Acta Paediatrica最新文献

Aim: Estimate the incidence of asthma among children aged 0 to 15 years in Denmark, Finland, Norway and Sweden during 2000-2017.

Methods: Cases of preschool asthma (up to 6 years) and school-age asthma (from 6 years) were identified through national registers using an algorithm including hospital diagnoses and prescription medicines. The respective cumulative incidence (CI) was estimated in 1-year age intervals for each country and birth year.

Results: The CI of algorithm-based preschool asthma peaked for the birth cohorts 2008 or 2009 at 14.8% in Denmark, 11.0% in Finland, 15.1% in Norway and 13.7% in Sweden. For later birth cohorts, a slight decrease was observed. The CI of school-age asthma was 7.1% in Denmark, 10.5% in Finland, 9.7% in Norway and 10.2% in Sweden (children born in 2002). A slight decline over time was seen in Denmark and Norway, and a slight increase in Sweden and Finland.

Conclusion: Finland had a markedly lower CI of preschool asthma and Denmark lower CI of school-age asthma as estimated by prescriptions and hospital diagnoses. Preschool asthma may have plateaued in the Nordic countries. For school-age asthma trends over time varied by country. Differences in diagnostic and prescription practices may have influenced the results.

Aim: This systematic review aimed to report on health outcomes of newborn babies admitted to special care nurseries up to age 1 year, and where possible, compare their outcomes with those of healthy term babies.

Methods: Systematic searches through Ovid MEDLINE, PubMed and Embase databases. We included studies reporting outcomes up to age 1 year for special care nursery babies and moderate-late preterm babies, restricting to studies published after 2000. We dual-screened studies and extracted study characteristics, prevalences and risk of health outcomes. We conducted meta-analysis to combine prevalence and risk estimates of each outcome.

Results: Among 22 585 eligible studies, 21 relevant studies were identified. Jaundice, hypothermia, hypoglycaemia and respiratory disease were prevalent in special care nursery babies, with pooled prevalence from 19% to 32%. Compared with healthy term babies, the special care nursery group had higher risk of all reported outcomes with pooled risk ratios from 1.93 to 14.85. There were limited studies reporting outcomes after discharge.

Conclusion: Babies admitted to special care nurseries face a higher burden of disease compared with non-admitted term babies, but there is currently limited literature describing their post-discharge outcomes.

Aim: To analyse the challenges faced by parents of extremely preterm infants born before 24 weeks of gestation and the potential buffering effect of perceived resources on the family's health continuum.

Methods: The qualitative data were obtained from 70 parents of 70 infants born before 24 weeks of gestation, through open-ended questions in a survey. An inductive content analysis was conducted to identify themes and patterns in the parents' experiences. To enhance the understanding of the findings, salutogenic theory was incorporated to contextualise the emerging patterns of resources and deficits.

Results: Parents described the neonatal care as exemplary. However, the integrated results showed that parents reported profound difficulties characterised as 'living in a bubble' with comprehensive neonatal care and varied access to support and participation. In addition, the parents had to manage a preterm born child with medical complexities and encountered significant barriers between care levels.

Conclusion: The findings highlight the need to improve support systems and address challenges for families of preterm born children. Enhancing collaboration between healthcare providers and families, identifying and overcoming barriers during care, and providing comprehensive support services are crucial. Addressing the parents' experienced deficits may mitigate potential adverse effects on family health outcomes.

Aim: Homecare for neonates has advanced, but combative analysis of contact methods remains unexplored. The aim was to identify predictors of readmission during homecare and to compare home visit, telemedicine or outpatient visit.

Methods: This retrospective study included infants receiving homecare from 1 January 2015 to 31 December 2022. Data were obtained from local databases from six neonatal units in Denmark. The medical records of readmitted infants were reviewed. The main outcome were causes and predictors of readmission during homecare. The secondary outcome was exclusive breastfeeding at discharge.

Results: The cohort consisted of 4827 infants (boys = 54.0%). The rate of unplanned readmissions was 4.6%. A gestational age (GA) <32 weeks (p-value <0.01) or bronchopulmonary dysplasia (BPD) (p-value <0.01) were predictors of readmission. There was no difference in unplanned readmissions based on contact method (p-value = 0.46 for telemedicine, p-value = 0.11 for outpatient visit). The overall exclusive breastfeeding rate at discharge from homecare was 64.1%.

Conclusion: Homecare can be provided for preterm and term infants while establishing oral feeding, with caution on infants with a GA < 32 or BPD. All types of contact methods during homecare investigated can be provided equally in relation to readmission and exclusive breastfeeding.

Aim: We evaluated the frequency and severity of COVID-19, and vaccination status, in children with different forms of inflammatory bowel disease (IBD).

Methods: This was a prospective, observational cohort study that used a questionnaire to gather data on the patients' vaccination doses, medication and disease activity. Disease flare was defined as worsening IBD symptoms and changes in medication. Outcomes were stratified by vaccine type and medication classes.

Results: The questionnaire was completed by 320 children with IBD, and their parents or carers: 52.8% had Crohn disease, 46.9% had ulcerative colitis and 0.3% were unclassified. Just over a third (35.6%) had COVID-19, which was mild in 69.3%, moderate in 27.2% and severe in 3.5%. We found that 127 patients received at least one vaccine dose, but 23 patients were vaccinated after they had COVID-19 and were classified as unvaccinated. This meant that 104 vaccinated patients and 216 unvaccinated patients were studied. A fifth (20.2%) of the vaccinated children developed COVID-19, compared to 43.1% of the unvaccinated children.

Conclusion: Vaccination status had no statistically significant impact on the severity of COVID-19. Morbidity rates were similar between patients with Crohn disease and ulcerative colitis.

Aim: The preferred antibiotic treatment for bacteraemia in infants continues to be debated. We examined the duration of hospital stays as a surrogate for the effectiveness of initial treatment with ceftriaxone versus cefuroxime.

Methods: This was a retrospective review of the medical records of all infants aged 3-36 months, admitted with suspected occult bacteraemia to the paediatric department at Laniado Hospital, Israel, between 2016 and 2022. The effect of antibiotic treatment, namely ceftriaxone versus cefuroxime, on hospital stays was determined, in both the total study population and population subgroups.

Results: We identified 217 patients (59.0% male) with a median age of 13 months and 12.4% had positive blood cultures. Approximately three-quarters (75.6%) received cefuroxime as their initial treatment for bacteraemia and the other quarter (24.4%) received ceftriaxone. The median length of hospital stay was 3.0 (interquartile range 3.0-4.0), with no statistically significant difference between the two drugs. However, we did notice a statistically significant shorter median length of hospital stay among fully vaccinated infants treated with cefuroxime rather than ceftriaxone (p = 0.055).

Conclusion: The length of hospital stay among infants diagnosed with bacteraemia was not affected by whether they initially received ceftriaxone or cefuroxime. Further studies in larger populations are needed.

Aim: The aim was to investigate feeding type at discharge; exclusively breastfeeding (EBF), mixed breastfeeding (MBF), and formula milk feeding (FMF), factors associated with feeding type, and changes in weight-for-age z-score (ΔWAZ) in infants admitted to Danish neonatal units.

Methods: Using data from the Danish National Quality Database for Births and the Danish Newborn Quality Database, we included 8639 mother-infant dyads admitted ≥5 days between February 2019 and December 2021. We used logistic regression to investigate associations between maternal and infant factors and feeding type, and descriptive statistics to describe ΔWAZ and feeding type at discharge.

Results: Of all infants 59.1% were EBF, 16.9% MBF and 24.0% FMF at discharge. Gestational age <37 weeks, caesarean section, multiple births, small for gestational age, weeks at hospital, ≥6 h before skin-to-skin contact, and few weeks at hospital were associated with failure to EBF at discharge. Median (min-max) ΔWAZ in EBF, MBF and FMF infants was -0.44 (-4.78 to 4.88), -0.43 (-3.47 to 4.42) and -0.39 (-3.54 to 4.03), respectively. ΔWAZ was higher in EBF compared to FMF infants, p-value 0.01, but no significant difference in ΔWAZ between MBF and FMF infants, p-value 0.06.

Conclusion: Danish newborn infants demonstrated satisfactory growth during admission to the neonatal unit, independent of feeding type at discharge. Rates of exclusively breastfeeding need improvement.

Aim: The relationship between bronchiolitis and asthma is complex. We assessed whether patients admitted to a paediatric intensive care unit (PICU) with bronchiolitis had a greater risk of developing asthma than patients admitted to a paediatric ward.

Methods: We retrospectively included children under 1 year of age, who were hospitalised for bronchiolitis for the first time at the University Hospital of Caen, France, between 2010 and 2014. The children were divided into two groups: 89 were admitted to the paediatric ward and 89 were admitted to the PICU. We wanted to assess which group developed more asthma before 6 years of age. The Global Initiative for Asthma definition was used.

Results: The median age of the 178 children (55% boys) was 32 (interquartile range 19-56) days. We found that 35% of the PICU group and 19% of the ward group had asthma at 6 years of age. The mean onset of symptoms was 3 years earlier in the PICU group than the ward group (p < 0.01). Both these findings were significant.

Conclusion: The severity of the first episode of bronchiolitis increased the risk of developing asthma symptoms. Regular follow-ups are suggested for infants admitted to PICUs for bronchiolitis.