Generalised oedema is characterised by tissue swelling due to excess water accumulation. It is a frequent complication encountered in infants admitted to paediatric and neonatal intensive care. In clinical practice, oedema assessment depends on a combination of weight monitoring, fluid balance calculations and direct visual inspection of the skin. However, all of these lack accuracy and sensitivity, especially in critically ill infants. We report the use of near infrared (NIR) spectroscopy using a portable spectrometer and an optical fibre with a custom attachment allowing continuous recordings for 30 min. Data were collected from 20 neonates and infants admitted to the intensive care unit, with or without oedema, across three consecutive days. Statistically significant differences were found in the 1450 nm features, amplitude (p = 0.009), ratio (p < 0.001) and band area (p < 0.001), and the 970 nm ratio followed the same direction (p = 0.005), all with higher values in the oedema group. A late fusion model, combining spectral data and clinical features, effectively differentiated between oedematous and non-oedematous infants, achieving AUC 0.909 ± 0.016, p = 0.004. This proof-of-concept study suggests that near-infrared spectroscopy can detect oedema in neonates and infants, as assessed against clinical evaluation, laying the groundwork for its potential application as a non-invasive clinical detection and monitoring tool.

Objectives: To determine the frequency and temporal trends of applications by National Health Service (NHS) hospital trusts to the High Court for judicial review in cases of disagreement with families regarding the withholding or withdrawal of life-sustaining treatment in paediatric and neonatal intensive care and to examine the outcomes of these applications. Setting: Retrospective study using publicly available legal records across England and Northern Ireland, reflecting cases arising from tertiary (level 3) paediatric and neonatal intensive care settings across multiple NHS trusts. Participants: All identified legal cases involving children aged 0–17 years, admitted to paediatric and neonatal intensive care unit who were referred to the High Court for a decision on the withholding or withdrawal of life-sustaining support in the last 20 years. A total of 50 cases were included. Cases were identified through systematic search of the British and Irish Legal Information Institute (BAILII) database. Exclusion criteria included adult cases and those not involving disputes over life-sustaining therapies. Main outcome measures: The primary outcome was assessing trends in frequency of judicial review applications. Secondary outcomes included to study the outcomes of those applications. Results: Fifty eligible cases were identified. The frequency of applications increased over the study period. In 96% of cases, the court ruled in favour of the applicant NHS trust, determining that limitation or withdrawal of treatment was in the child’s best interests. Conclusions: Applications to the High Court in cases of disagreement over life-sustaining treatment in paediatric intensive care are increasing in England and Northern Ireland. Judicial decisions consistently support clinicians, aligning with the child’s best interests following detailed legal scrutiny.