Acta Paediatrica最新文献

100% oxygen with the cord intact improves early oxygenation in preterm infants.

Aim: We aimed to investigate prevalence, associated anomalies and survival of congenital intestinal atresia and to examine maternal risk factors for jejunoileal atresia (JIA).

Methods: All children born with, or pregnancies terminated because of, JIA or colonic atresia (CA) in Finland during 1987-2019 were identified from the Finnish Register of Congenital Malformations. Clinical information was obtained from national health registers. Maternal risk factors were assessed using all JIA cases from 2004 to 2017 (n = 101). For each case, five appropriately matched live-born controls were selected.

Results: We identified 175 JIA and 48 CA cases. About half were isolated anomalies. Gastrointestinal anomalies were the most common associated defects (26% in JIA, 35% in CA), followed by cardiac anomalies in JIA (13%) and urinary tract anomalies in CA (19%). Survival was 88% in JIA and 94% in CA. Only two of 224 patients died directly due to intestinal atresia. Maternal insulin use (adjusted odds ratio [aOR] 8.4, 95% CI 1.4-51.0) and propionic acid derivatives (aOR 4.6, 95% CI 1.5-14.8) were associated with increased JIA risk.

Conclusion: Although associated anomalies were frequent, mortality in intestinal atresia remained low. Maternal insulin and propionic acid derivative use may meaningfully contribute to JIA risk.

Level of evidence: IV.

Aim: Medication errors are a leading cause of preventable harm in paediatric patients, both during hospitalisation and after discharge. Evidence on the effectiveness of educational interventions to improve caregiver medication knowledge remains limited.

Methods: A systematic review was conducted following PRISMA guidelines and registered in PROSPERO (ID: 1114374). Databases were searched for studies (2005-2025) involving paediatric patients (0-16 years) discharged on medication and evaluating caregiver-focused educational interventions.

Results: Seven studies (three Randomised controlled trials, three Interrupted Time Series and one cross-sectional) including 1293 participants were included. Interventions commonly combined advanced counselling, health literacy-informed education and standardised dosing tools. Multi-component strategies significantly improved caregiver medication knowledge (p < 0.001 in several studies) and reduced dosing errors (12%-54%, p < 0.05). Only one study assessed adherence, showing improvement. Methodological heterogeneity precluded meta-analysis.

Conclusion: Structured educational interventions effectively enhance caregiver understanding and reduce medication errors at home. Incorporating literacy-sensitive materials, counselling and dosing tools into discharge processes may improve safety and caregiver confidence. Further research should explore long-term impact, cost-effectiveness and applicability across diverse settings.

Aims: We aimed to evaluate the number and success rate of procedures performed by the paediatrics residents in the Neonatal Intensive Care Unit (NICU) such as intubation, umbilical venous catheter (UVC), and epicutaneous cava catheter (ECC) placement.

Methods: We prospectively collected data for NICU residents from 1 May 2020 to 1 May 2022. They reported online the number of procedures they performed, their success, and answered a motivational questionnaire.

Results: Eighteen residents participated. They performed a median number of 11 (1-24) intubation attempts, with a success rate of 116/171 (68%). After four successful attempts in a row, residents exceeded a 75% success rate. They performed a median number of 10 (2-26) UVC insertions, with a success rate of 162/174 (93%) attempts after procedures lasting 40 (12-90) min. Residents did not acquire skills in ECC placement, with only 91/250 (36%) successful attempts after 14 (4-24) attempts and a procedure duration of 55 (25-180) min. The residents who repeated the most procedures were the most competent.

Conclusions: Residents attempted an average of 11 intubations, 10 UVCs, and 14 ECCs placements during their semester. Intubation and UVC placement may be acquired by residents after one semester in the NICU. A follow up of their skills may improve their learning.

Aim: To compare adverse outcomes in neonates born by planned vaginal birth to those born by planned caesarean section.

Method: This retrospective cohort study analysed data from southern Sweden between 1995 and 2015, using the perinatal revision South Register. Only women with singleton, term (≥ 37 + 0 weeks) and cephalic presentation were included. Planned vaginal birth included all vaginal non-instrumental, instrumental, and emergency caesarean births. Logistic regression was used to study the relationship between neonates born via planned vaginal birth and planned caesarean section to adverse neonatal outcomes.

Results: Of 97,886 included, 91,834 (8.9%) underwent planned vaginal birth, and 6052 (91.1%) underwent planned caesareans. After adjustment, neonates with planned caesarean birth had lower odds for UApH < 7.05 [OR 0.64; 95% CI, 0.46-0.88, p = 0.006] but higher need for continuous positive airway pressure [OR 2.22; 95% CI, 1.74-2.85, p < 0.001]. No differences were seen for apgar score < 7 at 5 min, seizures, central nervous system disease or hypoxic ischemic encephalopathy.

Conclusion: While planned caesarean birth may reduce the risk of neonatal acidemia, it is associated with a higher odds of respiratory support after birth. Overall, both planned birth modes demonstrated comparable risks for other serious neonatal outcomes, indicating that decisions should balance these specific differences alongside individual clinical circumstances.

Aim: The incidence of neonatal abstinence syndrome (NAS) has risen, but published data are limited. The aim of this study was to investigate the incidence of NAS and the associated prenatal drug exposure in a Danish population.

Methods: We conducted a historical multicentre cohort study of neonates treated for NAS during 2013-2018. The Danish National Patient Register identified 447 neonates with one of four predefined diagnoses. Reviews of the medical records showed that 98 of the neonates were pharmacologically treated for NAS.

Results: The incidence of NAS in the 6-year period was stable at 0.6 per 1000 live births. The majority of neonates treated for NAS were born to mothers treated with analgesic opioids. However, one-third of the neonates treated for NAS were not exposed to opioids. The most frequent other drugs causing NAS were cannabis, benzodiazepines, antidepressants and psychoactive drugs. Half of the neonates were only exposed to a single drug; 14% were exposed to cannabis and 9% of all neonates treated for NAS were exposed to cannabis as a single drug in addition to tobacco.

Conclusion: The incidence of NAS in the 6-year period was stable. Healthcare professionals should be aware of NAS after prenatal exposure to cannabis.

Aim: Children with cerebral palsy (CP) have reduced bone mineral density (BMD) and increased risk of fragility fracture. Despite the critical role in skeletal development, no studies have examined insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein- 3 (IGFBP-3), and their association with BMD in children with CP when adjusted for bone age. This study assesses the relationship between IGF-1 and IGFBP-3 and BMD in children with CP while accounting for bone age adjustment.

Methods: Cross-sectional study, 81 children with CP GMFCS I-V, aged 2-17 years (55.6% males), underwent clinical examination, DXA scan, blood sampling and bone age assessment. Regression analysis assessed associations between IGF-1, IGFBP-3 and BMD.

Results: Bone age was 0.64 years lower than chronological age (p < 0.05). Adjusted for bone age, BMD showed a positive association with IGF-1 (p < 0.05) and IGFBP-3 (p < 0.05). BMD z-score negatively associated with CP severity (p < 0.05) and CP severity was negatively associated with IGF-1 (p < 0.5) and IGFBP-3 (p < 0.05).

Conclusion: Children with CP had lower bone age than chronological age. BMD was positively associated with IGF-1 and IGFBP-3 adjusted for bone age. These findings are useful in growth hormone and osteoporosis treatment, such as Zoledronate, in CP.

Aim: Medical gases, including nitric oxide, carbon monoxide, hydrogen sulphide and molecular hydrogen, have emerged as key regulators of redox balance and cellular signalling. This mini-review examines their relevance to paediatric endocrine and neurodevelopmental pathways, domains particularly sensitive to oxidative and inflammatory disturbances.

Methods: We surveyed preclinical and clinical studies published between 2007 and 2025 on gas-mediated regulation of metabolic-redox homeostasis, bone biology, pubertal control and neurodevelopment. Additional attention was given to conditions marked by oxidative stress, such as Klinefelter and Turner syndromes.

Results: Evidence shows that gasotransmitters modulate synaptic plasticity, neurotransmission and neuroinflammation, influencing disorders such as autism spectrum disorder, attention-deficit/hyperactivity disorder and outcomes after perinatal hypoxia. They also participate in metabolic regulation, osteogenesis, osteoclast activity and hypothalamic control of puberty. These mechanistic insights highlight the emerging translational potential of gas-mediated pathways in paediatric health.

Conclusion: Although paediatric clinical applications remain limited, advances in omics-based profiling, mechanistic studies and biomaterial-supported gas delivery are rapidly expanding the therapeutic horizon. Integrating gasotransmitter biology into paediatric endocrinology and neurodevelopment may support future diagnostic, preventive and targeted therapeutic strategies.