Endothelial Peripheral Arterial Tonometry (Endo-PAT 2000) use in paediatric patients: a systematic review.

OBJECTIVES: Endo Peripheral Artery Tonometry (EndoPAT-2000) is a non-invasive technology for measuring endothelial dysfunction (ED). The reactive hyperaemia index (RHI) is resulted and is low when ED is present. We aim to synthesise the literature on paediatric ED that used Endo-PAT analysis. DESIGN: A comprehensive systematic review was conducted from January 2015 to March 2021. The databases included Cochrane, MEDLINE EBSCO, EMBASE (Ovid), PUBMED and CINAHL EBSCO. Exclusion criteria were: (1) If a study used a different device, for example, (2) If the study had no results. Inclusion criteria were: (1) Published in the English, (2) more than 50% of study subjects were in the paediatric age range, (3) data relevant to paediatric age range children could be extrapolated from all data, where not all study subjects were children. RESULTS: Following the removal of duplicates, 156 articles were initially identified. Following exclusion, 50 articles were included for review. We have subdivided these papers into different systems for ease of reference and have reported our findings in six tables: patients with type 1/2 diabetes, obesity, cardiovascular, respiratory, psychiatric conditions and miscellaneous diseases. For each, the study design, population, control group (if available), RHI results and conclusions were reported. CONCLUSIONS: A number of papers using Endo-PAT for children with various chronic diseases have evidence of ED. However, in many cases, there has only been a single cohort study using Endo-PAT. Further studies are required to validate these findings and to help characterise the cardiovascular risk profile of children with chronic disease. Further studies are also required that will characterise more completely the cardiovascular risk profile of these children.Consensus on other vascular risk markers that could be included in future studies is ideal and if accomplished, this would facilitate meta-analyses of studies of relatively rare conditions.

Palliative care services for children with life-limiting conditions.

BACKGROUND: Palliative care (PC) for children with life-limiting conditions (LLC) is a holistic approach to achieve the best quality of life. AIMS: Highlighting collaboration between pediatric and PC services is essential in providing seamless care. METHODS: Retrospective data obtained including patient cohort, disease profile, place of death, and the resource requirements for children with a LLC in the Mid-West region of Ireland over a 7-year period. RESULTS: Seventy-seven patients were identified (n = 77); five still receiving care, four discharged, and 68 have died. The cohort ranged in age from 1 day to 17 years with a mean of approximately 6 years. Thirty-five percent of patients were less than 1 year old. Fifty-one percent were male. Seventy-one percent were referred initially to PC for end-of-life care and 29% for symptom management. Forty-four percent had home support services in place prior to referral to PC. An advanced care plan was created for 65%. Of those that died (n = 68), 70.5% died at home, 25% in hospital, and 4.4% in residential care or a children's hospice. The clinical nurse coordinator for children with life-limiting conditions (CNCCLLC) was involved with 88% of patients. The specialist PC teams were involved with 87%; 65 patients had community support, 31 patients had in-hospital support, and 29 patients were seen by both hospital and community services. CONCLUSIONS: Our study highlights the growing number of LLCs and current pediatric and PC services require further resources and development.