Is body composition important for paediatricians?

Body composition is increasingly demonstrated to be an important adult health outcome but receives little attention in paediatric clinical practice. There are several reasons why greater interest is merited. First, while obesity and eating disorders are currently defined by anthropometric criteria (weight relative to height, body mass index), these variables have poor sensitivity for monitoring response to treatment, and so body composition measurement could improve management. Second, body fat and its distribution merit monitoring more generally in patients in relation to the aetiology of cardiovascular disease, hypertension and type 2 diabetes, diseases now considered to have an "incubation period" during childhood and adolescence. Third, body composition is increasingly associated with clinical progress and outcome, including survival in some disease states. Finally, measurements of lean mass may improve the capacity to tailor nutrition, treatment and management to metabolic criteria.     

Influenza immunisation in children: good for everyone or reserve for the chosen few?

Influenza infection leads to significant morbidity in children. There is a lack of sound epidemiological data to define precisely the true burden, severity and rate of complications in otherwise normal children. Effective and safe vaccines are available with the prospect of an intranasally administered live attenuated vaccine being licensed in the near future. There are few contraindications to immunisation and, for children who will benefit from the procedure, short courses of oral corticosteroids and confirmed allergy to egg can no longer be regarded as such. The uptake of immunisation in the UK and other countries in categories of children defined and targeted by the Department of Health is currently low. A number of challenges remain. Firstly, to define more precisely which children will most benefit from immunisation and, secondly, to gather much more persuasive evidence if routine immunisation of healthy children is to be contemplated. Once these strands of evidence have been pulled together we need a clear evidence-based protocol which will reassure doctors and parents of the importance, efficacy and safety of influenza immunisation in whichever group of children have been identified as appropriate recipients.     

To what extent does maternal body mass index predict intentions,attitudes, or practices of early infant feeding?

Public health guidelines recommend women establish and maintain exclusive breastfeeding to 6 months postpartum. Women with a body mass index (BMI, kg/m²) in the overweight or obese range are less likely to initiate and continue breastfeeding than healthy weight women. Evidence for psychological mechanisms of this association using validated methods of measurement is limited, but factors such as attitudes and intentions for infant feeding are implicated. This study aimed to investigate the associations between maternal BMI, antenatal attitudes and intentions for infant feeding, and subsequent breastfeeding practices. A total of N = 128 women completed an online questionnaire antenatally, and n = 48 were followed‐up in the first month postpartum. Validated measures of intentions (Infant Feeding Intentions Scale) and attitudes (Iowa Infant Feeding Attitude Scale) for infant feeding were used. One‐way analysis of variance and multivariate regression analyses assessed study objectives. Infant feeding attitudes (p = .327) and intentions (p = .254) were similar among healthy weight, overweight, and obese women and did not differ significantly. In adjusted regression models, only intentions significantly predicted early breastfeeding behaviour (p = .036; AR² = .301). Missing data analysis revealed no significant differences in the profile of completing versus noncompleting women. Evidence suggests postnatal factors contribute significantly to lower breastfeeding rates in cohorts of women with overweight or obese BMIs. Further investigations should consider using theory and methods from behavioural science to longitudinally investigate modifiable mechanisms of action responsible for lower breastfeeding rates among overweight and obese women to inform practices that support prolonged breastfeeding.     

Adjuvant therapy in biliary atresia: hopelessly optimistic or potential for change?

Given that the aetiology of biliary atresia (BA) is complex and that there is a multiplicity of possible pathogenic mechanisms then it is perhaps not surprising that the evidence for effect of a number of different agents is contradictory. Post-operative cholangitis for instance is common, bacterial in origin and various antibiotic regimens have been tested (although none in a randomized trial) but continuation beyond the early post-operative period does not appear to offer any greater protection. There is an inflammatory reaction in about 25–35% of cases of BA illustrated by abnormal expression of class II antigen and upregulation of ICAM, VCAM and E-selectin with an infiltrate of immune-activated T cells (predominantly CD4?+?Th1 and Th17) and NK cells and a systemic surge in inflammatory cytokines (e.g. TNF-α, IL-2, IL-12). This has potential as a therapeutic target and is the main hypothesis behind the rationale use of steroids. The first report of steroids was published in 1985 by Karrer and Lilly as “blast” therapy to treat recalcitrant cholangitis, followed by a multiplicity of small-scale uncontrolled studies suggesting benefit. To date there has been one randomized placebo-controlled study with a low-dose (prednisolone 2 mg/kg/day) regimen (2007); one with a high-dose (IV prednisolone 4 mg/kg/day regimen) (2014); two prospective high-dose open-label studies (2013); a prospective comparison of low- and high-dose regimen and a large (380 infants) retrospective comparison. The most recent meta-analysis (2016) identified a significant difference in clearance of jaundice at 6 months (OR 1.59, 95% CI 1.03–2.45, P?=?0.04), in patients treated with high-dose steroids, particularly if?<?70 days at surgery. Ursodeoxycholic acid (UDCA) may increase choleresis or change the ratio of endogenous bile acids to a less hydrophobic and, therefore, less toxic millieu. UDCA may protect cholangiocyte membranes against damage and perhaps reduce the tendency to fibrogenesis. Biochemical benefit has been shown in a single crossover trial in older BA children who had cleared their jaundice. Other potential adjuvant therapies include immunoglobulin therapy, anti-viral agents and Chinese herbs although real evidence of benefit is lacking.     

Ultrasound,computed tomography or magnetic resonance imaging - which is preferred for acute appendicitis in children? A Meta-analysis

Pediatric Radiology - There is no established consensus about the relative accuracies of US, CT and MRI in childhood appendicitis. To compare, through meta-analysis, the accuracies of US, CT and...