Optimal birth weight percentile cut‐offs in defining small‐ or large‐for‐gestational‐age

Aims: It remains questionable what birth weight for gestational age percentile cut‐offs should be used in defining clinically important poor or excessive foetal growth. We aimed to evaluate the optimal birth weight percentile cut‐offs for defining small‐ or large‐for‐gestational‐age (SGA or LGA). Methods: In a birth cohort‐based analysis of 17 979 120 non‐malformation singleton live births, U.S. 1995–2001, we assessed the optimal birth weight percentile cut‐offs for defining SGA and LGA. The 25th–75th percentile group served as the reference. Primary outcomes are the risk ratios (RR) of neonatal death and low 5‐min Apgar score (<4) comparing SGA or LGA versus the reference group. More than 2‐fold risk elevations were considered clinically significant. Results: The 15th birth weight cut‐off already identified SGA infants at more than 2‐fold risk of neonatal death at pre‐term, term or post‐term, except for extremely pre‐term births <28 weeks (continuous risk reductions over increasing birth weight percentiles). LGA was associated with a reduced risk of low 5‐min Apgar score at pre‐term, but an elevated risk at term and post‐term. The 97th cut‐off identified LGA infants at 2‐fold risk of low 5‐min Apgar at term. Conclusion: The commonly used 10th and 90th birth weight percentile cut‐offs for defining SGA and LGA respectively seem largely arbitrary. The 15th and 97th percentiles may be the optimal cut‐offs to define SGA and LGA respectively.     

Bed‐sharing among six‐month‐old infants in western Sweden

Aim: In spite of several reports of an increased risk of sudden infant death syndrome (SIDS) in connection with bed‐sharing, it is not an uncommon practice. The aim of this study was to examine bed‐sharing at 6 months of age and the factors that are associated with bed‐sharing. Methods: Our cohort comprised 8176 randomly chosen families. At 6 month of age, the families received an invitation to the study, with a questionnaire, which was completed by 5605 families (response rate 68.5%). Results: Of the families, 19.8% bed‐shared. In the multivariate analysis, we found a correlation between breast‐feeding and bed‐sharing (breast‐feeding at 6 months: OR 1.94; 95% CI 1.56, 2.41). Moreover, we found an association with 3+ nightly awakenings at 6 months (2.70; 2.20, 3.32). It was more common to share a bed if the parent was single (2.04; 1.19, 3.51) and less common if the infant was bottle‐fed in the first week (0.70; 0.54, 0.90). Never using a pacifier was associated with a higher frequency of bed‐sharing. Conclusion: We found a correlation between breast‐feeding and bed‐sharing as well as between sleeping problems and a single parent. A lower percentage of infants sleeping in the parental bed were seen in association with formula feeding in the first week after birth.     

Two‐year diagnostic stability in early‐onset first‐episode psychosis

Background: Only one study has used a prospective method to analyze the diagnostic stability of first psychotic episodes in children and adolescents. The Child and Adolescent First‐Episode Psychosis Study (CAFEPS) is a 2‐year, prospective longitudinal study of early‐onset first episodes of psychosis (EO‐FEP). Aim: To describe diagnostic stability and the variables related to diagnostic changes. Methods: Participants were 83 patients (aged 9–17 years) with an EO‐FEP consecutively attended. They were assessed with a structured interview (Kiddie‐Schedule for Affective Disorders and Schizophrenia, Present and Lifetime version) and clinical scales at baseline and after 2 years. Results: The global consistency for all diagnoses was 63.9%. The small group of bipolar disorder had high stability (92.31%) as did the group with schizophrenia spectrum disorders (90.00%). Depressive disorder had lower stability (37.50%) and the lowest values were for psychotic disorder not otherwise specified (11.76%) and brief psychotic disorder (0%).The most frequent diagnostic shift was to schizophrenia spectrum and bipolar disorders. One group of patients did not meet the criteria for any diagnosis at follow‐up. Independent predictors of change to schizophrenia spectrum disorders were lower scores on the Children’s Global Assessment Scale (CGAS) and the Hamilton Depression Rating Scale. Predictors of not having a diagnosis at follow‐up were the CGAS and the Strauss–Carpenter Outcome Scale. Conclusions: Global diagnostic stability was 63.9%. Bipolar and schizophrenia spectrum disorders were the most stable diagnoses, while depressive disorder and other psychosis the least stable. Psychosocial functioning at baseline was a good predictor of diagnosis at follow‐up. These data show the need for longitudinal follow‐up in EO‐FEP before a stable diagnosis is reached.     

Hydrocortisone and long‐term outcomes in very‐low‐birthweight infants

Background: The long‐term effects of hydrocortisone (HDC) used for very‐low‐birthweight (VLBW) infants with chronic lung disease (CLD) are not fully understood. The aim of this study was to examine the short‐term clinical effects and long‐term impact of a physiological replacement dose of HDC on acute deterioration of CLD in VLBW infants. Methods: This prospective case–control study included 110 of the 174 VLBW infants admitted to our facility between 2003 and 2006 who were followed up to a corrected age of 18 months. Infant deaths and infants with congenital deformities were excluded from the study. The infants were classified into the following three groups: infants with CLD and treated with HDC (1–2 mg/kg/dose) due to progressive deterioration in oxygenation (CLD treatment group; n= 24); infants with CLD but not treated with HDC (CLD untreated group; n= 40); and infants without CLD (non‐CLD group; n= 46). Results: The fraction of inspired oxygen (F_IO₂) in the CLD treatment group improved significantly after treatment (P < 0.01). There were no significant differences among the three groups in terms of growth and neurodevelopmental quotient at the corrected age of 18 months following adjustment for birthweight, sex, and presence of light‐for‐date infants. There were also no significant intergroup differences in all three areas of developmental quotient. Conclusions: Physiological doses of HDC replacement are effective in treating acute deterioration in oxygenation in VLBW infants with CLD. Furthermore, this treatment modality did not adversely affect the growth and development of infants at the corrected age of 18 months.     

Self‐esteem in 6‐ to 16‐year‐olds with monosymptomatic nocturnal enuresis

Aim: Childhood nocturnal enuresis (NE) and incontinence has been shown to be associated with increased behavioural problems and reduced self‐esteem (SE) in Western populations. The impact on Asian children, however, is not known. This study investigates the relationship between SE and monosymptomatic NE in Malaysian children aged 6 to 16 years. Method: Children with wetting frequency of at least 4 out of 14 nights were recruited with controls matched for age, gender and race. SE scores were obtained using the ‘I Think I Am’ questionnaire for five domains: body image, talents and skills, psychological well‐being, relationship with family and relationship with others. Results: A total of 126 children were recruited; 22 enuretics aged 6–9 years and their matched controls (Group1) and 41 enuretics aged 10–16 years and their matched controls (Group 2). SE scores were similar between the enuretic and controls in Group 1, whereas in Group 2, enuretics had significantly lower scores (P < 0.05) in ‘body image’, ‘relationship with others’ and total SE scores. This difference was more pronounced among girls, adolescents and those who wet more than 10/14 nights. Conclusion: The SE of Malaysian children with monosymptomatic NE aged 10 years and above is significantly lower than their peers. This effect is seen particularly among girls, adolescents and those with frequent wetting. In the light of these findings, the ‘wait and see’ approach by the Malaysian medical profession is no longer appropriate. Treatment should begin before the age of 10 years.     

Health and the use of health care services in 5‐year‐old very‐low‐birth‐weight infants

Aim: We aimed to study the effect of prematurity, time of birth and level of birth hospital on morbidity and the use of health care services at age 5. Methods: This national study included all very‐low‐birth‐weight infants (VLBWI, <32 gestational weeks or birth weight ≤1500 g) born in Finnish level II or III hospitals in 2001–2002 (n = 918), and full‐term controls (n = 381). Parental questionnaires and register data were used to compare morbidity, and the use of health care services between VLBWI and full‐term controls, and within VLBWI according to the time of birth and birth hospital level. Results: Cerebral palsy, retinopathy of prematurity, other ophthalmic problems, respiratory infections, asthma or chronic lung disease, and inguinal hernia were overrepresented in VLBWI compared with the controls. VLBWI had more outpatient and inpatient days than the controls. The time of birth and birth hospital level were not associated with the use of services or with prematurity‐related morbidity. Conclusion: Although morbidity and the use of health care services were increased in the surviving VLBWI, the average use of services was relatively small at age 5. In surviving VLBWI, the time of birth and the birth hospital level did not affect morbidity or the use of services.     

Non‐immediate‐reading skin tests and prolonged challenges in non‐immediate hypersensitivity to beta‐lactams in children

Background

A minority of children reporting non‐immediate reactions to beta‐lactams (BLs) are allergic. Allergy workup usually includes late‐reading (48‐72 hours) skin tests (ST) and short (1‐3 days) drug provocation tests (DPT), regardless of the chronology of the index reaction. The sensitivity of hyper‐late‐reading (≥6‐7 days) ST and of prolonged DPT for the diagnosis of non‐immediate hypersensitivity to BLs is yet to be determined.

Objectives

To establish the diagnostic values of late‐reading ST and hyper‐late‐reading ST and of prolonged DPT in children reporting non‐immediate reactions to BLs.

Methods

Prospective assessment of children reporting non‐immediate reactions to BLs with late‐ and additional hyper‐late‐reading intradermal (ID) and patch tests, and if negative, with prolonged DPT.

Results

Five hundred and fifty children reporting reactions to a single or several BLs (674 suspected BLs) were included. Non‐immediate hypersensitivity to BLs was diagnosed in 63 children (11.5%), reporting 66 reactions (9.8%), based on responses in ST (n = 17, 25.8%: 5 to ID, 8 to patch tests, and 4 to both tests), DPT (n = 43, 65.2%), and clinical history (n = 6, 9.1%), including 3/9 children with severe cutaneous adverse reactions. Skin test positivity was observed after the 6‐7th day in 14/17 children, and DPT positivity after a median time of 3 days. No severe reaction was observed after ST or during prolonged DPT.

Conclusion

Additional hyper‐late‐reading of ST enhanced their positivity. However, their overall sensitivity remained weak, especially in non‐severe cases. Prolonged DPT are safe and may improve the performance of DPT in the diagnosis of non‐immediate hypersensitivity to BLs.     

Coping strategies for hospital‐related fears in pre‐school‐aged children

Aim: The aim of this study was to describe the child‐reported coping strategies for hospital‐related fears in 4–6‐year‐old children. Method: The data were collected by semi‐structured interviews of 4–6‐year‐old volunteering children (n= 82) in Finland. Thirty‐four children were interviewed in hospital, and 48 in kindergarten. The children were chosen through a purposive sampling method, in which volunteers were asked to take part in the study. The data were analysed with quantitative and qualitative methods. Results: The most frequent child‐reported coping strategies were: the presence of parents and other family members (81/517, 15.7%), the help of the hospital personnel (58/517, 11.2%), positive images and humour (57/517, 11%), play (57/517, 11%) and the child's own safety toy (45/517, 8.7%). The children interviewed in hospital mentioned significantly more often play (P= 0.000) as their coping strategy than children interviewed in a kindergarten. Children interviewed in kindergarten expressed significantly more often the presence of parents (P= 0.032) and the help of the doctor (P= 0.012) as their coping strategy than the children interviewed in the hospital. Conclusions: The results showed that children have many coping strategies, especially ones in which the children themselves play an active role. Besides, the traditional methods for alleviating fear, children need possibilities to use coping methods in which they have an active role giving them a feeling of some control over the hospital environment and medical procedures.     

Administration of high‐dose interleukin‐2 in a 2‐year‐old with metastatic melanoma

Malignant melanoma is rare in pediatrics, and therapies for patients with disseminated disease have not been well studied. This report describes our experience with the use of high‐dose interleukin 2 (aldesleukin, IL‐2) in a 2‐year‐old child with metastatic melanoma and describes our approach for the administration of this agent to young patients. Pediatr Blood Cancer 2009; 53:1346–1348. © 2009 Wiley‐Liss, Inc.     

Closure of aortopulmonary window using Nit‐Occlud® PDA‐R device in a 3‐month‐old infant

Aortopulmonary window (APW) is a rare abnormality in which a pulmonary defect exists between the ascending aorta and the main pulmonary artery. Given that it may result in cardiac failure and pulmonary vascular disease in the early period, treatment needs to be performed without delay. In addition to surgical treatment, transcatheter closure may also be performed for selected patients. This study describes the case of an infant diagnosed with APW and who underwent successful transcatheter closure using a Nit‐Occlud_®PDA‐R device.