BMJ Paediatrics Open最新文献

Background: Antibiotic use for early-onset neonatal sepsis (EONS) is common, but prolonged exposure can lead to poor outcomes. Laboratory capacity and infection prevention initiatives may impact antibiotic use for EONS in neonatal intensive care units. The objective of this study was to examine the influence of institutional capacity on antibiotic prescribing for EONS in India.

Methods: Between September 2023 and January 2024, we surveyed Indian paediatricians and neonatologists regarding institutional capacity and antibiotic prescribing practices for EONS. Five vignettes with varying maternal and infant risk profiles explored participants' decision to initiate empiric antibiotics at birth and the timing of discontinuation of antibiotics in term and preterm infants at risk for EONS. Variation in reported initiation and discontinuation of empiric antibiotic use by institutional capacity and antimicrobial stewardship initiatives were assessed using logistic regression models.

Results: Of 317 respondents, most (91%) reported antimicrobial stewardship initiatives at their institution and 56% reported receiving blood culture results within 48 hours. Screening tests such as complete blood count and C reactive protein were used in 56%-67% of cases, and abnormal results led to longer courses with fewer than 10% of respondents discontinuing antibiotics by 72 hours. When controlling for infant and maternal characteristics, the adjusted OR of observing infants without empiric antibiotics at birth was 0.38 (95% CI 0.16 to 0.70) for participants without infection prevention initiatives and was 1.57 (95% CI 1.05 to 2.35) for participants with timely (<48 hours) reporting of blood culture results, respectively. Infection prevention initiatives and laboratory capacity were not associated with increased odds of early discontinuation of empiric antibiotics for EONS.

Conclusions: Infection prevention and laboratory capacity may decrease the initiation of empiric antibiotics but are not associated with early discontinuation of empiric antibiotics for EONS. The use of sepsis screening tests remains common in Indian neonates and requires additional study.

Objectives: While the target of growth of very preterm infants (VPIs) during Neonatal Intensive care unit (NICU) admission is still controversial, the most accepted objective is that they should follow their intrauterine trajectory in terms of growth and body composition (BC). BC is difficult to measure in clinical daily routine but proxies like body ratios and skinfolds have been used. Prenatal and postnatal factors can influence the growth and BC of VPIs in the NICU.

Design, setting and patients: We conducted a case-control study, including preterm infants born before 32 weeks gestational age at term-corrected age (TCA) and healthy late preterm or term infants as controls and also a retrospective cohort analysis of factors influencing VPI's BC at discharge. Patients had an anthropometric evaluation at discharge including weight, length, head circumference, body circumferences (waist, arm), skinfolds and abdominal ultrasound (US).

Results: 191 VPIs were eligible for discharge visits, but only 83 had a complete evaluation and we collected 26 controls. VPIs at TCA were smaller in weight, length and head circumference but had greater ratios (arm fat-to-circumference and waist-to-length). Abdominal fat assessed by US was smaller in VPIs compared with term infants. Intrauterine growth restriction-VPI remained smaller at TCA but experienced less weight z-score loss. Sex did not seem to influence growth and BC proxies at TCA. Higher nutritional support during the first 2 weeks of life was related to a lower loss of length z-scores, and exclusive human milk feeding correlates with arm fat-to-circumference ratio.

Conclusions: Growth and BC of VPIs can be approached using simpler measures in clinical practice. Arm skinfolds and arm circumferences point to a greater adiposity of VPIs at TCA compared with term infants, while US does not show a greater visceral adiposity. Nutritional factors played a small effect in BC at the time of discharge.

Background: Human milk, especially the mother's own milk (MOM), is highly recommended for preterm babies considering its numerous benefits. Prioritising the use of exclusive MOM in enteral feeding plans is essential for maximising the health and development of preterm babies. This study evaluated the effect of early establishment of full enteral feed (FEF) with exclusive MOM on feeding rate and neonatal nutritional outcomes at discharge among preterm babies.

Methods: A retrospective cohort study was conducted using medical records of single preterm babies born between 27 and 33⁺⁶ weeks of gestational age and admitted to a single tertiary care hospital in South India between June 2019 and May 2022. The primary exposure was the establishment of FEF with exclusive MOM. The outcomes assessed were the exclusive MOM feeding rate and neonatal nutritional outcomes at discharge.

Results: A total of 160 preterm babies met the inclusion criteria. Among these 104 (65%) achieved FEF with exclusive MOM. The exclusive MOM feeding rate at discharge was significantly higher among preterm babies who achieved FEF with exclusive MOM, 91.3% vs 62.5% (RR: 1.46 (95% CI: 1.18 to 1.81)). Preterm babies who achieved FEF with exclusive MOM were five times more likely to continue exclusive MOM feeding at discharge (aOR: 5.37, 95% CI: 2.04 to 14.16). The median time taken to achieve exclusive MOM among the exposure group was 6 days (95% CI: 5.6 to 6.3) compared with 12 days (95% CI: 10.2 to 13.8) for the unexposed group (HR: 0.26 (95% CI: 0.17 to 0.38; p<0.001)). There was no significant difference in growth and neonatal complications between the groups. Availability of MOM within 48 hours was strongly associated with achieving FEF with exclusive MOM, with an adjusted OR of 6.12 (95% CI: 2.81 to 13.30).

Conclusions: Early establishment of FEF with exclusive MOM increases the exclusive MOM feeding rate at discharge. Early access to MOM within 48 hours significantly enhances the likelihood of achieving FEF with exclusive MOM.

SARS-CoV-2 infection during pregnancy can adversely affect maternal and neonatal health, although risks vary depending on the variant of concern (VOC). Omicron, although highly infectious, causes fewer maternal and neonatal complications than earlier VOC, so vaccination may be considered unnecessary in planned pregnancy. Using data from the CRONOS registry, we compared pregnancy outcomes according to VOC and vaccination status. We found that vaccination during pregnancy reduced preterm birth rates compared with unvaccinated or vaccinated women with Omicron infection, without increasing severe neonatal outcomes. Given the risks associated with preterm birth, the study consistently supports vaccination recommendations for women planning pregnancy.

Introduction: Pregestational diabetes mellitus (PGDM) occurs when a woman becomes pregnant after having diabetes mellitus. The presence of diabetes during the entire pregnancy can have an adverse impact on fetal and neonatal outcomes. The objective of this study is to examine the association between PGDM and neonatal outcomes at birth.

Methods and analysis: This prospective hospital-based cohort study is ongoing at three tertiary-level hospitals in Kerala, India. The study targets to recruit 1260 pregnant women. All pregnant women above the age of eighteen who had confirmed pregnancy in an early pregnancy scan and in the first trimester of pregnancy visiting the three study sites for antenatal care will be included in the study. Those who will have a miscarriage, an abortion or twin pregnancies will be excluded from the study. All pregnant women will be evaluated for diabetic state via RBS, HbA1c and FBS based on the International Association of Diabetes and Pregnancy Study Groups criteria during their initial visit to the study sites. PGDM will be diagnosed by the following criteria-FBS ≥126 mg% OR HbA1c ≥6.5 mg% OR Random blood glucose ≥200 mg% on the initial visit or documented prior to the index pregnancy. Neonatal outcomes among the newborn babies will be assessed on the day of birth. We will report adjusted ORs with 95% CI for significant associations derived from multivariable logistic regression analysis.

Ethics and dissemination: The present study received ethical approval from the three study sites. Informed consent will be obtained from the study participants before data collection.

Trial registration number: CTRI/2024/06/068978.

Conclusion: Early identification and management of PGDM among mothers will probably help to prevent adverse neonatal outcomes at birth.

Background: Urban health challenges, particularly for street and slum-dwelling children and families, have emerged as one of the most significant health concerns in India. While there is little published on effective healthcare delivery to these populations, mobile health vans (MHV) have been proposed as a proactive pathway to providing outreach healthcare. Our aims were to evaluate the impact of Bal Umang Drishya Sanstha (BUDS) MHV in providing health and support services to the urban slum populations in Delhi National Capital Region (NCR), focusing on benefits to children.

Methods: This was a mixed-methods evaluation, using routinely collected data. We collated and reviewed available data recorded by the BUDS staff in their health record system from June 2017 to December 2023. Qualitative data were provided by two recent focus group discussions carried out in the community; one with 18 mothers and another with a mixed group of 12 adults-all had used MHV clinics for children in their families. We chose two typical case studies that were reported to the funding bodies.

Results: Between 2017 and 2023, there were a total of 41 062 clinic visits for children<18 years, with visits increasing steadily and peaking at 8864 in 2023. Just under 10% of encounters were referred to specialist services, 122 children were diagnosed with disability. Health education sessions were provided mainly in group settings, to over 70 000 children. Themes extracted from focus group discussions were enhanced access to healthcare, quality of care, value adds from MHV and suggestions for improvement. Families expressed overwhelming appreciation of BUDS MHV. Case studies illustrated the benefits of facilitated access to tertiary healthcare.

Conclusions: MHV can serve as a valuable source of primary healthcare for street and slum-dwelling children and their families. Other benefits are empowering communities with health literacy and negotiating pathways to tertiary care.

Objective: To examine the association between preterm delivery and parental separation and identify associated risk factors.

Methods: All opposite sex, married or common-law parents whose relationship status was available at index delivery and for the next 5 years were eligible in this retrospective population-based cohort study in Manitoba, Canada. Parents of children born preterm were matched 1:5 to parents of children born full-term. Parental separation within 5 years of childbirth was the primary outcome. Secondary outcome was the time to separation. Multivariable Poisson regression model was created to estimate the 5-year incidence rate ratios (IRR) of the primary outcome.

Results: Parents of 6367 children born preterm (n=164 for <28 weeks, n=1196 for 28-33 weeks, n=5007 for 34-36 weeks) and parents of 30 663 children born full-term were included. Compared with parents of children born term (4.2%), only parents of children born at 34-36 weeks had a higher incidence rate of separation (5.5%, IRR: 1.26; 1.09-1.45, p=0.002), although parents of children born at 28-33 weeks (5.4%, IRR: 1.20; 0.93-1.55, p=0.16), and at<28 weeks (5.5%, IRR: 1.27; 0.66-2.45, p=0.48) had similar IRRs. Time to separation was similar between all groups.

Conclusions: Parents of children born at 34-36 weeks had higher separation rates than parents of children born full-term. The risk factors identified can be used to identify and provide supports to at-risk parents.

Purpose: A performance comparison of two myopia control spectacle lens designs, defocus incorporated multiple segments (DIMS) and highly aspherical lenslets (HAL), at slowing myopia progression in a European child/adolescent population. Previous research directly comparing these designs has been limited to Chinese participants and 1-year follow-up. The prevalence of myopia in European child/adolescent has been estimated at 22.60%.

Methods: Retrospective cohort study of individuals (6-17 years) with myopia progression. Participants wore DIMS (Hoya MiyoSmart) or HAL (Essilor Stellest) spectacles for a minimum of 2 years. Axial length (AL) and cycloplegic autorefraction (spherical equivalent refraction (SER)) were measured at baseline and 1 and 2 years.

Results: Mean 1-year SER changes for DIMS were -0.34D (±0.46 SD) and HAL -0.30D (±0.30); 2-year changes for DIMS were -0.50D (±0.64 SD) and HAL -0.63D (±0.56). Mean 1-year AL increases for DIMS were 0.19 mm (±0.56) and HAL 0.15 mm (±0.47); 2-year increases for DIMS were 0.29 mm (±0.63) and HAL 0.32 mm (±0.72). For equivalence margins of 0.25D and 0.50D for SER at 1 and 2 years, respectively, and similarly 0.20 mm and 0.30 mm margins for AL, DIMS and HAL lenses were equivalent apart from AL at 1 year where the 0.21 mm 95% CI upper limit just exceeded 0.20 mm. At both 1 and 2 years, none of the differences in mean SERs or ALs between DIMS and HAL were clinically or statistically significant (p≥0.05 Mann-Whitney U test). Using linear mixed model analysis, the interaction between lens type and time did not significantly affect SER or AL at 1- or 2-year follow-up (p≥0.05). 38.4% of children/adolescents with DIMS had no SER progression at 2 years, compared with 21.9% with HAL (p=0.047).

Conclusion: In a European population, DIMS and HAL lenses are essentially equivalent in their ability to reduce myopia progression and AL elongation over a 2-year follow-up period.

Background: The Convention on the Rights of the Child states that children need to be protected from 'any work that is likely to be hazardous or to interfere with the child's education, or to be harmful to the child's health or physical, mental, spiritual, moral or social development'. We aimed to determine the prevalence and correlates of child labour in five low-income African countries using the sixth wave of UNICEF Multiple Indicator Cluster Surveys (MICS6).

Methods: Data on child labour, reported by the household respondent for a randomly selected child (5-17 years), were extracted from MICS6 reports from Chad, Guinea Bissau, Malawi, Sierra Leone and Togo. Prevalence rates were extracted from three categories of child labour (household chores, economic activity and hazardous work) stratified by gender, age, wealth and residence.

Results: 140 598 children aged 5-17 years (61.2% 5-11; 22.0% 12-14; 16.8% 15-17) were included in the reports; 59 090 (42%) were engaged in child labour. The highest proportion of child labourers by age was 12-14 years old (61.1%) followed by 15-17 years old (51.1%) and 5-11 years old (36.1%). There were differences between countries, with Chad having the highest proportion of working children. Gender differences in working were limited (43.9% boys vs 40.3% girls); rural children were almost twice as likely to be working compared with urban children (47.5% rural vs 25.6% urban) as were children in the poorest quintile compared with those in the wealthiest quintile (46.9% vs 23.7%). Over a third (35.3%) of working children were exposed to hazardous conditions. Older, male, rural or poor children were over-represented among those in hazardous work.

Conclusions: Almost half of all children in these five sub-Saharan African countries are engaged in labour, of which one-third are in hazardous work. MICS6 surveys do not report on working children's health; however, working puts their health and development at risk.