Acta Paediatrica最新文献

Aim: Knowledge about the clinical role that respiratory viruses play in infants and toddlers with cystic fibrosis (CF) remains limited. We determined the prevalence of respiratory viruses in routine respiratory secretion samples in children aged 0-3 years with CF. Associations with bacterial infections, respiratory tract symptoms and lung function were also explored.

Methods: This prospective, longitudinal, single-centre study added viral polymerase chain reaction detection to the routine monitoring of CF lung disease at Copenhagen University Hospital, Denmark, from 1 July 2019 to 31 August 2020. The existing programme included monthly clinical assessments with endo-laryngeal suction for bacterial culturing and quarterly lung function testing.

Results: We studied 19 children (11 males) with a median age of 1.8 (range 0.11-2.99) years. Viruses were detected in 86/193 (45%) samples. Rhinoviruses and enteroviruses were the most common (88%), followed by adenoviruses (9%), parainfluenza 1-3 (6%) and the respiratory syncytial virus (5%). A positive association was found between the annual incidence of viruses and bacteria, but there was no correlation with respiratory tract symptoms or lung function.

Conclusions: Respiratory viruses were commonly detected in routine respiratory secretion samples. However, the results from this small study did not justify specific conclusions.

Aim: Hydrocephalus surgery with a ventriculoperitoneal shunt is a life-saving treatment, but it has been associated with a high risk of dysfunction and complications. We investigated whether infants who received a ventriculoperitoneal shunt below 12 months of age had a reduced risk of acute shunt dysfunction if they were included in a structured follow-up programme.

Methods: A population-based, retrospective chart review was performed at Uppsala University Children's Hospital, Sweden. Patients were identified by International Classification of Diseases, Tenth Revision codes and surgical codes from 1 January 2005 to 31 December 2019. Those who received the structured follow-up programme from April 2012 were compared with historical controls.

Results: We identified 95 patients (66% male): 47 in the follow-up group and 48 controls. Their mean age was 2.6 (range 0-12) months. There was a high 44% acute shunt dysfunction rate during the first year after primary surgery: 38% in the follow-up group and 50% in the control group (p = 0.25). The difference was not significant.

Conclusion: The structured follow-up programme was not associated with a significant reduction in acute shunt dysfunction. Predictive models could help to identify patients at risk for shunt dysfunction and complications and improve surveillance and follow-up programmes.

Aim: High flow nasal cannula (HFNC) therapy is a form of respiratory support used in children with bronchiolitis. A national guideline for the use of HFNC was published in The Netherlands in 2020. We studied the implementation and use of this guideline.

Methods: We performed a multicentre observational study amongst all hospitals in the North-West part of The Netherlands referring to the same paediatric intensive care unit (PICU). This study consisted of two parts: a comparison of local HFNC protocols to the national guideline and a survey about the use of HFNC amongst paediatricians in the participating centres.

Results: We observed considerable variations between the local protocols and the national protocol, especially regarding criteria to initiate HFNC treatment and weaning practices. Survey results showed that expectations of HFNC widely varied, while the clinical use of HFNC deviated from both the national guideline as well as local protocols, especially for weaning practices and the use of pCO₂ as a parameter for initiation and evaluation of the effect of HFNC.

Conclusion: Implementation of the national guideline for HFNC therapy in bronchiolitis was inefficacious, leading to non-uniform clinical practice.

Aim: Studies on treating infections in children with 22q11.2 deletion syndrome (22q11.2DS) have been limited. We characterised inpatient infections and outpatient antibiotic treatment.

Methods: Children born during 2005-2018 were eligible for this national Finnish retrospective register-based study. We recruited 98 children (54% male) with DiGeorge or velocardiofacial syndrome. The 980 matched controls had a benign murmur diagnosed before 1 year of age. The cumulative incidence of infections and antibiotic prescriptions and total prescriptions were measured.

Results: The median age for 22q11.2DS diagnoses was under 1 year of age (range 0-14 years), with a median follow-up time of 9 years for diagnoses and 11 years for prescriptions. Children with 22q11.2DS had significantly higher hospitalisation rates than the controls for any infection (68.1% vs. 30.5%), gastroenteritis (16.8% vs. 4.0%), pneumonia (23.4% vs. 4.3%), severe bacterial infections, excluding pneumonia or pyelonephritis (15.0% vs. 4.1%) and viral wheezing (23.2% vs. 9.1%). Outpatient antibiotic prescriptions were similar, but the children with 22q11.2DS received them earlier than the controls, with a hazard ratio of 3.29 for ages 0-5 years and 1.84 for the entire follow-up.

Conclusion: Children with 22q11.2DS had significantly more infections requiring hospitalisation than controls without the syndrome.

Aim: Vitamin D is crucial for the immune system, as it enhances pathogen-fighting cells and reduces inflammation. We reviewed serum 25-hydroxyvitamin D (25(OH)D) concentrations in children with viral upper respiratory tract infections (URTIs) and the impact of vitamin D supplements on those infections.

Methods: A mini literature review was conducted from 1 January 2000 to 30 April 2024. It used PubMed, Google Scholar, Cochrane and Scopus and focused on children aged 0-18 years.

Results: The review comprised 12 studies: seven randomised controlled trials, two prospective studies, two case-control studies and one cross-sectional study. The findings included lower 25(OH)D concentrations in children more susceptible to URTIs and significantly lower levels in those with recurrent infections. One study found reduced 25(OH)D concentrations and immunoglobulin G levels in children with URTIs. Of the nine studies that examined vitamin D supplements, five reported benefits for children with URTIs, one only showed short-term effects and three found no significant reductions. Two reported that taking 2000 IU a day did not reduce URTIs any more than 400 IU and high-dose supplements may be unnecessary.

Conclusion: Children with viral URTIs often had lower vitamin D concentrations and supplements frequently helped to reduce the risk of these infections.

Aim: To evaluate whether extremely preterm infants with considerable gastrointestinal (GI) symptoms during the neonatal period, but without major abdominal surgery or necrotising enterocolitis, had an increased probability of developing GI dysfunction later in life.

Methods: A retrospective, case-control study on extremely preterm neonates that underwent an upper gastrointestinal contrast series (UGI) between 2012 and 2017, with UGI used as a marker of considerable GI symptoms. Controls were matched for sex and gestational age. The primary outcome was GI dysfunction requiring ongoing medical support at 5.5 years. Secondary outcomes included respiratory, neurological and growth abnormalities.

Results: Thirty-three patients and 66 controls were included; mean gestational age at birth was 25w + 4d. Cases had an odds ratio of 3.8 (p = 0.005; 95% CI = 1.47-9.82) for developing GI dysfunction at 5.5 years after adjusting for confounders. Neonatal morbidities of sepsis, patent ductus arteriosus and hypothyroidism were more common in cases (p < 0.05). No differences were seen in secondary outcomes at 5.5 years of age.

Conclusion: Extremely preterm infants with unexplained GI symptoms during the neonatal period had increased odds of developing GI dysfunction later in life, which was not explained by other morbidities. We suggest appropriate attention concerning later GI dysfunction in these patients.

Background: The Special Issue articles describe six systems of parental interventions and developmental care several differences among each of the approaches. Nevertheless, on a deeper level there are profound similarities shared across the six systems. These similarities are at the heart of developmental care in general and parental interventions in particular.

Aim: The aim of this paper is to highlight the commonalities of these systems of developmental processes and parental interventions.

Materials and methods: We discuss the concept of symbiosis as a theoretical framework for entering into a new understanding of mother-infant and family systems biology based on perspectives that share themes of interconnection and mutualism.

Results: There are many rigorous, empirical studies of co-regulation, mutualism and interdependence in the human parent-offspring system that is moving us forward into this new territory. Perspectives that emphasize interconnection and interpenetration, reciprocity and mutualism, and integration over reduction are expanding to fill the spaces needed to answer today's questions.

Discussion: Recent contributions of perspectives on neurocognitive development have buttressed the symbiosis view with constructs of prenatal origins, such as 'co-embodiment' and 'co-homeostasis', that illuminate maternal-fetal reciprocities seen to underlie initiation and maintenance of developmental trajectories essential to support fetuses born prematurely into a NICU environment.

Conclusion: The six systems of parental intervention and developmental care presented in this Special Issue represent foundational approaches to developmental care for prematurely born infants. All these approaches recognize forms of reciprocity and mutualism on many levels, always including the infants as active parts of multiple regulatory systems.