Early healthcare utilization and welfare interventions among children of mothers with alcohol and substance abuse: a retrospective cohort study

Aim: Early childhood healthcare utilization, mortality and welfare interventions were studied among children of mothers with identified gestational alcohol and/or substance abuse. Methods: Register‐based retrospective cohort study. The exposed cohort consisted of 638 children born to 524 women followed up antenatally 1992–2001 at special outpatient clinics in the capital area of Finland. Nonexposed children (n = 1914) born to control women were matched for maternal age, parity, number of foetuses, month of birth and delivery hospital of the index child. Postnatal data of both cohorts were collected from national registers until 2007. Results: The exposed cohort displayed twice the amount of in‐ and outpatient hospital care episodes compared with nonexposed children. Differences attributable to exposure were found in categories of conditions originating in the perinatal period, mental and behavioural disorders, and nonspecific factors influencing health status and contact with health services. This was reflected in amounts of reimbursements for drugs of the central nervous system, as well as special care allowances and rehabilitation for mental and behavioural disorders. The highest degree of healthcare utilization was observed among exposed children placed in out‐of‐home care. One‐third of these children received outpatient care and one‐tenth required inpatient care for a mental and behavioural disorder. No significant differences were found in early mortality. Conclusion: The exposed children displayed significant neonatal and early mental and behavioural healthcare utilization, and need for significant psychosocial support during their first decade of life.     

Alcohol and substance abuse identified during pregnancy: maternal morbidity, child morbidity and welfare interventions

Aim: To study the relations between postnatal maternal morbidity, child morbidity and welfare interventions in families with prenatal alcohol or substance abuse. Methods: A register‐based longitudinal retrospective cohort study. The exposed cohort included 638 children born to 524 women followed‐up during pregnancy for alcohol or substance abuse 1992–2001. Non‐exposed children (n = 1914) born to control women were matched for maternal age, parity, number of foetuses, month of birth and delivery hospital of the index child. Perinatal and follow‐up data of both cohorts were collected from national registers until 2007. Results: Postnatal maternal abuse‐related healthcare utilization and use of medication were associated with child out‐of‐home care. Significant differences were in particular observed in the categories of maternal mental and behavioural disorders caused by psychoactive substance use as well as injury and poisoning. Maternal inpatient care for mental and behavioural disorders peaked at the time of child out‐of‐home care. Maternal abuse‐related healthcare utilization was associated with early child healthcare utilization and use of medication for mental and behavioural disorders. These associations were largely explained by the association with child out‐of‐home care. Conclusions: Postnatal maternal abuse‐related morbidity is associated with significant early child morbidity, use of medication and timing of out‐of‐home care.     

Risk factors for behavioural problems in foetal alcohol spectrum disorders

Aim: To examine risk and protective factors associated with behavioural problems of children and adolescents following prenatal alcohol exposure. Methods: A total of 73 children and adolescents with foetal alcohol spectrum disorders (FASD) were assessed for internalizing, externalizing and total behavioural problems using the Child Behavior Checklist. Linear regression models were used to determine the effects of diagnostic and environmental risk and protective factors on behaviour, while controlling for age, sex and IQ. Results: Length of time spent in residential care was the most pervasive risk factor associated with internalizing, externalizing and total behavioural problems. A low dysmorphology score was related to more internalizing and total problems. Conclusions: Children and adolescents prenatally exposed to alcohol faced greater risk of substantive behavioural problems (i) if they were less visibly alcohol affected and (ii) the longer time they had spent in residential care. The results underscore the clinical importance of appropriate services and care for less visibly affected children with FASD and highlight the need to attend to children with FASD being raised in institutions.     

Strategy for increasing detection rates of drug and alcohol abuse in paediatric emergency departments

Aim:  To determine whether implementation of criteria for performing a toxicology screen and increasing staff awareness improve detection of substance abuse among adolescents presenting to the emergency department.
Methods:  Patients 12 to 18 years of age presenting to one of three emergency departments in Israel were included in a prospective cohort study. In the 'study' hospital, a set of criteria for urine toxicology screen and measurements of ethanol serum level were implemented. No specific interventions were implemented in the two other hospitals. The main outcome measure was the rate of substance abuse detection.
Results:  The number of adolescents seen in the participating centres was 3200 at the study hospital, and 3493 and 2792 at the two other hospitals. High blood ethanol concentrations were found in 49 patients at the study hospital compared with 30 and 19 patients at the two other hospitals (p < 0.001).
Illicit drugs were detected in 13, 4 and 1 patients, respectively (p = 0.002).
Conclusions:  Introducing structured guidelines for ordering toxicological screening increases the detection of alcohol and drug of abuse among adolescents presenting to paediatric emergency departments.     

Improving detection and quality of assessment of child abuse and partner abuse is achievable with a formal organisational change approach

Aim:   To improve detection and quality of assessment of child and partner abuse within a health service.
Methods:   A formal organisational change approach was used to implement the New Zealand Family Violence Intervention Guidelines in a mid-sized regional health service. The approach includes obtaining senior management support, community collaboration, developing resources to support practice, research, evaluation and training. Formal pre–post evaluations were conducted of the training. Barriers and enablers of practice change were assessed through 85 interviews with 60 staff. More than 6000 clinical records were audited to assess rates of questioning for partner abuse. Identifications of partner abuse and referrals made were counted through the Family Violence Accessory File. Referrals to the Department of Child, Youth and Family Services (CYFS) were recorded routinely by the CYFS. Audits assessed quality of assessment of child and partner abuse, when identified.
Results:   More than 700 staff were trained in dual assessment for child and partner abuse. Evaluations demonstrate improved confidence following training, though staff still need support. Barriers and enablers to asking about partner abuse were identified. Referrals from the health service to the CYFS increased from 10 per quarter to 70 per quarter. Identification of partner abuse increased from 30 to 80 per 6-month period. Routine questioning rates for partner abuse vary between services.
Conclusion:   Achieving and sustaining improved rates of identification and quality of assessment of child and partner abuse is possible with a formal organisational change approach.     

Prevalence and risk indicators of alcohol abuse and marijuana use among on-reserve First Nations youth

The objectives of the present study were to identify the prevalence of alcohol abuse and marijuana use among First Nations youth living on-reserve, and to identify independent risk indicators associated with these behaviours. Two hundred four students from the Saskatoon Tribal Council (Saskatchewan) who were enrolled in grades 5 through 8 were asked to complete a school health survey. The prevalence of alcohol abuse and marijuana use among First Nations on-reserve youth was 23.5% and 14.7%, respectively. Surprisingly, female First Nations youth were more likely to abuse alcohol and use marijuana than male First Nations youth. The prevalence of alcohol abuse and marijuana use among Saskatoon urban youth of the same age were only 5.4% and 2.7%, respectively. After regression analysis, five independent risk indicators were associated with alcohol abuse and marijuana use among First Nations on-reserve youth. The prevalence of alcohol abuse among First Nations on-reserve youth is higher than that in neighbouring urban youth of the same age.     

Child health care uptake among low-income and immigrant families in a Swedish county

Aim: To study the uptake of child health care among low‐income and immigrant families in the county of Uppsala, Sweden, to investigate whether these families received extra attention as proposed in the Swedish Child Health Services (CHS) state‐of‐the‐art consensus document from the year 2000. Methods: Data were collected for 25 024 infants born 1998–2006 from the database of statistics of the Child Health Care Unit in Uppsala and socio‐demographic indicators from Swedish national registers. Disposable income was divided into quartiles. Country of birth of the mother was categorized into four regions with two subgroups each, mothers with or without a Swedish‐born partner. Analysis was conducted by Cox regression and linear regression models. Results: Small differences between Swedish vs. immigrant and high vs. low‐income families were detected. Low‐income mothers (RR 0.78) as well as mothers born in all country of birth regions with an immigrant partner (RR 0.28–0.95) had lower rates of participation in parental groups. Conclusion: The CHS provided basic child health care to almost all infants including children in immigrant and low‐income Swedish families. However, the results did not indicate that disadvantaged families received the extra attention proposed in the consensus document.     

Women's involvement in household decision-making and strengthening social capital-crucial factors for child survival in Ethiopia

AIMS: To assess the influence of household decision making, social capital, socio-economic factors and health service use on under-five mortality. SETTING: Butajira Demographic Surveillance Site, Ethiopia. METHODS: A prospective case-referent design with a total of 209 under-five year old deaths occurring in an 18-month period, together with 627 referents matched for age, sex and community of residence were included. Questionnaires were administered to mothers or caretakers. Matched case control analysis investigated the effect of risk factors on mortality and the presence of avoidable factors was assessed for each death. RESULTS: Lack of immunization was strongly associated with mortality (adjusted OR=9.8, 95% CI 5.9, 16.1). Low decision making capacity of women (adjusted OR=3.2 95% CI 2.0, 5.0) and low social capital scores (adjusted OR=1.9 95% CI 1.1, 3.5) were also related to high under-five mortality in multivariate analyses. Potentially avoidable household and health facility factors were identified, respectively in 71% and 40% of the deaths. CONCLUSION: Combined efforts to improve women's involvement in household decision making, social capital and immunization may decrease the high child mortality in this setting where the level of poverty is high and no appreciable trend in child mortality decline has been noted over the years.     

Classification,prevalence and integrated care for neurodevelopmental and child mental health disorders: A brief overview for paediatricians

‘Neurodevelopmental disorders’ comprise a group of congenital or acquired long-term conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations, including autism spectrum disorder, attention deficit/ hyperactivity disorder, tic disorder/ Tourette’s syndrome, developmental language disorders and intellectual disability. Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability. Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm. Together these are referred to as neurodevelopmental, emotional, behavioural, and intellectual disorders (NDEBIDs) in this paper. Varying prevalence rates for NDEBID have been reported in developed countries, up to 15%, based on varying methodologies and definitions. NDEBIDs are commonly managed by either child health paediatricians or child/ adolescent mental health (CAMH) professionals, working within multidisciplinary teams alongside social care, education, allied healthcare practitioners and voluntary sector. Fragmented services are common problems for children and young people with multi-morbidity, and often complicated by sub-threshold diagnoses. Despite repeated reviews, limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research. The recently developed “Mental, Behavioural and Neurodevelopmental disorder” chapter of the International Classification of Diseases-11 offers a way forward. In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID, enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.     

重症监护室患儿心脏停搏后早期出现急性肾损伤的危险因素及预后分析

目的 探讨心脏停搏（cardiac arrest,CA）患儿发生急性肾损伤（acute kidney injury,AKI）的相关因素及预后的影响因素。 方法 回顾性收集2016年6月—2021年6月湖南省儿童医院儿童重症监护室发生CA患儿的病历资料。按CA恢复自发循环（return of spontaneous circulation,ROSC）48 h内是否发生AKI分为AKI组（n=50）和非AKI组（n=113）,AKI组按ROSC 7 d时预后情况分为存活组（n=21）和死亡组（n=29）。采用多因素logistic回归分析CA患儿早期发生AKI的相关因素及预后影响因素。 结果 CA后AKI发生率为30.7%（50/163）。AKI组7 d及28 d病死率分别为58.0%（29/50）、78.0%（39/50）,非AKI组为31.9%（36/113）、58.4%（66/113）。多因素logistic回归分析显示,心肺复苏时间长（OR=1.164,95%CI：1.088~1.246,P<0.001）、基线血清白蛋白低（OR=0.879,95%CI：0.806~0.958,P=0.003）、CA前应用肾上腺素（OR=2.791,95%CI：1.119~6.961,P=0.028）与CA后AKI发生密切相关;基线小儿危重病例评分低（OR=0.761,95%CI：0.612~0.945,P=0.014）、CA前应用肾上腺素（OR=7.018,95%CI：1.196~41.188,P=0.031）、CA前机械通气（OR=7.875,95%CI：1.358~45.672,P=0.021）与CA后AKI患儿死亡密切相关。 结论 CA后ROSC患儿应密切监测血清白蛋白,尤其是心肺复苏时间长、基线小儿危重病例评分低、CA前应用肾上腺素、CA前机械通气者应及早识别和干预,以降低AKI发生率和病死率。     

惊厥患儿镇静后谵妄发生的危险因素及风险列线图预测模型的建立

目的 调查惊厥患儿镇静后谵妄发生的危险因素,建立惊厥患儿镇静后谵妄风险列线图预测模型。方法 前瞻性选取2020年8月—2022年1月在空军军医大学第二附属医院住院治疗的373例惊厥患儿作为研究对象,其中建模组245例,验证组128例。通过多因素logistic回归分析筛选患儿镇静后谵妄发生的独立预测因子,并建立列线图模型,分别采用校准曲线、受试者工作特征曲线和决策曲线分析对模型的准确度、区分度和临床应用价值进行评估。结果 惊厥患儿镇静后谵妄发生率为22.3%(83/373)。多因素logistic回归分析显示,年龄>5岁是惊厥患儿镇静后谵妄的保护因素(OR=0.401,P<0.05),合并感染、入住儿童重症监护病房、应用苯二氮?类药物、惊厥持续状态史、谵妄发作史是危险因素(OR分别为3.020、3.126、5.219、2.623、3.119,均P<0.05)。列线图预测模型H-L偏差度检验显示出较好的拟合度(χ²=9.494,P=0.302)。内部、外部验证显示,校准曲线实际值与预测值间的平均绝对误差分别为0.030和0.018,受试者工作特征曲...     

Risk factors for hospitalization at the pediatric intensive care unit among infants and children younger than 5 years of age diagnosed with infectious diseases

BackgroundChildren hospitalized with infectious diseases may develop severe, life-threatening conditions, often requiring admission to pediatric intensive care unit (PICU). The objectives of this study were to identify independent risk factors for PICU hospitalization with an infectious disease in children <5 years of age.MethodsIn southern Israel, two populations live side by side: the middle–high income Jewish population and the low-income Bedouin population, both receiving equal and free medical care at the only tertiary medical center in the area. The study population included all children born in southern Israel and hospitalized at PICU with an infectious disease during 1991–2012. Risk factors for PICU hospitalizations were retrospectively studied by Kaplan–Meier and Cox proportional hazard survival analyses.Results9951 Jewish children and 18,002 Bedouin children were enrolled; overall, 1135 episodes of PICU hospitalizations with an infectious disease were recorded (879, 77.4% Bedouin and 256, 22.6% Jewish patients). Bedouin children had a higher risk for PICU hospitalization with an infectious disease compared with Jewish children (adjusted Hazard Ratio [adj. HR] 1.7, 95% CI 1.5–2.0); maternal multiparity and low-birth weight (<2500 g) were additional risk factors for PICU hospitalization with an infectious disease compared to firstborns (adj. HR = 1.2, 95% CI 1.0–1.5) or to children with a birth weight ≥2500 g (adj. HR = 1.5, 95% 1.2–1.9). Older age was a protective factor for PICU hospitalization (adj. HR = 0.98, 95% CI 0.97–0.99). Children hospitalized with a central nervous system infection had the highest risk of PICU hospitalization (adj. HR 6.8, 95% CI 5.5–8.4), followed by those with urinary tract infections (UTI, adj. HR 3.1, 95% CI 2.5–3.8) and those with lower respiratory tract infections (LRTI, adj. HR 2.9, 95% CI 2.4–3.4).ConclusionBedouin ethnicity, low birth weight, maternal multiparity and younger age were significant risk factors for PICU hospitalizations with an infectious disease. Among the infectious diseases analyzed, CNS infection had the highest risk for PICU hospitalization, followed by UTI and LRTI.