Short-term prospective study of sleep disturbances in 5-8-year-old children

The course and psychological correlates of disturbed sleep during middle childhood were investigated using parents' responses to questionnaires. Five specified sleep disturbances were explored in 614 5-8-y-old children, at baseline and at follow-up, 14 +/- 3 mo later. Difficulties falling asleep, in 6.2% of the children at baseline, persisted in 47.4% of the cases at follow-up; night-waking, in 18.6% at baseline, persisted in 45.5%; snoring, in 9.4% at baseline, persisted in 60%; nightmares, in 4.4% at baseline, persisted in 29.6%, and bedwetting, in 6% at baseline, persisted in 46%. Moreover, children with difficulties falling asleep at baseline frequently displayed bedtime resistance and shorter sleep at follow-up, while night-waking at baseline was related to co-sleeping at follow-up. Snoring at baseline was associated with a trend towards restless sleep at follow-up. Nightmares at baseline were related to several other sleep complaints as well as to behavioural difficulties during daytime at follow-up. Bedwetting at baseline was associated with tendencies towards hyperactivity at follow-up. Separate analyses of cases of persisting sleep disturbances showed that persisting difficulties falling asleep were associated with a need to remedy sleep problems, while persisting nightmares were strongly related to reports suggesting behavioural and emotional problems. Conclusion: During middle childhood, difficulties falling asleep, night-waking, snoring, nightmares or bedwetting commonly persist over the course of a year. Persistent nightmares frequently indicate significant psychological problems in affected children.     

Impact of maternal probiotic-supplemented dietary counseling during pregnancy on colostrum adiponectin concentration: a prospective, randomized, placebo-controlled study

Background

The breast milk bioactive substances such as adiponectin, have a presumably long-term impact upon the health and well-being of a child.

Aim

To determine the impact of probiotic-supplemented dietary counseling during pregnancy on colostrum adiponectin concentration.

Study design and subjects

Altogether 256 pregnant women were randomized into three study groups: dietary intervention with probiotics (diet/probiotics) or with placebo (diet/placebo) and a control group (control/placebo). The intervention group received dietary counseling provided by a nutritionist, the main focus being the amount and the type of dietary fat. The probiotics used were Lactobacillus rhamnosus GG and Bifidobacterium lactis in combination. Dietary intake was evaluated by food records at every trimester of pregnancy. Breast milk samples were collected after birth (colostrum) for adiponectin concentration analysis (n = 181).

Results

The dietary intervention increased the colostrum adiponectin concentration (ng/mL, geometric mean [95% CI]), the difference being significant when comparing to the control group; 12.7 [10.6–29.7] vs. 10.2 [9.9–13.2], P = 0.024. Maternal weight gain during pregnancy (kg) correlated inversely with colostrum adiponectin concentration; β (SE) = − 1.7 (0.1), P = 0.020, and gestational diabetes mellitus was associated with the likelihood of adiponectin concentration falling into the lowest quartile; OR 2.36, 95% CI 1.1–3.2, P = 0.028.

Conclusions

In showing that the colostrum adiponectin concentration is markedly dependent on maternal diet and nutritional status during pregnancy, and considering that colostrum adiponectin has potential effects on metabolism, nutrition, and immune function in the neonates, the results of this study underscore the importance of the metabolic homeostasis of the mother for the child's initial nutritional environment.     

Efficacy of plasma exchange in children with severe hemophagocytic syndrome: a prospective randomized controlled trial北大核心CSCD

目的 探讨血浆置换在辅助救治儿童重症噬血细胞综合征（hemophagocytic syndrome,HPS）中的疗效和应用价值。 方法 采用前瞻性随机对照研究方法,选取2018年10月至2020年10月在湖南省儿童医院儿童重症监护室（pediatric intensive care unit,PICU）接受救治的重症HPS患儿40例为研究对象,将患儿随机分为置换组和常规组（n=20）,常规组患儿进行病因和对症常规支持治疗,置换组在常规治疗的基础上加以血浆置换辅助治疗。对两组患儿的基本情况、治疗前后的临床症状体征、主要实验室检查指标、疗效和预后情况进行比较分析。 结果 两组患儿治疗前在性别、年龄、入院前病程、病因构成、小儿危重病例评分、器官或系统功能累及情况等指标上比较差异均无统计学意义（P>0.05）,在实验室指标的比较上差异亦均无统计学意义（P>0.05）。两组患儿治疗7 d后,临床症状体征均有所缓解和改善。治疗后置换组C反应蛋白、降钙素原、血清铁蛋白、丙氨酸氨基转移酶、总胆红素水平均低于常规组（P<0.05）。置换组的PICU住院时间较常规组明显缩短,总有效率较常规组明显提高（P<0.05）,但两组总的住院时间和3个月病死率比较差异无统计学意义（P>0.05）。 结论 血浆置换在辅助治疗儿童重症HPS上的疗效优于常规治疗,能改善患儿的临床症状体征和部分实验室指标,缩短PICU住院时间,可能成为治疗儿童重症HPS的一项有效辅助治疗方法。     

A prospective randomized clinical trial of total parenteral nutrition in children with cancer

A prospective randomized clinical trial was undertaken to test the efficacy of total parenteral nutrition (TPN) among previously untreated children receiving abdominal/pelvic irradiation with or without adjuvant chemotherapy who were at risk for weight loss, malnutrition, and complications from treatment. Children were evaluated by weight/height determinations, anthropomorphic measurements, and laboratory studies. TPN was associated with an improved nutritional status during therapy as compared with control patients on ad libitum intake. However, when TPN was discontinued, weight declined and there were no differences among treated and control patients detected at three-month follow-up. Likewise there was no obvious effect from TPN on tolerance to therapy in the adequately nourished child. TPN as initial supportive therapy should be reserved for those children who are malnourished or marginally malnourished at the time of presentation. Close nutritional assessment during treatment is essential since approximately 25% of children undergoing abdominal/pelvic radiotherapy with chemotherapy can be expected to become malnourished during an initial course of therapy.     

Myocardial function after autologous bone marrow transplantation in children: a prospective long-term study

Early cardiac complications after autologous bone marrow transplantation (ABMT) were recorded for 49 children with haematological malignancies. There was no procedure-related mortality and only two cases of early post-transplant cardiac complications of clinical relevance, both of which were reversible. For 35 long-time survivors (median follow-up 7 y) serial evaluations before and after ABMT included ECG, chest radiography, echocardiography and equilibrium radionuclide ventriculography (RVG). One patient had frequent supraventricular ectopic beats after ABMT, a finding not previously noted. The mean left ventricular diastolic diameter (LVDD) was 104% of expected before ABMT (95% confidence interval 99-110). During the first year post-transplant LVDD was about 110% of expected, but thereafter normalization occurred. The mean shortening fraction before ABMT was 31% (CI 29-34), compared with the mean value of 34% for healthy children in our laboratory, and it ranged between 29% and 33% during the follow-up period. Mean left ventricular ejection fraction determined by RVG was 65% (CI 61-69) and mean right ventricular ejection fraction was 46% (CI 43-49) before ABMT, and they did not change during follow-up. It is encouraging that these heavily pre-treated children could be autografted without serious cardiac complications or deterioration in myocardial performance in a 5-10-y prospect, but longer follow-up is needed for a final evaluation.     

School functioning in 8- to 18-year-old children born after in vitro fertilization

The aim of this study was to examine the school functioning of 8- to 18-year-old children born after in vitro fertilization (IVF). We compared 233 children born after IVF to 233 matched control children born spontaneously from parents with fertility problems on measures of education level, general cognitive ability, school performance (need for extra help, repeating a grade, special education), and rates of learning and developmental disorders. No differences were found between IVF and control children on these measures of school functioning. More than 60% of adolescents at secondary school attended high academic levels (with access to high school or university). We conclude that children and adolescents born after IVF show good academic achievement and general cognitive ability. They do not experience any more educational limitations than the naturally conceived children and adolescents of the control group. The tendency of reassuring school functioning already found in younger IVF children has been shown to continue at secondary school age.     

Home delivery of an injury prevention kit for children in four French cities: a controlled randomized trial

OBJECTIVES: Home delivery of counselling and safety devices to prevent child injuries could help parents to adopt safe behaviour. The aim of this study was to test a safety kit designed and used in Quebec (Canada). DESIGN AND SUBJECTS: One hundred families from four towns in the Paris suburbs were visited at home by nurses or doctors when their child reached 6-9 months. Selection criteria were: primipara, medical problem, psychological, and/or socioeconomic difficulties. INTERVENTIONS: During the first visit, 50 families (group 1) received counselling and a kit including preventive devices and pamphlets about indoor injuries and ways to avoid them. The other 50 families (group 2) received counselling but not the kit. A second home visit was made 6-8 weeks later. MAIN OUTCOME MEASURES: The number of safety improvements was calculated 6-8 weeks after a first home visit. Perceived usefulness of the kit was collected from families and from interviewers. RESULTS: Between the first and the second visits, safety improvement was significantly higher in the group with the kit. This was mainly related to the risk of fall (p<0.02), fire and burns (p<0.001), poisoning (p<0.01), and suffocation (p<0.001). For improvement related to devices provided in the kit, the difference between the groups was significant: 64.4% improvement in group 1 versus 41.2% in group 2 (p<0.01). The relative risk (RR) of safety improvement between groups was 1.56 (95% confidence interval (CI) 1.35 to 1.80). Even for improvements not related to the kit the difference remained significant: 31.2% in group 1 versus 20.2% in group 2 (p<0.05); RR = 1.54 (95% CI 1.22 to 1.93). CONCLUSION: Routine home visits by social services offer a good opportunity to tackle child injury prevention. Free delivery of prevention kits and counselling allow families to modify their behaviour and homes so as to reduce risks.     

Commercial discharge packs and breast-feeding counseling: effects on infant-feeding practices in a randomized trial

A randomized controlled trial was conducted to evaluate two interventions for prolonging the duration of breast-feeding in a multiethnic sample of 343 low-income urban women. One intervention compared research breast-feeding bedside counseling by a trained counselor, who also made eight telephone calls during the first 3 months of the infant's life, with the routine breast-feeding counseling provided in the hospital by nurses. The other intervention compared commercial discharge packs provided by formula companies with research discharge packs designed to be consistent with the WHO Code of Marketing of Breastmilk Substitutes. When infants were 4 months old, a telephone interviewer unaware of treatment status contacted 95% (324/343) of the women to determine the infants' feeding and health histories. Compared with routine counseling, research counseling delayed the first introduction of solid foods to the infant's diet (P = .03, one-tailed) but did not exert a statistically significant effect on breast-feeding by 4 months' postpartum. Women who received the research discharge pack, compared with those who received the commercial pack, were more likely to prolong exclusive breast-feeding (P = .004, one-tailed), to be partially breast-feeding at 4 months postpartum (P = .04, one-tailed), and to delay the daily use of solid foods in the infant's diet (P = .017, one-tailed). Among the women who received research counseling, the research discharge pack was associated with lower rates of rehospitalization of infants than was the commercial pack (1% v 14%; P = .014, two-tailed). We conclude that in high-risk maternity populations, commercial discharge materials for breast-feeding women should be replaced by materials consistent with the WHO Code.     

甲基泼尼松龙冲击治疗小儿激素敏感肾病综合征的临床随机对照研究

目的客观评价甲基泼尼松龙(甲泼尼龙)冲击与传统的口服足量泼尼松对小儿肾病综合征的疗效及不良反应,为临床应用提供可参考的证据。方法以原发性肾病综合征、激素敏感复发或初发初治的病例为研究对象,采用分层区组随机有效对照,开放试验,以甲泼尼龙冲击为治疗组,口服泼尼松治疗为对照组,比较两者的疗效及不良反应。结果甲泼尼龙组13例患儿中2例冲击治疗期间因感染停止治疗,11例完成治疗并缓解,尿蛋白转阴时间为3～7d,中位时间5d;泼尼松组11例患儿均完成治疗并缓解,尿蛋白转阴时间为5～28d,中位时间8d(P=0.0008);甲泼尼龙冲击治疗组患儿2周内的不良反应有感染、情绪改变、消化道症状和浮肿加重,不良反应的发生率较泼尼松组高;缓解后3个月内的再次复发两组无差别;治疗后3个月的体质量和皮下脂肪厚度,泼尼松组较治疗前增加,身高和骨密度两组治疗前后均无差别;全部患儿的肾上腺皮质功能治疗后2周均受到抑制,至治疗后3个月绝大多数仍未恢复。结论与口服足量泼尼松治疗相比,甲泼尼龙冲击治疗显示了可使激素敏感的原发性肾病综合征患儿尿蛋白更快转阴的趋势,但治疗期间可能出现感染等不良反应;甲泼尼龙冲击治疗不能减少缓解后3个月内的再次复发,对患儿体质量和皮下脂肪分布的影响可能更小。     

Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population: a randomized controlled trial

BACKGROUND: Breastfeeding peer counseling has improved breastfeeding rates in developing countries; however, its impact in this country has not been adequately evaluated. OBJECTIVE: To evaluate the effectiveness of an existing, breastfeeding peer counseling program within the United States. DESIGN: Randomized, prospective, controlled trial in which participants were recruited prenatally and randomly assigned to receive either routine breastfeeding education or routine breastfeeding education plus peer counseling. SETTING: An urban hospital serving a large population of low-income Latinas. PARTICIPANTS: Pregnant women (< or =26 weeks' gestation) were recruited from the hospital's prenatal clinic. Inclusion criteria specified that participants be low income, be considering breastfeeding, have delivered a healthy, full-term singleton, and have access to a telephone.Intervention Breastfeeding peer counseling services included 1 prenatal home visit, daily perinatal visits, 3 postpartum home visits, and telephone contact as needed. MAIN OUTCOME MEASURES: Breastfeeding rates at birth and 1, 3, and 6 months postpartum. RESULTS: The proportion not initiating breastfeeding was significantly lower in the intervention group than among controls (8/90 [9%] vs 17/75 [23%]; relative risk, 0.39; 95% confidence interval, 0.18-0.86). The probability of stopping breastfeeding also tended to be lower in the intervention group at both 1 month (36% vs 49%; relative risk, 0.72; 95% confidence interval, 0.50-1.05) and 3 months (56% vs 71%; relative risk, 0.78; 95% confidence interval, 0.61-1.00). CONCLUSION: These findings demonstrate that, in the United States, peer counselors can significantly improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1 and 3 months post partum.     

A randomized clinical trial of dietary calcium to improve bone accretion in children with juvenile rheumatoid arthritis

OBJECTIVE: To examine a behavioral intervention (BI) to increase calcium intake in children with juvenile rheumatoid arthritis (JRA) on calcium intake and bone mass 6 and 12 months after treatment. STUDY DESIGN: A randomized trial compared a 6-session BI to a 3-session enhanced standard of care (ESC) with 49 children ages 4 to 10 years with JRA. Calcium intake was assessed via 3-day diet diaries. Total body bone mineral content (BMC), arms and legs BMC, and lumbar spine bone mineral density were assessed by dual energy x-ray absorptiometry. RESULTS: BI maintained an average calcium intake of 1500 mg/d at 6- and 12-month follow-up. This was greater than their baseline level of 972 mg/d, but not greater than the intake of 1300 mg/day maintained by ESC (P=.09). The BI had a 4% and 2.9% greater gain in total body bone mineral content than ESC at 6 and 12 months, respectively (P=.005), and a 7.1% and 5.3% greater gain in arms and legs BMC at 6 and 12 months than ESC (P=.0007). CONCLUSIONS: BI is effective in increasing calcium intake and BMC in children with JRA over a 12-month period.