Acta Paediatrica最新文献

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.

Aim: Touch is the first sense to develop during fetal life. Sensory exploration in preterm infants may underlie early sensory self-awareness. This study aimed to demonstrate the emergence of sensory self-awareness in preterm infants by analysing behavioural responses of the rooting reflex.

Methods: This single-centre, prospective study included preterm infants born between 24 and 37 weeks gestational age (wGA). The rooting reflex was assessed via video in two conditions: external stimulation and facilitated self-stimulation. The rooting reflex was characterised by four progressively complex behavioural responses. The primary outcome was the relative frequency of these behaviours, compared between the two stimulation types.

Results: Twenty-seven children were included (mean gestational age: 30.5 wGA; mean birth weight: 1416 g). Behaviour 3 (mouth opening and/or tongue protrusion without head movement) was significantly more frequent during self-stimulation than external stimulation (35.7% vs. 24.9%, p = 0.005). No significant differences were observed for other behaviours.

Conclusion: The rooting reflex response in preterm infants depends on stimulation type, with a preference for self-stimulation. This suggests an early ability to distinguish self from non-self, supporting the idea that the rooting reflex reflects implicit sensory self-awareness. These findings offer novel insights into preterm infant sensory processing and developmental care.

Trial registration: Favourable opinion from the committee for the protection of individuals CPP N2023-A02220-45. Favourable opinion of Clinical Trial: NCT NI38RC23.0354.

Aim: The aim of this study was to describe the routines for handling mother's own milk and donor human milk in Swedish neonatal care units related to national guidelines.

Methods: A web-based survey of 24 of 38 neonatal units and 19 of 28 human milk banks in Sweden.

Results: Despite national guidelines, breast milk handling varied widely. All units offered lactation support and free breast pumps during hospital stays; nine continued post-discharge. Use of mother's milk differed; some prioritised fresh, others mixed or used frozen milk by age. Donor milk was mainly given to infants < 34-35 weeks or post-surgery, though criteria varied. Some also provided it for hypoglycaemia, growth restriction or hypothermia treatment. Fortification routines varied in both target groups and preparation, ranging from bedside at each feed to once daily. Most milk banks tested donor milk before pasteurisation; one tested both before and after. Five units never declined donations, while others did due to storage limits, surplus supply or time constraints.

Conclusion: Substantial variation in practices indicates a need to clarify and update national guidelines and strengthen milk banking, with relevance both nationally and internationally.

Aim: The lack of data on bleeding risk assessment in children with genetic diseases is concerning given their increased care needs and risk of haemorrhagic complications compared to the general population. Identification of haemostatic disorders is crucial for implementing preventive measures and mitigating bleeding risk. This review aims to provide a comprehensive overview of genetic syndromes that predispose children to bleeding due to haemostatic dysfunction.

Methods: Genetic syndromes associated with bleeding diathesis related to haemostatic disorders were identified using the Human Phenotype Ontology. A comprehensive literature review was conducted to summarise the clinical and laboratory findings, as well as the types of haemostatic abnormalities associated with each genetic syndrome.

Results: Eighteen genetic diseases were included, with platelet dysfunction the most common cause of haemorrhagic syndrome in 17 of them. A coagulation factor deficiency has been described in four diseases. Six diseases expose patients to a risk of severe bleeding. For each genetic disorder, we detailed the mechanism of haemostasis dysfunction and the haemostasis abnormalities that may be observed.

Conclusion: Recognising haemostatic abnormalities in children with genetic diseases allows for more effective clinical management. Systematic coagulation screening is recommended for all patients with the syndromes discussed in this review.

Aim: This study's aim is to evaluate temporal trends in antimicrobial resistance in Shigella sonnei, with a focus on the emergence of ceftriaxone-resistant strains among paediatric patients.

Methods: We conducted a 10-year retrospective study of all paediatric patients diagnosed with Shigella sonnei via stool culture in our emergency department. Clinical features, laboratory results, and length of hospital stay were reviewed to assess trends in ceftriaxone resistance and compare between resistant and sensitive groups.

Results: We analysed 180 paediatric Shigella sonnei cases. Of these, 177 (98.3%) were tested for ceftriaxone susceptibility: 156 (88.1%) were sensitive, and 21 (11.9%) resistant. Resistant strains emerged in 2022 (85.7%, 6/7), rising to 88.2% (15/17) in 2023, showing a strong correlation with calendar year (p < 0.001). Resistant cases showed lower neutrophil (p < 0.01) and sodium levels (p < 0.006).

Conclusion: Ceftriaxone-resistant Shigella sonnei has risen sharply in Israel since 2022, mirroring global trends. This highlights the urgent need for strengthened antimicrobial resistance surveillance and to update current guidelines for the empiric treatment of childhood shigellosis.