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Showing 1 - 200 of 1577 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 12, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 64, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 46, SJR: 0.547, h-index: 30)
ACEP NOW     Free   (Followers: 1)
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 49, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 148, SJR: 0.101, h-index: 9)
Acta Geologica Sinica (English Edition)     Hybrid Journal   (Followers: 3, SJR: 0.552, h-index: 41)
Acta Neurologica Scandinavica     Hybrid Journal   (Followers: 5, SJR: 1.203, h-index: 74)
Acta Obstetricia et Gynecologica Scandinavica     Hybrid Journal   (Followers: 15, SJR: 1.197, h-index: 81)
Acta Ophthalmologica     Hybrid Journal   (Followers: 5, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 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: 3)
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: 26, 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: 50, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 13, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 256, 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: 5, 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: 19)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 12)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 9)
African Development Review     Hybrid Journal   (Followers: 35, 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: 10, SJR: 4.374, h-index: 95)
Agribusiness : an Intl. J.     Hybrid Journal   (Followers: 6, SJR: 0.627, h-index: 14)
Agricultural and Forest Entomology     Hybrid Journal   (Followers: 14, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 45, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 30, 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: 34, SJR: 2.833, h-index: 138)
Alimentary Pharmacology & Therapeutics Symposium Series     Hybrid Journal   (Followers: 3)
Allergy     Hybrid Journal   (Followers: 50, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 135, SJR: 0.951, h-index: 61)
American Business Law J.     Hybrid Journal   (Followers: 24, SJR: 0.205, h-index: 17)
American Ethnologist     Hybrid Journal   (Followers: 89, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 27, 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: 264, 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: 126, 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: 16)
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: 207)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 213, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 37, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 9, 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: 48, 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: 24, 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: 91, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 47, 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: 68, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 152, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 48, 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: 4)
Archives of Insect Biochemistry and Physiology     Hybrid Journal   (SJR: 0.768, h-index: 54)
Area     Hybrid Journal   (Followers: 12, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 231, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 51, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 27, SJR: 2.256, h-index: 114)
Artificial Organs     Hybrid Journal   (Followers: 1, SJR: 0.872, h-index: 60)
ASHE Higher Education Reports     Hybrid Journal   (Followers: 14)
Asia & the Pacific Policy Studies     Open Access   (Followers: 15)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 313, 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: 4, SJR: 1.443, h-index: 19)
Asian J. of Social Psychology     Hybrid Journal   (Followers: 5, SJR: 0.665, h-index: 37)
Asian Politics and Policy     Hybrid Journal   (Followers: 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: 13, 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: 7, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 13, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 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: 44, 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: 27, 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: 401, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 4, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 69, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 11, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 19, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 31, SJR: 2.126, h-index: 39)
Autonomic & Autacoid Pharmacology     Hybrid Journal   (SJR: 0.371, h-index: 29)
Banks in Insurance Report     Hybrid Journal   (Followers: 1)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 10, 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: 3, 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: 177, 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: 19, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 9, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 37, SJR: 0.763, h-index: 64)
Birth Defects Research Part A : Clinical and Molecular Teratology     Hybrid Journal   (Followers: 2, SJR: 0.727, h-index: 77)
Birth Defects Research Part B: Developmental and Reproductive Toxicology     Hybrid Journal   (Followers: 5, SJR: 0.468, h-index: 47)
Birth Defects Research Part C : Embryo Today : Reviews     Hybrid Journal   (SJR: 1.513, h-index: 55)
BJOG : An Intl. J. of Obstetrics and Gynaecology     Partially Free   (Followers: 225, 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  [1577 journals]
  • Retracted: Neonatal Pulse oximetry screening: A National Survey
    • Authors: SL Kang; S Tobin, W Kelsall
      Abstract: Retraction: The following article from Acta Paediatrica; ‘Neonatal pulse oximetry screening: A national survey’ by Sok-Leng Kang, Suzanne Tobin and Wilf Kelsall, posted online on 18 February 2011 in a format yet to undergo copy-editing and proof correction, in Wiley Online Library (, has been retracted by agreement between the authors, the Editor-in-Chief, Hugo Lagercrantz, and Blackwell Publishing Ltd. The retraction has been agreed due to overlap between this article and the following article published in Archives of Disease Fetal & Neonatal Edition; ‘Neonatal pulse oximetry screening: A national survey’, published online on 19 February 2011 in its final format, but in advance of the print journal.
      PubDate: 2011-02-15T10:27:17.893164-05:
      DOI: 10.1111/j.1651-2227.2011.02200.x
  • 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.
  • 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
  • Using probiotics to prevent necrotising enterocolitis
  • Are men monkeys' Why are child healthcare professionals reluctant to
           include fathers in parenting support interventions'
  • 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
  • Preschool children living in joint physical custody arrangements show less
           psychological symptoms than those living mostly or only with one parent
    • Abstract: AimJoint physical custody (JPC), where children spend about equal time in both parent's homes after parental separation, is increasing. The suitability of this practice for preschool children, with a need for predictability and continuity, has been questioned.MethodsIn this cross‐sectional study, we used data on 3656 Swedish children aged three to five years living in intact families, JPC, mostly with one parent or single care. Linear regression analyses were conducted with the Strengths and Difficulties Questionnaire, completed by parents and preschool teachers, as the outcome measure.ResultsChildren in JPC showed less psychological problems than those living mostly (adjusted B 1.81; 95% CI [0.66 to 2.95]) or only with one parent (adjusted B 1.94; 95% CI [0.75 to 3.13]), in parental reports. In preschool teacher reports, the adjusted Betas were 1.27, 95% CI [0.14 to 2.40] and 1.41, 95% CI [0.24 to 2.58], respectively. In parental reports, children in JPC and those in intact families had similar outcomes, while teachers reported lower unadjusted symptom scores for children in intact families.ConclusionJoint physical custody arrangements were not associated with more psychological symptoms in children aged 3–5, but longitudinal studies are needed to account for potential preseparation differences.
  • 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 2011–12 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 non‐treated 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.This article is protected by copyright. All rights reserved.
  • 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.
  • Oxygen needs during resuscitation and surfactant to achieve stabilisation
           were independent risks factors for pulmonary interstitial emphysema in
           preterm infants
    • Abstract: AimsPulmonary 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 2005‐2014 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 1,500g, 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.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
  • Changing diagnosis codes for lower respiratory tract infections can
           confound longitudinal studies
  • What paediatric obesity treatment programmes work, and how can we measure
           their success'
  • Issue Information
  • Highlights in this issue
  • Is 100% oxygen a sticking plaster for sore neonatal ventilation
  • Global gains after Helping Babies Breathe
  • Helping babies breathe can reduce deaths with the right combination
           of training and expertise
  • The care of a child with a newly diagnosed immune thrombocytopenia
  • Using a standardised protocol was effective in reducing hospitalisation
           and treatment use in children with newly diagnosed immune thrombocytopenia
    • Abstract: AimChildhood immune thrombocytopenia (ITP) has been associated with low bleeding rates and a high frequency of spontaneous remission. Although current guidelines suggest that most patients are just observed, children still receive platelet‐enhancing therapies for fear of bleeding complications. We hypothesised that a standardised protocol with a step‐down approach would reduce hospitalisation and treatment use.MethodA retrospective chart review was performed on patients diagnosed with acute ITP between January 2010 and December 2014, before (n = 54) and after (n = 37) the standardised protocol, which was introduced in January 2013. Management and events during the first 3 months following diagnosis were recorded.ResultsThe protocol resulted in a 34% decrease in the hospitalisation rate (p < 0.001) at diagnosis. Prednisone treatment duration at diagnosis was also significantly reduced (13.1 versus 5.8 days, p = 0.004). Children over 3 years of age were 3.8 times less likely to be hospitalised (95% CI 1.94–7.61) and 2.3 times less likely to receive treatment (95% CI 1.2–4.3). There was no difference in the rate of persistent ITP (38% versus 30%, p = 0.43) or serious bleeding complications (7% versus 5%, p = 0.70).ConclusionOur ITP management protocol significantly reduced hospitalisation rates and length of prednisone treatment without any increase in disease complications.
  • Antenatal betamethasone for women at risk for late preterm delivery
           reduces the rate of neonatal respiratory complications
  • Survey shows that Swedish healthcare professionals have a positive
           attitude towards surrogacy but the health of the child is a concern
    • Abstract: AimIn February 2016 Sweden upheld its ban on surrogacy following a Government inquiry. This survey investigated attitudes towards surrogacy among primary health professionals working with children and their experiences of working with families following surrogacy abroad.MethodsFrom April to November 2016, nurses, physicians and psychologist working in primary child healthcare in four counties in Sweden were invited to participate in a cross-sectional online survey about surrogacy.ResultsThe mean age of the 208 participants was 49.2 years (range 27-68) and nearly 91% were women. Approximately 60% supported legalised surrogacy. Wanting a conscience clause to be introduced in Sweden was associated with not supporting surrogacy for any groups, while personal experiences of infertility and clinical experiences with families following surrogacy was associated with positive attitudes towards surrogacy for heterosexual couples. The majority (64%) disagreed that surrogate children were as healthy as other children and many believed that they risked worse mental health (21%) and social stigmatisation (21%).ConclusionWe found that 60% supported legalised surrogacy, but many expressed concerns about the children's health and greater knowledge about the medical and psychosocial consequences of surrogacy is needed.This article is protected by copyright. All rights reserved.
  • 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 nenonates had birth asphyxia or required exchange transfusions.This article is protected by copyright. All rights reserved.
  • Infantile Retinal Haemorrhages in the Absence of Brain and Bodily Injury
    • Abstract: When retinal haemorrhages are found in infants hospitalized for neurologic problems a diagnosis of abusive head trauma is often made. Many pediatricians believe that rapid head acceleration and deceleration, such as that produced by violent shaking, can create vitreoretinal traction followed by haemorrhage.(1) This ‘traction theory’ is stated in some medical reviews as a hypothesis,(2) and in others as a simple fact.(3) Others have concluded that pathological evidence is more consistent with retinal venous stasis and subsequent leakage into the retina.(4)This article is protected by copyright. All rights reserved.
  • 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 was 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 non-surgical 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.This article is protected by copyright. All rights reserved.
  • Using smartphones with suitable apps can be safe and even useful if they
           are not misused or overused
    • Abstract: Different forms of media have played an important role in child development since prehistoric times. Drawing, reading and watching television and videos have been some of the traditional indoor recreational activities that have been pursued by children for many years. In the early 1980s, computers with graphical user interfaces that were affordable and small enough to be placed on desktops became available and in due course children started using computers at home and in school. Computers proved to be more interactive and customizable than the previously available forms of media and were also able to simulate many of them.This article is protected by copyright. All rights reserved.
  • Neural Breathing Pattern in Newborn Infants Pre and Post- Extubation
    • 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 2 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 post extubation change in EAdi-max (8.9 to 11.1 μv) and EAdi-delta (6 to 8 μv) was less in the failure group in comparison to the change in EAdi-max (10.2 to 13.4 μv) and EAdi delta (6.3 to 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.This article is protected by copyright. All rights reserved.
  • 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.This article is protected by copyright. All rights reserved.
  • Salivary cortisol circadian rhythm in infants at psychosocial risk showed
           more variations than previous studies of healthy full-term infants
    • Abstract: Healthy infants establish a salivary cortisol circadian rhythm (SCCR) at one month of age (1). This study investigated the development of SCCR in infants at high psychosocial risk, by measuring salivary cortisol levels during their first year of life and evaluating whether those were related to behavioural regularity.This article is protected by copyright. All rights reserved.
  • Staff Perceptions of Challenging Parent-Staff Interactions and Beneficial
           Strategies in the Neonatal Intensive Care Unit
    • Abstract: AimTo characterize Neonatal Intensive Care Unit (NICU) staff perceptions regarding factors which may lead to more challenging staff-parent interactions, and beneficial strategies for working with families with whom such interactions occurMethodsA survey of 168 physician and nursing staff at two NICUs in American teaching hospitals inquired about their perceptions of challenging parent-staff interactions and situations in which such interactions were likely to occurResultsFrom a medical perspective, staff perceptions of challenging interactions were noted when infants had recent decompensation, high medical complexity, malformations, or long duration of stay in the NICU. From a psychological/social perspective, a high likelihood of challenging interactions was noted with parents who were suspicious, interfere with equipment, or parents who hover in the NICU, express paranoid or delusional thoughts, repeat questions, perceive the staff as inaccessible, are managing addictions, or who require Child Protective Services involvement. Frequent family meetings, grieving opportunities, education of parents, social work referrals, clearly defined rules, partnering in daily care, and support groups were perceived as the most beneficial strategies for improving difficult interactionsConclusionThis study delineates what staff perceive as challenging interactions and provides support for an educational and interventional role that incorporates mental health professionals.This article is protected by copyright. All rights reserved.
  • Serum levels of omentin-1 are increased after weight loss and are
           particularly associated with increases in obese children with metabolic
    • Abstract: AimThere have been very few paediatric studies on omentin-1, an anti-inflammatory adipokine that provides a link between adiposity, insulin resistance and metabolic syndrome. This Chinese study evaluated the association between omentin-1 and metabolic syndrome and analysed the effect of a six-month lifestyle intervention on the levels in obese children.MethodsWe recruited 119 obese outpatients (75% boys) aged 7-18 years old from the Second Affiliated Hospital of Xi'an Jiaotong University, who underwent a six- month lifestyle intervention. Our controls were 55 matched children with normal weight. Anthropometric parameters, biochemical data and circulating omentin-1 levels were measured at baseline and after six months.ResultsOf the 119 obese children, 32 (27%) had metabolic syndrome. The obese children, particularly those with metabolic syndrome, had significantly lower serum omentin-1 levels at baseline than the controls. We also found that the omentin-1 levels were negatively associated with their body mass index, waist circumference and homoestasis model assessment of insulin resistance. After the six-month lifestyle intervention, the obese children showed significant weight loss and their omentin-1 levels increased.ConclusionSerum omentin-1 was regulated by weight and seemed to be associated with children's metabolic disorders. A six-month lifestyle intervention significantly increased serum omentin-1 levels.This article is protected by copyright. All rights reserved.
  • Re-evaluating the use of ultrasound to investigate first febrile urinary
           tract infections in childhood
  • Dysfunctional breathing in children and adolescents
  • It is not ethical to save an infant's life just because we can, without
           due regard to outcome
  • Why haven't the documented benefits of probiotics on preterm babies led to
           their wider acceptance and use'
  • 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, 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 likelihood ratio (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.This article is protected by copyright. All rights reserved.
  • 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.ResultsROP 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 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 birth weight (1,200g, range 980-1,590g versus 1,460g, range 770-2,475g, 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 retinopathy of prematurity were wide-ranging and included gestational age and weight, medical conditions and treatment.This article is protected by copyright. All rights reserved.
  • 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
  • Dopamine plasma clearance is increased in piglets compared to neonates
           during continuous dopamine infusion
    • Abstract: AimPiglets models have often been used to study the effects of dopamine infusion on hypotension in neonates. However, piglets need higher doses of dopamine than neonates to increase blood pressure. We investigated whether this difference was due to interspecific difference in dopamine pharmacokinetics.MethodsArterial blood samples were drawn from six neonates admitted to the neonatal intensive care unit of Copenhagen University Hospital and 20 newborn piglets during continuous dopamine infusion. Furthermore, to estimate the piglet plasma dopamine half-life, blood samples were drawn at 2.5 minute intervals after the dopamine infusion was discontinued. The plasma dopamine content was analysed by high performance liquid chromatography with electrochemical detection.ResultsThe dopamine displayed first-order kinetics in piglets and had a half-life of 2.5 minutes, while the median plasma clearance was 627.9 ml/kg/min (interquartile range 452.6-1914.4). Both piglets and neonates showed large inter-individual variations in plasma clearance, but the median tended to be lower in neonates (384.9, interquartile range 114.2-480.2 ml/kg/min).ConclusionOur results suggest that pharmacokinetic differences may explain the interspecific difference in required doses of dopamine infusion to increase blood pressure. This is important when translating the results obtained in piglet models to treating neonatal hypotension with dopamine.This article is protected by copyright. All rights reserved.
  • Maternal and infant factors had a significant impact on birth weight and
           longitudinal growth in a South African birth cohort
    • Abstract: AimThis birth cohort study investigated longitudinal infant growth and associated factors in a multi-ethnic population living in a low-resource district surrounding the town of Paarl in South Africa.MethodsBetween March 2012 and October 2014, all mothers attending their second trimester antenatal visit at Paarl Hospital were approached for enrollment. Mother-infant pairs were followed from birth until 12 months of age. Comprehensive socio-demographic, nutritional and psychosocial data were collected at birth, two, six and 12 months. Infant anthropometry was analysed as z-scores for weight and height. Linear regression was used to investigate predictors of birth weight and linear mixed effects models were used to investigate predictors of infant growth.ResultsLongitudinal anthropometric data from 792 infants were included: 53% were Black African, 47% were mixed race and 15% were born preterm. Stunting occurred in 13% of infants at 12 months. Maternal height, antenatal alcohol and tobacco use, ethnicity and socioeconomic status were significant predictors of birth weight. In the adjusted mixed effects model, birth weight was a significant predictor of growth during the first year of life.ConclusionBirth weight was an important predictor of growth trajectory during infancy. Birth weight and growth were influenced by several important modifiable factors.This article is protected by copyright. All rights reserved.
  • Infants with prenatally diagnosed kidney anomalies have an increased risk
           of urinary tract infections
    • Abstract: AimThis study estimated the urinary tract infection (UTI) risk in a nationwide cohort of infants prenatally diagnosed with parenchymal kidney anomalies compared with a comparison cohort.MethodsA Danish population-based nationwide cohort of fetuses diagnosed with parenchymal kidney anomalies between 2007 and 2012 had previously been identified. These were compared with fetuses without kidney anomalies who were prenatally scanned the same year. Live born infants were followed from birth until the diagnosis of UTI, emigration, death or two years of age. Cumulative incidences of UTIs were computed. Mortality was estimated using the Kaplan-Meier method.ResultsWe identified 412 fetuses with parenchymal kidney anomalies out of 362,069 who underwent ultrasound scans and 277 were born alive. The overall risk of a UTI before the age of two years was 19% and it was 14% among infants without prenatally diagnosed co-occurring urinary tract malformations. The corresponding risk in the 4,074 controls was 1%. After two years, mortality was 2.2% in infants with prenatally diagnosed parenchymal kidney anomalies and 0.2% in the controls.ConclusionInfants prenatally diagnosed with parenchymal kidney anomalies had a substantially increased risk of UTI. Awareness of this increased risk may facilitate earlier diagnosis of UTIs in this population.This article is protected by copyright. All rights reserved.
  • Survey highlights the need for specific interventions to reduce frequent
           conflicts between healthcare professionals providing paediatric
           end-of-life care
    • Abstract: AimsThis study explored how paediatric healthcare professionals experienced and coped with end-of-life conflicts and identified how to improve coping strategies.MethodsA questionnaire was distributed to all 2,300 professionals at a paediatric university hospital, covering the frequency of end-of-life conflicts, participants, contributing factors, resolution strategies, outcomes and the usefulness of specific institutional coping strategies.ResultsOf the 946 professionals (41%) who responded, 466 had witnessed or participated in paediatric end-of-life discussions: 73% said these had led to conflict, more frequently between professionals (58%) than between professionals and parents (33%). Frequent factors included professionals’ rotations, unprepared parents, emotional load, unrealistic parental expectations, differences in values and beliefs, parents’ fear of hastening death, precipitated situations and uncertain prognosis. Discussions with patients and parents and between professionals were the most frequently used coping strategies. Conflicts were frequently resolved by the time of death. Professionals mainly supported designating one principal physician and nurse for each patient, two-step interdisciplinary meetings - between professionals then with parents - post-death ethics meetings, bereavement follow-up protocols and early consultations with paediatric palliative care and clinical ethics services.ConclusionEnd-of-life conflicts were frequent and predominantly occurred between healthcare professionals. Specific interventions could target most of the contributing factors.This article is protected by copyright. All rights reserved.
  • A review of international clinical practice guidelines for the use of
           oxygen in the delivery room resuscitation of preterm infants
    • Abstract: AimTo collate and assess international clinical practice guidelines (CPG) to determine current recommendations guiding oxygen management for respiratory stablisation of preterm infants at delivery.MethodsA search of public databases using the terms “clinical practice guidelines”, “preterm”, “oxygen” and “resuscitation” was made and complemented by direct query to consensus groups, resuscitation expert committees and clinicians. Data were extracted to include the three criteria for assessment: country of origin, gestation and initial FiO2 and target SpO2 for the first 10 minutes of life.ResultsA total of 45 CPGs were identified: 36 provided gestation specific recommendations (
  • Observational study shows that nurses spend more time caring for
           mechanically ventilated preterm infants than those receiving non-invasive
    • Abstract: AimThis study analysed how nursing workloads in a neonatal intensive care unit (NICU) depended on the type of respiratory support provided and how this relationship varied by the infant's postnatal age and weight.MethodsWe used a prospective study design in a NICU in a tertiary perinatal centre in Germany. This entailed collecting data on nursing activities by observing 41 nurses for 155 hours between June 2015 and November 2015 and measuring the average nursing capacity required for direct care. Regression analysis was used to test for differences in nursing workloads between respiratory support types.ResultsMechanically ventilated infants each required an average of 60% of the time one nurse had available to spend on direct care during the periods observed. In contrast, those receiving non-invasive ventilation only required 34% and special care infants required 13%. After the first 72 hours of life, mechanical ventilated infants required an average nursing capacity of 40%, while infants receiving non-invasive ventilation required 32% and special care infants required 25%.ConclusionInvasive support was associated with higher workloads than non-invasive support. The differences were partially moderated by individual factors, such as the infant's age. The findings should be replicated within a multi-centre design.This article is protected by copyright. All rights reserved.
  • 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 if 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 4,436 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 60mg iron with 400μg folic acid, 30mg iron with 400μg folic acid or MMS. Quasi-Poisson regression was used to analyse morbidity.ResultsThere were 3,560 single live births and 3,516 had morbidity data. The incidence 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.This article is protected by copyright. All rights reserved.
  • Therapeutic drug monitoring was helpful in guiding the decision-making
           process for children receiving infliximab for inflammatory bowel disease
    • Abstract: AimThis study examined the impact of therapeutic drug monitoring (TDM) on clinical decision-making for children receiving infliximab for inflammatory bowel disease (IBD).MethodsThe medical records of children with IBD who had Infliximab trough levels (ITLs) measured between January 2013 and December 2015 at two Canadian tertiary-care centres were examined. The indications for TDM, clinical and laboratory disease activity indices, and TDM-driven treatment changes to infliximab therapy were documented.ResultsWe included 107 consecutive serum measurements of ITLs in 73 children (40 boys), with a median age of 16.1 years, including 52 with Crohn's disease. TDM was performed due to concerns about clinical disease activity in 24/107 (22.4%) measurements and 83 (77.6%) were ordered as routine tests. Of these 38 (35.5%) ITLs were suboptimal (< 3.5 ug/ml) and 36 (34.0%) resulted in more frequent doses of infliximab, with subsequent improvements in disease biomarkers. Interval changes were implemented as a result of 34 (32.0%) ITLs, with shorter intervals in 19 (17.0%) cases, and seven (6.5%) ITLs resulted in adding or increasing doses of immunomodulators. In addition, four children were switched to adalimumab.ConclusionTherapeutic drug monitoring was helpful in guiding the decision-making process for children with IBD on infliximab.This article is protected by copyright. All rights reserved.
  • Foetal growth restriction is associated with poor reading and spelling
           skills at 8–10 years of age
    • Abstract: AimFoetal growth restriction (FGR) is associated with communication problems, which might lead to poor literacy skills. The reading and spelling skills of 8−10-year-old FGR children born at 24−40 gestational weeks were compared with those of their gestational age-matched, appropriately grown (AGA) peers.MethodsA prospectively collected cohort of 37 FGR and 31 AGA children was recruited prenatally at a Finnish tertiary care centre during 1998–2001. The children's reading and spelling skills were assessed using standardised tests for Finnish-speaking second and third graders.ResultsSignificantly more children performed below the 10th percentile normal values for reading and spelling skills in the FGR group than in the AGA group. At nine years of age, the FGR children had significantly poorer performance in word reading skills and reading fluency, reading accuracy and reading comprehension than the AGA controls. No between-group differences were detected at eight years of age.ConclusionFGR is associated with poor performance in reading and spelling skills. A third of the FGR children performed below the 10th percentile normal values at nine years of age. These results indicate a need to continuously evaluate linguistic and literacy skills as FGR children age to ensure optimal support.This article is protected by copyright. All rights reserved.
  • Point-of-care instruments need to offer high levels of accuracy
    • Abstract: We appreciate the interest shown by Heffler et al in our paper on the HemoCue WBC DIFF instrument (1). Considering the return of eosinophils as markers in asthma monitoring (eosinophilia) or in sepsis (eosinopenia) it is important to remind ourselves how the levels of measured blood cells are influenced by the performance of an analytical instrument. We fully agree with Heffler et al (2) that the HemoCue WBC DIFF's results should be interpreted in the context of the clinical setting or medical condition of the patient.This article is protected by copyright. All rights reserved.
  • Magnetic Non-Invasive Acupuncture for Infant Comfort (MAGNIFIC) – A
           single-blinded randomized controlled pilot trial
    • Abstract: AimTo determine the safety and feasibility of auricular non-invasive magnetic acupuncture (MA) to decrease infant pain during heel pricks.MethodsInfants requiring heel pricks for blood collection were randomized to either MA (n=21) or placebo (P) (n=19) after parental informed consent. MA or placebo stickers were placed on both ears according to the Battlefield Protocol by an unblinded investigator and left on for 3 days. Pain was assessed with the Premature Infant Pain Profile (PIPP) by blinded clinicians.ResultsMean gestation (MA:34.1, P:34.4 weeks) and age of infants (MA:5.3, P:4.5 days) were similar as were mean (SD) pre (MA:1.7(1.4), P:2.1(1.9) and post (MA:1.6(1.4), P: 2.1(1.7) heel prick PIPP scores. PIPP scores were significantly lower in MA infants during heel pricks (MA:5.9(3.7), P: 8.3(4.7), p=0.04). One-way ANCOVA modelling showed that MA was significantly associated with lower PIPP scores after controlling for analgesic use (p=0.043). No differences in heart rate, oxygen saturation, analgesic use or adverse effects (e.g. local skin reactions) noted.ConclusionThis pilot study shows that auricular MA is feasible in neonates and may reduce PIPP scores during heel pricks. Further study is required to determine the impact of MA on other painful or stressful conditions and on neurodevelopment.This article is protected by copyright. All rights reserved.
  • Are electromagnetic fields in incubators a risk factor for autism'
    • Abstract: Hugo Lagercrantz recently argued (1) that a possible cause of infantile autism was the unnatural isolation that babies experienced in neonatal incubators. Atypical brain connectivity has been detected in children with autism and it is possible that this may be also due to environmental factors, including the lack of physiological stimuli that is typically found in the incubator environment. We suggest that also another factor may expose babies in incubators to the risk of developing autistic traits and that is the high electromagnetic fields (EMF) produced by the incubator's electric engine.This article is protected by copyright. All rights reserved.
  • Interleukin 17A gene polymorphism rs2275913 is associated with osteitis
           after the Bacillus Calmette-Guérin vaccination
    • Abstract: AimInterleukin-17 (IL-17) appears to promote the host's defense against mycobacterial infections. This study evaluated the association between IL17A gene polymorphism and the risk of Bacillus Calmette-Guérin (BCG) osteitis after newborn vaccination and between IL17A gene polymorphism and IL-17A concentrations in serum.MethodsIL17A rs2275913 gene polymorphisms and serum IL-17A concentrations were studied in 132 adults aged 21-49 years from across Finland, who had BCG osteitis in infancy after a newborn BCG vaccination. The subjects were recruited in 2007-2008 and their whole blood samples were sent to the National Institute for Health and Welfare, Turku, Finland. Their genotypes and minor allele frequencies were compared with 405 population-based unvaccinated controls aged two to three months from a prospective birth cohort study.ResultsThe genotypes and allele frequencies of IL17A rs2275913 differed significantly between the former BCG osteitis patients and controls. The genotype was variant in 75.8% of cases and 64.0% of controls (p=0.012) and the minor allele frequency was 50.0% in the cases and 41.6% of the controls (p=0.009). Serum IL-17 concentrations did not differ significantly between the cases with wild or variant genotypes.ConclusionIL17A rs2275913 gene polymorphism was associated with a risk of BCG osteitis after vaccination.This article is protected by copyright. All rights reserved.
  • 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 less than 36.5°C on admission. The primary outcome was severe RDS or death within the first three days of life and the secondary outcome was BPD or death before 36 postmenstrual weeks. The multivariable logistic regression was adjusted for early onset infection, gestational age, Apgar score, sex, treatment year and birth weight.ResultsInfants with hypothermia had a two-fold increase (OR) in the odds for RDS or death (2.03), but the adjusted OR was not statistically significant (1.36). They also demonstrated a two-fold increase (OR) in the odds for BPD or death (2.28), but again the adjusted OR was not statistically significant (1.03).ConclusionAfter adjusting for confounders, we found that the association between hypothermia on admission to the NICU and RDS or death, or BPD or death was statistically insignificant.This article is protected by copyright. All rights reserved.
  • Why was a local anaesthetic used before administering intranasal ketamine
           for paediatric injuries'
    • Abstract: We were very interested to read Scheier et al's brief report on the use of intranasal ketamine in their pediatric emergency department, specifically for pain and anxiety in children who had resisted venipuncture or intravenous placement (1). Intravenous access can be difficult for pre-hospital medical teams that are not specialised in paediatric care, namely when children complain of pain from, for example suspected fractures and burns.This article is protected by copyright. All rights reserved.
  • 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 3,951 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 8,000 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.This article is protected by copyright. All rights reserved.
  • Telephone monitoring and home visits significantly improved the quality of
           life, treatment adherence and lung function in children with cystic
    • Abstract: Cystic Fibrosis (CF) is a chronic and systemic disease with a progressive course. As survival rates continue to improve, there is a growing demand for new therapeutic options that improve treatment adherence, disease management and quality of life (QoL) (1). The aim of this study was to evaluate the safety and effectiveness of a home care programme for children with CF and to assess the value of regular telephone contact with the CF team based at Hippokration Hospital, Thessaloniki, Greece.This article is protected by copyright. All rights reserved.
  • A temperature gradient may support mother-infant thermal identification
           and communication in the breast crawl from birth to breastfeeding
    • Abstract: AimThe human female's nipple-areolar complex (NAC) is the point of arrival of a natural progression from birth to breastfeeding, linked to functional, chemical and biophysical cues that promote the breast crawl soon after birth. We investigated the thermal gradient generated by the lips of the neonate and warmth of the NAC, which may drive the infant directly to the nipple.MethodsWe prospectively studied 41 full-term singleton infants and their mothers at the Policlinico Abano Terme, Italy, between 1 January to 28 February 2015. NAC and breast quadrant temperatures were assessed 6±2 hours pre-partum and one and two days postpartum, together with the neonate's lip temperature.ResultsThe temperature of the neonate's lips was significantly lower than the forehead temperature on days one and two post-partum (delta = -1.24°C, p
  • Return of neonatal CPAP resistance - the Medijet device family examined
           using in-vitro flow simulations
    • Abstract: AimMedijet nasal continuous positive airway pressure (CPAP) generators are a family of devices developed from the Benveniste valve. Previous studies have shown that the in-vitro performance of the Medijet disposable generator was similar to the Neopuff resistor system. We hypothesised that resistance would be the main mechanism of CPAP generation in the Medijet disposable generator.MethodsThe in-vitro performance of the Medijet reusable and disposable systems, the Neopuff resistor system and the Benveniste and Infant Flow non-resistor systems were investigated using static and dynamic bench tests.ResultsLarge differences in performance were found between the different systems. The disposable Medijet demonstrated high resistance, low pressure stability and high imposed work of breathing. The results also showed that encapsulating the Benveniste valve changed it into a resistor system.ConclusionThe main mechanism of CPAP generation for the disposable Medijet generator was resistance. The Medijet device family showed increasing resistance with each design generation. The high resistance of the Medijet disposable generator could be of great value when examining the clinical importance of pressure stability. Our results suggest that this device should be used cautiously in patients where pressure stable CPAP is believed to be clinically important.This article is protected by copyright. All rights reserved.
  • 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 1999-2000 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% versus14%, p
  • A longitudinal study of cognitive and educational outcomes of those born
           small for gestational age
    • Abstract: AimThis study examined the long-term cognitive and educational outcomes of being born small for gestational age (SGA) and assessed whether the family's attitude towards education modified the effect of being born SGA on educational attainment.MethodsWe used anonymised data on 9,598 individuals from the Stockholm Birth Cohort. This study focused on babies born in 1953 in the Stockholm metropolitan area, who were followed up for 50 years, and included educational data at the age of 13 and 48. Ordinary least squares regression analyses, modification analyses and logistic regression analyses were conducted.ResultsThe findings suggested that individuals who were born SGA (n=798) had lower mean verbal, spatial, and numerical test scores than those born appropriate for gestational age (AGA) (n=7,364) and large for gestational age (n=1,436). The SGA/AGA differences were small, but statistically significant, and the effects of being born SGA on the test scores was modified by the family's attitude towards education. The findings also suggested that attaining higher education was largely, but not entirely, explained by the family's attitude towards education.ConclusionThe detrimental effects of being born SGA were limited on cognitive and educational outcomes, but may have been reduced by positive family attitudes.This article is protected by copyright. All rights reserved.
  • Lactobacillus reuteri DSM 17938 and a placebo both significantly reduced
           symptoms in children with functional abdominal pain
    • Abstract: AimLactobacillus reuteri is a Gram-positive bacterium that naturally inhabits the human intestinal tract. This study assessed how effectively the probiotic Lactobacilllus reuteri DSM 17938 managed childhood functional abdominal pain (FAP).MethodsWe recruited 54 children with a mean age 9.1±3.8 years, who were diagnosed with FAP in the outpatient clinics of three university hospitals in Greece, Slovenia and Poland, according to the Rome III criteria, from January 2013 to December 2015. They were randomly assigned to receive either 2x108 colony-forming units of L. reuteri (n=27) or a placebo (n=27) for four weeks.ResultsBoth L. reuteri and the placebo significantly reduced the frequency and intensity of abdominal pain episodes at four and eight weeks (all p
  • 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, was a predictor of more headache disability at follow up.ConclusionHigh depression scores in childhood was 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.This article is protected by copyright. All rights reserved.
  • 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.
  • Combined genetic analyses can achieve efficient diagnostic yields for
           subjects with Alagille syndrome and incomplete Alagille syndrome
    • Abstract: AimWe evaluated combined genetic analyses with targeted next-generation sequencing (NGS), multiplex ligation probe amplification (MLPA) of Jagged1 (JAG1) genes and microarray comparative genomic hybridisation (CGH) in subjects with Alagille syndrome, incomplete clinical features of Alagille syndrome and biliary atresia.MethodsSubjects recruited from April 2013 to December 2015 underwent a targeted NGS analysis, including JAG1 and Notch homolog 2 (NOTCH2). If no mutations were detected in JAG1 or NOTCH2, or if copy number variations were suggested by the NGS analysis, we performed an MLPA analysis of JAG1. We also performed a microarray CGH analysis with whole-exon deletion detected by the MLPA analysis.ResultsWe analysed 30 subjects with Alagille syndrome, nine with incomplete Alagille syndrome and 17 with biliary atresia and detected pathogenic mutations in JAG1 or NOTCH2 in 24/30 subjects with Alagille syndrome and in 4/9 subjects with incomplete Alagille syndrome. No pathogenic mutations were detected in subjects with biliary atresia. The frequency of JAG1 mutations was: single nucleotide variants (51.9%), small insertion or deletion (29.6%) and gross deletion (18.5%).ConclusionCombined genetic analyses achieved efficient diagnostic yields for subjects with Alagille syndrome and incomplete Alagille syndrome.This article is protected by copyright. All rights reserved.
  • Maternal intra-partum antibiotic treatment continues to exert a
           bactericidal effect on the umbilical cord and peripheral venous blood of
           newborn infants
    • Abstract: AimIt is unclear whether maternal intra-partum antibiotic treatment (IAT) continues to exert a bactericidal effect on common pathogens in neonates. We studied the in vitro bactericidal effect of IAT on the cord and peripheral venous blood of newborn infants.MethodsUmbilical cord and peripheral venous blood from newborn infants born at Kaplan Medical Center, Israel, from April to October 2014 were studied for serum bactericidal titers against Group B Streptococcus (GBS) and Escherichia coli (E. coli) strains. We studied 60 samples of umbilical cord blood and 18 samples of peripheral venous blood from 60 newborn infants whose mothers received IAT. The controls were 10 samples of cord blood from mothers without IAT.ResultsCord blood exerted a bactericidal effect against 98% of GBS isolates but only 8% of E.coli isolates. Peripheral blood exerted a bactericidal effect against GBS in 94% of cases, but not against E.coli. No bactericidal effect was seen in the blood from the controls.ConclusionWe found a continued bactericidal effect of umbilical cord blood and neonatal peripheral blood from newborn infants of IAT treated mothers, mainly against GBS, but rarely against E.Coli. These findings may assist clinicians treating at-risk infants exposed to IAT.This article is protected by copyright. All rights reserved.
  • Neonatal Therapeutic Hypothermia Outside of Standard Guidelines: A Survey
           of U.S. Neonatologists
    • Abstract: AimTherapeutic hypothermia is standard of care in term infants with moderate-to-severe hypoxic-ischemic encephalopathy (HIE). The goal of this survey was to explore the attitudes of U.S. neonatologists caring for infants with HIE who fall outside of current guidelines.MethodCase-based survey administered to members of the Section on Neonatal-Perinatal Medicine of American Academy of Pediatrics.Results447 responses were analyzed, i.e. a response rate of 19%. We found significant variability amongst U.S. neonatologists with regards to the use of therapeutic hypothermia for infants with HIE who fall outside standard inclusion criteria. Scenarios with the most variability included HIE in a late-preterm infant and HIE following a postnatal code. Provision of therapeutic hypothermia outside of standard guidelines was not influenced by number of years in practice, neonatal intensive care type (NICU) type or NICU size.ConclusionSignificant variability in practice exists when caring for infants with HIE who do not meet standard inclusion criteria, emphasizing the need for continued and rigorous research in this areaThis article is protected by copyright. All rights reserved.
  • Quality predictors of parental satisfaction after birth of infants with
           life-limiting conditions
    • Abstract: AimThis study examines parental satisfaction with care received in the context of a life-limiting fetal diagnosis and subsequent birth.MethodsSurvey methods were utilized to embed the Quality Indicators (QI) and Parental Satisfaction of Perinatal Palliative Care Instrument in a survey: “The Voice of Parents”.ResultsThe web-based survey had a final sample of N=405 parent responders. Overall, parents reported satisfaction with care (80.2%; n=393). Parents satisfied with care reported higher agreement with quality indicator items for all subscales. In total, 17 items from the 41-item instrument revealed the ability to predict higher parental satisfaction when particular QI are reported.ConclusionThis study has led to credible insights into parental satisfaction with care given after the birth of an infant with a life-limiting condition. The findings contribute to development of a model with a good fit in ascertaining the importance of compassion, unhurried provider-patient communication and bereavement interventions.This article is protected by copyright. All rights reserved.
  • The accuracy of the HemoCue WBC DIFF in assessing blood eosinophils
           depends on the clinical setting and medical condition
    • Abstract: We were very interested to read the paper by Karawajczyk et al on counting white blood cells using a portable, point-of-care device, the HemoCue WBC DIFF (HemoCue AB, Ängelholm, Sweden) (1). The authors concluded that this device was useful and reliable for assessing leucocyte and neutrophil counts, but not eosinophils and monocytes. The study was conducted in a population of children admitted to a paediatric emergency department and a paediatric oncology unit, without any further selection and therefore with a very low probability of eosinophilic diseases.This article is protected by copyright. All rights reserved.
  • Age-related off-label use of nasal corticosteroids for allergies is
           relatively common in Finnish children with asthma
    • Abstract: AimAllergies can worsen asthma symptoms and we used national data to identify allergy medication prescribed for Finnish children and adolescents who used asthma medication.MethodsRegister data were available for 13,435 Finnish children aged 0-17 who were entitled to special reimbursement for asthma medication during 2006-2009. Allergy medication purchases were individually analysed two years before and two years after the entitlement for asthma medication reimbursement was granted.ResultsTwo-thirds (66.5%) of the children had used at least one allergy medication during the four-year follow up, with an average of five purchases. Most (91%) of the allergy medication purchased was systemic antihistamines and half (50%) was nasal corticosteroids. In all, 8% of the allergy medication and 22% of the nasal corticosteroids were classified as off-label purchases based on the child's age. Paediatric allergologists and paediatricians prescribed 59% of the allergy medication and 76% of the off-label nasal corticoids.ConclusionMost asthmatic children and adolescents used allergy medication. Nasal corticosteroids were the commonly prescribed off-label item and the prescribers were mainly specialists in paediatric allergology or paediatrics. Official dosage instructions and more specific clinical guidelines are needed to support appropriate prescribing of nasal corticosteroids for young children.This article is protected by copyright. All rights reserved.
  • Traditional empiric antibiotic treatment is still effective for neonatal
    • Abstract: Fever may be the only sign of a serious bacterial infection (SBI) in neonates. Ampicillin plus cefotaxime (A+C) and ampicillin plus gentamicin (A+G) are commonly used as empiric therapies for Escherichia coli, Group B Streptococcus (GBS) and Listeria monocytogenes, which are the most likely neonatal SBI pathogens (1). Culture-based screening and prophylaxis has significantly lowered GBS infections and an alarming increase in the antimicrobial resistance rates of Gram-negative bacteria, including cefotaxime and gentamicin resistance, has been reported (1-3). We examined whether the current empiric treatment for neonatal SBI, namely A+G and A+C was still appropriate and identified easily recognisable risk factors for antimicrobial resistance.This article is protected by copyright. All rights reserved.
  • Toll-like receptor 1 and 10 gene polymorphisms are linked to
           post-bronchiolitis asthma in adolescence
    • Abstract: AimToll-like receptors (TLR) are innate immunity molecules and our previous studies found that TLR1 gene polymorphism was associated with post-bronchiolitis asthma at 1-6 years of age, as was TLR10 at 5-7 years of age. This study examined any associations at 11-13 years of age.MethodsThis prospective follow-up study was part of an on-going evaluation of children admitted to Tampere University Hospital Finland for bronchiolitis in 2001-2004 at less than six months of age. We evaluated the association of TLR1 rs5743618 and TLR10 rs4129009 polymorphisms with asthma and asthma medication in 125 children aged 11-13 years.ResultsAssociations were measured as adjusted odd ratios (aOR) with 95% confidence intervals (95% CI). The variant TLR1 rs5743618 (aOR 3.69, 95% CI 1.04-13.01) and TLR10 rs4129009 (aOR 7.02, 95% CI 1.56-31.53) genotypes increased the risk of needing inhaled corticosteroids at 11-13 years of age. The variant TLR10 genotype (aOR 7.69, 95% CI 1.35-43.95) increased the risk of persistent asthma continuing from 5-7 years of age until 11-13 years of age. The results were similar when the combined genotypes were analysed.ConclusionPolymorphisms in both the TLR1 and TLR10 genes may increase the risk of asthma at 11-13 years after infant bronchiolitis.This article is protected by copyright. All rights reserved.
  • Alcohol exposure during pregnancy altered childhood developmental
           trajectories in a rural South African community
    • Abstract: AimThis study examined the effects of prenatal alcohol exposure on childhood development trajectories in a rural South African community between 2003 and 2008.MethodsWe assessed 121 children at 7-12 months (year one) and 5-6 years (year five) using the Griffiths Mental Developmental Scales – Extended Revised, which measures sensorimotor, cognitive and social development, with lower scores indicating developmental delay. We also interviewed their mothers or caregivers. Three groups were identified: 29 with fetal alcohol syndrome (FAS) or partial FAS (pFAS), 57 more who had been exposed to alcohol and 35 controls who had not.ResultsThe scale's total score was higher in the controls than in the FAS/pFAS group at years one and year five and in the alcohol exposed group at year five. Many groups’ trajectories declined when compared with global norms, but the trajectories in the FAS/pFAS and the alcohol exposed groups declined more than the controls for eye-hand and performance and total score. Earlier pregnancy recognition in the FAS/pFAS group correlated strongly (r= -0.77) with higher GQ in year five.ConclusionFAS/pFAS and prenatal alcohol exposure affected the Griffiths scores more than the control group. Efforts are needed to detect pregnancy early and reduce alcohol exposure.This article is protected by copyright. All rights reserved.
  • Prevention and recognition of abusive head trauma: Training for healthcare
           professionals in Vietnam
    • Abstract: AimThis paper presents results from an intervention designed to improve identification and response to abusive head trauma in a tertiary paediatric hospital in Vietnam.MethodsOne hundred and sixteen healthcare professionals (paediatric medical and nursing staff) completed a clinical training programme and participated in its evaluation. A pre-post-test and follow-up design was used to evaluate the outcomes. Questionnaires were used to collect data prior to training, at six-weeks and at six-months. Generalised Linear Modelling was used to examine changes in diagnostic skills and knowledge of the consequences of Shaken Baby Syndrome (a form of abusive head trauma), its prevention, and treatment.ResultsAt baseline, awareness and knowledge reflected no former abusive head trauma training. Following the intervention participants had an increased awareness of Shaken Baby Syndrome, the potential consequences of shaking infants, and had acquired techniques to inform parents how to manage the crying infant.ConclusionThe intervention was effective in raising awareness of Shaken Baby Syndrome and its consequences amongst the participating healthcare professionals in Vietnam. Training can improve detection and prevention of abusive head trauma, and the intervention has the potential to be adapted for similar settings internationally.This article is protected by copyright. All rights reserved.
  • Paediatric obesity treatment had better outcomes when children were
           younger, well motivated and did not have acanthosis nigricans
    • Abstract: AimThis study evaluated the efficacy of a paediatric obesity treatment programme and explored the factors that contributed to the outcome.MethodsWe recorded the body mass index standard deviation scores (BMI SDS) of 654 children aged 2-18 years who were treated for obesity in 2005–2012 in three Finnish hospitals, one year before treatment and up to three years after treatment. The family-based multidisciplinary treatment included nutritional advice, exercise and behavioural counselling. The BMI SDS changes, and their contributors, were explored with mixed model and logistic regression analyses.ResultsBMI SDS increased before baseline and decreased at six, 12 and 24 months (all p < 0.001) and 36 months (p = 0.005). Younger age (p < 0.001), higher BMI SDS at baseline (p = 0.001), motivation (p = 0.013), adherence to the protocol (p = 0.033) and lack of acanthosis nigricans (p < 0.001) improved the outcome. The BMI SDS of children aged 2-6 decreased best from baseline to 12 (-0.35), 24 (-0.58) and 36 months (-0.64) (all p < 0.001).ConclusionPaediatric obesity treatment was most effective at a younger age. Good motivation and adherence contributed to favourable outcomes, while acanthosis nigricans was associated with a poor outcome.This article is protected by copyright. All rights reserved.
  • Growth impairment and gonadal axis abnormalities are common in survivors
           of paediatric brain tumours
    • Abstract: AimChildhood brain tumour survivors have a high risk of endocrine morbidity. This study evaluated the growth, pubertal development and gonadal function in survivors of childhood brain tumours and identified factors associated with the problems we observed.MethodsThe 52 subjects (52% male) were diagnosed in 1983-1997 and treated for brain tumours at Tampere University Hospital, Finland. They were followed up at a mean age of 14.2 (3.8-28.7) years, a mean of 7.5 (1.5-15.1) years after diagnosis.ResultsWe found that 30 (58%) participants had a lower height standard deviation score at follow up than at diagnosis and short stature at follow up was associated with tumour malignancy (p=0.005), radiotherapy (p=0.004), chemotherapy (p=0.024), growth hormone deficiency (p
  • Lean mass explains the association between muscular fitness and bone
           outcomes in 13-year-old boys
    • Abstract: AimThis study investigated the associations between fitness indices and bone outcomes in young males.MethodsData were collected between autumn and winter 2014-2015 on 121 males with a mean age of 13.1 ±0.1 years: 41 swimmers, 37 footballers, 29 cyclists and 14 non-athletes. Participants were recruited from athletic clubs and schools across South West England. Lean mass, areal bone mineral density and hip structural estimates were measured using dual-energy X-ray absorptiometry. The relationships between bone outcomes and the vertical jump, standing long jump and the 20m shuttle run test were analysed using three regression models: model one was adjusted by age and stature, model two added vigorous physical activity and model three then added lean mass.ResultsThe boys’ performance in the vertical jump and standing long jump was positively associated with the majority of bone outcomes in models one and two, but most of these disappeared in model three. The 20m shuttle run test was positively associated with most bone outcomes in all three models. Lean mass played a key role in the association between muscular fitness and bone outcomes.ConclusionVigorous physical activity did not explain the associations between fitness and bone outcomes, but lean mass did.This article is protected by copyright. All rights reserved.
  • Young children with severe congenital malformations (VACTERL) expressed
           mixed feelings about their condition and worries about needles and
    • Abstract: AimOur knowledge of the perceptions that children with severe congenital malformations have of their health, treatment and how to improve hospital care is limited. This study focused on patients with vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies and limb abnormalities (VACTERL).MethodsWe interviewed 10 children aged 5-8 years with VACTERL association who were treated in a Swedish tertiary paediatric surgical centre in 2015 and 2016, by using a computer-assisted technique called In My Shoes. The interviews were analysed by qualitative content analysis.ResultsThe children described their awareness of their health history and said they felt proud but different due to their physical dysfunction. They were happy to visit the hospital to meet familiar staff, but expressed negative feelings about missing normal life. They were afraid of needle-related procedures and not wakening up after anaesthesia. Various ways of coping with difficult situations were expressed and suggestions to improve hospital care were voiced.ConclusionCareful follow up of these children by multidisciplinary teams is crucial to optimise their health and functional status. Fear of medical procedures may be reduced by carefully delivered information, listening to the children, providing continuity of care and creating individual care strategies.This article is protected by copyright. All rights reserved.
  • Low weight gain at the start of a family-based intervention for adolescent
           girls with restrictive eating disorders predicted emergency hospital
    • Abstract: AimThis study examined predictors of emergency hospitalisation of adolescent girls with restrictive eating disorders and weight loss treated by a family-based intervention programme.MethodsWe studied 339 girls aged 10-17 years treated in a specialist unit at Uppsala University Children's Hospital, Sweden, from August 2010 to December 2015. Historical weight data were obtained from school health services and other weight data were determined at presentation. Weight controlling behaviour was recorded and patients were evaluated using the Eating Disorder Examination Questionnaire. A family-based intervention started after assessment and the early weight gain after one week, one month and three months was assessed.ResultsThere were 17 emergency admissions of 15 patients for refusing food, progressive weight loss and medical instability. Logistic regression analysis showed that emergency admissions were predicted by a low body mass index standard deviation score at presentation (odds ratio 2.57), a high rate of weight loss before presentation (odds ratio 4.38) and a low rate of weight gain at the start of treatment (odds ratio 4.59).ConclusionPoor weight gain at the start of a family-based intervention for adolescent girls with restrictive eating disorders predicted emergency hospital admission.This article is protected by copyright. All rights reserved.
  • Shared Decision Making, Value Pluralism, and the Zone of Parental
    • Abstract: “Good ethics start with good facts” wrote John Lantos and William Meadow in a 2009 editorial addressing periviability controversies - debates that continue to generate lively discussion amongst neonatologists, obstetricians, ethicists, and families (1). How do we best promote shared decision making with pregnant women who, through no fault of their own, might deliver an extremely premature infant' Unfortunately, the recent “A Different View” in this journal by Dr. Patrick Marmion regarding periviability issues in general, and specifically our shared decision making model at Providence St. Vincent Medical Center (PSVMC) in Portland, OR, is decidedly short on facts and is regrettably inflammatory (2). We appreciate the opportunity to respectfully clarify our bioethical foundation and periviability dialogue framework with the hope of promoting reasoned dialogue and understanding.This article is protected by copyright. All rights reserved.
  • Professionals’ positive perceptions of fathers are associated with more
           favourable attitudes towards including them in family interventions
    • Abstract: AimThis Université du Quebec 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 Quebec, 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% female) 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.This article is protected by copyright. All rights reserved.
  • Short stature homeobox-containing gene duplications in 3.7% of girls with
           tall stature and normal karyotypes
    • Abstract: AimThe short stature homeobox containing gene (SHOX) plays an important role in short stature, but has not been explored in detail in a tall stature population before. This study explored the prevalence of SHOX aberrations in girls diagnosed with idiopathic tall stature with a normal karyotype.MethodsWe studied SHOX aberrations in 81 girls with a median age of 10.43 (7.17-12.73) years diagnosed with tall stature who were referred to our clinic at Copenhagen University Hospital, Denmark, between 2003-2013. SHOX copy variations were analysed by quantitative polymerase chain reaction and aberrations were confirmed by multiplex ligation probe-dependent amplification.ResultsOne extra SHOX copy was found in three (3.7%) of the 81 girls with tall stature and their heights were 2.87, 3.71 and 3.98 standard deviation scores (SDS) above the median height SDS of the girls with two SHOX copies. Their sitting height / height ratios (-3.08, -2.00 and -2.18 SDS) were all lower than the populationmean. Despite these SHOX duplications, the three girls were clinically and biochemically comparable to the 78 girls with two SHOX copies.ConclusionsThis study was the first to demonstrate SHOX duplications in three girls with tall stature and normal karyotypes.This article is protected by copyright. All rights reserved.
  • 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, non-invasive, 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.This article is protected by copyright. All rights reserved.
  • Swedish population-based study of pupils showed that foster children faced
           increased risks for ill-health, negative lifestyles and school failure
    • Abstract: AimThis population-based study explored if foster children faced a higher risk of health problems than children of the same age who were not in foster care.MethodsData for 13,739 pupils aged 10, 13 and 16 years were obtained from the Pupil Health Database in the county of Värmland, Sweden, for the school years 2012/2013 and 2013/2014. These included data on school performance, health, lifestyle and social relationships, based on children's interviews with school nurses.ResultsOf all the pupils, 171 (1.2%) were in foster care. Children in foster care were generally unhealthier than other children. Both girls and boys were at higher risk of chronic health problems, daily smoking, use of drugs and school failure. When the girls in foster care were compared to other girls we found that they faced a higher risk of psychological and psychosomatic symptoms. This difference was not found for boys. Foster children were also more likely to express a more negative view on life.ConclusionWe confirmed earlier studies that children in foster care tended to have inferior health and wellbeing than other children. These findings emphasise that health, risky behaviour and school performance should be considered together when assessing foster children.This article is protected by copyright. All rights reserved.
  • Paediatricians should encourage the parents of children with special
           healthcare needs to disclose their use of complementary and alternative
    • Abstract: Complementary and alternative medicine (CAM) is widely used by the families of children who have special healthcare needs, such as developmental disabilities and severe clinical conditions, during the first years of life (1). However, they might be reluctant to disclose this to their child's paediatrician (2), which is a risk factor for the unsupervised and ineffective family care of such children (3).This article is protected by copyright. All rights reserved.
  • Does a comprehensive family-centred early intervention service affect
           stress reactivity and emotion regulation in very low birthweight preterm
           infants at toddler age'
  • Intranasal ketamine proved feasible for pain control in paediatric care
           and parental support was high
    • Abstract: Venipuncture and intravenous placement are common causes of pain in children. The Pediatric Emergency Department at Kaplan Medical Center carried out a feasibility trial to look at whether nasal ketamine could provide pain control during these procedures. From June to December 2016, we enrolled 20 children aged 1-12 years who resisted venipuncture or intravenous placement.This article is protected by copyright. All rights reserved.
  • 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 non-invasive 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 15/17 hospitals was 3.8 per 1,000 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.ConclusionHFNC was actively used for infants with bronchiolitis, with no substantial over-use. Randomised controlled studies are needed before any evidence-based guidelines can be constructed for using HFNC in infant bronchiolitis.This article is protected by copyright. All rights reserved.
  • Adipokines played a limited role in predicting temporary growth
           differences between very low birth weight infants with and without
           bronchopulmonary dysplasia
    • Abstract: AimsThis study explored whether growth was poorer among very low birth weight (VLBW) infants with bronchopulmonary dysplasia (BPD) and assessed adipokine levels as predictors of early growth.MethodsWe studied 53 VLBW infants born in Tampere University Hospital up to 12 months of corrected age (CA). The mean age of the 21 infants with BPD and 32 infants without BPD was 29 weeks and the mean weights were 930 (635-1,470) and 1,185 (650-1,470) grams. Growth parameters, macronutrients intake and plasma levels of adipokines were measured.ResultsBPD infants were lighter than controls until 36 weeks of CA, with catch-up growth achieved by three months of CA. Adipsin levels were lower in BPD infants at 28 days of postnatal age. High leptin levels seemed protective for low weight for height at nine months of CA. The duration of ventilator therapy predicted low weight for height, length for age and body mass index and BPD predicted low length for age at 12 months of CA.ConclusionsCatch-up growth in VLBW infants with BPD was achieved by three months of CA, but adipokines played a limited role in predicting growth. Shortening ventilator therapy could help growth in VLBW infants.This article is protected by copyright. All rights reserved.
  • Comparative study shows differences in screen exposure, sleep patterns and
           sleep disturbances between Jewish and Muslim children in Israel
    • Abstract: AimThis study determined the differences in screen exposure, sleep patterns and sleep disturbances, and the associations between these factors, among Jewish and Muslim children in Israel.MethodsThe participants were 1,049 school children - 499 Jewish and 550 Muslim - with a mean age of 9.20 ±0.71 years, who attended public schools in both urban and residential settings in 2014. They all completed the Sleep Self-Report questionnaire and the Screen Exposure Questionnaire.ResultsMuslim children reported increased screen time, despite having fewer televisions and computers in their bedroom than Jewish children. Muslim children also reported earlier bedtimes and longer sleep duration, but greater sleep disturbances. Having screens in bedrooms and non-school days were related to later bedtimes and later wake-up times for all children. Children who spent four or more hours watching television or using a computer on school days reported significantly more sleep disturbances than children with lower usage.ConclusionMuslim children with a mean age of nine years reported longer screen exposure, earlier bedtimes and longer sleep duration, but more sleep disturbances, than Jewish children. Cultural sleep practices may contribute to the differences in sleep patterns and sleep disturbances of Jewish and Muslim children in Israel.This article is protected by copyright. All rights reserved.
  • Normal neonatal hearing screening did not preclude sensorineural hearing
           loss in two-year-old very preterm infants
    • Abstract: AimVery preterm infants are at risk of neonatal hearing loss. However, it is unknown whether infants with a normal neonatal hearing screening result risk sensorineural hearing loss (SNHL) at a later age.MethodsThis cohort study was conducted at the Erasmus Medical University Center Rotterdam, the Netherlands, on 77 very preterm infants born between October 2005 and September 2008. All infants underwent auditory brainstem response audiometry during neonatal hearing screening and at two years of corrected age. The frequency of SNHL in infants with a normal neonatal hearing screening was analysed and the risk factors associated with newly diagnosed SNHL in these infants were examined.ResultsWe found that 3.9% (3/77) of the very preterm infants showed permanent hearing loss during their neonatal hearing screening. In addition, a relatively high prevalence of newly diagnosed SNHL (4.3%) was found in three of the 70 infants followed up at the age of two. The total prevalence rate of permanent hearing loss in the cohort was approximately 8%.ConclusionA normal outcome of neonatal hearing screening did not guarantee normal hearing at two years of age in this very preterm cohort and paediatricians should be alert to the possibility of late-onset SNHL.This article is protected by copyright. All rights reserved.
  • Non-randomised interventional study showed that early aggressive nutrition
    • Abstract: AimThis study evaluated whether an early aggressive nutrition (EAN) strategy could limit extrauterine growth restriction (EUGR) in a cohort of preterm infants.MethodsThis prospective non-randomised interventional study was carried out in the neonatal intensive care unit of an Italian hospital from January 2013 to December 2015. The prevalence of EUGR was assessed in 100 infants with a gestational age of ≤34 weeks, 50 after the introduction of an EAN regimen in October 2014 and 50 before.ResultsThe prevalence of EUGR at discharge was significantly lower after the introduction of EAN than before for weight (34% versus 66%), head circumference (22% versus 42%) and length at discharge (20% versus 48%). The Z-scores for all measurements were significantly higher after the introduction of EAN. In the EAN group, weight velocity was significantly higher and maximum weight loss and negative changes in the Z-scores from birth to discharge for weight were lower than in the pre-intervention controls. In extremely low birth weight subjects, the weight Z-score and weight velocity were significantly higher in the EAN group than the control group.ConclusionThe use of EAN at a very early age reduced EUGR and improved auxological outcomes in preterm infants.This article is protected by copyright. All rights reserved.
  • A parent-infant music therapy intervention improved neurodevelopment after
           neonatal intensive care
    • Abstract: Parental involvement is often essential to ensure that early intervention strategies that aim to improve the outcomes of former neonatal intensive care (NICU) patients are successful. However, hospitalisation can strain the caregiver-infant bond (1) and perception of the child's development. Structured music therapy programmes that focus on the progressive development of infant and caregiver dyads after hospital discharge have been associated with improvements in infants’ social skills and positive parenting behaviours (2).This article is protected by copyright. All rights reserved.
  • Phenotypic characterisation of coagulase-negative staphylococci isolated
           from blood cultures in newborn infants, with a special focus on
           Staphylococcus capitis
    • Abstract: AimThis Swedish study determined which species of coagulase-negative staphylococci (CoNS) were found in neonatal blood cultures and whether they included Staphylococcus capitis clones with decreased susceptibility to vancomycin.MethodsCoNS isolates (n=332) from neonatal blood cultures collected at Örebro University Hospital during 1987-2014 were identified to species level with matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). The antibiotic susceptibility pattern of S. capitis isolates was determined by the disc diffusion test and Etest and the presence of heterogeneous glycopeptide-intermediate Staphylococcus capitis (hGISC) was evaluated.ResultsStaphylococcus epidermidis (67.4%), Staphylococcus haemolyticus (10.5%) and Staphylococcus capitis (9.6%) were the most common CoNS species. Of the Staphylococcus capitis isolates, 75% were methicillin-resistant and 44% were multidrug resistant. No isolate showed decreased susceptibility to vancomycin, but at least 59% displayed the hGISC phenotype. Staphylococcus capitis isolates related to the strain CR01 displaying pulsotype NRCS-A were found.ConclusionStaphylococcus epidermidis, Staphylococcus haemolyticus, and Staphylococcus capitis were the predominant species detected in neonatal blood cultures by MALDI-TOF MS. The number of episodes caused by Staphylococcus capitis increased during the study period, but no isolates with decreased susceptibility to vancomycin were identified. However, Staphylococcus capitis isolates related to the strain CR01 displaying pulsotype NRCS-A were found.This article is protected by copyright. All rights reserved.
  • Very preterm children with fetal growth restriction demonstrated altered
           white matter maturation at nine years of age
    • Abstract: AimThis study evaluated the role of preterm birth and fetal growth restriction on white matter maturation in schoolchildren without any severe neurodevelopmental impairment.MethodsThe study group comprised 56 very preterm children and 21 term children born between November 1998 and November 2002 at Oulu University Hospital, Finland. The mean gestational age of the preterm children was 28.7 (24.1–31.9) weeks. All children underwent diffusion tensor imaging at a mean age of 9.0 (8.6–9.6) years. Voxel-wise statistical analyses of the imaging data were carried out using tract-based spatial statistics.ResultsPreterm children with fetal growth restriction had lower fractional anisotropy and higher radial diffusivity than term controls (p < 0.05), bilaterally in several white matter areas. Preterm children without fetal growth restriction had higher mean diffusivity and axial diffusivity than term controls (p < 0.05) in analogous areas, but more asymmetrically.ConclusionPreterm children had microstructural differences in white matter, compared to term-born children at a mean age of nine, and those with poor fetal growth showed widespread changes in white matter maturation compared to term-born children. Fetal growth and prematurity seemed to affect white matter maturation in a way that was still visible at that age.This article is protected by copyright. All rights reserved.
  • Does umbilical cord milking result in higher measures of systemic blood
           flow in preterm infants'
  • 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.This article is protected by copyright. All rights reserved.
  • Randomised study showed that recorded maternal voices reduced pain in
           preterm infants undergoing heel lance procedures in a neonatal intensive
           care unit
    • Abstract: AimAlleviating pain in neonates should be the goal of all caregivers. We evaluated whether recorded maternal voices were safe and effective in limiting pain in preterm infants undergoing heel lance procedures in the neonatal intensive care unit of an Italian children's hospital.MethodsThis prospective, controlled study took place from December 2013 to December 2015. We enrolled 40 preterm infants, born at a 26-34 weeks of gestation, at a corrected gestational age 29-36 weeks and randomised them to listen or not listen to a recording of their mother's voice during a painful, routine heel lance for blood collection. Changes in the infants’ Premature Infant Pain Profile, heart rate, oxygen saturation and blood pressure during the procedure were compared by analysis of variance. Possible side effects, of apnoea, bradycardia, seizures and vomiting, were also recorded.ResultsBoth groups showed a marked increase in PIPP scores and decrease in oxygen saturation during the procedure, but infants in the treatment group had significantly lower PIPP scores (p=0.00002) and lower decreases in oxygen saturation (p=0.0283). No significant side effects were observed.ConclusionUsing recorded maternal voices to limit pain in preterm infants undergoing heel lance procedures appeared safe and effective.This article is protected by copyright. All rights reserved.
  • Severe post-war malnutrition did not have a negative impact on the
           earnings and subsequent pensions of German men born in 1945-1948
    • Abstract: AimPoverty has often been associated with malnutrition, stunted growth, impaired cognitive development and poor earnings. We studied whether these associations were found in German men born and raised shortly after World War Two during severe and longstanding nationwide malnutrition.MethodsWe analysed German old-age pension payments, as a rough measure of lifetime earnings, in 132,460 Germans born from 1932-1960 and compared the at-risk-of-poverty rates of German men born in 1945-48 versus 1935-38 and 1955-1958.ResultsSubstantially fewer women worked during this period and their longer life expectancy makes their pension payments difficult to interpret. We therefore limited our analysis to men. Men born in the 1930s received the highest monthly old-age pensions and these declined slightly in men born from 1945-48, indicating a minute impairment in work-related income in cohorts born shortly after the war. We also found that there was no evidence for increased at-risk-of-poverty rates in men born in 1945-48 versus those born in 1935-38 and in 1955-1958.ConclusionBeing born and raised following World War Two, was associated with a minute work and pension impairment that was not visible in the at-risk-of-poverty rates. These findings question statements associating early childhood nutrition and future lifetime earnings.This article is protected by copyright. All rights reserved.
  • Using Quality Improvement to Decrease Birth Asphyxia Rates After
           “Helping Babies Breathe” Training in Kenya
    • Abstract: AimThe Helping Babies Breathe (HBB) program is known to decrease neonatal mortality in low-resource settings but gaps in care still exist. This study describes the use of quality improvement to sustain gains in birth asphyxia-related mortality after HBB.MethodsTenwek Hospital, a rural referral hospital in Kenya, identified high rates of birth asphyxia (BA). They developed a goal to decrease the suspected hypoxic ischemic encephalopathy (SHIE) rate by 50% within six months after HBB. Rapid cycles of change were used to test interventions including training, retention and engagement for staff/trainees and improved data collection. Run charts followed the rate over time and χ2 analysis was used.ResultsNinety-six providers received HBB from September-November 2014. Over 4000 delivery records were reviewed. Ten months of baseline data showed a median SHIE rate of 14.7/1000 live births (LB) with wide variability. Ten months post-HBB, the SHIE rate decreased by 53% to 7.1/1000 LB (p=0.01). SHIE rates increased after initial decline; investigation determined that half the trained midwives had been transferred. Presenting data to administration resulted in staff retention. Rates have after remained above goal with narrowing control limits.ConclusionFocused quality improvement can sustain and advance gains in neonatal outcomes post-HBB training.This article is protected by copyright. All rights reserved.
  • Providing teachers with education on epilepsy increased their willingness
           to handle acute seizures in children from 1-10 years of age
    • Abstract: AimIn Germany, preschool teachers supervise children up to six years of age and are also responsible for supervising older pupils after school. This study explored the impact of a teaching session on epilepsy for teachers in charge of children from 1-10 years of age.MethodsWe evaluated the benefit of a teaching session offered to all preschool teachers in Leipzig, Germany, in 2014-2015, by asking them to complete the same questionnaire 12-24 months pre-intervention, and 12 months post-intervention.ResultsBoth questionnaires were completed by 123 teachers. The number of teachers who felt they were prepared to handle an acute seizure rose from 36 (29%) pre-intervention to 65 (53%) post-intervention (p
  • Up to 89% of neonates received antibiotics in cross-sectional Indian study
           including those with no infections and unclear diagnoses
    • Abstract: AimThere is a global lack of data on antibiotic prescribing for neonates. This study compared antibiotic prescribing practices in the neonatal intensive care units (NICUs) of two private sector, tertiary-level hospitals.MethodsA three-year, cross-sectional study was conducted from 2008-2011 in the NICUs of a teaching and non-teaching hospital in the Ujjain district of India. The data were analysed using methods recommended by the World Health Organization.ResultsOf the 1,789 inpatients, 89% (1,399/1,572) in the non-teaching hospital and 71% (154/217) in the teaching hospital were prescribed antibiotics and 123 patients died. All the antibiotics were prescribed empircally and cephalosporins and aminoglycosides were the most commonly prescribed sub-classses. Fixed dose combinations of cephalosporins were commonly prescribed in the non-teaching hospital. Neonatal sepsis was the most common diagnosis, in more than 30% of patients, and more than 93% with sepsis neonates were prescribed antibiotics. In addition, 40% of neonates in the non-teaching hospital were admitted for observation and were frequently prescribed antibiotics.ConclusionThese two Indian NICUs prescribed antibiotics for non-infectious or unclear diagnoses in addition to prescribing combinations of broad spectrum antibiotics. Such practices increase the global risk of treatment failure, neonatal mortality rates and antibiotic resistance.This article is protected by copyright. All rights reserved.
  • Prophylactic sustained inflation is just one step to preventing
           bronchopulmonary dysplasia
    • Abstract: I am glad to see that the Sustained Lung Inflation (SLI) trial (1) still draws a great deal of attention and I would like to clarify some aspects of the trial, in response to the comments by Gupta and Argarwal (2) in Acta Paediatrica.A meta-analysis carried out in 2016 demonstrated that starting non-invasive respiratory support from birth could reduce the incidence of bronchopulmonary dysplasia and death. However, about 50% of very low birth weight infants who are initially on nasal continuous positive airway pressure need subsequent intubation and mechanical ventilation.This article is protected by copyright. All rights reserved.
  • One oxygen breath shortened the time to return of spontaneous circulation
           in severely asphyxiated piglets
    • Abstract: AimAsphyxiated neonates should be resuscitated with air, but it remains unclear if oxygen supplementation is needed in ineffectively ventilated newborn infants. We studied the return of spontaneous circulation (ROSC) with oxygen or air in an experimental model of inadequate ventilation.MethodsAsphyxia was induced in 16 newborn piglets until their heart rate was
  • National epidemiological study reveals longer paediatric bone and joint
           infection stays for infants and in general hospitals
    • Abstract: AimPublished studies have suggested that 2-5 days of intravenous treatment could effectively treat paediatric bone and joint infections (PBJI), allowing a faster discharge. This study analysed the factors associated with PBJI hospital stays lasting longer than five days using the French National Hospital Discharge Database.MethodsWe selected children under 15 years hospitalised in 2013 with haematogenous PBJIs using a validated French algorithm based on specific diagnosis and surgical procedure codes. Risk factors for stays of more than five days were analysed using logistic regression.ResultsIn 2013, 2,717 children were hospitalised for PBJI, with 49% staying more than five days. The overall incidence of 22 per 100,000, was highest in males and toddlers. The main causes were septic arthritis (50%) and osteomyelitis (46%) and 50% of the pathogens were Staphylococci. The odd ratios for stays of five days or more were: infancy, coded bacteria and sickle cell disease (7.0), having spondylodiscitis rather than septic arthritis (2.2) and being hospitalised in a general hospital rather than a teaching hospital (1.6).ConclusionHalf of the hospital stays exceeded five days, despite scientific evidence supporting a shorter intravenous antibiotherapy regimen. Greater knowledge and widespread use of short treatment regimens are needed.This article is protected by copyright. All rights reserved.
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