Acta Paediatrica最新文献

Aim: To determine the association between the duration and types of antibiotic exposure and the occurrence of short- and long-term outcomes among preterm, very-low-birthweight (VLBW) infants.

Methods: Retrospective cohort study of VLBW infants born <32 weeks gestation between January 2017-December 2021. Association between antibiotic exposure and the occurrence of death and/or major morbidities, and neurodevelopmental impairment (NDI) at 18-24 months corrected age, was evaluated.

Results: A total of 728 infants were included-median gestation 28 weeks (IQR 26, 30) and median birthweight 1070g (IQR 850, 1300). Compared to no antibiotics, antibiotics exposure >3 days was significantly associated with increased risk of mortality and/or bronchopulmonary dysplasia (BPD)-adjusted odds ratio (AOR) 2.0 (95% CI 1.1-3.8; p=0.03), 3.5 (95% CI 1.6-7.8; p=0.01) and 3.8 (95% CI 1.6-9.0; p<0.001) corresponding to antibiotic exposure of 4-7 days, 8-14 and >14 days, respectively. Additional exposure to broad-spectrum antibiotics was associated with AOR of 3.2 (95% CI 1.6-6.5; p<0.01) for death and/or BPD. There was no significant association between antibiotic exposure and NDI.

Conclusion: Infants who received >3 days of antibiotics and/or additional broad-spectrum antibiotics had significantly increased odds of death and/or BPD compared to no exposure. Antibiotic exposure was not significantly associated with NDI in our population.

Aim: This study aimed to investigate whether antibiotics should be administered to patients aged <2 years with a positive urine culture without pyuria by identifying their clinical characteristics and outcomes in the absence of antibiotic treatment.

Methods: This retrospective, observational study included children aged <2 years with positive findings on a culture of urine obtained using a catheter in the paediatric emergency department between 2016 and 2021. The primary outcome was the spontaneous resolution of fever without antibiotics in patients with a positive urine culture without pyuria. The clinical characteristics of the patients with and without pyuria were also compared.

Results: Of 391 patients, 86 (22%) were negative for pyuria. Of these, 63 (73%) received no antibiotics, and 56 (89%) had spontaneous defervescence and no symptom recurrence. The patients without pyuria had a higher proportion of other possible causes of fever, lower inflammatory markers, fewer cultured bacteria, and a higher proportion of multiple, bacterial species in their culture than the patients with pyuria.

Conclusions: Most of the patients with a positive urine culture without pyuria may not require antibiotics if their fever resolves spontaneously.

Aim: Small for gestational age is defined as birthweight <10th percentile on standardised age and sex-specific growth charts. Rapid catch-up growth seen post-natal is associated with adiposity and cardiometabolic syndromes later in life. Breastfeeding has positive effects on growth in premature and low-birthweight infants. Therefore, examining the impact of exclusive breastfeeding on growth parameters in small for gestational age infants is important.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and checklist guided review and meta-analysis. Four databases were searched.

Results: Five articles (4702 infants) met inclusion criteria. The effect of 4-6 months of breastfeeding on growth was measured using weight, length, head circumference, z-scores and change between timepoints. Study quality was considered very low using Grading of Recommendations, Assessment, Development and Evaluation tool. Random effects models assessed the effect of breastfeeding on weight and length catch-up growth. Differences in weight and length were seen (-8.36, 95%CI: -11.26 to -5.46 and -7.50, 95%CI: -1.92 to -4.18, p < 0.001), with substantial heterogeneity (I² > 90%).

Conclusions: Breastmilk supports growth in small for gestational age infants, though limited evidence exists for catch-up growth in the first 6 months. The magnitude and direction of the effect could not be determined.

Aim: To describe the concept of preterm birth in the history of medicine in France, from the 17th century up until the end of the 20th century, on the basis of old medical textbooks.

Methods: Historical manuscripts and books held in medical libraries and from our personal collection were examined. Digital copies of medical textbooks online were also studied.

Results: Premature deliveries were often referred to as spontaneous abortions or miscarriages, irrespective of the infant's condition at birth. The difference between growth restriction and prematurity was not known. At the end of the 18th century, care for newborn infants entered the age of modern medicine, with observations of the newborn infant and its illnesses and experiments concerning nutrition and thermoregulation treatments. The responsibility for newborn infants, long allocated to midwives and obstetricians, was passed to neonatologists and paediatricians in the 1960s, thanks to developments in our knowledge of neonatal physiology in general and respiration, nutrition and thermoregulation in particular.

Conclusion: This article delays the history of medicine concerned the care of preterm infants by obstetricians and then neonatologists, from the 17th century to modern period.

Aim: Infants born very preterm spend their early postnatal life in a neonatal intensive care unit, where irregular and unpredictable sounds replace the structured and familiar intrauterine auditory environment. Music interventions may contribute to alleviate these deleterious effects by reducing stress and providing a form of environmental enrichment.

Material and methods: This was an ancillary study as part of a blinded randomised controlled clinical trial entitled the effect of music on preterm infant's brain development. It measured the impact of music listening on the autonomic nervous system (ANS), we assessed heart rate variability (HRV) through high-resolution recordings of heart rate monitoring, at three specific postmenstrual ages in premature infants.

Results: From 29 included subjects, 18 were assessed for complete HRV dataset, including nine assigned to the music intervention and nine to the control group. Postmenstrual age appeared to be the main factor influencing HRV from 33 weeks to term equivalent age. Further analyses did not reveal any detectable effect of music intervention on ANS response.

Conclusion: This study found that ANS responses were not modified by recorded music intervention in very preterm infants during wakefulness or sleep onset. Further research is warranted to explore other factors influencing ANS development in this population.

Aim: A study reported that therapeutic hypothermia (TH) did not reduce the combined prognosis of mortality and disability at 18 months, in low- and middle-income countries for patients with hypoxic ischaemic encephalopathy (HIE) who received TH, suggesting its no implementation in these regions. We described characteristics, mortality, and neurological response before and after the use of TH in newborns with HIE within the EpicLatino Neonatal Network (ENN) and described the population of infants with HIE treated and not treated with TH.

Methods: Data were collected from 2015 to 2022 for patients with HIE. Mortality rates and Sarnat scores were compared before and after TH. The Wilcoxon Signed-Rank Test was used for comparisons.

Results: In this observational study 518 neonates of our total population of 26 970, had HIE (1.92%) of whom 150 underwent TH. Ten out of 21 neonatal intensive care units (NICUs) provided TH. The Wilcoxon Signed Rank Test for 138 cases with complete data showed a significant difference.

Conclusion: The findings support the benefits of TH in HIE within this cohort. TH should not be withheld solely due to the economic status of the country. A strict patient selection and TH protocol are essential.

Aim: To evaluate the effect of couplet care on parent-infant closeness among preterm infants.

Methods: A comparison study in a Level III neonatal intensive care unit (NICU) before and after the introduction of couplet care, including stabilising infants in the delivery unit for early skin-to-skin contact, providing mothers' postpartum care in the infant's room and providing the father's bed in the infant's room. The study included parents of preterm infants born below 35 weeks.

Results: Parents of 40 and 66 infants were included before and after couplet care was introduced, respectively. In the linear regression model, the first skin-to-skin contact happened significantly earlier after the introduction than before: mean 4.0 vs. 24.0 h after birth and mean difference -18.5 (95% confidence interval -34.8 to -2.1). A larger proportion of infants received their first skin-to-skin contact within 2 h after birth after the introduction than before (45.5% vs. 8.6%; odds ratio 13.8 [3.6-62.8]). At least one parent was present in the infant's NICU room longer after the introduction than before (mean 21.2 vs. 10.8 h per day; mean difference 10.8 [9.1-12.4]).

Conclusion: Couplet care significantly increased parent-infant closeness during the first weeks of life.

Aim: The aim of this study was to develop an outcome measure for caregivers of children with food allergy.

Methods: A community-informed measure development process was utilised to generate a novel parent-reported outcome tool for caregivers of children with food allergy. We conducted focus groups with parents and caregivers of food-allergic (n = 18) children, following which a team of coders identified themes and generated an initial set of candidate items. These items were reviewed by content-area experts (n = 10) using content validity indices. We then conducted a series of cognitive interviews with parents of children with food allergy (n = 12) validating the instrument draft.

Results: We describe the results of these development steps as well as future steps to produce the final, validated form of the measure. The resultant 91-item measure is intended for parents of children ages two to 12 years.

Conclusion: This measure fills a unique need in the field by leveraging key stakeholders' perspectives to develop and subsequently validate a novel parent-reported measure of parent and family food allergy impacts of children ages two to 12 years old.