Background Families from underserved communities face disproportionate barriers to accessing early years support. In response, Early Years GP Child Health Hub Pilots were set up in three North West London boroughs (Brent, Ealing, Harrow) between 2023 and 2025 to improve access to integrated services, reflecting the NHS 10-Year Plan’s ambition for neighbourhood-based care. The hubs have been funded to continue supporting local communities. However, there is limited understanding of how parents from underserved communities experience these services and the challenges they encounter in engaging with them. This study explored practitioner-reported barriers parents face in accessing and engaging with integrated child health services.Methods We used qualitative multiple practitioner-generated case study data specifically for families with children aged 0–5 years from the three pilot sites. We applied the Capability, Opportunity, Motivation-Behaviour (COM-B) framework to analyse the data thematically, guided deductively by the framework and inductively allowing for emergent themes.Results Twenty-one case studies, collected between September 2024 and January 2025, were generated by practitioners using information they recorded from contact with each family. Barriers were identified across all COM-B domains and multiple barriers overlapping domains. Capability barriers were reported to be the most common (eg, poor parental mental health, low parenting confidence and limited health literacy). Opportunity barriers included financial hardship, competing priorities, social isolation and family interference. Motivational barriers included fear of judgement, emotional stress and previous negative experiences with services. The case studies also identified several enablers including trusted practitioner relationships, culturally sensitive care, proactive follow-up and multidisciplinary collaboration.Conclusion Families living in disadvantaged areas face multiple, intersecting barriers to engaging with integrated services. Child Health Hubs should adopt co-produced, community-informed approaches with parents that integrate health and social support to improve equitable access and sustained engagement for families experiencing adversity.
Background Nurturing care involves creating a stable, supportive environment by caregivers that promotes health, protection and developmentally stimulating interactions. There is a paucity of evidence regarding caregivers’ practices on caregiving and child-rearing and support for early learning opportunities in India. This study was conducted to assess the practices among caregivers of children (0–3 years) in all domains of Nurturing Care for Early Childhood Development (NC-ECD).Methods This cross-sectional study included primary caregivers of 610 children aged 0–3 years with a birth weight of more than 2500 g. These children included those brought to a medical college affiliated hospital for routine vaccinations and those being discharged from the hospital following an acute illness without any residual health effects. Primary caregivers were interviewed individually with a predesigned proforma pertaining to their practices in five domains of nurturing care ie good health, adequate nutrition, safety and security, responsive caregiving and opportunities for early learning. Caregivers’ responses were categorised as ‘always’, ‘sometimes’ and ‘never’. Overall, ‘appropriate’ practices were defined when >85% of responses were ‘always’.Results Most caregivers (n=370 (60%)) belonged to urban middle-class families, with 475 (78%) being part of nuclear families. The mother was the primary caregiver for 580 (95%) children. Median (IQR) age of enrolled children was 13 (5, 24) months, 348 (57%) were boys. Appropriate nurturing care practices were followed by 316 (51.8%) for safety and security, 183 (30%) for adequate nutrition, 26 (4.3%) for good health, 17 (2.8%) for responsive caregiving and 14 (2.3%) for early learning opportunities.Conclusions Practices of caregivers on nurturing care for early child development were unsatisfactory in all the five domains, especially in domains of early learning opportunities, responsive caregiving and good health. Empowering the caregivers in nurturing care through existing health services needs to be prioritised.
Objective Small for gestational age (SGA) infants face neurodevelopmental risks, yet early catch-up growth’s link to later outcomes remains unclear. This study explored associations between catch-up growth (weight, length, head circumference) and neurodevelopment in full-term SGA infants during the first 2 years and developed a prediction model.Methods This prospective cohort study enrolled full-term SGA and appropriate for gestational age (AGA) infants from a single centre, yielding 91 SGA and 115 AGA after exclusion. All were followed to 24 months with regular anthropometry. Catch-up was defined as ΔZ ≥0.67 from birth to each time point. Neurodevelopment was assessed by Gesell Developmental Schedules at 24 months. Multivariate linear regression with false discovery rate (FDR) correction and logistic regression for prediction modelling were performed.Results Catch-up peaked at 8 months (85.71%). After FDR correction, head circumference catch-up showed nominally significant associations with adaptive development at 6 months (β=6.56, p=0.019), 8 months (β=6.89, p=0.013) and 12 months (β=5.63, p=0.045); none survived FDR. Weight and length catch-up showed none. A logistic model with 6-month head circumference catch-up, sex and maternal body mass index showed acceptable calibration (Hosmer-Lemeshow p=0.344) and modest discrimination (area under the curve=0.685, 95% CI 0.567 to 0.803).Conclusion Head circumference catch-up showed nominally significant associations with adaptive development—the core Gesell domain—whereas weight/length did not. Achieving head circumference catch-up by 6 months may predict adaptive outcomes at 24 months. Given the exploratory nature, confirmation in independent cohorts is needed before causal inferences can be made.
Background Central line-associated bloodstream infections (CLABSIs) remain a major morbidity in preterm neonates despite infection prevention bundles. While a closed multilumen infusion system (CMLIS) previously demonstrated CLABSI reduction, validation across different clinical settings remains limited.Objective To evaluate whether CMLIS implementation in a different neonatal intensive care unit (NICU) confirms reduced CLABSI incidence density and optimises antimicrobial stewardship.Methods This retrospective study in a French tertiary NICU included preterm neonates (23+0 to 31+6 weeks’ gestation) admitted between January 2024 and October 2025. Using multivariable Poisson regression and propensity score matching (PSM), we compared infants managed with standard manifolds versus the CMLIS. The primary outcome was CLABSI incidence density per 1000 catheter-days (defined as a central catheter-associated positive blood culture with infection signs, treated with appropriate antibiotics for ≥5 days). Secondary outcomes included antibiotic days of therapy, mortality, late-onset sepsis, prematurity-related complications and NICU length of stay.Results Among the 170 neonates included, CMLIS implementation was associated with a significant reduction in the primary outcome (adjusted incidence rate ratio (aIRR): 0.50; p=0.025). This protective effect was confirmed in the PSM cohort (IRR: 0.55; p=0.03). Regarding antimicrobial stewardship, total antibiotic consumption decreased by 41% (aIRR: 0.59; p=0.002) and vancomycin usage decreased by 39% (aIRR: 0.61; p=0.006). No significant differences were observed in other clinical outcomes or exploratory mortality.Conclusions CMLIS implementation was associated with lower CLABSI incidence density and reduced antibiotic exposure. These findings suggest CMLIS offers valuable incremental benefits when baseline hygiene bundles are optimised, though further prospective validation is warranted.
