Acta Paediatrica最新文献

Aim: Bacterial meningitis (BM) has become less frequent, partly due to national vaccination programmes, and recent data on BM in Nordic children is limited. We reviewed the incidence, aetiology, symptoms, treatment and outcomes of BM in Norwegian children.

Methods: Data were collected from electronic medical records of children under 15 diagnosed with microbiologically confirmed BM at Haukeland University Hospital, Bergen, from 2010 to 2023.

Results: We identified 40 cases of BM, of which 22 (55%) were boys. The median age was 10 days (range 0-5243). The overall annual incidence was 2.8 per 100 000. BM was most frequent in the neonatal period, with an annual incidence of 36 per 100 000 live births. BM after the neonatal period occurred in 1.1 per 100 000 per year. The most common bacteria were group B Streptococcus (50%), Streptococcus pneumoniae (18%) and Escherichia coli (18%). Altered consciousness occurred in 37 patients (93%). The combination of altered consciousness, fever and nuchal rigidity was found in three patients (8%). Long-term disabilities occurred in 15 patients (37%), and two died.

Conclusion: The incidence of BM in Norwegian children was low between 2010 and 2023, with neonates constituting the majority. BM still carries mortality risk and high sequelae rates.

Graphical abstract adapted from Böhmer et al. doi: https://doi.org/10.3389/ti.2023.11260.

Aim: To revise the 2011 Swiss recommendations for the perinatal care of extremely low gestational age neonates (ELGANs).

Methods: Based on review of recent literature, experts from various medical specialties involved in the perinatal care of ELGANs made suggestions for revisions. Following discussions, changes accepted by the whole working group were incorporated into the revised manuscript.

Results: The revised recommendations highlight the importance of individualised risk assessment and emphasise the importance of shared decision-making. While the care of preterm infants with a gestational age below 23 0/7 weeks should be limited to comfort-focused palliative care, risk assessment in preterm infants with a gestational age ≥ 23 0/7 weeks must be individualised by considering additional non-modifiable and modifiable risk factors; decision-making based on gestational age alone must be abandoned.

Conclusions: Management options for ELGANs will fall into three different trajectories. First, if survival-focused care is not in the patient's best interest, preference should be given to comfort-focused palliative care. Second, if survival-focused care clearly is in the patient's best interest, survival-focused care will be provided. Third, if the patient's best interest is uncertain, both survival-focused and comfort-focused palliative care can be considered and parental preferences must be explored, respected, and supported.

Aim: Food allergy in children is a potentially serious condition. Continuous allergen avoidance and risk of anaphylaxis can cause stress, fear and anxiety. The aim of this study was to describe health-related quality of life (HRQoL) in children with food allergies in Sweden, and to examine the impact of age, sex, disease severity and the number of food allergies.

Methods: This cross-sectional study included parents of children, 1-12 years old, with food allergies. Fifty-two parents completed the Food Allergy Quality of Life Questionnaire-Parental Form (FAQLQ-PF) online.

Results: Persistent food allergy was reported in 48 (92%) children. Those who had an epinephrine autoinjector, more than three allergies, symptoms affecting 4-6 organ systems, or an allergy to cow's milk reported worse health-related quality of life (HRQoL) than those without. Age, sex and history of anaphylaxis did not significantly impact HRQoL.

Conclusion: Children with food allergies face reduced HRQoL when burdened by multiple allergens, widespread symptoms or cow's milk allergy, especially those prescribed epinephrine autoinjectors. Identifying and supporting these high-risk groups is essential to improving their well-being.

Aim: This study aimed to compare providers' ratings of delivery and fidelity of a post-natal extended home visiting programme within Child Health Services for visits conducted in families' homes versus the clinic setting.

Methods: A retrospective quantitative study based on questionnaires (n = 3028) from child health services nurses and social workers was conducted using non-parametric tests to determine if there were any differences in professionals' perceptions of programme delivery and/or quality.

Results: The results from this study indicate significant differences in professionals' perceptions of fidelity, confidence in abilities, content coverage, alliance-building, and emotional climate between home and clinic visits, with higher ratings given in all areas for visits conducted in the home.

Conclusion: While clinic visits may offer certain logistical advantages for professionals and primary care clinics, they may not provide the optimal environment for delivering the programme with fidelity, which is necessary for achieving the desired outcomes for child health and family well-being. The findings need to be taken into consideration when making decisions about resource allocation for early childhood programmes aimed at equitable health for a more sustainable society.

Aim: This paper describes sudden infant death syndrome (SIDS) from a medical historical perspective and explores how risk-reducing advice was developed. A particular focus is the dramatic reduction in the incidence of SIDS in Sweden.

Methods: A mini review of the literature was carried out.

Results: Sudden unexpected deaths in infants have been recognised since biblical times and were attributed to overlaying. These are assumed to equate to modern-day SIDS cases. SIDS became an established entity in the late 1960s, and the incidence increased in Sweden in the 1970s and the 1980s, when prone sleeping was the norm. However, case-control studies from New Zealand and England showed that prone sleeping, maternal smoking, not breastfeeding and over-heating, were over-represented in SIDS. Advice in the early 1990s focused on supine sleeping and tackled these other key issues. This led to a drastic reduction in SIDS in Sweden, where the incidence fell sharply from 1.1 to 1.2 per 1000 live births. Since 2017 the incidence has been stable at around 0.1 per 1000. Abandoning prone sleeping for infants was the most important change.

Conclusion: The development of effective advice to reduce the risk of SIDS has been a major pediatric accomplishment.

Aim: This study aimed to describe cerebral magnetic resonance imaging (MRI) findings in children with cerebral palsy (CP) and compare them with risk factors and clinical features.

Methods: Data on 1867 children with CP born in 2000-2016 were retrieved from the Norwegian Quality and Surveillance Registry for CP and linked to the Medical Birth Registry. Descriptive statistics were used.

Results: MRI scans were performed in 1463 children, that revealed one predominant pathogenic finding: 44.6% white matter injuries, 28.4% grey matter injuries, 13.5% normal, 7.9% maldevelopments and 5.5% miscellaneous. The proportion of grey matter injuries increased as gestational age increased (p < 0.01). However, white matter injuries were more common in children born at term and small for gestational age (SGA) than in those not SGA (p = 0.03). In term-born children, grey matter injuries decreased with increasing 5-min Apgar scores (p < 0.01). Half of the children with spastic CP had white matter injuries, while half of those with dyskinetic CP had grey matter injuries. White matter injuries were the most common, regardless of the Gross Motor Function Classification System level. Children with epilepsy mainly had grey matter injuries.

Conclusion: This study highlighted the vulnerability of white and grey matter in preterm and term infants with CP, respectively.

Aim: Screening criteria for retinopathy of prematurity (ROP) vary among countries. Early detection of ROP and minimising the burden of screening are important.

Methods: We analysed data from very preterm infants born in Switzerland between 2006 and 2022. Logistic regression models were fitted to evaluate 17 potential risk factors for ROP treatment.

Results: 168/11354 patients (median (range) gestational age (GA) 29.6 (23.0-31.9) weeks) required ROP treatment. All would have been detected and screening burden would have been reduced by 56% if screening had required meeting ≥ 1 of the following criteria: GA < 27 weeks (89.3%), birth weight < 1000 g (97.0%), intraventricular haemorrhage≥II° (24.0%), congenital tumour (1.2%). We identified six statistically significant risk factors for ROP: GA (adjusted odds ratio (aOR) 0.46, 95% CI 0.40-0.52, p < 0.001), birth weight z-score (aOR 0.58, 95% CI 0.46-0.73, p < 0.001), duration of supplemental oxygen (aOR 1.01 95% CI 1.01-1.02, p < 0.001), duration of mechanical ventilation (OR 1.01, 95% CI 1.00-1.02, p = 0.018), caesarean section (OR 1.84, 95% CI 1.06-3.36, p = 0.038), and congenital tumour (OR 26.3, 95% CI 2.71-189, p = 0.002). The model allowed for excellent prediction of ROP treatment (AUC 0.963, 95% CI 0.944-0.981).

Conclusions: Safely reducing the burden of ROP screening appears achievable in Switzerland.