There’s a near-oath we clearly all have to sign to when we commit to paediatrics … “Children are not little adults” … and while this is definitely true … after all, how often have you seen someone smile whimsically at a grown-up asleep in their unicorn onsie being carried home … we know it has shades of truth in it. For some situations, we can’t easily extrapolate trials and studies undertaken in adults and apply them to children. Or teenagers. This has been clearly shown in risk-stratification systems for febrile neutropenia. [1] In other situations, such as the treatment of Ewings sarcoma, this may be less true.
But do we think enough about the differences between neonates, particularly very premature neonates, and infants and children? Avoiding the obvious initial issues of respiratory distress syndrome / surfactant deficiency and necrotising enterocolitis where the diagnoses don’t exist, we should be careful of our extrapolations one way and the other. It’s a bit like we’d be considering carefully the way we extrapolate either side of puberty, but in a tinier form.
These in-paediatric distinctions have been identified and highlighted by the work of the STAR-CHild group [2], who outline a ‘current best guess’ for age categories. They suggest prems, 0-28 days, 28 days – 12 months should be considered differently. Considering this when we undertake our analysis of studies is going to be very important for us to put our evidence-based approach into action as best we can.
- Archi
References
- Phillips et al. Risk Stratification in Febrile Neutropenic Episodes in Adolescent / Young Adult Patients with Cancer. European Journal Of Cancer Sept 2016:64;101–106 DOI doi:10.1016/j.ejca.2016.05.027
2. https://www.starchildhealth.org/completed-standards