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Publisher: John Wiley and Sons   (Total: 1576 journals)

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Showing 1 - 200 of 1576 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: 58, 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: 51, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 140, 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: 2)
Addiction     Hybrid Journal   (Followers: 33, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 12, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 24, 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: 250, 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: 44, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 29, 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: 131, 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: 91, 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: 31, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 12, SJR: 1.018, h-index: 58)
American J. of Industrial Medicine     Hybrid Journal   (Followers: 16, SJR: 0.993, h-index: 85)
American J. of Medical Genetics Part A     Hybrid Journal   (Followers: 15, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 3, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 5, SJR: 2.315, h-index: 79)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 36, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 251, 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: 16, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 9, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 121, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 11, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 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: 162)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 212, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 35, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 6, SJR: 0.569, h-index: 24)
Annalen der Physik     Hybrid Journal   (Followers: 5, SJR: 1.46, h-index: 40)
Annals of Anthropological Practice     Partially Free   (Followers: 2, SJR: 0.187, h-index: 5)
Annals of Applied Biology     Hybrid Journal   (Followers: 8, SJR: 0.816, h-index: 56)
Annals of Clinical and Translational Neurology     Open Access   (Followers: 1)
Annals of Human Genetics     Hybrid Journal   (Followers: 9, SJR: 1.191, h-index: 67)
Annals of Neurology     Hybrid Journal   (Followers: 44, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 2, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 9, SJR: 0.336, h-index: 23)
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5, SJR: 2.389, h-index: 189)
Annual Bulletin of Historical Literature     Hybrid Journal   (Followers: 12)
Annual Review of Information Science and Technology     Hybrid Journal   (Followers: 14)
Anthropology & Education Quarterly     Hybrid Journal   (Followers: 24, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 16, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 14)
Anthropology of Consciousness     Hybrid Journal   (Followers: 11, SJR: 0.172, h-index: 5)
Anthropology of Work Review     Hybrid Journal   (Followers: 11, SJR: 0.256, h-index: 5)
Anthropology Today     Hybrid Journal   (Followers: 93, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 45, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 6, SJR: 0.432, h-index: 59)
Anzeiger für Schädlingskunde     Hybrid Journal   (Followers: 1)
Apmis     Hybrid Journal   (Followers: 1, SJR: 0.855, h-index: 73)
Applied Cognitive Psychology     Hybrid Journal   (Followers: 67, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 136, 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: 34, SJR: 1.047, h-index: 57)
Arabian Archaeology and Epigraphy     Hybrid Journal   (Followers: 11, SJR: 0.453, h-index: 11)
Archaeological Prospection     Hybrid Journal   (Followers: 12, SJR: 0.922, h-index: 21)
Archaeology in Oceania     Hybrid Journal   (Followers: 13, SJR: 0.745, h-index: 18)
Archaeometry     Hybrid Journal   (Followers: 27, SJR: 0.809, h-index: 48)
Archeological Papers of The American Anthropological Association     Hybrid Journal   (Followers: 14, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 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: 219, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 51, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 28, 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: 14)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 316, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 7, SJR: 0.345, h-index: 20)
Asia-pacific J. of Clinical Oncology     Hybrid Journal   (Followers: 6, SJR: 0.554, h-index: 14)
Asia-Pacific J. of Financial Studies     Hybrid Journal   (SJR: 0.241, h-index: 7)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 3, SJR: 0.377, h-index: 7)
Asian Economic J.     Hybrid Journal   (Followers: 8, SJR: 0.234, h-index: 21)
Asian Economic Policy Review     Hybrid Journal   (Followers: 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: 13, SJR: 0.207, h-index: 7)
Asian Social Work and Policy Review     Hybrid Journal   (Followers: 5, SJR: 0.318, h-index: 5)
Asian-pacific Economic Literature     Hybrid Journal   (Followers: 5, SJR: 0.168, h-index: 15)
Assessment Update     Hybrid Journal   (Followers: 4)
Astronomische Nachrichten     Hybrid Journal   (Followers: 2, SJR: 0.701, h-index: 40)
Atmospheric Science Letters     Open Access   (Followers: 29, SJR: 1.332, h-index: 27)
Austral Ecology     Hybrid Journal   (Followers: 12, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 10, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 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: 43, SJR: 0.814, h-index: 49)
Australian and New Zealand J. of Public Health     Hybrid Journal   (Followers: 11, SJR: 0.82, h-index: 62)
Australian Dental J.     Hybrid Journal   (Followers: 6, SJR: 0.482, h-index: 46)
Australian Economic History Review     Hybrid Journal   (Followers: 4, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 23, SJR: 0.23, h-index: 9)
Australian Economic Review     Hybrid Journal   (Followers: 6, SJR: 0.357, h-index: 21)
Australian Endodontic J.     Hybrid Journal   (Followers: 3, SJR: 0.513, h-index: 24)
Australian J. of Agricultural and Resource Economics     Hybrid Journal   (Followers: 3, SJR: 0.765, h-index: 36)
Australian J. of Grape and Wine Research     Hybrid Journal   (Followers: 5, SJR: 0.879, h-index: 56)
Australian J. of Politics & History     Hybrid Journal   (Followers: 13, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 17, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 392, 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: 66, 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: 4, 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: 23, 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: 15, 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: 136, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 13, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 18, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 10, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 34, 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: 220, 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  [1576 journals]
  • The potential implications of using disability free survival and number
           needed to suffer as outcome measures for neonatal intensive care
    • Authors: Per-Arne Lönnqvist
      Abstract: The use of mortality and surrogate makers to determine outcomes after advanced medical treatment has been questioned, because often these dimensions do not agree with what both many medical staff and laypeople judge as adequate outcome measures. That is why Myles et al introduced the more adequate dimension of disability free survival (1-3). Furthermore, the suffering of other patients that is associated with one single individual having a good outcome has been discussed and the suggested term for this is the number needed to suffer (4), which reflects the similar terms of number needed to treat and number needed to harm.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T11:05:26.668444-05:
      DOI: 10.1111/apa.13888
       
  • Using internal and external reviewers can help to optimise neonatal
           mortality and morbidity conferences
    • Authors: Michael-Andrew Assaad; Annie Janvier, Anie Lapointe
      Abstract: AimThis study determined if there was a difference in the conclusions reached by paediatricians in morbidity and mortality conferences based on their level of involvement in a case.MethodsAll neonatal deaths occurring between August 2014 and September 2015 at Sainte-Justine Hospital, Montreal, Quebec, Canada, were reviewed by internal physicians involved in the case and external physicians who were not. The reviewers were asked to identify positive and negative clinical practice items and provide written recommendations. These were classified into eight categories and compared for each case.ResultsDuring the study, 55 patients died leading to 110 reviews and a total of 590 positive and negative items. Most items were in the communication (25.2%), ethical decision-making (16.7%) and clinical management (14.8%) categories. Both the internal and external reviewers were in agreement 48.5% of the time for positive items and 44.8% for negative items. There were 242 written recommendations, which differed significantly among the internal and external reviewers.ConclusionReviews of neonatal deaths by two independent reviewers, internal physicians and external physicians, led to different positive and negative practice items and recommendations. This could allow for a richer discussion and improve recommendations for patient care.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T11:00:28.139795-05:
      DOI: 10.1111/apa.13889
       
  • Randomised controlled trial shows that co-bedding twins may reduce birth
           weight recovery delay, parenteral nutrition weaning time and
           hospitalisation
    • Authors: Arnaud Legrand; Anne Frondas, Fabien Aubret, Anne Corre, Cyril Flamant, Laure Simon, Clothilde Desrobert, Jean-Christophe Rozé
      Abstract: AimCobedding describes a technique where premature twins are kept within the same incubator, inside a common cocoon, to prolong the alleged in utero behavioral bond and reduce post-natal stress. However there is no consensus amongst neonatologists regarding any clinical or developmental benefits cobedding may provide, in particular when performed early after the birth. The NEOCOB (NEOnatology & COBedding) trial aimed to assess, for the first time, early cobedding in preterm newborn twins.MethodsIn a controlled randomized design, we measured various physiological and neurodevelopmental responses in 15 cobedded vs 17 separated sets of preterm twins, born between 30 to 34 weeks of gestation, during the entire hospital stayResultsDespite limited cohort size, statistical trends suggest that cobedding may reduce birth weight recovery delay, decrease parenteral nutrition weaning time and ultimately hospital Length of Stay (LoSCobedded = 34.32 ± 1.57 days versus LoSSeparated = 40.19 ± 1.74 days; p = 0.067). Cobedding did not impact weight gain trajectories, neurodevelopment or thermoregulation. Unexpectedly, cobedded twins displayed increased tachycardia frequency, but with conserved comfortConclusionEven if speculative, the highlighted statistical trends may support the idea that cobedding could reduce LoS by maximizing developmental interactions and orality maturation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-24T01:30:42.754043-05:
      DOI: 10.1111/apa.13885
       
  • Changes in perinatal hospital deaths occurring outside the neonatal
           intensive care unit over a decade
    • Authors: Amélie Du Pont-Thibodeau; Keith Barrington, Catherine Taillefer, Annie Janvier
      Abstract: AimPerinatal deaths occurring outside the neonatal intensive care unit (NICU) are rarely recorded in outcome studies, despite having a direct impact on perinatal statistics. Our aim was to investigate the timing and modes of perinatal deaths that occurred outside the NICU and changes over time.MethodWe reviewed all perinatal deaths from 22 weeks of gestation onwards, without NICU admissions, during two periods in a Canadian tertiary mother and baby hospital and categorised deaths according to nine specific categories.ResultsThere were 444 perinatal deaths that satisfied the inclusion criteria. The total number of perinatal deaths increased from 2000 to 2002 (n=197) and 2007 to 2010 (n=247). The proportion of fetuses alive at the time of their mother's hospital admission, but then stillborn, decreased. There was a significant increase in terminations for congenital anomalies in the second cohort, and a decrease in deaths following induction of labour and comfort care for fetal anomalies.ConclusionApproaches to end of life care changed between the two study periods. Paediatricians should be aware of the epidemiology of perinatal mortality in their own practice, as it has a direct impact on the denominator in NICU outcome studies.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-23T05:55:49.161899-05:
      DOI: 10.1111/apa.13884
       
  • Receiving early information and trusting Swedish child health centre
           nurses increased parents’ willingness to vaccinate against rotavirus
           infections
    • Authors: Lina Schollin Ask; Anders Hjern, Ann Lindstrand, Ola Olen, Eva Sjögren, Margareta Blennow, Åke Örtqvist
      Abstract: AimRotavirus vaccines are effective against severe infections, but have a modest impact on mortality in high-income countries. Parental knowledge and attitudes towards vaccines are crucial for high vaccination coverage. This study aimed to identify why parents refused to let their infant have the vaccination or were unsure.MethodsThis cross-sectional study was based on 1,063 questionnaires completed by the parents of newborn children in 2014. Stepwise logistic regression was used to identify the main predictors.ResultsMost (81%) parents intended to vaccinate their child against the rotavirus, while 19% were unwilling or uncertain. Parents with less education and children up to five weeks of age were more likely to be unwilling or uncertain about vaccinating their child. Factors associated with a refusal or uncertainty about vaccinating were: not having enough information about the vaccine, no intention of accepting other vaccines, paying little heed to the child health nurses’ recommendations, thinking that the rotavirus was not a serious illness and not believing that the vaccine provided protection against serious forms of gastroenteritis.ConclusionEarly information, extra information for parents with less education and close positive relationships between parents and child health nurses were important factors in high rotavirus vaccination rates.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-17T07:35:59.08188-05:0
      DOI: 10.1111/apa.13872
       
  • Cardiorespiratory Physiology in the Safe Passage Study: Protocol, Methods
           and Normative Values in Unexposed Infants
    • Authors: Michael M. Myers; Amy J. Elliott, Hein J. Odendaal, Larry Burd, Jyoti Angal, Coen Groenewald, J. David Nugent, Joel S. Yang, Joseph R. Isler, Kim A. Dukes, Fay Robinson, William P. Fifer,
      Abstract: AimThe Safe Passage Study, conducted by the Prenatal Alcohol in SIDS and Stillbirth Network, is investigating contributions of prenatal alcohol exposure to fetal and infant demise. This current report presents physiological data from full term infants with no prenatal exposure to alcohol or maternal smoking.MethodsData are from 666 infants from the Northern Plains (North and South Dakota) and South Africa. A standardized protocol assessed cardiorespiratory function during baseline and head-up tilts shortly after birth and at 1 month of age.ResultsAnalyses revealed significant increases in heart rate and decreases in BP from the newborn to 1 month time period as well as diminished heart rate responses to head-up tilt in 1 month old infants.ConclusionThe Safe Passage Study was successful in characterizing physiology in a large number of infants at sites known to have elevated risks for SIDS. Results demonstrate that even with low prenatal adverse exposures, there are significant changes in cardiorespiratory function as infants enter the window of increased risk for SIDS.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-17T07:35:54.49015-05:0
      DOI: 10.1111/apa.13873
       
  • International opinions and national surveillance suggest insufficient
           consensus regarding the recognition and management practices of infants
           with congenital cytomegalovirus infections
    • Authors: J. Gunkel; J. Nijman, M.A. Verboon-Maciolek, T.F.W. Wolfs, L.S. de Vries
      Abstract: AimThis study evaluated the recognition and management practices with regard to congenital cytomegalovirus (cCMV) infections by a select group of experts and through a national surveillance study.MethodA questionnaire was sent to international experts involved in mother and infant care in 2014-2015. Monthly surveillance was conducted among Dutch paediatricians for cases of cCMV infections from 2013 until 2015.ResultsThe questionnaire was completed by 63/103 (62%) respondents, who indicated that recognition and management practices varied. Maternal screening was performed by 17/63 (27%) and infant screening by 3/61 (5%) of the respondents. Infant CMV diagnostics were most frequently initiated due to hepatosplenomegaly and, or, an increase in liver transaminases. Management practices included cranial ultrasound (57/63, 91%) and audiological follow up in symptomatic (61/63, 97%) and asymptomatic (52/63, 83%) infants. In terms of antiviral treatment, 46/63 (73%) treated symptomatic infants only and 6/63 (9%) treated all infected infants. In total, 48 cases were registered through the Dutch surveillance study and 43/48 (90%) infants were symptomatic.ConclusionThis study indicates that infants with cCMV infection were insufficiently recognised and highlights the need for consensus on management practices. Screening of infants and the development of an international management guideline are recommended.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-17T07:35:48.450963-05:
      DOI: 10.1111/apa.13882
       
  • Are extremely preterm born children with autism the victims of too much
           isolation in the incubator?
    • Authors: Hugo Lagercrantz
      Abstract: When autism was first identified by Leo Kanner in 1943, he thought it was partially due to “genuine lack of maternal warmth”. This “refrigerator mother theory” has been completely discarded and there is now a consensus that there is a connection between genetic heritability and autism spectrum disorder (ASD). Although Kanner was the first to publish a work on autism, the disease had already been observed by Hans Asperger in Vienna. The history of the discovery and recognition of autism is described in the interesting book: Neurotribes by Steve Silberman (1),This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-17T07:30:35.620453-05:
      DOI: 10.1111/apa.13874
       
  • Adults Born Preterm: A Review of General Health and System-Specific
           Outcomes
    • Authors: Tonse N. K. Raju; Sonia Buist, Carol J. Blaisdell, Marva Moxey-Mims, Saroj Saigal
      Abstract: In this review of 126 publications, we report that an overwhelming majority of adults born at preterm gestations remain healthy and well. However, a small, but a significant fraction of them remain at higher risk for neurological, personality and behavioral abnormalities, cardio-pulmonary functional limitations, systemic hypertension, and metabolic syndrome compared to their term-born counterparts. The magnitude of increased risk differed across organ systems, and varied across reports. The risks were proportional to the degree of prematurity at birth and seemed to occur more frequently among preterm infants born in the final two decades of the 20th century and later. These findings have considerable public health and clinical practice relevance.ConclusionPreterm birth needs to be considered a chronic condition, with a slight increase in the risk for long-term morbidities among adults born preterm. Therefore, obtaining a history of gestational age and weight at birth should be a routine part of care for patients of all age groups.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-17T07:30:34.649066-05:
      DOI: 10.1111/apa.13880
       
  • Feasibility and utility of portable ultrasound during retrieval of sick
           preterm infants
    • Authors: Kathryn Browning Carmo; Tracey Lutz, Mark Greenhalgh, Andrew Berry, Martin Kluckow, Nick Evans
      Abstract: AimDocument the incidence of haemodynamic pathology in critically ill preterm newborns requiring transport.MethodA transport neonatologist performed cardiac and cerebral ultrasound before and after transportation of infants born ≤ 30 weeks gestation.Results44 newborns were studied 2008 – 2015, 21 transported by road, 19 by helicopter and 4 by fixed wing. Median birth weight 1130g (680-1960g), median gestation 27 weeks (23-30) and 30/44 were male. Antenatal steroid course was complete in 2 babies. Ultrasound in the referring hospital was at a mean of 2hrs:47mins (00:15-7:00) of age. Low systemic blood flow was common: 50% had right ventricular output
      PubDate: 2017-04-17T07:30:27.348099-05:
      DOI: 10.1111/apa.13881
       
  • A novel approach for classifying protruding ears is easy to calculate and
           implement in daily clinical practice
    • Authors: J A Lopes-Santos; Constantino Martins, J M La Fuente, M F Costa-Carvalho
      Abstract: AimProtruding ears is a prevalent deformity, with a reported incidence of 5% in the paediatric population, but it lacks a simple digital classification. The aim of this study was to find a parameter that would objectively allow the photographic classification of protrusion, by comparing frontal facial images of patients with protruding ears with aged-matched controls.MethodsThis prospective cohort study compared the frontal facial images of 105 patients with protruding ears with 112 aged-matched controls without protruding ears. A rectangle was drawn on the image for each ear, encompassing its full visible anatomy. The height of each rectangle was divided by its width to create an index. The mean value of both ears was defined as the Frontal Aesthetics Translation Index for Measurement of Amplitude of the Ears (FATIMAE).ResultsThe calculated values for group with protruding ears were significantly higher than for the controls. No gender differences were found. However, the FATIMAE values decreased with age, establishing different classification criteria for separate age groups.ConclusionThe FATIMAE is easy to calculate and implement in daily clinical practice and establishes a practical approach for classification of protrusion, as well as for referral criteria for a specialised surgical consultation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-10T10:15:55.467073-05:
      DOI: 10.1111/apa.13870
       
  • Observer variability identifying attention deficit hyperactivity disorder
           in 10-year old children born extremely preterm
    • Authors: Alan Leviton; Scott J. Hunter, Megan N. Scott, Stephen R Hooper, Robert M. Joseph, T. Michael O'Shea, Elizabeth N. Allred, Karl Kuban
      Abstract: AimA DSM-5 diagnosis of Attention-Deficit/Hyperactive Disorder (ADHD) requires that symptoms be present in two settings. We wanted to see how teachers and parents compare on their assessments.MethodsWe evaluated how well Child Symptom Inventory-4 (CSI-4) reports from 871 parents and 634 teachers of 10-year old children born before the 28th week of gestation provided information about indicators of school dysfunctionResultsKappa values for parent and teacher agreement of any ADHD were at best fair to poor (< 0.41). Nevertheless, ADHD identified by each alone provided a moderate amount of information about such indicators of school dysfunction as grade repetition. Only occasionally did agreement provide more information than provided by only one reporter. Mother's social class and intelligence level did not discriminate between parents who did and did not agree with the teacher.ConclusionADHD identified by a single observer can provide appreciable information about a range of the child's functions needed for success in school and therefore should not be discounted when another observer does not consider the child to have ADHD symptoms.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-08T03:06:03.441613-05:
      DOI: 10.1111/apa.13869
       
  • Postnatal growth in term infants born small for gestational age is
           associated with later neurocognitive and metabolic outcomes
    • Authors: Esther Castanys-Muñoz; Kathy Kennedy, Eurídice Castañeda-Gutiérrez, Stewart Forsyth, Keith M. Godfrey, Berthold Koletzko, Susan E. Ozanne, Ricardo Rueda, Marieke Schoemaker, Eline M van der Beek, Stef van Buuren, Ken K. Ong
      Abstract: We systematically reviewed papers published in English between 1994 and October 2015 on how postnatal weight gain and growth affects neurodevelopment and metabolic outcomes in term-born small for gestational age (SGA) infants. Two randomised trials reported that enriched infant formulas that promoted early growth also increased fat mass, lean mass and blood pressure, but had no effect on early neurocognitive outcomes. Meanwhile, 31 observational studies reported consistent positive associations between postnatal weight gain and growth with neurocognitive outcomes, adiposity, insulin resistance and blood pressure.ConclusionFew intervention studies exist, despite consistent positive associations between early growth and neurocognition in term-born SGA infants.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-06T02:30:39.879571-05:
      DOI: 10.1111/apa.13868
       
  • Cluster randomised controlled trial showed that maternal and child health
           handbook was effective for child cognitive development in Mongolia
    • Authors: Amarjargal Dagvadorj; Takeo Nakayama, Eisuke Inoue, Narantuya Sumya, Rintaro Mori
      Abstract: Child development delays can cause lower school performance, which in turn can lead to long-term poverty, developmental delays in offspring and a vicious cycle of loss of human potential (1). Effective prevention strategies are vital. It is well known that effective early child development programmes should integrate health and education with family support, programme, but coverage is often low (1). Cost-effective, high-quality programmes should therefore be considered. The Japanese Maternal and Child Health (MCH) handbook has been shown to provide cost-effective, high-level coverage that assists child development (2).This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-04T02:51:03.967279-05:
      DOI: 10.1111/apa.13864
       
  • Letter to the Editor regarding the article ‘Introducing High-flow nasal
           cannula to the neonatal transport environment’
    • Authors: Andrew Brunton; Joyce O'Shea
      Abstract: We read with interest the above article by Boyle et al (1) regarding the use of High-flow nasal cannula oxygen during neonatal transport. We would like to congratulate the authors for a valuable article, and wish to add our experiences.This article is protected by copyright. All rights reserved.
      PubDate: 2017-04-04T02:40:32.886432-05:
      DOI: 10.1111/apa.13863
       
  • Simulation-based team training improved the self-assessed ability of
           physicians, nurses and midwives to perform neonatal resuscitation
    • Authors: B Malmström; E Nohlert, U Ewald, M Widarsson
      Abstract: AimThe use of simulation-based team training in neonatal resuscitation has increased in Sweden during the last decade, but no formal evaluation of this training method has been performed. This study evaluated the effect of simulation-based team training on the self-assessed ability of personnel to perform neonatal resuscitation.MethodsWe evaluated a full-day simulation-based team training course in neonatal resuscitation, by administering a questionnaire to 110 physicians, nurses and midwives before and after the training period. The questionnaire focused on four important domains: communication, leadership, confidence and technical skills. The study was carried out in Sweden from 2005-2007.ResultsThe response rate was 84%. Improvements in the participants′ self-assessed ability to perform neonatal resuscitation were seen in all four domains after training (p < 0.001). Professionally inexperienced personnel showed a significant improvement in the technical skills domain compared to experienced personnel (p = 0.001). No differences were seen between professions or time since training in any of the four domains. Personnel with less previous experience with neonatal resuscitation showed improved confidence (p = 0.007) and technical skills (p = 0.003).ConclusionA full-day course on simulation-based team training with video-supported debriefing improved the participants’ self-assessed ability to perform neonatal resuscitation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-31T18:30:23.119335-05:
      DOI: 10.1111/apa.13861
       
  • Using a standardised protocol was effective in reducing hospitalisation
           and treatment use in children with newly diagnosed immune thrombocytopenia
           
    • Authors: R Labrosse; M Vincent, U-P Nguyen, C Chartrand, L Di Liddo, Y Pastore
      Abstract: AimChildhood immune thrombocytopenia (ITP) has been associated with low bleeding rates and a high frequency of spontaneous remission. Although current guidelines suggest that most patients are just observed, children still receive platelet-enhancing therapy for fear of bleeding complications. We hypothesised that a standardised protocol with a step-down approach would reduce hospitalisation and treatment use.MethodA retrospective chart review was performed on patients diagnosed with acute ITP between January 2010 and December 2014, before (n=54) and after (n=37) the standardised protocol was introduced in January 2013. Management and events during the first three months following diagnosis were recorded.ResultsThe protocol resulted in a 34% decrease in the hospitalisation rate (p
      PubDate: 2017-03-31T18:25:34.372716-05:
      DOI: 10.1111/apa.13859
       
  • Interventions to Reduce Neonatal Mortality: A Mathematical Model to
           Evaluate Impact of Interventions in sub-Saharan Africa
    • Authors: Jennifer B Griffin; Elizabeth M McClure, Beena Kamath-Rayne, Bonnie Hepler, Doris Rouse, Alan H. Jobe, Robert L Goldenberg
      Abstract: AimTo determine which interventions would have the greatest impact on reducing neonatal mortality in sub-Saharan Africa in 2012.MethodsWe used MANDATE, a mathematical model, to evaluate scenarios for the impact of available interventions on neonatal deaths from primary causes, including: 1) for birth asphyxia -NDASH- obstetric care preventing intrapartum asphyxia, newborn resuscitation, and treatment of asphyxiated infants; 2) for preterm birth -NDASH- corticosteroids, oxygen, continuous positive air pressure, and surfactant; and, 3) for serious newborn infection -NDASH- clean delivery, chlorhexidine cord care, and antibiotics.ResultsReductions in infection-related mortality have occurred. Between 80 and 90% of deaths currently occurring from infections and asphyxia can be averted from available interventions, as can 58% of mortality from preterm birth. More than 200,000 neonatal deaths can each be averted from asphyxia, preterm birth, and infections. Using available interventions, more than 80% of the neonatal deaths occurring today could be prevented in sub-Saharan Africa.ConclusionReducing neonatal deaths from asphyxia require improvements in infrastructure and obstetric care to manage maternal conditions such as obstructed labor and preeclampsia. Reducing deaths from preterm birth would also necessitate improved infrastructure and training for preterm infant care. Reducing infection-related mortality requires less infrastructure and lower-level providers.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-31T18:10:37.286225-05:
      DOI: 10.1111/apa.13853
       
  • Ultrasound is an effective and non-invasive method of evaluating renal
           swelling in infants with their first urinary tract infection
    • Authors: Y Simrén; E Stokland, K M Lagerstrand, S Valdimarsson, S Hansson
      Abstract: AimThis study evaluated renal swelling in infants with a first urinary tract infection (UTI) by correlating renal length and volume to C-reactive protein (CRP) and body temperature.MethodsUltrasounds were carried out on 104 infants at the Queen Silvia Children's Hospital, Gothenburg, Sweden – 58 boys (mean age 3.3 months) and 46 girls (mean age 4.8 months) – during the acute phase of their UTI. A second scan was performed on 94 of them four weeks later. Renal length and volume were computed to standard deviation scores (SDS).ResultsThe mean renal length and volume at the first ultrasound were 1.90 SDS (±1.54) and 1.67 SDS (±1.13) for the larger kidney and 0.86 SDS (±1.01) and 0.84 SDS (±0.90) for the smaller kidney. There was a significant decrease in renal length and volume between the two ultrasounds, with a mean difference of 0.96 SDS (±1.24) and 1.07 SDS (±1.10) for the larger kidney (p
      PubDate: 2017-03-27T20:35:34.277858-05:
      DOI: 10.1111/apa.13849
       
  • Heart rate variability can be used to evaluate wellbeing in preterm
           infants
    • Authors: K. Kaar; J. Brandner, B. Minnich, J. Hilberath, C. Weisser, M. Wald
      Abstract: Preterm infants are exposed to various potentially stressful procedures during intensive care, which have been shown to compromise development. We explored the potential stress caused by echocardiograph and the correlation between the duration of the investigation and the amplitude of the alteration. The usefulness of the Newborn Infant Parasympathetic Evaluation (NIPE) monitor (Mdoloris Medical Systems, Loos, France) for assessing acute distress during daily routines, based on heart rate variability, was also investigated.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-21T02:20:56.934734-05:
      DOI: 10.1111/apa.13843
       
  • The coming of age of a young subspecialty: paediatric hepatology
    • Authors: Antal Németh
      Abstract: Paediatric hepatology dates from the 1970s and it is the youngest of the organ-specific subspecialties. Since then there have been impressive achievements in the fields of anatomical, metabolic, immunological and neoplastic diseases and the advent of modern molecular biology has resulted in a marked increase in exact diagnoses. Liver transplants provided enormous stimulus for the discipline. Due to changing morbidity patterns the discipline faces new challenges, such as environmental and lifestyle induced liver diseases, but different forms of chronic viral hepatitis are diminishing.ConclusionHigh levels of competence require good clinical research, optimal results and a high degree of centralisation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-03-21T02:05:32.2531-05:00
      DOI: 10.1111/apa.13842
       
  • 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
           fibrosis
    • 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
           fever
    • 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.
       
  • Is high-flow nasal cannula noninferior to nasal CPAP for the initial
           management of preterm infants'
    •  
  • Randomized trial of exclusive human milk versus preterm formula diets in
           extremely premature infants
    •  
  • Oral paracetamol or oral ibuprofen to close the ductus arteriosus: both
           ‘work’, but do we know when to use them'
    •  
  • In vivo assessment by parents and a physician using the Amsterdam Infant
           Stool Scale provided better inter-rater agreement than photographic
           evaluation
    • Abstract: AimThis study assessed the inter-rater variability of stool assessment, comparing the judgement of parents and a physician using the Amsterdam Infant Stool Scale (AISS) and the evaluation by another physician using photographs.MethodsThe stools of children aged two to 18 months, who were not toilet-trained, were independently assessed in vivo using the AISS by the parents and the first physician. Another physician, unaware of the results of the in vivo evaluation, assessed two stool photographs taken by the first physician with a smartphone.ResultsHaving analysed 100 stools, we found excellent inter-rater agreement between the parents and the first physician for consistency (κ: 0.87; 95% confidence interval [95% CI] 0.78–0.95) and colour (κ: 0.81; 95% CI: 0.71–0.91) and good inter-rater agreement for the amount (κ: 0.79; 95% CI 0.7–0.88). We found moderate inter-rater agreement between the parents’ in vivo assessment and the second physician's photographic assessment for stool consistency (κ: 0.5; 95% CI 0.36–0.64) and amount (κ: 0.44; 95% CI 0.29–0.59) and a fair inter-rater agreement for colour (κ: 0.33; 95% CI 0.21–0.45).ConclusionWhen parents and a physician used the AISS under in vivo conditions, there was better inter-rater agreement than photographic evaluation by a second physician.
       
  • Neurodevelopment of children born very preterm and free of severe
           disabilities: the Nord-Pas de Calais Epipage cohort study
    • Abstract: Aim:  To describe the development of very preterm children free of cerebral palsy or severe sensory impairment in the domains of gross and fine motor functions, language and sociability at a corrected age of 2 years; to identify factors associated with performances in each domain.Methods:  A total of 347 children born in 1997 before 33 weeks of gestation, part of the EPIPAGE population-based cohort study, had their psychomotor development assessed with the Brunet-Lezine scale.Results:  The study population had a mean gestational age of 30.1 ± 2.0 weeks. Lower developmental quotients (DQ) were observed in the study group compared to the reference sample (96 ± 13 vs 104 ± 8, p 
       
  • Issue Information
    •  
  • Highlights in this issue
    •  
  • More voice, less noise in NICUs
    •  
  • We need to change how we deal with continuous pain in neonates
    •  
  • Cardiorespiratory physiology in early infancy
    •  
  • The role of networks in improving perinatal and neonatal care
    •  
  • Assessment of continuous pain in newborns admitted to NICUs
           in 18 European countries
    • Abstract: AimContinuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown.MethodsA prospective cohort study in 243 neonatal intensive care units (NICUs) from 18 European countries recorded the frequency of pain assessments, use of mechanical ventilation, sedation, analgesia or neuromuscular blockade for each neonate for up to 28 days after NICU admission.ResultsOnly 2113 of 6648 (31.8%) of neonates received assessments of continuous pain, occurring variably among tracheal ventilation (TrV, 46.0%), noninvasive ventilation (NiV, 35.0%) and no ventilation (NoV, 20.1%) groups (p 
       
  • The impact of Italian regionalisation on transporting neonatal patients
           back from the neonatal intensive care unit to the referring level two unit
           
    •  
  • Preventing extubation failure in preterm infants: nasal CPAP remains the
           standard of care
    •  
  • Does single mega-dose vitamin A in early neonatal period reduce mortality
           during infancy in low- and middle-income countries'
    •  
  • Hypertension at late preterm gestation: deliver immediately or watch and
           wait'
    •  
  • 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
           anaesthesia
    • 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
           admission
    • 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
           Discretion
    • 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
           medicine
    • 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.
       
  • Athens-based meeting to discuss the paediatric virology crossroad in
           October 2017
    • Abstract: Viral infections are common diseases and they are well-described in the Ancient Greek Hippocratic Corpus (1), together with a limited spectrum of diagnostic and treatment options. However, over the past two decades, several exciting developments in the fields of clinical virology and molecular medicine have expanded our knowledge on the pathogenesis of viral infections in neonates and children (2,3). Since 2015, the workshop on paediatric virology has tried enthusiastically to explore these advances and to investigate recent challenges in the prevention strategies, molecular diagnostics, multimodality imaging and therapeutics of paediatric viral infections (2-5).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.
       
  • A review of important EEG features for the assessment of brain maturation
           in premature infants
    • Abstract: This review describes the maturational features of the baseline electroencephalogram (EEG) in the neurologically healthy preterm infant. Features such as continuity, sleep state, synchrony and transient waveforms are described, even from extremely preterm infants and includes abundant illustrated examples. The physiological significance of these EEG features and their relationship to neurodevelopment is highlighted where known. This review also demonstrates the importance of multichannel conventional EEG monitoring for preterm infants as many of the features described are not apparent if limited channel EEG monitors are used.ConclusionThis review aims to provide healthcare professionals in the neonatal intensive care unit with guidance on the more common normal maturational features seen in the EEG of preterm infants.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.
       
  • Family-centred care right from birth: the irreplaceable birthday cuddle
    • Abstract: Jack, twin 2, was born vaginally at 23+1 weeks’ gestation, 576 g. In good condition, despite no antenatal steroids, he was intubated and given surfactant at 3 minutes. After initial stabilisation, the resuscitaire was switched to the portable oxygen cylinder and moved alongside his mother's bed. Jack was then transferred into his mother's arms, still connected to the resuscitaire ventilator system. She was then able to cuddle him for 10-15 minutes while still being ventilated by the attendant neonatologist (Figure 1). During this time first family photographs were taken and first parental kisses given.This article is protected by copyright. All rights reserved.
       
  • Is accepting circular reasoning in shaken baby studies bad science or
           misconduct'
    • Abstract: Many of the comments on our systematic literature review on shaken baby syndrome (1) have focused on our criticism of how child protection teams’ classification of study cases and controls are used as gold standard and the faulty circular reasoning associated with that (2,3). Some commentators have also questioned how reasonable it is to focus on the triad of retinal hemorrhages,This article is protected by copyright. All rights reserved.
       
  • Improved postnatal care is needed to maintain gains in neonatal survival
           after the implementation of the Helping Babies Breathe initiative
    • Abstract: AimHelping Babies Breathe (HBB) is a neonatal resuscitation protocol proven to reduce intrapartum-related mortality in low-income settings. The aim of this study was to describe the timing and causes of neonatal in-hospital deaths before and after HBB training at a maternity health facility in Nepal.MethodsA prospective cohort study was conducted at the facility between July 2012 and September 2013. All 137 staffs, including medical doctors and midwives, were trained in January 2013. The causes of 299 neonatal deaths and the day of death, up to 27 days, were collected before and after the training course.ResultsDeaths caused by intrapartum-related complications were reduced from 51% to 33%. Preterm infants survived for more days (p < 0.01) during the neonatal period, but overall in-hospital neonatal mortality was unchanged (p = 0.46) after training. The survival rates linked to complications of infection, congenital anomalies and other causes were unaffected by the intervention.ConclusionThe continuum of postnatal care for newborn infants needs to be strengthened after Helping Babies Breathe training, to maintain the gains in neonatal survival on the day of delivery. Additional interventions in the postnatal period are therefore required to increase neonatal survival at facilities in low-income settings.
       
  • Systematic review of maternal voice interventions demonstrates increased
           stability in preterm infants
    • Abstract: We systematically reviewed how effectively maternal voice interventions supported the clinical outcomes and development of preterm infants. A total of 512 preterm infants were included in 15 studies with different designs, from January 2000 to July 2015. Live and recorded maternal voice interventions were associated with the physiologic and behavioural stabilisation of preterm infants, with fewer cardiorespiratory events, but the evidence was insufficient to evaluate the long-term effects. Well-defined determinants and clear setting conditions are needed for such interventions.ConclusionFurther research that investigates the long-term efficacy and effects of live maternal voices on preterm infant development is needed.
       
  • Probiotics and antimicrobial protein and peptide levels in preterm infants
    • Abstract: AimTo characterise the secreted and inducible antimicrobial protein and peptide (APP) levels in a prospective cohort of preterm infants (
       
  • Antenatal betamethasone for women at risk for late preterm delivery
           reduces the rate of neonatal respiratory complications
    •  
  • 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
       
  • Defining pain in newborns: Need for a uniform taxonomy'
    • Abstract: A scientific rationale for applying pain terms such as acute, persistent, prolonged, or chronic pain to newborns was derived from the scientific literature on neonatal pain assessments, previous attempts to define chronic pain, and the clinical and neurophysiological features of neonatal pain. This novel framework incorporates the temporal features, localizing characteristics, and secondary effects of the pain experienced, as well as the behavioral and physiological response patterns of newborns.ConclusionAlthough not evidence-based, this framework provides an initial starting point for defining commonly used neonatal pain terms. It will require future revision/refinement based on the accumulating evidence for non-acute pain.This article is protected by copyright. All rights reserved.
       
  • National cohort study showed that infants with Down's syndrome faced a
           high risk of hospitalisation for the respiratory syncytial virus
    • Abstract: AimThe respiratory syncytial virus (RSV) is a leading cause of hospitalisation in infants. We investigated this risk in children with Down's syndrome under two years of age, adjusted for other known risk factors.MethodsThis national, retrospective 1:2 matched cohort study comprised all Swedish children born with Down's from 2006–2011, who were each randomly matched to two controls without Down's. Data on RSV hospitalisation and risk factors for RSV were obtained from national registers. The risk for RSV hospitalisation was assessed using multivariable Cox regression with pairwise stratification.ResultsThe study comprised 814 children with Down's and 1,628 controls. We found that 82 children with Down's (10.1%) and 22 controls (1.4%) were hospitalised for RSV. The hazard ratio for children with Down's was 4.00 (95% confidence interval 1.58–10.13) for up to one year of age and 6.60 (95% confidence interval 2.83–15.38) for up to two years of age, adjusted for other risk factors. During the second year of life, RSV hospitalisation continued for children with Down's, while it was minimal for the controls.ConclusionChildren with Down's faced a high risk of RSV hospitalisation, which continued beyond the first year of age.This article is protected by copyright. All rights reserved.
       
  • 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.
       
  • Marked variability observed in inpatient management of bronchiolitis in
           three Finnish hospitals
    • Abstract: AimInfants hospitalised for bronchiolitis undergo examinations and treatments not supported by current research evidence and we investigated practice variations with regard to Finnish children under the age of two.MethodsThis prospective, multi-centre cohort study was conducted in paediatric units in three university hospitals in Finland from 2008-2010. Hospital medical records were reviewed to collect data on clinical course, testing and treatment. Data were analysed separately for children meeting our strict definition of bronchiolitis, aged under 12 months without a history of wheezing, and a loose definition, aged 12-23 months or with a history of wheezing.ResultsThe median age of the 408 children was 8.1 months. Clinical management varied between the three hospitals when stratified by strict and loose bronchiolitis subgroup definitions: complete blood counts ranged from 15-95% versus 16-94%, respectively, and the other measures were chest x-ray (16-91% versus 14-72%), intravenous fluids (2-47% versus 2-41%), use of nebulised epinephrine (10-84% versus 7-50%), use of salbutamol (18-21% versus 13-84%) and use of corticosteroids (6%-23% versus 60-76%).ConclusionThe clinical management of bronchiolitis varied considerably with regard to the three hospitals and the two definitions of bronchiolitis. A stronger commitment to evidence-based bronchiolitis guidelines is needed in Finland.This article is protected by copyright. All rights reserved.
       
  • Using a spontaneous profile rather than stimulation test makes the KIGS
           
    • Abstract: AimChildren treated with a growth hormone (GH) for idiopathic growth hormone deficiency (IGHD) may be monitored with the first-year prediction model from the Pfizer International Growth Database (KIGS) using auxology, age, GH dose and the maximum GH concentration from a stimulation test (GHmaxstim). We tested the hypothesis that using a 12-hour spontaneous profile (GHmax12h) would be as accurate.MethodsWe studied 98 prepubertal Swedish children (78 boys) aged 2-12 years enrolled in KIGS. The first-year growth was predicted using the GHmax from the GH profile and a stimulation test and both of these were compared separately with the observed growth response.ResultsThe increased height observed in the first year was 0.74 standard deviation scores (SDS) and the studentised residuals for the predicted and observed growth with GHmaxstim (-0.16 SDS) and GHmax12h (-0.22) were similar. Individual predictions calculated with stimulated or spontaneous GHmax showed a significant correlation (r=0.80).ConclusionWe validated the KIGS IGHD prediction model and found that the stimulated GHmax peak can be reliably replaced by the GHmax 12h with similar accuracy. This makes the model more accessible for clinicians, who can then provide realistic expectations for the growth response during the first year of treatment.This article is protected by copyright. All rights reserved.
       
  • The gene encoding the inwardly rectifying potassium channel Kir4.1 may be
           involved in sudden infant death syndrome
    • Abstract: AimDisturbances in brain function and development may play a role in sudden infant death syndrome (SIDS). This Norwegian study aimed to test the hypothesis that specific variants of genes involved in water transport and potassium homeostasis would be predisposing factors for SIDS.MethodsGenetic variation in the genes encoding aquaporin-4 (AQP4), Kir4.1 (KCNJ10) and α-syntrophin were analysed in 171 SIDS cases (62.6% male) with a median age of 15.5 (2-52) weeks and 398 adult controls (70.6% male) with a median age of 44 (11-91) years. All the subjects were Caucasians who were autopsied from 1988-2013.ResultsThe CC genotype of rs72878794 in the AQP4 gene and a combination of the CC genotype in rs17375748, rs1130183, rs12133079 and rs1186688 in KCNJ10 (4xCC) were found to be associated with SIDS. The SIDS cases with the 4xCC SNP combination were younger than the SIDS cases with other genotype combinations (p=0.006).ConclusionThis study indicates that genetic variations in KCNJ10 and AQP4 may be predisposing factors for SIDS. Alterations in the expression of the AQP4/Kir4.1 complex can disrupt water and ion homeostasis, which may influence brain development and facilitate brain oedema formation This may be especially unfavourable during the first weeks of life.This article is protected by copyright. All rights reserved.
       
  • Use of time and adolescent health-related quality of life/wellbeing: A
           scoping review
    • Abstract: Time use could profoundly affect adolescents’ health-related quality of life (HRQL). Ideally, overall time use patterns would be considered, because activities within a 24-hour day are inherently correlated (more in one activity means less in another). This review focused on the associations of 1) overall time use patterns and 2) components of time use patterns with HRQL in adolescents.ConclusionMore physical activity, less screen time and more/adequate sleep, in isolation, are associated with better profile-based HRQL subscales. Greater understanding of adolescents’ overall time use patterns and HRQL is a priority for policy development.This article is protected by copyright. All rights reserved.
       
  • Infected malnourished children displayed changes in early activation and
           lymphocyte subpopulations
    • Abstract: AimMalnutrition and infections cause immunological changes in lymphocyte subpopulations and their functionality. We evaluated the activation capacity of lymphocytes and memory cells in 10 well nourished, seven well nourished infected and eight malnourished infected children before and after treatment.MethodsAll the children were patients in Mexico City and were less than three years of age. The expression of various cluster of differentiation (CD) cells were assessed by flow cytometry: CD45RA (naïve) and CD45RO (memory) antigens on CD4 lymphocytes and CD69 in all lymphocytes.ResultsWell-nourished infected children showed a higher percentage of activated T lymphocyte (T cells), CD8+ and CD4+ memory cells during the infectious phase, suggesting that the activation mechanisms were triggered by infection. T cells from malnourished infected children showed a lower percentage of activated and memory cells. The T cell population size returned to baseline during the resolution phase of the infection in well-nourished infected children, but their T, B lymphocyte and natural killer (NK) cell counts remained high. In malnourished infected children, activated NK cells counts were low before and after therapy.ConclusionAfter therapy, malnourished infected children showed poor NK cell responses during the infection's resolution phase, suggesting a persistent malnutrition-mediated immunological deficiency.This article is protected by copyright. All rights reserved.
       
  • Prophylactic sustained inflation is just one step to preventing
           bronchopulmonary dysplasia
    • Abstract: I am glad to see that the Sustained Lung Inflation (SLI) trial (1) still draws a great deal of attention and I would like to clarify some aspects of the trial, in response to the comments by Gupta and Argarwal (2) in Acta Paediatrica.A meta-analysis carried out in 2016 demonstrated that starting non-invasive respiratory support from birth could reduce the incidence of bronchopulmonary dysplasia and death. However, about 50% of very low birth weight infants who are initially on nasal continuous positive airway pressure need subsequent intubation and mechanical ventilation.This article is protected by copyright. All rights reserved.
       
  • One oxygen breath shortened the time to return of spontaneous circulation
           in severely asphyxiated piglets
    • Abstract: AimAsphyxiated neonates should be resuscitated with air, but it remains unclear if oxygen supplementation is needed in ineffectively ventilated newborn infants. We studied the return of spontaneous circulation (ROSC) with oxygen or air in an experimental model of inadequate ventilation.MethodsAsphyxia was induced in 16 newborn piglets until their heart rate was
       
  • Changing diagnosis coding routines may confound the results of
           longitudinal childhood pneumonia studies
    • Abstract: AimThis Swedish study compared the discharge diagnosis codes used for children up to the age of five hospitalised for acute lower respiratory tract infections before and after the introduction of the pneumococcal conjugate vaccine in 2007.MethodsThe International Classification of Diseases - 10th revision codes were used. We compared the discharge diagnosis codes at the Astrid Lindgren Children's Hospital from 1 July 2005 to 30 June 2007 (n=1,127) and 1 July 2011 to 30 June 2013 (n=1,240) in relation to the diagnostic methods used.ResultsThere was a 54% reduction in the rate of all-cause pneumonia from the first to the second period in infants up to the age of one, but some of this could have been due to the improved diagnosis of viral infections and us changing the code for respiratory syncytial virus infection from pneumonia to bronchiolitis. The overall rate of acute lower respiratory tract infections was unchanged.ConclusionWe could not determine how much of the reduction in bacterial pneumonia in children under one was because of the introduction of the pneumococcal conjugate vaccine, based solely on discharge codes. Longitudinal register studies should take changes in diagnosis codes into account.This article is protected by copyright. All rights reserved.
       
  • Real life comparison of three general paediatric wards showed similar
           outcomes for children with bronchiolitis despite different treatment
           regimens
    • Abstract: AimThis study evaluated the effectiveness of three different treatments for bronchiolitis in a tertiary pediatric facility.MethodsPatients with bronchiolitis who were younger than two years of age and were randomly allocated to three general wards at Schneider Children's Medical Center, Israel, after admission were included. Different treatment protocols in the wards were retrospectively compared.ResultsThe study comprised 286 children. The clinical and laboratory parameters on admission were similar between the wards. In Ward C where nebulised hypertonic saline was infrequently administered (6.7%), the mean number of days with oxygen saturation under 92% and the meanlength of hospital stay (1.8 days and 3.8 days) were significantly lower than Ward A (2.8 days and 5.3 days) and Ward B, (2.9 days and 4.7 days) where nebulised hypertonic saline was given more frequently (38.7% to 74.7%). Multivariate analysis indicated that low saturation on admission, leukocytosis and use of nebulised hypertonic saline or adrenalin were independent predictors of a longer period of desaturation and hospital stay.ConclusionDifferent treatment protocols for bronchiolitis were used in three paediatric wards in this real life study. No treatment regimen proved superior. Inhalations of hypertonic saline or adrenaline were associated with a longer hospital stay.This article is protected by copyright. All rights reserved.
       
  • Case-control study shows that neonatal pneumococcal meningitis cannot be
           distinguished from group B Streptococcus cases
    • Abstract: AimStreptococcus pneumoniae (S. pneumoniae) is sometimes implicated in neonatal bacterial meningitis. This study described the demographic, clinical and biological features of neonatal S. pneumoniae meningitis and compared pneumococcal and group B streptococcal (GBS) neonatal meningitis.MethodsWe conducted a case–control study that compared neonates, aged one to 28 days with S. pneumoniae meningitis or GBS meningitis. Each case with S. pneumoniae was randomly matched to four control patients with GBS by age group and study year.ResultsFrom 2001 to 2013, the national French paediatric network, which comprises 227 paediatric wards, recorded 831 neonatal cases of meningitis. S. pneumoniae (n=18, 2.2%) was the fifth infection cause after GBS (n=464, 55.8%), Escherichia coli (n=232, 27.9%), Neisseria meningitidis (n=23, 2.8%) and Listeria monocytogenes (n= 20, 2.4%). Neonatal pneumococcal and GBS meningitis did not differ in demographic data or clinical and biological characteristics. All S. pneumoniae strains were fully susceptible to cefotaxime and we observed a decrease of 13-valent pneumococcal conjugate vaccine (PCV13) serotypes (88.9% to 20.0%) after PCV13 implementation.ConclusionClinically and biologically, neonatal pneumococcal meningitis could not be distinguished from GBS cases. A herd effect of PCV13 implementation was suggested by the decrease in the prevalence of vaccine serotypes.This article is protected by copyright. All rights reserved.
       
  • Nicotine withdrawal syndrome in a newborn baby after maternal use of oral
           applied moist tobacco (SNUS), should result in greater awareness to the
           use of snus among pregnant women
    • Abstract: The harm that smoking causes the fetus are well known. Smoking by young men and women in Scandinavia has steadily declined in the last few decades and the use of snus - moist tobacco that is placed in the mouth - has increased. This patient history highlights the effects of using snus during pregnancyThis article is protected by copyright. All rights reserved.
       
  • Secular trends in Australian school children's sleep and perceived
           importance of sleep between 1985 and 2013
    • Abstract: AimTo examine secular trends in Australian children's actual sleep time as well as the perceived importance of sleep between 1985-2004-2013.MethodsSecular trends in children's sleep and their perception of the importance of sleep across three time points 1985 (N=401), 2004 (N=450) and 2013 (N=395), were examined according to socioeconomic status (SES), age and sex. The children self-reported their bed-time, wake-up time and their perceived importance of sleep, among other questions.ResultsThere were no significant differences in sleep duration between boys and girls in any of the survey years, nor were there differences in sleep duration between SES categories at any time point. Independent of survey year, age, sex and SES, there was a graded difference in sleep duration (min) across response categories for perceived importance of sleep. Overall, trends in the perceived importance of sleep appeared to match trends in actual sleep time, but not for all subgroups.ConclusionThis study indicates that the sleep duration of high SES Australian school children is returning to, or near to, baseline sleep duration observed in 1985, while the sleep duration of low SES Australian children has remained at low levels.This article is protected by copyright. All rights reserved.
       
  • An index to predict asthma in wheezing young children produced promising
           initial results
    • Abstract: Diagnosing asthma is difficult in infants and preschool children because wheezing is common in this age group and it is not synonymous with asthma. Some children outgrow the tendency to wheeze during colds in a few years’ time, whereas other develop asthma. Efforts have been made to find ways to identify the subgroup of preschool children with wheeze who are most likely to develop asthma (1,2). However, the different asthma predictive indexes mainly aim to predict children who will have a persistent wheeze or asthma, not necessarily the subgroup who will outgrow their symptoms.This article is protected by copyright. All rights reserved.
       
  • Risk factors for executive function difficulties in preschool and early
           school-age preterm children
    • Abstract: AimTo investigate the relationship between executive functioning and social and perinatal risk factors in four- to five-year-old preterm children.Methods141 children born preterm (< 33 weeks of gestation) and 77 term comparison children were assessed using standardized measures of general intelligence and performance-based executive function tests prior to starting kindergarten. Parental and teacher reports of executive functioning were completed when the children commenced kindergarten. The preterm and the term comparison groups were compared on measures of intelligence and executive functions using independent groups t-tests, and multivariate regression analyses were performed to identify factors predictive of intelligence and executive functioning in the preterm group.ResultsThe preterm group performed significantly more poorly than the comparison group on all intelligence and executive function tests. The parental reports of the preterm and term comparison children's executive function did not differ significantly, but the teachers reported elevated executive function difficulties for the preterm group. Higher social risk, in particular lower educational level of the main caregiver, was the strongest predictor for the preterm children's intelligence and executive function results.ConclusionSocial risk factors are strongly associated with impaired early executive function outcomes in preterm children.This article is protected by copyright. All rights reserved.
       
  • Starting enteral nutrition with preterm single donor milk instead of
           formula affects time to full enteral feeding in very low birth weight
           infants
    • Abstract: AimThis study compared the impact of using either single donor breast milk or formula to start enteral feeding in preterm infants, on the time to full enteral feeding, growth and morbidity. The milk was provided by other preterm mothers.MethodsThis was an observational prospective study, carried out from June 2012 - March 2013 at the Medical University of Vienna, Austria, on the effects of preterm single donor milk on 133 very low birth weight infants with a birth weight
       
  • Introducing High- flow nasal cannula to the neonatal transport environment
    • Abstract: We are encouraged to see that other neonatal transport services are using High-Flow nasal cannula (HFNC) respiratory support during neonatal transport as outlined by Brunton et al (1). The experiences appear to be broadly similar across the two services, however, due to the central location of the neonatal transport base and the well served road network in the East of England region air transports are not conducted. Despite the increasing numbers of articles relating to HFNC use in neonatal units and consensus statements on best practice there is a relative paucity of data relating to its use on transport (2,3).This article is protected by copyright. All rights reserved.
       
  • National epidemiological study reveals longer paediatric bone and joint
           infection stays for infants and in general hospitals
    • Abstract: AimPublished studies have suggested that 2-5 days of intravenous treatment could effectively treat paediatric bone and joint infections (PBJI), allowing a faster discharge. This study analysed the factors associated with PBJI hospital stays lasting longer than five days using the French National Hospital Discharge Database.MethodsWe selected children under 15 years hospitalised in 2013 with haematogenous PBJIs using a validated French algorithm based on specific diagnosis and surgical procedure codes. Risk factors for stays of more than five days were analysed using logistic regression.ResultsIn 2013, 2,717 children were hospitalised for PBJI, with 49% staying more than five days. The overall incidence of 22 per 100,000, was highest in males and toddlers. The main causes were septic arthritis (50%) and osteomyelitis (46%) and 50% of the pathogens were Staphylococci. The odd ratios for stays of five days or more were: infancy, coded bacteria and sickle cell disease (7.0), having spondylodiscitis rather than septic arthritis (2.2) and being hospitalised in a general hospital rather than a teaching hospital (1.6).ConclusionHalf of the hospital stays exceeded five days, despite scientific evidence supporting a shorter intravenous antibiotherapy regimen. Greater knowledge and widespread use of short treatment regimens are needed.This article is protected by copyright. All rights reserved.
       
  • Higher Serum 25(OH)D Concentration is Associated with Lower Risk of
           Chronic Otitis Media with Effusion: A Case-Control Study
    • Abstract: AimVitamin D supplementation and higher 25(OH)-vitamin D concentration are associated with reduced risk of acute respiratory infection. This study examined whether there is a similar association between higher serum 25(OH)D concentration and lower risk of chronic otitis media with effusion (COME).MethodsIn a case-control study, serum 25(OH)D concentration in children referred for tympanostomy tube placement for COME (n=178) was compared to that of healthy children randomly sampled from primary care practices (n=179). Subjects aged three and four years were recruited in Auckland, New Zealand between May 2011 and November 2013. Blood samples were collected from the children and their guardians were interviewed. Odds ratios were calculated using logistic regression.ResultsIn a multivariable analysis, higher serum 25(OH)D concentration was associated with a lower risk of COME (OR: 0.86 per 10 nmol/L; 95% CI 0.77 to 0.97) after adjusting for age, sex, deprivation index, ethnicity, tobacco smoke exposure, duration of breastfeeding, and season of blood sampling. Further adjustment for eight additional risk factors did not change the result.ConclusionThis finding supports further investigation into whether the risk of COME could be reduced by increasing serum 25(OH)D concentration through increased sun exposure, higher dietary intake, or vitamin D supplementation.This article is protected by copyright. All rights reserved.
       
  • TV or Unrestricted, Unmonitored Internet Access in the Bedroom and BMI in
           Youth Athletes
    • Abstract: AimTo correlate television or unrestricted, unmonitored internet access in room of sleep with BMI.MethodsCross sectional study of athletes ≤ 19 years who underwent an Injury Prevention Evaluation. Independent variables included proportion of athletes categorized as overweight or obese who answered positively to American Academy of Pediatrics recommended questions: 1) Do you have a TV in the room where you sleep' 2) Do you have unrestricted, unmonitored access to the internet in the room where you sleep'.Results555 athletes; 324 female; mean age 13.83±2.60. Athletes with a TV in their room of sleep had higher BMI (22.73 vs. 20.54; P
       
  • Sound levels in a neonatal intensive care unit significantly exceeded
           recommendations, especially inside incubators
    • Abstract: AimThis study measured sound levels in a 2008 built French neonatal intensive care unit (NICU) and compared them to the 2007 American Academy of Pediatrics (AAP) recommendations. The ultimate aim was to identify factors that could influence noise levels.MethodsThe study measured sound in 17 single or double rooms in the NICU. Two dosimeters were installed in each room, one inside and one outside the incubators, and these conducted measurements over a 24-hour period. The noise metrics measured were the equivalent continuous sound level (Leq), the maximum noise level (Lmax) and the noise level exceeded for 10% of the measurement period (L10).ResultsThe mean Leq, L10 and Lmax were 60.4, 62.1 and 89.1 decibels (dBA), which exceeded the recommended levels of 45, 50 and 65 dBA (p
       
  • Optimising physiology for adolescents with dysautonomia
    • Abstract: I congratulate Armstrong et al (1) on their high quality paper, which will enable us to plan interventions that improve the quality of life of the dysautonomic paediatric population. I support the movement toward programmes that facilitate closely monitored, appropriate exercise regimes, tailored for the dysautonomic adolescent. This may, in the medium to long term be physiologically equivalent to, but more cost-effective than, the intermittent intravenous infusions of saline that have been found to dramatically reduce symptoms and improve the quality of life of patients suffering from postural orthostatic hypotention syndrome (2).This article is protected by copyright. All rights reserved.
       
  • Cohort study shows that peripheral dual energy x-ray absorptiometry is of
           limited epidemiologic use in prepubertal children
    • Abstract: AimPeripheral methods are increasingly used to assess bone health, despite little evidence on their predictive ability. We aimed to evaluate the usefulness of forearm dual energy x-ray absorptiometry in prepubertal children, by estimating the agreement between peripheral and central measures and the ability to predict fracture history.MethodsIn 2012/14, we assessed 1,177 seven-year-old children from the Generation XXI cohort who were recruited at birth in all five public hospitals with maternity wards in Porto, Portugal. Subtotal and lumbar spine bone mineral density (BMD) and content, left arm BMD and peripheral forearm BMD were measured. Parents reported the child's lifetime fracture history. We estimated agreement using Bland-Altman's method and Cohen's kappa. Fracture prediction ability was calculated using area under the receiver operator characteristic curve (ROC-AUC).ResultsThe limits of agreement were very wide, ranging from -2.20/2.20 to -1.87/1.87 standard deviations for the comparison between peripheral and central measures. Categorical agreement was also poor, with all kappa values below 0.40. In addition, none of the measures predicted fractures, since all the ROC-AUCs were close to 0.50.ConclusionThis study suggests that forearm BMD has limited use for bone health research or as a basis for clinical decisions in prepubertal children.This article is protected by copyright. All rights reserved.
       
  • Body Mass Index and vigorous physical activity in children and
           adolescents: an international cross-sectional study
    • Abstract: AimTo examine the relationship between reported vigorous physical activity (VPA) and body mass index (BMI) in children (6-7 years) and adolescents (13-14 years).MethodsIn the International Study of Asthma and Allergies in Childhood Phase Three, 75,895 children's parents and 199,502 adolescents answered questions relating to VPA, height and weight. The association between VPA and BMI was analysed using general linear models, adjusting for country gross national index.ResultsCompared to children who undertook no VPA, those in the infrequent group (once or twice per week) and those in the frequent group (three or more times per week) had mean (95%CI) BMI values 0.07 kg/m2 (0.03 to 0.11) and 0.09 kg/m2 (0.03 to 0.15) greater respectively (P=0.001). Compared to adolescents reporting no VPA, those in the infrequent group had a BMI 0.19 kg/m2 (0.15 to 0.23) greater while those in the frequent group had a BMI 0.01 kg/m2 (-0.03 to 0.05) greater (P
       
  • European Academy of Paediatric consensus statement on successful
           transition from paediatric to adult care for adolescents with chronic
           conditions
    • Abstract: Around one in ten adolescents suffer from chronic conditions and disabilities and the transition from paediatric to adult care can be particularly challenging. Unplanned transfers can complicate education, work and health and result in patients being lost to follow up, poor treatment adherence and more frequent hospitalisation. The Adolescent Health and Medicine Working Group of the European Academy of Paediatrics has developed a consensus statement for successful transitionConclusionThis statement will help paediatricians, adult care specialists, policy makers and other stakeholders to handle chronic care transitions so that they meet the expectations and needs of adolescents and their families.This article is protected by copyright. All rights reserved.
       
  • Probiotics for the prevention of necrotizing enterocolitis in
           very-low-birth-weight infants: A meta-analysis and systematic review
    • Abstract: We performed an updated meta-analysis incorporating the results of recent randomised controlled trials (RCTs) to measure the effectiveness of probiotic supplementation in preventing necrotizing enterocolitis (NEC) and death in very-low-birth-weight (VLBW) infants, and to investigate any differences in efficacy by probiotic agent. Using meta-regression analysis, we assessed the contribution of other measured variables on the overall effect size and between-study variability.ConclusionOverall, probiotics lead to significant reductions in NEC incidence and mortality in VLBW infants. Differences in probiotic agents and the influence of prenatal steroids and feeding regimens may explain the differences in outcomes between studies.This article is protected by copyright. All rights reserved.
       
  • Preterm infants at discharge: Nap polysomnography versus 24-hour oximetry
    • Abstract: AimThis study aimed to determine whether measures of intermittent hypoxia derived from 24-hour oximetry correlate with measures of apnoea derived from modified nap polysomnography undertaken for preterm infants before discharge.MethodsInfants born ≤32 weeks gestation were recruited from the Neonatal Intensive Care Unit, and had a modified polysomnography to assess their respiratory stability once they were ≥35 weeks postmenstrual age. Infants were defined as unstable if they had more than 10 obstructive events per hour or any apnoea of > 20 seconds in length. Infants also had a 24-hour oximetry performed during this period. The results of the 24-oximetry desaturation index (DSI) were compared to nap polysomnography results for central and obstructive apnoea indices and correlations tested.ResultsTwenty-four infants completed the study. There were 15 (63%) infants defined as unstable by the modified polysomnography. The 3% DSI and 4% DSI from the 24-hour oximetry were significantly higher in the unstable infants and values for all infants correlated with the obstructive index and the central apnoea index from the modified polysomnography.ConclusionThe 3% DSI and 4% DSI values from a 24-hour oximetry study may provide non-invasive measures of respiratory stability in preterm infants ready for discharge.This article is protected by copyright. All rights reserved.
       
  • Swedish child health nurses treat fathers more equally in 2014 than 2004,
           but mothers remain their primary focus
    • Abstract: AimThis study focused on Swedish child health nurses’ attitudes and the support they provided to fathers and mothers, highlighting changes from 2004 to 2014.MethodIn 2014, 363 child health nurses in Stockholm County completed a 23-item questionnaire, similar to the questionnaire by Massoudi et al in 2004, on their attitudes and the support they gave to fathers and mothers. Analyses were completed using chi-square tests of nurses’ attitudes and support to fathers and mothers and the results from the 2004 and 2014 studies were compared.ResultsIn 2014, the vast majority of nurses fully agreed that it was important to have close contact with both parents, but more than two-thirds did not feel they had the same competencies for mothers and fathers and three-quarters found it complicated to support both parents. The majority viewed fathers more equally in 2014 than in 2004 and although they did provide more support to both parents, mothers in 2014 still received more support than fathers.ConclusionWhile Swedish child health nurses viewed fathers as more equal to mothers in 2014 than 2004, mothers still received the majority of the parenting support.This article is protected by copyright. All rights reserved.
       
  • Vascular endothelial growth factor A gene polymorphism is associated with
           congenital renal lesions in children with urinary tract infections
    • Abstract: AimThis study investigated the relationship between vascular endothelial growth factor A (VEGF-A)-460C/T functional gene polymorphism and renal parenchymal lesions, vesicoureteral reflux and other urinary tract abnormalities in children with a urinary tract infection (UTI).MethodsVEGF-A-460C/T gene polymorphism was investigated with restriction length polymorphism analysis in 76 children with their first UTI and in 63 controls without infections. Genotype and allele frequencies were compared between children with urinary tract infections and controls and between different groups with UTIs.ResultsThe VEGF-A-460C/T genotype frequencies differed significantly between those with and without renal parenchymal lesions in the UTI cohort. Allele C homozygosity was significantly more common in those with renal parenchymal lesions (36.6% versus 8.7%, p=0.007). A separate analysis showed that allele C was associated with lesions compatible with hypodysplasia, rather than with focal ones associated with infections, with an odds ratio of 11.55 and 95% confidence interval of 3.03-43.9 (p=0.0001). No significant differences in genotypes or allele frequencies were found between children with and without reflux or other urinary tract anomalies.ConclusionIn children with UTIs, C allele polymorphism of the VEGF-A gene was associated with hypodysplastic renal parenchymal lesions, which were possibly congenital and existed before the infection.This article is protected by copyright. All rights reserved.
       
  • Variation in term birth weight across European countries affects the
           prevalence of small for gestational age among very preterm infants
    • Abstract: AimThis study assessed the prevalence of small for gestational age (SGA) among very preterm (VPT) infants using national and European intrauterine references.MethodsWe generated country-specific and common European intrauterine growth references for 11 European countries, according to Gardosi's approach and Hadlock's fetal growth model, by using national data on birth weights by sex. These references were applied to the Effective Perinatal Intensive Care in Europe (EPICE) cohort, which comprised 7,766 live VPT births without severe congenital anomalies under 32 weeks of gestation in 2011-12, to estimate the prevalence of infants with SGA birth weights, namely those below the 10th percentile.ResultsThe SGA prevalence was 31.8% with country-specific references and 34.0% with common European references. The European references yielded a 10-point difference in the SGA prevalence between countries with lower term birth weights (39.9%) - Portugal, Italy and France - and higher term birth weights, namely Denmark, Netherlands, Sweden (28.9%) (p
       
 
 
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