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Publisher: John Wiley and Sons   (Total: 1592 journals)

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Showing 1 - 200 of 1592 Journals sorted alphabetically
Abacus     Hybrid Journal   (Followers: 13, SJR: 0.48, h-index: 22)
About Campus     Hybrid Journal   (Followers: 5)
Academic Emergency Medicine     Hybrid Journal   (Followers: 66, SJR: 1.385, h-index: 91)
Accounting & Finance     Hybrid Journal   (Followers: 47, SJR: 0.547, h-index: 30)
ACEP NOW     Free   (Followers: 1)
Acta Anaesthesiologica Scandinavica     Hybrid Journal   (Followers: 54, SJR: 1.02, h-index: 88)
Acta Archaeologica     Hybrid Journal   (Followers: 171, 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: 14, SJR: 1.197, h-index: 81)
Acta Ophthalmologica     Hybrid Journal   (Followers: 6, SJR: 0.112, h-index: 1)
Acta Paediatrica     Hybrid Journal   (Followers: 56, SJR: 0.794, h-index: 88)
Acta Physiologica     Hybrid Journal   (Followers: 6, SJR: 1.69, h-index: 88)
Acta Polymerica     Hybrid Journal   (Followers: 9)
Acta Psychiatrica Scandinavica     Hybrid Journal   (Followers: 37, SJR: 2.518, h-index: 113)
Acta Zoologica     Hybrid Journal   (Followers: 7, SJR: 0.459, h-index: 29)
Acute Medicine & Surgery     Hybrid Journal   (Followers: 5)
Addiction     Hybrid Journal   (Followers: 36, SJR: 2.086, h-index: 143)
Addiction Biology     Hybrid Journal   (Followers: 15, SJR: 2.091, h-index: 57)
Adultspan J.     Hybrid Journal   (SJR: 0.127, h-index: 4)
Advanced Energy Materials     Hybrid Journal   (Followers: 26, SJR: 6.411, h-index: 86)
Advanced Engineering Materials     Hybrid Journal   (Followers: 26, SJR: 0.81, h-index: 81)
Advanced Functional Materials     Hybrid Journal   (Followers: 51, SJR: 5.21, h-index: 203)
Advanced Healthcare Materials     Hybrid Journal   (Followers: 14, SJR: 0.232, h-index: 7)
Advanced Materials     Hybrid Journal   (Followers: 279, SJR: 9.021, h-index: 345)
Advanced Materials Interfaces     Hybrid Journal   (Followers: 6, SJR: 1.177, h-index: 10)
Advanced Optical Materials     Hybrid Journal   (Followers: 7, SJR: 2.488, h-index: 21)
Advanced Science     Open Access   (Followers: 5)
Advanced Synthesis & Catalysis     Hybrid Journal   (Followers: 18, SJR: 2.729, h-index: 121)
Advances in Polymer Technology     Hybrid Journal   (Followers: 13, SJR: 0.344, h-index: 31)
Africa Confidential     Hybrid Journal   (Followers: 21)
Africa Research Bulletin: Economic, Financial and Technical Series     Hybrid Journal   (Followers: 13)
Africa Research Bulletin: Political, Social and Cultural Series     Hybrid Journal   (Followers: 11)
African Development Review     Hybrid Journal   (Followers: 33, SJR: 0.275, h-index: 17)
African J. of Ecology     Hybrid Journal   (Followers: 16, SJR: 0.477, h-index: 39)
Aggressive Behavior     Hybrid Journal   (Followers: 16, SJR: 1.391, h-index: 66)
Aging Cell     Open Access   (Followers: 11, SJR: 4.374, h-index: 95)
Agribusiness : an Intl. J.     Hybrid Journal   (Followers: 3, SJR: 0.627, h-index: 14)
Agricultural and Forest Entomology     Hybrid Journal   (Followers: 16, SJR: 0.925, h-index: 43)
Agricultural Economics     Hybrid Journal   (Followers: 45, SJR: 1.099, h-index: 51)
AIChE J.     Hybrid Journal   (Followers: 32, 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: 51, SJR: 3.048, h-index: 129)
Alternatives to the High Cost of Litigation     Hybrid Journal   (Followers: 3)
American Anthropologist     Hybrid Journal   (Followers: 152, 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: 93, SJR: 2.325, h-index: 51)
American J. of Economics and Sociology     Hybrid Journal   (Followers: 29, SJR: 0.211, h-index: 26)
American J. of Hematology     Hybrid Journal   (Followers: 35, SJR: 1.761, h-index: 77)
American J. of Human Biology     Hybrid Journal   (Followers: 13, 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: 17, SJR: 1.115, h-index: 61)
American J. of Medical Genetics Part B: Neuropsychiatric Genetics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 107)
American J. of Medical Genetics Part C: Seminars in Medical Genetics     Partially Free   (Followers: 6, SJR: 2.315, h-index: 79)
American J. of Physical Anthropology     Hybrid Journal   (Followers: 38, SJR: 1.41, h-index: 88)
American J. of Political Science     Hybrid Journal   (Followers: 296, 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: 4, SJR: 1.347, h-index: 75)
American J. of Transplantation     Hybrid Journal   (Followers: 18, SJR: 2.792, h-index: 140)
American J. on Addictions     Hybrid Journal   (Followers: 10, SJR: 0.843, h-index: 57)
Anaesthesia     Hybrid Journal   (Followers: 141, SJR: 1.404, h-index: 88)
Analyses of Social Issues and Public Policy     Hybrid Journal   (Followers: 10, SJR: 0.397, h-index: 18)
Analytic Philosophy     Hybrid Journal   (Followers: 20)
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: 166)
Angewandte Chemie Intl. Edition     Hybrid Journal   (Followers: 234, SJR: 6.229, h-index: 397)
Animal Conservation     Hybrid Journal   (Followers: 41, SJR: 1.576, h-index: 62)
Animal Genetics     Hybrid Journal   (Followers: 8, SJR: 0.957, h-index: 67)
Animal Science J.     Hybrid Journal   (Followers: 6, SJR: 0.569, h-index: 24)
Annalen der Physik     Hybrid Journal   (Followers: 5, SJR: 1.46, h-index: 40)
Annals of Anthropological Practice     Partially Free   (Followers: 2, SJR: 0.187, h-index: 5)
Annals of Applied Biology     Hybrid Journal   (Followers: 7, SJR: 0.816, h-index: 56)
Annals of Clinical and Translational Neurology     Open Access   (Followers: 1)
Annals of Human Genetics     Hybrid Journal   (Followers: 9, SJR: 1.191, h-index: 67)
Annals of Neurology     Hybrid Journal   (Followers: 49, SJR: 5.584, h-index: 241)
Annals of Noninvasive Electrocardiology     Hybrid Journal   (Followers: 1, SJR: 0.531, h-index: 38)
Annals of Public and Cooperative Economics     Hybrid Journal   (Followers: 8, 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: 26, SJR: 0.72, h-index: 31)
Anthropology & Humanism     Hybrid Journal   (Followers: 18, SJR: 0.137, h-index: 3)
Anthropology News     Hybrid Journal   (Followers: 15)
Anthropology of Consciousness     Hybrid Journal   (Followers: 11, SJR: 0.172, h-index: 5)
Anthropology of Work Review     Hybrid Journal   (Followers: 11, SJR: 0.256, h-index: 5)
Anthropology Today     Hybrid Journal   (Followers: 93, SJR: 0.545, h-index: 15)
Antipode     Hybrid Journal   (Followers: 52, SJR: 2.212, h-index: 69)
Anz J. of Surgery     Hybrid Journal   (Followers: 8, 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: 73, SJR: 0.754, h-index: 69)
Applied Organometallic Chemistry     Hybrid Journal   (Followers: 7, SJR: 0.632, h-index: 58)
Applied Psychology     Hybrid Journal   (Followers: 181, SJR: 1.023, h-index: 64)
Applied Psychology: Health and Well-Being     Hybrid Journal   (Followers: 51, 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: 32, SJR: 0.807, h-index: 60)
Aquatic Conservation Marine and Freshwater Ecosystems     Hybrid Journal   (Followers: 36, SJR: 1.047, h-index: 57)
Arabian Archaeology and Epigraphy     Hybrid Journal   (Followers: 11, SJR: 0.453, h-index: 11)
Archaeological Prospection     Hybrid Journal   (Followers: 12, SJR: 0.922, h-index: 21)
Archaeology in Oceania     Hybrid Journal   (Followers: 13, SJR: 0.745, h-index: 18)
Archaeometry     Hybrid Journal   (Followers: 30, SJR: 0.809, h-index: 48)
Archeological Papers of The American Anthropological Association     Hybrid Journal   (Followers: 15, SJR: 0.156, h-index: 2)
Architectural Design     Hybrid Journal   (Followers: 27, SJR: 0.261, h-index: 9)
Archiv der Pharmazie     Hybrid Journal   (Followers: 3, SJR: 0.628, h-index: 43)
Archives of Drug Information     Hybrid Journal   (Followers: 5)
Archives of Insect Biochemistry and Physiology     Hybrid Journal   (SJR: 0.768, h-index: 54)
Area     Hybrid Journal   (Followers: 13, SJR: 0.938, h-index: 57)
Art History     Hybrid Journal   (Followers: 267, SJR: 0.153, h-index: 13)
Arthritis & Rheumatology     Hybrid Journal   (Followers: 55, SJR: 1.984, h-index: 20)
Arthritis Care & Research     Hybrid Journal   (Followers: 27, SJR: 2.256, h-index: 114)
Artificial Organs     Hybrid Journal   (Followers: 1, SJR: 0.872, h-index: 60)
ASHE Higher Education Reports     Hybrid Journal   (Followers: 15)
Asia & the Pacific Policy Studies     Open Access   (Followers: 16)
Asia Pacific J. of Human Resources     Hybrid Journal   (Followers: 326, SJR: 0.494, h-index: 19)
Asia Pacific Viewpoint     Hybrid Journal   (Followers: 1, SJR: 0.616, h-index: 26)
Asia-Pacific J. of Chemical Engineering     Hybrid Journal   (Followers: 8, SJR: 0.345, h-index: 20)
Asia-pacific J. of Clinical Oncology     Hybrid Journal   (Followers: 6, SJR: 0.554, h-index: 14)
Asia-Pacific J. of Financial Studies     Hybrid Journal   (SJR: 0.241, h-index: 7)
Asia-Pacific Psychiatry     Hybrid Journal   (Followers: 4, SJR: 0.377, h-index: 7)
Asian Economic J.     Hybrid Journal   (Followers: 8, SJR: 0.234, h-index: 21)
Asian Economic Policy Review     Hybrid Journal   (Followers: 4, SJR: 0.196, h-index: 12)
Asian J. of Control     Hybrid Journal   (SJR: 0.862, h-index: 34)
Asian J. of Endoscopic Surgery     Hybrid Journal   (Followers: 1, SJR: 0.394, h-index: 7)
Asian J. of Organic Chemistry     Hybrid Journal   (Followers: 6, SJR: 1.443, h-index: 19)
Asian J. of Social Psychology     Hybrid Journal   (Followers: 5, SJR: 0.665, h-index: 37)
Asian Politics and Policy     Hybrid Journal   (Followers: 12, SJR: 0.207, h-index: 7)
Asian Social Work and Policy Review     Hybrid Journal   (Followers: 5, SJR: 0.318, h-index: 5)
Asian-pacific Economic Literature     Hybrid Journal   (Followers: 5, SJR: 0.168, h-index: 15)
Assessment Update     Hybrid Journal   (Followers: 4)
Astronomische Nachrichten     Hybrid Journal   (Followers: 3, SJR: 0.701, h-index: 40)
Atmospheric Science Letters     Open Access   (Followers: 29, SJR: 1.332, h-index: 27)
Austral Ecology     Hybrid Journal   (Followers: 15, SJR: 1.095, h-index: 66)
Austral Entomology     Hybrid Journal   (Followers: 9, SJR: 0.524, h-index: 28)
Australasian J. of Dermatology     Hybrid Journal   (Followers: 8, SJR: 0.714, h-index: 40)
Australasian J. On Ageing     Hybrid Journal   (Followers: 6, SJR: 0.39, h-index: 22)
Australian & New Zealand J. of Statistics     Hybrid Journal   (Followers: 14, SJR: 0.275, h-index: 28)
Australian Accounting Review     Hybrid Journal   (Followers: 3, SJR: 0.709, h-index: 14)
Australian and New Zealand J. of Family Therapy (ANZJFT)     Hybrid Journal   (Followers: 3, SJR: 0.382, h-index: 12)
Australian and New Zealand J. of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 47, SJR: 0.814, h-index: 49)
Australian and New Zealand J. of Public Health     Hybrid Journal   (Followers: 13, 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: 6, SJR: 0.171, h-index: 12)
Australian Economic Papers     Hybrid Journal   (Followers: 31, 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: 15, SJR: 0.203, h-index: 14)
Australian J. of Psychology     Hybrid Journal   (Followers: 18, SJR: 0.384, h-index: 30)
Australian J. of Public Administration     Hybrid Journal   (Followers: 429, SJR: 0.418, h-index: 29)
Australian J. of Rural Health     Hybrid Journal   (Followers: 6, SJR: 0.43, h-index: 34)
Australian Occupational Therapy J.     Hybrid Journal   (Followers: 74, SJR: 0.59, h-index: 29)
Australian Psychologist     Hybrid Journal   (Followers: 12, SJR: 0.331, h-index: 31)
Australian Veterinary J.     Hybrid Journal   (Followers: 23, SJR: 0.459, h-index: 45)
Autism Research     Hybrid Journal   (Followers: 37, SJR: 2.126, h-index: 39)
Autonomic & Autacoid Pharmacology     Hybrid Journal   (SJR: 0.371, h-index: 29)
Banks in Insurance Report     Hybrid Journal   (Followers: 1)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 11, SJR: 0.539, h-index: 70)
Basic and Applied Pathology     Open Access   (Followers: 2, SJR: 0.113, h-index: 4)
Basin Research     Hybrid Journal   (Followers: 5, SJR: 1.54, h-index: 60)
Bauphysik     Hybrid Journal   (Followers: 2, SJR: 0.194, h-index: 5)
Bauregelliste A, Bauregelliste B Und Liste C     Hybrid Journal  
Bautechnik     Hybrid Journal   (Followers: 1, SJR: 0.321, h-index: 11)
Behavioral Interventions     Hybrid Journal   (Followers: 9, SJR: 0.297, h-index: 23)
Behavioral Sciences & the Law     Hybrid Journal   (Followers: 23, SJR: 0.736, h-index: 57)
Berichte Zur Wissenschaftsgeschichte     Hybrid Journal   (Followers: 10, 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: 18, SJR: 1.172, h-index: 90)
Biological Reviews     Hybrid Journal   (Followers: 5, SJR: 6.469, h-index: 114)
Biologie in Unserer Zeit (Biuz)     Hybrid Journal   (Followers: 41, SJR: 0.12, h-index: 1)
Biology of the Cell     Full-text available via subscription   (Followers: 9, SJR: 1.812, h-index: 69)
Biomedical Chromatography     Hybrid Journal   (Followers: 6, SJR: 0.572, h-index: 49)
Biometrical J.     Hybrid Journal   (Followers: 5, SJR: 0.784, h-index: 44)
Biometrics     Hybrid Journal   (Followers: 37, SJR: 1.906, h-index: 96)
Biopharmaceutics and Drug Disposition     Hybrid Journal   (Followers: 10, SJR: 0.715, h-index: 44)
Biopolymers     Hybrid Journal   (Followers: 18, SJR: 1.199, h-index: 104)
Biotechnology and Applied Biochemistry     Hybrid Journal   (Followers: 44, SJR: 0.415, h-index: 55)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 157, SJR: 1.633, h-index: 146)
Biotechnology J.     Hybrid Journal   (Followers: 14, SJR: 1.185, h-index: 51)
Biotechnology Progress     Hybrid Journal   (Followers: 39, SJR: 0.736, h-index: 101)
Biotropica     Hybrid Journal   (Followers: 20, SJR: 1.374, h-index: 71)
Bipolar Disorders     Hybrid Journal   (Followers: 9, SJR: 2.592, h-index: 100)
Birth     Hybrid Journal   (Followers: 38, SJR: 0.763, h-index: 64)
Birth Defects Research Part A : Clinical and Molecular Teratology     Hybrid Journal   (Followers: 2, SJR: 0.727, h-index: 77)
Birth Defects Research Part B: Developmental and Reproductive Toxicology     Hybrid Journal   (Followers: 7, 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: 248, 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  [1592 journals]
  • Cryopyrin-associated periodic syndrome in early childhood can be
           successfully treated with interleukin-1 blockades
    • Authors: Vesa Eskola; Heini Pohjankoski, Liisa Kröger, Kristiina Aalto, Katariina Latva, Matti Korppi
      Abstract: Cryopyrin-associated periodic syndrome (CAPS) is caused by a mutation in the NLRP3 gene encoding cryopyrin production. Overproduction of interleukin-1 (IL-1) leads to symptoms that are associated with elevated inflammatory markers, including periodic fever and a rash. We provide a clinical overview of CAPS in children, including three Finnish case studies. ConclusionWhen CAPS has been diagnosed, an IL-1 blockade with biologicals should be introduced to lessen the symptoms and to prevent the progression of organ damage.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-13T10:00:20.998228-05:
      DOI: 10.1111/apa.14217
       
  • Dog bites in a US county: age, body part, and breed in pediatric dog bites
    • Authors: Sriram Ramgopal; Lauren Bealafeld Brungo, Michael Bykowski, Raymond Pitetti, Robert Hickey
      Abstract: AimTo compare characteristics of gender, age, body part, and breed in dog bites.MethodsWe reviewed 14,956 dog bites (4,195 pediatric) reported to the Allegehny County Health Department, USA, between 2007-2015. Using pre-defined age groups, we performed linear regression to assess for subject age and bite frequency and used binary logistic regression to evaluate for differences in gender and body part and chi-squared tests with Bonferroni correction to evaluate for differences in reported breeds with age.ResultsThere was a negative correlation (-0.80, r2=0.64) between age and bite frequency. Children 0-3 years had a higher odds ratio (OR) of bites to the face (21.12, 95% confidence interval [CI] 17.61–25.33) and a lower OR of bites to the upper (OR 0.14, 95% CI 0.12-0.18) and lower (OR 0.19, 95% CI 0.14-0.27) extremities. “Pit bulls” accounted for 27.2% of dog bites and were more common in children 13-18 years (p
      PubDate: 2018-01-13T06:00:19.720257-05:
      DOI: 10.1111/apa.14218
       
  • Playing music to preemies: boosting of soothing the brain'
    • Authors: Sampsa Vanhatalo
      PubDate: 2018-01-10T08:15:43.532895-05:
      DOI: 10.1111/apa.14204
       
  • Does Erythropoietin monotherapy reduce mortality or moderate/severe
           disability in neonates with hypoxic ischaemic encephalopathy'
    • Authors: Joseph S. Bircher; Dmitry Dukhovny
      PubDate: 2018-01-09T23:15:49.581411-05:
      DOI: 10.1111/apa.14195
       
  • Walter Harris (1647-1732) and his contribution to paediatrics
    • Authors: Konstantinos Laios
      Abstract: Walter Harris (1647-1732) was a very interesting figure in paediatrics during the second half of the 17th century and first half of 18th century. He was born in Gloucester, England, and studied medicine at Bourge, France, in 1675. He continued his medical studies at Cambridge. He became physician in ordinary to Charles II (1630-1685) in 1683 and later to William III (1650-1702), accompanying him to Holland (1).This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-08T03:50:30.278696-05:
      DOI: 10.1111/apa.14216
       
  • Parental education and family income affect birth weight, early
           longitudinal growth and body mass index development differently
    • Authors: Rebecka Bramsved; Susann Regber, Daniel Novak, Kirsten Mehlig, Lauren Lissner, Staffan Mårild
      Abstract: AimThis study investigated the effects of two parental socioeconomic characteristics, education and income, on the growth and obesity risks of children from birth to eight years of age.MethodsLongitudinal growth data and national register-based information on socioeconomic characteristics were available for 3,030 Swedish children. The development of body mass index (BMI) and height were compared in groups dichotomised by parental education and income.ResultsLow parental education was associated with a higher BMI from four years of age, independent of income, immigrant background, maternal BMI and smoking during pregnancy. Low family income was associated with a lower birth weight, but did not independently affect BMI development. At eight years of age, children from less-educated families had a three times higher risk of obesity, independent of parental income. Children to low educated-high income parents had significantly higher BMI and height than children to high educated-high income parents.ConclusionParental education protected against childhood obesity, even after adjusting for income and other important parental characteristics. Income-related differences in height, despite similar BMIs, raise questions about body composition and metabolic risk profiles. The dominant role of education underscores the value of health literacy initiatives for the parents of young children.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-07T22:40:20.997251-05:
      DOI: 10.1111/apa.14215
       
  • Five‐country manikin study found that neonatologists preferred using the
           LISAcath rather than the Angiocath for less invasive surfactant
           administration
    • Authors: Laura Fabbri; Katrin Klebermass-Schrehof, Marta Aguar, Catherine Harrison, Ewa Gulczyńska, Debora Santoro, Marco Di Castri, Vincent Rigo
      Abstract: AimLess invasive surfactant administration (LISA) has been shown to decrease the risk of death and bronchopulmonary dysplasia in preterm neonates. The LISAcath is the first catheter to be specifically developed for LISA and we compared the clinical impressions of neonatologists using the LISAcath and the commonly‐used Angiocath in a simulated setting.MethodsThis was a multinational, multicentre study, conducted in October 2016, which involved 39 neonatologists who were recruited by employees of the sponsor from large, well‐recognised neonatal intensive care units across Europe. LISA was not the standard of care in these units in Austria, Belgium, Poland, Spain and the UK at the time of the study. After training, participants simulated LISA on a neonatal manikin, once with the LISAcath and once with Angiocath, then answered a 10‐item questionnaire.ResultsThe responses to 9/10 questions showed that 67‐95% of the respondents preferred the LISAcath to the Angiocath, with most of the remainder indicating no preference. The only exception was the luer connection question, with two‐thirds expressing no preference. The LISAcath was considered potentially safer by 33/39 participants, with no votes for the Angiocath.ConclusionOverall, neonatologists preferred using the LISAcath rather than the Angiocath on a neonatal manikin.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-05T08:13:44.325572-05:
      DOI: 10.1111/apa.14214
       
  • Legislation can help children to receive the support they need to manage
           chronic health conditions like type 1 diabetes at school
    • Authors: Gun Forsander
      PubDate: 2018-01-04T08:30:40.166922-05:
      DOI: 10.1111/apa.14192
       
  • The ongoing challenge of meningococcal disease
    • Authors: Hans Fredlund
      PubDate: 2018-01-03T06:55:26.350683-05:
      DOI: 10.1111/apa.14193
       
  • Wrapping preterm infants in cloth and newspaper after delivery led to
           higher temperatures on arrival at the neonatal intensive care unit
    • Authors: Nitika Agrawal; Kunal Das, Prachi Patwal, Neerul Pandita, Alpa Gupta
      Abstract: AimNeonatal hypothermia is a preventable cause of neonatal mortality and morbidity and wrapping neonates in newspaper sandwiched between cotton sheets is a simple intervention. This 2017 Indian pilot study tested the heat insulating property of sandwiched sheetsMethodsAt birth we randomised 100 neonates who were more than 32 weeks of gestation and needed neonatal intensive care unit (NICU) observation or care without a ventilator or bilevel positive airway pressure support into two groups of 50. The intervention and control groups were wrapped in two pre‐warmed sheets at birth that did or did not contain a layer of newspaper. Their axillary temperatures on arrival at the NICU and one hour after arrival were measured. Other environmental factors were similar.ResultsThe neonates wrapped in the sandwiched sheets showed significantly higher temperatures on arrival at the NICU than the control group (35.9°C versus 35.4°C, p
      PubDate: 2018-01-03T06:36:12.492283-05:
      DOI: 10.1111/apa.14211
       
  • Oral mucosa lesions and gingival bleeding can indicate the progression of
           liver disease in children and adolescents aged two to 18 years
    • Authors: Dorota Olczak-Kowalczyk; Ewa Krasuska-Sławińska, Dariusz Gozdowski, Wojciech Kowalczyk, Joanna Pawłowska
      Abstract: AimThis study assessed correlations between systemic disturbances of paediatric chronic liver diseases (CLD) and oral symptoms in subjects aged 2‐18 years.MethodsIt was carried out during outpatient appointments at the Children's Memorial Health Institute, Warsaw, Poland, from 2010‐2015 and comprised 52 CLD patients with a mean age of 12.3 ±4.6. We also recruited 54 generally healthy controls with a mean age of 12.0 ±3.7 from the Department of Paediatric Dentistry at the Medical University of Warsaw. The study used various measures, including the Child‐Pugh score, which assesses CLD prognosis. We also assessed the causes of liver disease and the medication taken by the CLD patients.ResultsA total of 24 patients received a Child‐Pugh score of seven or more points, while 28 patients were awarded five or six points. More severe cases of gingivitis and a greater prevalence of oral lesions were evident in patients suffering from liver disease. Oral candidiasis, telangiectasia, bald tongue, cracked strawberry lip, yellowish‐brown gum discoloration, petechiae and gingival bleeding all correlated with the severity of liver dysfunction, coagulopathy, protein, bilirubin and creatinine levels and portal hypertension.ConclusionThis study found that oral lesions and gingival bleeding may indicate the progression of liver failure.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-03T06:35:58.265434-05:
      DOI: 10.1111/apa.14213
       
  • Impaired cognitive ability at 2.5 years predicts later visual and
           ophthalmological problems in children born very preterm
    • Authors: Jonina Hreinsdottir; Ylva Fredriksson Kaul, Lena Hellström-Westas, Kerstin Rosander, Claes von Hofsten, Gerd Holmström
      Abstract: AimTo identify possible predictive factors for visual problems at 6.5 years in children born very preterm.MethodsDuring 2004 to 2007, all very preterm infants (gestational age < 32 weeks) in Uppsala County, Sweden, were screened for retinopathy of prematurity (ROP) neonatally; at four months visual tracking was tested; at 2.5 years, visuospatial and cognitive tests were carried out. At 6.5 years, 84 preterm children and a reference group of 64 full‐term children underwent ophthalmological testing.ResultsMean visual acuity (VA) did not differ between the groups, but subnormal VA (≤ 0.8) was more common in the preterm group (31% versus 14%; p
      PubDate: 2017-12-29T20:40:27.829284-05:
      DOI: 10.1111/apa.14209
       
  • Repeated doses of salbutamol and aeroallergen sensitisation both increased
           salbutamol‐induced hypoxia in children and adolescents with acute asthma
           
    • Authors: Murat Ozer; Betul Buyuktiryaki, Umit Murat Sahiner, Ozlem Teksam, Betul Karaatmaca, Ozge Soyer, Bulent Enis Sekerel
      Abstract: AimWe aimed to identify the frequency, magnitude and risk factors of salbutamol‐induced hypoxia in children with acute asthma.MethodsThis study was conducted at Hacettepe University on children who presented to the paediatric allergy clinic or the paediatric emergency room with acute asthma between July 2014 and June 2015. Vital signs, pulse oximeter defined oxygen saturation and modified pulmonary index scores were evaluated before and after the first, second and third doses of nebulised salbutamol and repeated one and 10 days later.ResultsWe included 304 patients (65.7% male) from median age of 5.3 years (range 1‐18 years). Salbutamol‐induced hypoxia was detected in 14.7%, 3.9% and 1.3%, respectively, after the first, second and third doses of salbutamol. The risk factors for hypoxia were younger age and a higher modified pulmonary index score, but the risk factors for salbutamol‐induced hypoxia were the number of salbutamol doses given in the last six hours and the presence of aeroallergen sensitisation. The maximum decrease in oxygen saturation after salbutamol was %5.ConclusionAlthough bronchodilators are the first‐line treatment for acute asthma, they caused modest hypoxemia, especially at repeated doses and, or, in patients with aeroallergen sensitisation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-28T18:01:08.887327-05:
      DOI: 10.1111/apa.14202
       
  • Study of top ballet school students revealed large deficiencies in their
           body weight and body fat
    • Authors: Elżbieta Grochowska-Niedworok; Marek Kardas, Edyta Fatyga, Karolina Piórkowska-Staniek, Małgorzata Muc-Wierzgoń, Teresa Kokot
      Abstract: AimThis study assessed the nutritional status and physical activity levels of 150 female students aged 10‐18 from three top Polish ballet schools, where the most promising dancers go on to pursue professional ballet careers.MethodsWe analysed the girls’ body composition, physical activity level (PAL) and PAL coefficient. The ballet students also completed a questionnaire.ResultsThe results revealed large deficiencies in the body weight and body fat of the young ballerinas. The mean body mass index (BMI) for the group was 16.8 kg/m2. Polish centile charts showed that 18% of the girls had BMIs below the norm and 54% had a lower than average body fat content, with a mean of 15.6%. The body fat content was lowest (13.8%) in the 13‐15 year age group. On average, girls aged 10‐12 had 15.7% body fat, while girls aged 16‐18 had 18.4%. The mean values for the anthropometric measurements were higher in older girls. The majority (72%) of the respondents reported high physical activity levels, defined as more than 15 hours of exercise per week.ConclusionSpecial attention should be paid to low BMIs and body fat in young ballet school dancers aged 10 to 15 yearsThis article is protected by copyright. All rights reserved.
      PubDate: 2017-12-28T18:00:35.714112-05:
      DOI: 10.1111/apa.14208
       
  • Extreme prematurity, treated retinopathy, bronchopulmonary dysplasia and
           cerebral palsy are significant risk factors for ophthalmological
           abnormalities at 6.5 years of age
    • Authors: Ann Hellström; Karin Källén, Birgitta Carlsson, Gerd Holmström, Peter Jakobsson, Pia Lundgren, Fredrik Serenius, Karin Stjernqvist, Kristina Tornqvist, Kerstin Hellgren
      Abstract: AimThis study evaluated the contributions of various prenatal and postnatal predictive factors to a documented high prevalence of ophthalmological abnormalities in children aged 6.5 years who were born extremely preterm.MethodsWe carried out a prospective population-based study of all children born in Sweden at a gestational age of 22+0 to 26+6 weeks based on the Extremely Preterm Infants in Sweden Study. The main outcome measures were a combined score of visual impairment, refractive errors and strabismus at 6.5 years of age. Models of univariate and multivariable regression were used to analyse potential prenatal and postnatal predictive factors at different clinically relevant time-points from one minute after birth to 30 months.ResultsWe focused on 399 known extremely preterm survivors and compared them to 300 full-term controls. Significant antecedents for ophthalmological abnormalities included prematurity per se, retinopathy of prematurity that required treatment, severe bronchopulmonary dysplasia and cerebral palsy. Severe intraventricular haemorrhage was no longer a significant risk factor when we adjusted it for the 30-month cognitive and neuromotor development outcomes.ConclusionThis time-course risk analysis model showed a changing panorama of significant risk factors for ophthalmological abnormalities in children aged 6.5 years who were born extremely preterm.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-27T14:00:24.024043-05:
      DOI: 10.1111/apa.14206
       
  • Urine dipstick tests can aid decision making when treating infants with
           unexplained fever but more research is needed
    • Authors: Astha Panghal; Aakash Pandita, Girish Gupta, Kirti Naranje, Anita Singh
      Abstract: A recent paper by Herreros et al in Acta Paediatrica reported, for the first time, that performing a dipstick test on a clean-catch urine sample was an accurate way of diagnosing a urinary tract infection (UTI) in a febrile infant under 90 days of age (1), without the need for invasive procedures. We have a number of comments on this study. It would have been useful to know how old the youngest infants were and the duration of unexplained fever. In addition, they used low-risk Rochester criteria to select the infants and one criterion is normal urinalysis, which may have affected the consistency of the study.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-27T14:00:22.333967-05:
      DOI: 10.1111/apa.14207
       
  • Brain connectivity in children is increased by the time they spend reading
           books and decreased by the length of exposure to screen‐based media
    • Authors: Tzipi Horowitz-Kraus; John S. Hutton
      Abstract: AimThis study compared the time spent using screen‐based media or reading on the functional connectivity of the reading‐related brain regions in children aged 8‐12.MethodsWe recruited 19 healthy American children from a private school in Cincinnati, USA, in 2015‐6 after advertising the study to parents. The parents completed surveys on how many hours their children spent on independent reading and screen‐based media time, including smartphones, tablets, desktop or laptop computers and television. The children underwent magnetic resonance imaging that assessed their resting‐state connectivity between the left visual word form area, as the seed area, and other brain regions, with screen time and reading time applied as predictors.ResultsTime spent reading was positively correlated with higher functional connectivity between the seed area and left‐sided language, visual and cognitive control regions. In contrast, screen time was related to lower connectivity between the seed area and regions related to language and cognitive control.ConclusionScreen time and time spent reading showed different effects on functional connectivity between the visual word form area and language, visual and cognitive‐control regions of the brain. These findings underscore the importance of children reading to support healthy brain development and literacy and limiting screen time.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-27T08:26:17.191307-05:
      DOI: 10.1111/apa.14176
       
  • Subdural haemorrhage in infants: abuse or natural causes' The
           importance of thorough child death review
    • Authors: Peter Fleming; Roger W. Byard
      PubDate: 2017-12-27T08:22:10.896542-05:
      DOI: 10.1111/apa.14185
       
  • Effect of maturity and infection on the rate of relaxation of the
           respiratory muscles in ventilated, newborn infants
    • Authors: Theodore Dassios; Ourania Kaltsogianni, Paul Dixon, Anne Greenough
      Abstract: AimTo assess the respiratory muscle time constant of relaxation (τ), an index of respiratory muscle function in ventilated newborns.MethodsSixty‐two infants (42 born prematurely) with a median gestational age of 29 [interquartile range (IQR) 26‐37] weeks were prospectively studied. Measurement of τ was done during spontaneous breathing on endotracheal continuous positive airway pressure prior to extubation and τ was calculated from the reciprocal of the slope of the airway pressure decline versus time. Infants were classified as having had systemic or respiratory infection (positive microbiology) if they had any positive bacterial blood or respiratory culture prior to measurement.ResultsMeasurement of τ was made at a median postnatal age of 6 (IQR 3‐29) days. The median τ was higher in premature infants [17.4 (IQR 7.7–28.3) sec/cmH2O] compared to term infants [6.8 (IQR 4.4‐8.7) sec/cmH2O, p
      PubDate: 2017-12-27T08:15:43.598491-05:
      DOI: 10.1111/apa.14188
       
  • Randomised study found that improved nutritional intake was associated
           with better sleep patterns in prepubertal children who were both short and
           lean
    • Authors: Michal Yackobovitch-Gavan; Ayelet Machtei, Liora Lazar, Raanan Shamir, Moshe Phillip, Yael Lebenthal
      Abstract: AimsNutrition and sleep are prerequisites for linear growth and we addressed the under‐researched role of sleep in this equation.MethodsThis was a prospective randomised, double‐blinded, placebo‐controlled study of nutritional supplements in 164 healthy lean, short, prepubertal children with 83 in the supplement group and 81 in the placebo group. From November 2010 to November 2013, we focussed on children aged 3‐9 years referred for specialist growth assessments to the Schneider Children's Medical Center, Israel. Progress was assessed using anthropometric measurements, sleep questionnaires and three‐day food diaries at baseline and after the six‐month intervention.ResultsChildren in the supplement group who took at least 50% of the recommended dose had shorter sleep latency than those who did not (p = 0.046). Children who feel asleep in less than 15 minutes had significantly improved standard deviation scores for weight (0.25 ± 0.34 versus 0.07 ± 0.36, p = 0.044) and height (0.09 ± 0.13 versus 0.03 ± 0.13, p = 0.057) than those who took longer to fall asleep. Positive correlations were found between mean sleep duration and caloric and macronutrient intake per kilogram.ConclusionAdequate nutritional intake was associated with better sleep patterns and may enhance linear growth.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-27T04:45:20.812279-05:
      DOI: 10.1111/apa.14205
       
  • Neural perspectives on cognitive control development during childhood and
           adolescence should take into account how the obesity affects brain
           development
    • Authors: Irene Esteban-Cornejo; Francisco B. Ortega, Andrés Catena
      Abstract: Cognitive control comprises working memory, inhibition, cognitive flexibility and error monitoring and is closely tied to the development of the prefrontal cortex. The fact that the prefrontal cortex is important for cognitive control has been consistently shown among adults (1). Crone and Steinbeis explored new ways of categorising developmental progressions in cognitive control during childhood and adolescence (1). They revealed that the functional development of the dorsolateral prefrontal cortex supports the development of deliberative processes, whereas the medial prefrontal cortex supports the development of internalised decisions (1).This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-27T04:06:40.666336-05:
      DOI: 10.1111/apa.14200
       
  • Systematic review and meta‐analysis found higher levels of behavioural
           problems in male left behind children aged 6‐11 years
    • Authors: Guang-Bo Qu; Wei Wu, Ling-Ling Wang, Xue Tang, Ye-Huan Sun, Jie Li, Jun Wang
      Abstract: AimLeft behind children (LBC) now account for more than one in five Chinese children and they often suffer from behavioural problems when their parents leave their rural homes to seek work in urban areas. The primary aim of this meta‐analysis was to compare the incidence rates and factor scores of behavioural problems in LBC children, who now account for more than one‐fifth of Chinese children, and non LBC children.MethodsThis systematic review and meta‐analysis explored the children's characteristic behavioural problems using the Achenbach Child Behavior Check List. A subgroup analysis was conducted to compare the different behavioural problems of LBC children with different characteristics. The meta‐analysis assessed 1,405 papers and analysed 13 papers from 2007‐2015, covering 10,264 LBC and 8,909 non LBC children from 2‐19 years of age.ResultsThe incidence rates of behavioural problems were higher in LBC children than non LBC children. The highest risks were noted in boys aged between six and 11 years of age, who were more likely to be withdrawn and be affected by somatic complaints, schizophreniform disorder, compulsive behaviour and depression.ConclusionInterventions and policies are urgently needed to tackle behavioural issues among LBC children, especially high‐risk males aged 6‐11 years.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-27T04:05:20.534689-05:
      DOI: 10.1111/apa.14199
       
  • Paediatricians’ expectations and perspectives regarding genetic testing
           for children with developmental disorders
    • Authors: Isabelle Tremblay; Anne-Marie Laberge, Dominique Cousineau, Lionel Carmant, Anita Rowan, Annie Janvier
      Abstract: AimInvestigate paediatricians’ expectations and perspectives of genetic testing for children with developmental disorders.MethodsPaediatricians working in a developmental clinic were surveyed each time they ordered a chromosomal microarray (CMA) for a child with developmental disorders. Clinical charts were reviewed. Results were analysed using mixed methodology.ResultsNinety‐seven % (73/76) of surveys were completed. Pediatricians reported that 36% of parents had difficulties understanding genetic testing and that 40% seemed anxious. The majority expected testing to have positive impacts on children/families. The themes raised were 1) clarifying the diagnosis (56%), 2) understanding the aetiology of the condition (55%), 3) enabling prenatal diagnosis/counselling (43%), 4) improving medical care for the child (15%) and 5) decreasing parental guilt/anxiety (8%). Less than half anticipated negative impacts; 74% expected that the most helpful result for their patient would be an abnormal result explaining the disorder. Among the 73 children for whom CMA was ordered, 81% got tested: 66% of the results were normal, 19% were abnormal and contributed to explain the condition and 12% were abnormal but of unknown significance.ConclusionPaediatricians generally expect many positive and less negative impacts of genetic testing for children with developmental disorders. Parental perspectives are needed.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-27T03:36:50.854752-05:
      DOI: 10.1111/apa.14203
       
  • The highest mortality rates in childhood dilated cardiomyopathy occur
           during the first year after diagnosis
    • Authors: Shalan Fadl; Håkan Wåhlander, Katja Fall, Yang Cao, Jan Sunnegårdh
      Abstract: AimThe aim of the study was to assess the incidence, mortality and morbidity of dilated cardiomyopathy (DCM) and non‐compaction of the left ventricle (LVNC) in Swedish children.MethodsWe reviewed hospital records of all children with dilated cardiomyopathy (DCM) or left ventricular non‐compaction cardiomyopathy (LVNC) up to the age of 18 in the healthcare region of western Sweden from 1991 to 2015.ResultsIn total, 69 cases (61% males) were identified. The combined incidence of DCM and LVNC was 0.77 (95% CI 0.59‐0.96) per 100,000 person years. Children were divided into six groups and their outcomes were analysed depending on their aetiology. Idiopathic DCM was reported in 43% and familial dilated and left ventricular non‐compaction aetiology was present in 32%. DCM due to various diseases occurred in 8%. DCM associated with neuromuscular diseases was present in 16%. The overall risk of death or receiving transplants in children with idiopathic and familial DCM was 30% over the study period and 21% died in the first year after diagnosis.ConclusionThe combined incidence of DCM and LVNC was similar to previous reports. Most children with idiopathic DCM presented during infancy and mortality was highest during the first year after diagnosis.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-26T05:00:23.869681-05:
      DOI: 10.1111/apa.14183
       
  • Responding to parental requests for life‐sustaining treatment…
           relational potential revisited
    • Authors: Aaron Wightman; Jennifer Cobelli Kett, Benjamin S. Wilfond
      Abstract: One of the most challenging situations for pediatric clinicians is responding to parental requests for life‐sustaining medical therapies for a child with profound neurodevelopmental disabilities. These therapies (e.g. intravenous medications and fluids, gastrostomy tube feeds, dialysis, tracheostomy, and/or mechanical ventilation) offer the possibility for the child to live, at home or in a facility, for months or years as opposed to experiencing their imminent death. While relatively rare, the tension surrounding these requests can be exceptionally high, as illustrated by the cases of Baby K, Baby Joseph, Jahi McMath, Charlie Gard, and many others from our own experience.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-26T04:56:38.272872-05:
      DOI: 10.1111/apa.14179
       
  • Are inhaled steroids safe and effective for prevention or treatment of
           bronchopulmonary dysplasia'
    • Authors: Eric S. Shinwell
      Abstract: Bronchopulmonary Dysplasia (BPD) represents a major threat to the short and long‐term health and development of very preterm infants. Unfortunately, despite much study and progress in neonatology in recent years and some modest improvements in survival, both the incidence and severity of BPD remain frustratingly stable (1).This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-26T04:56:28.413894-05:
      DOI: 10.1111/apa.14180
       
  • Association of Intralipid Intake in Extremely Low Birth Weight Infants
           with Neurodevelopmental Outcomes
    • Authors: William Oh; Lynn Przystac, Leslie McKinley, Richard Tucker, Elisabeth C. McGowan, Betty R Vohr
      Abstract: AimTo determine if high intake of Intralipid, (IL) in extremely low birthweight (ELBW) neonates is associated with higher rates of neuroimpairment and Bayley III scores at 2 years corrected age.MethodsQuartiles of IL received by 389 ELBW infants were linked to neurodevelopmental outcomes. Logistic regression analyses, adjusted for confounders, were done to determine the association between IL dose and neuroimpairment. Linear regression analyses were done to predict Bayley III scores.ResultsNo association was found between IL dose and neuroimpairment A significant association was found between higher IL intake and lower Bayley Cognitive, motor and language scores. Adding breast milk intake to the linear regression eliminated the associations.ConclusionHigher IL intake was associated with lower cognitive, motor and language scores. Breast milk intake eliminated the latter associations, which underscores the important role of breast milk in developmental outcome.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-23T07:08:51.32157-05:0
      DOI: 10.1111/apa.14201
       
  • Supportive palliative care should be integrated into routine care for
           paediatric patients with life‐limiting kidney disease
    • Authors: Julia Thumfart; Tobias Reindl, Cornelia Rheinlaender, Dominik Müller
      Abstract: AimPaediatric palliative care is no longer restricted to patients with cancer and has been extended to patients with other chronic conditions, such as cystic fibrosis or neuromuscular disorders. This review focused on the current state of palliative care for children and adolescents with chronic kidney disease (CKD).MethodWe assessed the literature on CKD published up to August 2017. All the papers, except one from 1996, were published this century. This review discusses the role that palliative care plays in the process of decision‐making and explores the possibilities of implementing palliative care into the routine therapy of affected patients and providing support for their families.ResultsOffering early palliative care as an integral part of the kidney supportive care provided by the nephrology care team is both necessary and feasible for patients with CKD. As a minimum, a specialised palliative care team should be involved in patients with multiple comorbidities, in conservative treatment scenarios and in acute life‐threatening complications. Further studies and guidelines are required to improve the care of patients with CKD and their families.ConclusionSupportive palliative care should be implemented into the routine care of patients with life‐limiting kidney disease.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-22T12:05:24.702666-05:
      DOI: 10.1111/apa.14182
       
  • Sleep disorders in obese children are not limited to obstructive sleep
           apnoea syndrome
    • Authors: Caroline Carriere; Olivier Coste, Marie-Claire Meiffred-Drouet, Pascal Barat, Hélène Thibault
      Abstract: AimThis study was to characterised respiratory and non‐respiratory sleep disorders in obese children and evaluated the diagnostic and therapeutic impact of a specific sleep consultation.MethodsA descriptive study was conducted in obese French children who received multidisciplinary care management from the hospital centre for paediatric obesity in Bordeaux. This followed a specific sleep consultation between 2007 and 2015, because their paediatrician had identified symptoms suggestive of sleep disorders.ResultsThe sleep specialist confirmed the presence of a sleep disorder in 98.4% of the 128 obese children, with a mean age of 12.1 ±3.2 years. These included respiratory sleep disorders, hypersomnolence, insomnia and circadian rhythm sleep‐wake disorders. Polysomnography revealed that 46.1% had respiratory sleep disorders and 24.2% had obstructive sleep apnoea syndrome (OSAS). Just under half (47.6%) were referred to an otorhinolaryngologist for sleep care management, 30.5% were referred to an orthodontist, 17.9% had melatonin treatment and 13.3% received continuous positive airway pressure ventilation.ConclusionSleep disorders in obese children were not limited to respiratory sleep disorders including OSAS. A systematic specific consultation with a sleep specialist is essential for the diagnosis and care of such children and would be beneficial when treating paediatric obesityThis article is protected by copyright. All rights reserved.
      PubDate: 2017-12-22T11:45:23.139088-05:
      DOI: 10.1111/apa.14178
       
  • Exploratory and confirmatory studies have different targets and both are
           needed in clinical research
    • Authors: Matti Korppi; Kirsi Nuolivirta
      Abstract: Conclusions drawn from medical studies are usually based on statistical analyses of collected quantitative data and the typical conclusion drawn from the statistical analysis is whether the hypothesis in question can be accepted or rejected and by what probability. This means that the study must have a hypothesis, or some hypotheses, but it is important that there are not too many in relation to the sample size. Indeed, most clinical journals currently only accept studies if the authors have clearly stated the hypothesis they want to evaluate. In addition, most journals demand a power analysis, at least in the case of intervention studies, mainly to make sure that the sample size of the study is sufficient to also prove the negative result.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-22T09:35:18.656396-05:
      DOI: 10.1111/apa.14197
       
  • Assessing Truncal Obesity in Predicting Cardiometabolic Risk in Children:
           Clinical Measures versus Dual‐energy X‐ray Absorptiometry
    • Authors: Vincent J. Palmieri; Melissa H. Henshaw, Janet Carter, Shahryar M. Chowdhury
      Abstract: AimThe objectives of this study were to: 1) Compare the accuracy of waist:hip ratio (WHR) and waist:height ratio (WHtR) by determining their association with reference‐standard measures derived from dual‐energy X‐ray absorptiometry (DXA) and 2) assess the relationship of DXA, WHR, and WHtR to measures of dyslipidemia, insulin resistance, and inflammation in children.MethodsSubjects aged four to 21 were prospectively recruited. Truncal obesity by DXA was defined as the trunk fat:height ratio and trunk fat:non‐trunk fat ratio. 308 subjects were studied, 246 (80%) were obese.ResultsThere was a strong correlation between WHtR and trunk fat:height (r=0.84, p
      PubDate: 2017-12-22T09:15:29.76372-05:0
      DOI: 10.1111/apa.14175
       
  • Paediatric breath‐holding spells are associated with autonomic
           dysfunction and iron deficiency may play a role
    • Authors: H Tomoum; N Habeeb, I Elagouza, H Mobarez
      Abstract: AimThis study assessed cardiac performance and iron in subjects aged 12‐36 months with breath‐holding spells (BHS).MethodsWe consecutively recruited 40 subjects (55% male) experiencing BHS from the general paediatric outpatients department at the Children's Hospital, Ain Shams University, Egypt from 2015‐2016. The 20 matched comparisons were mainly healthy siblings. The workup included iron levels and electrocardiograms.ResultsThe age at the onset of BHS was 5‐24 months with a median monthly frequency of 13. Almost two‐thirds of the patients had cyanotic spells and one‐third had pallid spells, lasting 25‐90 seconds. Lower serum iron levels and higher QT dispersion and T‐wave dispersion were recorded in patients than the comparison group and 4.8% had dysrhythmia and bradycardia. We observed higher durations of bradycardia during attacks and higher occurrences of dysrhythmia during cyanotic spells, which were more frequent in patients with prolonged or frequent BHS.ConclusionOur study of patients aged 12‐13 months supported the theory of autonomic dysfunction in BHS. The ECG findings, especially in patients with prolonged or frequent spells, need to be studied further to evaluate the risk of life‐threatening events. Iron deficiency may play a role in autonomic dysfunction in patients with BHS.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-22T09:15:23.733906-05:
      DOI: 10.1111/apa.14177
       
  • Endocrine Manifestations in Children with Williams‐Beuren Syndrome
    • Authors: Yael Levy-Shraga; Doron Gothelf, Shiran Pinchevski-Kadir, Uriel Katz, Dalit Modan-Moses
      Abstract: AimEndocrine abnormalities in Williams‐Beuren syndrome (WBS) include growth retardation, precocious puberty, hypercalcaemia and thyroid disorders. We aimed to characterise these abnormalities in a national cohort of children with WBS.MethodsA retrospective study comprising a national cohort of individuals with WBS in Israel (16 males, 18 females) followed between 2010‐2016.ResultsThe age at diagnosis of WBS was 1.4±1.0 years. Height standard deviation score (SDS) at last visit was correlated to the mid‐parental height‐SDS (r=0.46 p=0.007). Yet, participants did not reach their mid‐parental height, with a difference of 1.40±0.85SD (p
      PubDate: 2017-12-21T09:40:31.528884-05:
      DOI: 10.1111/apa.14198
       
  • Multi‐country cross‐sectional study found that functional
           gastrointestinal disorders such as colic and functional dyschezia were
           common in South American infants
    • Authors: Ashish Chogle; Carlos A. Velasco-Benitez, Ricardo Chanis, Milton Mejia, Miguel Saps
      Abstract: AimOur aim was to perform a population‐based study using Rome III criteria to describe the prevalence of functional gastrointestinal disorders (FGIDs) in infants in three countries in South America.MethodsWe conducted a multi‐country, cross‐sectional study to investigate the epidemiology of functional gastrointestinal disorders in children aged 0‐12 months of age, using the Rome III criteria, in Colombia, Panama and Nicaragua. These patients presented for well‐child visits in primary care clinics in the three countries between May 2015 and October 2016. A Spanish version of the Questionnaire on Paediatric Gastrointestinal Symptoms for Infants and Toddlers was used for the data collection.ResultsWe included questionnaires completed by 351 parents and they reported at least one FGID in 141 (40%) infants. The majority were male (56%), with a median age of seven months. Colic and functional dyschezia were the most commonly diagnosed disorders in the whole cohort, at 23% and 15% respectively. The risk of developing FGIDs was not affected by the marital status of the mother, number of siblings, birth order and history of diarrhoea.ConclusionFunctional gastrointestinal disorders were common in infants from the South American countries of Colombia, Panama and Nicaragua, particularly colic and functional dyschezia.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-20T05:10:41.660146-05:
      DOI: 10.1111/apa.14196
       
  • Neurally adjusted ventilatory assist can be used to wean infants with
           congenital diaphragmatic hernias off respiratory support
    • Authors: Arata Oda; Liisa Lehtonen, Hanna Soukka
      Abstract: Neurally adjusted ventilatory assist (NAVA) is a mode of mechanical ventilation that triggers, cycles and delivers assistance in response to the electrical activity of the diaphragm (EAdi). The EAdi signal is measured with an EAdi catheter (Maquet, Solna, Sweden) that includes nine miniaturised electrodes and is positioned in the oesophagus at the level of the diaphragm. NAVA has been shown to decrease peak inspiratory pressures, which are potentially harmful for immature lungs (1,2) and, therefore, it may decrease ventilator induced lung injury, particularly pulmonary hypoplasia in congenital diaphragmatic hernia (CDH).This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-16T16:37:28.227643-05:
      DOI: 10.1111/apa.14191
       
  • Narrative review shows that the short‐term use of ketorolac is safe and
           effective in the management of moderate to severe pain in children
    • Authors: Pierluigi Marzuillo; Lorenzo Calligaris, Stefano Amoroso, Egidio Barbi
      Abstract: In June 2013, the European Medicine Agency recommended limiting codeine use in paediatric patients, creating a void in managing moderate pain. We reviewed literature published in English (1985‐June 2017) on the pharmacokinetic, pharmacodynamic and safety profile of ketorolac, a possible substitute for codeine and opioids, for treating moderate to severe pain. We found that gastrointestinal side effects were mainly reported with prolonged use, significant bleeding was reported in adenotonsillectomies and adverse renal effects appeared to be limited to patients with specific coexisting risk factors.ConclusionThe short‐term use of ketorolac appears to be safe for children in many situations.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-16T16:35:41.329651-05:
      DOI: 10.1111/apa.14189
       
  • Comment on how fetal growth restriction and preterm birth affects cardiac
           morphology and function during infancy
    • Authors: P P Bassareo; G Mercuro
      Abstract: We read with great interest the recent paper by Cohen et al regarding the early morphological and functional changes induced by intrauterine growth restriction on the heart and detected during echocardiography(1). In particular, the authors found increases in left ventricular sphericity and posterior and relative wall thicknesses. They also noted that the diastolic function, measured with tissue Doppler imaging, dropped.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-15T17:10:38.774833-05:
      DOI: 10.1111/apa.14190
       
  • Duration of anaemia during the first week of life is an independent risk
           factor for retinopathy of prematurity
    • Authors: Pia Lundgren; Sam E Athikarisamy, Sanjay Patole, Geoffrey C Lam, Lois E Smith, Karen Simmer
      Abstract: AimThis study evaluated the correlation between retinopathy of prematurity (ROP), anaemia and blood transfusions in extremely preterm infants.MethodsWe included 227 infants born below 28 weeks of gestation at King Edward Memorial Hospital, Perth, Australia, from 2014–2016. Birth characteristics and risk factors for ROP were retrieved and anaemia and severe anaemia were defined as a haemoglobins of
      PubDate: 2017-12-15T04:32:29.280826-05:
      DOI: 10.1111/apa.14187
       
  • A systematic review of instruments for assessing parent satisfaction with
           family‐centred care in neonatal intensive care units
    • Authors: Immacolata Dall'Oglio; Rachele Mascolo, Orsola Gawronski, Emanuela Tiozzo, Anna Portanova, Angela Ragni, Rosaria Alvaro, Gennaro Rocco, Jos M. Latour
      Abstract: This systematic review synthesised and described instruments measuring parent satisfaction with the increasingly standard practice of family‐centred care (FCC) in neonatal intensive care units. We evaluated 11 studies published from January 2006 to March 2016: two studies validated a parent satisfaction questionnaire and nine developed or modified previous questionnaires to use as outcome measures in their local settings. Most instruments were not tested on reliability and validity. Conclusion: Only two validated instruments included all six of the FCC principles and could assess parent satisfaction with FCC in neonatal intensive care units and be considered as outcome indicators for further research.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-14T01:15:30.523757-05:
      DOI: 10.1111/apa.14186
       
  • Long‐term cardiovascular re‐programming by short‐term perinatal
           exposure to nicotine's main metabolite cotinine
    • Authors: Stefano Bastianini; Viviana Lo Martire, Alessandro Silvani, Giovanna Zoccoli, Chiara Berteotti, Hugo Lagercrantz, Anders Arner, Gary Cohen
      Abstract: AimGather “proof‐of‐concept” evidence of the adverse developmental potential of cotinine (a seemingly benign biomarker of recent nicotine / tobacco smoke exposure).MethodsPregnant C57 mice drank nicotine or cotinine‐laced water for 6wks from conception (NPRE = 2% saccharin+100μg nicotine/ml; CPRE = 2% saccharin + 10μg cotinine/ml) or 3wks after birth (CPOST = 2% saccharin + 30μg cotinine/ml). Controls drank 2% saccharin (CTRL). At 17±1weeks (male pups; CTRL n=6; CPOST n=6; CPRE n=8; NPRE n=9) we assessed (i) cardiovascular control during sleep; (ii) arterial reactivity ex vivo; (iii) expression of genes involved in arterial constriction / dilation.ResultsBlood cotinine levels recapitulated those of passive smoker mothers‐infants. Pups exposed to cotinine exhibited (i) mild bradycardia ‐ hypotension at rest (p
      PubDate: 2017-12-09T20:20:42.376482-05:
      DOI: 10.1111/apa.14181
       
  • Cortisol and blood pressure levels decreased in fathers during the first
           hour of skin‐to‐skin contact with their premature babies
    • Authors: Natalia Varela; Réjean Tessier, George Tarabulsy, Tamarha Pierce
      Abstract: AimPremature birth is an extremely stressful experience. In 2013 to 2014 we explored the physiological stress responses of fathers during their first skin‐to‐skin contact with their new baby.MethodsWe recruited 49 fathers whose partners had given birth to a premature baby of up to 33 weeks and three days. The study, in the neonatal intensive care unit (NICU) of a Quebec hospital, measured the physiological stress responses of the fathers before and after they first experienced skin‐to‐skin contact with their new baby. Cortisol levels and blood pressure were measured and a generalised estimating equation was used for the data analysis.ResultsThe fathers’ cortisol levels decreased from 10.55 nmol/l, with a 95% confidence interval (95% CI) of 9.61‐11.59 at the beginning of the experiment to 8.26 nmol/l (95% CI 7.51‐9.07) after 75 minutes. Meanwhile, their systolic blood pressure decreased from 135.16 mmHg (95% CI 130‐140) to 125.25 mmHg (95% CI 121‐129).ConclusionFathers who held their baby in skin‐to‐skin contact for the first time showed a significant reduction in physiological stress responses. Our findings support hospital practices that enable fathers to experience their first intimate contact with their newborn infant in the NICU.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-09T20:20:36.538924-05:
      DOI: 10.1111/apa.14184
       
  • Serum 25‐hydroxyvitamin D3 levels of one‐month‐old term infants in
           Tokyo using liquid chromatography tandem mass spectrometry
    • Authors: Kaori Hara; Kazushige Ikeda, Yuhei Koyama, Yasuhiro Wada, Tomonobu Hasegawa
      Abstract: The major circulating form of vitamin D, 25 hydroxyvitamin D (25(OH)D), is usually measured by radioimmunoassay (RIA) or competitive protein binding assay. However, studies have shown discrepancies between assays, mainly due to cross reactivity with vitamin D metabolites (1). Liquid chromatography tandem mass spectrometry (LC‐MS/MS) has now become the gold standard for measuring serum 25(OH)D levels (2).This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-05T08:05:54.47555-05:0
      DOI: 10.1111/apa.14155
       
  • A comparative study found that a seven-year school-based exercise
           programme increased physical activity levels in both sexes
    • Authors: F. Cronholm; B. E. Rosengren, C. Karlsson, M. K. Karlsson
      Abstract: AimThis study assessed whether a Swedish school-based exercise intervention programme could increase total physical activity.MethodsWe followed up 228 children who started school in 1998-2000 seven years later, when they had reached a mean age of 14.8. The 152 children (59% boys) at the intervention school did 200 minutes of physical education per week during that period and the 76 children (50% boys) in the three control schools did the standard 60 minutes. Questionnaires assessed the durations of total and leisure-time physical activity and screen-time activity at baseline and after five and seven years.ResultsPhysical activity and screen-time activity were similar between the two groups before the study started. The intervention group then achieved higher durations of total physical activity than the controls (p
      PubDate: 2017-12-01T02:46:48.45126-05:0
      DOI: 10.1111/apa.14172
       
  • Exposure to human voices has beneficial effects on preterm infants in the
           neonatal intensive care unit
    • Authors: S Saliba; R Esseily, M Filippa, P Kuhn, M Gratier
      Abstract: We reviewed the literature up to March 2016 on the effects of non-maternal voices on preterm infants’ clinical outcomes. Of the 11 studies that met the inclusion criteria, 10 focused on short-term outcomes and one looked at long-term effects. The studies mainly showed that vocal stimuli increased preterm infants’ stability in terms of heart rate, respiratory rate, oxygen saturation and behavioural measures. Improvements in feeding skills were also reported. The methods and the measures used in the studies were heterogeneous, making it difficult to draw reliable conclusions.ConclusionVocal stimuli increased preterm infants’ stability, but further studies are needed.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-28T07:55:29.284778-05:
      DOI: 10.1111/apa.14170
       
  • Review shows that implementing a nationwide protocol for congenital
           
    • Authors: L Storme; J Boubnova, S Mur, L Pognon, D Sharma, E Aubry, R Sfeir, P Vaast, T Rakza, A Benachi,
      Abstract: The French Rare Disease Reference Center for Congenital Diaphragmatic Hernia (CDH) was created in 2008, to implement a national protocol for fetuses and children with this serious condition. Neonatal mortality from CDH is 30-40%, mainly due to pulmonary hypoplasia and persistent pulmonary hypertension, and half of those who live have high respiratory, nutritional and digestive morbidity. CDH management requires long-term and specialised multidisciplinary care. It has been well established that a standardised management protocol improves the prognosis of children with CDH.ConclusionOrganising healthcare and implementing a nationwide French protocol were key factors for reducing mortality and morbidity from CDH.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-28T07:35:57.945385-05:
      DOI: 10.1111/apa.14169
       
  • Clinicians need to decrease antibiotic use in previously healthy infants
           hospitalised with bronchiolitis
    • Authors: Marion Bailhache; Emilie Bloudeau, Olivier Richer, Pascal Pillet, Marie Lagarde
      Abstract: Bronchiolitis is a common viral acute respiratory infection that leads to frequent hospitalisation. Although serious bacterial infections are uncommon in such children (1), they could be co-infected with bacteria and the distinction between colonisation, co-infection or superinfection is not always possible. Antibiotics use varies in these situations (2) and their unnecessary use is a major cause of antibiotic resistance (3). We explored the factors that influenced prescribing antibiotic for previously healthy children hospitalised with bronchiolitis. What prescribing criteria do clinicians use and is there scope for decreasing antibiotic use'This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-28T07:30:44.173797-05:
      DOI: 10.1111/apa.14168
       
  • A randomised trial of enteral glutamine supplementation for very preterm
           children showed no beneficial or adverse long-term neurodevelopmental
           outcomes
    • Authors: E. Sabrina Twilhaar; Jorrit F. de Kieviet, Jaap Oosterlaan, Ruurd M. van Elburg
      Abstract: AimThis study evaluated the long-term effects of enteral glutamine supplementation on neurodevelopmental outcomes of a Dutch cohort of very preterm children at 13 years of age.MethodsThe cohort was enrolled in a randomised placebo-controlled trial between 2001-2003 in which infants received glutamine- or alanine-supplemented enteral nutrition during the first month of life. Participants were invited for follow up at a mean age of 13.30 years. Motor, neurocognitive, academic and behavioural outcomes were assessed in 61 children.ResultsNo differences were found between the groups regarding motor, intellectual, academic and behavioural functioning. Forward span visuospatial working memory performance was better in the controls (crude/adjusted model: d = 0.67/0.64, p = 0.02/0.02), but no difference was found for backward span. After the data were adjusted for confounders, the groups differed regarding parent-rated attention (crude/adjusted model: d = 0.47/0.73, p = 0.07/0.003), but both groups scored within the normal range.ConclusionThis was the first study on the long-term effects of enteral glutamine supplementation on the neurodevelopmental outcomes of very preterm children. Our study provided no evidence that enteral glutamine supplementation had any beneficial or adverse effects on the children's motor, neurocognitive, academic and behavioural outcomes at 13 years of age.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-28T07:05:50.99696-05:0
      DOI: 10.1111/apa.14167
       
  • Obese children aged 4‐6 displayed decreased fasting and postprandial
           ghrelin levels in response to a test meal
    • Authors: Jenny Önnerfält; Charlotte Erlanson-Albertsson, Caroline Montelius, Kristina Thorngren-Jerneck
      Abstract: AimGhrelin is a hunger hormone that plays a role in glucose homeostasis and its levels increase before a meal and decrease during and after eating. This study compared the fasting ghrelin and insulin levels of obese children aged 4‐6 with those of normal weight children and tested postprandial ghrelin levels in the obese children after a standard breakfast.MethodsWe recruited 67 children at Lund University Hospital from 2008‐2011. They comprised 30 obese children from a weight study and 37 normal weight children receiving minor elective surgery. Their mean ages were 4.7 ±0.6 years and 4.3 ±0.8 years, respectively. The obese children ate a standard breakfast and postprandial ghrelin was measured after 60 minutes.ResultsThe obese children had lower ghrelin levels than the controls (p
      PubDate: 2017-11-24T19:00:23.277022-05:
      DOI: 10.1111/apa.14165
       
  • Strictly controlled glucose infusion rates are associated with a reduced
           risk of hyperglycaemia in extremely low birth weight preterm infants
    • Authors: Hans Jorgen Stensvold; Astri M. Lang, Kenneth Strommen, Tore G. Abrahamsen, Bjorn Ogland, Are H. Pripp, Arild E. Ronnestad
      Abstract: AimWe evaluated a strict strategy that aimed to avoid fluctuations in glucose infusion rates (GIRs) and assessed the independent effects of maximal daily GIRs on the hyperglycaemia risk among extremely low birth weight (ELBW) infants receiving early enhanced parenteral nutrition.MethodsThis study comprised all ELBW infants admitted to the neonatal intensive care unit of Oslo University Hospital Rikshospitalet, Norway before (2007‐2009) and after (2012‐2013) implementing a strict GIR strategy. Severe hyperglycaemia was defined as two consecutive blood glucose values over12 mmol/L. Maximum daily GIRs (mg/kg/min) were categorised into low (7.0). Mixed effects logistic regression modelling for repeated measurements was applied to investigate independent determinants of hyperglycaemia.ResultsWe included 1,293 treatment days for 195 infants. The maximum daily GIR decreased (6.3 versus 5.8 mg/kg/min), while mean daily glucose and energy intakes were maintained in the post strategy period. The prevalence of severe hyperglycaemia (48% versus 23%), insulin use (39% versus 16%) and mortality (26% versus 10%) fell. Intermediate GIR (odds ratio 2.11) and high GIR (odds ratio 2.85) were significant independent predictors of severe hyperglycaemia compared to low GIR.ConclusionA strict GIR strategy reduced the risk of severe hyperglycaemia and adverse outcomes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-24T18:55:28.567515-05:
      DOI: 10.1111/apa.14164
       
  • Review demonstrates that less invasive surfactant administration in
           preterm neonates leads to fewer complications
    • Authors: Ludwig Gortner; Simone S. Schüller, Egbert Herting
      Abstract: Surfactant treatment of neonatal respiratory distress syndrome (RDS) was introduced into Europe during the 1990s. Meta‐analyses have indicated that using less invasive surfactant administration (LISA) techniques on preterm neonates receiving continuous positive airway pressure (CPAP) results in improved survival rates without bronchopulmonary dysplasia. Surfactant should be administered early and ventilator settings adapted to changing oxygen requirements and lung mechanics. Side effects including initial bradycardia, oxygen desaturation, tube obstruction and isolated cases of pulmonary haemorrhage have been reportedConclusionLess invasive surfactant therapy improves pulmonary outcomes in preterm neonates with RDS and should ideally be administered in combination with CPAP.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-24T18:55:26.992743-05:
      DOI: 10.1111/apa.14161
       
  • Children with optic nerve hypoplasia face a high risk of
           neurodevelopmental disorders
    • Authors: Sara Dahl; Ronny Wickström, Ulla Ek, Kristina Teär Fahnehjelm
      Abstract: AimOptic nerve hypoplasia (ONH) is a congenital ocular malformation that has been associated with neurodevelopmental disorders, but the prevalence in unilateral disease and less severe visual impairment is unknown. We studied intellectual disability and autism spectrum disorders in patients with ONH.MethodsThis was a population‐based cross‐sectional cohort study of 65 patients (33 female) with ONH below 20 years of age, living in Stockholm in December 2009, with data analysed in January 2016. Of these 35 were bilateral and 30 were unilateral. Neurodevelopmental disorders were diagnosed or confirmed by neurological assessments, the Five to Fifteen parent questionnaire and by reviewing previous neuropsychological investigations or conducting neuropsychological tests.ResultsBilateral ONH patients had lower mean Full Scale Intelligence Quotient scores than unilateral patients (84.4 and 99.4, respectively, p = 0.049). We assessed intellectual disability in 55 eligible patients and it was more common in patients with bilateral ONH (18/32, 56%) than unilateral ONH (2/23, 9%, p < 0.001). Autism spectrum disorders were diagnosed in 7/42 (17%) patients.ConclusionChildren with bilateral ONH had a high risk of neurodevelopmental disorders, especially intellectual disability. The risk was lower in unilateral ONH, but the levels of neurodevelopmental disorders warrants screening of both groups.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-24T18:55:25.152546-05:
      DOI: 10.1111/apa.14163
       
  • Asphyxiated neonates who received active therapeutic hypothermia during
           transport had higher rates of hypocapnia than controls
    • Authors: Eniko Szakmar; Kata Kovacs, Unoke Meder, Geza Bokodi, Andras Szell, Zsolt Somogyvari, Attila J Szabo, Miklos Szabo, Agnes Jermendy
      Abstract: AimWe investigated the association between active hypothermia and hypocapnia in neonates with moderate to severe hypoxic‐ischaemic encephalopathy (HIE) transported after birth.MethodsThis was a retrospective cohort study of neonates with HIE born between 2007‐2011 and transported to Semmelweis University, Hungary, for hypothermia treatment before and after we introduced active cooling during transport in 2009. Of these, 71 received intensive care plus controlled active hypothermia during transport, while the 46 controls just received standard intensive care. Incident hypocapnia was defined as a partial pressure of carbon‐dioxide (pCO2) that decreased below 35 mmHg during transport. Multivariable logistic regression investigated the relationship between hypothermia and incident hypocapnia.ResultsIncident hypocapnia was more frequent in the actively cooled transport group (36.6%) than control group (17.4%; p=0.025). PCO2 decreased from a median of 45 to 35 mmHg (p
      PubDate: 2017-11-24T11:10:33.083964-05:
      DOI: 10.1111/apa.14159
       
  • The effect of skin‐to‐skin care on cerebral oxygenation during
           nasogastric feeding of preterm infants
    • Authors: A Marulli; C. O. F Kamlin, J. A Dawson, S. M Donath, P. G Davis, L Lorenz
      Abstract: AimTo describe cerebral oxygenation during gavage feeding of preterm infants during incubator and skin‐to‐skin care.MethodsFurther analysis of data from two crossover studies comparing cerebral oxygenation, heart rate and oxygen saturation during skin‐to‐skin care with incubator care. Data were analysed in three epochs; 10 mins pre‐feed, during‐feed, and 10 mins post‐feed. Measurements from infants fed during incubator care were compared with those obtained during skin‐to‐skin care.ResultsIn 39 infants (median (IQR) 27.8 (26.1‐30.0) weeks’ gestation) there was no difference in cerebral oxygenation between pre‐, during‐ and post‐feed. Heart rate increased by 3 beats per minute post‐feed compared with during‐feed. Twenty infants received two gavage feeds, one feed in the incubator and another during skin‐to‐skin care. There was no difference in cerebral oxygenation and heart rate whilst peripheral oxygen saturation decreased by 3% during feeding whilst skin‐to‐skin care compared with feeding in the incubator.ConclusionCerebral oxygenation remained stable before, during and after gavage feeding in an incubator and during skin‐to‐skin care. The small decrease in oxygen saturation whilst receiving gavage feeding during skin‐to‐skin care is unlikely to be clinically important, providing reassurance that preterm infants maintain physiological stability during skin‐to‐skin care.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-23T02:35:38.19732-05:0
      DOI: 10.1111/apa.14158
       
  • Systematic review of the effect of denosumab on children with osteogenesis
           imperfect showed inconsistent findings
    • Authors: Guowei Li; Yanling Jin, Mitchell A H Levine, Heike Hoyer-Kuhn, Leanne Ward, Jonathan D Adachi
      Abstract: Osteogenesis imperfecta (OI) is a rare, inherited disorder characterised by increased bone fragility, reduced bone mass and often short stature. Most cases are due to mutations in one of the two genes encoding collagen type‐1 ‐ COL1A1 and COL1A2 (1) ‐ and the signs and symptoms vary substantially with the disease severity. The risk of fractures is 100 times higher than the general population, even in patients with mild OI. Bisphosphonates are the current standard pharmacotherapy for managing and treating patients with severe OI, but concerns about their long‐term safety have been raised (1). Denosumab is a RANK ligand antibody that prevents RANKL ligand‐RANK interaction and inhibits osteoclast formation, thus reducing bone resorption, which has been approved to treat postmenopausal osteoporosis. Its effects on osteoclast may make it suitable for patients with OI and this systematic review summarises the most recent evidence from clinical studies exploring its potential for paediatric OI cases.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-20T05:15:19.926247-05:
      DOI: 10.1111/apa.14154
       
  • Randomised crossover trial showed that using breast milk or sucrose
           provided the same analgesic effect in preterm infants of at least 28 weeks
           
    • Authors: L Collados-Gómez; P Ferrera-Camacho, E Fernandez-Serrano, V Camacho-Vicente, C Flores-Herrero, A M García-Pozo, R Jiménez-García
      Abstract: AimRepeated, on‐going exposure to pain influences the growth, cognitive and motor functions, behaviour, personality and neurodevelopment of preterm infants. We compared the analgesic effects of expressed breast milk and 24% oral sucrose on preterm neonates during venipuncture.MethodsThis multicentre randomised, non‐inferiority, cross‐over trial focused on five neonatal university units in Madrid, Spain, from October 2013 to October 2014. It comprised 66 preterm infants born at less than 37 weeks and randomly split into two groups. They received either expressed breast milk or sucrose two minutes before venepuncture, together with non‐nutritive sucking and swaddling, then the opposite procedure at a later point. Pain was measured with the Premature Infant Pain Profile (PIPP) and crying was also measured.ResultsThere were no statistically significant differences between the groups. The PIPP scores were seven (4‐9) with breast milk and six (4‐8.25) with sucrose (p = 0.28). The 11 infants born at under 28 weeks of age showed higher median scores of nine (9‐14) for breast milk and four (4‐7) for sucrose (p =0.009).ConclusionExpressed breast milk and 24% sucrose had the same analgesic effect during venipuncture in most of the preterm neonates, but sucrose worked better in extremely preterm infants.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-18T02:40:30.542626-05:
      DOI: 10.1111/apa.14151
       
  • Neonatal Eating Outcome Assessment: Tool Development and Inter‐rater
           Reliability
    • Authors: Roberta Pineda; Rachel Harris, Felicia Foci, Jessica Roussin, Michael Wallendorf
      Abstract: AimTo define the process of tool development and revision for the Neonatal Eating Outcome (NEO) Assessment and to report preliminary inter‐rater reliability.MethodsTool development consisted of a review of the literature and observations of feeding performance among 178 preterm infants born ≤ 32 weeks gestation. 11 neonatal therapy feeding experts provided structured feedback to establish content validity and define the scoring matrix. The tool was then used to evaluate feeding in 50 preterm infants born ≤ 32 weeks gestation and 50 full term infants. Multiple revisions occurred at each stage of development. Finally, six neonatal occupational therapists participated in reliability testing by independently scoring five videos of oral feeding of preterm infants using version 4 of the tool.ResultsThe intraclass correlation for the “pre‐feeding” score was 0.71 (0.37‐0.96), and the intraclass correlation for the “total” score was 0.83 (0.56‐0.98).ConclusionThe “total” score had good to excellent reliability. Fleiss’ Kappa scores for all 18 scorable items ranged from slight agreement to moderate agreement. Items with lowest Kappa scores were revised, and additional feedback from therapists engaged in reliability testing was incorporated, resulting in final version 5.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-23T11:50:47.567566-05:
      DOI: 10.1111/apa.14128
       
  • European guidance on paediatric use of probiotics states that benefits are
           limited to several conditions and urges caution with specific vulnerable
           groups
    • Abstract: AimThe use of probiotics has been covered by many guidelines, position papers and evidence‐based recommendations, but few have referred to specific patient groups or clinical indications. This European study summarises recommendations and scientifically credited guidelines on the use of probiotics for children and provides practice points.MethodsAn expert panel was convened by the European Paediatric Association in June 2017 to define the relevant clinical questions for using probiotics in paediatric healthcare and review and summarise the guidelines, recommendations, position papers and high‐quality evidence.ResultsThe panel found that specific probiotic strains were effective in preventing antibiotic associated and nosocomial diarrhoea, treating acute gastroenteritis and treating infantile colic in breast fed infants. However special caution is indicated for premature infants, immunocompromised and critically ill patients and those with central venous catheters, cardiac valvular disease and short‐gut syndrome. We discuss the safety of using probiotics for paediatric patients and the quality of the products that are available and provide practice points based on our findings.ConclusionThe efficacy of probiotics is strain specific and the scientifically proven benefits are currently limited to several clinical indications in the paediatric age group and not recommended for certain patient groups.This article is protected by copyright. All rights reserved.
       
  • Long‐chain polyunsaturated fatty acids decline rapidly in milk from
           mothers delivering extremely preterm indicating the need for
           supplementation
    • Abstract: AimOur aim was perform an in‐depth analysis of the composition of fatty acids in milk from mothers delivering extremely preterm babies. We investigated longitudinal changes in milk fatty acid profiles and the relationship between several types of fatty acids, including omega‐3 and omega‐6.MethodsMilk samples were collected at three stages of lactation from 78 mothers who delivered at less than 28 weeks of pregnancy at the Sahlgrenska University Hospital, Gothenburg, Sweden, from April 2013 to September 2015. Fatty acid composition was analysed by gas chromatography‐mass spectrometry.ResultsA reduction in long‐chain polyunsaturated fatty acids (LCPUFAs) was observed during the lactation period. The concentrations of arachidonic acid and docosahexaenoic acid declined from medians of 0.34 to 0.22 mol% and 0.29 to 0.15 mol%, respectively, between postnatal day seven and a post‐menstrual age of 40 weeks. Strong correlations were found between the intermediates of several classes of fatty acids, including omega‐3, omega‐6 and omega‐9.ConclusionA rapid reduction in LCPUFA content in the mother′s milk during the lactation period emphasises the importance of fatty acid supplementation to infants born extremely preterm, at least during the period corresponding to the third trimester, when rapid development of the brain and adipose tissue require high levels of LCPUFAs.This article is protected by copyright. All rights reserved.
       
  • Transcutaneous bilirubinometry should be carried out in newborn infants at
           least seven hours after phototherapy finishes
    • Abstract: Bilirubin rebound, which is a reincrease in serum bilirubin levels after the cessation of phototherapy, may develop due to variations in the rates of bilirubin production and clearance. The most commonly used method for testing bilirubin rebound is measuring total serum bilirubin (TSB) levels, because transcutaneous bilirubin (TcB) gives false negative results in newborn infants receiving phototherapy or when phototherapy has just finished. However, TcB is a more preferable method, because TSB is invasive and time consuming. Limited data exist about when TcB measurement should be carried out after phototherapy has ceased.This article is protected by copyright. All rights reserved.
       
  • Recent gestational diabetes was associated with mothers stopping
           predominant breastfeeding earlier in a multi‐ethnic population
    • Abstract: AimIt has previously been shown that breastfeeding may reduce the risk of type 2 diabetes in mothers with recent gestational diabetes mellitus (GDM). This study compared the cessation of predominant breastfeeding in mothers with and without recent GDM in a multi‐ethnic population.MethodsFrom May 2008 to May 2010, healthy pregnant women attending antenatal care provided by community health services in Eastern Oslo, Norway, were recruited. We included 616 women ‐ 58% non‐Western ‐ and interviewed and examined them at a mean of 15 and 28 weeks of gestation and 14 weeks’ postpartum. Cox regression models examined the association between GDM, as assessed by the 2013 World Health Organization criteria, and breastfeeding cessation.ResultsOverall, 190 of the 616 (31%) mothers had GDM and they ended predominant breastfeeding earlier than mothers without GDM, with an adjusted hazard ratio (aHR) of 1.33 and 95% confidence interval (95% CI) of 1.01‐1.77. Mothers of South Asian origin ended predominant breastfeeding earlier than Western European mothers in the adjusted analysis (aHR 1.53, 95% CI 1.04‐2.25), but Middle Eastern mothers did not.ConclusionRecent gestational diabetes was associated with earlier cessation of predominant breastfeeding in Western European and non‐Western women.This article is protected by copyright. All rights reserved.
       
  • Patterns of use of Near‐Infrared Spectroscopy in neonatal intensive care
           units: international usage survey
    • Abstract: AimTo assess uptake and applications of near‐infrared spectroscopy (NIRS) by neonatal intensive care units (NICUs).MethodsA pre‐piloted online questionnaire was distributed in May 2015 to 12 perinatal societies in Asia, Europe, Australasia, North America, and Middle East for dissemination to NICUs. Questions surveyed demographics, NIRS research/clinical applications, usage frequency, training approaches, and target infant populations.ResultsIn total, 255 responses from 235 NICUs were obtained. Of these, 85 (36%) owned a NIRS device. Australian and New Zealand NICUs were more likely to own NIRS technology than Asian (OR 1.12, 95%CI 0.38‐3.37) and North American (OR 2.63, 95%CI 1.07‐6.45) NICUs. 69 (71%) used NIRS within clinical or mixed clinical‐research settings, however routine reliance for management and prognostication was low (9% and 3% respectively). Of those without NIRS technology, 96 (64%) had no acquisition intentions. The main limiting factors were controversial evidence on efficacy (59%) and financial considerations (50%). 51% of respondents received in‐house NIRS training and 32% had access to written guidelines.ConclusionThere is considerable geographical variation in NIRS usage in NICUs that is, on the whole, limited by consumer perception of lack of evidence for its clinical utility. This knowledge gap should be addressed by future research.This article is protected by copyright. All rights reserved.
       
  • Observational study shows that it is feasible to provide neuroprotective
           treatment for neonatal encephalopathy in low‐income countries
    • Abstract: AimPerinatal asphyxia is one of the most frequent causes of neonatal morbidity and mortality worldwide and 96% of the burden of neonatal encephalopathy occurs in low‐income countries. This study investigated the feasibility of providing neuroprotective treatment for neonatal encephalopathy in low‐income countries.MethodsNeonates with a gestational age of at least 36 weeks, with signs of perinatal asphyxia, were included in this 2015 observational study in three hospitals in Kinshasa, capital of the Democratic Republic of Congo. Their characteristics were described, including the time to admission and Thompson score on admission.ResultsWe found that 42/134 patients (31.3%) reached the hospital within six hours of birth with a Thompson score of at least seven on admission. Another 15 patients (11.2%) had a five‐minute Apgar score of up to five, without a Thompson score, and were eligible for treatment. Of the 57 (42.5%) eligible patients 31 were discharged (54.4%), 25 died (43.9%) and one (1.8%) remained in hospital at the end of the study.ConclusionInterventional studies are feasible and necessary, especially in countries where the burden of neonatal encephalopathy is largest. A Thompson score of 7‐15 might be a useful entry criterion for neuroprotective treatment in low‐income countries.This article is protected by copyright. All rights reserved.
       
  • Percutaneous endoscopic gastrostomy placement in paediatric Crohn's
           disease patients contributes to both improved nutrition and growth
    • Abstract: AimThis paper describes the outcomes of gastrostomy feeding in patients with Crohn's disease (CD).MethodsPatients with CD who attended the Royal Hospital for Children, Glasgow, and received gastrostomy feeding for at least two years between 2003‐2010, were identified from the clinical database. The data recorded included the anthropometric data, CD phenotype, the surgical technique that was used, complications, medication, feed type, median feed, calories, volume and clinical outcomes.ResultsThe study identified 16 patients (14 male) who had a gastrostomy inserted using a pull technique at a median age of 12.6 years at. Of these two required laparoscopic placement. Short‐term complications lasting less than one month were experienced by nine (56%) patients and one (6%) experienced long‐term complications. Anthropometry significantly improved at follow up compared to baseline: at 12 months the body mass index z‐score was 1.11 (p=0.005) and the weight z‐score was 0.19 (p
       
  • A realistic evaluation approach highlighted the success factors and
           difficulties of an innovative and comprehensive malnutrition programme in
           Madagascar
    • Abstract: AimMalnutrition has multiple causes, not just a lack of calories. We explored the successes and barriers of an innovative, comprehensive programme in Madagascar that educated mothers in particular about nutrition.MethodsThe outpatient programme in Antananarivo treats 2,400 malnourished children from 6‐59 months each year. The 35‐day programme comprises health checks, cooking demonstrations, the distribution of enriched flour supplements and two food‐related games that are called Nutricartes and are based on boards and picture cards. In 2014, we involved 74 of the children's mothers in a realistic evaluation process, which investigates the mechanisms that produce a particular outcome in a given context.ResultsThe mechanisms of success were the community‐based aspects of the programme, the kindness and equality displayed by the nutritional assistants and improved household budgeting and hygiene. Children ate better and improved their health, which reduced medical visits and costs. Finally, the mothers became proud of their achievements and told other mothers what they had learnt. Adherence was greatest when the women were on a minimum wage and strongly motivated.ConclusionThe effect of this multi‐faceted programme was that the mothers received sustainable education about healthy eating and improved childhood health and nutrition.This article is protected by copyright. All rights reserved.
       
  • Survey highlights important discrepancies between definitions of
           paediatric abnormal growth taught to medical students in 23 European
           countries
    • Abstract: AimThis study compared the definitions of abnormal growth that are taught across Europe to explain previously reported variations in growth‐monitoring practices.MethodsWe developed two online surveys in 2016 to obtain the definitions of abnormal growth in European countries and approached the national chairs of the European Confederation of Primary Care Paediatricians in 18 countries and the International Federation of Medical Students’ Associations in 33 countries.ResultsWe obtained definitions from 10/18 paediatricians and 18/33 students, covering 23 of the 33 European countries surveyed. Abnormal faltering growth was always defined, either by a single parameter (24%) or combined parameters (76%). Four static parameters were used: standardised height (100%), standardised weight (60%), standardised body mass index (12%) and distance to target height (20%). Two dynamic parameters were used: growth deflection (28%) and growth velocity (32%). The thresholds used to define abnormal faltering growth varied slightly in some cases and widely in others. Abnormal accelerated growth appeared in 52% of the definitions, with important variations in parameters and thresholds.ConclusionThere were important between‐country discrepancies in the definitions of paediatric abnormal growth that were taught in 23 European countries. Standardisation is vital.This article is protected by copyright. All rights reserved.
       
  • Review shows that maternal obesity induces serious adverse neonatal
           effects and is associated with childhood obesity in their offspring
    • Abstract: AimObesity at the start of pregnancy has been rising worldwide, increasing the risk of maternal complications. We reviewed the independent effects of maternal obesity during pregnancy on neonatal adverse outcomes and the risk of childhood obesity and adverse cardio‐metabolic profiles.MethodsWe searched MEDLINE for papers published in English between December 2007 and November 2017, focusing primarily on human studies published in the last five years. However, we also chose to highlight examples derived from model animals that could bring mechanistic insight and preventive and therapeutic avenues.ResultsOur review showed that maternal obesity had independent effects on neonatal adverse outcomes such as macrosomia, perinatal mortality and birth defects. Maternal obesity alone increased the risks for adverse neonatal outcomes, including macrosomia, perinatal mortality, induced preterm birth and birth defects. In association with excess gestational weight gain, mainly early in pregnancy, increased the risks of childhood obesity, higher fat mass and, to a smaller extent, adverse cardio‐metabolic profiles. Animal models highlighted sexually dimorphic responses to maternal obesity.ConclusionMaternal obesity induced serious adverse neonatal effects and was associated with childhood obesity in their offspring. The peri‐conceptional period is critical for metabolic programming and obese women need close monitoring from conception.This article is protected by copyright. All rights reserved.
       
  • Why do children with severe Bronchopulmonary Dysplasia not attend neonatal
           follow‐up care' Parental views of barriers
    • Abstract: AimTo assess in children with severe bronchopulmonary dysplasia at a corrected age of 18‐36 months: 1)Neonatal follow‐up clinic attendance rates; 2)Parent‐identified reasons for difficulty attending neonatal follow‐up.MethodsMixed methods study utilizing semi‐structured phone interviews with parents of infants eligible for follow‐up with severe bronchopulmonary dysplasia (defined as gestational age two liters nasal cannula at 36 weeks postmenstrual age) at 18‐36 months corrected age. Questions addressed barriers to neonatal follow‐up attendance. Enrollment continued to saturation (no new themes emerging).Results58 infants (69% male) were enrolled. Infants were 26±2.1 weeks gestational age and birth weight 794±262g. At 28±5.8 months corrected age, 26% had never attended neonatal follow‐up clinic, 16% stopped attending before discharge, five percent were discharged, and 53% were still followed. Longer travel distance from home to follow‐up clinic was associated with poorer attendance. Parent‐generated items related to neonatal follow‐up barriers were coded into four themes: Logistics, Time, Perceptions, Emotional Stress.ConclusionDespite high risk of developmental delay in infants with severe bronchopulmonary dysplasia, neonatal follow‐up rates are suboptimal. Careful review of parent‐identified barriers could be utilized to develop targeted strategies to improve neonatal follow‐up attendance in this high‐risk population.This article is protected by copyright. All rights reserved.
       
  • Observational study found that even small variations in light can wake up
           very preterm infants in a neonatal intensive care unit
    • Abstract: AimThis prospective observational study evaluated the behavioural responses of very preterm infants to spontaneous light variations.MethodsWe measured spontaneous light variations in the incubators of 27 very preterm infants, with a median gestational age of 28 weeks (range 26‐31 weeks), over 10 hours. All of them had been admitted to the neonatal care unit of the Strasbourg University Hospital, France, between April 2008 and July 2009. Two independent raters examined changes in the infants’ behavioural states by using video recordings. The percentage of awakenings was recorded when there were light variations and during control periods with no changes.ResultsWe analysed 275 periods following light variations and 275 control periods. The overall percentage of awakenings was greater during periods following a change in light than during control periods (16.3 versus 11%, p = 0.03). The extent of light protection affected the percentage of awakenings. In mild light protection, there were more awakenings following changes in light than in control periods (25.6% versus 6.7%, p = 0.01). This difference was not found in high light protection.ConclusionVery preterm infants can be woken up by small variations in light, when the light protection in their incubator is insufficient.This article is protected by copyright. All rights reserved.
       
  • Review concludes that specific recommendations are needed to harmonise the
           provision of fresh mother's milk to their preterm infants
    • Abstract: AimThere are no specific recommendations for using a mother's fresh milk for her preterm infant. We reviewed the available evidence on its collection, storage and administration.MethodsThe working group of the French Neonatal Society on fresh human milk use in preterm infants searched the MEDLINE database and Cochrane Library up to June 2017 for papers published in English or French. They specifically analysed 282 papers providing information on prospective, retrospective and clinical studies and examined guidelines from various countries.ResultsThe review concluded that fresh mother's own milk should be favoured in accordance with the latest recommendations. However, it must be carried out under stringent conditions so that the expected benefits are not offset by risks related to different practices. The working group has summarised the best conditions for feeding preterm infants with human milk, balancing high nutritional and immunological quality with adequate virological and bacteriological safety. Professionals must provide parents with the necessary conditions to establish breastfeeding, together with specific and strong support.ConclusionBased on their review, the working group has made specific recommendations for using fresh mother's own milk under stringent conditions, so that the expected benefits are not offset by risks related to practices.This article is protected by copyright. All rights reserved.
       
  • Using anaerobic blood cultures for infants younger than 90 days rarely
           showed anaerobic infections but increased yields of bacterial growth
    • Abstract: AimThe use of anaerobic blood cultures in infants suspected of bacteraemia is controversial. Our children's hospital uses both aerobic and anaerobic media, regardless of the risk of anaerobic infection, and the aim of this study was to re‐evaluate the use of anaerobic cultures in infants.MethodsWe collected retrospective data from 2002 to 2016 on all blood cultures taken from infants younger than 90 days in the Hadassah‐Hebrew University Medical Centre, Jerusalem, Israel. The incidence and characteristics of infants with positive anaerobic blood cultures were assessed.ResultsDuring the study period, 51,035 blood cultures were drawn from 44,304 infants. Of these, 1,496 (2.9%) were clinically significant positive cultures. Pathogenic obligatory anaerobic bacteraemia was extremely rare, with only 37 positive cultures (0.07%) from all of the cultures drawn. No specific risk factors for obligatory anaerobic bacteraemia could be defined, but as many as 174 (11.6%) clinically significant isolates were only detected in the anaerobic culture bottle.ConclusionTrue anaerobic bacteraemia was extremely rare in neonates. Nevertheless, using anaerobic culture media may increase the overall yield of bacterial culture growth by isolating anaerobic‐facultative bacteria. This should be weighed up against increasing the volume of blood used for the aerobic culture.This article is protected by copyright. All rights reserved.
       
  • Proactive telephone support provided to breastfeeding mothers of preterm
           infants after discharge: a randomised controlled trial
    • Abstract: AimThe aim was to evaluate the effectiveness of proactive telephone support provided to breastfeeding mothers of preterm infants after discharge from neonatal intensive care units (NICU).MethodsBetween March 2013 and December 2015, a randomised controlled trial was conducted at six NICUs across Sweden. At each NICU, a breastfeeding support team recruited, randomised and delivered the support to participating mothers. The intervention group received a daily proactive telephone call up to 14 days after discharge from the support team. The control group could initiate telephone contact themselves. Primary outcome was exclusive breastfeeding eight weeks after discharge. Secondary outcomes were maternal satisfaction with breastfeeding, attachment, quality of life and parental stress.ResultsIn total, 493 mothers were randomised, 231 to intervention group and 262 to control group. There were no differences between the groups for exclusive breastfeeding, odds ratio 0.96, 95% CI 0.66‐1.38, nor for maternal satisfaction with breastfeeding, attachment or quality of life. The intervention group reported significantly less parental stress than the controls, t=2.44, 95% CI 0.03‐0.23, effect size d=0.26.ConclusionIn this trial, proactive telephone support was not associated with increased exclusive breastfeeding prevalence eight weeks following discharge. However, intervention group mothers showed significantly lower parental stress.This article is protected by copyright. All rights reserved.
       
  • Nutritional therapy complications in children with ultra‐short bowel
           syndrome include growth deficiency but not cholestasis
    • Abstract: AimChildren with ultra‐short bowel syndrome (USBS) have not been extensively studied to date because the condition is rare. The aim of the study was to assess the nutritional status of children with USBS receiving home parenteral nutrition, by using citrulline serum concentration and cholestasis.MethodsWe studied 17 patients with USBS, with a median age of 6.6 years and median duration of parenteral nutrition of 6.6 years. The study was carried out at The Children's Memorial Health Institute, Warsaw, from January 2014 to January 2015.ResultsThe median standard deviation score (SDS) was ‐1.2 for body mass according to chronological age, ‐1.72 according to height and ‐0.59 according to height for age. Patients requiring seven days per week parenteral nutrition had a citrulline concentration below 10μmol/L. Decreased bone‐mineral density was observed in 87% of the patients. Low values of 25‐hydroxyvitamin D were found in 53% of the children. None of the patients had elevated conjugated bilirubin levels above 34.2μmol/L.ConclusionChildren with USBS were growth deficient according to their chronological age, with frequent abnormal bone mineralisation and vitamin D deficiency. Children requiring parenteral nutrition seven days a week had citrulline concentrations below 10μmol/l. Cholestasis was not seen.This article is protected by copyright. All rights reserved.
       
  • Do substantial BMI reduction episodes among Swedish schoolchildren have
           any impact on their final height'
    • Abstract: AimThis study investigated whether substantial body mass index (BMI) reductions in Swedish schoolchildren aged 7–19 years, caused by disease, healthy or unhealthy behaviour, had any impact on their final height.MethodsWe used height and weight data on 6,572 subjects from two nationally representative longitudinal samples of Swedish children born in 1973 and 1981. These provided information on their final height and any BMI reduction episodes.ResultsOf the 6,572 subjects (50.9% boys), among individuals with information on final height, 1,118 had a BMI reduction of 5% and less than 10%, and 346 had at least one substantial BMI reduction of 10% of more. On a group level, there was no statistically significant difference in the final height of individuals with BMI reductions of 10% or more and those without. The findings were independent of age and the subject's BMI at the start of the reduction episode. However, there were a number of cases where a substantial BMI reduction probably had an impact on the subject's final height.ConclusionOur study found no evidence that a substantial BMI reduction had any impact on final height on a group level, but further analyses of specific case studies are necessary to determine whether substantial BMI reduction might have an impact on final height.This article is protected by copyright. All rights reserved.
       
  • The role of breastfeeding in the association between maternal and infant
           cortisol attunement in the first postpartum year
    • Abstract: AimTo explore the role of breastfeeding as a possible link between maternal and infant cortisol attunement across the first postpartum year.MethodsMothers (n=93) provided salivary samples for cortisol levels over a two‐day period during mid‐pregnancy and at three, six, and 12 months and infants at six and 12 months postpartum. Breastfeeding status was established at these same time points.ResultsAmong breastfeeding mothers, positive correlations were found between maternal cortisol levels during pregnancy and at three months postpartum and infant cortisol at six or 12 months postpartum. Among non‐breastfeeding mothers, these same maternal and infant cortisol relations were inverse and less pronounced. Further, in breastfeeding mothers, the relationship between maternal prenatal cortisol and infant cortisol at 12 months was mediated through maternal cortisol at 3 m postpartum.ConclusionThese results suggest that maternal cortisol levels are positively associated with cortisol levels of the infant, among mothers who breastfeed. This relationship persists over a one‐year period.This article is protected by copyright. All rights reserved.
       
  • Phototherapy in the neonatal intensive care unit – quantity and
           quality
    •  
  • Young Investigator Award 2017
    •  
  • Activity levels of preterm children at seven years of age
    •  
  • Issue Information
    •  
  • Highlights in this issue
    •  
  • The continually changing epidemiology of cerebral palsy
    •  
  • Questions, challenges and perspectives relating to Internet gaming
           disorder
    •  
  • Using smartphones with suitable apps can be safe and even useful if they
           are not misused or overused
    •  
  • What we do in neonatal analgesia overshadows how we do it
    •  
  • Norepinephrine infusion improves haemodynamics in the preterm infants
           during septic shock
    • Abstract: AimThis study evaluated the clinical and haemodynamic effects of norepinephrine infusion in preterm infants.MethodsThe effects of norepinephrine therapy for refractory hypotension were evaluated in preterm infants between April 2009 and April 2011 at the neonatal intensive care unit of Sainte‐Justine Hospital, Montreal, Quebec. Changes in haemodynamics and clinical parameters were analysed eight hours before and eight hours after the start of norepinephrine infusion, and eight hours after its cessation.ResultsDuring the study, 30 preterm infants at a mean gestational age of 26.5 ± 2.6 weeks (median: 25.7, 23.4–34) and birthweight of 903 ± 437 g (median 827, 450–2550) received norepinephrine infusion for neonatal septic shock. After eight hours of treatment, mean blood pressure, urine output and FiO2 significantly improved. Eight hours after cessation of norepinephrine infusion, the number of patients treated with other inotropes decreased significantly, 24 patients (80%) had normal mean blood pressure and 27 patients (90%) had normal urine output.ConclusionNorepinephrine therapy could be considered to improve blood pressure and urine output during neonatal septic shock in preterm infants. Further studies are needed to prove the efficacy and safety of norepinephrine infusion in neonates.
       
  • A Serratia marcescens outbreak in a neonatal intensive care unit was
           successfully managed by rapid hospital hygiene interventions and screening
           
    • Abstract: AimSerratia marcescens is a rare, but important, pathogen in hospital‐acquired infections, especially in neonatal units. Outbreaks may cause significant mortality among neonates. This study describes how an outbreak of S. marcescens was handled in a neonatal intensive care unit in Finland in June 2015.MethodsTampere University Hospital is the only hospital that offers intensive care for preterm neonates in the Pirkanmaa health district area in Finland. Between June 9, 2015 and June 29, 2015, seven neonates were screened positive for S. marcescens in the hospital. We examined the management and outcomes, including environmental sampling.ResultsTwo of the seven neonates developed a bloodstream infection, and one with S. marcescens sepsis died after six days of antibiotic treatment. The outbreak was rapidly managed with active hospital hygiene interventions, including strict hand hygiene, cleaning, patient screening, contact precautions and education. Environmental sampling was limited to one water tap and a ventilator, and the results were negative. The outbreak was contained within three weeks, and no further cases appeared. The screening of healthcare workers was not necessary.ConclusionA S. marcescens outbreak caused significant morbidity in neonates and one death. Rapid hospital hygiene interventions and patient screening effectively contained the outbreak.
       
  • Effects of foetal growth restriction and preterm birth on cardiac
           morphology and function during infancy
    • Abstract: AimTo investigate the effects of foetal growth restriction (FGR) and prematurity on cardiac morphology and function in infancy. We hypothesised that FGR and prematurity would both alter cardiac development.MethodsCardiac morphology and function were evaluated in 24 preterm FGR infants (p‐FGR) and 23 preterm and 19 term appropriately grown for gestational age infants (p‐AGA and t‐AGA, respectively) by conventional echocardiography and Tissue Doppler Imaging. p‐FGR and p‐AGA infants were studied on postnatal day 1 and all groups were studied at one‐and six‐months post‐term age.Resultsp‐FGR infants demonstrated increased cardiac sphericity compared to AGA peers on postnatal day 1 (p = 0.004) and at one‐month post‐term age (p = 0.004). Posterior and relative wall thickness increased overtime in the p‐FGR group only (p 
       
  • Extremely prematurely born adolescents self‐report of anxiety symptoms,
           and the mothers' reports on their offspring
    • Abstract: AimTo compare anxiety symptoms in adolescents born extremely prematurely to term‐born controls.MethodsWe had 96 preterm‐born adolescents and 40 term‐born controls from Denmark, and their mothers score the adolescents on the Revised Children Anxiety and Depression scale. We analysed group differences, cross‐informant correlations and relative risks for elevated anxiety symptoms.ResultsSelf‐reported anxiety symptoms did not significantly differ, although the upper confidence limit (95% CI: −3.3 to 5.1) supported an odds ratio of 2 for the preterm‐born participants. Mothers of the preterm‐born participants reported higher social anxiety symptoms than did mothers of controls (51.7 versus 46.8, p = 0.001). The relative risk for being above a threshold indicating distressing anxiety was small from self‐reports (1.39; p = 0.60). From mother‐reports, the relative risk was noticeable but not significant (4.58; p = 0.14). Cross‐informant scores correlated significant for total anxiety and social anxiety for the preterm‐born (rτ = 0.2, p = 0.001; rτ = 0.3, p ≤ 0.001).ConclusionsSelf‐reports did not clearly indicate more anxiety in the preterm group, although confidence intervals supported a possible twofold increase. Mother‐ and self‐reports correlated only for the preterm group, which may indicate increased sensitivity for their children's symptoms.
       
  • The panorama of cerebral palsy in Sweden part XII shows that patterns
           changed in the birth years 2007–2010
    • Abstract: AimThis was the 12th population‐based study to explore the epidemiology of cerebral palsy (CP) in western Sweden.MethodsFrom 2007 to 2010, there were 104 713 live births in the area. We analysed the birth characteristics, aetiology and neuroimaging findings, calculated the prevalence and compared the results with previous study cohorts.ResultsCerebral palsy was found in 205 children, corresponding to a crude prevalence of 1.96 per 1000 live births. The gestational age‐specific prevalence for 36 weeks. Hemiplegia accounted for 44%, diplegia for 34%, tetraplegia for 5%, dyskinetic CP for 12% and ataxia for 3%. Neuroimaging showed maldevelopment in 12%, white matter lesions in 49%, cortical/subcortical lesions in 15% and basal ganglia lesions in 11%. The aetiology was considered prenatal in 38%, peri/neonatal in 38% and remained unclassified in 24%. CP due to term or near‐term asphyxia had decreased.ConclusionA nonsignificant decrease in CP prevalence was seen in term‐born children. Hemiplegia was still the most prevalent CP type, while the prevalence of dyskinetic CP had decreased. One in two children had white matter lesions, indicating late second‐ or early third‐trimester timing.
       
  • Longitudinal study showed that the quality of life of Finnish adolescents
           with cerebral palsy continued to be relatively good
    • Abstract: AimThis longitudinal study examined what perceptions paediatric patients with cerebral palsy (CP) and their caregivers had of the patient's quality of life (QoL). It examined changing trends as children with CP became adolescents and examined the feasibility of the Finnish version of the CP QOL‐Teen questionnaire.MethodsCarried out in autumn 2015, this study formed part of the multi‐centre Finnish national CP project and aimed to validate the CP QOL‐Teen questionnaire, which was posted to 54 adolescents and their caregivers. They included 24 who had responded to CP QOL‐Child questionnaire in 2013.ResultsThe questionnaires were returned by 27 pairs of adolescents and caregivers and one extra caregiver also responded. Of these, 24 pairs had taken part in the 2013 survey. The internal consistencies of the sum variables were found to be acceptable in all cases. Overall QoL showed an average score of 81.8 on a scale from 0 to 100. Adolescents reported significantly higher QoL than their caregivers. There were no significant differences between the responses of the children and adolescents.ConclusionWe showed that QoL was relatively good in childhood and adolescence. The Finnish version of the CP QOL‐Teen questionnaire was an appropriate clinical tool for assessing QoL.
       
  • National study shows that abusive head trauma mortality in Sweden was at
           least 10 times lower than in other Western countries
    • Abstract: AimThe validity of the diagnostic criteria for abusive head trauma (AHT) and its attributes has been widely debated. This national study investigated the possibility of false‐positive and false‐negative cases of fatal AHT in Sweden.MethodThis was a retrospective evaluation of the records of 733 deceased infants up to the age of 365 days who were examined during 1994–2013 at the six forensic medicine departments. All the records were scrutinised for possible cases of AHT.ResultsWe included 12 cases, of which eight had been diagnosed as AHT. Of these 12 infants, eight had a concomitant disease or perinatal illness, five were born prematurely and three were twins. Figures from other Western countries would suggest 6–7 deaths per 100,000 per year in Sweden, but in reality, there was a maximum possible incidence of 0.6 per 100,000 infants per year.ConclusionThe risk of unreported fatal AHT in Sweden was low, and there may have been cases misdiagnosed as AHT. The at least 10 times lower incidence than has been reported from other Western countries, raises the question if previously reported higher incidences of fatal AHT have been exaggerated.
       
  • An epidemic of meningococcal disease in children in North Norway in the
           1970s and 1980s was dominated by a hypervirulent group B strain
    • Abstract: AimWe examined children hospitalised for invasive meningococcal disease, a leading cause of paediatric sepsis, in Troms County, North Norway, from 1973 to 2016, including the epidemic in the 1970s and 1980s.MethodsThis study was a retrospective review of children under the age of 15 years who were hospitalised for meningococcal disease at the University Hospital of North Norway and Harstad Hospital. We studied hospital and bacteriological records to determine the incidence rates and phenotypes involved.ResultsThere were 300 cases under 15 years and an incidence rate of 17 per 100,000 cases for 1973–2016. This was broken down into the following: 1973–1980 (n = 130, 49), 1981–1990 (n = 129, 39), and 1991–2016 (n = 41, 4.7), respectively. There were 21 (7%) deaths. Phenotype B:15:P1.7,16 was more common than the other phenotypes in the epidemic period before 1990 than after 1990 (p = 0.02) and had a significantly lower mortality rate than the other phenotypes (p = 0.04). Later years showed a more heterogenous phenotype distribution. Serogroup B was the dominant serogroup.ConclusionThe B:15:P1.7,6 strain was more prevalent during the Norwegian epidemic of invasive meningococcal disease, but had a significantly lower mortality rate. The phenotype distribution was more heterogeneous after 1990. The dominant serogroup was B.
       
  • Performance of risk stratification criteria in the management of febrile
           young infants younger than three months of age
    • Abstract: AimWe evaluated the diagnosis, risk stratification and management of febrile infants under three months of age who presented to an Israeli paediatric emergency room (ER).MethodsThis retrospective study enrolled all febrile infants examined in the paediatric ER of Soroka Medical Center during 2010–2013. The patients were classified into low‐risk and high‐risk subgroups and compared by age and ethnicity.ResultsOverall, 2251 febrile infants (60.5% of Bedouin and 34.4% of Jewish ethnicity) were enrolled. Hospitalisation rates were higher among Bedouin vs. Jewish infants (55 vs. 39.8%, p 
       
  • Virus detection in critically ill children with acute respiratory disease:
           a new profile in view of new technology
    • Abstract: AimTo describe the epidemiology of critically ill children admitted to a paediatric intensive care unit (PICU) with acute respiratory disease. The association with intubation was analysed for the three most prevalent viruses and in those with and without viral co‐infection.MethodsPatients admitted to the PICU (2004–2014) with acute respiratory disease were included. Analyses were performed utilising each respiratory viral infection or multiple viral infections as an exposure.ResultsThere were 1766 admissions with acute respiratory disease of which 1372 had respiratory virus testing and 748 had one or more viruses detected. The risk of intubation before or during the PICU stay was higher if parainfluenza virus was detected compared to respiratory syncytial virus (RSV) (OR: 2.20; 95% CI: 1.06–4.56). Sixty‐three admissions had two or more viruses detected, and the combination of RSV and Rhinovirus/enterovirus was the most common. No significant difference was observed in the risk of intubation between patients with multiple and single viral infections.ConclusionHigher risk of intubation was found in patients with parainfluenza as compared to RSV. The risk of intubation comparing parainfluenza virus to other viruses and for patients with multiple versus single virus needs to be further studied.
       
  • The Internet Game Use‐Elicited Symptom Screen proved to be a valid tool
           for adolescents aged 10–19 years
    • Abstract: AimThis study tested the diagnostic validity of the nine‐item Internet Game Use‐Elicited Symptom Screen (IGUESS) tool, which was developed by the authors after the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, identified Internet gaming as a condition that needed further study.MethodsA self‐report screening test comprising IGUESS and Young's Internet Addiction Test was administered to 121 adolescents (74% boys) with a median age of 14 (range 10–19) recruited from school and health settings in Korea. After the screening test, a clinician conducted one‐to‐one interviews with all of the subjects to set a gold standard for diagnosis.ResultsThe sensitivity and specificity of IGUESS were 87.0 and 86.7%, respectively, for a cut‐off score of 10 points, with an area under the curve value of 0.93. Its reliability, as determined by Cronbach's alpha, was 0.94, and the correlation coefficient between IGUESS and Young's Internet Addiction Test was r = 0.902.ConclusionThe findings suggest that a cut‐off score of 10 is appropriate for administering the IGUESS in various community‐based settings, including schools, to screen for potential subjects in need of further assessment for Internet gaming problems.
       
  • Education, school type and screen time were associated with overweight and
           obesity in 2930 adolescents
    • Abstract: AimThis cross‐sectional study analysed the influence of socio‐economic factors on screen time, overweight and obesity.MethodsWe asked adolescents aged 10, 14 and 17 from 10 school types in urban and rural regions in Upper Austria to complete questionnaires from December 2012 to February 2013. Their parents were also asked to complete questionnaires.ResultsThe questionnaires were completed by 2930 adolescents and 2209 parents. Total weekend screen time was significantly associated with a higher body mass index (BMI) in 10‐year‐old boys (p < 0.005) and 10‐year‐old girls (p = 0.002), and there were significant associations between higher BMI and television time and longer weekend video game use in subjects aged 10 and 14. Higher education levels were associated with shorter daily video game use and longer computer use. Males (p < 0.0001) and adolescents from immigrant families (p < 0.0001) reported longer screen times at all ages. Lower parental education and higher parental BMI correlated significantly with longer screen time and BMI in the youngest age group.ConclusionThe greatest weight problems were in younger adolescents, despite shorter screen times, and boys and adolescents from immigrant families reported the longest screen times. Prevention strategies need to start early.
       
  • 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.
       
  • Shaken or Stirred' Evaluating the combination of
           budesonide–surfactant for survival free of bronchopulmonary dysplasia
    •  
  • Spanish population‐study shows that healthy late preterm infants had
           worse outcomes one year after discharge than term‐born infants
    • Abstract: AimThis study assessed the risks associated with healthy late preterm infants and healthy term‐born infants using national hospital discharge records.MethodWe used the minimum basic data set of the Spanish hospital discharge records database for 2012 to 2013 to analyse the hospitalisation of newborn infants. The outcomes were in‐hospital mortality and hospital re‐admissions at 30 days and one year after their first discharge.ResultsOf the 95,011 newborn infants who were discharged, 2,940 were healthy late preterm infants, born at 34+0‐36+6 weeks, and 18,197 were healthy term‐born infants. The mean and standard deviation (SD) length of hospital stay was 6.0 (4.5) days in late preterm infants versus 2.8 (1.3) days in term‐born infants (p
       
  • Procalcitonin and C‐reactive protein may help to detect invasive
           bacterial infections in children who have fever without source
    • Abstract: AimThis study evaluated the epidemiology and performance of biomarkers for identifying bacterial infections in children who presented with fever without source.MethodsWe conducted a prospective cohort study in the paediatric department at the University Hospital of Nantes, France, in 2016. Children older than six days and younger than five years of age were included.ResultsA total of 1,060 children (52.2% male) with fever without source were admitted and the median age was 17 months (interquartile range 6.6‐24.3 months). Severe bacterial infections were diagnosed in 127 (11.9%) children and invasive bacterial infections in 11 (1.0%) children: four (0.3%) with bacterial meningitis and seven (0.6%) with bacteraemia. A further 114 (10.7%) had urinary tract infections. We explored the area under the receiver operating characteristic curves for identifying invasive bacterial infections. The curves for procalcitonin and C‐reactive protein assays were better than those for the absolute neutrophil counts and the white blood cell counts.ConclusionThis study found that there was a low prevalence of invasive bacterial infections in children who presented with fever without source. It also showed that procalcitonin and C‐reactive protein may help to detect invasive bacterial infections in children who have fever without sourceThis article is protected by copyright. All rights reserved.
       
  • Body length and occipitofrontal circumference may be good indicators of
           neurodevelopment in very low birth weight infants ‐ secondary
           publication
    • Abstract: AimThe aim of this study was to predict the neurological prognosis of very low birth weight (VLBW) infants. We examined the relationship between nutritional status, brain volume measured by magnetic resonance imaging (MRI) and anthropometric measurements of VLBW infants at term‐equivalent age (TEA).MethodsWe evaluated 27 VLBW infants, born at Showa University Hospital in Japan between April 2012 and August 2013, who underwent brain MRI at TEA. Based on their clinical data, we analysed their protein and energy intake.ResultsMedian values for the 27 VLBW infants were as follows: gestational age, 29.7 weeks; birth weight 1,117g; protein intake 2.7 g/kg/day and energy intake 97.9 kcal/kg/day. At TEA, the standard deviation scores (SDSs) of body weight, body length and the occipitofrontal circumference (OFC) were −0.8, −1.4 and 0.7, respectively. Multiple regression analysis revealed that the SDSs of body length and the OFC at TEA were significant determinants of white‐matter volume, but that the SDS of body weight at TEA was not.ConclusionOur findings suggest that the SDSs of body length and the OFC at TEA may be better indicators than body weight for predicting the development of the central nervous system in VLBW infants receiving nutritional management.This article is protected by copyright. All rights reserved.
       
  • Randomised controlled trial of diazoxide for small for gestational age
           neonates with hyperinsulinaemic hypoglycaemia provided early hypoglycaemic
           control without adverse effects
    • Abstract: AimHyperinsulinaemic hypoglycaemia (HH) is a very common cause of hypoglycaemia in small for gestational age (SGA) neonates. We compared using early oral diazoxide or a placebo for this patient group.MethodsThis was a randomised, double‐blind, placebo‐controlled trial that focused on SGA neonates born at at least 32 weeks of gestation with HH during the first five days of life. Neonates with severe perinatal asphyxia, sepsis or contraindications for oral feeds were excluded. The primary outcome was the hours taken to achieve hypoglycaemic control, with a glucose infusion rate of ≤4mg/kg/min. The secondary outcomes were the duration of intravenous fluids, sepsis episodes, time to achieve full feeds and mortality.ResultsWe screened 490 neonates and 30 neonates were eligible for randomisation and completed the trial. Half received diazoxide and half received a placebo. The median time to achieve hypoglycaemia control (40 versus71.5 hours, p=0.015), total duration of intravenous fluids (114 versus 164 hours, p=0.04) and time to achieve full feeds (74 versus124 hours, p=0.02) were significantly lower in the diazoxide group, with no adverse effects attributed to the drug.ConclusionUsing oral diazoxide for SGA neonates with HH provided early hypoglycaemic control with no apparent adverse effects.This article is protected by copyright. All rights reserved.
       
  • Retrospective observational study indicates that the Pediatric Assessment
           Triangle may suggest the severity of Kawasaki disease
    • Abstract: AimWe examined whether the Pediatric Assessment Triangle (PAT) could predict the severity of Kawasaki disease.MethodsWe enrolled patients diagnosed with Kawasaki disease between July 2012 and June 2016 at the emergency department of Tokyo Metropolitan Children's Medical Center in Tokyo, Japan. Triage nurses assigned participants to unstable or stable PAT groups. We compared the incidence of coronary artery aneurysms (CAA), the Kobayashi score, which measures resistance to intravenous immunoglobulin treatment, and the incidence of initial treatment resistance.ResultsOf the 420 participants, who were aged 0‐145 months with a mean age of 31.2 ±23.9 months, 66 (16%) were assigned to the unstable PAT group. The incidence of CAA was similar between the two groups. The percentage of unstable PAT group participants with a Kobayashi score of at least five points (39% versus 18%, p
       
  • What does the world think of ankyloglossia'
    • Abstract: AimThe diagnosis of tongue‐tie (or ankyloglossia) has increased more than 10‐fold in some countries. Whether this is a global phenomenon or related to cultural and professional differences is uncertain.MethodsAn online survey in English, Japanese, Mandarin Chinese and Spanish was disseminated between May to November 2016 via 27 international professional bodies to >30 clinical professions chosen a priori to represent occupations involved in the management of neonatal ankyloglossia.ResultsA total of 1,721 responses came from nursing (51%), medical (40%), dental (6%) and allied health (4%) clinicians. Nurses (40%) and allied health (34%) professionals were more likely than doctors (8%) to consider ankyloglossia as important for lactation problems, as were Western (83%) compared to Asian (52%) clinicians. Referrals to clinicians for ankyloglossia management originated mainly from parents (38%). Inter‐professional referrals were not clearly defined. Frenotomies were most likely to be performed by surgeons (65%) and dentists (35%), who were also less likely to be involved in lactation support. Clinicians performing frenotomies were more likely to consider analgesia as important compared to those not performing frenotomies.ConclusionThe diagnosis and treatment of ankyloglossia varies considerably around the world and between professions. Efforts to standardize management are required.This article is protected by copyright. All rights reserved.
       
  • Prescriptive birth weight charts can improve the prediction of adverse
           outcomes in very preterm infants who are small for gestational age
    • Abstract: AimWe compared three anthropometric charts to determine which provided the best predictions for adverse outcomes in very preterm small for gestational age infants to address a lack of consensus on this subject.MethodsThis was a retrospective cohort study of infants born below 32 weeks, who were admitted to two level three neonatal intensive care units in The Netherlands from 2008‐2013. The birth weights of 1,720 infants were classified as SGA using: a conventional, gender‐specific birth weight chart, based on births in The Netherlands between 2000‐2007, a prescriptive, gender‐specific birth weight chart, based on the same data but without risk factors for intrauterine growth restrictions, and a non‐gender‐specific fetal weight chart derived from American ultrasonographic measurements.ResultsThe conventional, prescriptive and fetal weight charts classified 126 (7.3%), 494 (28.7%) and 630 (36.6%) infants as SGA. The prescriptive chart, which excluded IUGR, identified 368 SGA infants with significantly increased risks of neonatal mortality and morbidity. The 136 SGA infants just classified by the American fetal weight chart were not at increased risk.ConclusionThe prescriptive birth weight chart, which excluded infants with IUGR, was the most effective chart when it came to identifying clinically important risk increases in SGA infants.This article is protected by copyright. All rights reserved.
       
  • The preterm infant stomach actively degrades milk proteins with increasing
           breakdown across digestion time
    • Abstract: AimThis study investigated the effect of time post‐ingestion on gastric digestion and gastric hormones after feeding preterm infants unfortified and fortified human milk.MethodsHuman milk and infant gastric samples were collected from 14 preterm (23–32 wk birth gestational age) mother‐infant pairs within 7–98 days postnatal age. Gastric samples were collected 1, 2 and 3 h after beginning of feeding. Samples were analyzed for pH, proteolysis, general protease activity and the concentrations of pepsin, gastrin and gastrin‐releasing peptide. One‐way ANOVA with repeated measures followed by Tukey's multiple comparisons test was used.ResultsGastric pH was significantly decreased after each hour in the preterm infant stomach from 1 to 3 h postprandial. Proteolysis increased significantly from human milk to gastric contents at 1, 2 and 3 h postprandial (by 62, 131% and 181%, p < 0.05). General protease activity increased significantly by 58% from human milk to the gastric contents at 2 h postprandial. Gastrin‐releasing peptide was present in human milk whereas gastrin was produced in the infant stomach.ConclusionThough preterm infants may digest human milk proteins to a lesser extent than term infants, we demonstrated that the preterm infant stomach actively degrades milk proteins with increasing breakdown over digestion time.This article is protected by copyright. All rights reserved.
       
  • Prenatal phthalate exposure was associated with croup in Swedish infants
    • Abstract: AimThis study examined whether prenatal phthalate exposure was associated with lower or upper airway inflammation in infants.MethodsFrom 2007‐2010 we used liquid chromatography tandem mass spectrometry, adjusted for creatinine, to analyse 14 phthalate metabolites and one phthalate replacement in the urine of 1,062 Swedish mothers at a median of 10 weeks of pregnancy. This was used to determine any associations between prenatal phthalate exposure and croup, wheezing or otitis in their offspring until 12 months of age, using logistic regression, adjusted for potential confounders.ResultsThere were significant associations between phthalate metabolites of butyl‐benzyl phthalate (BBzP) and di‐ethyl‐hexyl phthalate (DEHP) concentrations in maternal prenatal urine and croup in 1,062 infants during the first year of life, when adjusted for potential confounders. A dose response relationship was found between prenatal phthalates exposure and maternal reported croup in the children, with a significant association in boys. There was no clear indication with regard to associations between prenatal phthalate exposure and wheezing or otitis media in the children during the first year of life.ConclusionOur analysis suggests that exposure to BBzP and DEHP phthalates was associated with maternal reports of croup in infants up to 12 months of age.This article is protected by copyright. All rights reserved.
       
  • The distress thermometer provides a simple screening tool for selecting
           distressed childhood cancer survivors
    • Abstract: AimWe investigated the value of the distress thermometer, a one‐item screening tool, in childhood cancer survivors.MethodsThe participants were 286 childhood cancer survivors who visited an outpatient clinic at Erasmus MC University‐Sophia Children's Hospital, Rotterdam, the Netherlands for the first time from 2001‐2008 and completed the distress thermometer and Hospital Anxiety and Depression Scale (HADS). Higher scores reflected more distress. A HADS score ≥15 was used as the cut‐off point for emotional distress. We calculated the correlation between the HADS and distress thermometer, the relationship between the HADS anxiety and HADS depression ratings and the distress score and the sensitivity and specificity for different cut‐off scores of the distress thermometer.ResultsA moderate correlation was found between the HADS score and the distress thermometer (r 0.56, p
       
  • Exploratory study found that pacifier use did not affect feeding
           performance in full‐term newborn infants but it was related to lower
           socioeconomic status
    • Abstract: AimMothers are often advised not to use pacifiers until breastfeeding has been well‐established. This study determined the infant and social factors that were related to pacifier use during the first few days of life and whether it led to alterations in feeding performance.MethodsWe enrolled 42 full‐term infants and their mothers at Barnes‐Jewish Hospital in urban St Louis, USA, in 2015. Before they were discharged the mothers completed a questionnaire, and infant feeding was assessed using a standardised assessment.ResultsThere were 24 (57%) infants who used a pacifier during the first few days of life and seven (29%) of these were exclusively breastfed. Pacifier use was less common among mothers who exclusively breastfed (p=0.04). Pacifier use was more common among mothers whose income was less than 25,000 US dollars (p=0.02), who were single (p=0.002) and who did not have a college education (p=0.03). No associations between pacifier use and feeding performance were observed.ConclusionWhile lower socioeconomic status was related to pacifier use, feeding performance in the first few days of life was no different between those infants who did and did not use pacifiers after a full‐term birth.This article is protected by copyright. All rights reserved.
       
  • Limited association between markers of stress during pregnancy and fetal
           growth in “Born into Life”, a new prospective birth cohort
    • Abstract: AimsWe aimed to investigate the associations between perceived maternal stress or salivary cortisol levels during pregnancy and birth weight.MethodsIn 2010–2012 we recruited 92 women living in Stockholm, Sweden, and followed them from before conception and through pregnancy and childbirth. Their Perceived Stress Scale (PSS) scores and salivary cortisol levels were collected at 26‐28 gestational weeks. Birth weight was collected from medical records. Linear regression analyses and Pearson correlations were performed between the PSS scores or cortisol levels and birth weight respectively, adjusted for gestational age.ResultsNo significant associations were found between PSS scores or cortisol levels and birth weight. There was a trend towards higher salivary cortisol levels among infants with lower birth weights and this effect was attenuated after adjusting for gestational age. Morning cortisol levels (r=‐0.31, p=0.01), the decline in cortisol levels (r=‐0.26, p=0.03) and evening cortisol levels (r=‐0.21, p=0.09) were negatively correlated with PSS scores.ConclusionMaternal stress during pregnancy was not associated to birth weight. The inverse correlation between PSS scores and cortisol levels may indicate other mechanisms for maternal stress on child outcomes than the previous explanation of hypothalamic‐pituitary‐adrenal axis activity.This article is protected by copyright. All rights reserved.
       
  • National data showed that delayed sleep in six‐year‐old children was
           associated with excessive use of electronic devices at 12 years
    • Abstract: AimCross‐sectional studies have shown associations between adolescent sleep problems and the use of electronic devices, such as mobile phones, but longitudinal studies remain scarce. We explored any association between delayed bedtimes at six years old and the excessive use of electronic devices at 12 years of age. Texting was a prime focus.MethodsWe analysed 9,607 adolescents who owned mobile phones in 2013 using the Japanese Longitudinal Survey of Newborns in the 21st Century, which started in 2001. The outcomes were daily excessive use of a mobile phone, television, and video games.ResultsDelayed bedtime at the age of six years was associated with excessive texting at weekends. The adjusted odds ratios and 95% confidence intervals obtained from logistic regression analyses were 1.88 (1.14‐3.10) for the 10‐11pm group and 1.98 (1.08‐3.63) for the after 11 pm group, compared with the before 9pm group. Later bedtimes were also associated with increased risks of excessive television viewing and video game use.ConclusionOur study indicated that six‐year‐olds who regularly stayed up late at night used electronic devices more frequently, or for longer, at the age of 12. Parents need to be more aware of links between sleep issues and electronic devices.This article is protected by copyright. All rights reserved
       
  • Consensus should be adapted to the evidence and not vice‐versa
    • Abstract: In their editorial (1) on Andersson and Thiblin's study on abusive head trauma in Sweden (2), Fleming and Byard refer to a systematic literature study on shaken baby syndrome (3). They maintain that the review was strongly criticised and that major methodological flaws have been described. We would like respond to these comments. Firstly, we agree that our systematic review was criticised by paediatricians, ophthalmologists and radiologists, but strongly criticised'.This article is protected by copyright. All rights reserved.
       
  • High‐fibre enteral feeding results in improved anthropometrics and
           favourable gastrointestinal tolerance in malnourished children with growth
           failure
    • Abstract: AimThe practical value of using fibre‐enriched enteral feeding regimens to rehabilitate malnourished children remains inconclusive. This study determined the usage patterns, gastrointestinal tolerance, anthropometrics and safety of high‐fibre enteral feeding in malnourished children with growth failure.MethodsThis Turkish observational study between February 2013‐June 2015 comprised 345 paediatric patients from 17 centres with malnutrition related growth failure, with a weight and height of less than two standard deviation percentiles for their age. Changes in anthropometrics, gastrointestinal symptoms, defecation habits and safety data relating to adverse events were analysed during the six‐month follow‐up period.ResultsMost subjects (99.7%) were supplemented with enteral feeding.. The absolute difference and 95% confidence interval values for the Z‐scores of height for age, weight for age, weight for height and body mass index for height increased significantly in 4‐6 months to 0.21 (0.09‐0.32), 0.61 (0.51‐0.70), 0.81 (0.56‐1.06) and 0.70 (0.53‐0.86), respectively (p
       
  • Cross‐sectional study of randomly selected 18‐year‐old students
           showed that body mass index was only associated with sleep duration in
           girls
    • Abstract: AimThis study investigated the associations, by sex, between sleep and adiposity, dietary habits, cardiorespiratory fitness and metabolic risk in 18‐year‐old students.MethodsWe carried out a cross‐sectional study of 199 randomly chosen, healthy 18‐year‐old students (53% girls) in Iceland's capital region. The data collection took place in the winter months of 2012 to 2015. The anthropometric measurements were body mass index, waist circumference and body fat percentage. Sleep duration and dietary habits were self‐reported. Cardiorespiratory fitness was measured on a stationary bicycle. A subsample of 152 participants gave blood samples.ResultsA quarter of the adolescents failed to reach the minimum recommended sleep duration of seven hours per night on weekdays. In girls, the average sleep score was associated with body mass index and waist circumference, after adjusting for cardiorespiratory fitness and unhealthy eating scores. In boys, the average sleep score was not associated with anthropometric measurements, but cardiorespiratory fitness was an independent predictor (p
       
  • Tactile stimulation during neonatal transition and its effect on vital
           parameters in neonates during neonatal transition
    • Abstract: AimThis study analysed tactile stimulation during neonatal transition and resuscitation in preterm and term neonates born by Caesarean delivery. It examined the frequency, location and body region, duration and possible effects of stimulation on heart rate and arterial oxygen saturation (SpO2).MethodsTwo independent investigators analysed video recordings of tactile stimulation on term and preterm neonates during neonatal transition from January 2012 to December 2014. They were recorded during a prospective observational study and randomised controlled trial at a tertiary centre, the Medical University of Graz, Austria. SpO2 and heart rate were continuously recorded. Data on the frequency, body region and duration of stimulation were collected. To investigate the possible effects of stimulation, SpO2 and heart rate were compared before and after stimulation.ResultsTerm infants received tactile stimulation more than once and it tended to start later, last longer and be applied in more locations than in preterm infants. Only preterm infants showed a significant increase in SpO2 after stimulation and heart rates did not show any significant changes in either group.ConclusionTactile stimulation was applied in different ways to preterm and term infants during neonatal transition and SpO2 showed a significant increase in preterm infants.This article is protected by copyright. All rights reserved.
       
  • Italian multicentre study found infectious and vaccine preventable
           diseases in children adopted from Africa and recommends prompt medical
           screening
    • Abstract: AimThis study evaluated the prevalence of infectious diseases and immunisation status of children adopted from AfricaMethodsWe studied 762 African children referred to 11 Italian paediatric centres in 2009‐2015. Clinical and laboratory data were retrospectively collected and analysed.ResultsThe median age of the children (60.3% males) was 3.6 years, 52.6% came from Ethiopia and 50.1% had at least one infectious disease. Parasitic infections accounted for the majority of the infectious diseases (409/715) and the most common were Giardia lamblia (n=239), Toxocara canis (n=65) and skin infections (n=205), notably Tinea capitis/corporis (n=134) and Molluscum contagiosum (n=56) Active tuberculosis (TB) was diagnosed in nine children (1.2%). Latent TB infections were diagnosed in 52 (6.8%) children and only 23 had concordant positive tuberculin skin tests and Quantiferon Gold In Tube results. Discordant results were associated with BCG vaccinations (odd ratio 6.30 and 95% confidence interval of 1.01‐39.20, p=0.011). Non‐protective anti‐tetanus or anti‐hepatitis B antibody titres were documented in 266 (34.9%) and 396 (51.9%) of the 762 children.ConclusionThe prevalence of infectious conditions and not‐protective titres for vaccine preventable diseases observed in our population underlines the need for prompt and complete medical screening of children adopted from Africa.This article is protected by copyright. All rights reserved.
       
  • Community study found that cutaneous allergies in childhood were
           associated with conduct problems in girls
    • Abstract: Several studies have shown that children with eczema, which is the most common form of cutaneous allergy, have an increased prevalence of psychological and behavioural problems or mental health disorders (1). Higher rates of anxiety and depression have been found in females than males with eczema (2) in adult studies, but the role that sex plays in influencing the association between eczema and the risk for mental health problems has not been extensively studied in young children. Our goal was to determine if cutaneous allergies during childhood were associated with socio‐emotional outcomes in young girls and boys.This article is protected by copyright. All rights reserved.
       
  • Low Apgar scores at both one and five minutes are associated with
           long‐term neurological morbidity
    • Abstract: AimThis study evaluated the associations between low Apgar scores at one and five minutes and long‐term neurological impairments.MethodsThis study used population‐based data on 399,815 singletons born in Finland in 2004‐2010 and multivariable logistic regression to examine any associations between low (0‐3) and intermediate (4‐6) Apgar scores and cerebral palsy, epilepsy, intellectual disability and sensorineural defects by the age of four years.ResultsThe odd ratios (OR) and 95% confidence intervals (95% CI) showed that low Apgar scores were associated with cerebral palsy at one and five minutes (ORs 2.08, 95% CI 1.32–3.26 and 5.19, 95% CI 3.06–8.80), epilepsy (ORs 1.62, 95% CI 1.13–2.33 and 4.79, 95% CI 3.03–7.56), and intellectual disability (ORs 2.46, 95% CI 1.45–4.16 and 6.21, 95% CI 3.33–11.58). Only a low five‐minute Apgar score was associated with sensorineural defects (OR 3.13, 95% CI 1.95–5.02). Neurological impairment risks were increased by low Apgar scores at both one and five minutes (OR 11.1, 95% CI 8.6–14.5), but 90.3% of children with persistent low Apgar scores had no impairment.ConclusionsLow one‐minute and five‐minute Apgar scores were associated with long‐term neurological morbidity, especially when both scores were low.This article is protected by copyright. All rights reserved.
       
  • Cohort study from 11 European countries highlighted differences in the use
           and efficacy of hypothermia prevention strategies after very preterm birth
           
    • Abstract: AimThis study investigated the different strategies used in 11 European countries to prevent hypothermia, which continues to affect a large proportion of preterm births in the region.MethodsWe examined the association between the reported use of hypothermia prevention strategies in delivery rooms and body temperatures on admission to neonatal intensive care units (NICUs) in 5,861 infants born at 22+0 – 31+6 weeks of gestation. The use of plastic bags, wraps, caps, exothermic heat and mattresses was investigated.ResultsThe proportion of infants born in units that systematically used one or more hypothermia prevention strategies was 88.2% and 50.9% of those infants were hypothermic on admission to NICUs. Of the 9.6% born in units without systematic hypothermia prevention, 73.2% were hypothermic. Only 2.2% of infants were born in units with no reported prevention strategies. Lower gestational age increased the probability of hypothermia. No significant differences were found between the various hypothermia prevention strategies. Hyperthermia was seen in 4.8% of all admitted infants.ConclusionVery preterm infants had lower risks of hypothermia on NICU admission if the unit used systematic prevention strategies. All the strategies had similar effects, possibly due to implementation rather than a strategy's specific efficacy.This article is protected by copyright. All rights reserved.
       
  • National population‐based cohort study found that visual‐motor
           integration was commonly affected in extremely preterm born children at
           6.5 years
    • Abstract: AimThis study aimed to explain the relationship between visual‐motor integration abilities and extremely preterm birth, by exploring the influence of perinatal variables, cognition, manual dexterity and ophthalmological outcomes.MethodsThis was part of the population‐based national Extremely Preterm Infant Study in Sweden (EXPRESS) study. We studied 355 children, born at a gestational age of less than 27 weeks from April 2004 to March 2007, and 364 term‐born controls. At 6.5 years of age we assessed visual‐motor integration, cognitive function, motor skills and vision. Visual‐motor integration impairment was classified as
       
  • Prospective questionnaire study showed that higher self‐efficacy
           predicted longer exclusive breastfeeding by the mothers of late preterm
           infants
    • Abstract: AimAn important variable that influences breastfeeding outcomes is how confident a woman feels about her ability to breastfeed successfully at an early stage. We investigated breastfeeding self‐efficacy in the mothers of late preterm infants.MethodsThis was a prospective, comparative study that focused on mothers who had delivered babies at 34+0 to 36+6 weeks and were recruited in 2012–2015 from a neonatal intensive care unit and a postnatal ward at a Swedish university hospital. The Breastfeeding Self–Efficacy Scale–Short Form (BSES‐SF) was used to psychometrically assess the mothers at 40 weeks of postmenstrual age (n=148) and at three months of corrected age (n=114).ResultsThe BSES‐SF scores were higher in the 87% of mothers that exclusively breastfed when their babies reached 40 weeks (57.1 out of 70) than those who did not (41.4, p
       
  • Wheat oral immunotherapy was moderately successful but was associated with
           very frequent adverse events in children aged 6‐18 years
    • Abstract: AimThis study investigated oral immunotherapy for children aged 6‐18 years with wheat allergies.MethodsWell‐cooked wheat spaghetti was given to 100 children with wheat allergies every day for 17 weeks, increasing from 0.3mg to 2,000mg of wheat protein, followed by three‐month and nine‐month maintenance phases. Blood samples were taken before therapy and at follow‐up visits. The study was carried out in 2009‐2015 in four Finnish paediatric allergology units.ResultsThe children (67% male) had a mean age of 11.6 years (range 6.1 to 18.6) and 57 were using wheat daily 16 months after the initiation of therapy. Allergic symptoms occurred in 94/100 children: mild in 34, moderate in 36 and severe in 24. Specific immunoglobulin E for ω‐5‐gliadin was significantly higher in patients who did not reach the target dose and were related to the intensity of reactions.ConclusionThe majority (57%) of children with wheat allergies could use wheat in their daily diet 16 months after the initiation of oral immunotherapy, but 94/100 had adverse reactions and 60 were moderate or severe. Specific immunoglobulin E to omega‐5‐gliadin may provide a biomarker for how much wheat can be tolerated and the intensity of the reactions to immunotherapy.This article is protected by copyright. All rights reserved.
       
  • Evaluation of bowel function in healthy children ‐ untreated
           constipation is common
    • Abstract: AimWe evaluated bowel function in healthy children with regard to gender and age.MethodsThe study was carried out in 2016 at a tertiary children's hospital. Healthy children aged 3.5‐15 years old who were admitted to the hospital, siblings to patients, or offspring of staff members were included. Validated self‐report questionnaires, and internally developed questions regarding obstructive outlet‐ and gas‐related symptoms were used.ResultsA total of 310 participants (50% girls) were included, which corresponded to a 94% answer frequency. Respondents were divided into a younger age group (3.5‐7 years), consisting of 135 children, and an older age group (8–15 years), consisting of 175 children. Younger children reported more foul odours than older children (50% versus 29%) (p=0.001) and more obstructive symptoms (21% versus 10%) (p=0.01). There was no difference between the age groups regarding constipation (19% versus 16%, NS). Overall, 55% of those with constipation had no treatment for the condition, although they reported abdominal pain (51%) and problems with foul odours (57%).ConclusionHealthy children frequently reported constipation, abdominal pain and gas‐related problems, but treatment was rare. Overall, bowel function seemed to improve during childhood, although constipation remained largely untreated.This article is protected by copyright. All rights reserved.
       
  • Aetiology of neonatal conjunctivitis evaluated in a population‐based
           setting
    • Abstract: AimOur aim was to study prospectively the aetiology of neonatal conjunctivitis in a population‐based setting.MethodsAltogether 173 neonates with clinical conjunctivitis aged on average 20 (SD 10) days were recruited from child welfare clinics in Oulu, Finland, in 2010‐2015. Conjunctival specimens were collected from 167 neonates for multiplex polymerase chain reaction to detect 16 respiratory viruses, from 163 for polymerase chain reaction to detect Chlamydia trachomatis and Neisseria gonorrhoeae and from 160 for bacterial culture studies. The cases were followed up until the age of 18 months.ResultsViral conjunctivitis was diagnosed in 8/167 (4.8%; 95% CI 2.1%‐9.2%), chlamydial or gonococcal conjunctivitis in 0/163 cases (0%; 95% CI 0%‐2.2%) and other bacterial conjunctivitis in 58/160 (36%; 95% CI 29%‐44%). Rhinovirus was found at the ocular site in 4/167 (2.4%) neonates, adenovirus in 3/167 (1.8%) and bocavirus in 1/167 (0.6%). The most commonly isolated bacteria included Staphylococcus aureus (16%), Moraxella catarrhalis (9.4%) and Streptococcus pneumoniae (3.1%). None of these pathogens was associated with the 4/173 (2.3%) cases later operated on for persistent nasolacrimal duct obstruction.ConclusionChlamydia trachomatis was a rare pathogen in neonatal conjunctivitis in a population‐based setting, but respiratory viruses were detected more frequently than indicated earlier.This article is protected by copyright. All rights reserved.
       
  • Painful procedures can affect postnatal growth and neurodevelopment in
           preterm infants
    • Abstract: AimThis Italian study evaluated whether painful procedures during the first four weeks of life were related to subsequent weight gain, head circumference (HC) and neurodevelopmental outcomes in preterm infants,MethodsWe evaluated the number of invasive procedures that infants born at less than 32 weeks of gestational age (GA) underwent in the Neonatal Intensive Care Unit of Careggi Hospital, Florence from January to December 2015. Weight and HC were recorded at birth, 36 weeks of PMA and six and 12 months of CA. Neurological outcomes were assessed at six and 12 months of CA using the Bayley Scales of Infant and Toddler Development ‐ Third Edition.ResultsWe studied 83 preterm infants with a GA of 28 ±2 weeks and birth weight of 1,098 ±340g. A higher number of invasive painful procedures was related to a lower HC standard deviation score at 36 weeks of PMA and six and 12 months of CA and with lower cognitive scores at six months. At 12 months the relationship only remained significant for infants born at less than 28 weeks (p
       
  • The five‐year survival of children with Down syndrome in Norway
           1994‐2009 differed by associated congenital heart defects and
           extracardiac malformations
    • Abstract: AimWe investigated the prevalence of Down syndrome in a nationwide birth cohort, focusing on congenital heart defects, their associations with extracardiac malformations, and survival.MethodsNational registers were used to identify Norwegian births (1994‐2009) and deaths (1994‐2014) and updated with hospital diagnoses. We estimated birth defect frequencies in Down syndrome and the general population, the association between heart defects and extracardiac malformations and hazard ratios for death from different combinations of heart defects and extracardiac malformations.ResultsDown syndrome was found in 1,672/953,450 births (17.6 per 10,000). Of the 1,251 live births (13.3 per 10,000), 58% had heart defects and 9% extracardiac malformations. Heart defects were associated with oesophageal atresia (p=0.02) and Hirschsprung′s disease (p=0.03), but with no other malformations. The five‐year survival for Down syndrome increased from 91.8% (1994‐1999) to 95.8% (2000‐2009) (p=0.006) and overall survival was 92.0% with heart defects and 97.4% without. Compared with Down syndrome children without cardiac or extracardiac malformations, the five‐year mortality was similar for those with non‐severe heart defects, without or with extracardiac malformations; but 4‐7 times higher in those with severe heart defects without extracardiac malformations, and 13‐28 times higher in those with severe heart defects and extracardiac malformations.ConclusionDown syndrome childhood survival improved, but mortality remained high with severe heart defects and extracardiac defects.This article is protected by copyright. All rights reserved.
       
  • Interaction between healthcare professionals and parents is a key
           determinant of parental distress during childhood hospitalisation for
           respiratory syncytial virus infection (European RSV Outcomes Study [EROS])
           
    • Abstract: AimWe characterised the distress that parents experienced when their child was hospitalised for respiratory syncytial virus (RSV) infection.MethodsThis survey‐based, observational study was conducted during 2014‐2015. Meetings were held in Spain and Italy, with 24 parents of RSV hospitalised infants and 11 healthcare professionals experienced in RSV, which identified 110 factors related to parental distress. The resulting questionnaire was completed by another 105 Spanish and Italian parents and 56 healthcare professionals, to assess the impact these factors had on parental distress, using a scale from 0‐10 (very unimportant to very important).ResultsThe five most important factors for parents were: healthcare professionals’ awareness of the latest developments, readmission, reinfections, painful procedures and positive experiences with healthcare professionals. Healthcare professionals associated only medical factors with a meaningful impact on parents. Half of the six medical factors were given similar importance by both groups and the overall scoring for the 110 factors was comparable, with a correlation coefficient of 0.80. A primary concern on discharge was ongoing support.ConclusionThe relationship between parents and healthcare professionals was a significant factor in determining parental distress. Healthcare professionals appeared to have a good understanding of the overall impact on parents, particularly the key medical factors.This article is protected by copyright. All rights reserved.
       
  • Review shows that early fetal alcohol exposure may cause adverse effects
           even when the mother consumes low levels
    • Abstract: AimStudies are increasingly focusing on the effects of prenatal alcohol exposure (PAE) on child health. The aim of this review was to provide paediatricians with new insights to help them communicate key messages about avoiding alcohol during pregnancy.MethodsInspired by the 7th International Conference on Fetal Alcohol Spectrum Disorder, which focused on integrating research, policy and practice, we studied English language papers published since 2010 on how early PAE triggered epigenetic mechanisms that had an impact on the development of some chronic diseases. We also report the findings of a human study using three‐dimensional photography of the face to explore associations between PAE and craniofacial phenotyping.ResultsAnimal models with different alcohol exposure patterns show that early PAE may lead to long‐term chronic effects, due to developmental programming for some adult diseases in cardiovascular, metabolic and renal systems. The study with three‐ dimensional photograping is very promising in helping paediatricians to understand how even small amounts of PAE can affect craniofacial phenotyping.ConclusionEven low levels of PAE can cause adverse fetal effects and not just in the brain. It is not currently possible to determine a safe period and level when alcohol consumption won't affect the fetus.This article is protected by copyright. All rights reserved.
       
  • A case report and literature review of autism and attention deficit
           hyperactivity disorder in paediatric chronic pain
    • Abstract: Psychiatric disorders are common in paediatric patients with chronic pain, but the overall prevalence of comorbid neurodevelopmental disorders is unclear. We report on a case of severe chronic pain in a child with undiagnosed comorbid autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), where significant improvements in pain and function occurred following methylphenidate medication and parental behavioural training. Conclusion: The inclusion of behavioural assessment and screening for neurodevelopmental comorbidity may be essential in addressing complex paediatric chronic pain.This article is protected by copyright. All rights reserved.
       
  • The Changing Relationship between Bronchopulmonary Dysplasia and Cognition
           in Very Preterm Infants
    • Abstract: AimTo characterize the relationship between bronchopulmonary dysplasia (BPD) severity and cognition in the post‐surfactant era.MethodsThis was a single‐center retrospective analysis of a cohort of infants born 2009–2012. Inclusion criteria were: admission within 48 hours of birth, gestational age 22‐0/7–31‐6/7 weeks, birth weight 400–1500 g, and Bayley Scales of Infant and Toddler Development‐III testing at 18‐26 months corrected age. Infants (n=151) were classified by BPD severity with the NIH Workshop definition. Generalized linear modeling and multivariate logistic regression were performed.ResultsBayley cognitive score was not associated with BPD severity in univariate (p=.053) or multivariate (p=.503) analysis. 27% of infants with no/mild BPD, 33% of infants with moderate BPD, and 40% of infants with severe BPD had a cognitive score
       
  • Use of social media is associated with short sleep duration in a
           dose–response manner in students aged 11 to 20 years
    • Abstract: AimThis study examined the association between social media and sleep duration among Canadian students aged 11–20.MethodsData from 5242 students were obtained from the 2015 Ontario Student Drug Use and Health Survey, a province‐wide, school‐based survey that has been conducted every two years since 1977. We measured the respondents’ sleep duration against the recommended ranges of 9–11 h per night at 11–13 years of age, 8–10 h at 14–17 and 7–9 h per night for those aged 18 years or more.ResultsOverall, 36.4% of students met or exceeded the recommended sleep duration and 63.6% slept less than recommended, with 73.4% of students reporting that they used social media for at least one hour per day. After adjusting for various covariates, the use of social media was associated with greater odds of short sleep duration in a dose–response manner (p for linear trend
       
  • Cost‐effectiveness of universal and targeted newborn screening for
           congenital cytomegalovirus infection
    •  
 
 
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