherapy can reduce hearing loss in children with a liver tumour called hepatoblastoma. The risk of hearing loss was reduced by 48% in children who had the combination treatment compared with those who had cisplatin only.
This phase 3 trial involved 109 children with standard-risk hepatoblastoma and tested the addition of sodium thiosulfate six hours after cisplatin treatment. The additional drug caused few major side effects, and there was no difference in event-free or overall survival between treatment groups after three years.
Although small, the study adds to growing evidence that this well tolerated, cheap treatment might reduce cisplatin-induced hearing loss in a range of childhood cancers