Paediatric and perinatal epidemiology最新文献

Background: Postneonatal cerebral palsy (PNCP) is rare and requires large databases to be studied over time.

Objectives: To study the time trend of prevalence of PNCP overall and by cause, and to describe the clinical characteristics of children with PNCP according to cause and compared with children with pre/peri/neonatal CP (PPNCP).

Methods: The Surveillance of Cerebral Palsy in Europe (SCPE) database was used. Primary events (the first known chronological event in the causal chain) were classified according to the SCPE classification (six main and 19 sub-categories). Prevalence trends for children born during 1976-2012 were modelled using multilevel generalised linear models. The clinical characteristics of PNCP and PPNCP cases born after 1998 were reported as proportions.

Results: The prevalence rates of PNCP were 1.76 (95% confidence interval (CI) 1.37, 2.23) and 0.82 per 10,000 live births (95% CI 0.73, 0.92) in children born during 1976-1980 and 2006-2012, respectively. The models showed a 2% annual decline in overall prevalence (prevalence rate multiplied by 0.98 each year) and a 10% decline for infectious causes for every 5-year change. The prevalence rate in children born during 2006-2012 was 0.26 per 10,000 (95% CI 0.21, 0.32) for infectious causes, which remained the most frequent. No trend emerged for other causes. Unilateral spastic CP, associated impairments and severe gross motor dysfunction were more frequent in PNCP than in PPNCP, and PNCP showed predominantly grey matter injury (55.6%). Seventeen percent were born preterm. PNCP differed by cause, with cerebrovascular accidents presenting the least severe and hypoxic causes the most severe forms.

Conclusion: Our study confirms the decrease in the prevalence of PNCP in children born up to 2012, particularly for CP, due to infectious causes, which remain the most frequent. Children with PNCP had more severe presentation overall than those with PPNCP, with severity depending on the cause.

Background: Given the high prevalence of both mental health and acute pain conditions during pregnancy, use of antidepressants and analgesic opioids in this period is widespread. Whether single and combined use of these medications is associated with spontaneous preterm birth (sPTB) remains unclear.

Objectives: To investigate the association between maternal prescription opioid and antidepressant medication exposures for co-occurring mental health and acute pain management, either alone or in combination, and sPTB.

Methods: We used Tennessee Medicaid data (2007-2019) linked to birth certificates to conduct a nested case-control study among 15- to 44-year-old pregnant patients with singleton live births. Cases were identified as spontaneous live births between 24 and <37 gestational weeks using a validated birth certificate-based algorithm. We selected up to 10 controls per case, matched on estimated pregnancy start date and other factors. We identified analgesic opioid and antidepressant pharmacy fills to define medication exposures in the 60 days before index date (case delivery date) and categorised them as unexposed, opioid-only, antidepressant-only and combined exposure. We estimated odds ratios (OR) and 95% confidence intervals (CI) using conditional logistic regression, adjusting for confounders. We assessed the additive interaction between opioids and antidepressants by estimating relative excess risk due to interaction.

Results: We identified 25,406 eligible cases of sPTB and 225,771 matched controls. Opioid-only and combined exposures were associated with higher odds of sPTB relative to unexposed (adjusted OR 1.29, 95% CI 1.23, 1.35 and 1.22, 95% CI 1.06, 1.40, respectively), while antidepressant-only exposure was not (1.04, 95% CI 0.96, 1.12). No additive interaction was identified for combined exposure.

Conclusions: Exposure to prescription opioids during pregnancy, but not antidepressants, was associated with increased relative odds of sPTB. Co-exposure to opioids and antidepressants did not elevate the odds of sPTB above what we observed for opioid-only exposure.

Background: With wildfires increasing globally due to climate change, children may be more behaviourally exposed and more physiologically vulnerable to adverse health outcomes.

Objective: To complete a comprehensive investigation of epidemiological studies examining respiratory and non-respiratory impacts of wildfires to identify research gaps and inform decision-making to protect children's health.

Data sources: The databases searched were PubMed, Embase, Scopus and Google Scholar.

Study selection and data extraction: Global epidemiological studies that investigated individuals under the age of 18 and were published from January 2006 to July 2024 were eligible to be included. Studies were included if they had wildfire days, smoke, or pollutants as the main exposure and had an outcome related to children's health. Though a meta-analysis was not possible, results were reported qualitatively through summaries of evidence tables and noteworthy results and the magnitude of the associations for each outcome was reported.

Results: Twenty-four studies were selected. Sixteen studies examined respiratory outcomes and 11 studies included non-respiratory outcomes. A meta-analysis was not conducted, and consistent conclusions could not be made due to the heterogeneity and the small number of studies. Most respiratory-related studies found positive associations between wildfire exposure and adverse respiratory outcomes. All non-respiratory outcomes, except physical activity, had positive associations with wildfire exposure. For most non-respiratory outcomes, only one study evaluated each outcome. Higher-risk children were asthmatic, obese, under the age of five, in low-income countries or with a low socio-economic status.

Conclusions: There is consistent evidence that wildfire exposure is associated with adverse respiratory health in children, globally. There is less consistent evidence for the effect of wildfire exposure on non-respiratory outcomes. Further long-term research on non-respiratory outcomes in children, specifically physical activity, academic success and mental health is needed, especially in high-risk populations.

Background: Physical fitness is one of the most important health indicators in children. Although appropriate body composition or certain lifestyle factors such as frequent physical activity are thought to improve physical fitness, results of previous studies are inconsistent, and most studies were from Western countries.

Objectives: We investigated associations of body composition and modifiable lifestyle factors such as physical activity, screen time, diet and sleep duration with physical fitness in Japanese primary school children.

Methods: 2308 children (age 10-12 years old) in 12 primary schools were analysed in this cross-sectional study. Physical fitness was evaluated by sports battery tests conducted routinely and annually at schools. The total score of sports battery tests, 20-m shuttle run (laps) and grip strength (kg) were selected as outcomes. Information about lifestyle factors was collected by two questionnaires. Associations between lifestyle factors and physical fitness were assessed by multivariable linear mixed models by sex.

Results: Frequent exercise was related to better overall physical fitness. Regarding the 20-m shuttle run, many unfavourable lifestyle factors such as higher BMI in boys (β -7.37, 95% confidence interval [CI] -8.39, -6.35) and girls (β -3.54, 95% CI -4.50, -2.58), longer screen time (β -4.31, 95% CI -7.29, -1.34) in boys and girls (β -5.65, 95% CI -9.01, -2.30); shortest (reference) versus longest, breakfast skipping in boys (β -5.24, 95% CI -8.71, -1.77) and girls (β -3.57, 95% CI -6.84, -0.30); consumers (reference) versus skippers were associated with worse performance. Better quality of diet was associated with better results in the 20-m shuttle run only in girls (β 2.58, 95% CI 0.24, 4.93); lowest (reference) versus highest.

Conclusions: Frequent exercise was related to better physical fitness. Higher BMI and unfavourable lifestyle factors such as longer screen time and breakfast skipping were associated with worse results of the 20-m shuttle run.

Background: Maternal exposure to unfavourable social conditions is associated with a higher rate of perinatal complications, such as placental vascular pathologies. A higher risk of preterm birth (PTB) has also been reported, and variations across studies and settings suggest that different patterns may be involved in this association.

Objective: To assess the association between maternal social deprivation and PTB (overall and by phenotype).

Methods: We analysed 9365 patients included in the PreCARE cohort study. Four dimensions (social isolation, insecure housing, no income from work and absence of standard health insurance) defined maternal social deprivation (exposure). They were considered separately and combined into a social deprivation index (SDI). The associations between social deprivation and PTB <37 weeks (primary outcome) were analysed with univariable and multivariable log-binomial models (adjusted for maternal age, parity, education level and birthplace). Then we used multinomial analysis to examine the association with preterm birth phenotypes (secondary outcome): spontaneous labour, preterm prelabour rupture of membranes (PPROM) and placental vascular pathologies.

Results: In all, 66.3%, 17.8%, 8.9% and 7.0% of patients had an SDI of 0, 1, 2 and 3, respectively. Social isolation affected 4.5% of the patients, insecure housing 15.5%, no income from work 15.6% and no standard health insurance 22.4%. Preterm birth complicated 7.0% of pregnancies (39.8% spontaneous labour, 28.3% PPROM, 21.8% placental vascular pathologies and 10.1% other phenotypes). Neither the univariable nor multivariable analyses found any association between social deprivation and the risk of preterm birth overall (SDI 1 versus 0: aRR 1.02, 95% confidence interval [CI] 0.83, 1.26; 2 versus 0: aRR 1.05, 95% CI 0.80, 1.38; 3 versus 0: aRR 0.92, 95% CI 0.66, 1.29) or its different phenotypes.

Conclusions: In the French PreCARE cohort, we observed no association between markers of social deprivation and the risk of preterm birth, regardless of phenotype.