Prediction of asthma in children at 6 and 12 years of age: Perth infant asthma follow-up study

Longitudinal studies, starting in infancy, provide an opportunity to assess risk factors prior to long-term exposure to environmental factors. The status of the infant soon after birth is determined by genetic background and factors related to in utero influences. As a result of recent advances in molecular biology, the genetic component can now be evaluated.     

The effects of early postnatal dexamethasone therapy on pulmonary outcome in premature infants with respiratory distress syndrome: a two-year follow-up study

AIM: To evaluate the pulmonary outcome at corrected age of 2 y on preterm infants who participated in a double-blind trial of early postnatal dexamethasone therapy (< 12 h after birth) for the prevention of chronic lung disease. METHODS: Clinical respiratory status, blood gases, acid-base balance and pulmonary function were evaluated at corrected age of 2 y in 116 preterm infants (59 infants in the control group; 57 in the dexamethasone-treated group). In the dexamethasone-treated group, dexamethasone was administered intravenously every 12 h in tapering doses: 0.25 mg/kg on days 1 through 7, 0.12 mg/kg on days 8 through 14, 0.05 mg/kg on days 15 through 21, and 0.02 mg/kg on days 21 through 28. RESULTS: The clinical and laboratory characteristics in the perinatal period were comparable between the groups. At the time of follow-up (mean +/- SD corrected age was 25.1 +/- 4.8 mo for the control group and 24.6 +/- 5.1 mo for the dexamethasone-treated group), there was a slightly lower mean body weight and body length, and a lower psychomotor developmental index in the dexamethasone-treated group than in the control group (10.9 +/- 2.1 vs 11.5 +/- 1.9 kg, 84.4 +/- 6.1 vs 85.9 +/- 5.8 cm, and 82 +/- 24 vs 89 +/- 26, respectively); however, these differences were not statistically significant. There were no significant differences between the control and dexamethasone-treated groups in clinical respiratory status, blood gases, acid-base balance or in lung mechanics (V(T): 9.5 +/- 2.0 vs 9.4 +/- 1.9 ml/kg; V(min): 0.23 +/- 0.04 vs 0.23 +/- 0.03 l/min/kg; C(RS): 13.1 +/- 3.9 vs 12.6 +/- 3.6 ml/kPa/kg; R(RS): 1.56 +/- 0.64 vs 1.62 +/- 0.58 kPa/l/s, respectively). CONCLUSION: There was no apparent adverse respiratory outcome associated with early postnatal dexamethasone therapy.     

Factors associated with catch‐up growth in early infancy in rural Pakistan: A longitudinal analysis of the women's work and nutrition study

The adverse health impacts of early infant stunting can be partially ameliorated by early catch‐up growth. Few studies have examined predictors of and barriers to catch‐up growth to identify intervention points for improving linear growth during infancy. This study aimed to estimate the prevalence of, and factors associated with, catch‐up growth among infants in Pakistan. A longitudinal study of mother–infant dyads (n = 1,161) was conducted in rural Sindh province, with enrolment between December 2015 and February 2016 (infants aged 0.5–3 months), and follow‐up (n = 1035) between November 2016 and January 2017 (infants aged 9–15 months). The outcome was catch‐up growth (change in conditional length‐for‐age z‐scores >0.67 between baseline and endline). Associated factors were examined using multivariable logistic regression analyses. The prevalence of stunting was 45.3% at baseline and 60.7% at follow‐up. 22.8% of infants exhibited catch‐up growth over this period. Factors positively associated with catch‐up growth included maternal height (odds ratio (OR) = 1.08 [1.05–1.11]), household wealth (OR = 3.61 [1.90–6.84]), maternal (OR = 2.43 [1.30–4.56]) or paternal (OR = 1.46 [1.05–2.03]) education, and households with two or more adult females (OR = 1.91 [1.26–2.88]). Factors negatively associated with catch‐up growth were two (OR = 0.64 [0.45–0.89]) or three or more (OR = 0.44 [0.29–0.66]) preschool children in the household and the infant being currently breastfed (OR = 0.59 [0.41–0.88]). Catch‐up growth was exhibited among approximately a quarter of infants despite living in challenging environments associated with extremely high rates of early infant stunting. Several modifiable factors were identified that might represent suitable programme intervention points to off‐set early infant stunting in rural Pakistan.     

Recruiting primary care physicians to qualitative research: Experiences and recommendations from a childhood cancer survivorship study

1 Background

Primary care physicians (PCPs) are essential for healthcare delivery but can be difficult to recruit to health research. Low response rates may impact the quality and value of data collected. This paper outlines participant and study design factors associated with increased response rates among PCPs invited to participate in a qualitative study at Sydney Children's Hospital, Australia.

2 Procedure

We invited 160 PCPs by post, who were nominated by their childhood cancer patients in a survey study. We followed‐up by telephone, email, or fax 2 weeks later.

3 Results

Without any follow‐up, 32 PCPs opted in to the study. With follow‐up, a further 42 PCPs opted in, with email appearing to be the most effective method, yielding a total of 74 PCPs opting in (46.3%). We reached data saturation after 51 interviews. On average, it took 34.6 days from mail‐out to interview completion. Nonrespondents were more likely to be male (P = 0.013). No survivor‐related factors significantly influenced PCPs’ likelihood of participating. Almost double the number of interviews were successfully completed if scheduled via email versus phone. Those requiring no follow‐up did not differ significantly to late respondents in demographic/survivor‐related characteristics.

4 Conclusion

PCP factors associated with higher opt in rates, and early responses, may be of interest to others considering engaging PCPs and/or their patients in cancer‐related research, particularly qualitative or mixed‐methods studies. Study resources may be best allocated to email follow‐up, incentives, and personalization of study documents linking PCPs to patients. These efforts may improve PCP participation and the representativeness of study findings.     

Exploring barriers and enablers for scaling up a community‐based grain bank intervention for improved infant and young child feeding in Ethiopia: A qualitative process evaluation

Child malnutrition remains high in Ethiopia, and inadequate complementary feeding is a contributing factor. In this context, a community‐based intervention was designed to provide locally made complementary food for children 6–23 months, using a bartering system, in four Ethiopian regions. After a pilot phase, the intervention was scaled up from 8 to 180 localities. We conducted a process evaluation to determine enablers and barriers for the scaling up of this intervention. Eight study sites were selected to perform 52 key informant interviews and 31 focus group discussions with purposely selected informants. For analysis, we used a framework describing six elements of successful scaling up: socio‐political context, attributes of the intervention, attributes of the implementers, appropriate delivery strategy, the adopting community, and use of research to inform the scale‐up process. A strong political will, alignment of the intervention with national priorities, and integration with the health care system were instrumental in the scaling up. The participatory approach in decision‐making reinforced ownership at community level, and training about complementary feeding motivated mothers and women's groups to participate. However, the management of the complex intervention, limited human resources, and lack of incentives for female volunteers proved challenging. In the bartering model, the barter rate was accepted, but the bartering was hindered by unavailability of cereals and limited financial and material resources to contribute, threatening the project's sustainability. Scaling up strategies for nutrition interventions require sufficient time, thorough planning, and assessment of the community's capacity to contribute human, financial, and material resources.     

The relation of infant attachment to attachment and cognitive and behavioural outcomes in early childhood

Background

In China, research on the relation of mother–infant attachment to children's development is scarce.

Aims

This study sought to investigate the relation of mother–infant attachment to attachment, cognitive and behavioural development in young children.

Study design

This study used a longitudinal study design.

Subjects

The subjects included healthy infants (n = 160) aged 12 to 18 months.

Outcome measures

Ainsworth's “Strange Situation Procedure” was used to evaluate mother–infant attachment types. The attachment Q-set (AQS) was used to evaluate the attachment between young children and their mothers. The Bayley scale of infant development-second edition (BSID-II) was used to evaluate cognitive developmental level in early childhood. Achenbach's child behaviour checklist (CBCL) for 2- to 3-year-olds was used to investigate behavioural problems.

Results

In total, 118 young children (73.8%) completed the follow-up; 89.7% of infants with secure attachment and 85.0% of infants with insecure attachment still demonstrated this type of attachment in early childhood (κ = 0.738, p < 0.05). Infants with insecure attachment collectively exhibited a significantly lower mental development index (MDI) in early childhood than did infants with secure attachment, especially the resistant type. In addition, resistant infants were reported to have greater social withdrawal, sleep problems and aggressive behaviour in early childhood.

Conclusion

There is a high consistency in attachment development from infancy to early childhood. Secure mother–infant attachment predicts a better cognitive and behavioural outcome; whereas insecure attachment, especially the resistant attachment, may lead to a lower cognitive level and greater behavioural problems in early childhood.     

Cognitive behavioral treatment for childhood anxiety disorders: long‐term effects on anxiety and secondary disorders in young adulthood

Background: The present study’s aim was to examine the long‐term effects (8 to 13 years post‐treatment; M = 9.83 years; SD = 1.71) of the most widely used treatment approaches of exposure‐based cognitive behavioral treatment for phobic and anxiety disorders in children and adolescents (i.e., group treatment and two variants of individual treatment). An additional aim was to compare the relative long‐term efficacy of the treatment approaches. Method: At long‐term follow‐up, participants (N = 67) were between 16 and 26 years of age (M = 19.43 years, SD = 3.02). Primary outcome was the targeted anxiety disorder and targeted symptoms. Secondary outcomes were other disorders and symptoms not directly targeted in the treatments including (1) other anxiety disorders and symptoms, (2) depressive disorders and symptoms, and (3) substance use disorders and symptoms. Results: Long‐term remission for anxiety disorders and symptoms targeted in the treatments was evident 8 to 13 years post‐treatment. Long‐term remission also was found for the secondary outcomes. There were more similarities than differences in the long‐term gains when comparing the treatment approaches. Conclusions: Consistent with past research, the study’s findings provide further evidence that the short‐term benefits of exposure‐based CBT for childhood phobic and anxiety disorders using both group and individual treatment may extend into the critical transition years of young adulthood.     

Sense and sensibility in infant observation: a response to Margot Waddell

This response to Margot Waddell's paper welcomes its argument, and draws attention to a number of issues which it raises. One of these is the origin of the theory of container-contained relations, and the possible links between the work of Esther Bick and Wilfred Bion, in its development. A second issue is the relation between infant observation as a form of learning, and a method of research. It argues that infant observation has given rise to significant discoveries, and also that it makes a significant implicit contribution to clinical research in child psychotherapy. Finally the paper notes the distinctive sensibility nurtured by observational experience, and agrees with Waddell that the value of infant observation lies as much in this sphere as in more theoretical and empirical domains.     

Milk bolus obstruction secondary to the early introduction of premature baby milk formula: an old syndrome re-emerging in a new population

Milk bolus obstruction of the neonatal bowel apparently related to the use of artificial powder milk, particularly full cream cows milk, was first recognised in the late 1960s. The syndrome almost disappeared with the use of highly modified cows milk formulae but has now re-emerged in the low birth weight population with the early use of high calorific feeds specifically designed for these infants. We describe four cases of obstruction and perforation of the bowel seen on our neonatal intensive care unit in 1 calendar year and discuss the possible aetiology of this condition.Abbreviation NEC necrotizing enterocolitis     

Early functional echocardiogram and inhaled nitric oxide: usefulness in managing neonates born following extreme preterm premature rupture of membranes (PPROM)

Aim: Poor neonatal outcome of preterm premature rupture of membranes (PPROM) <24 weeks' gestational age (GA) is probably a result of abnormalities in both airway and vascular developments, ventilation perfusion mismatch, and possibly persistent pulmonary hypertension of the newborn (PPHN). Perinatal mortality of 50–90% has been reported in the past, with recent literature reporting significant improvement in neonatal survival. We report our 8‐year experience in this group of infants using early diagnostic functional echocardiography (fECHO), high‐frequency ventilation (HFV) and inhaled nitric oxide (iNO). Methods: The obstetric and neonatal databases were searched to identify babies with PPROM (<20 weeks' gestation) or rupture earlier than 25 weeks for more than 14 days. Results: Twenty‐six infants were identified, of whom 20 were admitted to the neonatal intensive care unit (NICU; mean GA 27.8 weeks, mean birth weight (BW) 1207 g). Early echocardiographic data were available in 12/15 infants requiring mechanical ventilation of whom 10 had evidence of PPHN. All infants who received iNO therapy survived to discharge and only two infants died. Survival to discharge was 69% for the whole cohort of infants and 90% for infants admitted to the NICU. In contrast, for the cohort from pre‐iNO and ‐HFV era, the overall survival to discharge was 62% and 66% for the infants admitted to the NICU. Conclusion: Premature infants with PPROM and presumed severe hypoxemic respiratory failure because of hypoplastic lungs often have significant PPHN and may show improvement in oxygenation after treatment with HFV and iNO. Early fECHO results in earlier identification and treatment of infants with PPHN in this high‐risk group.     

Successful outcome after early combined liver and en bloc-kidney transplant in an infant with primary hyperoxaluria type 1: A case report

Abstract:  PH1 is a metabolic disorder characterized by urolithiasis and the accumulation of oxalate crystals in the kidneys and other organs. Although patients often first present with renal failure, PH1 results from a deficiency of the hepatic peroxisomal enzyme AGT. Ultimately only liver transplantation will cure the underlying metabolic defect. Herein, we report the case of a three-month-old male infant diagnosed with PH and treated using a combined liver and en bloc- kidney transplant from a single donor. At the time of transplant, the patient was 11 months old and weighed 7.9 kg. He received a full size liver graft and en bloc kidneys from a two-yr-old donor. At 36 months post-transplant, the patient is steadily growing with normal renal and hepatic function. This is one of the first reports of successful liver and en bloc -kidney transplantation with abdominal compartment expansion by PTFE for the infantile form of PH1 in a high risk child before one yr of age. Prompt diagnosis and early referral to a specialized center for liver and kidney replacement offer the best chance for survival for infants with this otherwise fatal disease.     

Unsettled infant behaviour and health service use: a cross-sectional community survey in Melbourne, Australia

Aims: To investigate factors associated with health service use by women and their infants in Victoria, Australia. Methods: Cross‐sectional screening survey of 875 women with 4‐month‐old infants attending immunisation clinics in five local government areas in Melbourne between May 2007 and August 2008. The self‐report instrument assessed socio‐demographic characteristics, unsettled infant behaviour, maternal mood (Edinburgh Postnatal Depression Scale) and, the outcome, health service use during the first 4 months post‐partum. Results: Mothers and their infants used on average 2.8 different health services in the first 4 months post‐partum (range 0–8). After adjustment for other factors, high health service use (defined as >3 different services) was more common in mothers whose infants were unsettled with persistent crying, resistance to soothing and poor sleep. A one‐point increase on the unsettled infant behaviour measure was associated with an 8% (2–14%) increase in the use of >3 services, 9% (3–16%) in use of emergency departments, 7% (2–13%) in use of telephone helplines and 9% (3–14%) of parenting services. Poorer maternal mental health was also implicated with a one‐point increase on the Edinburgh Postnatal Depression Scale associated with a 4% (0.4–8%) increase in the likelihood of using more than three services. Conclusions: Unsettled infant behaviour is associated with increased use of multiple health services. The high use of emergency departments by families with unsettled infants found in this study suggests that enhancement of primary health‐care capacity might be required.