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Showing 1 - 200 of 1580 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 13, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 65, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 47, SJR: 0.547, h-index: 30)
ACEP NOW     Free   (Followers: 1)
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 52, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 158, 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: 6, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 56, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 6, 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: 6, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 4)
Addiction     Hybrid Journal   (Followers: 35, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 13, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 27, SJR: 6.411, h-index: 86)
Advanced Engineering Materials     Hybrid Journal   (Followers: 26, SJR: 0.81, h-index: 81)
Advanced Functional Materials     Hybrid Journal   (Followers: 51, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 14, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 268, SJR: 9.021, h-index: 345)
Advanced Materials Interfaces     Hybrid Journal   (Followers: 6, SJR: 1.177, h-index: 10)
Advanced Optical Materials     Hybrid Journal   (Followers: 7, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 5)
Advanced Synthesis & Catalysis     Hybrid Journal   (Followers: 17, SJR: 2.729, h-index: 121)
Advances in Polymer Technology     Hybrid Journal   (Followers: 13, SJR: 0.344, h-index: 31)
Africa Confidential     Hybrid Journal   (Followers: 21)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 13)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 10)
African Development Review     Hybrid Journal   (Followers: 33, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 15, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 15, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 11, 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: 16, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 45, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 31, 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: 51, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 145, 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: 90, 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: 33, 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: 16, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 6, SJR: 2.315, h-index: 79)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 37, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 272, SJR: 5.101, h-index: 114)
American J. of Primatology     Hybrid Journal   (Followers: 15, 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: 17, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 136, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 10, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 18)
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: 196)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 219, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 39, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 6, 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: 7, 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: 47, 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: 13)
Annual Review of Information Science and Technology     Hybrid Journal   (Followers: 14)
Anthropology & Education Quarterly     Hybrid Journal   (Followers: 25, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 17, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 15)
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: 90, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 49, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 7, 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: 70, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 206, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 49, 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: 14, 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: 36, 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: 15, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 25, 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: 5)
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: 246, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 50, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 26, 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: 15)
Asia & the Pacific Policy Studies     Open Access   (Followers: 16)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 323, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (Followers: 1, SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 8, 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: 4, 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: 4, 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: 6, 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: 12, 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: 15, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 9, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 8, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 6, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 14, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 4, 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: 47, 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: 7, 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: 29, 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: 14, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 18, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 408, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 5, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 72, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 12, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 20, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 36, 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: 11, 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: 5, 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: 9, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 24, 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: 16, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 4, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 42, 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: 36, 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: 160, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 14, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 20, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 9, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 38, 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: 6, SJR: 0.468, h-index: 47)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal   (SJR: 1.513, h-index: 55)
BJOG : An Intl. J. of Obstetrics and Gynaecology     Partially Free   (Followers: 243, SJR: 2.083, h-index: 125)

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Journal Cover Acta Paediatrica
  [SJR: 0.794]   [H-I: 88]   [56 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  [1580 journals]
  • The neonatal transport index could be used as a reference tool for the
           Italian perinatal care regionalisation plan
    • Abstract: We read with interest the editorial by Hummler on the role of networks in improving perinatal and neonatal care in Acta Paediatrica (1), which dealt with healthcare systems for perinatal care. This included a reference to our paper on this subject, which was also published in the journal (2). There is general agreement that regionalising perinatal care and delivery at high‐volume, high‐technology hospitals reduces neonatal mortality.This article is protected by copyright. All rights reserved.
  • Education, school type and screen time were associated with overweight and
           obesity in 2,930 adolescents
    • Abstract: AimThis cross‐sectional study analysed the influence of socioeconomic factors on screen time, overweight and obesity.MethodsWe asked adolescents aged 10, 14 and 17 from 10 school types in urban and rural regions in Upper Austria to complete questionnaires from December 2012 to February 2013. Their parents were also asked to complete questionnaires.ResultsThe questionnaires were completed by 2,930 adolescents and 2,209 parents. Total weekend screen time was significantly associated with a higher body mass index (BMI) in 10‐year‐old boys (p
  • Virus Detection in Critically Ill Children with Acute Respiratory Disease
           : A New Profile in View of New Technology
    • Abstract: AimTo describe the epidemiology of critically ill children admitted to a pediatric intensive care unit (PICU) with acute respiratory disease. The association with intubation was analyzed for the three most prevalent viruses and in those with and without viral co‐infection.MethodsPatients admitted to the PICU (2004 ‐ 2014) with acute respiratory disease were included. Analyses were performed utilizing each respiratory viral infection or multiple viral infections as an exposure.ResultsThere were 1,766 admissions with acute respiratory disease of which 1,372 had respiratory virus testing and 748 had one or more viruses detected. The risk of intubation before or during the PICU stay was higher if parainfluenza virus was detected compared to respiratory syncytial virus (RSV) (OR: 2.20; 95%CI: 1.06 ‐ 4.56). Sixty‐three admissions had two or more viruses detected and the combination of RSV and rhino/entero virus was the most common. No significant difference was observed in the risk of intubation between patients with multiple and single viral infections.ConclusionHigher risk of intubation was found in patients with parainfluenza as compared to RSV. The risk of intubation comparing parainfluenza virus to other viruses and for patients with multiple versus single virus needs to be further studied.This article is protected by copyright. All rights reserved.
  • The panorama of cerebral palsy in Sweden part XII shows that patterns
           changed in the birth years 2007‐2010
    • Abstract: AimThis was the 12th population‐based study to explore the epidemiology of cerebral palsy (CP) in western Sweden.MethodsFrom 2007‐2010 there were 104,713 live births in the area. We analysed the birth characteristics, aetiology and neuroimaging findings, calculated the prevalence and compared the results with previous study cohorts.ResultsCP was found in 205 children, corresponding to a crude prevalence of 1.96 per 1,000 live births. The gestational age‐specific prevalence for < 28 gestational weeks was 59.0 per 1,000 live births, 45.7 for 28‐31 weeks, 6.0 for 32‐36 weeks and 1.2 for > 36 weeks. Hemiplegia accounted for 44%, diplegia for 34%, tetraplegia for 5%, dyskinetic CP for 12% ataxia for 3%. Neuroimaging showed maldevelopment in 12%, white‐matter lesions in 49%, cortical/subcortical lesions in 15% and basal ganglia lesions in 11%. The aetiology was considered prenatal in 38%, peri/neonatal in 38% and remained unclassified in 24%. CP due to term or near‐term asphyxia had decreased.ConclusionA non‐significant decrease in CP prevalence was seen in term‐born children. Hemiplegia was still the most prevalent CP type, while the prevalence of dyskinetic CP had decreased. One in two children had white matter lesions, indicating late second or early third trimester timing.This article is protected by copyright. All rights reserved.
  • Uniform national guidelines do not prevent wide variations in the clinical
           application of phototherapy for neonatal jaundice
    • Abstract: AimThis study compared the use of phototherapy for neonatal jaundice in all 21 Norwegian neonatal intensive care units (NICUs) from 2013‐2014 in order to improve practice.MethodsInformation on all types of phototherapy devices were collected and irradiance was measured from random units at 20cm and 50cm from the light source. We gathered information on local practice rules, including the use of single, double or triple phototherapy, how infants were positioned, the frequency of blood sampling, rules for using reflective surfaces and interrupting phototherapy. In every NICU we asked one nurse with more than five years of experience, and one with less than one year, to set up phototherapy equipment, then measured the irradiance and distance.ResultsPhotodiodes were the most common of the eight types of phototherapy devices used. Rules for the distance from the device to the infant varied from 10‐40cm and in practice they varied from 15‐48cm, with irradiance ranging from 11.1‐56.1 W/m2. There were significant variations between NICUs with regard to the overall treatment duration and duration in most birth weight categories.ConclusionThere were considerable variations in phototherapy practices among Norwegian NICUs. In particular, the significant variations in duration need to be addressed.This article is protected by copyright. All rights reserved.
  • Phototherapy is commonly used for neonatal jaundice but greater control is
           needed to avoid toxicity in the most vulnerable infants
    • Abstract: AimLimited information is available about how guidelines on phototherapy for neonatal jaundice are applied in practice and toxicity is a concern. We studied the use of phototherapy in relation to birth weight and gestational age (GA) in Norwegian neonatal intensive care units (NICUs).MethodsThe study population was all 5,382 infants admitted to the 21 NICUs in Norway between 1 September 2013 and 31 August 2014. Data were recorded daily in the Norwegian Neonatal Network database and anonymised data on patient characteristics, diagnoses, duration, the ages at the start and discontinuation of phototherapy were analysed.ResultsMore than a quarter (26.6%) of all infants admitted to Norwegian NICUs during the study period received phototherapy. The use of phototherapy was inversely related to GA and birth weight. More than 80% of the preterm infants under 28 weeks of GA received phototherapy. The duration was significantly longer in the lowest birth weight and GA groups and decreased with increasing birth weight and GA.ConclusionPhototherapy is proved to be a strong candidate for the most common therapeutic modality in NICU infants. However, in light of reported toxicity in the smallest, most vulnerable infants, we recommend increased emphasis on quality control.This article is protected by copyright. All rights reserved.
  • Adults who were born preterm with a very low birth weight reported a
           similar health‐related quality of life to their term‐born peers
    • Abstract: Approximately 1% of European infants are born preterm with a very low birth weight (VLBW) of less than 1,500g and the first babies born at the threshold of viability who received modern neonatal intensive care are now adults. While most live healthy lives, average VLBW adults tend to have more neurodevelopmental disabilities, lower educational achievement and higher rates of chronic conditions (1). Health‐related quality of life (HRQoL) is defined as a construct of physical, mental and social wellbeing.This article is protected by copyright. All rights reserved.
  • Effects of fetal growth restriction and preterm birth on cardiac
           morphology and function during infancy
    • Abstract: AimTo investigate the effects of fetal growth restriction (FGR) and prematurity on cardiac morphology and function in infancy. We hypothesized that FGR and prematurity would both alter cardiac development.MethodsCardiac morphology and function were evaluated in 24 preterm FGR infants (p‐FGR) and 23 preterm and 19 term appropriately‐grown‐for‐gestational‐age infants (p‐AGA and t‐AGA, respectively) by conventional echocardiography and Tissue Doppler Imaging. p‐FGR and p‐AGA infants were studied on postnatal Day One and all groups were studied at one and six months post‐term age.Resultsp‐FGR infants demonstrated increased cardiac sphericity compared to AGA peers on postnatal Day One (p=0.004) and at one month post‐term age (p=0.004). Posterior and relative wall thickness increased over time in the p‐FGR group only (p
  • Infant Brain Development. Formation of the Mind and the Emergence of
           Consciousness. By Hugo Lagercrantz. Springer International Publishing,
           Switzerland, 2016. 156 pp. ISBN 978‐3‐319‐44843‐5.
  • Does a procalcitonin‐guided approach to term and late‐preterm neonates
           with suspected early‐onset sepsis safely decrease unnecessary antibiotic
  • Do fidgety general movements predict cerebral palsy and cognitive outcome
           in clinical follow‐up of very preterm infants'
  • Shaken or Stirred' Evaluating the combination of
           budesonide–surfactant for survival free of bronchopulmonary dysplasia
  • Implementing higher oxygen saturation targets reduced the impact of poor
           weight gain as a predictor for retinopathy of prematurity
    • Abstract: AimThis study evaluated poor weight gain as a risk factor for infants who required treatment for retinopathy of prematurity (ROP), by comparing those born before and after the implementation of higher oxygen saturation (SpO2) targets at the Queen Silvia Children's Hospital, Gothenburg, Sweden.MethodsWe compared infants born at less than 31 weeks, who were screened and, or, treated for ROP: 127 in 2011–2012 when SpO2 targets were 88–92% and 142 in 2015–2016 when they were 91–95%. The subjects were reviewed for birth characteristics, weekly weight and ROP treatment. Data were analysed using the weight, insulin‐like growth factor 1, neonatal, ROP (WINROP) prediction tool.ResultsThe 2011–2012 infants who needed ROP treatment (12.6%) had significantly poorer postnatal weight gain than those who did not, but this was not seen in the treated (17.6%) and nontreated ROP groups in 2015–2016. WINROP sensitivity decreased from 87.5% in 2011–12 to 48% in 2015–2016.ConclusionAfter the SpO2 target range was increased from 88–92% to 91–95%, postnatal weight gain was no longer a significant risk factor and WINROP lost its ability to predict ROP requiring treatment. Risk factors clearly change as neonatal care develops.
  • Outcomes of infants with a birthweight less than or equal to 500 g in
           Northern England: 15 years experience
    • Abstract: AimWe aimed to evaluate mortality and short‐term neonatal morbidity of babies born ≤500 g cared for in the Northern Neonatal Network over a 15‐year period.MethodUsing regional databases, we identified all live‐born babies ≥22 weeks gestation and ≤500 g, in North East England and North Cumbria from 1998 to 2012. We quantified major neonatal morbidities and survival to one year.ResultsWe identified 104 live‐born babies ≥22 weeks gestation and ≤500 g (birth prevalence 0.22/1000), of which 49 were admitted for intensive care. Overall one‐year survival was 11%, but survival for those receiving intensive care was 22%. There was significant short‐term neonatal morbidity in survivors, in particular retinopathy of prematurity and chronic lung disease.ConclusionSurvival of babies born weighing ≤500 g in this cohort remains poor despite advances in neonatal care, with considerable short‐term neonatal morbidity in survivors. This could be due to a combination of attitudes and a rather conservative approach towards resuscitation and intensive care, and the intrinsic nature of these tiny babies.
  • It's all in the genes... well almost
  • Oxygen needs during resuscitation and surfactant to achieve stabilisation
           were independent risks factors for pulmonary interstitial emphysema in
           preterm infants
    • Abstract: AimPulmonary interstitial emphysema is a severe complication of mechanical ventilation in preterm infants that leads to air leakage and, or, chronic lung disease. We determined the associated risk factors.MethodsThis was a retrospective case–control study from 2005 to 2014 at a regional referral centre in Valencia, Spain. The cases were 54 preterm infants up to 30 weeks’ gestation and, or, born weighing less than 1500 g, who were diagnosed with pulmonary interstitial emphysema (PIE). The 54 controls were preterm infants without PIE matched by gestational age. Univariate analysis and multivariate analysis were performed to assess the independent predicting factors.ResultsInfants with PIE had been resuscitated with higher mean fractional inspired oxygen concentration (FiO2) (p = 0.008), had received higher peak mean positive end expiratory pressure (p = 0.00) and higher mean airway pressure (p = 0.026) 24 hours before diagnosis. PIE patients also received more surfactant (p = 0.00) and had higher mortality (p = 0.034). A Cox regression model identified that independent risk factors were the total amount of surfactant administered and the mean FiO2 during the 24 hours before diagnosis.ConclusionIndependent risk factors for pulmonary interstitial emphysema in preterm infants were higher oxygen during resuscitation and a higher need for surfactant and ventilatory pressures before diagnosis.
  • Issue Information
  • Highlights in this issue
  • Are men monkeys' Why are child healthcare professionals reluctant to
           include fathers in parenting support interventions'
  • Dysfunctional breathing in children and adolescents
  • Infantile retinal haemorrhages in the absence of brain and bodily injury
  • 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 
  • 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%–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.
  • Retrospective cohort study shows that the risks for retinopathy of
           prematurity included birth age and weight, medical conditions and
    • Abstract: AimThis study described the characteristics and risk factors of neonates who developed retinopathy of prematurity (ROP) and severe treatable ROP in two Egyptian neonatal intensive care units (NICUs).MethodsThis retrospective cohort study comprised 108 preterm neonates who were screened for ROP after being admitted to the two NICUs run by Cairo University Hospital from June 2014 to May 2015. Patients were examined using digital fundus photography and indirect ophthalmoscopy was performed if ROP was detected.ResultsRetinopathy of prematurity occurred in 75 patients. Late‐onset sepsis, ventilation and hypercapnia were independently associated with ROP. Patients who developed severe treatable ROP had a younger gestational age (GA) than patients who did not develop ROP or developed mild or moderate ROP (29 weeks, range 27–33 weeks versus 32 weeks, range 28–36 weeks, p = 0.002) and a lower birthweight (1200 g, range 980–1590 g versus 1460 g, range 770–2475 g, p = 0.029). The risk factors associated with severe treatable ROP included the duration of admission, the duration of incubator oxygen, late‐onset sepsis, intraventricular haemorrhage, total parenteral nutrition and the duration of caffeine citrate therapy.ConclusionThis study showed that the risks for ROP were wide‐ranging and included GA and weight, medical conditions and treatment.
  • Neural breathing pattern in newborn infants pre‐ and postextubation
    • Abstract: AimTo describe the neural breathing pattern before and after extubation in newborn infants.MethodsProspective, observational study. In infants deemed ready for extubation, the diaphragm electrical activity (EAdi) was continuously recorded from 30 minute before to two hours after extubation.ResultsTotal of 25 neonates underwent 29 extubations; 10 extubations resulted in re‐intubation within 72 hours. Postextubation, there was an increase in peak EAdi (EAdi‐max) and EAdi‐delta (peak minus minimum EAdi) in both groups. The pre‐ to postextubation change in EAdi‐max (8.9–11.1 μv) and EAdi‐delta (6–8 μv) was less in the failure group in comparison with the change in EAdi‐max (10.2–13.4 μv) and EAdi‐delta (6.3–10.6 μv) in the success group, (p = 0.02 and 0.01, respectively).ConclusionIn our neonatal cohort, extubation failure was associated with a smaller increase in peak and delta EAdi after extubation. If confirmed, these findings indicate an important cause of extubation failure in preterm infants.
  • Hypothermia at neonatal intensive care unit admission was not associated
           with respiratory disease or death in very preterm infants
    • Abstract: AimThis study investigated the association between hypothermia and respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD) or death in very preterm infants admitted to a Danish neonatal intensive care unit (NICU).MethodsWe studied 675 infants born at Aalborg University Hospital before 32 weeks and admitted to the NICU from April 1997 to December 2011. Hypothermia was defined as a core temperature of
  • Professionals’ positive perceptions of fathers are associated with more
           favourable attitudes towards including them in family interventions
    • Abstract: AimThis Université du Québec en Outaouais study examined professionals’ attitudes towards fathers, their perceived self‐efficacy when working with them and their perceptions of the importance of including fathers in family interventions.MethodsProfessionals in Québec, Canada, working in childcare fields such as education, social services, health, community services and management answered a self‐report questionnaire between 2013 and 2015. The 296 respondents (90% females) had a mean age of 39 (20–65), were from urban, semi‐urban and rural settings and provided services to families with children up to five years of age.ResultsSocial service professionals perceived fathers more negatively than did other professionals. Even though male professionals perceived fathers more negatively, they felt more confident working with them than did their female counterparts. Positive perceptions of fathers were associated with more favourable attitudes towards including them in family interventions, and this association was mediated by the professionals’ perceptions of their own self‐efficacy.ConclusionThe most negative attitudes were reported by social service professionals. Male professionals viewed fathers more negatively but were more confident working with them than were female colleagues. Improving professionals’ perceptions of fathers could help to promote their inclusion in family interventions.
  • Longitudinal study shows that depression in childhood is associated with a
           worse evolution of headaches in adolescence
    • Abstract: AimThe aim of this study was to examine the course of headache diagnosis, headache frequency, anxiety, comorbid depressive symptoms and school absenteeism in adolescents with migraine and tension‐type headaches five years after baseline.MethodsWe followed a group of 122 children with a mean age of 10.1 (±1.3) years, with headache from a paediatric migraine centre in Paris who had taken part in a previous study from September 2007 to June 2008. This five‐year longitudinal study took place in January to June 2012. The measures that were used included demographic variables, headache diagnosis, headache data and a psychological assessment.ResultsAt the five‐year point, about 22% of the children had become headache free, 34% had little to no disability, and 36% had a changed diagnosis. Moreover, a longer history of headache at baseline was associated with a worse evolution of headache at follow‐up. Lastly, high depression scores, but not anxiety, were a predictor of more headache disability at follow‐up.ConclusionHigh depression scores in childhood were a risk factor that was associated with persistence and worsening of headaches in adolescence. This suggests that mental health assessments should be carried out in paediatric headache pain clinics.
  • Children born extremely preterm had different sleeping habits at 11 years
           of age and more childhood sleep problems than term‐born children
    • Abstract: AimThis study explored whether extremely preterm (EPT) children had different sleep characteristics in childhood than children born at term and how neurodevelopmental disabilities (NDD) affected sleep in children born EPT.MethodsA Norwegian national cohort of 231 children born EPT from 1999 to 2000 and separate study data on 556 children born at term in 2001 were compared. Parental questionnaires mapped the children's current sleep habits at 11 years of age, namely the prevalence of sleep problems throughout childhood until this age and five categories of sleep problems. In addition, the EPT children were clinically assessed at five years of age.ResultsThe EPT children had different sleep habits than the controls, for example they went to bed earlier. EPT children had a higher prevalence of sleep problems than the controls throughout childhood (26% versus 14%, p < 0.001) and this was also higher for the 93 EPT children with no NDD (20%) than for the controls (14%) and increased with increasing NDD to 67% (p = 0.015) for the six children with severe NDD.ConclusionEPT children had different sleep habits to term‐born controls at 11 years of age, including those with no NDD. The prevalence of sleep problems increased with increasing NDD.
  • Boys have better short‐term and long‐term survival rates after
           intensive care admissions than girls
    • Abstract: AimWe investigated possible gender differences in paediatric intensive care morbidity‐adjusted mortality.MethodsIn this study, data on all 21 972 paediatric intensive care admissions in Sweden between 2008 and 2015 were analysed regarding morbidity‐adjusted survival, using Cox regression, with age, gender and estimated mortality ratio as dependent variables and using the standardised mortality ratio at 90 days after admission. The data were obtained from the Swedish Intensive Care Registry.ResultsWe found that boys had better overall survival than girls (hazard ratio 0.91 for boys, p = 0.035). In addition, the 90‐day survival was also better for boys (standardised mortality ratio 0.85 for boys versus 1.02 for girls, p = 0.0014). The survival advantage was most evident in children less than a year old and for nonsurgical patients. The male advantage was also seen in children admitted with respiratory insufficiency and seizures and was furthermore independent of any concurrent cardiac condition. We did not find any gender difference in the intensity of care or length of stay when corrected for morbidity.ConclusionThis study showed that boys have better outcomes than girls after intensive care admissions. The difference does not seem to be based on inequality of care.
  • Prenatal early food and multiple micronutrient supplementation trial
           reduced infant mortality in Bangladesh, but did not influence morbidity
    • Abstract: AimA previous maternal and infant nutrition intervention in rural Matlab, Bangladesh, showed that prenatal nutrient supplements improved child survival, but had no effect on size at birth. This secondary analysis examined whether prenatal multiple micronutrient supplements (MMS), on their own or combined with an early invitation to receive prenatal food supplements, affected child morbidity.MethodsThis randomised trial enrolled 4436 pregnant women from November 2001 to October 2003 and allocated them to early or standard invitations to food supplements, in the ninth and 20th weeks of pregnancy, respectively, and supplements of either the standard 60 mg iron with 400 μg folic acid, 30 mg iron with 400 μg folic acid or MMS. Quasi‐Poisson regression was used to analyse morbidity.ResultsThere were 3560 single live births and 3516 had morbidity data. The incidence rates of fever, diarrhoea and acute lower respiratory tract infection were 15.3, 3.6 and 2.3 episodes per person‐year, respectively. The separate or combined interventions had no effect on morbidity up to 24 months.ConclusionEarly invitations to prenatal food supplements or prenatal MMS had no effect on common infections in rural Bangladesh, suggesting that earlier findings on improved child survival were not mediated by an effect on child morbidity.
  • Self‐care management of type 1 diabetes has improved in Swedish schools
           according to children and adolescents
    • Abstract: AimAge‐appropriate support for diabetes self‐care is essential during school time, and we investigated the perceived quality of support children and adolescents received in 2015 and 2008.MethodsThis national study was based on questionnaires answered by children and adolescents aged 6–15 years of age with type 1 diabetes attending schools or preschools in 2008 (n = 317) and 2015 (n = 570) and separate parental questionnaires. The subjects were recruited by Swedish paediatric diabetes units, with 41/44 taking part in 2008 and 41/42 in 2015.ResultsFewer participants said they were treated differently in school because of their diabetes in 2015 than 2008. The opportunity to perform insulin boluses and glucose monitoring in privacy increased (80% versus 88%; p < 0.05). Most (83%) adolescents aged 13–15 years were satisfied with the support they received, but levels were lower in girls (p < 0.05). More subjects had hypoglycaemia during school hours (84% versus 70%, p < 0.001), but hypoglycaemia support did not increase and was lower for adolescents than younger children (p < 0.001).ConclusionChildren and adolescents received more support for type 1 diabetes in Swedish schools in 2015 than 2008, but more support is needed by girls and during hypoglycaemia.
  • National high‐flow nasal cannula and bronchiolitis survey highlights
           need for further research and evidence‐based guidelines
    • Abstract: AimHigh‐flow nasal cannula (HFNC) therapy provides noninvasive respiratory support for infant bronchiolitis and its use has increased following good clinical experiences. This national study describes HFNC use in Finland during a severe respiratory syncytial virus (RSV) epidemic.MethodsA questionnaire on using HFNC for infant bronchiolitis during the 2015–2016 RSV epidemic was sent to the head physicians of 18 Finnish children's hospitals providing inpatient care for infants: 17 hospitals answered, covering 77.5% of the infants born in Finland in 2015.ResultsMost (85%) HFNC was given on paediatric wards. The mean incidence for bronchiolitis treated with HFNC in infants under the age of one in 15 of 17 hospitals was 3.8 per 1000 per year (range: 1.4–8.1): one hospital did not supply the relevant data and one supplied a figure of 34.1 due to a different treatment policy. Instructions on how to start and wean HFNC therapy were present in 71% and 61% of the hospitals, respectively, weighted to the population. Providing weaning instructions was associated with shorter weaning times.ConclusionHigh‐flow nasal cannula was actively used for infants with bronchiolitis, with no substantial overuse. Randomised controlled studies are needed before any evidence‐based guidelines can be constructed for using HFNC in infant bronchiolitis.
  • DNA methylation profiles between airway epithelium and proxy tissues in
    • Abstract: AimEpidemiological studies of deoxyribonucleic acid (DNA) methylation in airway disease have largely been conducted using blood or buccal samples. However, given tissue specificity of DNA methylation, these surrogate tissues may not allow reliable inferences about methylation in the lung. We sought to compare the pattern of DNA methylation in blood, buccal and nasal epithelial cells to that in airway epithelial cells from children.MethodsSamples of blood, and buccal, nasal and airway epithelium were obtained from six children undergoing elective anaesthesia for adenotonsillectomy. DNA methylation was assessed at 450 000 5′‐C—phosphate—G‐3′ (CpG) sites using the Illumina HumanMethylation450 array.ResultsEighteen samples from all sites were suitable for analysis. Hierarchical clustering demonstrated that the methylation profile in nasal epithelium was most representative of that in airway epithelium; the profile in buccal cells was moderately similar and that in blood was least similar.ConclusionDNA methylation in blood poorly reflects methylation in airway epithelium. Future epidemiological studies of DNA methylation and airway diseases should consider measurement of methylation either in buccal cells or, preferably, in nasal epithelial cells.
  • C‐reactive protein concentrations can help to determine which febrile
           infants under three months should receive blood cultures during influenza
    • Abstract: AimWe explored whether C‐reactive protein (CRP) concentrations could indicate which infants with fever without source (FWS) should receive undergo blood culture tests during influenza seasons.MethodsThis retrospective study focused on patients under three months of age with FWS who had received blood culture tests at the West China Second University Hospital Paediatric Emergency Department during the influenza seasons from June 2013 to January 2015. The statistical analysis comprised specificity, sensitivity, multilevel likelihood ratios (LRs), receiver operating characteristic analysis and a multivariate logistic regression model.ResultsWe enrolled 592 febrile patients and 7.1% had bacteraemia, with levels falling with increasing age. According to the receiver operating characteristic analysis, the optimum threshold of CRP was 30.5 mg/L, and when the CRP level was higher than 30.5 mg/L, the positive LR of bacteraemia was 2.32. In patients aged 29–90 days, when the CRP level was higher than 5 mg/L, the negative LR of bacteraemia was 0.38. In the neonatal group, a CRP level of ≥30.5 mg/L had a positive LR of bacteraemia of 3.55.ConclusionWe found that CRP concentrations could indicate which febrile children under three months of age should undergo blood culture tests during influenza seasons.
  • A one‐step immune‐chromatographic Helicobacter pylori stool antigen
           test for children was quick, consistent, reliable and specific
    • Abstract: AimThis French study assessed a quick, noninvasive, immuno‐chromatographic, Helicobacter pylori (H. pylori) stool antigen test for detecting infections in children.MethodsWe enrolled 158 children, with a median age of 8.5 years (range eight months to 17 years), with digestive symptoms suggesting upper gastrointestinal tract disease. Upper digestive endoscopy was performed with gastric biopsy specimens for histology, a rapid urease test, culture test and quantitative real‐time polymerase chain reaction. The H. pylori stool antigen test was performed twice for each child and the results were compared to the reference method.ResultsThe reference methods showed that 23 (14.6%) of the 158 children tested were H. pylori positive. The H. pylori stool antigen test showed 91.3% sensitivity, with a 95% confidence interval (95% CI) of 86.9–95.6 and 97% specificity (95% CI 94.3–99.6), 30.84 positive likelihood ratio and 0.09 negative likelihood ratio. The test accuracy was 96.2% (95% CI 93.2–99.1). The two blinded independent observers produced identical H. pylori stool antigen test results and the Kappa coefficient for the H. pylori stool antigen test was one.ConclusionThe H. pylori stool antigen test was found to be a consistent, reliable, quick and specific test for detecting the H. pylori infection in children.
  • Severe neonatal hyperbilirubinaemia is frequently associated with long
           hospitalisation for emergency care in Nigeria
    • Abstract: AimThis study investigated the frequency and predictors of a long hospital stay (LHS) for severe neonatal hyperbilirubinaemia in Nigeria.MethodsLength of stay (LOS) for severe hyperbilirubinaemia was examined among neonates consecutively admitted to the emergency department of a children's hospital in Lagos from January 2013 to December 2014. The median LOS was used as the cut‐off for LHS. Multivariate logistic regression determined the independent predictors of LHS based on demographic and clinical factors significantly associated with the log‐transformed LOS in the bivariate analyses.ResultsWe enrolled 622 hyperbilirubinaemic infants with a median age of four days (interquartile range 2–6 days) and 276 (44.4%) had LHS based on the median LOS of five days. Regardless of their birth place, infants were significantly more likely to have LHS if they were admitted in the first two days of life (p = 0.008) – especially with birth asphyxia – or had acute bilirubin encephalopathy (p = 0.001) and required one (p = 0.020) or repeat (p = 0.022) exchange transfusions. Infants who required repeat exchange transfusions had the highest odds for LHS (odds ratio 4.98, 95% confidence interval 1.26–19.76).ConclusionSevere hyperbilirubinaemia was frequently associated with long hospitalisation in Nigeria, especially if neonates had birth asphyxia or required exchange transfusions.
  • National data study showed that adolescents living in poorer households
           and with one parent were more likely to be bullied
    • Abstract: AimThe aim of this study was to assess whether sociodemographic household characteristics were associated with which Swedish adolescents were more likely to be bullied.MethodsThe data were derived from the Swedish Living Conditions Survey and its child supplements from the survey years 2008–2011. The analyses included information on 3951 adolescents aged 10–18 years. Exposure to bullying was reported by adolescents, and information on sociodemographic household characteristics was reported by parents and obtained from official registers. Binary logistic regression was used to analyse the data.ResultsAdolescents were more likely to be bullied if they lived in households with no cash margin, defined as the ability to pay an unexpected bill of 8000 Swedish Kronor or about 800 Euros, and if they lived with just one custodial parent. In the unadjusted analyses, elevated risks were identified if adolescents lived in working class households and had unemployed and foreign‐born parents. However, these associations were at least partly accounted for by other sociodemographic household characteristics, in particular the lack of a cash margin.ConclusionThis study showed that Swedish adolescents living in households with more limited financial resources had an increased risk of being bullied, supporting results from previous international research.
  • Randomised controlled trial shows that co‐bedding twins may reduce
           birthweight recovery delay, parenteral nutrition weaning time and
  • Salivary cortisol circadian rhythm in infants at psychosocial risk showed
           more variations than previous studies of healthy full‐term infants
  • Are electromagnetic fields in incubators a risk factor for autism'
  • Optimising physiology for adolescents with dysautonomia
  • A possible way to assess tidal exhaled nitric oxide in neonates and
           infants treated with nasal continuous positive airway pressure
    • Abstract: The endogenous compound nitric oxide (NO) is released into the airways via inducible NO synthase (1),which has the capacity to produce NO when up‐regulated by pro‐inflammatory cytokines or exogenous factors, like hypoxia, bacterial toxins and viruses (2).Prematurely born infants are susceptible to various acute and chronic respiratory diseases, such as respiratory distress syndrome and bronchopulmonary dysplasia (BPD). BPD involves a range of lung function abnormalities and increases the risk of re‐hospitalisation (3).This article is protected by copyright. All rights reserved.
  • The self‐reported quality of life of Lithuanian children with asthma was
           comparable to Western populations
    • Abstract: AimQuality of life (QoL) has been widely researched among children with asthma in Western countries, but there is a lack of data from Eastern Europe, where the prevalence is relatively low, but hospital admission rates are higher. We evaluated the overall level and major determinants of QoL in Lithuanian children aged 5‐11 years with asthma.MethodsThis study was carried out in six asthma outpatient clinics in the two largest cities of Lithuania from January 2015 to July 2016. The children's QoL was measured using the Pediatric Quality of Life Inventory (PedsQL) asthma module, which was completed by the child and one parent.ResultsWe collected questionnaires from 226 children (68% boys) with a mean age of eight (±2) years: 65% had mild asthma, 31% had moderate asthma and 4% had severe asthma. One in 10 had been hospitalised in the preceding six months. The mean self‐reported QoL score was 74 and the parent‐reported QoL score was 73. QoL was associated with asthma severity and control, shortness of breath and the child's general health, but not socioeconomic factors.ConclusionThe overall level and major determinants of QoL in children with asthma in Lithuania were comparable with Western populations.This article is protected by copyright. All rights reserved.
  • National study shows that abusive head trauma mortality in Sweden was at
           least 10 times lower than in other Western countries
    • Abstract: AimThe validity of the diagnostic criteria for abusive head trauma (AHT) and its attributes have been widely debated. This national study investigated the possibility of false positive and false negative cases of fatal AHT in Sweden.MethodThis was a retrospective evaluation of the records of 733 deceased infants up to the age of 365 days who were examined during 1994–2013 at the six forensic medicine departments. All the records were scrutinised for possible cases of AHT.ResultsWe included 12 cases, out of which eight had been diagnosed as AHT. Of these 12 infants, eight had a concomitant disease or perinatal illness, five were born prematurely, and three were twins. Figures from other Western countries would suggest 6‐7 deaths per 100,000 per year in Sweden but in reality, there was a maximum possible incidence of 0.6 per 100,000 infants per year.ConclusionThe risk of unreported fatal AHT in Sweden was low and there may have been cases misdiagnosed as AHT. The at least 10 times lower incidence than has been reported from other Western countries, raises the question if previously reported higher incidences of fatal AHT have been exaggerated.This article is protected by copyright. All rights reserved.
  • Intravenous paracetamol was associated with closure of the ductus
           arteriosus in extremely premature infants
    • Abstract: AimSymptomatic patent ductus arteriosus may lead to serious complications in extremely preterm and extremely low birth weight infants and is often resistant to medication. We evaluated early intravenous paracetamol for pain prevention during respiratory therapy, in an attempt to understand the ductal treatment of such infants.MethodsOur cohort were 295 extremely preterm or extremely low birth weight infants, born at less than 28 weeks or 1,000g, respectively, who were treated in the neonatal intensive care unit of Oulu University Hospital from 2002‐2015, before and after intravenous paracetamol was introduced in June 2009. Ductal closure dates, paracetamol medication details, morbidities and mortality data were evaluated.ResultsIntravenous paracetamol was given to 128 infants, starting at a median of 4.4 hours age (range 0‐169 hours), with a mean total dosage of 212 mg/kg (range 7.5 ‐ 1175 mg/kg). We also included 167 controls who were mainly treated before we used intravenous paracetamol. Ibuprofen (p
  • Translating animal research from the laboratory to the neonatal clinical
           arena requires great caution
  • An epidemic of meningococcal disease in children in North Norway in the
           1970s and 1980s was dominated by a hypervirulent group B strain
    • Abstract: AimWe examined children hospitalised for invasive meningococcal disease, a leading cause of paediatric sepsis, in Troms county, North Norway, from 1973‐2016, including the epidemic in the 1970s and 1980s.MethodsThis study was a retrospective review of children under the age of 15 years who were hospitalised for meningococcal disease at the University Hospital of North Norway and Harstad Hospital. We studied hospital and bacteriological records to determine the incidence rates and phenotypes involved.ResultsThere were 300 cases under 15 years and an incidence rate of 17 per 100,000 cases for 1973‐2016. This was broken down into: 1973‐1980 (n=130, 49), 1981‐1990 (n=129, 39) and 1991‐2016 (n=41, 4.7), respectively. There were 21 (7%) deaths. Phenotype B:15:P1.7,16 was more common than the other phenotypes in the epidemic period before 1990 than after 1990 (p = 0.02) and had a significantly lower mortality rate than the other phenotypes (p = 0.04). Later years showed a more heterogenous phenotype distribution. Serogroup B was the dominant serogroup.ConclusionThe B:15:P1.7,6 strain was more prevalent during the Norwegian epidemic of invasive meningococcal disease, but had a significantly lower mortality rate. The phenotype distribution was more heterogeneous after 1990. The dominant serogroup was B.This article is protected by copyright. All rights reserved.
  • Performance of risk stratification criteria in the management of febrile
           young infants younger than three months of age
    • Abstract: AimWe evaluated the diagnosis, risk stratification and management of febrile infants under three months of age who presented to an Israeli pediatric emergency room (ER).MethodsThis retrospective study enrolled all febrile infants examined in the pediatric ER of Soroka Medical Center during 2010‐2013. The patients were classified into low‐risk and high‐risk subgroups and compared by age and ethnicity.ResultsOverall, 2,251 febrile infants (60.5% of Bedouin and 34.4% of Jewish ethnicity) were enrolled. Hospitalisation rates were higher among Bedouin versus Jewish infants (55% vs. 39.8%, p
  • Interpretation of pyuria in children with urinary tract infection
    • Abstract: Urinary Tract Infections (UTI) occurs in up to 7% of febrile infants and young children (1). The most common uropathogen is Escherichia coli (E.coli) (2). Significant growth of a known uropathogen and pyuria (≥10 white blood cells per cubic millimetre (≥10 WBC/mm3)) on urinalysis are essential to diagnose UTI (2). However certain uropathogens, such as non‐E.coli for example, are less likely to be associated with pyuria in symptomatic children (2).This article is protected by copyright. All rights reserved.
  • A Serratia marcescens outbreak in a neonatal intensive care unit was
           successfully managed by rapid hospital hygiene interventions and screening
    • Abstract: AimSerratia marcescens is a rare, but important, pathogen in hospital‐acquired infections, especially in neonatal units. Outbreaks may cause significant mortality among neonates. This paper describes how an outbreak of Serratia marcescens was handled in a neonatal intensive care unit in Finland in June 2015.MethodsTampere University Hospital is the only hospital that offers intensive care for preterm neonates in the Pirkanmaa health district area in Finland. Between 9 June to 29 June 2015 seven neonates were screened positive for Serratia marcescens in the hospital. We examined the management and outcomes, including environmental sampling.ResultsTwo of the seven neonates developed a blood stream infection and one with Serratia marcescens sepsis died after six days of antibiotic treatment. The outbreak was rapidly managed with active hospital hygiene interventions, including strict hand hygiene, cleaning, patient screening, contact precautions and education. Environmental sampling was limited to one water tap and a ventilator and the results were negative. The outbreak was contained within three weeks and no further cases appeared. The screening of healthcare workers was not necessary.ConclusionA Serratia marcescens outbreak caused significant morbidity in neonates and one death. Rapid hospital hygiene interventions and patient screening effectively contained the outbreak.This article is protected by copyright. All rights reserved.
  • Oxygen, weight gain, IGF‐1 and ROP: not a straight‐forward
  • Antenatal magnesium for preterm delivery reduces risk of cerebral palsy
           among surviving very preterm infants
  • Communication between healthcare professionals and parents is a key factor
           in involving parents in neonatal intensive care
  • Neonatal Eating Outcome Assessment: Tool Development and Inter‐rater
    • Abstract: AimTo define the process of tool development and revision for the Neonatal Eating Outcome (NEO) Assessment and to report preliminary inter‐rater reliability.MethodsTool development consisted of a review of the literature and observations of feeding performance among 178 preterm infants born ≤ 32 weeks gestation. 11 neonatal therapy feeding experts provided structured feedback to establish content validity and define the scoring matrix. The tool was then used to evaluate feeding in 50 preterm infants born ≤ 32 weeks gestation and 50 full term infants. Multiple revisions occurred at each stage of development. Finally, six neonatal occupational therapists participated in reliability testing by independently scoring five videos of oral feeding of preterm infants using version 4 of the tool.ResultsThe intraclass correlation for the “pre‐feeding” score was 0.71 (0.37‐0.96), and the intraclass correlation for the “total” score was 0.83 (0.56‐0.98).ConclusionThe “total” score had good to excellent reliability. Fleiss’ Kappa scores for all 18 scorable items ranged from slight agreement to moderate agreement. Items with lowest Kappa scores were revised, and additional feedback from therapists engaged in reliability testing was incorporated, resulting in final version 5.This article is protected by copyright. All rights reserved.
  • Skin‐to‐skin hospital transfers are physiologically sound and
           empower parents
    • Abstract: Medical care for newborn infants is provided at different levels, ranging from well‐baby nurseries to highly specialised intensive care units. There have been numerous studies on neonatal transport and most of them have been descriptive and, or, quality assessments (1,2) that have had a predominantly strong focus on intensive care transport. In this issue of Acta Paediatrica, Hennequin et al (3) describe their experience of transferring relatively well babies between hospitals using skin‐to‐skin care (STS) during transport.This article is protected by copyright. All rights reserved.
  • What we do in neonatal analgesia overshadows how we do it
    • Abstract: Studies on neonatal pain have skyrocketed in the last 10 years, according to a PubMed search, but pain treatment is still insufficient despite this high level of research. More than 50 pain scales have been validated and published for newborn infants, but only a few of these are used and not to any great extent (1). In addition, analgesic drugs and strategies continue to increase, but are still underused (1). This shows a gap between the data that academics produce in this field and the measures that clinicians put into practice.This article is protected by copyright. All rights reserved.
  • Systematic review found that there was moderate evidence that vaccinating
           healthcare workers prevented pertussis in infants
    • Abstract: This systematic review investigated the effectiveness of vaccinating healthcare workers against pertussis on the occurrence of nosocomial pertussis outbreaks or infections among unprotected infants. We focused on eight studies, with five different study designs, that involved 39,129 healthy adolescents and adults, 115 healthcare workers, 2,000 simulated healthcare workers and a simulated population of 200,000 people.ConclusionThere was moderate evidence that tetanus–diphtheria acellular pertussis vaccinations for healthcare workers were effective in preventing pertussis in all age groups and specifically in infants. The results must be interpreted with caution due to the low quality and heterogeneity of the studies.This article is protected by copyright. All rights reserved.
  • Longitudinal study showed that the quality of life of Finnish adolescents
           with cerebral palsy continued to be relatively good
    • Abstract: AimThis longitudinal study examined what perceptions paediatric patients with cerebral palsy (CP) and their caregivers had of the patient's quality of life (QoL). It examined changing trends as children with CP became adolescents and examined the feasibility of the Finnish version of the CP QOL‐Teen questionnaire.MethodsCarried out in autumn 2015, this study formed part of the multi‐centre Finnish national CP project and aimed to validate the CP QOL‐Teen questionnaire, which was posted to 54 adolescents and their caregivers. They included 24 who had responded to CP QOL‐Child questionnaire in 2013.ResultsThe questionnaires were returned by 27 pairs of adolescents and caregivers and one extra caregiver also responded. Of these, 24 pairs had taken part in the 2013 survey. The internal consistencies of the sum variables were found to be acceptable in all cases. Overall QoL showed an average score of 81.8 on a scale from 0‐100. Adolescents reported significantly higher QoL than their caregivers. There were no significant differences between the responses of the children and adolescents.ConclusionWe showed that QoL was relatively good in childhood and adolescence. The Finnish version of the CP QOL‐Teen questionnaire was an appropriate clinical tool for assessing QoL.This article is protected by copyright. All rights reserved.
  • The early signs of reading difficulties at school can start with foetal
           growth restriction
  • Teamwork and conflicts in paediatric end‐of‐life care
  • IMPACT‐III is a valid and reliable questionnaire for assessing
           health‐related quality of life in Swedish children with inflammatory
           bowel disease
    • Abstract: AimThis study examined the reliability, validity and factor structure of the Swedish version of the IMPACT‐III questionnaire for assessing health‐related quality of life in children with inflammatory bowel disease.MethodsWe recruited 202 participants aged 8‐18 years, who were enrolled from 16 of the 23 paediatric gastroenterology clinics across Sweden during 2010‐2013. This cross‐sectional study compared two versions of the IMPACT‐III questionnaire – one with six factors and 35 items and one with four factors and 19 items ‐ plus the Pediatric Quality of Life Inventory 4.0 Generic Core Scale. Disease activity was assessed and defined as active or inactive.ResultsThe mean total score for the six‐factor IMPACT‐III scale was 143.7/175, with a standard deviation (SD) of 17.9. There was a significant difference in mean total scores between the 133 children with inactive disease (147.8, SD 14.9) and the 52 with active disease (133.0, SD 20.3). Confirmatory factor analysis showed that the four‐factor scale was more robust than the original six‐factor scale. Concurrent validity and discriminant validity were high for both versions.ConclusionThe Swedish version of the IMPACT‐III questionnaire was valid and reliable, but the shorter, four‐factor version is quicker and may be more convenient in clinical settings.This article is protected by copyright. All rights reserved.
  • Functional variants in intercellular adhesion molecule‐1 and toll‐like
           receptor‐4 genes are more frequent in children with febrile urinary
           tract infection with renal parenchymal involvement
    • Abstract: AimWe studied the functional polymorphisms of intercellular adhesion molecule‐1 and toll‐like receptor‐4 genes and risk of acute pyelonephritis in children attending Assiut University Children's Hospitals, Egypt from 2011 to 2015.MethodsUrinary tract infections (UTIs) were diagnosed in 380 children: 98 had acute pyelonephritis and 282 had lower UTIs. Four single‐nucleotide polymorphisms in intercellular adhesion molecule‐1 and toll‐like receptor‐4 genes were genotyped in all subjects: ICAM‐1 rs1799969 Gly241Arg, ICAM‐1 rs5498 Glu469Lys, TLR‐4 rs4896791 Thr399Ile and TLR‐4 rs4896790 Asp299Gly.ResultsPatients with acute pyelonephritis were significantly more likely to have AA genotype of the ICAM‐1 rs5498 (1462 A/G) polymorphism (p=0.04) than children with lower UTIs and the TLR‐4 Asp299Gly GG genotype (p=0.002) and G allele (p=0.006) than healthy controls.. The association with the ICAM‐1 Glu469Lys (1462A/G) was less evident. The GG genotype was associated with a modest relative risk of 1.4 (p=0.1) of developing acute pyelonephritis, but was not an independent odds ratio, at 1.2 (p=0.48).ConclusionFunctional variants in intercellular adhesion molecule‐1 and toll‐like receptor‐4 genes were increasingly common in children with febrile UTIs with renal parenchymal involvement, but the ICAM‐1 Glu469Lys (1462A/G) association was less evident. TLR4 Asp299Gly might independently increase renal parenchymal infection rather than renal scarring.This article is protected by copyright. All rights reserved.
  • Elevated serum adipsin may predict unsuccessful treatment for cows' milk
           allergy but other biomarkers do not
    • Abstract: AimThis study evaluated whether 15 allergy, immunology or inflammatory markers predicted the long‐term use of cows’ milk or milk products seven years after the start of oral immunotherapy (OIT) for cows’ milk allergy in children.MethodsThe following laboratory parameters were measured before the OIT at Tampere University Hospital, Finland, and after the six‐month escalation phase: serum total immunoglobulin (Ig) E, milk‐specific IgG and IgG4, eosinophil cationic protein, eosinophil‐derived neurotoxin, interleukins 4, 5, 6,10 and 12p70 and serum adipokines adiponectin, adipsin, leptin and resistin. Follow‐up data from a seven‐year phone questionnaire in 2015 were available for 24 children: 14 successful and 10 unsuccessful milk users.ResultsThere were no significant differences in any of the 15 markers measured at the start of the study between the subjects who later formed the successful and unsuccessful groups. At the end of the six‐month escalation phase of OIT, serum adipsin was higher in the group who were unsuccessful milk users at the seven‐year follow‐up study.ConclusionNone of the 15 allergy, immunology or inflammatory markers were useful in predicting the outcome of OIT. Preliminary evidence was found that high serum adipsin after the six‐month escalation phase of OIT might predict unsuccessful outcome.This article is protected by copyright. All rights reserved.
  • Severe obesity is a limitation for the use of body mass index standard
           deviation scores in children and adolescents
    • Abstract: AimWe analysed the distribution of the body mass index standard deviation scores (BMI SDS) in children and adolescents seeking treatment for severe obesity, according to the International Obesity Task Force (IOTF), World Health Organization (WHO) and the national Norwegian Bergen Growth Study (BGS) BMI reference charts and the percentage above the International Obesity Task Force 25 cut‐off (IOTF‐25).MethodsThis was a cross‐sectional study of 396 children aged 4‐17 years, who attended a tertiary care obesity centre in Norway from 2009‐2015. Their BMI was converted to SDS using the three growth references and expressed as the percentage above IOTF‐25. The percentage of body fat was assessed by bioelectrical impedance analysis.ResultsRegardless of which BMI reference chart was used, the BMI SDS was significantly different between the age groups, with a wider range of higher values up to 10 years of age and a more narrow range of lower values thereafter. The distributions of the percentage above IOTF‐25 and percentage of body fat were more consistent across age groups.ConclusionsOur findings suggest that it may be more appropriate to use the percentage above a particular BMI cut‐off, such as the percentage above IOTF‐25, than the IOTF, WHO and BGS BMI‐SDS in paediatric patients with severe obesity.This article is protected by copyright. All rights reserved.
  • Norepinephrine infusion improves hemodynamics in the preterm infants
           during septic shock
    • Abstract: AimThis study evaluated the clinical and hemodynamic effects of norepinephrine infusion in preterm infants.MethodsThe effects of norepinephrine therapy for refractory hypotension were evaluated in preterm infants between April 2009 and April 2011 at the neonatal intensive care unit of Sainte‐Justine Hospital, Montreal, Quebec. Changes in hemodynamics and clinical parameters were analyzed eight hours before and eight hours after the start of norepinephrine infusion, and eight hours after its cessation.ResultsDuring the study, 30 preterm infants at a mean gestational age of 26.5 ± 2.6 weeks (median 25.7, 23.4 – 34) and birth weight of 903 ± 437 g (median 827, 450 – 2550) received norepinephrine infusion for neonatal septic shock. After 8 hours of treatment, mean blood pressure, urine output and FiO2 significantly improved. Eight hours after cessation of norepinephrine infusion, the number of patients treated with other inotropes decreased significantly, 24 patients (80%) had normal mean blood pressure and 27 patients (90%) had normal urine output.ConclusionNorepinephrine therapy could be considered to improve blood pressure and urine output during neonatal septic shock in preterm infants. Further studies are needed to prove the efficacy and safety of norepinephrine infusion in neonates.This article is protected by copyright. All rights reserved.
  • High Blood Pressure in the Young: Why Should We Care'
    • Abstract: While primary hypertension clearly occurs in children and adolescents, the approach of many providers to such patients can best be described as ambivalent: the condition may be recognized, but is not acted upon. Such ambivalence may stem from incomplete understanding of the effects of high blood pressure in the young, which in turn is related to the shortage of information on long‐term outcomes of primary childhood hypertension. However. other evidence on the short and long‐term effects of blood pressure elevation in childhood clearly show that it is not a benign condition at allConclusionChildhood hypertension warrants action to prevent adult cardiovascular disease.This article is protected by copyright. All rights reserved.
  • Children in out‐of‐home care are at high risk of somatic,
           dental and mental ill health
    • Abstract: AimThe Swedish Social Board has implemented a support strategy to guide out‐of‐home care for children, which translates as children's needs in focus (CNIF) and includes a systematic health assessment. It was fully introduced into the Skåne province in 2012 and our study covered the first four years of the CNIF health assessments, from 2012‐2015.MethodsWe studied children aged 0–17 years in out‐of‐home care who had been referred by social workers for a CNIF health assessment, using their medical records to investigate both their health and the value of the health assessments.ResultsFrom 2012‐2015 only 409 (6%) of the 11,413 children in out‐of‐home care were referred for health assessments. Their health issues included: depression and anxiety (29%), poor dental health (30%), seeking medical care for traumatic injuries (36%), previous contact with child psychiatry services (38%) and missed medical appointments (36%), dental appointments (36%) and child health programme appointments (39%). In addition 10% of the girls and 9% of the boys were obese.ConclusionThis study found high levels of wide‐ranging health issues. Despite national Swedish guidelines and policies, only 6% of the children in out‐of‐home care were referred by social workers for a CNIF health assessment.This article is protected by copyright. All rights reserved.
  • The distance between the delivery room and neonatal intensive care unit
           had no impact on the respiratory management of preterm infants at birth
    • Abstract: The respiratory management of extremely low birth weight (ELBW) infants is crucial during the postnatal stabilisation phase, as it has potential short and long‐term consequences (1). Ideally, the neonatal intensive care unit (NICU) should be located near the delivery area (1). We hypothesised that a longer distance between the delivery room and NICU could encourage clinicians to favour invasive respiratory support for ELBW infants to maximise their safe transport to the NICU.This article is protected by copyright. All rights reserved.
  • Serum complement factor 5a levels are associated with non‐alcoholic
           fatty liver IL‐6 disease in obese children
    • Abstract: AimNonalcoholic fatty liver disease (NAFLD) is a leading cause of progressive and chronic liver injury. Complement factor 5a (C5a) may be involved in many inflammation disorders. This study investigated levels of systemic C5a in patients with and without NAFLD and lean controlsMethodsA cross‐sectional study was conducted from July 2012 to June 2013 among 96 Chinese children, aged 6‐17 years, recruited from the Pediatric Department of the Second Affiliated Hospital of Xi'an Jiao Tong University: 40 obese children with NAFLD, 31 obese children without NAFLD and 25 lean controls. Anthropometric parameters, clinical data and circulating C5a levels were measured.ResultsObese children had higher serum concentrations of complement factor C5a compared with lean controls, especially in obese children with NAFLD. C5a was positively correlated with body mass index, waist circumference, diastolic blood pressure, triglycerides and homeostasis model of insulin resistance, independent of their body mass index standard deviations score and age. Of the well‐known risk factors, C5a was a significant predictor of NAFLD in obese children.ConclusionSerum C5a was elevated in obese children, especially in those with NAFLD and it may be proposed as a novel marker to predict advanced disease.This article is protected by copyright. All rights reserved.
  • Challenging intra‐institutional moral complicity
    • Abstract: I would like to thank Kaempf et al, for expressing their thoughts (1) about my critique of the Providence Periviablilty Guidelines. Their response highlights precisely why I wanted to seem my Different View paper published in Acta Paediatrica (2). I appreciate the opportunity to address their comments.This article is protected by copyright. All rights reserved.
  • Families’ perceived benefits of home visits for managing paediatric
           obesity outweigh the potential costs and barriers
    • Abstract: AimHome visits have successfully been used to deliver various health services, but what role could they play in paediatric weight management' Low treatment initiation and high attrition prompted our multidisciplinary paediatric weight management clinic to investigate how families perceived the benefits and barriers of home visits.MethodsWe focused on children with obesity aged 2‐17 who were enrolled in our tertiary‐level clinic in Alberta, Canada. None had received a home visit. The families were interviewed face‐to‐face from October 2015 to October 2016 and we used a qualitative description methodological framework and manifest content analysis. The parents were the main interviewees.ResultsOf the 56 families, 89% were interested in a home visit, 82% wanted support from a dietician and 54% from an exercise specialist. The perceived benefits of home visits included comprehensive assessment (95%), convenience (86%), tailored care (29%) and family involvement (13%), while the costs and barriers included clinicians’ potential judgmental attitudes (30%), loss of privacy (19%) and distractions (10%). Some thought clinicians would find home visits inconvenient (25%), with bureaucratic challenges (14%) and sustainability issues (5%).ConclusionFamilies felt home visits were a convenient option for managing paediatric obesity and identified important benefits and barriers that could guide such interventions.This article is protected by copyright. All rights reserved.
  • High‐sensitivity C‐reactive protein concentration in young adults in
           the Helsinki Study of Very Low Birth Weight Adults
    • Abstract: Low birth weight and chronic low‐grade inflammation have been significantly associated with an increased risk of cardiovascular disease (CVD) (1,2). C‐reactive protein (CRP) is a highly sensitive biomarker that is used to detect the inflammation associated with predictive factors related to CVD, such as atherogenesis or atherosclerosis (3). Adults born preterm at a very low birth weight (VLBW) of less than 1,500g represent the low end of the low birth weight spectrum and have increased levels of CVD risk factors (4). Follow‐up population studies have reported higher CRP concentrations in low birth weight children and adults (5, 6, 7) but the effect of VLBW on CRP in young adulthood needs to be further explored. We examined the effect of VLBW on CRP concentrations in a cohort of VLBW and control subjects and considered whether conditions that occurred prenatally, at birth or during later life contributed to inflammation in young adulthood.This article is protected by copyright. All rights reserved.
  • Arterial catheterisation in neonates can result in severe ischaemic
           complications but does not impair long‐term extremity function
    • Abstract: AimWe evaluated the incidence of arterial catheterisation and analysed the risk factors and the extent and outcome of ischaemic complications in neonates.MethodsThis was a retrospective cohort study of 1,506 neonates admitted to two, 10‐bed neonatal intensive care units (NICUs) at the Medical University of Vienna, Austria, between 1 January 2011 and 31 December 2014. Medical charts, daily reports and photo documentation were reviewed for arterial catheterisation and ischaemic complications. Patients with severe ischaemic complications were followed up to evaluate extremity function, scaring and cosmetic results.ResultsThere were 542 arterial catheterisations in 485 patients, including 275 born below 28 weeks, which resulted in severe complications in 19/485 (4%) patients. Three died before follow up. Patients with complications had a significantly lower birth‐weight, lower postmenstrual age and higher rates of intracranial haemorrhage, retinopathy of prematurity and necrotising enterocolitis. They had also undergone multiple arterial catheterisations more often, needed longer inotropic support and had longer NICU stays than patients without complications. Extremity function was unimpaired in 10/16 patients with severe ischaemic complications.ConclusionSevere ischaemic complications in neonates following arterial catheterisation were rare events, but could cause devastating damage. Most patients didn't show impaired extremity function at follow up.This article is protected by copyright. All rights reserved.
  • Near‐infrared spectroscopy is a promising non‐invasive technique for
           monitoring the effects of feeding regimens on the cerebral and splanchnic
    • Abstract: AimThe effects of different milk and, or, administration regimens on cerebro‐splanchnic perfusion are still a matter of debate. We investigated the effects of the bolus administration of breast milk or formula on cerebro‐splanchnic oximetry, function and perfusion, assessed by near‐infrared spectroscopy (NIRS).MethodsThis observational study of 30 infants fed with breast (n=15) or formula (n=15) milk, and matched for gestational age and birth weight, was carried out in the neonatal intensive care unit of the C Arrigo Children's Hospital, Alessandria, Italy, a tertiary level referral centre, from October 2015 to December 2016. NIRS monitoring parameters, such as cerebral and splanchnic oximetry, fraction of tissue oxygen extraction and the cerebral‐splanchnic ratio, were recorded before, during and after feeding.ResultsBreast milk led to a significant increase in cerebro‐splanchnic oximetry and tissue oxygen extraction (p
  • Parents spend an average of nine hours a day providing palliative care for
           children at home and need to maintain an average of five life‐saving
    • Abstract: AimThis Italian study investigated home‐based palliative care for young children and how long it took parents to meet their needs.MethodsThe study population consisted of 33 families with a child under the responsibility of the Veneto Regional Center for Pediatric Palliative Care, northern Italy, who needed medical support in at least two of the following areas: respiratory, feeding, pain and seizures.ResultsThe children had a mean age of 6.8 ±4.7 years. We found that 72% of the patients needed medical devices for feeding, 36% had a tracheostomy and 55% were on mechanical ventilatory support. The children needed an average of five different life‐supporting medical appliances and the time taken to provide for their care increased significantly with each additional appliance (p=0.016). Their most time‐consuming daily needs were feeding (174 minutes) and support when they woke up at night (67 minutes). The average daily time that parents spent taking care of their child amounted to eight hours and 54 minutes per day.ConclusionParents providing palliative care for children with life‐limiting diseases spent an average of nine hours a day caring for them each day and had to maintain an average of five medical appliances.This article is protected by copyright. All rights reserved.
  • Early hydrocortisone improves survival without bronchopulmonary dysplasia
           in extremely preterm born infants
  • Marshall H. Klaus M.D., A Life Sketch
  • Treatment methods for respiratory syncytial virus bronchiolitis need to be
           evaluated before they are introduced on a large scale
  • Symptom management and psychological support for families are the
           cornerstones of end‐of‐life care for children with spinal muscular
           atrophy type 1
    • Abstract: AimThis study described end‐of‐life care for children affected by spinal muscular atrophy type 1 (SMA1), which is characterised by progressive muscle weakness and develops in the first six months of life.MethodsWe retrospectively analysed 17 children (13 boys) who attended the University of Padua's paediatric palliative care centre in Italy from March 2000 to March 2015. All the children received supportive care without proactive respiratory intervention to prolong survival.ResultsThe median age at admission was 3.57 months and the median age at death was 6.80 months. The most frequent symptoms were dyspnoea and pain. In the last 72 hours of life 15/17 children required more intense doses of morphine and, or, benzodiazepines for intractable dyspnoea and pain, but deep palliative sedation was not needed. Airway suction to manage secretions and nasogastric tubes were required in all cases. The place of death was previously planned by the parents in all cases ‐ home, hospital or hospice ‐ and 15/17 deaths occurred in that place. We also interviewed 16 of the 17 parents after their child died.ConclusionOur study found that symptom management and psychological support for families were the cornerstones of end‐of‐life care for children with SMA1.This article is protected by copyright. All rights reserved.
  • Performing a urine dipstick test with a clean‐catch urine sample is an
           accurate screening method for urinary tract infections in young infants
    • Abstract: AimThis study evaluated using urine dipstick tests with the clean‐catch method to screen for urinary tract infection (UTI) in febrile infants under 90 days of age.MethodsWe carried out a comparative diagnostic accuracy study of infants under 90 days old, who were studied for unexplained fever without any source, in the emergency room of a hospital in Madrid from January 2011 to January 2013. We obtained matched samples of urine using two different methods: a clean‐catch, standardised stimulation technique and catheterisation collection. The results of the leucocyte esterase test and nitrite test were compared with their urine cultures.ResultsWe obtained 60 pairs of matched samples. A combined analysis of leukocyte esterase and, or, nitrites yielded a sensitivity of 86% and a specificity of 80% for the diagnosis of UTIs in clean‐catch samples. The sensitivity of leukocyte esterase and, or, nitrites in samples obtained by catheterisation were not statistically different to the clean‐catch samples (p=0.592).ConclusionPerforming urine dipstick tests using urine samples obtained by the clean‐catch method was an accurate screening test for diagnosing UTIs in febrile infants of less than 90 days old. This provided a good alternative to bladder catheterisation when screening for UTIs.This article is protected by copyright. All rights reserved.
  • Assessing bone development in preterm infants using quantitative
           ultrasonography showed a decline in the early postnatal period
    • Abstract: AimPreterm infants have an insufficient bone mineral store at birth and this study explored their bone development during the early postnatal period.MethodsThe metacarpal speed of sound (mcSOS) and metarcarpal bone transmission time (mcBTT) were used to assess bone development in 277 preterm infants, admitted to the neonatal intensive care unit of the VU University Medical Center, Amsterdam, the Netherlands from 2007‐2012.ResultsDuring the first nine postnatal weeks the mcSOS declined from 10‐38 meters per second per week and the mcBTT declined from 20 to 71 nanoseconds per week. The pattern of change in both of these measurements showed a significant difference between infants born before 32 weeks of gestation (p = 0.048) and those born between 28‐32 weeks of gestation (p = 0.008). There was a borderline significant difference in the pattern of change of the mcBTT in infants with a protein intake below two grams per kilogram per day versus a higher intake (p = 0.050).ConclusionThe mcSOS and mcBTT of preterm infants showed a small to moderate decline during the early postnatal period. Future studies should explore the clinical relevance of this decline and develop interventions to halt it.This article is protected by copyright. All rights reserved.
  • Using the Sophia Observational Withdrawal Scale improved the assessment of
           paediatric iatrogenic withdrawal symptoms
    • Abstract: Analgesia and sedation are standard practice when paediatric intensive care patients receive mechanical ventilation. Prolonged exposure to opioid and benzodiazepine leads to an increased risk of withdrawal symptoms when medication ceases or patients are weaned off them (1).When we were updating our local clinical guidelines for managing withdrawal symptoms, we identified the need to improve the assessment of withdrawal symptoms.This article is protected by copyright. All rights reserved.
  • Respiratory morbidity was an important consequence of prematurity in the
           first two years after discharge in three cohorts from 1996‐2009
    • Abstract: AimThis study aimed to evaluate the respiratory morbidity of preterm infants in the first two years after discharge in three cohorts from 1996‐2009.MethodsWe included infants with a gestational age from 25+0 to 29+6 weeks, who were born in 1996‐1997, 2003‐2004 and 2008‐2009 at the Leiden University Medical Center in the Netherlands. The following parameters were recorded: bronchopulmonary dysplasia (BPD), defined as oxygen demand or positive pressure at 36 weeks, mortality, duration of supplemental oxygen, discharge with supplemental oxygen and a nasogastric feeding tube, rehospitalisation and the use of inhaled medication.ResultsIn line with our protocols, 106, 120 and 156 infants were analysed in the three study periods and 29%, 22% and 18% were diagnosed with BPD. Respiratory morbidity did not change over time in infants with and without BPD, except for an increase in rehospitalisation for respiratory issues in infants with BPD. This decreased in infants without BPD. Respiratory morbidity occurred more frequently in infants with BPD than without BPD, but this was not statistically significantConclusionThis study showed that when cohorts of preterm infants were compared over time, respiratory morbidity in the first two years of life remained an important consequence after discharge.This article is protected by copyright. All rights reserved.
  • The Internet Game Use‐Elicited Symptom Screen proved to be a valid tool
           for adolescents aged 10‐19 years
    • Abstract: AimThis study tested the diagnostic validity of the nine‐item Internet Game Use‐Elicited Symptom Screen (IGUESS) tool, which was developed by the authors after the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, identified Internet gaming as a condition that needed further study.MethodsA self‐report screening test comprising IGUESS and the Young's Internet Addiction Test was administered to 121 adolescents (74% boys) with a median age of 14 (range 10 to 19) recruited from school and health settings in Korea, After the screening, a clinician conducted one‐to‐one interviews with all of the subjects to set a gold standard for diagnosis.ResultsThe sensitivity and specificity of IGUESS were 87.0% and 86.7%, respectively, for a cut‐off score of 10 points, with an area under the curve value of 0.93. Its reliability, as determined by Cronbach's alpha, was 0.94, and the correlation coefficient between IGUESS and the Young's Internet Addiction Test was r = 0.902.ConclusionThe findings suggest that a cut‐off score of 10 is appropriate for administering the IGUESS in various community‐based settings, including schools, to screen for potential subjects in need of further assessment for Internet gaming problems.This article is protected by copyright. All rights reserved.
  • Number needed to suffer'
    • Abstract: I was surprised to read in the “different view” article that Dr Lönnqvist believes that “disability‐free survival” is a new concept (1). “Disability‐free survival” is unfortunately a widespread concept in neonatology, with literally hundreds of publications addressing the combined outcome of “death or NDI”. It is a concept which I and others have severely criticised for several years (2), and which is criticised also by parents (3).This article is protected by copyright. All rights reserved.
  • Music exposure and maturation of late preterm sleep‐wake cycles: A
           randomized crossover trial
    • Abstract: AimTo determine the effect of music on sleep‐wake cycle (SWC) patterns in late preterm neonates.MethodsIn a masked crossover study, infants between 32‐36 6/7 weeks gestation were randomized to music exposure either during the first six or last six hours of a 12‐hour observation period. SWC characteristics were determined by continuous amplitude integrated electroencephalography (aEEG) read by two coders masked to exposure sequence. Analysis was done in paired comparisons. ANOVA was used to assess the effects of music exposure, period and crossover on SWC outcomes: 1) Burdjalov Scores (BS) during active sleep (AS) 2) percent and duration of quiet sleep (QS).ResultsThirty infants were studied. A total of 222 quiet sleep cycles (median seven per patient; range five to 12) were analyzed. Music exposure was associated with higher BS (F= 10.60, p = 0.0019) in active sleep and decreased interruptions during QS. The advanced post conceptual age (PCA) SWC pattern during AS was equivalent to a one‐week mean. Number, duration and ratio of quiet sleep cycles did not change with music exposure.ConclusionMusic exposure elicits an increasing PCA pattern in active sleep and fewer interruptions in quiet sleep. Music may benefit sleep in late preterm infants.This article is protected by copyright. All rights reserved.
  • Follow‐up protocol was useful for children whose parents attended
           emergency departments after partner violence, substance abuse or a suicide
    • Abstract: AimThis was a one‐year follow up of families referred to support services after the parents visited the emergency department due to intimate partner violence, substance abuse or a suicide attempt. Its aim was to evaluate the wellbeing of any children.MethodsData on families identified a year earlier by the Amsterdam Protocol were gathered from child protective services and parent and child self‐reports in two Dutch regions from 2012‐2015.ResultsWe included 399 children (52%) boys with a median age of eight years (range 1‐18) in the study using child protective services data. Of the 101 families who participated in the first measurement, 67 responded one year after the parent's emergency department visit. The results showed that 20% of the children had no or minor problems, voluntary support services were involved in 60% of cases and child protective services in 20%. Compared to their first assessment a year earlier, the children's psychosocial problems had not increased, but this could have been an underestimation due to selective responses.ConclusionThe Amsterdam protocol was valuable in referring families to voluntary support services, but given the on‐going problems in some families, professionals need to carefully monitor whether support services are sufficiently effective.This article is protected by copyright. All rights reserved.
  • Evaluation of neonatal transport in a European country shows that regional
           provision is not cost‐effective or sustainable and needs to be
    • Abstract: AimThere are three dedicated and 41 on‐call neonatal emergency transport services (NETS) in Italy and activity levels vary dramatically. We examined the cost‐effectiveness of a hub‐and‐spoke NETS by looking at the costs and activity levels in the Liguria region and established the financial needs for improving NETS across Italy.MethodsThe cost of running NETS in the Liguria region from 2012‐2015 was evaluated and analysed and three different models determined the transports needed each year to provide the best organisational model.ResultsThe average number of NETS transports in the Liguria region during the study period was 234 and the models indicated that 200‐350 transports per year was the optimal amount of activity that was needed to achieve good financial performance and for the personnel to acquire a suitable skill set. Only five of the 41 on‐call Italian NETS and the three dedicated services carried out more than 200 transports a year. Of the rest, 26 carried out up to 100 and 10 carried out 101‐200.ConclusionItalian NETS, which is managed on the basis of regional decisional autonomy, is expensive and no longer sustainable in this era of limited financial resources. A complete overhaul is urgently needed.This article is protected by copyright. All rights reserved.
  • National allergy programme had little impact on parent‐reported food
           allergies in children aged 6‐7 years
    • Abstract: AimThe ten‐year Finnish national allergy programme was launched in 2008 to lessen the disease and psychological burden of allergy. This study assessed the prevalence of parent‐reported food allergies requiring avoidance diets at primary school in children aged six and seven years.MethodsThe cohort comprised 1,937 children (51% boys) who started primary school in Tampere, Finland in August 2016. School health nurses charted parent‐reported, doctor‐diagnosed food allergies requiring avoidance diets as part of the routine health examination.ResultsWe found that 127 (6.6%) children had parent‐reported, doctor‐diagnosed allergies to at least one food and 37 (1.9%) were allergic to basic foods, namely cows’ milk, wheat and one other grain. All required an avoidance diet. The figure did not differ significantly from the 2.7% and 2.5% found by studies of this age group in 2009 and 2013, respectively. Allergies to fresh fruit and vegetables decreased from 5.8% in 2009 to 3.6% in 2016.ConclusionWe studied the national allergy programme that started in 2008 and found that there was a non‐significant overall decrease in the number of children aged 6‐7 on avoidance diets for allergies between 2009‐2016. The only allergies that showed signficiant decreases were fresh fruit and vegetables.This article is protected by copyright. All rights reserved.
  • Persistent pain in neonates: challenges in assessment without the aid of a
           clinical tool
    • Abstract: AimEvaluation of comfort and pain in neonates is important for management. Specific signs of persistent pain in neonates remain undefined; few validated clinical tools assess persistent pain. We sought to determine (i) difficulty perceived by staff and parents in assessing comfort/persistent pain in babies, (ii) strategies employed when no clinical tool is used (iii) variation between clinicians’ assessments.MethodsParent and staff questionnaires addressed difficulty in assessing pain/comfort in neonates and strategies used in making assessments.Results47/50 (94%) parents and 83/91 (91%) staff participated. 50% of staff reported it was moderately/very difficult to assess persistent pain, and 13% very easy. 75% of parents found it moderately/very easy and 23% difficult to assess their baby's comfort. 15% of parents thought staff found pain assessment difficult. Staff described 94 different factors indicative of comfort and 139 factors of persistent pain. Terminology differed widely and was often non‐specific. 67% of staff described forming a ‘general impression’ConclusionPain assessment is challenging for staff. Most parents feel confident in assessing their babies’ comfort, but may overestimate the ease with which staff can do so. Indicators of persistent pain/comfort are poorly defined; staff use differing, subjective assessments, which may complicate communication between carers.This article is protected by copyright. All rights reserved.
  • Sex and maturity status affected the validity of a submaximal cycle test
           in adolescents
    • Abstract: AimThis study assessed the validity and reliability of the Ekblom‐Bak (EB) submaximal cycle test in adolescents and identified any sex or maturity‐related factors for prediction errors.MethodsWe recruited 50 healthy subjects through a public announcement in Stockholm, Sweden, in 2016. The 27 boys and 23 girls were aged 10‐15 years and in Tanner stages I‐IV. They performed an EB test and incremental treadmill running test for direct measurement of maximal oxygen uptake (VO2max).ResultsThe estimation error of VO2max was 0.09 L/min. The correlation (r) was 0.86 and the standard error of the estimate (SEE) was 0.29 L/min. The largest overestimation was seen in pre‐pubertal boys (0.49 L/min). The best precision of the EB test was achieved when boys in Tanner stages I and II were re‐calculated using the prediction equation developed for adult women. This yielded a mean difference of ‐0.05 L/min, r = 0.92 and SEE 0.23 L/min, in the entire sample. The prediction error was lowered in boys, but not girls, with increasing pubertal maturity.ConclusionThe EB test was reasonably valid in adolescents, seemed to be related to sex and maturity status and our findings support its use.This article is protected by copyright. All rights reserved.
  • Preterm infants with necrotising enterocolitis demonstrate individual and
           unbalanced gut microbiota
    • Abstract: AimThis Lebanese study tested the hypothesis that differences would exist in the gut microbiota of preterm infants with and without necrotising enterocolitis (NEC), as reported in western countries.MethodsThis study compared 11 infants with NEC and 11 controls, all born at 27‐35 weeks, in three neonatal intensive care units between January 2013 and March 2015. Faecal samples were collected at key time points and microbiota was analysed by culture, quantitative PCR (qPCR), and temperature temporal gel electrophoresis (TTGE).ResultsThe cultures revealed that all preterm infants were poorly colonised and harboured no more than seven species. Prior to NEC diagnosis, significant differences were observed by qPCR with a higher colonisation by staphylococci (p= 0.034) and lower colonisations by enterococci (p= 0.039) and lactobacilli (p= 0.048) in the NEC group compared to the healthy controls. Throughout the study, virtually all of the infants were colonised by Enterobacteriaceae at high levels. TTGE analysis revealed no particular clusterisation, showing high inter‐individual variability.ConclusionThe NEC infants were poorly colonised with no more than seven species and the controls had a more diversified and balanced gut microbiota. Understanding NEC aetiology better could lead to more effective prophylactic interventions and a reduced incidence.This article is protected by copyright. All rights reserved.
  • National survey on managing minor childhood traumatic head injuries in The
           Netherlands shows low guideline adherence and large inter‐hospital
    • Abstract: More than 12,000 children are seen in Dutch emergency departments with a mild traumatic head injury (MTHI) every year. In The Netherlands, the paediatric MTHI guidelines are primarily based on the Pediatric Emergency Care Applied Research Network study (1). The guidelines define several criteria, based on the patient's age, to help clinicians to decide whether they need to perform a computed tomography (CT) scan (2). This national study determined the adherence to the guidelines and the reasons why clinicians deviated from them.This article is protected by copyright. All rights reserved.
  • Reporting anxiety symptoms in extremely preterm born adolescents and by
           their mothers
    • Abstract: AimTo compare anxiety symptoms in adolescents born extremely prematurely to term‐born controls.MethodsWe had 96 preterm‐born adolescents and 40 term‐born controls from Denmark and their mothers score the adolescents on the Revised Children Anxiety and Depression scale. We analysed group differences, cross‐informant correlations, and relative risks for elevated anxiety symptoms.ResultsSelf‐reported anxiety symptoms did not significantly differ, although the upper confidence limit (95% CI [‐3.3 to 5.1]) supported an odds ratio of 2 for the preterm‐born participants. Mothers of the preterm‐born participants reported higher social anxiety symptoms than did mothers of controls (51.7 vs. 46.8, p = 0.001). The relative risk for being above a threshold indicating distressing anxiety were small from self‐reports (1.39; p= 0.60). From mother‐reports, the relative risk was noticeable but not significant (4.58; p = 0.14). Cross informant scores correlated significant for total anxiety and social anxiety for the preterm‐born (rτ = 0.2, p = 0.001; rτ = 0.3, p =
  • Response Letter to “Optimising physiology for adolescents with
    • Abstract: We would like to thank Dr Thaxter Nesbeth (1) for her interest and insightful comments on our paper entitled, “Exercise and the multidisciplinary holistic approach to adolescent dysautonomia”(2). We agree that recurrent orthostatic intolerance is often best managed through lifestyle modification rather than pharmacologic intervention (at least as an initial step), and as such in the present study we evaluated the impact of our exercise programme incorporated in addition to our standard clinical multidisciplinary management approach. Currently, our approach incorporates advice to patients and their families regarding the importance of maintaining adequate hydration, salt supplementation, good sleep and nutrition habits, as well as our structured exercise program. We also provide written literature about living with dysautonomia of adolescence and have the benefit of psychological support for our patients in our Dysautonomia Clinic.This article is protected by copyright. All rights reserved.
  • Investigation and management of gastro‐oesophageal reflux in United
           Kingdom neonatal intensive care units
    • Abstract: AimIn 2004 wide variation in the investigation and management of gastro‐oesophageal reflux (GOR) of infants on UK major neonatal units was demonstrated. Our aim was to re‐survey neonatal practitioners to determine current practice and whether it was now evidence based.MethodsA questionnaire was sent to all 207 UK neonatal units.ResultsResponses were obtained from 84% of units. The most frequent “investigation” was a trial of therapy (83% of units); pH studies were used in 38%, upper GI contrast studies in 19% and multichannel intraluminal impedance (MII)/pH studies in 5%. Only six units suggested a threshold for an abnormal pH study and two units for an abnormal MII study. Infants were commenced on anti‐reflux medication without investigation always in 32% of units, often in 29%, occasionally in 19% and only never in 1%. Gaviscon was used as first line treatment in 60% of units, other medications included ranitidine in 53%, thickening agents in 27%, proton pump inhibitors in 23%, domperidone in 22% and erythromycin in 6%.ConclusionThere remains a wide variation in diagnostic and treatment strategies for infants with suspected GOR on neonatal intensive care units, emphasizing the need for randomised trials to determine appropriate GOR management.This article is protected by copyright. All rights reserved.
  • Nutritional support in paediatric Crohn's disease; Outcome at 12 months
    • Abstract: AimPaediatric Crohn's disease (CD) is associated with growth delay and poor nutritional status. Maintenance enteral nutrition (MEN) supplementation is a potential adjunct to improve growth/prolong remission.MethodsNewly‐diagnosed CD patients were identified. Anthropometry, treatments and outcomes were collected for 12 months following diagnosis. Data are presented as medians.Results102 patients were identified (age=13 years, 76% male), 58(57%) completed exclusive enteral nutrition (EEN) as induction therapy, 77(75%) entered clinical remission. Following induction 58(57%) of all patients continued MEN and 44(43%) consumed normal diet (ND). BMI Z‐score increased (diagnosis‐12 months) for EEN (‐1.41 to ‐0.21(p=
  • Response to Mortazavi's comment
    • Abstract: Mortazavi's comment (1) on our letter (2) on whether electromagnetic fields (EMF) in incubators are a risk factor for autism contains several points that need to be corrected. First, we did not base our observations just on our previous papers as Mortazavi maintains. In fact, our observations were also based on several more papers about EMF in incubators, including the paper by Calvente et al, which was published in 2017 (3). Second, it is incorrect to write that a very simple intervention, such as changing the infants’ sleep position, namely the position of the head and feet, can lead to a significant drop, as big as several orders of magnitude, in the infant's brain exposure (1), because in most incubators EMF levels are similar at all points of the mattress. Third, he writes that EMF can only be a risk for autism when the exposure happens in the first trimester of pregnancy. However, the paper he quotes deals with adult mice, not embryos, which does not support this opinion. On the contrary, studies supporting the correlation between EMF and autism in adults are available (4).Any association between EMF and autism is still a hypothesis. Despite this, the EMFs that babies are exposed to in incubators would hardly be acceptable for a hospitalised adult and we continue to maintain that these levels should be monitored and regulated.This article is protected by copyright. All rights reserved.
  • Establishing a regional paediatric registry improved the overview and
           detection of side effects in children on anticoagulants
    • Abstract: The use of oral anticoagulants is rarer in children than adults, but studies indicate that their paediatric use is increasing (1). Warfarin has been used in children, at the discretion of the treating physician, but both the number of children and the data on its use are limited (2). There is also a lack of experience on the use of new oral anticoagulants for children.This article is protected by copyright. All rights reserved.
  • Physical activity may decrease the likelihood of children developing
    • Abstract: AimChildhood constipation is common. We evaluated children diagnosed with constipation, who were referred to an Icelandic paediatric emergency department, and determined the effect of lifestyle factors on its aetiology.MethodsThe parents of children who were diagnosed with constipation and participated in a phase IIB clinical trial on laxative suppositories answered an online questionnaire about their children's lifestyle and constipation in March‐April 2013. The parents of non‐constipated children that visited the paediatric department of Landspitali University Hospital or an Icelandic outpatient clinic answered the same questionnaire.ResultsWe analysed responses regarding 190 children aged 1‐18 years: 60 with constipation and 130 without. We found that 40% of the constipated children had recurrent symptoms, 27% had to seek medical attention more than once and 33% received medication per rectum. The 47/130 control group subjects aged 10‐18 were much more likely to exercise more than three times a week (72%) and for more than a hour (62%) than the 26/60 constipated children of the same age (42% and 35%, respectively).ConclusionConstipation risk factors varied with age and many children diagnosed with constipation had recurrent symptoms. Physical activity may affect the likelihood of developing constipation in older children.This article is protected by copyright. All rights reserved.
  • Urinary prostaglandin D2 metabolite excretion during the first six months
           of life was significantly lower in breast‐fed than formula‐fed infants
    • Abstract: AimThe metabolic changes that occur during the postnatal weaning period appear to be particularly important for future health and breast milk is considered to provide the optimal source of infant nutrition. This pilot study from September 2013 to May 2015 examined the effect of breastfeeding on prostaglandin metabolism in healthy term infants.MethodsUrine samples were collected from 19 infants at one month of age in the Juntendo University Hospital, Tokyo, Japan. The 13 infants in the breast‐fed group received less than 540 mL/week of their intake from formula and the other nine were exclusively fed on formula. At six months we sampled 14 infants: six breastfed and five receiving formula. The infants were from normal single pregnancies and free from perinatal complications. We analysed urinary prostaglandin metabolites ‐ tetranor prostaglandin E2 metabolite (t‐PGEM) and tetranor prostaglandin D2 metabolite (t‐PGDM) ‐ using liquid chromatography tandem‐mass spectrometry.ResultsUrinary t‐PGDM excretion at one and six months was significantly lower in breast‐fed infants than formula‐fed infants. However, urinary t‐PGEM excretion at one and six months was not significantly different between the groups.ConclusionOur study showed that the type of feeding in early infancy affected prostaglandin metabolism in healthy term infants.This article is protected by copyright. All rights reserved.
  • Skin‐to‐skin back transfers provide a feasible, safe and low‐stress
           alternative to conventional neonatal transport
    • Abstract: Skin‐to‐skin (STS) contact is increasingly practised in neonatal intensive care units (NICUs) (1), especially to dampen the detrimental impact of negative stress (2). These days high‐risk infants are usually transferred in‐utero to centralised tertiary level care units. Once these infants have been born, stabilised and are ready for convalescence, they are back transferred to less specialist neonatal units near their homes.This article is protected by copyright. All rights reserved.
  • Failing to meet relative humidity targets for incubated neonates causes
           higher heat loss and metabolic costs in the first week of life
    • Abstract: AimFrequent nursing procedures can modify a newborn infant's thermal environment when their incubator is opened. This study evaluated the impact of relative humidity on preterm infants in closed incubators and calculated their heat loss and additional metabolic cost.MethodsWe studied 45 preterm infants born before 32+0 weeks, nursed at the neonatal intensive care unit at Amiens University Hospital, France from January 2009 to November 2011. Their body, skin and air temperatures and the incubator's relative humidity were continuously recorded from days 1‐8 of life and the differences between the measured and target relative humidity were calculated. Body heat loss was also calculated.ResultsOn day one, the measured relative humidity (68.7 ±1.0%) was significantly lower than the target relative humidity (75%, p
  • Elective transfers of preterm neonates to regional centres on
           non‐invasive respiratory support is cost effective and increases
           tertiary care bed capacity
    • Abstract: AimManaging capacity at regional facilities caring for sick neonates is increasingly challenging. This study estimated the clinical and economic impact of the elective transfer of stable infants requiring nasal continuous positive airway pressure (NCPAP) from level three to level two neonatal intensive care units (NICUs) within an established clinical network of five NICUs.MethodsWe retrospectively analysed the records of 99 stable infants transferred on NCPAP between two level three NICUs and three level two NICUs in Calgary, Canada, between June 2014 and May 2016.ResultsThe median gestational age and weight at birth were 28 weeks and 955 grams and the median corrected gestational age and weight at transfer were 33 weeks and 1,597 grams respectively. This resulted in cost savings of $2.65 million Canadian dollars during the two‐year study period and 848 level three NICU days were free up for potentially sick neonates. There were no adverse events associated with the transfers.ConclusionThe elective transfer of stable neonates on NCPAP from level three to level two NICUs within an established clinical network led to substantial cost savings, was safe and increased the bed capacity at the two level three NICUs.This article is protected by copyright. All rights reserved.
  • Non‐publication and Discontinuation of Randomised Controlled Trials
           in Newborns
    • Abstract: AimTo determine the rate of non‐publication and discontinuation of randomised controlled trials (RCTs) in newborns.MethodsThis was a retrospective, cross‐sectional study of RCTs registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR) between 2008 and 2012.ResultsFifty trials were identified, of which 23 (46%) were retrospectively registered. Thirty trials (60%) were published. After a median follow‐up of 8.0 (range 4.6 to 17.4) years from Research Ethics Committee approval, 15 of 41 completed trials (37%) remained unpublished, representing 5422 neonatal trial participants. Nine trials (18%) were discontinued, including four that were published. The most frequent reason for discontinuation was poor recruitment (n=4). Sample size discrepancies between registration and publication were found in 17 (65%) of the 26 completed, published trials. In nine of these trials (35%), the calculated sample size in the method section of the published article differed from the planned sample size in the trial registry (relative difference ‐20% to +33%).ConclusionNon‐publication and discontinuation of RCTs conducted in newborns is common. Additional efforts are needed to minimise the number of neonatal trial participants that are exposed to interventions without subsequent publication.This article is protected by copyright. All rights reserved.
  • Deaths and end‐of‐life decisions differed between neonatal and
           paediatric intensive care units at the same children's hospital
    • Abstract: AimWe compared neonatal deaths and end‐of‐life decisions in a neonatal intensive care unit (NICU) and paediatric intensive care unit (PICU) in a Dutch tertiary children's hospital.SubjectsAll 235 full‐term infants who died within 28 days of life between 2003‐2013 in the NICU (n=199) and PICU (n=36) were retrospectively studied.ResultsThe median length of stay was three days in the NICU and seven days in the PICU (p=0.003). The main reasons for NICU stays were asphyxia (52.8%) and congenital malformations (42.2%) and in the PICU they were congenital malformations (97.2%) primarily cardiac problems (83.3%, p
  • Oropharyngeal surfactant can improve initial stabilisation and reduce
           rescue intubation in infants born below 25 weeks of gestation
    • Abstract: AimMinimally aggressive and easily performed techniques that facilitate spontaneous respiratory stabilisation are required to reduce rescue intubation in extremely premature infants. This study evaluated the feasibility and safety of administering surfactant into the pharynx of infants born at less than 25 weeks immediately after birth.MethodsThis study of 19 infants was conducted from January 2013 to July 2014 in a tertiary perinatal centre in Prague. We administered 1.5ml of Curosurf as a bolus into the pharynx and simultaneously performed a sustained inflation manoeuvre (SIM). The extent of the interventions, death and severe neonatal morbidity in the study group were compared with 20 controls born before the study period and 20 born after it.ResultsAll infants received oropharyngeal surfactant within the median (inter‐quartile range) time of 40 seconds (25‐75) after cord camping. The surfactant had to be suctioned in one infant because of upper airway obstruction. Although more subsequent surfactant was administered in the study group, significantly fewer study period infants required intubation than the before and after controls (16% versus 75% and 58%, respectively, p
  • Introducing universal ultrasound screening for developmental dysplasia of
           the hip doubled the treatment rate
    • Abstract: AimThere is no evidence on the effect of universal ultrasound screening on developmental dysplasia of the hip. We examined the impact of adding an ultrasound examination to a one examiner clinical screening strategy on treatment, follow‐up rates and the number of cases detected late in a low‐prevalence population.MethodsAll eligible babies born at Kongsberg Hospital, Norway, from 1998‐2006 (n=4,245) underwent both clinical and ultrasound hip examinations within three days of life. Indications for immediate treatment were positive Barlow or Ortolani manoeuvures and, or, sonographic dysplasia. Sonographic immature hips were followed until normalisation. Treatment rates and rates from the 1989‐97 pre‐study period (n=3,594), including late diagnoses, were collected from hospital records.ResultsTreatment was initiated in 90 (2.1%) infants (74 girls), 63 (70%) from birth, compared to 33 (0.9%) during the pre‐study period. The follow‐up rate did not change (11%). There were two (0.5 per 1,000) and four (1.0 per 1,000) cases detected late, respectively. No‐one underwent surgery during the first year of life and no avascular necrosis was seen.ConclusionAdding universal ultrasound to clinical screening performed by the same, experienced paediatrician doubled the treatment rate, without influencing the already low numbers of late cases.This article is protected by copyright. All rights reserved.
  • Shaken baby syndrome and the risk of losing scientific scrutiny
    • Abstract: A systematic review of shaken baby syndrome by the Swedish Agency for Health Technology Assessment and Assessment of Social Services generated numerous reactions from professional organisations, even before the review was published. There was also a lively debate after a paper summarising its findings were published in Acta Paediatrica The various responses are worth debating further, as they raise several important issues with regard to research ethics, having an open debate and publishing scientific findings.ConclusionThe responses to the SBS report indicate that scientific scrutiny risks being lost when researchers and organisations are not open to challenging established ideas.This article is protected by copyright. All rights reserved.
  • Re: Are electromagnetic fields in incubators a risk factor for autism'
    • Abstract: This letter is regarding the article by Bellieni and Buonocore entitled “Are electromagnetic fields in incubators a risk factor for autism'” published in Acta Paediatrica (1). The authors of this short article suggest that exposure of the infants to electromagnetic fields which are referred to as “high electromagnetic fields (EMFs) produced by the incubator's electric engine” can be linked to increased risk of autism. Despite its challenging topic, the paper authored by Bellieni and Buonocore has some shortcomings.This article is protected by copyright. All rights reserved.
  • Vitamin D status of gastrostomy‐fed children with special needs: a
           cross‐sectional pilot study
    • Abstract: AimTo assess the vitamin D status of gastrostomy‐fed children.MethodsVitamin D status was measured in 32 children aged five to 16 years recruited from special schools in Manchester, UK (53° 48′ N). All children were receiving a nutritionally complete, commercially prepared enteral feed via gastrostomy, and had been established on this regimen for over 12 months. Serum concentrations of 25 hydroxyvitamin D (25OHD) were measured at the end of winter. Children with serum concentrations of 25OHD >50nmol/L were considered to be sufficient, and those with concentrations 50nmol/L). One subject was vitamin D deficient (serum 25OHD 25nmol/L ‐
  • Cerebral oxygenation measured by near‐infrared spectroscopy correlates
           with arterial oxygenation only poorly in preterm infants – a strength of
           that technology'
    • Abstract: We read with interest the article by Hunter et al, titled “Cerebral oxygenation as measured by near‐infrared spectroscopy in neonatal intensive care: correlation with arterial oxygenation”. We agree that cerebral oxygenation only correlates poorly with the arterial oxygenation in preterm infants. We do not agree with the authors conclusions that this is a disadvantage of near‐infrared spectroscopy (NIRS) and that “strong correlation between rScO2 and ABG parameters such as SaO2, SpO2 and PaCO2 would have provided more clinically meaningful implications.”This article is protected by copyright. All rights reserved.
  • Children who commute to school unaccompanied have greater autonomy and
           perceptions of safety
    • Abstract: AimWe explored the rates of children who actively commuted to school, both accompanied and unaccompanied, and identified their safety perceptions.MethodsThis cross‐sectional study focused on 745 children, aged 6‐12 years, from public schools in the Spanish Granada region. They completed a questionnaire, providing personal data, their school grade, safety perceptions, whether they were accompanied to school and how they travelled to school. We analysed how active commuters were accompanied to school by age group and assessed the associations between safety perceptions and whether or not they were accompanied.ResultsChildren aged 10‐12 years were more likely to travel to school unaccompanied, more likely to travel actively and had better safety perceptions than younger children. We also found differences in how active commuters between 10‐12 years and children aged 6‐7 and 8‐9 years (all p
  • Family Nurture Intervention in Preterm Infants Increases Early Development
           of Cortical Activity and Independence of Regional Power Trajectories
    • Abstract: AimPremature delivery and maternal separation during hospitalization increase infant neurodevelopmental risk. Previously, a randomized controlled trial of Family Nurture Intervention (FNI) in the neonatal intensive care unit demonstrated improvement across multiple mother and infant domains including increased electroencephalographic (EEG) power in the frontal polar region at term age. New aims were to quantify developmental changes in EEG power in all brain regions and frequencies and correlate developmental changes in EEG power among regions.MethodsEEG (128 electrodes) was obtained at 34‐44 weeks postmenstrual age from preterm infants born 26‐34 weeks. 44 infants were treated with Standard Care and 53 with FNI. EEG power was computed in 10 frequency bands (1 to 48 Hz) in 10 brain regions and in active and quiet sleep.ResultsPercent change/week in EEG power was increased in FNI in 132/200 tests (p
  • Low age, low birth weight and congenital heart disease are risk factors
           for intensive care in infants with bronchiolitis
    • Abstract: AimThis study evaluated the incidence and risk factors for intensive care and respiratory support in infant bronchiolitis.MethodsThis retrospective descriptive case-control study focused on 105 patients treated in the paediatric intensive care unit (PICU) and 210 controls treated in the emergency department or on the paediatric ward in Tampere University Hospital in Finland between 2000-2015. Statistically significant risk factors in non-adjusted analyses were included in the adjusted logistic regression.ResultsThe average age-specific annual incidence of bronchiolitis requiring PICU admission under the age of 12 months was 1.5/1,000/year (range 0.18-2.59). Independently significant risk factors for PICU admission were: being less than two months old with an adjusted odds ratio (aOR) of 11.5, birth weight
  • Adolescents with type 1 diabetes mellitus and
           attention-deficit/hyperactivity disorder require specific support from
           healthcare professionals
    • Abstract: AimManaging type 1 diabetes mellitus requires efficient cognitive and executive skills and adolescents who have attention-deficit/hyperactivity disorder (ADHD) may face specific challenges. This study explored young people′s experiences of diabetes treatment and care.MethodIn a population-based study, comprising 175 patients aged 5-16 years with type 1 diabetes mellitus in two Swedish counties, we found that eight also met criteria for ADHD. Six of these, aged 14.5-16 years, participated 2013-2014 in interviews that targeted aspects of their diabetes treatment. Conducted by two psychologists, these used the inductive qualitative, semi-structured interview format.ResultsThe two boys and four girls all reported difficulties in creating routines for their diabetes treatment and that problems were aggravated during stress. They had been criticised by their parents and the diabetes team when their blood levels indicated inadequate diabetes control. They requested ongoing information, involvement of their friends, group meetings and easy access to the healthcare system during difficult times.ConclusionPatients with type 1 diabetes mellitus and concomitant ADHD faced problems with their diabetes management, especially during stressful situations. Diabetes care provision should pay particular attention to patients with co-existing neuropsychiatric and neurodevelopmental disorders such as ADHD.This article is protected by copyright. All rights reserved.
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