Acta Paediatrica最新文献

Aim: This study described the aetiological factors associated with neonatal seizures and the risks for adverse neurological outcomes.

Methods: We identified all infants born at ≥ 36 weeks of gestation between 2009 and 2015 who were diagnosed with or treated for neonatal seizures and registered in the Norwegian Neonatal Network. Data from four nationwide registries provided information on perinatal factors and neurological outcomes until 5 years of age.

Results: There were 892 infants with seizures, which was an incidence of 2.2 per 1000 live births. More than half (58.5%) underwent electroencephalography monitoring and examinations. Mortality before discharge was 8.4% and deaths occurred a median of 5 days after birth. The most frequent presumed aetiology for neonatal seizures was moderate to severe hypoxic-ischaemic encephalopathy (25.1%). Of the 817 survivors, 115 (14.1%) were diagnosed with post-neonatal epilepsy, 119 (14.6%) with cerebral palsy (CP), and 43 (5.3%) had both diagnoses. The epilepsy risk was greatest after neonatal encephalopathy with normal Apgar scores (40.9%) and the CP risk was greatest after an ischaemic stroke (29.9%).

Conclusion: Neonatal seizures were associated with a high risk of mortality and about a quarter were later diagnosed with epilepsy and/or CP. Improved access to electroencephalography and higher usage could improve diagnostics.

Cholecystectomy is a relatively uncommon procedure in the paediatric population. Day-case cholecystectomy is the standard procedure for adults but is not yet established in children. This systematic review assesses the current literature on day-case cholecystectomy in children under 18 years of age. Fourteen final papers were analysed which include 5690 individuals. This systematic review describes the population deemed suitable for day-case procedures, perioperative protocols and the associated outcomes in those who have undergone a day-case procedure. Paediatric day-case cholecystectomy can be safe and effective in certain populations within a defined protocol.

Aim: Visual assessment of neonatal jaundice, especially in infants with dark skin pigmentation, is imprecise, and better tools are needed in low-resource settings. We aimed to assess the accuracy of the Picterus smartphone app in estimating total serum bilirubin (TSB) in darkly pigmented newborn infants, compared with a transcutaneous bilirubin (TcB) device.

Method: A prospective study was conducted in Botswana, where term newborn infants aged 1-14 days were recruited. Bilirubin levels were measured using the Picterus app and a TcB device and compared with laboratory-measured TSB values.

Results: Complete datasets were available for 123 participants. The Pearson's R correlation with TSB was 0.66 (95% confidence interval (CI) 0.55-0.75) for the Picterus app, and 0.84 (95% CI 0.78-0.89) for TcB. For TSB ≥ 250 μmol/L (14.6 mg/dL), the Picterus app tended to underestimate while the TcB overestimated TSB values. For TSB values ≥ 250 μmol/L (14.6 mg/dL), the Picterus app showed 64% sensitivity, compared with 95% for TcB.

Conclusion: The Picterus app underestimated high TSB values, reducing its screening sensitivity. The app, however, holds potential as an accessible screening tool but requires optimization for darkly pigmented newborn infants. The TcB device proved reliable for hyperbilirubinemia screening in this population.

Aim: Individuals born very preterm have specific deficits in the fluid domain of intelligence. We investigated whether changes in brain volume and diffusivity, measured using magnetic resonance imaging, were linked to these deficits.

Method: A systematic search in MEDLINE focused on studies published in English from 1 January 2000 to 11 April 2023. Studies of individuals born very preterm were eligible if data were available on both structural magnetic resonance imaging and intelligence tests or school achievements. These were screened and analysed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: We identified 16 reports on 1576 individuals born very preterm and 754 born term. The age range was 4-30 years. Most local measures of grey matter were reduced in individuals born very preterm, except for volumes in the prefrontal cortex. General intelligence was positively associated with structural brain measures, except for white matter mean diffusivity and prefrontal cortical thickness in some studies. Similar positive associations were found between both crystallised and fluid intelligence and most structural brain measures.

Conclusion: The fluid domain did not show a specific brain signature related to volume or diffusivity. Brain network organisation may be more important for higher-order cognitive function.

Aim: Children with Prader-Willi syndrome (PWS) are at increased risk of both central (CSA) and obstructive sleep apnoea (OSA). Studies examining the effects of growth hormone have focused on older children; however, therapy is often initiated before the age of 2 years. We determined the effects of age on (1) the number of children diagnosed with OSA and CSA; (2) the sleep and respiratory characteristics and (3) the effects of growth hormone on OSA and CSA.

Methods: Retrospective review of children with PWS who underwent polysomnography pre- and post-growth hormone between January 2011 and June 2024.

Results: Fifty-six children (35 < 2 years; 21 ≥ 2 years) pre-growth hormone; 28 children < 2 years and 15 children ≥ 2 years after growth hormone. Pre-growth hormone, children ≥ 2 years had more severe OSA than children < 2 years (p < 0.05). There was no difference between age groups for CSA. Post-growth hormone, 21% of children < 2 years and 20% of children ≥ 2 years developed OSA. CSA resolved post-growth hormone in 21% of children < 2 years and 6% of children ≥ 2 years, whilst CSA developed in 11% and 13%, respectively.

Conclusion: Our study highlights that very young children do not appear to be at higher risk of development of OSA or CSA when treated with growth hormone.

Aim: An electrocardiogram is commonly recommended in breath-holding spell management, mainly to rule out long QT syndrome. This retrospective study investigated the risk of long QT syndrome being misdiagnosed as breath-holding spells in a paediatric population in southern Sweden.

Methods: Data on patient characteristics and diagnostic findings were reviewed for patients aged < 10 years who were diagnosed with long QT syndrome between 2004 and 2018.

Results: Sixteen children were diagnosed with long QT syndrome; 10 were diagnosed through genetic screening, 4 following perinatal cardiac symptoms, and 2 due to episodes of syncope or seizures later diagnosed as epilepsy and breath-holding spells. Three patients were > 24 months old at suspicion of long QT syndrome, and 10 were < 3 months old. No patient exhibited symptoms directly attributable to long QT syndrome, and no diagnosis of long QT syndrome was delayed due to suspicion of or misdiagnosis as breath-holding spells.

Conclusions: The number of symptomatic long QT syndrome cases overlapping with the presentation of breath-holding spells is likely small. The findings of this study suggest that children < 3 months old with suspected breath-holding spells should undergo an electrocardiogram.

Aim: To evaluate the overall effectiveness of kangaroo mother care (KMC) for newborn infants and parents.

Methods: In February 2024, PubMed, Scopus, and Web of Science were searched to identify systematic reviews with meta-analyses of randomised controlled trials that investigated KMC. Two authors independently screened the literature to identify relevant studies, which were extracted by one author and verified by another author.

Results: Thirty-one systematic reviews with meta-analyses were included in the umbrella review. KMC demonstrated multiple benefits for infants, such as improved thermoregulation, glycemic stability, head circumference growth, reduced infection risk, shorter hospital stays, and enhanced physiological stability. Among preterm or low-birthweight newborn infants, KMC was associated with reduced mortality when compared to standard care, particularly in low- and middle-income countries. Maternal benefits included higher breastfeeding rates and improved psychological well-being among mothers practicing KMC compared to mothers who did not practice KMC.

Conclusion: The KMC intervention provides numerous advantages for both infants and mothers. As a safe, simple, and cost-effective intervention, KMC should be widely promoted and integrated into neonatal practices globally. However, limitations in the quality of evidence from previous systematic reviews and meta-analyses warrant cautious interpretation of the findings.

Aim: Children born to mothers with chronic Hepatitis B virus (HBV) infection are at substantial risk of developing chronic HBV-infection without appropriate perinatal post-exposure treatment. This study aimed to explore midwives' and public health nurses' (PHNs) experiences with HBV-post-exposure treatment for infants and identify factors influencing the timeliness of follow-up care.

Methods: Data were collected through individual and focus group interviews with midwives and PHNs in hospitals and catchment-area municipalities and analysed with thematic analysis.

Results: The study revealed significant vulnerabilities in the care pathway, primarily due to fragmented information sharing and a lack of seamless interprofessional collaboration between hospital and municipal healthcare services. Unclear roles, poor communication, and inconsistent documentation impede timely intervention. High workload and reliance on temporary staff further compromised continuity of care. Contrary, the within-hospital joint mother-child medical record and co-location of PHNs, general practitioners, and municipal antenatal care midwives enhanced implementation.

Conclusions: Despite individual awareness of responsibilities, significant system-level challenges persist in ensuring effective interprofessional collaboration and holistic mother-infant pathways after perinatal HBV-exposure in Norway. System-based improvements, such as electronic pregnancy records and automated reporting to the National Immunisation Registry could improve documentation, easing communication and ensuring appropriate and timely follow-up for all high-risk infants.