Recommendations for respiratory support in the newborn (I)

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into twelve modules, with the first three modules being developed in this work. Each module it is the result of a consensus process amongst all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic and of the clinical experience of each one of the members of the group. Each module includes a summary of the scientific evidence available, graded into four levels of recommendations.     

Intensive consolidation chemotherapy for acute lymphoblastic leukaemia (UKALL X pilot study).

Eighty two children with acute lymphoblastic leukaemia presenting at this hospital received one or two modules of intensive chemotherapy to consolidate remission. Modules were given after four and roughly 19 weeks on treatment. Each included two doses of daunorubicin (45 mg/m2/day), cytosine arabinoside (100 mg/m2 twice daily X 5), etoposide (100 mg/m2/day X 5), and 6-thioguanine (80 mg/m2/day X 5). A total of 132 courses were given. This study included all new patients except girls aged 1-14 years with presenting leucocyte count less than 20 X 10(9)/l. Twenty patients with recurrent disease were also included. The first 32 patients were given cytosine as a 24 hour infusion, but combined with the other agents this was associated with severe intestinal toxicity, which necessitated a change to a less toxic 12 hourly bolus regimen. The complications of the module are reviewed in terms of myelosuppression, enterotoxicity, infection, and other clinical problems encountered. All patients became profoundly neutropenic and thrombocytopenic. The latter was significantly more severe after cytosine infusion. Overall, 64% received platelet transfusions and 85% were re-admitted with fevers requiring intravenous antibiotics for between four and 56 days. Gastrointestinal toxicity with the modified module occurred in 38% of patients and was severe in 13%. This intensification module has been adopted by the Medical Research Council Working Party on Childhood Leukaemia for use in a multicentre study (UKALL X) and the details of the problems encountered in the pilot study may be of value to other centres now using this protocol.     

Leitlinie zur Behandlung des Asthma bronchiale bei Kindern und Jugendlichen

Due to new insights into asthma management, the consensus recommendations on treatment of bronchial asthma in children and adolescents originally published in 1999 and amended in 2003 needed updating. It was decided that the recommendations should be replaced with guidelines which would standardize patient management and provide assistance to all caregivers. First of all, evidence grades were included. Particular emphasis was attributed to practicability, feasibility, compliance, and costs. A further focus is the concept whereby patient-oriented therapy is carried out according to symptom control and includes asthma self-management strategies. Since a recommendation on the treatment of recurrent obstructive bronchitis and bronchial asthma in pre-school age was issued in 2006, the present guidelines are restricted to patients over the age of 5. To guarantee their implementation, the Austrian Society for Pediatrics and Adolescent Medicine is offering modules on “Asthma” and “Asthma training” in the framework of a diploma program.     

Infective endocarditis: Updated guidelines

The most recent revision of the American Heart Association guidelines on infective endocarditis prophylaxis occurred in 2007. These revisions were based on the fact that current data have brought into question the benefit of previous recommendations for infective endocarditis prophylaxis. It was noted that the bacteremia that occurs following dental procedures represents only a fraction of the episodes of bacteremia that occur with activities of daily living (such as chewing, brushing teeth and other oral hygiene measures). The target groups and the procedures for which prophylaxis is reasonable have been significantly reduced in number. The focus is now on patients who are most likely to have adverse outcomes from infectious endocarditis. The present article is targeted at practicing Canadian physicians and provides the rationale for the current recommendations. In addition to a summary of the indications for prophylaxis, information is provided on the conditions for which prophylaxis is not recommended.     

Hearing impairment in children

This article describes the current standard for infant hearing loss identification and intervention. Since the standard of care was driven by the recommendations made by the Joint Committee on Infant Hearing, a summary of the most recent recommendations is provided, followed by illustrative case studies that highlight how implementation of these guidelines allow access to the critical window for auditory and speech-language development.     

Child passenger safety

Despite significant reductions in the number of children killed in motor vehicle crashes over the past decade, crashes continue to be the leading cause of death for children 4 years and older. Therefore, the American Academy of Pediatrics continues to recommend inclusion of child passenger safety anticipatory guidance at every health-supervision visit. This technical report provides a summary of the evidence in support of 5 recommendations for best practices to optimize safety in passenger vehicles for children from birth through adolescence that all pediatricians should know and promote in their routine practice. These recommendations are presented in the revised policy statement on child passenger safety in the form of an algorithm that is intended to facilitate their implementation by pediatricians with their patients and families. The algorithm is designed to cover the majority of situations that pediatricians will encounter in practice. In addition, a summary of evidence on a number of additional issues that affect the safety of children in motor vehicles, including the proper use and installation of child restraints, exposure to air bags, travel in pickup trucks, children left in or around vehicles, and the importance of restraint laws, is provided. Finally, this technical report provides pediatricians with a number of resources for additional information to use when providing anticipatory guidance to families.     

Seeing the Forest in Family Violence Research: Moving to a Family-Centered Approach

Victims of family violence are sorted into fragmented systems that fail to address the family as an integrated unit. Each system provides specialized care to each type of victim (child, older adult, adult, animal) and centers on the expertise of the medical and service providers involved. Similarly, researchers commonly study abuse from the frame of the victim, rather than looking at a broader frame—the family. We propose the following 5 steps to create a research paradigm to holistically address the response, recognition, and prevention of family violence.

• (1)Establish common definitions and data elements for family violence. Definitions and data elements should be useable across medical, social, and legal systems of care. Outcomes should be relevant to patients, family members, and providers.
• (2)Measure the efficacy and cost of the current medical-social-legal system that addresses violence.
• (3)Develop actionable screening recommendations for at-risk household contacts when violence is initially identified.
• (4)Develop and test family-centered interventions, especially those that target modifiable risk factors such as substance use or mental illness.
• (5)Target support and prevention strategies for families at highest risk.

By developing an integrated research model to address family violence, and by using that model to support integrated systems of care, we propose a fundamental paradigm shift to improve the lives of families living with and suffering from violence.     

Dietary recommendations to prevent and manage chronic pediatric health conditions: adherence, intervention, and future directions

This review provides a summary of the dietary aspects of pediatric health conditions. Within each condition, dietary recommendations are reviewed, and adherence rates, factors affecting adherence, and known interventions are reported. Findings indicate that knowledge is necessary but not sufficient for dietary change. Interventions specifically targeting diet appear more promising than interventions aimed at global treatment adherence. Behavioral interventions and group treatment modalities also appear promising. Recommendations for future research include a systematic assessment of barriers to dietary adherence across populations, integration of the research on normative development of eating behavior in childhood, and the application of this information to the design and implementation of future treatment.     

Cognitive interviewing to improve women's empowerment questions in surveys: Application to the health and nutrition and intrahousehold relationships modules for the project‐level Women's Empowerment in Agriculture Index

In 2015, the United Nations adopted the Sustainable Development Goals, which include fostering gender equality and women's empowerment and ending hunger and malnutrition. To monitor progress and evaluate programmes that aim to achieve these goals, survey instruments are needed that can accurately assess related indicators. The project‐level Women's Empowerment in Agriculture Index (pro‐WEAI) is being developed to address the need for an instrument that is sensitive to changes in empowerment over the duration of an intervention. The pro‐WEAI includes new modules with previously untested survey questions, including a health and nutrition module (focused on women's agency in this area) and an intrahousehold relationships module. This study uses cognitive interviewing to identify how new survey questions might be misinterpreted and to understand what experiences women are referencing when they respond to these questions. This was undertaken with the goal of informing revision to the modules. The study was conducted in Bangladesh with women from nuclear, extended, and migrant‐sending households and from two regions of the country to identify difficulties with interpretation and response formulation across these groups. Findings revealed that questions were generally understood, but participants occasionally responded to the wrong part of the question, did not understand key phrases, or were uncomfortable with questions. The findings also suggested ways to revise the modules and strengthen the pro‐WEAI. The revised pro‐WEAI health and nutrition and intrahousehold relationships modules will advance the ability to measure changes in these domains and their relationship with the health and nutritional status of women and their children.     

Changes in food habits in families with a newly diagnosed child with type 1 diabetes mellitus

Dietary recommendations for children with type 1 diabetes mellitus (DM) are in line with the recommendations for the general population and applicable to the whole family. We review what is known about the food habits of non-diabetic family members and present original data on dietary changes in families with a child with DM. Some studies suggest that family members eat mostly the same food as the affected child. In a Finnish study of siblings of children with DM, favourable changes were observed after diagnosis in the type of milk and fat used. In a study of young children with DM, family members increased their consumption of skim milk, low-fat cheese and low-fat cold meat cuts. The consumption frequencies of fruit and vegetables increased. In conclusion, family members of a child with DM are willing to change their food habits towards the recommended diet. Dietary advice should be directed to the whole family from the very beginning.     

Säuglingsernährung und Ernährung der stillenden Mutter

The German network“Healthy Start – Young Families’ Network” (Gesund ins Leben – Netzwerk Junge Familie), was set up to form a basis for an effective, nationwide communication network between actors, institutions and media wishing to accompany and support parents through pregnancy and birth. The recommendations of various relevant professional organisations and institutions have been compiled, discussed among the members of the scientific advisory board and formulated into standardized key messages (recommendations for action). These recommendations will be passed on to young families on the one hand in the form of application-oriented messages for everyday life, and on the other as an integral part of disseminator training in the form of background information. They include key messages on breastfeeding, infant formula, baby foods, drinks (complementary fluids intake), nutritional supplements, nutrition for breastfeeding mothers, stimulants while breastfeeding, medication and food supplements while breastfeeding, as well as advice on non-nutrition- and non-smoking-related allergies in children.     

Haitian, Chinese, Somali, Ethiopian, and Asian/Pacific Islander perspectives on research

Researchers often approach community-based organizations as an access point to engage underserved populations in studies. In this article, 5 representatives of community organizations present their perspectives on the complexity of researcher-community partnerships and the nuances of engaging Haitian, Ethiopian, Somali, Chinese, and Asian/Pacific Islander populations in research. Each representative presents recommendations for gaining trust and understanding within their communities and challenge researchers to move beyond seeking knowledge and into social action that improves the lives of their constituents.     

Barriers to following the back-to-sleep recommendations: insights from focus groups with inner-city caregivers.

BACKGROUND: African American infants have a higher incidence of SIDS and increased risk of being placed in the prone position for sleep. OBJECTIVE: To determine new barriers and more information about previously identified barriers that interfere with adherence to the Back-to-Sleep recommendations among inner-city, primarily African Americans. DESIGN/METHODS: We conducted 9 focus groups with caregivers of infants and young children from women, infants, and children centers and clinics in New Haven and Boston. Themes were identified using standard qualitative techniques. RESULTS: Forty-nine caregivers participated, of whom 86% were African American, 6% were Hispanic, 4% were white, and 4% were other. Four themes were identified: 1) Safety: Participants chose the position for their infants based on which position they believed to be the safest. Some participants did not choose to put their infants in the supine position for sleep because they feared their infants would choke; 2) Advice: Participants relied on the advice of more experienced female family members. Health care providers were not uniformly a trusted source of advice; 3) Comfort: Participants made choices about their infants sleeping positions based on their perceptions of whether the infants appeared comfortable. Participants thought that their infants appeared more comfortable in the prone position; 4) Knowledge: Some participants had either limited or erroneous knowledge about the Back-to-Sleep recommendations. CONCLUSIONS: We identified multiple barriers to adherence to recommendations regarding infant sleep position. Data obtained from these focus groups could be used to design educational interventions aimed at improving communication about and adherence to the Back-to-Sleep recommendations.     

Nutrition education via a touchscreen: a randomized controlled trial in latino immigrant parents of infants and toddlers

ObjectiveTo investigate whether educational modules presented on a touchscreen computer increase immediate nutrition and feeding knowledge in low-income, Spanish-speaking Latino immigrant parents.MethodsThis was a randomized controlled trial conducted in an urban pediatric clinic with a sample of low-income, Spanish-speaking Latino parents of children <3 years randomly assigned to the intervention (n = 80) and control groups (n = 80). Intervention group members viewed 5 modules on nutrition and feeding presented on an interactive platform using a touchscreen computer. Modules contained text, pictures, and audio. Content was drawn from Bright Futures Guidelines. The primary outcome was a parental total summed knowledge score based on correct responses to 19 questions related to module content. Domain-specific scores were also analyzed.ResultsIntervention and control groups did not differ on demographic characteristics. Participants were of varied Latino origins, mean age was 27.5 years, 41% reported a <7th grade education, and 65% reported that they rarely/never use a computer. Compared with the control group, the intervention group had a superior mean total summed knowledge score (72.3% vs 90.8%, P < .001). Mean domain-specific summed knowledge scores were also greater in the intervention arm compared with the control for all 5 domains. These results did not differ on the basis of participant education level. 71% (n = 57) of intervention arm participants planned to change something based on what they learned from the computer program, and 80% reported that they will (n = 49) or may (n = 15) talk to their child’s doctor about what they learned in the modules.ConclusionsResults of this pilot study add to the growing literature on the use of this technology for health education in low-income Latino immigrants. Despite low education levels and computer experience, findings suggest that immediate parental knowledge was enhanced supporting the need for a more rigorous evaluation of this technology and its impact on health behaviors.     

Disorders of sex development: Summaries of long-term outcome studies

Existing outcomes for DSD individuals are inadequate because reports are based upon information collected retrospectively. This paper is presented to review existing data emphasizing information needed to lead to better future care, is based on presentations and discussions at a multi-disciplinary meeting on DSD held in Annecy in 2012, and is not intended to define the present status of management of each of the various DSD diagnoses. Rather it is intended to provide information needed to do studies regarding outcome data from the treatment of children with DSD by providing a summary of recommendations of ‘patient-centered’ topics that need investigation. The hope is that by being concerned with what is not known, new protocols will be developed for improving both early management and transition to adult life.     

Developmental course of general movements in early infancy. I. Descriptive analysis of change in form.

In order to describe the developmental changes of general movements (GM) in early infancy and to relate them to changes in other aspects of the neurological repertoire, the spontaneous motility in supine position was recorded on video tape at 4-week intervals in a group of twenty-two full-term healthy infants aged 2-18 weeks. Each follow-up session included a neurological examination. In newborn infants GM have a 'writhing' quality. The movements are characterized by a tight appearance, a relatively slow speed and a limited amplitude. The 'writhing' character of the GM is gradually broken down into a so-called 'fidgety' quality. These GM are typified by an ongoing flow of small movements occurring irregularly all over the body. The transformation of GM from a 'writhing' character into a 'fidgety' character was related more closely to postmenstrual than to postnatal age. 'Fidgety' GM were almost constantly present at the age of 8-12 weeks. In the third month very rapid arm movements ('swipes' and 'swats') occurred. The developmental changes in the form of the GM and those of the neurological repertoire showed no significant correlation. This demonstrates that within the normal CNS the various functional modules develop autonomously.     

Guideline for primary antifungal prophylaxis for pediatric patients with cancer or hematopoietic stem cell transplant recipients

This guideline provides clinicians with evidence‐based recommendations on the use of antifungal prophylaxis in children with cancer and undergoing hematopoietic stem cell transplantation (HSCT). Recommendations are divided into: (1) allogeneic HSCT (2) autologous HSCT (3) acute myeloid leukemia or myelodysplastic syndrome and (4) patients with malignancy and neutropenia for >7 days. A systematic review was conducted and evidence summaries compiled. The quality of evidence and strength of each recommendation was determined using GRADE. Implementation of these recommendations will require adaptation to local context. The contribution of this guideline in the prevention of invasive fungal infections requires prospective evaluation. Pediatr Blood Cancer 2014;61:393–400. © 2013 Wiley Periodicals, Inc.     

《儿科重症监护输血和贫血专家倡议-控制/防止出血：危重儿童血浆和血小板输注实践的建议和专家共识》解读

危重症患儿出血风险高,血小板及血浆输注是儿科重症监护病房（pediatric intensive care unit,PICU）常用治疗措施之一,在挽救患儿生命的同时,也带来输血相关性不良反应。为促进危重症患儿合理输注血浆和血小板,儿科重症监护输血和贫血专家倡议-控制/防止出血（transfusion and anemia expertise initiative,TAXI）专家组于2022年制订了危重儿童血浆和血小板输注实践的建议和专家共识。共识由7篇独立文章组成,包括共识推荐意见汇总1篇,涉及严重创伤、颅内出血或创伤性脑损伤、体外循环（cardiopulmonary bypass,CBP）手术、体外膜氧合、肿瘤性疾病和造血干细胞移植、急性肝功能衰竭或肝移植、非心脏手术、手术室外侵入性手术、脓毒症和（或）弥漫性血管内凝血共8类特殊危重人群的血浆和血小板输注的专家共识4篇及2篇补充内容分别为实验室检查、血浆和血小板的选择与处理、危重儿童血浆和血小板输注策略的研究优先事项,最终形成53项推荐意见,其中4项基于循证医学证据,5项良好实践声明及44项基于专家共识。该文仅介绍临床推荐意见。     

Children with diabetes mellitus and family functioning: translating research into practice

The specific challenges of living with diabetes mellitus (DM) which the child and parent must confront at each developmental stage are identified from infancy through adolescence. This discussion is divided into four developmental stages: 1) DM in infancy (0-2 years of age); 2) DM in toddlers and preschoolers (2-5 years); 3) DM in the school-age child (6-11 years); and 4) DM during early- to mid-adolescence (12-16 years). The central milestones of normal psychosocial development are reviewed and a summary is provided of recent research at each developmental stage with an emphasis on clinical implications for pediatric diabetes care teams.