Virus detection in critically ill children with acute respiratory disease: a new profile in view of new technology

Aim

To describe the epidemiology of critically ill children admitted to a paediatric intensive care unit (PICU) with acute respiratory disease. The association with intubation was analysed for the three most prevalent viruses and in those with and without viral co‐infection.

Methods

Patients admitted to the PICU (2004–2014) with acute respiratory disease were included. Analyses were performed utilising each respiratory viral infection or multiple viral infections as an exposure.

Results

There were 1766 admissions with acute respiratory disease of which 1372 had respiratory virus testing and 748 had one or more viruses detected. The risk of intubation before or during the PICU stay was higher if parainfluenza virus was detected compared to respiratory syncytial virus (RSV) (OR: 2.20; 95% CI: 1.06–4.56). Sixty‐three admissions had two or more viruses detected, and the combination of RSV and Rhinovirus/enterovirus was the most common. No significant difference was observed in the risk of intubation between patients with multiple and single viral infections.

Conclusion

Higher risk of intubation was found in patients with parainfluenza as compared to RSV. The risk of intubation comparing parainfluenza virus to other viruses and for patients with multiple versus single virus needs to be further studied.

     

Influence of fitness on health status among survivors of acute lymphoblastic leukemia

Introduction

We aimed to determine the prevalence of self‐reported adverse health status among childhood acute lymphoblastic leukemia (ALL) survivors and to identify associations between components of physical fitness and health status.

Methods

Participants included 365 ALL survivors (mean age at evaluation of 28.6 ± 5.9 years) and 365 age‐, sex‐, and race‐matched community controls. Self‐report of poor general health, poor mental health, functional impairments, and activity limitations were used to describe adverse health status. Fitness was evaluated by assessing flexibility, muscular strength and endurance, peak oxygen uptake, and balance. Generalized linear models were used to examine associations between fitness metrics and health status.

Results

Survivors were more likely than controls to report poor general health (20.6% vs. 10.4%, risk ratio [RR] = 2.0, 95% confidence intervals [CI] = 1.4–2.9), poor mental health (28.0% vs. 14.5%, RR = 1.9, 95% CI = 1.4–2.6), functional impairments (10.5% vs. 4.1%, RR = 2.5, 95% CI = 1.4–4.6), and activity limitations (29.0% vs. 14.4%, RR = 2.0, 95% CI = 1.5–2.7). Survivors whose balance scores were more than 1.5 standard deviations below the mean of the control population were more likely to report poor general health (RR = 1.7, 95% CI = 1.1–2.8), poor mental health (RR = 1.9, 95% CI = 1.3–2.8), and functional limitations (RR = 2.5, 95% CI = 1.2–56). Survivors with low strength were more likely to report poor general health (RR = 1.8, 95% CI = 1.1–3.1), functional impairments (RR = 4.2, 95% CI = 1.7–10.4), and activity limitations (RR = 1.8, 95% CI = 1.2–2.8).

Conclusions

ALL survivors, particularly those with poor balance and reduced muscular strength, are at increased risk for adverse health status.

     

Accurate and fast neonatal heart rate assessment with a smartphone‐based application – a manikin study

Aim

This study determined the accuracy and speed of the NeoTapLifeSupport (NeoTapLS), a free smartphone application that aims to assess a neonate's heart rate.

Methods

We asked 30 participants with a variety of backgrounds to test the NeoTapLS, which was developed by our own nonprofit organisation Tap4Life, to determine a randomly selected heart rate by auscultation or palpation. The study was carried out in 2014 at Sachs’ Children and Youth Hospital, Sweden, using a Laerdal SimNewB manikin that simulates true values. The NeoTapLS calculates the heart rate based on the user's last three taps on the smartphone screen.

Results

A total of 1200 measurements were carried out. A high correlation was found between measured and true values by auscultation (correlation coefficient 0.993) as well as by palpation (correlation coefficient 0.986) with 93.5% of the auscultations and 86.3% of the palpations differing from the true value by five beats or fewer. The mean time to the first estimated heart rate was 14.9 seconds for auscultation and 16.3 seconds for palpation.

Conclusion

Heart rates could be accurately and rapidly assessed using the NeoTapLS on a manikin. A globally accessible mobile health system could offer a low‐cost alternative to expensive medical equipment.

     

Perspectives on periviability counselling and decision‐making differed between neonatologists in the United States and the Netherlands

Aim

American guidelines suggest that neonatal resuscitation be considered at 23 weeks of gestation, one week earlier than in the Netherlands, but how counselling practices differ at the threshold of viability is unknown. This pilot study compared prenatal periviability counselling in the two countries.

Methods

In 2013, a cross‐sectional survey was sent to 121 Dutch neonatologists as part of a nationwide evaluation of prenatal counselling. In this pilot study, the same survey was sent to a convenience sample of 31 American neonatologists in 2014. The results were used to compare the organisation, content and decision‐making processes in prenatal counselling at 24 weeks of gestation between the two countries.

Results

The survey was completed by 17 (55%) American and 77 (64%) Dutch neonatologists. American neonatologists preferred to meet with parents more frequently, for longer periods of time, and to discuss more intensive care topics, including long‐term complications, than Dutch neonatologists. Neonatologists from both countries preferred shared decision‐making when deciding whether to initiate intensive care.

Conclusion

Neonatologists in the United States and the Netherlands differed in their approach to prenatal counselling at 24 weeks of gestation. Cross‐cultural differences may play a role.

     

Observation study showed that the continuity of skin‐to‐skin contact with low‐birthweight infants in Uganda was suboptimal

Aim

Kangaroo mother care (KMC) is a safe and effective method of reducing neonatal mortality in resource‐limited settings, but there has been a lack of data on the duration of skin‐to‐skin contact (SSC) in busy, low‐resource newborn units. Previous studies of intermittent KMC suggest the duration of SSC ranged from 10 minutes to 17 hours per day.

Methods

This was an observational study of newborn infants born weighing less than 2000 g, which collected quantitative data on SSC over the first week after birth. The study took place in July 2016 in the newborn unit of a low‐resource facility in Uganda.

Results

The mean daily duration of SSC over the first week after birth was three hours. This differed significantly from the World Health Organization recommendation of at least 20 hours of SSC per day. SSC was provided by mothers most of the time (73.5%), but other family members also took part, especially on the day of birth.

Conclusion

Our study found a disappointingly low daily duration of SSC in this Ugandan newborn unit. However, advocacy and community education of SSC may help to decrease the stigma of KMC, improve overall acceptance and reduce the age at SSC initiation.

     

Aerosol generation during paediatric procedural sedation with continuous-flow nitrous oxide suggests a low risk of airborne viral transmission to health-care workers

Aim

Inhaled nitrous oxide is a common form of procedural sedation in paediatric care. During the COVID-19 pandemic, concerns about potential aerosol generation and associated viral transmission to health-care workers have led to controversy regarding its use. We aimed to measure the degree of aerosol generation during continuous flow nitrous oxide sedation to inform future guidelines.

Methods

Aerosol numbers in the respirable range were measured using a particle counter during 30 procedures undertaken in children under nitrous oxide sedation in the Emergency Department.

Results

Changes from baseline measurements were greatest in particles in the 0.3 μm range. The mean increase from baseline in 0.3 μm particles per cubic metre was 18 022 (95% confidence interval (CI) 5949–30 096) after the child entered the room, and 2931 (95% CI −4407 to 10 269) during nitrous oxide administration.

Conclusion

Variation of respirable particle numbers from baseline levels was no greater during nitrous oxide administration than for breathing and talking asymptomatic children. These results suggest the additional risk of airborne viral transmission to staff during inhaled nitrous oxide sedation is low.

     

Quality of life in children with retinoblastoma after enucleation in China

Objective

To study the quality of life of Chinese pediatric patients with retinoblastoma (RB) after enucleation and the influencing factors.

Methods

A questionnaire survey was performed on 71 cases of pediatric patients with RB after enucleation and 80 cases of healthy children, using the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL? 4.0).

Results

The social dimension scores, school dimension scores, and total scores for the PedsQL? 4.0 among the pediatric patients with RB were statistically significantly lower than those of healthy children. The influencing factors were unilateral/bilateral affected eyes, diagnosis age, and ocular prosthesis satisfaction.

Conclusion

Early discovery, timely treatment, increased eye salvage rate, and cosmetic effects of ocular prosthesis were key factors for increasing the quality of life of pediatric patients with RB. Attention should be paid to the health, social, and school development of pediatric patients with RB.

     

Obesity in elementary school children after the Great East Japan Earthquake

Background

Rikuzentakata was one of the cities most devastated by the Great East Japan Earthquake on 11 March 2011. Many buildings were swept away or destroyed and affected families were placed into temporary housing. The aim of this study was to determine the impact of long‐term temporary housing on the body mass index (BMI ) of elementary school children living in Rikuzentakata City.

Methods

A retrospective cohort study of was carried out of students attending 1st–3rd grade in 2010, and 4th–6th grade in 2013, in eight elementary schools in Rikuzentakata City. Height and weight were measured annually. We compared changes in BMI between children in temporary housing and those in permanent housing. Separately, parents of students attending one of the elementary schools were surveyed in 2013.

Results

Of 526 children in the present study, 32% were living in temporary housing. The prevalence of obesity climbed from 5.3% in 2010 to 7.8% in 2013 in the temporary housing group, and from 7.6% to 7.8% in the permanent housing group. BMI z‐score in the temporary housing group increased by 0.102 points between 2010 and 2013 (P  <  0.02). Children in temporary housing spent more time reading comic books and their walking commute time had decreased by 2 min compared with before the disaster.

Conclusion

Obesity prevalence and BMI z‐score increased in children in temporary housing compared with permanent housing. A more sedentary lifestyle may explain this trend. It is important for policy makers and health‐care providers to recognize potential consequences of long‐term residence in temporary housing.

     

Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants

Aim

Regurgitation, infantile colic and functional constipation are common functional gastrointestinal disorders (FGIDs) during infancy. Our aim was to carry out a concise review of the literature, evaluate the impact of these common FGIDs on infants and their families, and provide an overview of national and international guidelines and peer‐reviewed expert recommendations on their management.

Methods

National and international guidelines and peer‐reviewed expert recommendations on the management of regurgitation, infantile colic and functional constipation were examined and summarised.

Results

Regurgitation, infantile colic and functional constipation cause frequent parental concerns, lead to heavy personal and economic costs for families and impose a financial burden on public healthcare systems. Guidelines emphasise that the first‐line management of these common FGIDs should focus on parental education, reassurance and nutritional advice. Nutritional advice should stress the benefits of continuing breastfeeding, while special infant formulas may be considered for non‐breastfed infants with common FGIDs. Drug treatment is seldom required, with the exception of functional constipation.

Conclusion

By providing complete and updated parental education, reassurance and nutritional advice, healthcare professionals can optimise the management of FGIDs and related symptoms and reduce the inappropriate use of medication or dietary interventions.

     

Gender disparities in preterm neonatal outcomes

Aim

From birth to old age, males generally have poorer disease outcomes compared to females. Preterm infants display a marked gender disparity in disease outcomes, and the underlying mechanisms are not well delineated. Our aim was to review the literature on clinical outcomes between preterm infants of different genders and discuss the potential mechanisms underlying the differences observed.

Methods

A literature review was undertaken for experimental and clinical research related to gender differences in preterm outcomes.

Results

Preterm male infants appear to have consistently worse outcomes compared to females, and the aetiology of these differences, while mostly undetermined, is likely multifactorial.

Conclusion

The male disadvantage in preterm outcomes is likely multifactorial with hormonal, genetic and immunological differences likely playing key roles. Gender is an important variable in preterm outcome and should be considered when designing clinical and experimental research.

     

Aetiology of neonatal conjunctivitis evaluated in a population‐based setting

Aim

Our aim was to study prospectively the aetiology of neonatal conjunctivitis in a population‐based setting.

Methods

Altogether 173 neonates with clinical conjunctivitis aged on average 20 (SD 10) days were recruited from child welfare clinics in Oulu, Finland, in 2010–2015. Conjunctival specimens were collected from 167 neonates for multiplex polymerase chain reaction to detect 16 respiratory viruses, from 163 for polymerase chain reaction to detect Chlamydia trachomatis and Neisseria gonorrhoeae and from 160 for bacterial culture studies. The cases were followed up until the age of 18 months.

Results

Viral conjunctivitis was diagnosed in 8/167 (4.8%; 95% CI 2.1–9.2%), chlamydial or gonococcal conjunctivitis in 0/163 cases (0%; 95% CI 0–2.2%) and other bacterial conjunctivitis in 58/160 (36%; 95% CI 29–44%). Rhinovirus was found at the ocular site in 4/167 (2.4%) neonates, adenovirus in 3/167 (1.8%) and bocavirus in 1/167 (0.6%). The most commonly isolated bacteria included Staphylococcus aureus (16%), Moraxella catarrhalis (9.4%) and Streptococcus pneumoniae (3.1%). None of these pathogens was associated with the 4/173 (2.3%) cases later operated on for persistent nasolacrimal duct obstruction.

Conclusion

Chlamydia trachomatis was a rare pathogen in neonatal conjunctivitis in a population‐based setting, but respiratory viruses were detected more frequently than indicated earlier.

     

Early risk predictors for impaired numerical skills in 5‐year‐old children born before 32 weeks of gestation

Aim

To unravel risk predictors for impaired numerical skills at 5 years of age in a population‐based cohort of very preterm infants.

Methods

Between January 2003 and August 2006, we prospectively enrolled all infants born in Tyrol with <32 weeks of gestation. A total of 161 of 223 preterm infants (participation rate 72.2%) had a detailed examination at 5 years of age including cognitive assessment (Hannover‐Wechsler Intelligence Test for preschool children, third edition (HAWIVA‐III) or Snijders‐Oomen Nonverbal Intelligence Test (SON‐R)). In 135 children, numerical abilities were assessed with the dyscalculia test TEDI‐MATH. The association between pre‐ and postnatal factors and impaired numerical skills was analyzed by means of logistic regression analysis.

Results

Dyscalculia test showed delayed numerical skills (TEDI‐MATH Sum T‐score <40) in 27 of 135 children tested (20.0%). In half of the children tested, delayed numerical abilities were related to lower IQ scores. Smoking in pregnancy, intracerebral haemorrhage and chronic lung disease were predictive of delayed numerical skills at 5 years of age in the multivariate analysis.

Conclusion

This study identified risk predictors for impaired numerical skills in preterm infants. Our data support the role of both pre‐ and perinatal factors in the evolution of mathematical deficits.

     

Insecurity,distress and mental health: experimental and randomized controlled trials of a psychosocial intervention for youth affected by the Syrian crisis

Background

Strengthening the evidence base for humanitarian interventions that provide psychosocial support to war‐affected youth is a key priority. We tested the impacts of an 8‐week programme of structured activities informed by a profound stress attunement (PSA) framework (Advancing Adolescents), delivered in group‐format to 12–18 year‐olds in communities heavily affected by the Syrian crisis. We included both Syrian refugee and Jordanian youth.

Methods

We followed an experimental design, comparing treatment youth and wait‐list controls over two programme implementation cycles, randomizing to study arm in cycle 2 (ClinicalTrials.gov ID: NCT03012451). We measured insecurity, distress, mental health difficulties, prosocial behaviour and post‐traumatic stress symptoms at three time‐points: baseline (n = 817 youth; 55% Syrian, 43% female), postintervention (n = 463; 54% Syrian, 47% female), and follow‐up (n = 212, 58% Syrian, 43% female). Regression models assessed: prospective intervention impacts, adjusting for baseline scores, trauma exposure, age, and gender; differential impacts across levels of trauma exposure and activity‐based modality; and sustained recovery 1 year later. We analysed cycle‐specific and cycle‐pooled data for youth exclusively engaged in Advancing Adolescents and for the intent‐to‐treat sample.

Results

We found medium to small effect sizes for all psychosocial outcomes, namely Human Insecurity (β = ?7.04 (95% CI: ?10.90, ?3.17), Cohen's d = ?0.4), Human Distress (β = ?5.78 (?9.02, ?2.54), d = ?0.3), and Perceived Stress (β = ?1.92 (?3.05, ?0.79), d = ?0.3); and two secondary mental health outcomes (AYMH: β = ?3.35 (?4.68, ?2.02), d = ?0.4; SDQ: β = ?1.46 (?2.42, ?0.50), d = ?0.2). We found no programme impacts for prosocial behaviour or post‐traumatic stress reactions. Beneficial impacts were stronger for youth with exposure to four trauma events or more. While symptoms alleviated for both intervention and control groups over time, there were sustained effects of the intervention on Human Insecurity.

Conclusions

Findings strengthen the evidence base for mental health and psychosocial programming for a generation affected by conflict and forced displacement. We discuss implications for programme implementation and evaluation research.

     

Nutritional therapy complications in children with ultra‐short bowel syndrome include growth deficiency but not cholestasis

Aim

Children with ultra‐short bowel syndrome (USBS) have not been extensively studied to date because the condition is rare. The aim of the study was to assess the nutritional status of children with USBS receiving home parenteral nutrition, using citrulline serum concentration and cholestasis.

Methods

We studied 17 patients with USBS, with a median age of 6.6 years and median duration of parenteral nutrition of 6.6 years. The study was carried out at The Children's Memorial Health Institute, Warsaw, from January 2014 to January 2015.

Results

The median standard deviation score (SDS) was ?1.2 for body mass according to chronological age, ?1.72 according to height and ?0.59 according to height for age. Patients requiring seven days per week parenteral nutrition had a citrulline concentration below 10 μmol/L. Decreased bone‐mineral density was observed in 87% of the patients. Low values of 25‐hydroxyvitamin D were found in 53% of the children. None of the patients had elevated conjugated bilirubin levels above 34.2 μmol/L.

Conclusion

Children with USBS were growth deficient according to their chronological age, with frequent abnormal bone mineralisation and vitamin D deficiency. Children requiring parenteral nutrition seven days a week had citrulline concentrations below 10 μmol/L. Cholestasis was not seen.

     

Detection of gastro‐oesophageal reflux in the neonatal unit

Aim

To determine whether a pH probe or multichannel intraluminal impedance (MII) more frequently detected gastro‐oesophageal reflux and test the hypothesis that acid reflux was associated with lower baseline impedance.

Methods

A prospective study of infants in whom reflux was suspected and evaluated using combined pH and multichannel impedance. Studies were considered abnormal if the acid index was >10% or there were >79MII reflux events in 24 hours. The acid index was the percentage of total study time with a pH

Results

Forty‐two infants [median gestational age 31 (range 23–42) weeks] were assessed. Only nine infants (21%) had abnormal studies, seven detected by pH monitoring, one by MII monitoring and one by both techniques (p = 0.04). After correcting for gestational age and post‐natal age, baseline impedance remained negatively correlated with the acid index (r = ?0.34, p = 0.038) and the maximum ACT (r = ?0.44, p = 0.006).

Conclusion

Clinical suspicion of reflux was frequently incorrect, and reflux was more frequently detected by a pH probe. The inverse relationship of acid reflux to baseline impedance suggests that mucosal disruption may result from acid reflux in this population.

     

Unexpected collapse of healthy newborn infants: risk factors,supervision and hypothermia treatment

Aim

To determine the occurrence and risk factors of sudden unexpected postnatal collapse (SUPC) in presumably healthy newborn infants.

Methods

All live‐born infants during a 30‐month period, in five major delivery wards in Stockholm, were screened, and possible cases of SUPC thoroughly investigated. Infants were ≥35 weeks of gestation, had an Apgar score >8 at 10 min and collapsed within 24 h after birth. Maternal, infant, event characteristics and outcome data were collected.

Results

Twenty‐six cases of SUPC were found among 68 364 live‐born infants, an incidence of 38/100 000 live births. Sixteen of these cases of SUPC required resuscitation with ventilation >1 min, and 14 of these remained unexplained (21/100 000). Fifteen of the 26 children were found in a prone position, during skin‐to‐skin contact, 18 were primipara, and 13 occurred during unsupervised breastfeeding at <2 h of age. Three cases occurred during smart cellular phone use by the mother. Five developed hypoxic–ischaemic encephalopathy (HIE) grade 2, and 4 underwent hypothermia treatment. Twenty‐five infants had a favourable neurological outcome.

Conclusion

SUPC in apparent healthy babies is associated with initial, unsupervised breastfeeding, prone position, primiparity and distractions. Guidelines outlining the appropriate monitoring of newborns and safe early skin‐to‐skin contact should be implemented.

     

Review shows that Icelandic society is taking firmer steps to tackle the diverse forms of child abuse and neglect that its children are exposed to

Aim

This review examined and summarised the research published on child abuse in Iceland, which was mainly in the country's native language, to make the findings more accessible to English speakers. It specifically focused on child rearing and the physical, emotional and sexual abuse, neglect and intrafamilial conflicts suffered by children at the hands of their parents and other carers.

Method

The review drew on published research, books and reports and compared the findings with Nordic research and global estimates of child abuse.

Results

Qualitative and quantitative research revealed that the prevalence of different forms of child abuse, child neglect and intra‐familial conflicts in Iceland was similar to, or higher than, global and Nordic estimates. Younger respondents reported less physical abuse than older respondents, but higher levels of emotional abuse. Legislation, greater awareness, public debates and research on child abuse in Iceland have contributed to the growing recognition of the negative consequences of child abuse and strengthened support for prevention strategies.

Conclusion

Icelandic children have reportedly experienced diverse forms of child abuse and neglect from their parents and other carers. Diverse initiatives have been put in place that underline the urgent need to tackle such behaviour.

     

Possible effect of maternal safe food preparation behavior on child malnutrition in Benin,Africa

Background

In many developing countries, faulty complementary feeding practises and frequently contaminated foods are contributing factors to child malnutrition. The aims of this study were to evaluate the nutrition status of, and clarify the maternal safe food preparation behaviors associated with malnutrition in, children aged <5 years in Cotonou, Benin.

Methods

This study targeted 300 mother–child pairs visiting the University Hospital of Mother and Child Cotonou Lagoon. Mothers were interviewed using a structured questionnaire. Child height/length and weight measurements were determined and Z ‐scores were calculated using the 2006 World Health Organization Child Growth Standards. Children with Z ‐score < ?2 were considered to have stunting or be underweight. On logistic regression analysis, significant variables on bivariate analysis, the associations of which were clarified in previous studies, were established as independent variables. Approximately 80% of the children who participated in this study were aged < 1 year. Being underweight was analyzed as a dependent variable.

Results

Regarding nutrition status, 11.0% of the children had stunting and 14.7% were underweight. On logistic regression analysis, underweight was correlated significantly with birthweight. As a remarkable point, food refrigeration was statistically significant. Food refrigeration can possibly be regarded as a maternal safe food preparation behavior.

Conclusions

Maternal safe food preparation behaviors can prevent child malnutrition, even after considering biological and socioeconomic factors.

     

Japanese clinical practice guidelines for allied disorders of Hirschsprung's disease, 2017

Background

Despite the presence of ganglion cells in the rectum, some patients have symptoms similar to those of Hirschsprung's disease. A consensus has yet to be established regarding the terminology for these diseases. We defined this group of diseases as “allied disorders of Hirschsprung's disease” and compiled these guidelines to facilitate accurate clinician diagnosis and provide appropriate treatment strategies for each disease.

Methods

These guidelines were developed using the methodologies in the Medical Information Network Distribution System (MINDS ). Of seven allied disorders, isolated hypoganglionosis; megacystis‐microcolon‐intestinal hypoperistalsis syndrome; and chronic idiopathic intestinal pseudo‐obstruction were selected as targets of clinical questions (CQ ). In a comprehensive search of the Japanese‐ and English‐language articles in PubMed and Ichu‐Shi Web, 836 pieces of evidence related to the CQ were extracted from 288 articles; these pieces of evidence were summarized in an evidence table.

Results

We herein outline the newly established Japanese clinical practice guidelines for allied disorders of Hirschsprung's disease. Given that the target diseases are rare and intractable, most evidence was drawn from case reports and case series. In the CQ , the diagnosis, medication, nutritional support, surgical therapy, and prognosis for each disease are given. We emphasize the importance of full‐thickness intestinal biopsy specimens for the histopathological evaluation of enteric ganglia. Considering the practicality of the guidelines, the recommendations for each CQ were created with protracted discussions among specialists.

Conclusions

Clinical practice recommendations for allied disorders of Hirschprung's disease are given for each CQ , along with an assessment of the current evidence. We hope that the information will be helpful in daily practice and future studies.