Acta Paediatrica最新文献

Aim: Neonatal hyperglycaemia is associated with a multitude of adverse outcomes, including mortality and impaired neurological development. The aim of this study was to characterise the current management of neonatal hyperglycaemia in Swedish neonatal units.

Methods: A digital survey was sent to 27 Swedish neonatal units providing care to preterm infants born before 32 completed gestational weeks.

Results: Sixty-eight responses were collected from 21 different units. Thirty-two percent (22/68) of clinicians reported having a local treatment guideline for neonatal hyperglycaemia. Hyperglycaemia was defined as a glucose concentration above a value in the range of 8.0-10.0 mmol/L by 62.5% of clinicians, while 16.7% and 21.8% used a definition between 10.1 and 12.0 mmol/L and > 12 mmol/L, respectively. Intravenous glucose reduction was initiated at higher glucose concentrations by clinicians working at university hospital units (p = 0.006). Glucose concentration threshold for initiation of insulin treatment varied between 8 and 30 mmol/L. Three clinicians (3/35 (8.5%)) reported having experienced problems with frequent hypoglycaemia during ongoing insulin treatment.

Conclusions: This study demonstrates extensive differences in clinical practice regarding neonatal hyperglycaemia both within and between neonatal units in Sweden. Randomised controlled trials are needed to provide evidence for clinical guidelines and to improve and standardise the care of these infants.

Aim: Young people with childhood-onset motor disabilities face unique challenges in understanding and managing their condition. This study explored how they learnt about their condition.

Method: A descriptive qualitative study was conducted in 2023-2024 at a Swiss paediatric neurorehabilitation unit. Ten participants aged 15-24 years were recruited through purposive sampling, representing diverse conditions and socio-educational backgrounds. Inductive thematic analysis was conducted on interview transcripts.

Results: Four themes emerged. First, learning paths revealed that participants gradually acquired knowledge about their condition. Early explanations often involved parents and visual aids, with moments of awareness and evolving information needs shaping their learning over time. Second, building blocks of understanding showed that knowledge was constructed through interactions with physicians, therapists, parents, peers and the Internet. Third, interacting with healthcare professionals highlighted the importance of trust and continuity in relationships with healthcare professionals to support learning. Last, improving the learning process suggested strategies such as dedicated consultations for recapping information during adolescence and increasing disability awareness in schools.

Conclusion: Young people with motor disabilities require information and support tailored to their individual learning needs. Adapting these resources could enhance their understanding of their condition, supporting the development of their autonomy and self-advocacy within healthcare.

Aim: Diagnostic error can result in the appendectomy of a normal appendix, commonly known as negative appendectomy (NA). Missed appendicitis (MA) is related to a poor outcome. The aim of this study was to determine whether there are factors in presentation associated with NA or MA.

Methods: This is a single-centre, retrospective chart review of histology-confirmed appendicitis over an eight-year period. We defined MA as appendicitis diagnosed within the week of a paediatric emergency department discharge for a similar presentation. Negative appendectomy was defined as a histologic examination of the appendix that lacked signs of inflammation.

Results: A total of 845 children had appendicitis on pathologic examination. NA included 69 children, and MA 29 children. Inflammatory markers were lower for children with NA than for children with appendicitis, and children with NA were less likely to undergo CT. Almost half of the children with MA were discharged without laboratory evaluation, and almost three quarters were discharged without imaging evaluation. Half of the children with MA returned with complicated appendicitis.

Conclusion: Increased rates of laboratory and/or imaging evaluations in patients with abdominal pain or non-classic gastroenteritis, along with observation or early follow-up, may decrease MA. More frequent use of ultrasound and MRI may keep the NA rate to a minimum.

Aim: To describe the long-term neurodevelopmental outcomes of asphyxiated neonates treated with hypothermia in association with neonatal magnetic resonance imaging (MRI) findings.

Methods: We evaluated, retrospectively, clinical and radiological single-centre data at 0, 2, and 5 years of age of 53 asphyxiated neonates born between 2005 and 2015. Neonatal cranial MRI was re-evaluated using the Weeke score ranging from 0 (normal finding) to 55 (cerebral devastation) by a single neuroradiologist blinded to patient outcomes. Neurodevelopmental outcomes were evaluated using the Bayley Scales of Infant Development (BSID) at 2 years, and tests assessing intellectual performance at 5 years of age.

Results: Of the 191 asphyxiated neonates treated with hypothermia, 53 returned for their 5-year follow-up. There were 10 children with MRI scores ≥ 10, all of whom had epilepsy, 9 had severe cognitive impairment, and 9 had cerebral palsy. In contrast, MRI scores < 10 were poorly predictive of later development. BSID at 2 years of age showed good correlation with IQ scores at 5 years of age (R_s = 0.58, p < 0.001).

Conclusion: The Weeke score can be used to identify severely impaired children in the neonatal period. In contrast, the neurocognitive test results at 2 years of age were indicative of mild or moderate impairment at 5 years of age.

Aim: Newborn infants with critical aortic arch obstruction are often undiagnosed at discharge, despite screening. This study investigated if adding the perfusion index improved early detection.

Methods: We retrospectively studied 38 newborn infants with critical aortic arch obstruction, who were routinely screened in 2014-2019 by 13 Swedish hospitals using pulse oximetry and the perfusion index. They were identified through surgery records and national mortality databases. The controls were 512 healthy newborn infants from one hospital. Optimal perfusion index cut-offs were determined using frequency distribution analysis.

Results: The groups had similar median gestational ages and birth weight. No infants with critical aortic arch obstruction were diagnosed just because of a positive perfusion index result. However, the right-hand perfusion index was significantly higher in the cases than in controls (p < 0.001). A perfusion index of > 3%, or positive pulse oximetry or positive physical examination, yielded 76% sensitivity and 85% specificity, with an area under the receiver operating characteristic curve of 0.81 (range 0.73-0.89, p < 0.0001). Pulse oximetry and just neonatal physical examinations had a lower sensitivity (45%, p = 0.009).

Conclusion: A high perfusion index in the right hand enhanced critical aortic arch obstruction screening and repeated measurements should be explored to minimise false positives.

Aim: We aimed to investigate the prevalence and factors associated with C-reactive protein (CRP) and procalcitonin (PCT) discordance in febrile infants with serious bacterial infections (SBIs).

Methods: We performed a retrospective review of febrile infants ≤ 90 days old presenting to the emergency department between December 2018 and June 2023. We compared conservative and pragmatic thresholds for PCT (< 0.5 ng/mL and < 1.7 ng/mL) and CRP (< 10 mg/L and < 20 mg/L). Discordance was defined as normal CRP with abnormal PCT and vice versa. Performance was presented using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results: Among 3459 infants, 426 infants (12.3%) had SBIs, among whom 355 (83.3%) had both CRP and PCT performed. Overall, a conservative CRP threshold had the highest sensitivity (74.1%, 95% CI 69.2%-78.6%) and NPV (95.6%, 95% CI 94.6%-96.4%). Among those with SBIs, 148/355 (41.7%) had a normal PCT (< 1.7 ng/mL) and an abnormal CRP (≥ 20 mg/L), while 16/355 (4.5%) had a normal CRP (< 20 mg/L) and an abnormal PCT (≥ 1.7 ng/mL). An increased discordance, specifically abnormal CRP with normal PCT, was found in males, infants 29-90 days old, and those with urinary tract infections.

Conclusion: SBI clinical decision rules should consider CRP-PCT discordance in specific patient populations.