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Abacus     Hybrid Journal   (Followers: 11, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 53, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 43, SJR: 0.547, h-index: 30)
ACEP NOW     Free  
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Acta Archaeologica     Hybrid Journal   (Followers: 133, SJR: 0.101, h-index: 9)
Acta Geologica Sinica (English Edition)     Hybrid Journal   (Followers: 3, SJR: 0.552, h-index: 41)
Acta Neurologica Scandinavica     Hybrid Journal   (Followers: 5, SJR: 1.203, h-index: 74)
Acta Obstetricia et Gynecologica Scandinavica     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 81)
Acta Ophthalmologica     Hybrid Journal   (Followers: 5, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 54, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 7, SJR: 1.69, h-index: 88)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Acta Psychiatrica Scandinavica     Hybrid Journal   (Followers: 35, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 5, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 2)
Addiction     Hybrid Journal   (Followers: 32, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 12, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
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Advances in Polymer Technology     Hybrid Journal   (Followers: 13, SJR: 0.344, h-index: 31)
Africa Confidential     Hybrid Journal   (Followers: 19)
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African Development Review     Hybrid Journal   (Followers: 33, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 14, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 15, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 9, SJR: 4.374, h-index: 95)
Agribusiness : an Intl. J.     Hybrid Journal   (Followers: 6, SJR: 0.627, h-index: 14)
Agricultural and Forest Entomology     Hybrid Journal   (Followers: 14, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 44, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 28, SJR: 1.122, h-index: 120)
Alcoholism and Drug Abuse Weekly     Hybrid Journal   (Followers: 7)
Alcoholism Clinical and Experimental Research     Hybrid Journal   (Followers: 7, SJR: 1.416, h-index: 125)
Alimentary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 33, SJR: 2.833, h-index: 138)
Alimentary Pharmacology & Therapeutics Symposium Series     Hybrid Journal   (Followers: 3)
Allergy     Hybrid Journal   (Followers: 49, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 129, SJR: 0.951, h-index: 61)
American Business Law J.     Hybrid Journal   (Followers: 24, SJR: 0.205, h-index: 17)
American Ethnologist     Hybrid Journal   (Followers: 89, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 28, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 30, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 12, SJR: 1.018, h-index: 58)
American J. of Industrial Medicine     Hybrid Journal   (Followers: 16, SJR: 0.993, h-index: 85)
American J. of Medical Genetics Part A     Hybrid Journal   (Followers: 15, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 3, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 5, SJR: 2.315, h-index: 79)
American J. of Orthopsychiatry     Hybrid Journal   (Followers: 4, SJR: 0.756, h-index: 69)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 35, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 237, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 14, SJR: 1.197, h-index: 63)
American J. of Reproductive Immunology     Hybrid Journal   (Followers: 3, SJR: 1.347, h-index: 75)
American J. of Transplantation     Hybrid Journal   (Followers: 15, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 115, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 11, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 15)
Anatomia, Histologia, Embryologia: J. of Veterinary Medicine Series C     Hybrid Journal   (Followers: 3, SJR: 0.295, h-index: 27)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1, SJR: 0.633, h-index: 24)
Andrologia     Hybrid Journal   (Followers: 2, SJR: 0.528, h-index: 45)
Andrology     Hybrid Journal   (Followers: 2, SJR: 0.979, h-index: 14)
Angewandte Chemie     Hybrid Journal   (Followers: 154)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 205, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 34, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 5, SJR: 0.569, h-index: 24)
Annalen der Physik     Hybrid Journal   (Followers: 5, SJR: 1.46, h-index: 40)
Annals of Anthropological Practice     Partially Free   (Followers: 2, SJR: 0.187, h-index: 5)
Annals of Applied Biology     Hybrid Journal   (Followers: 8, SJR: 0.816, h-index: 56)
Annals of Clinical and Translational Neurology     Open Access   (Followers: 1)
Annals of Human Genetics     Hybrid Journal   (Followers: 9, SJR: 1.191, h-index: 67)
Annals of Neurology     Hybrid Journal   (Followers: 42, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 2, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 9, SJR: 0.336, h-index: 23)
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5, SJR: 2.389, h-index: 189)
Annual Bulletin of Historical Literature     Hybrid Journal   (Followers: 12)
Annual Review of Information Science and Technology     Hybrid Journal   (Followers: 14)
Anthropology & Education Quarterly     Hybrid Journal   (Followers: 24, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 16, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 14)
Anthropology of Consciousness     Hybrid Journal   (Followers: 11, SJR: 0.172, h-index: 5)
Anthropology of Work Review     Hybrid Journal   (Followers: 11, SJR: 0.256, h-index: 5)
Anthropology Today     Hybrid Journal   (Followers: 92, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 45, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 6, SJR: 0.432, h-index: 59)
Anzeiger für Schädlingskunde     Hybrid Journal   (Followers: 1)
Apmis     Hybrid Journal   (Followers: 1, SJR: 0.855, h-index: 73)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 66, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 6, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 128, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 47, SJR: 0.868, h-index: 13)
Applied Stochastic Models in Business and Industry     Hybrid Journal   (Followers: 5, SJR: 0.613, h-index: 24)
Aquaculture Nutrition     Hybrid Journal   (Followers: 13, SJR: 1.025, h-index: 55)
Aquaculture Research     Hybrid Journal   (Followers: 31, SJR: 0.807, h-index: 60)
Aquatic Conservation Marine and Freshwater Ecosystems     Hybrid Journal   (Followers: 34, SJR: 1.047, h-index: 57)
Arabian Archaeology and Epigraphy     Hybrid Journal   (Followers: 11, SJR: 0.453, h-index: 11)
Archaeological Prospection     Hybrid Journal   (Followers: 12, SJR: 0.922, h-index: 21)
Archaeology in Oceania     Hybrid Journal   (Followers: 13, SJR: 0.745, h-index: 18)
Archaeometry     Hybrid Journal   (Followers: 27, SJR: 0.809, h-index: 48)
Archeological Papers of The American Anthropological Association     Hybrid Journal   (Followers: 14, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 24, SJR: 0.261, h-index: 9)
Archiv der Pharmazie     Hybrid Journal   (Followers: 4, SJR: 0.628, h-index: 43)
Archives of Drug Information     Hybrid Journal   (Followers: 4)
Archives of Insect Biochemistry and Physiology     Hybrid Journal   (SJR: 0.768, h-index: 54)
Area     Hybrid Journal   (Followers: 12, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 203, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 48, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 27, SJR: 2.256, h-index: 114)
Artificial Organs     Hybrid Journal   (Followers: 1, SJR: 0.872, h-index: 60)
ASHE Higher Education Reports     Hybrid Journal   (Followers: 13)
Asia & the Pacific Policy Studies     Open Access   (Followers: 15)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 321, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 7, SJR: 0.345, h-index: 20)
Asia-pacific J. of Clinical Oncology     Hybrid Journal   (Followers: 6, SJR: 0.554, h-index: 14)
Asia-Pacific J. of Financial Studies     Hybrid Journal   (SJR: 0.241, h-index: 7)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 3, SJR: 0.377, h-index: 7)
Asian Economic J.     Hybrid Journal   (Followers: 8, SJR: 0.234, h-index: 21)
Asian Economic Policy Review     Hybrid Journal   (Followers: 3, SJR: 0.196, h-index: 12)
Asian J. of Control     Hybrid Journal   (SJR: 0.862, h-index: 34)
Asian J. of Endoscopic Surgery     Hybrid Journal   (SJR: 0.394, h-index: 7)
Asian J. of Organic Chemistry     Hybrid Journal   (Followers: 4, SJR: 1.443, h-index: 19)
Asian J. of Social Psychology     Hybrid Journal   (Followers: 5, SJR: 0.665, h-index: 37)
Asian Politics and Policy     Hybrid Journal   (Followers: 13, SJR: 0.207, h-index: 7)
Asian Social Work and Policy Review     Hybrid Journal   (Followers: 5, SJR: 0.318, h-index: 5)
Asian-pacific Economic Literature     Hybrid Journal   (Followers: 5, SJR: 0.168, h-index: 15)
Assessment Update     Hybrid Journal   (Followers: 4)
Astronomische Nachrichten     Hybrid Journal   (Followers: 2, SJR: 0.701, h-index: 40)
Atmospheric Science Letters     Open Access   (Followers: 29, SJR: 1.332, h-index: 27)
Austral Ecology     Hybrid Journal   (Followers: 12, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 10, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 7, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 7, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 13, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 3, SJR: 0.709, h-index: 14)
Australian and New Zealand J. of Family Therapy (ANZJFT)     Hybrid Journal   (Followers: 3, SJR: 0.382, h-index: 12)
Australian and New Zealand J. of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 42, SJR: 0.814, h-index: 49)
Australian and New Zealand J. of Public Health     Hybrid Journal   (Followers: 11, SJR: 0.82, h-index: 62)
Australian Dental J.     Hybrid Journal   (Followers: 6, SJR: 0.482, h-index: 46)
Australian Economic History Review     Hybrid Journal   (Followers: 4, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 22, SJR: 0.23, h-index: 9)
Australian Economic Review     Hybrid Journal   (Followers: 6, SJR: 0.357, h-index: 21)
Australian Endodontic J.     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 24)
Australian J. of Agricultural and Resource Economics     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 36)
Australian J. of Grape and Wine Research     Hybrid Journal   (Followers: 5, SJR: 0.879, h-index: 56)
Australian J. of Politics & History     Hybrid Journal   (Followers: 13, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 16, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 383, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 4, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 64, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 11, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 19, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 31, SJR: 2.126, h-index: 39)
Autonomic & Autacoid Pharmacology     Hybrid Journal   (SJR: 0.371, h-index: 29)
Banks in Insurance Report     Hybrid Journal   (Followers: 1)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 9, SJR: 0.539, h-index: 70)
Basic and Applied Pathology     Open Access   (Followers: 2, SJR: 0.113, h-index: 4)
Basin Research     Hybrid Journal   (Followers: 3, SJR: 1.54, h-index: 60)
Bauphysik     Hybrid Journal   (Followers: 2, SJR: 0.194, h-index: 5)
Bauregelliste A, Bauregelliste B Und Liste C     Hybrid Journal  
Bautechnik     Hybrid Journal   (Followers: 1, SJR: 0.321, h-index: 11)
Behavioral Interventions     Hybrid Journal   (Followers: 7, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 21, SJR: 0.736, h-index: 57)
Berichte Zur Wissenschaftsgeschichte     Hybrid Journal   (Followers: 9, SJR: 0.11, h-index: 5)
Beton- und Stahlbetonbau     Hybrid Journal   (Followers: 2, SJR: 0.493, h-index: 14)
Biochemistry and Molecular Biology Education     Hybrid Journal   (Followers: 6, SJR: 0.311, h-index: 26)
Bioelectromagnetics     Hybrid Journal   (Followers: 1, SJR: 0.568, h-index: 64)
Bioengineering & Translational Medicine     Open Access  
BioEssays     Hybrid Journal   (Followers: 10, SJR: 3.104, h-index: 155)
Bioethics     Hybrid Journal   (Followers: 14, SJR: 0.686, h-index: 39)
Biofuels, Bioproducts and Biorefining     Hybrid Journal   (Followers: 1, SJR: 1.725, h-index: 56)
Biological J. of the Linnean Society     Hybrid Journal   (Followers: 14, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 2, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 44, SJR: 0.12, h-index: 1)
Biology of the Cell     Full-text available via subscription   (Followers: 9, SJR: 1.812, h-index: 69)
Biomedical Chromatography     Hybrid Journal   (Followers: 6, SJR: 0.572, h-index: 49)
Biometrical J.     Hybrid Journal   (Followers: 5, SJR: 0.784, h-index: 44)
Biometrics     Hybrid Journal   (Followers: 37, SJR: 1.906, h-index: 96)
Biopharmaceutics and Drug Disposition     Hybrid Journal   (Followers: 10, SJR: 0.715, h-index: 44)
Biopolymers     Hybrid Journal   (Followers: 18, SJR: 1.199, h-index: 104)
Biotechnology and Applied Biochemistry     Hybrid Journal   (Followers: 45, SJR: 0.415, h-index: 55)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 134, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 13, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 17, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 10, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 33, SJR: 0.763, h-index: 64)
Birth Defects Research Part A : Clinical and Molecular Teratology     Hybrid Journal   (Followers: 2, SJR: 0.727, h-index: 77)
Birth Defects Research Part B: Developmental and Reproductive Toxicology     Hybrid Journal   (Followers: 5, SJR: 0.468, h-index: 47)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal   (SJR: 1.513, h-index: 55)

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Journal Cover Acta Paediatrica
  [SJR: 0.794]   [H-I: 88]   [54 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0803-5253 - ISSN (Online) 1651-2227
   Published by John Wiley and Sons Homepage  [1583 journals]
  • A misunderstanding. Response to Dr Bilo et al
    • Authors: Niels Lynøe; Göran Elinder, Boubou Hallberg, Måns Rosén, Pia Sundgren, Anders Eriksson
      Abstract: In their comments on the shaken baby syndrome report (1) and subsequent paper in Acta Paediatrica (2) Dr Bilo et al (3) assumed that the expert panel responsible for both publications used the “same meticulous approach to compile Table 1” in the Appendix to the report as they did in the main references to the report (1).This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-25T10:10:39.582648-05:
      DOI: 10.1111/apa.13892
  • The potential implications of using disability free survival and number
           needed to suffer as outcome measures for neonatal intensive care
    • Authors: Per-Arne Lönnqvist
      Abstract: The use of mortality and surrogate makers to determine outcomes after advanced medical treatment has been questioned, because often these dimensions do not agree with what both many medical staff and laypeople judge as adequate outcome measures. That is why Myles et al introduced the more adequate dimension of disability free survival (1-3). Furthermore, the suffering of other patients that is associated with one single individual having a good outcome has been discussed and the suggested term for this is the number needed to suffer (4), which reflects the similar terms of number needed to treat and number needed to harm.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T11:05:26.668444-05:
      DOI: 10.1111/apa.13888
  • What are acceptable conclusions? Response to Dr Ludvigsson
    • Authors: Niels Lynøe; Göran Elinder, Boubou Hallberg, Måns Rosén, Pia Sundgren, Anders Eriksson
      Abstract: We would like to thank to Dr Ludvigsson (1), who was the only critical commentary author to acknowledge the methodological problems inherent in the diagnosis of shaken baby syndrome, following the publication of our systematic review (2) in Acta Paediatrica. Dr Ludvigsson posed two questions regarding the two main conclusions, which deserve responses.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T11:00:34.34534-05:0
      DOI: 10.1111/apa.13890
  • Conflicts of interest issues. Response to Lucas et al
    • Authors: Niels Lynøe; Göran Elinder, Boubou Hallberg, Måns Rosén, Pia Sundgren, Anders Eriksson
      Abstract: Lucas et al (1) maintain that there were substantial flaws in the way our review on shaken baby syndrome (2) was conducted and in our choice of research focus. They suggest that the reason for these major shortcomings was that the expert panel lacked clinicians and scientists with deep knowledge in the research area.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T11:00:32.625434-05:
      DOI: 10.1111/apa.13891
  • Using internal and external reviewers can help to optimise neonatal
           mortality and morbidity conferences
    • Authors: Michael-Andrew Assaad; Annie Janvier, Anie Lapointe
      Abstract: AimThis study determined if there was a difference in the conclusions reached by paediatricians in morbidity and mortality conferences based on their level of involvement in a case.MethodsAll neonatal deaths occurring between August 2014 and September 2015 at Sainte-Justine Hospital, Montreal, Quebec, Canada, were reviewed by internal physicians involved in the case and external physicians who were not. The reviewers were asked to identify positive and negative clinical practice items and provide written recommendations. These were classified into eight categories and compared for each case.ResultsDuring the study, 55 patients died leading to 110 reviews and a total of 590 positive and negative items. Most items were in the communication (25.2%), ethical decision-making (16.7%) and clinical management (14.8%) categories. Both the internal and external reviewers were in agreement 48.5% of the time for positive items and 44.8% for negative items. There were 242 written recommendations, which differed significantly among the internal and external reviewers.ConclusionReviews of neonatal deaths by two independent reviewers, internal physicians and external physicians, led to different positive and negative practice items and recommendations. This could allow for a richer discussion and improve recommendations for patient care.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T11:00:28.139795-05:
      DOI: 10.1111/apa.13889
  • Selective imaging modalities after first pyelonephritis failed to identify
           significant urological anomalies, despite normal antenatal ultrasounds
    • Authors: Gylli Mola; Therese Ramstad Wenger, Petra Salomonsson, Inge Jenny Dahl Knudsen, Jan Lysgaard Madsen, Søren Møller, Beth Härstedt Olsen, Pablo Gustavo Vinicoff, Jorgen Thorup, Dina Cortes
      Abstract: AimWe investigated the consequences of applying different imaging guidelines for urological anomalies after first pyelonephritis in children with normal routine antenatal ultrasounds.MethodsThe cohort comprised 472 children treated for their first culture positive pyelonephritis and investigated with ultrasound and renal scintigraphy. We excluded patients with known urological anomalies and patients born before routine antenatal ultrasound. We followed the cohort for a median of 5.7 years (3.1-10.1 years) by reviewing their medical reports.ResultsUrological anomalies were diagnosed in 95 patients. Dilated vesicoureteral reflux (VUR) was the predominant finding (n=29), including nine who initially had surgery. Using imaging guidelines from the American Academy of Pediatrics would have missed 11 urological patients, including two with initial surgery, and avoided 339 scintigraphies. Using the European Association of Paediatric Urology guidance would have missed three urological patients, one with initial surgery, and avoided 46 scintigraphies. Investigating patients under two years with ultrasound and scintigraphy, and just ultrasound in children over two years, would have identified all patients initially treated with surgery and avoided 65 scintigraphies.ConclusionDilated VUR was the dominant anomaly in a cohort with first time pyelonephritis and normal antenatal ultrasound. The optimal imaging strategy after pyelonephritis must be identified.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T10:55:32.919168-05:
      DOI: 10.1111/apa.13894
  • The shaken baby syndrome report was not the result of a conspiracy.
           Response to Dr. Narang et al
    • Authors: Niels Lynøe; Göran Elinder, Boubou Hallberg, Måns Rosén, Pia Sundgren, Anders Eriksson
      Abstract: Narang et al (1) maintain that the research question in our systematic review in Acta Paediatrica (2) was based on the findings of Guthkelch in 1971 (3), and that we presumed that Guthkelch introduced the shaken baby syndrome triad. That is not correct. We used the Guthkelch example in the introduction in order to illustrate when the discussion on shaken baby syndrome was initiated. As our research question was a reverse causality version of the Guthkelch hypothesis, it was not influenced by that hypothesis.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T10:50:57.017525-05:
      DOI: 10.1111/apa.13895
  • The scientific evidence regarding retinal haemorrhages. Response to
           Hellgren et al and Levin
    • Authors: Niels Lynøe; Göran Elinder, Boubou Hallberg, Måns Rosén, Pia Sundgren, Anders Eriksson
      Abstract: In most studies on the diagnostic accuracy of the triad of subdural haematoma, retinal haemorrhages and encephalopathy, the classification of study cases and controls was performed by a child protection team. Since the triad is a very important criterion used by child protection teams, the extremely high diagnostic accuracy of the triad is obviously based on circular reasoning rather than scientific criteria. That is the main reason why we only included confessed, convicted and witnessed cases in our paper (3). We saw no other way to overcome this huge methodological problem and do not agree with Levin that the criteria for the review were “impossibly strict” (2).This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T10:49:28.248913-05:
      DOI: 10.1111/apa.13896
  • Authors’ overarching reply to all the responses received to the
           systematic literature review on shaken baby syndrome
    • Authors: Niels Lynøe; Göran Elinder, Boubou Hallberg, Måns Rosén, Pia Sundgren, Anders Eriksson
      Abstract: There have been a lot of views expressed about our paper on shaken baby syndrome, which was published in Acta Paediatrica (1). We acknowledge the concerns expressed by all of the authors who responded with regard to child welfare and the possibility that the diagnoses may be delayed in individual cases of child abuse. However, we are very troubled by the disregard displayed by those authors to the significant methodological problems inherent in published research on shaken baby syndrome.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T10:15:33.054071-05:
      DOI: 10.1111/apa.13887
  • May the fear of being falsely accused of having shaken a baby increase
           parents’ demands for scheduled Caesareans?
    • Authors: Niels Lynøe; Anders Eriksson
      Abstract: In a recently published systematic review of the shaken baby literature in Acta Paediatrica (1), we and our fellow authors concluded that there was very little support for the claim that if the triad of subdural haematoma (SDH), retinal haemorrhages (RHs) and encephalopathy were present with absence of any impact, the infant must have been violently shaken. We also stated that there might be several other explanations for why the baby might have developed these symptoms and signs. One alternative explanation, which has been insufficiently explored, is the sequelae of delivery. Different delivery modes might result in different proportions of SDH in newborn infants (2-4) (Table 1).This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T10:15:32.049365-05:
      DOI: 10.1111/apa.13886
  • Randomised controlled trial shows that co-bedding twins may reduce birth
           weight recovery delay, parenteral nutrition weaning time and
    • Authors: Arnaud Legrand; Anne Frondas, Fabien Aubret, Anne Corre, Cyril Flamant, Laure Simon, Clothilde Desrobert, Jean-Christophe Rozé
      Abstract: AimCobedding describes a technique where premature twins are kept within the same incubator, inside a common cocoon, to prolong the alleged in utero behavioral bond and reduce post-natal stress. However there is no consensus amongst neonatologists regarding any clinical or developmental benefits cobedding may provide, in particular when performed early after the birth. The NEOCOB (NEOnatology & COBedding) trial aimed to assess, for the first time, early cobedding in preterm newborn twins.MethodsIn a controlled randomized design, we measured various physiological and neurodevelopmental responses in 15 cobedded vs 17 separated sets of preterm twins, born between 30 to 34 weeks of gestation, during the entire hospital stayResultsDespite limited cohort size, statistical trends suggest that cobedding may reduce birth weight recovery delay, decrease parenteral nutrition weaning time and ultimately hospital Length of Stay (LoSCobedded = 34.32 ± 1.57 days versus LoSSeparated = 40.19 ± 1.74 days; p = 0.067). Cobedding did not impact weight gain trajectories, neurodevelopment or thermoregulation. Unexpectedly, cobedded twins displayed increased tachycardia frequency, but with conserved comfortConclusionEven if speculative, the highlighted statistical trends may support the idea that cobedding could reduce LoS by maximizing developmental interactions and orality maturation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T01:30:42.754043-05:
      DOI: 10.1111/apa.13885
  • Changes in perinatal hospital deaths occurring outside the neonatal
           intensive care unit over a decade
    • Authors: Amélie Du Pont-Thibodeau; Keith Barrington, Catherine Taillefer, Annie Janvier
      Abstract: AimPerinatal deaths occurring outside the neonatal intensive care unit (NICU) are rarely recorded in outcome studies, despite having a direct impact on perinatal statistics. Our aim was to investigate the timing and modes of perinatal deaths that occurred outside the NICU and changes over time.MethodWe reviewed all perinatal deaths from 22 weeks of gestation onwards, without NICU admissions, during two periods in a Canadian tertiary mother and baby hospital and categorised deaths according to nine specific categories.ResultsThere were 444 perinatal deaths that satisfied the inclusion criteria. The total number of perinatal deaths increased from 2000 to 2002 (n=197) and 2007 to 2010 (n=247). The proportion of fetuses alive at the time of their mother's hospital admission, but then stillborn, decreased. There was a significant increase in terminations for congenital anomalies in the second cohort, and a decrease in deaths following induction of labour and comfort care for fetal anomalies.ConclusionApproaches to end of life care changed between the two study periods. Paediatricians should be aware of the epidemiology of perinatal mortality in their own practice, as it has a direct impact on the denominator in NICU outcome studies.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-23T05:55:49.161899-05:
      DOI: 10.1111/apa.13884
  • The way forward in addressing abusive head trauma in infants – current
           perspectives from Sweden
    • Authors: Steven Lucas; Anna Bärtås, Anna-Karin Edstedt Bonamy, Lisa Törnudd, Peter Wide, Gabriel Otterman
      PubDate: 2017-04-19T09:23:39.684883-05:
      DOI: 10.1111/apa.13840
  • Antenatal betamethasone for women at risk for late preterm delivery
           reduces the rate of neonatal respiratory complications
    • Authors: Hannah R. Canty; Stephanie Dukhovny, Jamie B. Warren
      PubDate: 2017-04-18T11:46:13.273463-05:
      DOI: 10.1111/apa.13825
  • Is high-flow nasal cannula noninferior to nasal CPAP for the initial
           management of preterm infants?
    • Authors: Megan J. Kirkley; Sunah S. Hwang
      PubDate: 2017-04-17T11:10:24.25221-05:0
      DOI: 10.1111/apa.13817
  • Child health in Sweden is characterised by good health and low accidents,
           but rising psychological problems
    • Authors: Hugo Lagercrantz
      PubDate: 2017-04-17T10:10:42.610631-05:
      DOI: 10.1111/apa.13803
  • Does single mega-dose vitamin A in early neonatal period reduce mortality
           during infancy in low- and middle-income countries?
    • Authors: Sindhu Sivanandan; M Jeeva Sankar
      PubDate: 2017-04-17T10:00:24.392757-05:
      DOI: 10.1111/apa.13800
  • Receiving early information and trusting Swedish child health centre
           nurses increased parents’ willingness to vaccinate against rotavirus
    • Authors: Lina Schollin Ask; Anders Hjern, Ann Lindstrand, Ola Olen, Eva Sjögren, Margareta Blennow, Åke Örtqvist
      Abstract: AimRotavirus vaccines are effective against severe infections, but have a modest impact on mortality in high-income countries. Parental knowledge and attitudes towards vaccines are crucial for high vaccination coverage. This study aimed to identify why parents refused to let their infant have the vaccination or were unsure.MethodsThis cross-sectional study was based on 1,063 questionnaires completed by the parents of newborn children in 2014. Stepwise logistic regression was used to identify the main predictors.ResultsMost (81%) parents intended to vaccinate their child against the rotavirus, while 19% were unwilling or uncertain. Parents with less education and children up to five weeks of age were more likely to be unwilling or uncertain about vaccinating their child. Factors associated with a refusal or uncertainty about vaccinating were: not having enough information about the vaccine, no intention of accepting other vaccines, paying little heed to the child health nurses’ recommendations, thinking that the rotavirus was not a serious illness and not believing that the vaccine provided protection against serious forms of gastroenteritis.ConclusionEarly information, extra information for parents with less education and close positive relationships between parents and child health nurses were important factors in high rotavirus vaccination rates.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-17T07:35:59.08188-05:0
      DOI: 10.1111/apa.13872
  • Cardiorespiratory Physiology in the Safe Passage Study: Protocol, Methods
           and Normative Values in Unexposed Infants
    • Authors: Michael M. Myers; Amy J. Elliott, Hein J. Odendaal, Larry Burd, Jyoti Angal, Coen Groenewald, J. David Nugent, Joel S. Yang, Joseph R. Isler, Kim A. Dukes, Fay Robinson, William P. Fifer,
      Abstract: AimThe Safe Passage Study, conducted by the Prenatal Alcohol in SIDS and Stillbirth Network, is investigating contributions of prenatal alcohol exposure to fetal and infant demise. This current report presents physiological data from full term infants with no prenatal exposure to alcohol or maternal smoking.MethodsData are from 666 infants from the Northern Plains (North and South Dakota) and South Africa. A standardized protocol assessed cardiorespiratory function during baseline and head-up tilts shortly after birth and at 1 month of age.ResultsAnalyses revealed significant increases in heart rate and decreases in BP from the newborn to 1 month time period as well as diminished heart rate responses to head-up tilt in 1 month old infants.ConclusionThe Safe Passage Study was successful in characterizing physiology in a large number of infants at sites known to have elevated risks for SIDS. Results demonstrate that even with low prenatal adverse exposures, there are significant changes in cardiorespiratory function as infants enter the window of increased risk for SIDS.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-17T07:35:54.49015-05:0
      DOI: 10.1111/apa.13873
  • International opinions and national surveillance suggest insufficient
           consensus regarding the recognition and management practices of infants
           with congenital cytomegalovirus infections
    • Authors: J. Gunkel; J. Nijman, M.A. Verboon-Maciolek, T.F.W. Wolfs, L.S. de Vries
      Abstract: AimThis study evaluated the recognition and management practices with regard to congenital cytomegalovirus (cCMV) infections by a select group of experts and through a national surveillance study.MethodA questionnaire was sent to international experts involved in mother and infant care in 2014-2015. Monthly surveillance was conducted among Dutch paediatricians for cases of cCMV infections from 2013 until 2015.ResultsThe questionnaire was completed by 63/103 (62%) respondents, who indicated that recognition and management practices varied. Maternal screening was performed by 17/63 (27%) and infant screening by 3/61 (5%) of the respondents. Infant CMV diagnostics were most frequently initiated due to hepatosplenomegaly and, or, an increase in liver transaminases. Management practices included cranial ultrasound (57/63, 91%) and audiological follow up in symptomatic (61/63, 97%) and asymptomatic (52/63, 83%) infants. In terms of antiviral treatment, 46/63 (73%) treated symptomatic infants only and 6/63 (9%) treated all infected infants. In total, 48 cases were registered through the Dutch surveillance study and 43/48 (90%) infants were symptomatic.ConclusionThis study indicates that infants with cCMV infection were insufficiently recognised and highlights the need for consensus on management practices. Screening of infants and the development of an international management guideline are recommended.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-17T07:35:48.450963-05:
      DOI: 10.1111/apa.13882
  • Are extremely preterm born children with autism the victims of too much
           isolation in the incubator?
    • Authors: Hugo Lagercrantz
      Abstract: When autism was first identified by Leo Kanner in 1943, he thought it was partially due to “genuine lack of maternal warmth”. This “refrigerator mother theory” has been completely discarded and there is now a consensus that there is a connection between genetic heritability and autism spectrum disorder (ASD). Although Kanner was the first to publish a work on autism, the disease had already been observed by Hans Asperger in Vienna. The history of the discovery and recognition of autism is described in the interesting book: Neurotribes by Steve Silberman (1),This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-17T07:30:35.620453-05:
      DOI: 10.1111/apa.13874
  • Adults Born Preterm: A Review of General Health and System-Specific
    • Authors: Tonse N. K. Raju; Sonia Buist, Carol J. Blaisdell, Marva Moxey-Mims, Saroj Saigal
      Abstract: In this review of 126 publications, we report that an overwhelming majority of adults born at preterm gestations remain healthy and well. However, a small, but a significant fraction of them remain at higher risk for neurological, personality and behavioral abnormalities, cardio-pulmonary functional limitations, systemic hypertension, and metabolic syndrome compared to their term-born counterparts. The magnitude of increased risk differed across organ systems, and varied across reports. The risks were proportional to the degree of prematurity at birth and seemed to occur more frequently among preterm infants born in the final two decades of the 20th century and later. These findings have considerable public health and clinical practice relevance.ConclusionPreterm birth needs to be considered a chronic condition, with a slight increase in the risk for long-term morbidities among adults born preterm. Therefore, obtaining a history of gestational age and weight at birth should be a routine part of care for patients of all age groups.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-17T07:30:34.649066-05:
      DOI: 10.1111/apa.13880
  • Feasibility and utility of portable ultrasound during retrieval of sick
           preterm infants
    • Authors: Kathryn Browning Carmo; Tracey Lutz, Mark Greenhalgh, Andrew Berry, Martin Kluckow, Nick Evans
      Abstract: AimDocument the incidence of haemodynamic pathology in critically ill preterm newborns requiring transport.MethodA transport neonatologist performed cardiac and cerebral ultrasound before and after transportation of infants born ≤ 30 weeks gestation.Results44 newborns were studied 2008 – 2015, 21 transported by road, 19 by helicopter and 4 by fixed wing. Median birth weight 1130g (680-1960g), median gestation 27 weeks (23-30) and 30/44 were male. Antenatal steroid course was complete in 2 babies. Ultrasound in the referring hospital was at a mean of 2hrs:47mins (00:15-7:00) of age. Low systemic blood flow was common: 50% had right ventricular output
      PubDate: 2017-04-17T07:30:27.348099-05:
      DOI: 10.1111/apa.13881
  • Icons in paediatrics: Rolf Kostmann (1909–1982)
    • Authors: Carl Gustaf Ljunggren; Lars Stenhammar, Leif Strömberg
      Abstract: In the medical literature, diseases and syndromes are sometimes named after the first person to publish a report on, or describe, a condition. This is, of course, a great honour, both for the physician and his or her country and only a handful of Swedish medical researchers have achieved this. Swedish paediatrician Rolf Kostmann (Fig. 1) joined this elite group following his report on what he called infantile hereditary agranulocytosis (agranulocytosis infantilis hereditaria), which was first published 1950 in Swedish (1), and his dissertation in 1956 (2), He was the first to describe severe chronic neutropenia as an inherited disease.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-12T12:40:46.632842-05:
      DOI: 10.1111/apa.13871
  • Randomized trial of exclusive human milk versus preterm formula diets in
           extremely premature infants
    • Authors: Nicholas Embleton; Jemma Cleminson
      PubDate: 2017-04-11T01:15:44.538602-05:
      DOI: 10.1111/apa.13820
  • A novel approach for classifying protruding ears is easy to calculate and
           implement in daily clinical practice
    • Authors: J A Lopes-Santos; Constantino Martins, J M La Fuente, M F Costa-Carvalho
      Abstract: AimProtruding ears is a prevalent deformity, with a reported incidence of 5% in the paediatric population, but it lacks a simple digital classification. The aim of this study was to find a parameter that would objectively allow the photographic classification of protrusion, by comparing frontal facial images of patients with protruding ears with aged-matched controls.MethodsThis prospective cohort study compared the frontal facial images of 105 patients with protruding ears with 112 aged-matched controls without protruding ears. A rectangle was drawn on the image for each ear, encompassing its full visible anatomy. The height of each rectangle was divided by its width to create an index. The mean value of both ears was defined as the Frontal Aesthetics Translation Index for Measurement of Amplitude of the Ears (FATIMAE).ResultsThe calculated values for group with protruding ears were significantly higher than for the controls. No gender differences were found. However, the FATIMAE values decreased with age, establishing different classification criteria for separate age groups.ConclusionThe FATIMAE is easy to calculate and implement in daily clinical practice and establishes a practical approach for classification of protrusion, as well as for referral criteria for a specialised surgical consultation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-10T10:15:55.467073-05:
      DOI: 10.1111/apa.13870
  • Observer variability identifying attention deficit hyperactivity disorder
           in 10-year old children born extremely preterm
    • Authors: Alan Leviton; Scott J. Hunter, Megan N. Scott, Stephen R Hooper, Robert M. Joseph, T. Michael O'Shea, Elizabeth N. Allred, Karl Kuban
      Abstract: AimA DSM-5 diagnosis of Attention-Deficit/Hyperactive Disorder (ADHD) requires that symptoms be present in two settings. We wanted to see how teachers and parents compare on their assessments.MethodsWe evaluated how well Child Symptom Inventory-4 (CSI-4) reports from 871 parents and 634 teachers of 10-year old children born before the 28th week of gestation provided information about indicators of school dysfunctionResultsKappa values for parent and teacher agreement of any ADHD were at best fair to poor (< 0.41). Nevertheless, ADHD identified by each alone provided a moderate amount of information about such indicators of school dysfunction as grade repetition. Only occasionally did agreement provide more information than provided by only one reporter. Mother's social class and intelligence level did not discriminate between parents who did and did not agree with the teacher.ConclusionADHD identified by a single observer can provide appreciable information about a range of the child's functions needed for success in school and therefore should not be discounted when another observer does not consider the child to have ADHD symptoms.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-08T03:06:03.441613-05:
      DOI: 10.1111/apa.13869
  • Postnatal growth in term infants born small for gestational age is
           associated with later neurocognitive and metabolic outcomes
    • Authors: Esther Castanys-Muñoz; Kathy Kennedy, Eurídice Castañeda-Gutiérrez, Stewart Forsyth, Keith M. Godfrey, Berthold Koletzko, Susan E. Ozanne, Ricardo Rueda, Marieke Schoemaker, Eline M van der Beek, Stef van Buuren, Ken K. Ong
      Abstract: We systematically reviewed papers published in English between 1994 and October 2015 on how postnatal weight gain and growth affects neurodevelopment and metabolic outcomes in term-born small for gestational age (SGA) infants. Two randomised trials reported that enriched infant formulas that promoted early growth also increased fat mass, lean mass and blood pressure, but had no effect on early neurocognitive outcomes. Meanwhile, 31 observational studies reported consistent positive associations between postnatal weight gain and growth with neurocognitive outcomes, adiposity, insulin resistance and blood pressure.ConclusionFew intervention studies exist, despite consistent positive associations between early growth and neurocognition in term-born SGA infants.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-06T02:30:39.879571-05:
      DOI: 10.1111/apa.13868
  • Point-of-care tests for infectious diseases: barriers to implementation
           across three London teaching hospitals
    • Authors: Amaya L. Bustinduy; Dakshika Jeyaratnam, Sam Douthwaite, Sarah Tonkin-Crine, Rebecca Shaw, Laura Hyrapetian, Nick Sevdalis, Simon Goldenberg, Elizabeth Adams, Mike Sharland,
      Abstract: Existing Point-of-care tests (POCT) to help identify infection-related causes of illness can complement diagnostic and disposition decisions in children attending emergency departments.(1) Evidence-based clinical algorithms can integrate such POCT to aid in the admission and discharge decision process. Paediatric studies validating these tools are scarce, with very few studies conducted in UK centres.(2-5) POCT can be based on host infection markers (e.g. finger prick tests for C-reactive protein (CRP) to help decide if the patient has a bacterial or viral infection) or pathogen detection tests (e.g. throat/nose swabs to rapidly diagnose viral infections such as RSV or influenza).This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-04T02:51:15.069286-05:
      DOI: 10.1111/apa.13867
  • Postoperative complications following percutaneous endoscopic gastrostomy
           are common in children
    • Authors: E Hansen; N Qvist, L Rasmussen, M B Ellebæk
      Abstract: AimInserting a feeding tube using percutaneous endoscopic gastrostomy may be necessary to ensure that children with eating problems receive sufficient enteral nutrition. The aim of this study was to investigate the perioperative and postoperative complications of percutaneous endoscopic gastrostomy when the pull-through method was the standard procedure.MethodsThis was a retrospective review of 229 children (50.7% male) who underwent a gastrostomy procedure at Odense University Hospital, Denmark, from 1 January 2000 to 31 December 2012. The median age of the children was 1.6 years (range 0–14.9) and the follow-up period was 36 months. Complications were graded according to the Clavien-Dindo classification.ResultsA total of 167 postoperative complications occurred in 118 of the 229 patients (51.5%). Of these, 89 were grade 1 complications, 49 were grade 2 complications and 29 were grade 3b complications. No gastrostomy related deaths were observed and no single preoperative risk factor was identified. Perioperative complications were experienced by 2.6% of the patients.ConclusionGastrostomy feeding tube placement was associated with a high rate of postoperative complications of various grades when the pull-through method was the standard procedure. A consensus on how to report and grade complications arising from this procedure is warranted.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-04T02:51:11.681149-05:
      DOI: 10.1111/apa.13865
  • Cluster randomised controlled trial showed that maternal and child health
           handbook was effective for child cognitive development in Mongolia
    • Authors: Amarjargal Dagvadorj; Takeo Nakayama, Eisuke Inoue, Narantuya Sumya, Rintaro Mori
      Abstract: Child development delays can cause lower school performance, which in turn can lead to long-term poverty, developmental delays in offspring and a vicious cycle of loss of human potential (1). Effective prevention strategies are vital. It is well known that effective early child development programmes should integrate health and education with family support, programme, but coverage is often low (1). Cost-effective, high-quality programmes should therefore be considered. The Japanese Maternal and Child Health (MCH) handbook has been shown to provide cost-effective, high-level coverage that assists child development (2).This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-04T02:51:03.967279-05:
      DOI: 10.1111/apa.13864
  • Letter to the Editor regarding the article ‘Introducing High-flow nasal
           cannula to the neonatal transport environment’
    • Authors: Andrew Brunton; Joyce O'Shea
      Abstract: We read with interest the above article by Boyle et al (1) regarding the use of High-flow nasal cannula oxygen during neonatal transport. We would like to congratulate the authors for a valuable article, and wish to add our experiences.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-04T02:40:32.886432-05:
      DOI: 10.1111/apa.13863
  • Biventricular function on Early Echocardiograms in Neonatal
           Hypoxic-ischemic Encephalopathy
    • Authors: Sanjeev Aggarwal; Girija Natarajan
      Abstract: AimTo compare early (
      PubDate: 2017-04-04T02:31:07.751767-05:
      DOI: 10.1111/apa.13866
  • Using the table in the Swedish review on shaken baby syndrome will not
           help courts deliver justice
    • Authors: Robert A.C. Bilo; Sibylle Banaschak, Bernd Herrmann, Wouter A. Karst, Bela Kubat, Hubert G.T. Nijs, Rick R. van Rijn, Jan Sperhake, Arne Stray-Pedersen
      Abstract: The paper by Lynøe et al (1) summarises a systematic review carried out by the Swedish Agency for Health Technology Assessment (2), including the conclusion that there was insufficient evidence to assess the diagnostic accuracy of the triad in identifying traumatic shaking. Concerns regarding the methodological weaknesses of the Agency's report have been highlighted by a number of commentators, including one of our co-authors (AS-P) (3). This Different View draws attention to what Lynøe et al stated about possible alternative explanations of the triad, based on Appendix 1 of the Agency report (2) (Table 1), which is cited in the Lynøe et al paper (1).This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-03T22:35:24.294564-05:
      DOI: 10.1111/apa.13857
  • Preventing extubation failure in preterm infants: nasal CPAP remains the
           standard of care
    • Authors: Laurie G. Sherlock; Clyde J. Wright
      PubDate: 2017-04-02T22:40:23.993151-05:
      DOI: 10.1111/apa.13814
  • Lynöe et al–#theRestoftheStory
    • Authors: Sandeep K Narang; Christopher S Greeley
      Abstract: Lynöe et al is an adjunct to a larger report by the Swedish Agency For Health Technology Assessment And Assessment Of Social Services (“SBU”) entitled “Traumatic shaking – The role of the triad in medical investigations of suspected traumatic shaking” (1). Lynoe et al purports to rigorously, objectively, and transparently examine the evidence-based medical literature on Shaken Baby Syndrome (SBS) under well-established guidelines of systematic reviews (2). And, having done so, it concludes that there is “very low” scientific evidence supporting the premise that the “triad” implies that an infant has been violently shaken, and “low” scientific evidence supporting the assumption that shaking an infant causes the triad.”(3)This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-01T03:10:26.987985-05:
      DOI: 10.1111/apa.13858
  • Velocity vector imaging shows normal cardiac systolic function in
           survivors of severe bronchopulmonary dysplasia at 6-16 years of age
    • Authors: Piia Suursalmi; Tiina Ojala, Tuija Poutanen, Anneli Eerola, Päivi Korhonen, Tarja Kopeli, Outi Tammela
      Abstract: AimThis study evaluated global myocardial function and associations between cardiac function and lung function in very low birth weight (VLBW) children, with and without severe radiographic bronchopulmonary dysplasia (BPD), at 6-14 years of age.MethodsWe studied 34 VLBW and 19 term-born controls and the VLBW group was further divided into a BPD group with severe radiographic BPD and those without radiographic BPD in infancy. Detailed right and left ventricular myocardial function was analysed by velocity vector imaging and the left ventricular mass was calculated. The associations between cardiac function and lung function were assessed by impulse oscillometry.ResultsThe right and left ventricular myocardial systolic functions and the left ventricular mass were similar in the three groups. Lung function was not associated with cardiac systolic function. Neonatal exposure to dexamethasone treatment was negatively associated with right ventricular function, as measured by the automated fractional area change, with an odds ratio of 7.9 and 95% confidence interval of 1.9 -33.5 (p = 0.005).ConclusionLung function measurements were not associated with cardiac systolic function in preterm infants at 6-14 years of age. Neonatal exposure to dexamethasone, used for weaning from the ventilator, was negatively associated with right ventricular function.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-31T18:30:31.492036-05:
      DOI: 10.1111/apa.13860
  • Sports activities in preschool children differed between those born to
           immigrants and native Italians
    • Authors: Luciana Zaccagni; Stefania Toselli, Francesca Celenza, Augusta Albertini, Emanuela Gualdi-Russo
      Abstract: AimDespite the health benefits of physical activity in early childhood, little is known about sports practices in preschool children with different ethnic origins. The aim of this study was to investigate the sport activity patterns in native and immigrant children in northern Italy. The influence of some child and family determinants on the child's practice of club-organised sport was analysed to plan interventions.MethodsThe study group comprised 2,682 preschool children (49.5% girls) aged 5.9±0.3, 2,396 fathers and 2,478 mothers. All the children had their height and weight measured and their parents completed a self-administered questionnaire on their child's sports participation and family characteristics.ResultsSports activities were significantly more frequent in native Italian girls than in native Italian boys and immigrant girls. Multiple linear regression analysis showed that the weekly amount of club-organised sport in preschool children was related to the sex and migrant status in the whole sample, to paternal educational level and occupation in the native-born sample and to paternal body mass index, offspring and paternal occupation in the immigrant group.ConclusionThis study highlighted the need to develop specific interventions for native and immigrant preschool children to promote a healthy lifestyle.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-31T18:30:30.315852-05:
      DOI: 10.1111/apa.13862
  • Simulation-based team training improved the self-assessed ability of
           physicians, nurses and midwives to perform neonatal resuscitation
    • Authors: B Malmström; E Nohlert, U Ewald, M Widarsson
      Abstract: AimThe use of simulation-based team training in neonatal resuscitation has increased in Sweden during the last decade, but no formal evaluation of this training method has been performed. This study evaluated the effect of simulation-based team training on the self-assessed ability of personnel to perform neonatal resuscitation.MethodsWe evaluated a full-day simulation-based team training course in neonatal resuscitation, by administering a questionnaire to 110 physicians, nurses and midwives before and after the training period. The questionnaire focused on four important domains: communication, leadership, confidence and technical skills. The study was carried out in Sweden from 2005-2007.ResultsThe response rate was 84%. Improvements in the participants′ self-assessed ability to perform neonatal resuscitation were seen in all four domains after training (p < 0.001). Professionally inexperienced personnel showed a significant improvement in the technical skills domain compared to experienced personnel (p = 0.001). No differences were seen between professions or time since training in any of the four domains. Personnel with less previous experience with neonatal resuscitation showed improved confidence (p = 0.007) and technical skills (p = 0.003).ConclusionA full-day course on simulation-based team training with video-supported debriefing improved the participants’ self-assessed ability to perform neonatal resuscitation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-31T18:30:23.119335-05:
      DOI: 10.1111/apa.13861
  • Using a standardised protocol was effective in reducing hospitalisation
           and treatment use in children with newly diagnosed immune thrombocytopenia
    • Authors: R Labrosse; M Vincent, U-P Nguyen, C Chartrand, L Di Liddo, Y Pastore
      Abstract: AimChildhood immune thrombocytopenia (ITP) has been associated with low bleeding rates and a high frequency of spontaneous remission. Although current guidelines suggest that most patients are just observed, children still receive platelet-enhancing therapy for fear of bleeding complications. We hypothesised that a standardised protocol with a step-down approach would reduce hospitalisation and treatment use.MethodA retrospective chart review was performed on patients diagnosed with acute ITP between January 2010 and December 2014, before (n=54) and after (n=37) the standardised protocol was introduced in January 2013. Management and events during the first three months following diagnosis were recorded.ResultsThe protocol resulted in a 34% decrease in the hospitalisation rate (p
      PubDate: 2017-03-31T18:25:34.372716-05:
      DOI: 10.1111/apa.13859
  • Determining normal values of urinary phosphorus excretion in 3,913 healthy
           children aged 2-18 to aid early diagnosis and treatment for urolithiasis
    • Authors: Katarzyna Taranta-Janusz; Łukasz Łabieniec, Tadeusz Porowski, Krzysztof Szymański, Halina Porowska, Anna Wasilewska
      Abstract: AimThis study determined the specific reference values for urinary phosphorus excretion in healthy children and adolescents aged 2-18 years and evaluated whether they changed with age during growth and were gender dependent.MethodsWe enrolled 3,913 healthy children and adolescents aged 2-18 years to this study. The study population was divided into age groups and the analysis was performed in one-year periods, separately for boys and girls. Urinary phosphorus excretion was analysed using four categories: P1 in mmol/24 hour units, P2 in mmol/kg/24 hours, P3 in mmol/1.73m2/24 hours and P4 in mmol/mmol creatinine.ResultsClear differences in urinary exertion for girls and boys were observed as well as systematic changes with age. The boys presented with significantly higher daily urinary phosphorus excretion independent of its manner of expression (p
      PubDate: 2017-03-31T18:20:36.71798-05:0
      DOI: 10.1111/apa.13856
  • The clinical spectrum of celiac disease: beyond autoimmunity
    • Authors: Valentina Discepolo; Riccardo Troncone
      Abstract: A large cross-sectional study by Assa et al in this issue of Acta Paediatrica (1) investigated the prevalence of celiac disease (CD) co-morbidities and related symptoms in a cohort of late adolescents. It confirmed an increased prevalence of autoimmune disorders and other inflammatory conditions and also revealed new associations.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-31T18:20:32.808181-05:
      DOI: 10.1111/apa.13855
  • Interventions to Reduce Neonatal Mortality: A Mathematical Model to
           Evaluate Impact of Interventions in sub-Saharan Africa
    • Authors: Jennifer B Griffin; Elizabeth M McClure, Beena Kamath-Rayne, Bonnie Hepler, Doris Rouse, Alan H. Jobe, Robert L Goldenberg
      Abstract: AimTo determine which interventions would have the greatest impact on reducing neonatal mortality in sub-Saharan Africa in 2012.MethodsWe used MANDATE, a mathematical model, to evaluate scenarios for the impact of available interventions on neonatal deaths from primary causes, including: 1) for birth asphyxia -NDASH- obstetric care preventing intrapartum asphyxia, newborn resuscitation, and treatment of asphyxiated infants; 2) for preterm birth -NDASH- corticosteroids, oxygen, continuous positive air pressure, and surfactant; and, 3) for serious newborn infection -NDASH- clean delivery, chlorhexidine cord care, and antibiotics.ResultsReductions in infection-related mortality have occurred. Between 80 and 90% of deaths currently occurring from infections and asphyxia can be averted from available interventions, as can 58% of mortality from preterm birth. More than 200,000 neonatal deaths can each be averted from asphyxia, preterm birth, and infections. Using available interventions, more than 80% of the neonatal deaths occurring today could be prevented in sub-Saharan Africa.ConclusionReducing neonatal deaths from asphyxia require improvements in infrastructure and obstetric care to manage maternal conditions such as obstructed labor and preeclampsia. Reducing deaths from preterm birth would also necessitate improved infrastructure and training for preterm infant care. Reducing infection-related mortality requires less infrastructure and lower-level providers.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-31T18:10:37.286225-05:
      DOI: 10.1111/apa.13853
  • The flexion withdrawal reflex increases in premature infants at 22-26
           weeks of gestation due to changes in spinal cord excitability
    • Authors: Kyriakos Martakis; Christoph Hünseler, Peter Herkenrath, Kruthika Thangavelu, Angela Kribs, Bernhard Roth
      Abstract: AimOur aim was to study the development of the cutaneous flexion withdrawal reflex among premature infants admitted to the neonatal intensive care unit of the Children's Hospital, University of Cologne, in 2013.MethodologyThis longitudinal cohort study explored the development of spinal cord excitability of 19 premature infants born at 22-26 weeks of gestation. We performed five investigations per subject and studied changes in the reflex threshold with increasing postnatal age at different behavioural states. The premature infants were stimulated with von-Frey-filaments on the plantar surface of the foot near the first metatarsophalangeal joint during the first three days of life and at postnatal ages of 10-14 days, 21-28 days, 49- 59 days and a corrected gestational age of 37-40 weeks.ResultsThe mean gestational age of the premature infants included in the study was 24 weeks. Premature infants with a gestational age of less than 26 weeks presented a flexion withdrawal reflex with a low threshold (0.5 - 2.85 milli-Newton) in the first 72 hours of life.ConclusionThe flexion withdrawal reflex among premature infants born at less than 26 weeks showed a continuous threshold increase with increasing postnatal age, reflecting changes in spinal cord excitability.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-31T18:10:35.057881-05:
      DOI: 10.1111/apa.13854
  • Population-based study showed that necrotising enterocolitis occurred in
           space-time clusters with a decreasing secular trend in Sweden
    • Authors: Amanda Magnusson; Margareta Ahle, Diana Swolin-Eide, Anders Elfvin, Roland E. Andersson
      Abstract: AimThis study investigated space-time clustering of neonatal necrotising enterocolitis over three decades.MethodsSpace-time clustering analyses objects that are grouped by a specific place and time. The Knox test and Kulldorff's scan statistic were used to analyse space-time clusters in 808 children diagnosed with necrotising enterocolitis in a national cohort of 2,389,681 children born between 1987-2009 in Sweden. The municipality the mother lived in and the delivery hospital defined closeness in space and the time between when the cases were born - seven, 14 and 21 days - defined closeness in time.ResultsThe Knox test showed no indication of space-time clustering at the residential level, but clear indications at the hospital level in all the time windows: seven days (p=0.026), 14 days (p=0.010) and 21 days (p=0.004). Significant clustering at the hospital level was found from 1987-1997, but not 1998-2009. Kulldorff's scan statistic found seven significant clusters at the hospital level.ConclusionSpace-time clustering was found at the hospital but not residential level, suggesting a contagious environmental effect after delivery, but not in the prenatal period. The decrease in clustering over time may reflect improved routines to minimise the risk of contagion between patients receiving neonatal care.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-27T20:50:20.975329-05:
      DOI: 10.1111/apa.13851
  • Ultrasound is an effective and non-invasive method of evaluating renal
           swelling in infants with their first urinary tract infection
    • Authors: Y Simrén; E Stokland, K M Lagerstrand, S Valdimarsson, S Hansson
      Abstract: AimThis study evaluated renal swelling in infants with a first urinary tract infection (UTI) by correlating renal length and volume to C-reactive protein (CRP) and body temperature.MethodsUltrasounds were carried out on 104 infants at the Queen Silvia Children's Hospital, Gothenburg, Sweden – 58 boys (mean age 3.3 months) and 46 girls (mean age 4.8 months) – during the acute phase of their UTI. A second scan was performed on 94 of them four weeks later. Renal length and volume were computed to standard deviation scores (SDS).ResultsThe mean renal length and volume at the first ultrasound were 1.90 SDS (±1.54) and 1.67 SDS (±1.13) for the larger kidney and 0.86 SDS (±1.01) and 0.84 SDS (±0.90) for the smaller kidney. There was a significant decrease in renal length and volume between the two ultrasounds, with a mean difference of 0.96 SDS (±1.24) and 1.07 SDS (±1.10) for the larger kidney (p
      PubDate: 2017-03-27T20:35:34.277858-05:
      DOI: 10.1111/apa.13849
  • Cerebral oxygenation as measured by Near-Infrared Spectroscopy in neonatal
           intensive care: correlation with arterial oxygenation
    • Authors: Carol Lu Hunter; Ju Lee Oei, Kei Lui, Timothy Schindler
      Abstract: AimTo assess correlation between cerebral oxygenation (rScO2), as measured by near-infrared spectroscopy (NIRS), and arterial oxygenation (PaO2), as measured by arterial blood gases, in preterm neonates.MethodsPreterm neonates
      PubDate: 2017-03-27T20:35:23.957728-05:
      DOI: 10.1111/apa.13848
  • Rigid catheters reduced duration of less invasive surfactant therapy
           procedures in manikins
    • Authors: V. Rigo; C. Debauche, P. Maton, I. Broux, D. Van Laere
      Abstract: AimDifferent catheters can be used for less invasive surfactant therapy (LIST): feeding tubes inserted with or without Magill forceps, different angiocatheters and centre specific devices, such as umbilical catheters affixed to a stylet. This study compared the effectiveness of LIST devices and endotracheal tubes (ETT).MethodsVideo recordings of 20 neonatologists simulating different LIST techniques on two manikin heads were analysed. Procedural effectiveness was evaluated by the duration of procedures and failure rates. Ease of use was scored.ResultsThe median procedure time for the Neonatal Intubation Trainer was significantly longer with feeding tubes without Maggil forceps. For the more difficult ALS Baby Trainer, successful procedures lasted a median of 24 (17-32) seconds with ETT, 24 (15-36) seconds with stylet-guided catheters and 34 (27-46) seconds and 37 (29-42) seconds with 13cm and 30cm angiocatheters, respectively. Both methods using feeding tubes were statistically slower than ETT intubation, lasting 32 (25-44) seconds and 39 (27-95) seconds with or without Maggil forceps. Failure rates (7-20%) were no different between the LIST methods. Techniques using feeding tubes were rated as more difficult.ConclusionOnly rigid or stylet-guided catheters required tracheal catheterisation times similar to those of endotracheal intubation and neonatologists found them easier.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-27T20:35:20.776628-05:
      DOI: 10.1111/apa.13850
  • Eliminating cows’ milk, but not wheat, barley or rye, increases the risk
           of growth deceleration and nutritional inadequacies
    • Authors: Jetta Tuokkola; Päivi Luukkainen, Jaakko Nevalainen, Suvi Ahonen, Jorma Toppari, Jorma Ilonen, Riitta Veijola, Mikael Knip, Suvi M Virtanen, Minna Kaila
      Abstract: AimOur study examined the growth and nutritional intake of children on milk and, or, wheat, barley or rye elimination diets.MethodsThis was a nested case-control study within the Finnish Type 1 Diabetes Prediction and Prevention Study. It investigated 295 children born in the Tampere University Hospital area between 1997-2004 on a diet without cows’ milk and, or, wheat, barley or rye due to food allergies and 265 matched controls. Nutritional intake was recorded with three-day food records at the ages of one, two and three years. Serial growth measurements were recorded annually up to the age of five years.ResultsDespite consuming a balanced diet with sufficient energy and protein, the children on milk elimination diets grew slower than the control children (p=0.009). Wheat, barley or rye elimination was not associated with growth. The intakes of protein and calcium were lower in children in the milk elimination group than the controls, at p < 0.05 for all. However, children on elimination diets consumed less saturated fats and sugar and more vitamin C and iron than the control children.ConclusionChildren on elimination diets faced an increased risk of growth deceleration and suboptimal intake of several micronutrients.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-27T02:56:02.331819-05:
      DOI: 10.1111/apa.13846
  • Population-based study shows that teenage girls with asthma had impaired
           health-related quality of life
    • Authors: Linnea Hedman; Caroline Stridsman, Martin Andersson, Helena Backman, Sven-Arne Jansson, Eva Rönmark
      Abstract: AimThis study examined the health-related quality of life (HRQoL) of teenagers with and without asthma, including the impact of their sex, allergic conditions, smoking, living conditions and physical activity.MethodsThe Obstructive Lung Disease in Northern Sweden (OLIN) studies recruited a cohort of schoolchildren in 2006. The parents of all children aged 7-8 years in three municipalities were invited to complete a questionnaire and 2,585 (96%) participated. The cohort was followed up at the ages of 11-12 years and 14-15 years with high participation rates. At 14-15 years, the HRQoL questionnaire KIDSCREEN-10 and Asthma Control Test were added.ResultsGirls with current asthma at 14-15 years had a lower mean HRQoL score than girls without asthma (46.4 versus 49.3, p
      PubDate: 2017-03-27T02:35:33.499826-05:
      DOI: 10.1111/apa.13847
  • The new Swedish report on Shaken Baby Syndrome is misleading
    • Authors: Kerstin Hellgren; Ann Hellström, Anna-Lena Hård, Lena Jacobson, Ulrika Lidén, Stefan Löfgren, Kristina Teär Fahnehjelm, Jan Ygge
      Abstract: In this issue of Acta Paediatrica, Professor Alex Levin, Director of the Pediatric Ophthalmology and Strabismus Service at Wills Eye Hospital, (PA, USA), expresses relevant concerns (1) about a report produced by the Swedish Agency for Technology Assessment of Health and Social Services (SBU) (2) and summarized in a paper by Lynøe et al (3). He also provides necessary input on the importance of the morphology and distribution of retinal hemorrhages in diagnosing different causes of retinal bleedings.SBU undertakes independent assessments of methods used in health, medical, dental and social services and services provided to persons with certain functional disabilities.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-27T02:10:33.282775-05:
      DOI: 10.1111/apa.13845
  • Randomised controlled trial demonstrates that fermented infant formula
           with short-chain galacto-oligosaccharides and long-chain
           fructo-oligosaccharides reduces the incidence of infantile colic
    • Authors: Yvan Vandenplas; Thomas Ludwig, Hetty Bouritius, Philippe Alliet, Derek Forde, Stefaan Peeters, Frederic Huet, Jonathan Hourihane
      Abstract: AimWe examined the effects on gastrointestinal tolerance of a novel infant formula that combined specific fermented formula (FERM) with short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides (scGOS/lcFOS), with a 9:1 ratio and concentration of 0.8g/100ml.MethodsThis prospective, double-blind, randomised, controlled trial comprised 432 healthy, term infants aged 0-28 days whose parents decided to not start, or discontinued,, breastfeeding. Infant formula with scGOS/lcFOS+50%FERM, scGOS/lcFOS+15%FERM, 50%FERM and scGOS/lcFOS were tested. Parents completed standardised seven-day diaries on gastrointestinal symptoms, crying, sleeping and stool characteristics each month until the infants were 17 weeks.ResultsAll the formulas were well tolerated. At four weeks, the overall incidence of infantile colic was significantly lower (8%) with scGOS/lcFOS+50%FERM than scGOS/lcFOS (20%, p=0.034) or 50%FERM (20%, p=0.036). Longitudinal modelling showed that scGOS/lcFOS+50%FERM fed infants also displayed a persistently lower daily crying duration. and showed a consistent stool softening effect than infants who received formula without scGOS/lcFOS.ConclusionThe combination of fermented formula with scGOS/lcFOS was well tolerated and showed a lower overall crying time, a lower incidence of infantile colic and a stool softening effect in healthy term infants. These findings suggest for the first time that a specific infant formula has a preventive effect on infantile colic in formula fed infantsThis article is protected by copyright. All rights reserved.
      PubDate: 2017-03-22T10:11:56.607039-05:
      DOI: 10.1111/apa.13844
  • Neurophysiological Assessment of Acute Pain in Infants: A Scoping Review
           of Research Methods
    • Authors: B Benoit; R Martin-Misener, A Newman, M Latimer, M Campbell-Yeo
      Abstract: A systematic scoping search to describe the neurophysiological methods used in infant acute pain assessment research was conducted. Of the 2411 abstracts screened, 19 articles were retained. Nine studies utilized near infrared spectroscopy (NIRS), two utilized functional magnetic resonance imaging (fMRI), and eight utilized electroencephalography (EEG). There was methodological variability in studies utilizing NIRS, whereas EEG and fMRI studies reported consistent methods. Of the eight EEG studies, six identified a nociceptive specific event-related potential. Conclusion: While more methodologically rigorous studies are needed, ERPs appear to hold some promise as indicators of infant nociception during clinical procedures to supplement existing measures.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-22T02:22:19.051439-05:
      DOI: 10.1111/apa.13839
  • Heart rate variability can be used to evaluate wellbeing in preterm
    • Authors: K. Kaar; J. Brandner, B. Minnich, J. Hilberath, C. Weisser, M. Wald
      Abstract: Preterm infants are exposed to various potentially stressful procedures during intensive care, which have been shown to compromise development. We explored the potential stress caused by echocardiograph and the correlation between the duration of the investigation and the amplitude of the alteration. The usefulness of the Newborn Infant Parasympathetic Evaluation (NIPE) monitor (Mdoloris Medical Systems, Loos, France) for assessing acute distress during daily routines, based on heart rate variability, was also investigated.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-21T02:20:56.934734-05:
      DOI: 10.1111/apa.13843
  • The coming of age of a young subspecialty: paediatric hepatology
    • Authors: Antal Németh
      Abstract: Paediatric hepatology dates from the 1970s and it is the youngest of the organ-specific subspecialties. Since then there have been impressive achievements in the fields of anatomical, metabolic, immunological and neoplastic diseases and the advent of modern molecular biology has resulted in a marked increase in exact diagnoses. Liver transplants provided enormous stimulus for the discipline. Due to changing morbidity patterns the discipline faces new challenges, such as environmental and lifestyle induced liver diseases, but different forms of chronic viral hepatitis are diminishing.ConclusionHigh levels of competence require good clinical research, optimal results and a high degree of centralisation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-21T02:05:32.2531-05:00
      DOI: 10.1111/apa.13842
  • The increasing consumption of unprescribed antibiotics by Greek preschool
           children amounts to unacceptable malpractice
    • Authors: Fotini Andritsou; Vassiliki Benetou, Koralia A. Michail, Nikolaos Pantazis, Ioanna D. Pavlopoulou
      Abstract: In Greece, the illegal dispensing of prescription-only medicines, including antibiotics, by pharmacies without the necessary medical prescription, remains standard practice (1,2). This has continued, despite the fact that the country has the highest rates of antibiotic consumption, both in hospitals and the community, as well as antibiotic resistance, compared to other European countries (3). The frequency of antibiotic administration without a prescription, and the factors associated with this practice, was evaluated in a sample of preschool children under the age of six years (range 10-65 months) in the Municipality of Athens, Greece.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-21T02:01:51.527921-05:
      DOI: 10.1111/apa.13841
  • Therapeutic options for dysfunctional breathing in children and
    • Authors: Bodo Niggemann; Christine Lehmann, Dorothea Pfeiffer-Kascha, Christa Weiss
      Abstract: Dysfunctional breathing is common and represents important differential diagnoses for respiratory discomfort. Typical examples include habit cough, sighing dyspnoea, hyperventilation syndrome, dysfunctional breathing patterns or vocal cord dysfunction (1,2). Comorbidities are frequent, especially with bronchial asthma. In some cases dysfunctional breathing may be a sequelae of child neglect or abuse.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-17T17:55:55.404942-05:
      DOI: 10.1111/apa.13838
  • Hypoxaemia and septic shock were independent risk factors for mechanical
           ventilation in Bangladeshi children hospitalised for diarrhoea
    • Authors: Mohammod Jobayer Chisti; KM Shahunja, Farzana Afroze, Abu SMSB Shahid, Sharifuzzaman, Tahmeed Ahmed
      Abstract: AimIn Bangladesh approximately 6% of children under five years of age die due to diarrhoea. We evaluated the admission and hospitalisation risk factors for mechanical ventilation and outcomes in children with diarrhoea.MethodsThis retrospective case-control chart analysis was conducted in the intensive care unit of Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh. We enrolled 219 children with diarrhoea aged 0–59 months between August 2009 and July 2013. The 73 cases were children who were initially identified as requiring mechanical ventilation during the study period and the 146 controls were randomly selected from those who did not require mechanical ventilation. We compared the groups to determine the risk factors for mechanical ventilation.ResultsMortality was significantly higher among the cases than the controls (p
      PubDate: 2017-03-17T17:55:51.84306-05:0
      DOI: 10.1111/apa.13836
  • Late preterm birth has direct and indirect effects on infant gut
           microbiota development during the first six months of life
    • Authors: M Forsgren; E Isolauri, S Salminen, S Rautava
      Abstract: AimPreterm infants display aberrant gut microbial colonisation. We investigated whether the differences in gut microbiota between late preterm and full-term infants results from prematurity or external exposures.MethodsThis study comprised 43 late preterm infants (340/7 – 366/7) and 75 full-term infants based on faecal samples collected following birth and at two to four weeks and six months of age. We assessed clinically relevant bacteria using quantitative polymerase chain reaction. Logistic regression analyses were performed to determine whether the observed differences in gut microbiota were attributable to prematurity or perinatal exposure.ResultsThe prevalence of bifidobacteria differed in the intestinal microbiota of the full-term and late preterm neonates’. Differences in the presence of specific species were detected at the age of six months, although the microbiota alterations were most prominent following delivery. As well as prematurity, the mode of birth, intrapartum and neonatal antibiotic exposure, and the duration of breastfeeding had an additional impact on gut microbiota development.ConclusionThe gut microbiota composition was significantly different between late preterm and full-term infants at least six months after birth. Antibiotic exposure was common in late preterm infants and modulated gut colonisation, but preterm birth also affected gut microbiota development independently.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-17T17:55:48.692737-05:
      DOI: 10.1111/apa.13837
  • Improved postnatal care is needed to maintain gains in neonatal survival
           after the implementation of the Helping Babies Breathe initiative
    • Authors: J Wrammert; A KC, U Ewald, M Målqvist
      Abstract: AimHelping Babies Breathe (HBB) is a neonatal resuscitation protocol proven to reduce intrapartum-related mortality in low-income settings. The aim of this study was to describe the timing and causes of neonatal in-hospital deaths before and after HBB training at a maternity health facility in Nepal.MethodsA prospective cohort study was conducted at the facility between July 2012 and September 2013. All 137 staff, including medical doctors and midwives, were trained in January 2013. The causes of 299 neonatal deaths and the day of death, up to 27 days, were collected before and after the training course.ResultsDeaths caused by intrapartum-related complications were reduced from 51% to 33%. Preterm infants survived for more days (p
      PubDate: 2017-03-17T17:50:44.98977-05:0
      DOI: 10.1111/apa.13835
  • The SBU Report: A Different View
    • Authors: Alex V. Levin
      Abstract: The paper by Lynøe and coworkers(1) is a summary of the previously published SBU report of 2016 (2) in which the authors correctly state, “The injuries in question in situations in which traumatic shaking is suspected may be serious in nature, both in acute terms and also in the longer term. The injuries may be life-threatening, or entail a risk of permanent consequences in terms of the child's development, health and future quality of life.”This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-16T09:05:38.684137-05:
      DOI: 10.1111/apa.13834
  • Authorised access web portal for Italiandata bank on sudden unexpected
           perinatal and infant death
    • Authors: Giulia Ottaviani; Paolo Perlasca, Marco Mesiti, Luca Ferrari, Anna M. Lavezzi
      Abstract: Sudden infant death syndrome (SIDS) is common during the first year of life and affects 0.40every 1,000 births (1). Stillbirths are seven times more common than SIDS; in 40–80% of cases remain unexplained and are categorised as sudden intrauterine unexpected death syndrome (2).In 2006 Italy passed legislation that fetuses, and infants, from 25 weeks of gestation to one postnatal year, that died suddenly and unexpectedly should be sent to the University of Milan, Italy, for an in-depth diagnostic post-mortem with parental permission (3).This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-15T03:21:08.461554-05:
      DOI: 10.1111/apa.13833
  • Auditory impairment in infants with neonatal chronic lung disease is
           alleviated after term
    • Authors: Ze D. Jiang
      Abstract: AimVery premature infants with neonatal chronic lung disease (CLD) have been reported to have major auditory impairment at term and we examined the outcomes in 30 infants after term age.MethodsBrainstem auditory evoked response (BAER) was recorded at a postconceptional age of 46-61 weeks in 13 CLD cases and 14 controls from China and 17 CLD cases and 22 controls from the UK.ResultsThe BAER threshold in the CLD infants was slightly higher. Clicks at the normal hearing level (60 dB) showed no significant differences between the cases and controls in the latencies of BAER waves I, III and V and the I-V interval. However, the CLD infants demonstrated marginal shortening in the I-III interval and a marginal increase in the III-V interval. The amplitudes of BAER waves in the CLD infants were all slightly smaller than the controls. At 70 and 40 dB normal hearing level, the BAER findings were similar to those obtained at 60 dB normal hearing level, with only small variations.ConclusionThere were minor BAER abnormalities in the CLD infants, suggesting minor auditory impairment. The auditory impairment previously detected at the term date was later alleviated.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-12T05:45:58.643116-05:
      DOI: 10.1111/apa.13831
  • Systematic review of non-pharmacological analgesic interventions for
           common needle-related procedure in newborn infants and development of
           evidence-based clinical guidelines
    • Authors: P. Lago; E. Garetti, C.V. Bellieni, D. Merazzi, P. Savant Levet, G. Ancora, A. Pirelli,
      Abstract: The aim of this literature review was to develop clinical guidelines for the prevention and control of needle-related pain in newborn infants. The guidelines were developed by the Italian Society of Neonatology, using the Grading of Recommendations, Assessment, Development and Evaluation approach, based on the assessment of 232 papers published between 1986 and 2015. The quality of the evidence was high or moderate for some behavioural and non-pharmacological interventions.ConclusionThere was sufficient evidence to strongly support the use of non-pharmacological interventions for common needle-related procedures in newborn infants. Combined interventions seemed to be more effective in relieving procedural pain.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-12T04:25:26.982683-05:
      DOI: 10.1111/apa.13827
  • Child survival revolutions revisited. Lessons learned from Bangladesh,
           Nicaragua, Rwanda and Vietnam
    • Authors: Lars Åke Persson; Anisur Rahman, Rodolfo Peña, Wilton Perez, Aimable Musafili, Dinh Phuong Hoa
      Abstract: Analysing child mortality may enhance our perspective on global achievements in child survival. We used data from surveillance sites in Bangladesh, Nicaragua and Vietnam and Demographic Health Surveys in Rwanda to explore the development of neonatal and under-five mortality. The mortality curves showed dramatic reductions over time, but child mortality in the four countries peaked during wars and catastrophes and was rapidly reduced by targeted interventions, multi-sectorial development efforts and community engagementConclusionLessons learned from these countries may be useful when tackling future challenges, including persistent neonatal deaths, survival inequalities and the consequences of climate change and migration.This article is protected by copyright. All rights reserved
      PubDate: 2017-03-12T03:25:25.053265-05:
      DOI: 10.1111/apa.13830
  • Higher growth, fat and fat-free masses correlate with larger cerebellar
           volumes in preterm infants at term
    • Authors: Giulia Paviotti; Angela De Cunto, Floriana Zennaro, Giulia Boz, Laura Travan, Gabriele Cont, Jenny Bua, Sergio Demarini
      Abstract: AimSmaller cerebellar volumes in very low birth weight (VLBW) infants at term have been related to adverse cognitive outcomes and this study evaluated whether these volumes were associated with a growth in body composition during hospital stays.MethodsWe prospectively recruited 42 VLBW infants from an Italian neonatal unit between January 2013 and August 2015. Cerebellar volumes and body composition were measured by magnetic resonance imaging (MRI) and air-displacement plethysmography, respectively, at 40 weeks of gestational age and anthropometric and nutritional data were collected. We also included 20 term-born controls.ResultsThe mean gestational age and birth weight of the VLBW infants were 29.4 (±1.9) weeks and 1,120 (±290) grams. There was a positive correlation between cerebellar volumes and daily weight gain from birth to term (R2=0.26, p=0.001), weight (R2=0.25, p=0.001), length (R2=0.16, p=0.01), fat mass (R2=0.15, p=0.01) and fat-free mass at term (R2=0.20, p=0.003). In multiple regression analysis, daily weight gain, mechanical ventilation and postconceptional age at MRI were independently associated with cerebellar volumes. Anthropometric data and cerebellar volumes were similar between VLBW and control infantsConclusionHigher growth, higher fat mass and fat-free mass were associated with larger cerebellar volumes in VLBW infants at term.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-12T03:20:24.758742-05:
      DOI: 10.1111/apa.13829
  • Practitioner perceptions of the anesthetic needs for magnetic resonance
           imaging in pediatric patients
    • Authors: Glenn E Mann; Adam Canter, Singh Nair, Donna LaMonica, Madelyn Kahana, Jennifer Yoo, Ellise Delphin
      Abstract: There is currently an increasing use of magnetic resonance imaging (MRI) as a diagnostic tool in the pediatric population(1). MRI is often viewed as an ideal diagnostic modality because it does not require exposure to ionizing radiation, provides superior soft tissue image quality compared with computed tomography (CT) and is thus well-suited for neurological, musculoskeletal, cardiac, thoracic, and abdominal studies(2). However, MRIs require patient cooperation and extended time periods of immobility, as the studies are often long, loud, and may induce claustrophobia (2-7).This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-12T03:15:25.423937-05:
      DOI: 10.1111/apa.13828
  • Probiotics and antimicrobial protein and peptide levels in preterm infants
    • Authors: Tobias Strunk; Julie Hibbert, Dorota Doherty, Caitlyn Granland, Stephanie Trend, Karen Simmer, David Burgner, Sanjay Patole, Andrew Currie
      Abstract: AimTo characterise the secreted and inducible antimicrobial protein and peptide (APP) levels in a prospective cohort of preterm infants (
      PubDate: 2017-03-12T03:05:31.958312-05:
      DOI: 10.1111/apa.13826
  • Child mental health behaviours that predicted the use of health services
           in Wales from 2011-2014
    • Authors: Ivy Shiue
      Abstract: In 2014 Basa et al (1) reported an alarming increase in paediatric mental disorders in North Wales from 1994-2008 (1). The aim of this study was to investigate the association between mental health and health service use in children, using the annual Welsh Health Survey, and update the evidence.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-12T03:00:22.785734-05:
      DOI: 10.1111/apa.13823
  • The impact of Italian regionalisation on transporting neonatal patients
           back from the neonatal intensive care unit to the referring level two unit
    • Authors: Carlo Bellini; Luca A. Ramenghi
      Abstract: Perinatal regionalisation networks aim to centralise highly skilled care for high-risk neonates and their mothers (1). This study examined how the regional policy in Liguria, Italy, had changed the management of very low birth weight preterm infants. We were particularly keen to look at the impact on back transports, namely transferring patients back to a Level II unit once they did not need to be in the neonatal intensive care unit (NICU) at the IRCCS Istituto Giannina Gaslini, Genoa, Italy.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-10T17:50:32.070911-05:
      DOI: 10.1111/apa.13821
  • Children aged two to four are able to scribble and draw using a smart
           phone app
    • Authors: Savita Yadav; Pinaki Chakraborty
      Abstract: AimDrawing apps are an attractive medium and this study assessed the fluency and skills with which children aged two to four drew using an app on a smart phone.MethodsWe provided 90 children between two and four years of age with a drawing app at a playschool in an upper-class suburb in New Delhi in November 2016. The app allowed them to draw by sliding their finger on the screen and selecting the drawing colour from a palette. The children were given five minutes to draw with the app.ResultsAll the children were able to draw with the app. The children aged two and three were in the scribbling stage. The children aged two typically drew zigzag lines with a single colour, while the children aged three were able to draw distinct lines and shapes with multiple colours. The children aged four had moved from the scribbling stage to the preschematic stage. They drew multicoloured figures identifiable as real-world objects and were able to explain what they were drawing.ConclusionWe found that drawing apps were appropriate for young children aged two to four and may be used by them along with other drawing media.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-08T03:40:42.383121-05:
      DOI: 10.1111/apa.13818
  • Observation study identifies that a lack of canonical babbling can
           indicate future speech and language problems
    • Authors: A Lohmander; K Holm, S. Eriksson, M. Lieberman
      Abstract: AimWe investigated how accurate observations of canonical babbling were and explored predictive babbling measures in children with and without medical diagnoses of conditions that can lead to speech and language problems.MethodsFrom 2012-2014 this Stockholm-based study recruited 38 children aged 9-21 months with medical diagnoses and 30 children aged 10 months without diagnoses and included 21 previously studied 12-month-old children without medical diagnoses. Canonical babbling and consonant sound production were directly observed by video recording natural play with a caregiver. The percentage of canonical babbling was calculated from each recording and a validated observation form was used. How accurately the children with and without canonical babbling were classified was investigated with sensitivity and specificity. The groups were compared using predictive babbling variables.ResultsThe observation method identified children with and without canonical babbling well, with a specificity of 0.89 and sensitivity of 0.93, respectively. Children with predictive babbling measures were identified in the clinical group (specificity 0.93-0.97) and a lack of these measures indicated a risk of being in the clinical group (odds ratios> 10). The sensitivity was low (0.32-0.42).ConclusionObservation effectively identified a lack of canonical babbling and supported the importance of assessing babbling measures.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-08T03:05:38.617301-05:
      DOI: 10.1111/apa.13816
  • Neonatal somatosensory evoked potentials persist during hypothermia
    • Authors: Päivi Nevalainen; Leena Lauronen, Marjo Metsäranta, Tuula Lönnqvist, Eero Ahtola, Sampsa Vanhatalo
      Abstract: AimTreatment with therapeutic hypothermia has challenged the use of amplitude-integrated electroencephalography in predicting outcomes after perinatal asphyxia. In this study, we assessed the feasibility and gain of somatosensory evoked potentials (SEP) during hypothermia.MethodsThis retrospective study comprised neonates from 35+6 to 42+2 gestational weeks and treated for asphyxia or hypoxic-ischaemic encephalopathy at Helsinki University Hospital between 14 February 2007 and 23 December 2009. This period was partly before the introduction of routine therapeutic hypothermia, which enabled us to include normothermic neonates who would these days receive hypothermia treatment. We analysed SEPs from 47 asphyxiated neonates and compared the results between 23 normothermic and 24 hypothermic neonates.ResultsOur data showed that hypothermia led to SEP latencies lengthening by a few milliseconds, but the essential gain for predicting outcomes by SEPs was preserved during hypothermia. In the 24 hypothermic neonates, bilaterally absent SEPs were associated with poor outcome in 2/2 neonates, normal SEPs were associated with good outcomes in 13/15 neonates and 5/7 neonates with unilaterally absent or grossly delayed SEPs had a poor outcome.ConclusionOur findings indicated that SEPs were a reliable tool for evaluating the somatosensory system in asphyxiated neonates in both normothermic and hypothermic conditions.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-04T02:45:24.696756-05:
      DOI: 10.1111/apa.13813
  • A novel missense mutation Q495K of SLC26A3 gene identified in a Chinese
           child with congenital chloride-losing diarrhoea
    • Authors: Hongmei Guo; Bi-Xia Zheng, Yu Jin
      Abstract: A partially-breastfed male baby aged 11 months and 22 days was admitted as he had been passing loose stools since birth and had experienced occasional vomiting and failure to thrive. He passed watery stools 8-10 times per day, but there was no blood or mucous. The parents were healthy and their marriage was nonconsanguineous. The antenatal and birth history included polyhydramnios and premature delivery at 35 weeks of gestation. The baby's birthweight was 2.3kg (P23). He was hospitalised several times for persistent diarrhoea before coming to our hospital, but had no episodes of intestinal pseudo-obstruction. He always had to take medication, such as oral rehydration salts and Smectite.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-04T02:30:27.800332-05:
      DOI: 10.1111/apa.13811
  • Response to a letter to the editor
    • Authors: Rebecca F Slykerman; John Thompson, Karen E Waldie, Rinki Murphy, Clare Wall, Edwin A Mitchell
      Abstract: Renton and Low (1) are “unable to accept our conclusions” that there is an association between antibiotic use in the first year of life and subsequent neurocognitive outcomes in childhood due to “reservations about the methodology and confounding impact of socioeconomic status”.(2) We agree that socioeconomic status is an important confounder, as it may be associated both with the exposure (antibiotic use) and neurocognitive outcomes, however Renton and Low appear to have missed the fact that we did adjust for this factor. Socioeconomic status can be measured in different ways, most commonly using occupation, income or education, and it may vary with time.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-04T02:30:25.594721-05:
      DOI: 10.1111/apa.13809
  • The Multidisciplinary Fetal Center: Clinical Expertise is Only Part of the
    • Authors: Jennifer C. Kett; Elana Wolfe, Margaret M. Vernon, David Woodrum, Douglas Diekema
      Abstract: AimMultidisciplinary fetal centers have recently emerged in partnership with children's hospitals throughout the US. The aim of this investigation was to describe the patient experience of pregnant women who were referred to our fetal centers for the evaluation of fetal congenital anomalies.MethodsA qualitative interview study of women referred to our fetal centers was conducted using semi-structured telephone interviews. The data was coded and analyzed using thematic networks analysis.ResultsSix themes were identified: 1) fetal center evaluations had a far-reaching impact on participants’ lives, 2) participants appreciated both expertise and support from providers, 3) participants recognized the need to cope with uncertainty, 4) participants sought additional support from multiple arenas, 5) participants specifically looked to the internet for both information and support, and 6) participants had pre-established views about pregnancy termination.ConclusionMultidisciplinary fetal centers can provide a unified source of clinical expertise to women who are carrying a fetus with a suspected or identified congenital anomaly. Despite this diagnostic acumen, uncertainty is pervasive and patients seek support and additional information from a variety of other sources. This investigation is an important initial step in the evaluation of this emerging model of care.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-04T02:21:09.359314-05:
      DOI: 10.1111/apa.13812
  • Assessment of Continuous Pain in Newborns admitted to NICUs in 18 European
    • Authors: Kanwaljeet J. S. Anand; Mats Eriksson, Elaine M Boyle, Alejandro Avila-Alvarez, Randi Dovland Andersen, Kosmas Sarafidis, Tarja Polkki, Cristina Matos, Paola Lago, Thalia Papadouri, Simon Attard-Montalto, Mari-Liis Ilmoja, Sinno Simons, Rasa Tameliene, Bart van Overmeire, Angelika Berger, Anna Dobrzanska, Michael Schroth, Lena Bergqvist, Emilie Courtois, Jessica Rousseau, Ricardo Carbajal,
      Abstract: AimContinuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown.MethodsA prospective cohort study in 243 Neonatal Intensive Care Units (NICUs) from 18 European countries recorded frequency of pain assessments, use of mechanical ventilation, sedation, analgesia, or neuromuscular blockade for each neonate upto 28 days after NICU admission.ResultsOnly 2113/6648 (31·8%) of neonates received assessments of continuous pain, occurring variably among tracheal ventilation (TrV, 46·0%), noninvasive ventilation (NiV, 35·0%), and no ventilation (NoV, 20·1%) groups (p
      PubDate: 2017-03-03T09:20:24.735699-05:
      DOI: 10.1111/apa.13810
  • Large population study shows that adolescents with celiac disease have an
           increased risk of multiple autoimmune and non-autoimmune comorbidities
    • Authors: Amit Assa; Yael Frenkel-Nir, Dorit Tzur, Lior H Katz, Raanan Shamir
      Abstract: AimCeliac disease (CD) is a systemic disorder that is associated with various autoimmune disorders and a higher prevalence of other diagnoses and complications. This large, cross-sectional, population-based study investigated the associations between CD and various medical conditions during late adolescence.MethodsWe included 2,001,353 Jewish Israeli adolescents who underwent a general health examination at a median age of 17.1 (16.9-17.4) years from 1988-2015. Comprehensive data regarding medical status were available for 1,588,041 (79%) subjects. A definite diagnosis of CD was based on accepted criteria. Covariate data included demographic measures and data on associated medical conditions.ResultsOverall, data on 7,145 subjects with CD and 1,580,896 controls were analysed. Multivariate analyses showed that autoimmune diseases were significantly more common in subjects with CD, including insulin dependent diabetes, with an odds ratio (OR) of 5.5, inflammatory bowel diseases (OR=3.8), arthritis (OR=2.4), thyroid diseases (OR=1.8), and psoriatic skin disorders (OR=1.6). Further associations included asthma (OR=1.5), bile stones (OR=3.6), migraine (OR=2.3), anaemia (OR=1.7) and menstrual abnormalities (OR=1.5). Long bone fractures and axial fractures were no more common in adolescents with CD than controls.ConclusionCD was already associated with multiple comorbidities by adolescence and these were not limited to autoimmune disorders.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-01T01:55:33.809649-05:
      DOI: 10.1111/apa.13808
  • The Kaempf Periviability Guidelines: return of the “god
    • Authors: Patrick J. Marmion
      Abstract: Not all births are happy occasions. As an obstetrician, I have helped many families as they experienced stillbirths and untimely deliveries over the last thirty years. During the last ten years I have witnessed a disturbing phenomenon: preterm babies dying needlessly because they are being denied life-sustaining interventions. I remember the families who were simply told their 23-week newborns would die because “all of them do”. I remember the families who were told “we do not recommend intensive care for babies born at 24 weeks because when they survive their outcomes are bleak”. I remember the 25-week babies who died because their parents chose palliative care after being told that their child could be disabled and destroy their family. I have been constrained to “follow the party line” even though I know that some babies do survive at 23 weeks, that when babies survive at 24 weeks their outcomes are often good, and I know that preterm babies do not destroy families. These babies, their families, their physicians and nurses and the integrity of health care facilities are victims of flawed guidelines that give an unbalanced message to parents. In this article I will describe how these guidelines were developed and how an absent dialogue has led to moral distress and adverse patient outcomes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-01T01:55:30.114003-05:
      DOI: 10.1111/apa.13806
  • Birth asphyxia measured by the pH value of the umbilical cord may predict
           an increased risk of attention deficit hyperactivity disorder
    • Authors: Susanne Hvolgaard Mikkelsen; Jørn Olsen, Bodil Hammer Bech, Chunsen Wu, Zeyan Liew, Mika Gissler, Carsten Obel, Onyebuchi A. Arah
      Abstract: AimAlthough birth asphyxia is a major risk factor for neonatal and childhood morbidity and mortality, it has not been investigated much in relation to attention deficit hyperactivity disorder (ADHD). We examined if birth asphyxia measured by the pH of the blood in the umbilical artery cord was associated with childhood ADHD.MethodA population-based cohort of 295,687 children born in Finland between1991-2002 was followed until 31 December 2007. ADHD was identified by the International Classification of Diseases, tenth edition, as a diagnosis of hyperkinetic disorder. We examined the risk of ADHD with varying pH values using Cox regression, taking time trends into consideration.ResultsWhen compared to the reference group, a pH value below 7.10 was significantly associated with an increased risk of ADHD. The strongest risks were observed among children with a pH value
      PubDate: 2017-03-01T01:55:29.221673-05:
      DOI: 10.1111/apa.13807
  • Assessing the growth of preterm infants using detailed anthropometry
    • Authors: James J Ashton; Mark J Johnson, Jenny Pond, Philippa Crowley, Borislav D Dimitrov, Freya Pearson, R Mark Beattie
      Abstract: AimPreterm infants display altered body composition compared to term-infants, weight gain is a crude indicator body composition. Childhood mid-upper arm circumference (MUAC) is a measure of nutritional status. This study investigates MUAC and mid-thigh circumference (MTC) to monitor growth in preterm infants.MethodsPreterm infants (
      PubDate: 2017-02-27T05:20:49.29098-05:0
      DOI: 10.1111/apa.13804
  • The Global Network Neonatal Cause of Death algorithm for low-resource
    • Authors: Ana L. Garces; Elizabeth M. McClure, Wilton Pérez, K. Michael Hambidge, Nancy F. Krebs, Lester Figueroa, Carl L. Bose, Waldemar A. Carlo, Constance Tenge, Fabian Esamai, Shivaprasad S. Goudar, Sarah Saleem, Archana B. Patel, Melody Chiwila, Elwyn Chomba, Antoinette Tshefu, Richard J. Derman, Patricia L. Hibberd, Sherri Bucher, Edward A. Liechty, Melissa Bauserman, Janet L. Moore, Marion Koso-Thomas, Menachem Miodovnik, Robert L. Goldenberg
      Abstract: AimThis study estimated the causes of neonatal death using an algorithm for low-resource areas, where 98% of the world's neonatal deaths occur.MethodsWe enrolled women in India, Pakistan, Guatemala, the Democratic Republic of Congo, Kenya and Zambia from 2014-2016 and tracked their delivery and newborn outcomes for up to 28 days. Antenatal care and delivery symptoms were collected using a structured questionnaire, clinical observation and, or, a physical examination. The Global Network Cause of Death algorithm was used to assign the cause of neonatal death, analysed by country and day of death.ResultsOne third (33.1%) of the 3,068 neonatal deaths were due to suspected infection, 30.8% to prematurity, 21.2% to asphyxia, 9.5% to congenital anomalies and 5.4% did not have a cause of death assigned. Prematurity and asphyxia-related deaths were more common on the first day of life (46.7% and 52.9%, respectively), while most deaths due to infection occurred after the first day of life (86.9%). The distribution of causes was similar to global data reported by other major studies.ConclusionsThe Global Network algorithm provided a reliable cause of neonatal death in low-resource settings and can be used to inform public health strategies to reduce mortality.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-27T05:07:31.182474-05:
      DOI: 10.1111/apa.13805
  • Pulse oximetry is a feasible method for detecting neonatal critical
           congenital heart disease
    • Authors: Xiao-jing Hu; Guo-ying Huang
      Abstract: We would like to respond to the letter by Dr Fernandes and Dr Lakshminrusimha, which stated that using pulse oximetry to screen critical congenital heart disease (CCHD) in neonatal units (NICU) is complex and difficult to implement, because the infants are all in a critical condition (1). That is why our study, which they were commenting on, used a relatively simple screening approach that could be performed by NICU staff in our centre with a good level of compliance (2).Indeed, ventilation or supplemental oxygen would interfere with the accuracy of screening. Most of study neonates who were admitted to our NICU were put on oxygen therapy.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-24T15:10:24.624335-05:
      DOI: 10.1111/apa.13801
  • Parents’ presence and parent–infant closeness in 11 NICUs in six
           European countries varies between and within the countries
    • Authors: Simo Raiskila; Anna Axelin, Liis Toome, Sylvia Caballero, Bente Silnes Tandberg, Rosario Montirosso, Erik Normann, Boubou Hallberg, Björn Westrup, Uwe Ewald, Liisa Lehtonen
      Abstract: AimLittle is known about the amount of physical parent-infant closeness in neonatal intensive care units (NICUs) and this study explored that issue in six European countries.MethodsThe parents of 328 preterm infants were recruited in 11 NICUs in Finland, Estonia, Sweden, Norway, Italy and Spain. They filled in daily diaries about how much time they spent in the NICU, in skin-to-skin contact (SSC) and holding their babies in the first two weeks of their hospitalisation.ResultsThe parents’ NICU presence varied from a median of 3.3 (minimum 0.7- maximum 6.7) to 22.3 (18.7-24.0) hours per day (p
      PubDate: 2017-02-24T14:50:26.809764-05:
      DOI: 10.1111/apa.13798
  • Most children who took part in a comprehensive malnutrition programme in
           Madagascar reached and maintained the recovery threshold
    • Authors: Magnin Margot; Beat stoll, Rajaobelina Voahangy, Emilien Jeannot
      Abstract: AimThe benefits of including nutritional education in programmes that tackle moderate and severe acute malnutrition remain poorly documented. This study in Madagascar evaluated the nutritional status of children who took part in an innovative programme that included maternal education, on completion and after a year.MethodsEach year, this outpatient programme admits 2,400 malnourished children from 6-59 months in the lower districts of Antananarivo, Madagascar. Children were drawn by lots and their anthropometric data measured. A descriptive retrospective longitudinal study was conducted on 573 children who took part between 2010-2013.ResultsThe programme lasted an average of 38 days and, on completion, 82.2% had reached the recovery threshold and 16.2% had moved up to mild malnutrition. This was achieved with food supplements of 720 kilocalories per day, despite the Malagasy Public Health recommendation of 1,000-1,500 kilocalories per day. After one year, 79.1% were still above the recovery threshold and 15% had mild malnutrition. The recovery rate was higher for children under 24 months of age (odds ratio 2.9, 95% confidence interval 1.93-4.59).ConclusionMost children who attended this malnutrition programme with maternal education in Madagascar reached the recovery threshold on completion and had maintained it after one year.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-23T13:30:27.46873-05:0
      DOI: 10.1111/apa.13796
  • The HemoCue WBC DIFF system could be used for leucocyte and neutrophil
           counts but not for full differential counts
    • Authors: Malgorzata Karawajczyk; Saba Haile, Magnus Grabski, Anders Larsson
      Abstract: AimThe aim of this study was to evaluate the HemoCue WBC DIFF system for point of care testing of fingerstick samples from paediatric patients.MethodsWe analysed 158 white blood cell counts on both the point of care HemoCue WBC DIFF instrument and the Cell Dyn Sapphire cell counter used by our central laboratory and compared the results. The measurements were performed using fingerstick samples drawn by nurses working in paediatric emergency and paediatric oncology units.ResultsThere was good agreement between the two instruments for white blood cell and neutrophil counts. The correlation was weaker for lymphocytes and the correlations were poor for monocytes and eosinophils. The HemoCue WBC DIFF flagged 56 of the 148 capillary drawn samples as abnormal, but none of the 10 venously collected samples. Only two of the flagged samples differed significantly between the instruments, with regard to the cell counts.ConclusionThe correlations between the white blood cell counts and neutrophil counts in this real life study were good enough to diagnose children in emergency department and oncology unit settings. However, the high number of pathological flags from fingerstick samples, which made reruns necessary, limited the usefulness of the instrument.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-20T15:25:21.796653-05:
      DOI: 10.1111/apa.13790
  • The triglyceride and glucose index is useful for recognising insulin
           resistance in children
    • Authors: M. Rodríguez-Morán; L E. Simental-Mendía, F. Guerrero-Romero
      Abstract: AimAlthough recognising insulin resistance in children is particularly important, the gold standard test used to diagnose it, the euglyceamic glucose clamp, is costly, invasive and is not routinely available in our clinical settings in Mexico. This study evaluated whether the triglyceride-glucose (TyG) index would provide a useful alternative.MethodsA total of 2,779 school children aged 7-17 years, from Durango, Mexico, were enrolled during 2015-2016. The gold standard euglyceamic-hyperinsulinemic clamp test was performed in a randomly selected subsample of 125 children and diagnostic concordance between the TyG index and the homeostasis model assessment of IR was evaluated in all of the 2,779 enrolled children.ResultsThe best cut-off values for recognising IR using the TyG index were 4.65 for prepubertal girls and boys, 4.75 for pubertal girls and 4.70 for pubertal boys. Concordance between the TyG index and the homeostasis model assessment of IR was 0.910 and 0.902 for the prepubertal girls and boys, 0.932 for the pubertal girls and 0.925 for the pubertal boys.ConclusionThe TyG index was useful for recognising IR in both prepubertal and pubertal children and could provide a feasible alternative to the costly and invasive gold standard test for IR in resource-limited settings.This article is protected by copyright. All rights reserved.
      PubDate: 2017-02-20T15:25:19.671181-05:
      DOI: 10.1111/apa.13789
  • Marked variability observed in inpatient management of bronchiolitis in
           three Finnish hospitals
    • Abstract: AimInfants hospitalised for bronchiolitis undergo examinations and treatments not supported by current research evidence and we investigated practice variations with regard to Finnish children under the age of two.MethodsThis prospective, multi-centre cohort study was conducted in paediatric units in three university hospitals in Finland from 2008-2010. Hospital medical records were reviewed to collect data on clinical course, testing and treatment. Data were analysed separately for children meeting our strict definition of bronchiolitis, aged under 12 months without a history of wheezing, and a loose definition, aged 12-23 months or with a history of wheezing.ResultsThe median age of the 408 children was 8.1 months. Clinical management varied between the three hospitals when stratified by strict and loose bronchiolitis subgroup definitions: complete blood counts ranged from 15-95% versus 16-94%, respectively, and the other measures were chest x-ray (16-91% versus 14-72%), intravenous fluids (2-47% versus 2-41%), use of nebulised epinephrine (10-84% versus 7-50%), use of salbutamol (18-21% versus 13-84%) and use of corticosteroids (6%-23% versus 60-76%).ConclusionThe clinical management of bronchiolitis varied considerably with regard to the three hospitals and the two definitions of bronchiolitis. A stronger commitment to evidence-based bronchiolitis guidelines is needed in Finland.This article is protected by copyright. All rights reserved.
  • Using a spontaneous profile rather than stimulation test makes the KIGS
    • Abstract: AimChildren treated with a growth hormone (GH) for idiopathic growth hormone deficiency (IGHD) may be monitored with the first-year prediction model from the Pfizer International Growth Database (KIGS) using auxology, age, GH dose and the maximum GH concentration from a stimulation test (GHmaxstim). We tested the hypothesis that using a 12-hour spontaneous profile (GHmax12h) would be as accurate.MethodsWe studied 98 prepubertal Swedish children (78 boys) aged 2-12 years enrolled in KIGS. The first-year growth was predicted using the GHmax from the GH profile and a stimulation test and both of these were compared separately with the observed growth response.ResultsThe increased height observed in the first year was 0.74 standard deviation scores (SDS) and the studentised residuals for the predicted and observed growth with GHmaxstim (-0.16 SDS) and GHmax12h (-0.22) were similar. Individual predictions calculated with stimulated or spontaneous GHmax showed a significant correlation (r=0.80).ConclusionWe validated the KIGS IGHD prediction model and found that the stimulated GHmax peak can be reliably replaced by the GHmax 12h with similar accuracy. This makes the model more accessible for clinicians, who can then provide realistic expectations for the growth response during the first year of treatment.This article is protected by copyright. All rights reserved.
  • The gene encoding the inwardly rectifying potassium channel Kir4.1 may be
           involved in sudden infant death syndrome
    • Abstract: AimDisturbances in brain function and development may play a role in sudden infant death syndrome (SIDS). This Norwegian study aimed to test the hypothesis that specific variants of genes involved in water transport and potassium homeostasis would be predisposing factors for SIDS.MethodsGenetic variation in the genes encoding aquaporin-4 (AQP4), Kir4.1 (KCNJ10) and α-syntrophin were analysed in 171 SIDS cases (62.6% male) with a median age of 15.5 (2-52) weeks and 398 adult controls (70.6% male) with a median age of 44 (11-91) years. All the subjects were Caucasians who were autopsied from 1988-2013.ResultsThe CC genotype of rs72878794 in the AQP4 gene and a combination of the CC genotype in rs17375748, rs1130183, rs12133079 and rs1186688 in KCNJ10 (4xCC) were found to be associated with SIDS. The SIDS cases with the 4xCC SNP combination were younger than the SIDS cases with other genotype combinations (p=0.006).ConclusionThis study indicates that genetic variations in KCNJ10 and AQP4 may be predisposing factors for SIDS. Alterations in the expression of the AQP4/Kir4.1 complex can disrupt water and ion homeostasis, which may influence brain development and facilitate brain oedema formation This may be especially unfavourable during the first weeks of life.This article is protected by copyright. All rights reserved.
  • Use of time and adolescent health-related quality of life/wellbeing: A
           scoping review
    • Abstract: Time use could profoundly affect adolescents’ health-related quality of life (HRQL). Ideally, overall time use patterns would be considered, because activities within a 24-hour day are inherently correlated (more in one activity means less in another). This review focused on the associations of 1) overall time use patterns and 2) components of time use patterns with HRQL in adolescents.ConclusionMore physical activity, less screen time and more/adequate sleep, in isolation, are associated with better profile-based HRQL subscales. Greater understanding of adolescents’ overall time use patterns and HRQL is a priority for policy development.This article is protected by copyright. All rights reserved.
  • Infected malnourished children displayed changes in early activation and
           lymphocyte subpopulations
    • Abstract: AimMalnutrition and infections cause immunological changes in lymphocyte subpopulations and their functionality. We evaluated the activation capacity of lymphocytes and memory cells in 10 well nourished, seven well nourished infected and eight malnourished infected children before and after treatment.MethodsAll the children were patients in Mexico City and were less than three years of age. The expression of various cluster of differentiation (CD) cells were assessed by flow cytometry: CD45RA (naïve) and CD45RO (memory) antigens on CD4 lymphocytes and CD69 in all lymphocytes.ResultsWell-nourished infected children showed a higher percentage of activated T lymphocyte (T cells), CD8+ and CD4+ memory cells during the infectious phase, suggesting that the activation mechanisms were triggered by infection. T cells from malnourished infected children showed a lower percentage of activated and memory cells. The T cell population size returned to baseline during the resolution phase of the infection in well-nourished infected children, but their T, B lymphocyte and natural killer (NK) cell counts remained high. In malnourished infected children, activated NK cells counts were low before and after therapy.ConclusionAfter therapy, malnourished infected children showed poor NK cell responses during the infection's resolution phase, suggesting a persistent malnutrition-mediated immunological deficiency.This article is protected by copyright. All rights reserved.
  • Prophylactic sustained inflation is just one step to preventing
           bronchopulmonary dysplasia
    • Abstract: I am glad to see that the Sustained Lung Inflation (SLI) trial (1) still draws a great deal of attention and I would like to clarify some aspects of the trial, in response to the comments by Gupta and Argarwal (2) in Acta Paediatrica.A meta-analysis carried out in 2016 demonstrated that starting non-invasive respiratory support from birth could reduce the incidence of bronchopulmonary dysplasia and death. However, about 50% of very low birth weight infants who are initially on nasal continuous positive airway pressure need subsequent intubation and mechanical ventilation.This article is protected by copyright. All rights reserved.
  • One oxygen breath shortened the time to return of spontaneous circulation
           in severely asphyxiated piglets
    • Abstract: AimAsphyxiated neonates should be resuscitated with air, but it remains unclear if oxygen supplementation is needed in ineffectively ventilated newborn infants. We studied the return of spontaneous circulation (ROSC) with oxygen or air in an experimental model of inadequate ventilation.MethodsAsphyxia was induced in 16 newborn piglets until their heart rate was
  • Changing diagnosis coding routines may confound the results of
           longitudinal childhood pneumonia studies
    • Abstract: AimThis Swedish study compared the discharge diagnosis codes used for children up to the age of five hospitalised for acute lower respiratory tract infections before and after the introduction of the pneumococcal conjugate vaccine in 2007.MethodsThe International Classification of Diseases - 10th revision codes were used. We compared the discharge diagnosis codes at the Astrid Lindgren Children's Hospital from 1 July 2005 to 30 June 2007 (n=1,127) and 1 July 2011 to 30 June 2013 (n=1,240) in relation to the diagnostic methods used.ResultsThere was a 54% reduction in the rate of all-cause pneumonia from the first to the second period in infants up to the age of one, but some of this could have been due to the improved diagnosis of viral infections and us changing the code for respiratory syncytial virus infection from pneumonia to bronchiolitis. The overall rate of acute lower respiratory tract infections was unchanged.ConclusionWe could not determine how much of the reduction in bacterial pneumonia in children under one was because of the introduction of the pneumococcal conjugate vaccine, based solely on discharge codes. Longitudinal register studies should take changes in diagnosis codes into account.This article is protected by copyright. All rights reserved.
  • Real life comparison of three general paediatric wards showed similar
           outcomes for children with bronchiolitis despite different treatment
    • Abstract: AimThis study evaluated the effectiveness of three different treatments for bronchiolitis in a tertiary pediatric facility.MethodsPatients with bronchiolitis who were younger than two years of age and were randomly allocated to three general wards at Schneider Children's Medical Center, Israel, after admission were included. Different treatment protocols in the wards were retrospectively compared.ResultsThe study comprised 286 children. The clinical and laboratory parameters on admission were similar between the wards. In Ward C where nebulised hypertonic saline was infrequently administered (6.7%), the mean number of days with oxygen saturation under 92% and the meanlength of hospital stay (1.8 days and 3.8 days) were significantly lower than Ward A (2.8 days and 5.3 days) and Ward B, (2.9 days and 4.7 days) where nebulised hypertonic saline was given more frequently (38.7% to 74.7%). Multivariate analysis indicated that low saturation on admission, leukocytosis and use of nebulised hypertonic saline or adrenalin were independent predictors of a longer period of desaturation and hospital stay.ConclusionDifferent treatment protocols for bronchiolitis were used in three paediatric wards in this real life study. No treatment regimen proved superior. Inhalations of hypertonic saline or adrenaline were associated with a longer hospital stay.This article is protected by copyright. All rights reserved.
  • Case-control study shows that neonatal pneumococcal meningitis cannot be
           distinguished from group B Streptococcus cases
    • Abstract: AimStreptococcus pneumoniae (S. pneumoniae) is sometimes implicated in neonatal bacterial meningitis. This study described the demographic, clinical and biological features of neonatal S. pneumoniae meningitis and compared pneumococcal and group B streptococcal (GBS) neonatal meningitis.MethodsWe conducted a case–control study that compared neonates, aged one to 28 days with S. pneumoniae meningitis or GBS meningitis. Each case with S. pneumoniae was randomly matched to four control patients with GBS by age group and study year.ResultsFrom 2001 to 2013, the national French paediatric network, which comprises 227 paediatric wards, recorded 831 neonatal cases of meningitis. S. pneumoniae (n=18, 2.2%) was the fifth infection cause after GBS (n=464, 55.8%), Escherichia coli (n=232, 27.9%), Neisseria meningitidis (n=23, 2.8%) and Listeria monocytogenes (n= 20, 2.4%). Neonatal pneumococcal and GBS meningitis did not differ in demographic data or clinical and biological characteristics. All S. pneumoniae strains were fully susceptible to cefotaxime and we observed a decrease of 13-valent pneumococcal conjugate vaccine (PCV13) serotypes (88.9% to 20.0%) after PCV13 implementation.ConclusionClinically and biologically, neonatal pneumococcal meningitis could not be distinguished from GBS cases. A herd effect of PCV13 implementation was suggested by the decrease in the prevalence of vaccine serotypes.This article is protected by copyright. All rights reserved.
  • Nicotine withdrawal syndrome in a newborn baby after maternal use of oral
           applied moist tobacco (SNUS), should result in greater awareness to the
           use of snus among pregnant women
    • Abstract: The harm that smoking causes the fetus are well known. Smoking by young men and women in Scandinavia has steadily declined in the last few decades and the use of snus - moist tobacco that is placed in the mouth - has increased. This patient history highlights the effects of using snus during pregnancyThis article is protected by copyright. All rights reserved.
  • Secular trends in Australian school children's sleep and perceived
           importance of sleep between 1985 and 2013
    • Abstract: AimTo examine secular trends in Australian children's actual sleep time as well as the perceived importance of sleep between 1985-2004-2013.MethodsSecular trends in children's sleep and their perception of the importance of sleep across three time points 1985 (N=401), 2004 (N=450) and 2013 (N=395), were examined according to socioeconomic status (SES), age and sex. The children self-reported their bed-time, wake-up time and their perceived importance of sleep, among other questions.ResultsThere were no significant differences in sleep duration between boys and girls in any of the survey years, nor were there differences in sleep duration between SES categories at any time point. Independent of survey year, age, sex and SES, there was a graded difference in sleep duration (min) across response categories for perceived importance of sleep. Overall, trends in the perceived importance of sleep appeared to match trends in actual sleep time, but not for all subgroups.ConclusionThis study indicates that the sleep duration of high SES Australian school children is returning to, or near to, baseline sleep duration observed in 1985, while the sleep duration of low SES Australian children has remained at low levels.This article is protected by copyright. All rights reserved.
  • An index to predict asthma in wheezing young children produced promising
           initial results
    • Abstract: Diagnosing asthma is difficult in infants and preschool children because wheezing is common in this age group and it is not synonymous with asthma. Some children outgrow the tendency to wheeze during colds in a few years’ time, whereas other develop asthma. Efforts have been made to find ways to identify the subgroup of preschool children with wheeze who are most likely to develop asthma (1,2). However, the different asthma predictive indexes mainly aim to predict children who will have a persistent wheeze or asthma, not necessarily the subgroup who will outgrow their symptoms.This article is protected by copyright. All rights reserved.
  • Risk factors for executive function difficulties in preschool and early
           school-age preterm children
    • Abstract: AimTo investigate the relationship between executive functioning and social and perinatal risk factors in four- to five-year-old preterm children.Methods141 children born preterm (< 33 weeks of gestation) and 77 term comparison children were assessed using standardized measures of general intelligence and performance-based executive function tests prior to starting kindergarten. Parental and teacher reports of executive functioning were completed when the children commenced kindergarten. The preterm and the term comparison groups were compared on measures of intelligence and executive functions using independent groups t-tests, and multivariate regression analyses were performed to identify factors predictive of intelligence and executive functioning in the preterm group.ResultsThe preterm group performed significantly more poorly than the comparison group on all intelligence and executive function tests. The parental reports of the preterm and term comparison children's executive function did not differ significantly, but the teachers reported elevated executive function difficulties for the preterm group. Higher social risk, in particular lower educational level of the main caregiver, was the strongest predictor for the preterm children's intelligence and executive function results.ConclusionSocial risk factors are strongly associated with impaired early executive function outcomes in preterm children.This article is protected by copyright. All rights reserved.
  • Starting enteral nutrition with preterm single donor milk instead of
           formula affects time to full enteral feeding in very low birth weight
    • Abstract: AimThis study compared the impact of using either single donor breast milk or formula to start enteral feeding in preterm infants, on the time to full enteral feeding, growth and morbidity. The milk was provided by other preterm mothers.MethodsThis was an observational prospective study, carried out from June 2012 - March 2013 at the Medical University of Vienna, Austria, on the effects of preterm single donor milk on 133 very low birth weight infants with a birth weight
  • Introducing High- flow nasal cannula to the neonatal transport environment
    • Abstract: We are encouraged to see that other neonatal transport services are using High-Flow nasal cannula (HFNC) respiratory support during neonatal transport as outlined by Brunton et al (1). The experiences appear to be broadly similar across the two services, however, due to the central location of the neonatal transport base and the well served road network in the East of England region air transports are not conducted. Despite the increasing numbers of articles relating to HFNC use in neonatal units and consensus statements on best practice there is a relative paucity of data relating to its use on transport (2,3).This article is protected by copyright. All rights reserved.
  • Issue Information
  • Highlights in this issue
  • Blowing the whistle: moral distress and advocacy for preterm infants and
           their families
  • How do we measure childhood'
  • Survey of neonatal resuscitation practices showed post-training
           improvements but need to reinforce preterm management, monitoring and
           adrenaline use
    • Abstract: AimNeonatal resuscitation surveys have showed practice variations between countries, centres and levels of care. We evaluated delivery room practices after a nationwide neonatal resuscitation training programme focused on nontertiary centres.MethodsA 2012 survey sent to all Spanish hospitals handling deliveries covered staff availability and training, equipment and practices in the delivery room and during transfers to neonatal intensive care units. The results from 98 centres that had completed a previous survey in 2007 were analysed by levels of care. Pearson's chi-square test was used to compare the proportions.ResultsThe following had significantly improved in 2012 compared to 2007: the availability of T-piece resuscitators (71.4% vs. 41.8%), plastic wraps (69.4% vs. 31.6%), gas blenders (79.6% vs. 40.8%), pulse oximetry (92.9% vs. 61.2%), use of continuous positive airway pressure (82.7% vs. 43.9%) (all p < 0.01), the availability of instructors (55.6% vs. 83.3%, p < 0.05) and neonatal resuscitation courses (40.8% vs. 79.6%, p < 0.05) in nontertiary centres. In 2012, the use of exhaled carbon dioxide detectors was 90%.ConclusionNeonatal resuscitation equipment and practices improved over time, but several aspects needed to be reinforced in training programmes, namely preterm infants' management, monitoring and adrenaline administration.
  • Sapropterin treatment does not enhance the health-related quality of life
           of patients with phenylketonuria and their parents
    • Abstract: AimSapropterin causes reductions in blood phenylalanine concentrations in sensitive patients with phenylketonuria (PKU). We examined whether the subsequent relaxation of dietary restrictions influenced the quality of life (QoL) of patients and parents.MethodsThe study cohort comprised 112 patients with PKU followed at the metabolic centre at Münster University Children's Hospital, Germany, from 2012 to 2015. A sapropterin response was defined as a ≥30% reduction in blood phenylalanine levels. The QoL of 38 children and adolescents from the study cohort, with a mean age of 12.4 (range 6.6–18.7) years, was assessed in an outpatient setting and 49 parents of children with PKU also commented on their child's QoL and their own. The participants’ QoL was assessed before the start of therapy, and again after six months, using self-report questionnaires.ResultsAfter six months of continuous therapy or diet, QoL was largely unchanged in the patients, according to their self-reports and the parental reports. QoL also remained unchanged in the parents.ConclusionSapropterin did not seem to improve QoL in PKU patients and their parents. Patients with PKU had already reached high levels of QoL following classic diets, and these levels were not easily improved by sapropterin.
  • The amount of television that infants and their parents watched influenced
           children's viewing habits when they got older
    • Abstract: AimExcessive television (TV) exposure has negative impacts on a child's development, health and behaviour. This study examined the under-researched area of what impact infant and parental TV viewing during a child's infancy had on the child's later viewing habits.MethodsData on 18 577 babies born in 2005 were collected from the Taiwan Birth Cohort Study, a prospective longitudinal study of a nationally representative cohort. Group-based trajectory analysis was conducted to identify childhood TV viewing trajectories at 18, 36 and 66 months of age. Multinomial logistic regression was used to examine the influence of parents’ TV behaviour on their children's TV viewing trajectories.ResultsThe percentage of children falling into the TV viewing trajectories that were identified were low (20%), increasing (46.5%) and high (33.5%). The child's TV viewing trajectory was significantly associated with the child's sex, parent's monthly household income, child's day care arrangements, maternal and paternal education, maternal and paternal TV viewing time and whether the child's TV viewing time was restricted.ConclusionThe amount of TV that children watched when they were older was associated with a range of factors, and the results particularly highlight the need to restrict child and parental viewing time in infancy.
  • Student peer teaching in paediatric simulation training is a feasible
           low-cost alternative for education
    • Abstract: AimThe World Health Organization recommends regular simulation training to prevent adverse healthcare events. We used specially trained medical students to provide paediatric simulation training to their peers and assessed feasibility, cost and confidence of students who attended the courses.MethodsStudents at the Medical University of Vienna, Austria were eligible to participate. Students attended two high-fidelity simulation training sessions, delivered by peers, which were videorecorded for evaluation. The attendees then completed questionnaires before and after the training. Associated costs and potential benefits were analysed.ResultsFrom May 2013 to June 2015, 152 students attended the sessions and 57 (37.5%) completed both questionnaires. Satisfaction was high, with 95% stating their peer tutor was competent and 90% saying that peer tutors were well prepared. The attendees’ confidence in treating critically ill children significantly improved after training (p < 0.001). The average costs for a peer tutor were six Euros per working hour, compared to 35 Euros for a physician.ConclusionUsing peer tutors for paediatric simulation training was a feasible and low-cost option that increased the number of medical students who could be trained and increased the self-confidence of the attendees. Satisfaction with the peer tutors was high.
  • The limitations of pulse oximetry for critical congenital heart disease
           screening in the neonatal intensive care units
  • Response: Slykerman et al.'s antibiotics in the first year of life and
           subsequent neurocognitive outcome
  • Permissive hypercapnia in extremely low-birthweight infants: how far
           should we go'
  • Twin birth – planned vaginal delivery still standard of care
  • Predictors for referral-warranted retinopathy of prematurity
  • Oxygen-saturation targets in extremely preterm infants
  • Handbook of Child & Adolescent Tuberculosis. Edited by Starke JR, Donald
           PR. Oxford University Press, New York, NY, 2016. 448 pp, first edition
           published in 2016.
  • National epidemiological study reveals longer paediatric bone and joint
           infection stays for infants and in general hospitals
    • Abstract: AimPublished studies have suggested that 2-5 days of intravenous treatment could effectively treat paediatric bone and joint infections (PBJI), allowing a faster discharge. This study analysed the factors associated with PBJI hospital stays lasting longer than five days using the French National Hospital Discharge Database.MethodsWe selected children under 15 years hospitalised in 2013 with haematogenous PBJIs using a validated French algorithm based on specific diagnosis and surgical procedure codes. Risk factors for stays of more than five days were analysed using logistic regression.ResultsIn 2013, 2,717 children were hospitalised for PBJI, with 49% staying more than five days. The overall incidence of 22 per 100,000, was highest in males and toddlers. The main causes were septic arthritis (50%) and osteomyelitis (46%) and 50% of the pathogens were Staphylococci. The odd ratios for stays of five days or more were: infancy, coded bacteria and sickle cell disease (7.0), having spondylodiscitis rather than septic arthritis (2.2) and being hospitalised in a general hospital rather than a teaching hospital (1.6).ConclusionHalf of the hospital stays exceeded five days, despite scientific evidence supporting a shorter intravenous antibiotherapy regimen. Greater knowledge and widespread use of short treatment regimens are needed.This article is protected by copyright. All rights reserved.
  • Higher Serum 25(OH)D Concentration is Associated with Lower Risk of
           Chronic Otitis Media with Effusion: A Case-Control Study
    • Abstract: AimVitamin D supplementation and higher 25(OH)-vitamin D concentration are associated with reduced risk of acute respiratory infection. This study examined whether there is a similar association between higher serum 25(OH)D concentration and lower risk of chronic otitis media with effusion (COME).MethodsIn a case-control study, serum 25(OH)D concentration in children referred for tympanostomy tube placement for COME (n=178) was compared to that of healthy children randomly sampled from primary care practices (n=179). Subjects aged three and four years were recruited in Auckland, New Zealand between May 2011 and November 2013. Blood samples were collected from the children and their guardians were interviewed. Odds ratios were calculated using logistic regression.ResultsIn a multivariable analysis, higher serum 25(OH)D concentration was associated with a lower risk of COME (OR: 0.86 per 10 nmol/L; 95% CI 0.77 to 0.97) after adjusting for age, sex, deprivation index, ethnicity, tobacco smoke exposure, duration of breastfeeding, and season of blood sampling. Further adjustment for eight additional risk factors did not change the result.ConclusionThis finding supports further investigation into whether the risk of COME could be reduced by increasing serum 25(OH)D concentration through increased sun exposure, higher dietary intake, or vitamin D supplementation.This article is protected by copyright. All rights reserved.
  • TV or Unrestricted, Unmonitored Internet Access in the Bedroom and BMI in
           Youth Athletes
    • Abstract: AimTo correlate television or unrestricted, unmonitored internet access in room of sleep with BMI.MethodsCross sectional study of athletes ≤ 19 years who underwent an Injury Prevention Evaluation. Independent variables included proportion of athletes categorized as overweight or obese who answered positively to American Academy of Pediatrics recommended questions: 1) Do you have a TV in the room where you sleep' 2) Do you have unrestricted, unmonitored access to the internet in the room where you sleep'.Results555 athletes; 324 female; mean age 13.83±2.60. Athletes with a TV in their room of sleep had higher BMI (22.73 vs. 20.54; P
  • Sound levels in a neonatal intensive care unit significantly exceeded
           recommendations, especially inside incubators
    • Abstract: AimThis study measured sound levels in a 2008 built French neonatal intensive care unit (NICU) and compared them to the 2007 American Academy of Pediatrics (AAP) recommendations. The ultimate aim was to identify factors that could influence noise levels.MethodsThe study measured sound in 17 single or double rooms in the NICU. Two dosimeters were installed in each room, one inside and one outside the incubators, and these conducted measurements over a 24-hour period. The noise metrics measured were the equivalent continuous sound level (Leq), the maximum noise level (Lmax) and the noise level exceeded for 10% of the measurement period (L10).ResultsThe mean Leq, L10 and Lmax were 60.4, 62.1 and 89.1 decibels (dBA), which exceeded the recommended levels of 45, 50 and 65 dBA (p
  • Optimising physiology for adolescents with dysautonomia
    • Abstract: I congratulate Armstrong et al (1) on their high quality paper, which will enable us to plan interventions that improve the quality of life of the dysautonomic paediatric population. I support the movement toward programmes that facilitate closely monitored, appropriate exercise regimes, tailored for the dysautonomic adolescent. This may, in the medium to long term be physiologically equivalent to, but more cost-effective than, the intermittent intravenous infusions of saline that have been found to dramatically reduce symptoms and improve the quality of life of patients suffering from postural orthostatic hypotention syndrome (2).This article is protected by copyright. All rights reserved.
  • Cohort study shows that peripheral dual energy x-ray absorptiometry is of
           limited epidemiologic use in prepubertal children
    • Abstract: AimPeripheral methods are increasingly used to assess bone health, despite little evidence on their predictive ability. We aimed to evaluate the usefulness of forearm dual energy x-ray absorptiometry in prepubertal children, by estimating the agreement between peripheral and central measures and the ability to predict fracture history.MethodsIn 2012/14, we assessed 1,177 seven-year-old children from the Generation XXI cohort who were recruited at birth in all five public hospitals with maternity wards in Porto, Portugal. Subtotal and lumbar spine bone mineral density (BMD) and content, left arm BMD and peripheral forearm BMD were measured. Parents reported the child's lifetime fracture history. We estimated agreement using Bland-Altman's method and Cohen's kappa. Fracture prediction ability was calculated using area under the receiver operator characteristic curve (ROC-AUC).ResultsThe limits of agreement were very wide, ranging from -2.20/2.20 to -1.87/1.87 standard deviations for the comparison between peripheral and central measures. Categorical agreement was also poor, with all kappa values below 0.40. In addition, none of the measures predicted fractures, since all the ROC-AUCs were close to 0.50.ConclusionThis study suggests that forearm BMD has limited use for bone health research or as a basis for clinical decisions in prepubertal children.This article is protected by copyright. All rights reserved.
  • Body Mass Index and vigorous physical activity in children and
           adolescents: an international cross-sectional study
    • Abstract: AimTo examine the relationship between reported vigorous physical activity (VPA) and body mass index (BMI) in children (6-7 years) and adolescents (13-14 years).MethodsIn the International Study of Asthma and Allergies in Childhood Phase Three, 75,895 children's parents and 199,502 adolescents answered questions relating to VPA, height and weight. The association between VPA and BMI was analysed using general linear models, adjusting for country gross national index.ResultsCompared to children who undertook no VPA, those in the infrequent group (once or twice per week) and those in the frequent group (three or more times per week) had mean (95%CI) BMI values 0.07 kg/m2 (0.03 to 0.11) and 0.09 kg/m2 (0.03 to 0.15) greater respectively (P=0.001). Compared to adolescents reporting no VPA, those in the infrequent group had a BMI 0.19 kg/m2 (0.15 to 0.23) greater while those in the frequent group had a BMI 0.01 kg/m2 (-0.03 to 0.05) greater (P
  • European Academy of Paediatric consensus statement on successful
           transition from paediatric to adult care for adolescents with chronic
    • Abstract: Around one in ten adolescents suffer from chronic conditions and disabilities and the transition from paediatric to adult care can be particularly challenging. Unplanned transfers can complicate education, work and health and result in patients being lost to follow up, poor treatment adherence and more frequent hospitalisation. The Adolescent Health and Medicine Working Group of the European Academy of Paediatrics has developed a consensus statement for successful transitionConclusionThis statement will help paediatricians, adult care specialists, policy makers and other stakeholders to handle chronic care transitions so that they meet the expectations and needs of adolescents and their families.This article is protected by copyright. All rights reserved.
  • Probiotics for the prevention of necrotizing enterocolitis in
           very-low-birth-weight infants: A meta-analysis and systematic review
    • Abstract: We performed an updated meta-analysis incorporating the results of recent randomised controlled trials (RCTs) to measure the effectiveness of probiotic supplementation in preventing necrotizing enterocolitis (NEC) and death in very-low-birth-weight (VLBW) infants, and to investigate any differences in efficacy by probiotic agent. Using meta-regression analysis, we assessed the contribution of other measured variables on the overall effect size and between-study variability.ConclusionOverall, probiotics lead to significant reductions in NEC incidence and mortality in VLBW infants. Differences in probiotic agents and the influence of prenatal steroids and feeding regimens may explain the differences in outcomes between studies.This article is protected by copyright. All rights reserved.
  • Preterm infants at discharge: Nap polysomnography versus 24-hour oximetry
    • Abstract: AimThis study aimed to determine whether measures of intermittent hypoxia derived from 24-hour oximetry correlate with measures of apnoea derived from modified nap polysomnography undertaken for preterm infants before discharge.MethodsInfants born ≤32 weeks gestation were recruited from the Neonatal Intensive Care Unit, and had a modified polysomnography to assess their respiratory stability once they were ≥35 weeks postmenstrual age. Infants were defined as unstable if they had more than 10 obstructive events per hour or any apnoea of > 20 seconds in length. Infants also had a 24-hour oximetry performed during this period. The results of the 24-oximetry desaturation index (DSI) were compared to nap polysomnography results for central and obstructive apnoea indices and correlations tested.ResultsTwenty-four infants completed the study. There were 15 (63%) infants defined as unstable by the modified polysomnography. The 3% DSI and 4% DSI from the 24-hour oximetry were significantly higher in the unstable infants and values for all infants correlated with the obstructive index and the central apnoea index from the modified polysomnography.ConclusionThe 3% DSI and 4% DSI values from a 24-hour oximetry study may provide non-invasive measures of respiratory stability in preterm infants ready for discharge.This article is protected by copyright. All rights reserved.
  • Swedish child health nurses treat fathers more equally in 2014 than 2004,
           but mothers remain their primary focus
    • Abstract: AimThis study focused on Swedish child health nurses’ attitudes and the support they provided to fathers and mothers, highlighting changes from 2004 to 2014.MethodIn 2014, 363 child health nurses in Stockholm County completed a 23-item questionnaire, similar to the questionnaire by Massoudi et al in 2004, on their attitudes and the support they gave to fathers and mothers. Analyses were completed using chi-square tests of nurses’ attitudes and support to fathers and mothers and the results from the 2004 and 2014 studies were compared.ResultsIn 2014, the vast majority of nurses fully agreed that it was important to have close contact with both parents, but more than two-thirds did not feel they had the same competencies for mothers and fathers and three-quarters found it complicated to support both parents. The majority viewed fathers more equally in 2014 than in 2004 and although they did provide more support to both parents, mothers in 2014 still received more support than fathers.ConclusionWhile Swedish child health nurses viewed fathers as more equal to mothers in 2014 than 2004, mothers still received the majority of the parenting support.This article is protected by copyright. All rights reserved.
  • Vascular endothelial growth factor A gene polymorphism is associated with
           congenital renal lesions in children with urinary tract infections
    • Abstract: AimThis study investigated the relationship between vascular endothelial growth factor A (VEGF-A)-460C/T functional gene polymorphism and renal parenchymal lesions, vesicoureteral reflux and other urinary tract abnormalities in children with a urinary tract infection (UTI).MethodsVEGF-A-460C/T gene polymorphism was investigated with restriction length polymorphism analysis in 76 children with their first UTI and in 63 controls without infections. Genotype and allele frequencies were compared between children with urinary tract infections and controls and between different groups with UTIs.ResultsThe VEGF-A-460C/T genotype frequencies differed significantly between those with and without renal parenchymal lesions in the UTI cohort. Allele C homozygosity was significantly more common in those with renal parenchymal lesions (36.6% versus 8.7%, p=0.007). A separate analysis showed that allele C was associated with lesions compatible with hypodysplasia, rather than with focal ones associated with infections, with an odds ratio of 11.55 and 95% confidence interval of 3.03-43.9 (p=0.0001). No significant differences in genotypes or allele frequencies were found between children with and without reflux or other urinary tract anomalies.ConclusionIn children with UTIs, C allele polymorphism of the VEGF-A gene was associated with hypodysplastic renal parenchymal lesions, which were possibly congenital and existed before the infection.This article is protected by copyright. All rights reserved.
  • Variation in term birth weight across European countries affects the
           prevalence of small for gestational age among very preterm infants
    • Abstract: AimThis study assessed the prevalence of small for gestational age (SGA) among very preterm (VPT) infants using national and European intrauterine references.MethodsWe generated country-specific and common European intrauterine growth references for 11 European countries, according to Gardosi's approach and Hadlock's fetal growth model, by using national data on birth weights by sex. These references were applied to the Effective Perinatal Intensive Care in Europe (EPICE) cohort, which comprised 7,766 live VPT births without severe congenital anomalies under 32 weeks of gestation in 2011-12, to estimate the prevalence of infants with SGA birth weights, namely those below the 10th percentile.ResultsThe SGA prevalence was 31.8% with country-specific references and 34.0% with common European references. The European references yielded a 10-point difference in the SGA prevalence between countries with lower term birth weights (39.9%) - Portugal, Italy and France - and higher term birth weights, namely Denmark, Netherlands, Sweden (28.9%) (p
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