Paediatric and perinatal epidemiology最新文献

Background: Studies show that foetal and birthweight-for-gestational age centiles are poor predictors of serious neonatal morbidity and neonatal mortality (SNMM) in univariable models.

Objective: We assessed the predictive performance of multivariable SNMM models based on maternal/pregnancy characteristics, with and without birthweight centiles.

Methods: The study was based on all live births in the United States, 2019-2021, with data obtained from the period live birth-infant death files of the National Center for Health Statistics. SNMM was defined as any one or more of the following: 5-minute Apgar score < 4, seizures, assisted ventilation for> 30 or neonatal death. SNMM was modelled by log-linear regression on maternal/pregnancy characteristics as predictors, with and without birthweight centiles. Models were developed for live births at 24-42 weeks' and 39 weeks' gestation to all women and those with hypertensive disorders or pre-existing diabetes. Model performance was assessed using area under the curve (AUC).

Results: The study population included 10,487,243 live births and 221,728 SNMM cases (2.1 per 100 live births). The models with all live births at 24-42 weeks' gestation had AUCs of 0.83 (95% confidence interval [CI] 0.82, 0.83) based on maternal/pregnancy characteristics and 0.83 (95% CI 0.83, 0.84) based on maternal/pregnancy characteristics and birthweight centiles. However, AUCs of models based on all live births at 39 weeks' gestation were 0.66 (95% CI 0.64, 0.68) with maternal/pregnancy characteristics and 0.69 (95% CI 0.68, 0.71) with maternal/pregnancy characteristics and birthweight centiles. AUCs of the models with live births at 39 weeks' gestation to women with pre-existing diabetes were 0.69 (95% CI 0.66, 0.72) based on maternal/pregnancy characteristics, and 0.77 (95% CI 0.74, 0.79) with the addition of birthweight centiles.

Conclusions: Birthweight centiles improve multivariable SNMM predictive performance in specific subpopulations, although evaluation of decision thresholds is required to determine the clinical importance of improvement in predictive ability.

Background: Antimicrobial resistance (AMR) poses a critical public health issue, exacerbated by the overuse and misuse of antibiotics. Children are particularly susceptible to bacterial infections and are frequently prescribed antibiotics.

Objective: This study examined trends in antibiotic dispensing to children aged under 13 years in Australia between 2013 and 2023.

Methods: This retrospective observational study used a 10% random sample of dispensing records for nationally subsidised prescription antibiotics. The number of children dispensed an antibiotic was calculated for each year and expressed per 100 children. Trends were analysed using joinpoint regression overall and by age group, sex, the World Health Organisation's Access, Watch, Reserve (AWaRe) system of antibiotic classification and antibiotic subtype.

Results: Between 2013 and 2023, 3,406,208 antibiotic prescriptions were dispensed to 554,837 children. There was a decrease in the total number of antibiotic prescriptions dispensed, falling from 103 prescriptions dispensed for every 100 children in 2013 to 63 prescriptions in 2023 (annual percent change [APC]: -6.9, 95% CI: -9.8, -4.4). While decreases were observed for medications classified as 'Access' (APC: -5.8, 95% CI: -8.7, -3.1), the largest decrease was observed in 'Watch' medications (APC: -15.0, 95% CI: -19.4, -11.7). Decreases were observed in the proportion of children dispensed an antibiotic, declining from 45.7% in 2013 to 33.6% in 2023 (APC: -4.7%, 95% CI: -7.1%, -2.5%). Reductions in dispensing were observed overall and by sex, age groups and most antibiotic types.

Conclusions: Antibiotic dispensing in Australian children has decreased over the past decade, for all ages, sexes and antibiotic sub-classes, likely reflecting implemented policies and efforts to curb overuse of antibiotic medicines and AMR during this period.

Background: Maternal acetaminophen use during pregnancy is common globally. However, its potential risks for neurodevelopmental disorders in offspring, including attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID), remain uncertain in Asian populations.

Objective: We examined the association between maternal acetaminophen use during pregnancy and diagnoses of neurodevelopmental disorders in offspring.

Methods: This nationwide birth cohort study included 217,602 children contributing 966,546 person-years using a nationwide administrative database from 2005 to 2022. We investigated the association between maternal acetaminophen use during pregnancy and offspring's neurodevelopmental outcomes using Cox proportional hazards models, with primary analyses based on 1:1 propensity score (PS) matching. The robustness of the primary findings was evaluated through alternative statistical approaches (adjusted model and inverse probability of treatment weighting [IPTW]), sibling comparison, probabilistic bias analyses for exposure misclassification, and negative exposure control methods.

Results: Of the 217,602 children, 85,853 (39.5%) were exposed to acetaminophen during pregnancy. PS-matched analyses (N = 42,123 children per comparator) yielded hazard ratios of 1.08 (95% CI: 1.00, 1.16) for composite neurodevelopmental outcomes, 1.22 (95% CI: 1.09, 1.36) for ADHD, 1.06 (95% CI: 0.98, 1.15) for ASD, and 1.02 (95% CI: 0.90, 1.19) for ID. Similar findings were observed in adjusted models and IPTW methods. Sibling comparisons (n = 23,593) showed point estimates in the opposite direction (e.g., HR of ADHD, 0.86; 95% CI, 0.52, 1.44). Probabilistic bias analysis for exposure misclassification suggested overestimation due to unrecorded over-the-counter acetaminophen use, with effect estimates shifting towards the null as misclassification increased. Negative exposure controls (e.g., NSAIDs and acetaminophen use after pregnancy) indicated potential positive bias in the observed associations.

Conclusions: Although PS-matched analyses indicated small increases in risk, sensitivity analyses suggested that unmeasured confounding, misclassification and other biases may partially explain these associations.

Background: Early-onset neonatal infections are among the most common neonatal diseases. However, the long-term outcomes of the infections are not well understood.

Objective: To study the association between early-onset neonatal infection and attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

Methods: A nationwide register-based cohort study was conducted, including near-term and term children born between 1997 and 2013 with follow-up until 2021. An early-onset infection was defined as an invasive bacterial infection occurring within the first week of life, including both physician-assigned diagnoses and positive bacterial cultures. ADHD and ASD were defined by diagnoses or prescriptions of relevant medication. Associations between sepsis and the neurodevelopmental disorders were investigated using multivariable Cox regression to estimate adjusted hazard ratios (HR), whereas associations with meningitis were examined using person-time incidence rate ratios (IRR). Sibling-matched analyses were also conducted for associations with sepsis.

Results: A total of 981,869 children were included, with 8154 defined as having sepsis and 152 defined as having meningitis. Among these, only 257 children had culture-positive sepsis, whereas 32 had culture-positive meningitis. The incidence rate of ADHD and ASD for children with sepsis was 4.5 per 1000 and 3.3 per 1000 person-years, respectively. Sepsis was associated with an increased adjusted likelihood of both ADHD (HR 1.28, 95% CI 1.17, 1.39) and ASD (HR 1.43, 95% CI 1.30, 1.58). However, sibling-matched analyses especially attenuated the association with ADHD (HR 1.12, 95% CI 0.93, 1.34). Point estimates suggested that children with meningitis also had an increased likelihood of both ADHD (IRR 1.77, 95% CI 0.88, 3.17) and ASD (IRR 2.05, 95% CI 0.89, 4.04).

Conclusions: Early-onset sepsis was associated with an increased likelihood of ASD, whereas the majority of the association with ADHD could be explained by unmeasured shared familial confounding.

Background: While individual socioeconomic attributes have been widely studied in relation to child growth, the associations with broader, area-level socio-demographic characteristics of residential areas have not been thoroughly assessed.

Objectives: To examine the associations between area-level socio-demographic features of small residential areas and child growth trajectories.

Methods: We conducted a population-based retrospective cohort study, including all children born in Israel from 2004 to 2018, who underwent postnatal follow-up in the Mother and Child Health Clinics (MCHC) of the Ministry of Health. The MCHC network covers a significant proportion of the Israeli paediatric population, providing vaccination and developmental assessments to children up to 6 years old. Socio-demographic scoring was retrieved from the Israel Bureau of Statistics' geographical unit grading system, established for 990 rural areas and 1629 micro-geographical areas in 81 cities, using various population measurements. Height-for-age (HAZ) and weight-for-age (WAZ) z-scores were calculated using data from MCHC visits at birth and specific intervals.

Results: A total of 1,485,198 children were included (51.3% male). The mean birthweight and length were 3210 ± 52.2 g (z = -0.22) and 49.4 ± 3.33 cm (z = -0.06), respectively. Children resided in low (47%), intermediate (24.4%) and high (28.5%) socioeconomic areas. Throughout follow-up, children from low SES areas had consistently lower HAZ and WAZ scores across all birthweight groups, particularly among those with normal and high birthweight. In linear mixed-effects models, birth HAZ and WAZ scores were higher in high vs. low SES areas (β = 0.3 and β = 0.1, respectively), with non-linear growth trajectories characterised by early advantages in higher SES groups, a plateau in mid-childhood and renewed growth acceleration later in childhood.

Conclusions: The study provides evidence of impaired child growth in lower socio-demographic areas. This underscores the importance of identifying areas based on global attributes to identify regions predisposed to child growth impairment, particularly in developed nations.

Background: There is limited data on the extent of psychotropic medication exposure through breast milk in infants. This information is essential for identifying research gaps and informing clinical practice.

Objectives: To examine the prevalence and trend of psychotropic medication exposure among exclusively breastfed infants.

Methods: A population-based descriptive study among exclusively breastfed infants during 2012-2022, using Danish nationwide registers. Psychotropic prescriptions (Anatomical Therapeutic Chemical Classification System codes N05-N06) filled by mothers during the recorded breastfeeding period were identified in the Prescription Registry. We calculated the prevalence of potential exposure to any psychotropic medication (expressed per 1000 infants), categorised by drug class and stratified by maternal demographic and clinical factors.

Results: Among 446,573 exclusively breastfed infants, 7882 (17.6 per 1000 infants, 95% confidence interval [CI] 17.2, 18.1) were exposed to at least one, and 699 (1.6 per 1000 infants, 95% CI 1.5, 1.7) to two different psychotropic medications via breastfeeding. The most frequent exposure was antidepressants, with a prevalence of 15.0 per 1000 infants (95% CI 14.6, 15.4), primarily sertraline. This was followed by hypnotics and sedatives, at 1.3 per 1000 infants (95% CI 1.2, 1.4), predominantly zopiclone, and antipsychotics, at 1.1 per 1000 infants (95% CI 1.0, 1.2), mainly quetiapine. Psychotropic medication exposure in exclusively breastfed infants increased 1.39-fold, from 15.7 per 1000 infants (95% CI 14.5, 17.1) in 2012 to 21.8 per 1000 infants (95% CI 20.3, 23.4) in 2022. This increase was observed for all drug classes except anxiolytics. The prevalence of psychotropic medication exposure varied by maternal demographic and clinical factors.

Conclusions: Approximately 2% of exclusively breastfed infants are potentially exposed to psychotropic medications through breast milk in Denmark. The prevalence has shown an upward trend over time, especially for psychostimulants.