Showing papers in "Acta Paediatrica in 2015"

Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis

Abstract: Aim: To systematically review the evidence on the associations between breastfeeding and overweight / obesity blood pressure total cholesterol and type 2 diabetes. Methods: Two independent literature searches were carried out using the MEDLINE LILACS SCIELO and Web of Science databases. Studies restricted to infants and those without an internal comparison group were excluded. Fixed- and random-effects models were used to pool the estimates. Results: Breastfed subjects were less likely to be considered obese / overweight [pooled odds ratio: 0.74 (95% confidence interval (CI): 0.70; 0.78)] (n = 113). Among the 11 high-quality studies the association was smaller [pooled odds ratio: 0.87 (95%CI: 0.76; 0.99)]. Total cholesterol (n = 46) was independent of breastfeeding [pooled mean difference: -0.01 mmol/L (95%CI: -0.05; 0.02)]. Systolic blood pressure (n = 43) was lower among breastfed subjects [mean difference: -0.80 (95%CI: -1.17; -0.43)] but no association was observed among larger studies and for diastolic blood pressure (n = 38) [mean difference: -0.24 (95%CI: -0.50; 0.02)]. For type 2 diabetes (n = 11) the odds ratio was lower among those subjects who had been breastfed [pooled odds ratio: 0.65 (95%CI: 0.49; 0.86)]. Conclusion: Breastfeeding decreased the odds of type 2 diabetes and based on high-quality studies decreased by 13% the odds of overweight / obesity. No associations were found for total cholesterol or blood pressure. ©2015 The Authors. Open Access.

Breastfeeding and maternal health outcomes: a systematic review and meta-analysis

Abstract: Aim: To evaluate the effect of breastfeeding on long-term (breast carcinoma ovarian carcinoma osteoporosis and type 2 diabetes mellitus) and short-term (lactational amenorrhoea postpartum depression postpartum weight change) maternal health outcomes. Methods: A systematic literature search was conducted in PubMed Cochrane Library and CABI databases. Outcome estimates of odds ratios or relative risks or standardised mean differences were pooled. In cases of heterogeneity subgroup analysis and meta-regression were explored. Results: Breastfeeding >12 months was associated with reduced risk of breast and ovarian carcinoma by 26% and 37% respectively. No conclusive evidence of an association between breastfeeding and bone mineral density was found. Breastfeeding was associated with 32% lower risk of type 2 diabetes. Exclusive breastfeeding and predominant breastfeeding were associated with longer duration of amenorrhoea. Shorter duration of breastfeeding was associated with higher risk of postpartum depression. Evidence suggesting an association of breastfeeding with postpartum weight change was lacking. Conclusion: This review supports the hypothesis that breastfeeding is protective against breast and ovarian carcinoma and exclusive breastfeeding and predominant breastfeeding increase the duration of lactational amenorrhoea. There is evidence that breastfeeding reduces the risk of type 2 diabetes. However an association between breastfeeding and bone mineral density or maternal depression or postpartum weight change was not evident. ©2015 The Authors. Open Access.

Optimal breastfeeding practices and infant and child mortality: A systematic review and meta-analysis

Abstract: Social inequality in BMI change and gestational weight gain in the first and second pregnancy among women in Sweden

Breastfeeding and intelligence: a systematic review and meta-analysis.

Abstract: Aim: This study was aimed at systematically reviewing evidence of the association between breastfeeding and performance in intelligence tests. Methods: Two independent searches were carried out using Medline LILACS SCIELO and Web of Science. Studies restricted to infants and those where estimates were not adjusted for stimulation or interaction at home were excluded. Fixed- and random-effects models were used to pool the effect estimates and a random-effects regression was used to assess potential sources of heterogeneity. Results: We included 17 studies with 18 estimates of the relationship between breastfeeding and performance in intelligence tests. In a random-effects model breastfed subjects achieved a higher IQ [mean difference: 3.44 points (95% confidence interval: 2.30; 4.58)]. We found no evidence of publication bias. Studies that controlled for maternal IQ showed a smaller benefit from breastfeeding [mean difference 2.62 points (95% confidence interval: 1.25; 3.98)]. In the meta-regression none of the study characteristics explained the heterogeneity among the studies. Conclusion: Breastfeeding is related to improved performance in intelligence tests. A positive effect of breastfeeding on cognition was also observed in a randomised trial. This suggests that the association is causal. ©2015 The Authors. Open Access.

Breastfeeding and asthma and allergies: a systematic review and meta‐analysis

Abstract: Aim: To systematically review the association between breastfeeding and childhood allergic disease. Methods: Predetermined inclusion / exclusion criteria identified 89 articles from PubMed CINAHL and EMBASE databases. Meta-analyses performed for categories of breastfeeding and allergic outcomes. Meta-regression explored heterogeneity. Results: More vs. less breastfeeding (duration) was associated with reduced risk of asthma for children (5-18 years) particularly in medium- / low-income countries and with reduced risk of allergic rhinitis

Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis.

Abstract: Aim: To provide comprehensive evidence of the effect of interventions on early initiation exclusive continued and any breastfeeding rates when delivered in five settings: (i) Health systems and services (ii) Home and family environment (iii) Community environment (iv) Work environment (v) Policy environment or a combination of any of above. Methods: Of 23977 titles identified through a systematic literature search in PUBMED Cochrane and CABI 195 articles relevant to our objective were included. We reported the pooled relative risk and corresponding 95% confidence intervals as our outcome estimate. In cases of high heterogeneity we explored its causes by subgroup analysis and meta-regression and applied random effects model. Results: Intervention delivery in combination of settings seemed to have higher improvements in breastfeeding rates. Greatest improvements in early initiation of breastfeeding exclusive breastfeeding and continued breastfeeding rates were seen when counselling or education were provided concurrently in home and community health systems and community health systems and home settings respectively. Baby friendly hospital support at health system was the most effective intervention to improve rates of any breastfeeding. Conclusion: To promote breastfeeding interventions should be delivered in a combination of settings by involving health systems home and family and the community environment concurrently. ©2015 The Authors. Open Access.

Postnatal growth in preterm infants and later health outcomes: a systematic review.

Abstract: In preterm infants, poor postnatal growth is associated with adverse neurocognitive outcomes; conversely, rapid postnatal growth is supposedly harmful for future development of metabolic diseases. Conclusion: In this systematic review, observational studies reported consistent positive associations between postnatal weight or head growth and neurocognitive outcomes; however, there was limited evidence from the few intervention studies. Evidence linking postnatal weight gain to later adiposity and other cardiovascular disease risk factors in preterm infants was also limited.

Breastfeeding and childhood acute otitis media: a systematic review and meta‐analysis

Abstract: Aim: To synthesise the evidence on the association between duration and exclusivity of breastfeeding and the risk of acute otitis media (AOM). Methods: Systematic review and meta-analysis following searching of PubMed CINAHL and EMBASE electronic databases. Results: Twenty-four studies all from the USA or Europe met the inclusion criteria. In the pooled analyses any form of breastfeeding was found to be protective for AOM in the first 2 years of life. Exclusive breastfeeding for the first 6 months was associated with the greatest protection (OR 0.57 95% CI 0.44 0.75) followed by ‘more vs less’ breastfeeding (OR 0.67; 0.59 0.76) and ‘ever vs never’ breastfeeding (OR 0.67; 0.56 0.80). Conclusion: This systematic review and meta-analysis provides evidence that breastfeeding protects against AOM until 2 years of age but protection is greater for exclusive breastfeeding and breastfeeding of longer duration. Exclusive breastfeeding during the first 6 months was associated with around a 43% reduction in ever having AOM in the first 2 years of life. After 2 years of age there is no evidence that breastfeeding protects against AOM; however there were few studies and the evidence quality was low. ©2015 The Authors. Open Access.

The Gateway Hypothesis of substance abuse: developmental, biological and societal perspectives.

Abstract: The Gateway Hypothesis describes how tobacco or alcohol use precedes marijuana and other illicit drug use. We review the epidemiological data, explore the underlying molecular mechanisms in mice and discuss the societal implications of the hypothesis, including the use of e-cigarettes by young people. Conclusion Our mouse model identifies biological processes underlying the hypothesis, showing that nicotine is a gateway drug that exerts a priming effect on cocaine through increased global acetylation in the striatum.

Breastfeeding and the risk of dental caries: a systematic review and meta-analysis

Abstract: Aim: To synthesise the current evidence for the associations between breastfeeding and dental caries with respect to specific windows of early childhood caries risk. Methods: Systematic review meta-analyses and narrative synthesis following searches of PubMed CINAHL and EMBASE databases. Results: Sixty-three papers included. Children exposed to longer versus shorter duration of breastfeeding up to age 12 months (more versus less breastfeeding) had a reduced risk of caries (OR 0.50; 95%CI 0.25 0.99 I2 86.8%). Children breastfed >12 months had an increased risk of caries when compared with children breastfed 12 months those fed nocturnally or more frequently had a further increased caries risk (five studies OR 7.14; 3.14 16.23 I2 77.1%). There was a lack of studies on children aged >12 months simultaneously assessing caries risk in breastfed bottle-fed and children not bottle or breastfed alongside specific breastfeeding practices consuming sweet drinks and foods and oral hygiene practices limiting our ability to tease out the risks attributable to each. Conclusion: Breastfeeding in infancy may protect against dental caries. Further research needed to understand the increased risk of caries in children breastfed after 12 months. ©2015 The Authors. Open Access.

Effect of breastfeeding on malocclusions: a systematic review and meta‐analysis

Abstract: Aim: The objective of this systematic review was to investigate whether breastfeeding decreases the risk of malocclusions. Methods: Six databases were systematically searched to the end of October 2014. Observational and interventional studies were included. Breastfeeding was evaluated in three categories: (i) ever versus never; (ii) exclusive versus absence of exclusive; and (iii) longer periods versus shorter periods. All types of malocclusion were considered as the outcome. Pooled adjusted odds ratio and its 95% confidence interval (95%CI) were obtained from meta-analyses. Heterogeneity was assessed with both the Q-test and the I-square. Funnel plots and Egger’s test were employed to assess publication bias. Results: Forty-eight studies were included in the systematic review and 41 were included in the overall meta-analysis (n = 27 023 participants). Subjects who were ever breastfed were less likely to develop malocclusions than those never breastfed (OR 0.34; 95% CI 0.24; 0.48) those who were exclusively breastfed presented lower risk to present malocclusion than those with absence of exclusive breastfeeding (OR 0.54; 95% CI 0.38; 0.77) and subjects longer breastfed were less likely to have malocclusions than those shorter breastfed (OR 0.40; 95% CI 0.29; 0.54). Conclusion: Breastfeeding decreases the risk of malocclusions. ©2015 The Authors. Open Access.

Smoking during pregnancy affects foetal brain development

Abstract: Environmental factors such as maternal smoking can significantly modulate genetically programmed brain development during foetal life. This review looks at how prenatal smoking exposure modulates brain development, including new evidence on the effects of smoking on foetal brain development and function. Conclusion Smoking during pregnancy exposes the foetus to thousands of health-threatening chemicals, restricting foetal body and head growth. Alterations in brain structure and function have been seen in children exposed to prenatal smoking.

Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants

Abstract: Aim Providing less invasive surfactant administration (LISA) to spontaneously breathing preterm infants has been reported to reduce mechanical ventilation and bronchopulmonary dysplasia (BPD) in randomised controlled trials. This large cohort study compared these outcome measures between LISA-treated infants and controls. Methods Infants receiving LISA, who were born before 32 gestational weeks and enrolled in the German Neonatal Network, were matched to control infants by gestational age, umbilical cord pH, Apgar-score at 5 min, small for gestational age status, antenatal treatment with steroids, gender and highest supplemental oxygen during the first 12 h of life. Outcome data were compared with chi-square and Mann–Whitney U-tests and adjusted for multiple comparisons. Results Between 2009 and 2012, 1103 infants were treated with LISA at 37 centres. LISA infants had lower rates of mechanical ventilation (41% versus 62%, p < 0.001), postnatal dexamethasone treatment (2.5% versus 7%, p < 0.001), BPD (12% versus 18%, p = 0.001) and BPD or death (14% versus 21%, p < 0.001) than the controls. Conclusion Surfactant treatment of spontaneously breathing infants was associated with lower rates of mechanical ventilation and BPD. Additional large-scale randomised controlled trials are needed to assess the possible long-term benefits of LISA.

A workshop report on the development of the Cow's Milk-related Symptom Score awareness tool for young children.

Abstract: Clinicians with expertise in managing children with gastrointestinal problems and/or atopic diseases attended a workshop in Brussels in September 2014 to review the literature and determine whether a clinical score derived from symptoms associated with the ingestion of cow's milk proteins could help primary healthcare providers. The Cow's Milk-related Symptom Score (CoMiSS), which considers general manifestations, dermatological, gastrointestinal and respiratory symptoms, was developed as an awareness tool for cow's milk-related symptoms. It can also be used to evaluate and quantify the evolution of symptoms during therapeutic interventions, but does not diagnose cow's milk protein allergy and does not replace a food challenge. Its usefulness needs to be evaluated by a prospective randomised study.

Effect of breastfeeding promotion interventions on child growth: a systematic review and meta-analysis

Abstract: AIM: To update a previous systematic review and meta-analyses about the effect of breastfeeding promotion interventions on child growth. METHODS: Studies evaluating the effect of any type of breastfeeding promotion intervention on child weight length (or height) and weight/height (or BMI) were screened. Papers published between 2006 and 2014 were checked using the following databases: PubMed/MEDLINE Embase Cochrane Database of Systematic Reviews Lilacs and SciELO. RESULTS: Sixteen studies were added to 19 other studies identified in the previous review resulting in 35 studies. Meta-analyses of studies reporting on mean weight length weight/length or BMI showed that the interventions had no impact on weight or length/height z scores [pooled effect: 0.03 (95% confidence interval: -0.06;0.12) and 0.03 (95% confidence interval: -0.02;0.08) respectively] and had a modest but significant reduction in body mass index/weight-for-height z scores [z score mean difference: -0.06 (95% confidence interval: -0.12;0.00)] which was limited to studies from low- and high-incomes settings. For all three outcomes there was important heterogeneity among studies which should be taken into account when interpreting the results. CONCLUSION: Breastfeeding promotion interventions were not associated with significant changes in weight or length but led to a modest albeit significant reduction in body mass index/weight-for-height z scores. (c)2015 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.

Problematic Internet use is associated with substance use in young adolescents.

Abstract: AIM: This study examined whether problematic Internet use was associated with substance use among young adolescents and assessed whether this association accounted for the use of tobacco, alcohol, cannabis and other drugs. METHODS: Using the Internet Addiction Test we divided a representative sample of 3,067 adolescents in Switzerland (mean age 14 years) into regular and problematic Internet users. We performed a bivariate analysis and two logistic regression models, to analyse substances separately and simultaneously, and developed a log-linear model to define the associations between significant variables. RESULTS: Problematic Internet users were more likely to be female, to use substances, to come from non-intact families, to report poor emotional wellbeing and to be below average students. The first model showed significant associations between problematic users and each substance, with adjusted odds ratios of 2.05 for tobacco, 1.72 for alcohol, 1.94 for cannabis and 2.73 for other drugs. Only smoking remained significant in the second model, with an adjusted odds ratio of 1.71. CONCLUSIONS: Problematic Internet use is associated with other risky behaviours and may be an important early predictor of adolescent substance use. Therefore it should be included in the psychosocial screening of adolescents. This article is protected by copyright. All rights reserved. Language: en

Perinatal conditions related to growth restriction and inflammation are associated with an increased risk of bronchopulmonary dysplasia

Abstract: AIM: Bronchopulmonary dysplasia (BPD) is a frequent chronic lung disease in preterm infants, and we aimed to identify factors associated with this condition in infants with respiratory distress syn ...

Evening media exposure reduces night-time sleep.

Abstract: Aim To investigate whether evening media exposure, bedroom media use and night-time sleep duration at age 6 months are associated with night-time sleep duration in 12-month-old Thai infants. Methods We enrolled 208 infants in this study at 6 months of age. They were followed-up at 12 months of age. A sleep diary was used to document the infant's sleep onset and wake time at each visit. Night-time sleep duration was then calculated at both ages. Screen media exposure in the household was assessed in depth at both visits. Results Infants who were exposed to screen media in the evening at 12 months of age had a 28-min decrease in 12-month night-time sleep duration on weekdays. Moreover, infants who were exposed to screen media in the evening at age 6 months and 12 months had shorter 12-month night-time sleep duration compared with those who were not exposed to screen media after 7 pm at both ages. Night-time sleep duration at 12 months of age was also directly related to 6-month night-time sleep duration. Conclusion Infants exposed to screen media in the evening at 12 months of age had decreased 12-month night-time sleep duration. To promote good sleep hygiene and optimal sleep for infants at this age, screen media exposure after 7 pm should be avoided.

Sexual debut before the age of 14 leads to poorer psychosocial health and risky behaviour in later life

Abstract: Aim: This study investigated the relationship between sexual debut before 14 years of age and socio-demographics, sexual experience, health, experience of child abuse and behaviour at 18 years of a ...

Systematic review of neonatal seizure management strategies provides guidance on anti-epileptic treatment.

Abstract: There is a lack of scientific evidence to support the best management of neonatal seizures. Current strategies for neonatal seizure management were investigated by analysis of all surveys published ...

Summarising the health effects of breastfeeding

Abstract: This supplement to Acta Paediatrica presents a series of meta-analyses and systematic literature reviews examining a variety of health effects potentially related to breastfeeding. The authors carefully study a wide breadth of the literature to describe current knowledge on the benefits of breast-feeding or put differently the harms from not breastfeeding and the effectiveness of interventions to promote breastfeeding. Five key messages emerge from the analyses presented. First the health benefits of breastfeeding are substantial. Second it is critical to examine the breadth of the literature on an outcome of interest before drawing any conclusions. Third the mechanisms by which breastfeeding affect health are extremely varied and this variation implies that different metrics of breastfeeding behaviour must be utilised to truly understand the relationships of interest. Fourth many of the articles these meta-analyses are based on suffer from methodological weaknesses that limit the ability to make firm conclusions. Fifth breastfeeding practices are responsive to interventions delivered in health systems communities and homes. The largest effects are achieved when interventions are delivered in combination. (Excerpts) Copyright 2015 The Authors. Open Access.

The endocrine disruptor bisphenol A may play a role in the aetiopathogenesis of polycystic ovary syndrome in adolescent girls

Abstract: Aim Experimental in vitro studies have shown that bisphenol A affects steroidogenesis, folliculogenesis and ovarian morphology The aim of this study was to investigate the role of the endocrine disruptor bisphenol A in the aetiopathogenesis of polycystic ovary syndrome (PCOS) in adolescents and its relationship with metabolic parameters, insulin resistance and obesity in this population Methods A total of 112 girls with PCOS and 61 controls between 13 and 19 years of age were enrolled in the study Serum bisphenol A levels were measured by high-pressure liquid chromatography An oral glucose tolerance test was also performed Results Adolescents with PCOS had markedly increased serum bisphenol A levels (mean: 11 ng/mL 95% CI: 10–12) than controls (mean: 08 ng/mL 95% CI: 06–09, p = 0001) When we compared the subgroups according to obesity, the main factor determining the significant increase in bisphenol A was the presence of PCOS, but not obesity (p = 0029) Bisphenol A was significantly correlated with total testosterone (r = 052), free testosterone (r = 044), dehydroepiandrosterone sulphate (r = 037) and Ferriman–Gallwey score (r = 043) (p < 005) Conclusion Adolescents with PCOS had higher serum bisphenol A levels than controls, independent of obesity Bisphenol A concentrations were significantly correlated with androgen levels, leading us to consider that bisphenol A might play a role in the aetiopathogenesis of PCOS in adolescents

Reduced primary care respiratory infection visits following pregnancy and infancy vitamin D supplementation: a randomised controlled trial

Abstract: Aim To determine whether vitamin D supplementation reduces primary care visits for acute respiratory infection (ARI). Methods A randomised, double-blind, placebo-controlled trial was conducted in New Zealand and powered to determine the vitamin D dose needed to achieve normal vitamin D status during infancy. Healthy pregnant women, from 27 weeks’ gestation to birth, and their infants, from birth to age 6 months, were assigned to placebo or one of the two dosages of daily oral vitamin D3. Woman/infant pairs were randomised to placebo/placebo, 1000 IU/400 IU or 2000 IU/800 IU. For this ad hoc analysis, the primary care records of enrolled children were audited to age 18 months. Results Two hundred and sixty pregnant women were randomised to placebo (n = 87), lower-dose (n = 87) or higher-dose (n = 86) vitamin D3. In comparison with the placebo group (99%), the proportion of children making any ARI visits was smaller in the higher-dose (87%, p = 0.004), but not the lower-dose vitamin D3 group (95%, p = 0.17). The median number of ARI visits/child was less in the higher-dose vitamin D3 group from age 6–18 months (placebo 4, lower dose 3, higher dose 2.5; p = 0.048 for higher-dose vitamin D3 vs. placebo). Conclusion Vitamin D3 supplementation during pregnancy and infancy reduces primary care visits for ARI during early childhood.

New reference charts for testicular volume in Dutch children and adolescents allow the calculation of standard deviation scores

Abstract: Aim Accurate calculations of testicular volume standard deviation (SD) scores are not currently available. We constructed LMS-smoothed age-reference charts for testicular volume in healthy boys. Methods The LMS method was used to calculate reference data, based on testicular volumes from ultrasonography and Prader orchidometer of 769 healthy Dutch boys aged 6 months to 19 years. We also explored the association between testicular growth and pubic hair development, and data were compared to orchidometric testicular volumes from the 1997 Dutch nationwide growth study. Results The LMS-smoothed reference charts showed that no revision of the definition of normal onset of male puberty - from nine to 14 years of age - was warranted. In healthy boys, the pubic hair stage SD scores corresponded with testicular volume SD scores (r = 0.394). However, testes were relatively small for pubic hair stage in Klinefelter's syndrome and relatively large in immunoglobulin superfamily member 1 deficiency syndrome. Conclusion The age-corrected SD scores for testicular volume will aid in the diagnosis and follow-up of abnormalities in the timing and progression of male puberty and in research evaluations. The SD scores can be compared with pubic hair SD scores to identify discrepancies between cell functions that result in relative microorchidism or macroorchidism. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Maternal psychological distress and visitation to the neonatal intensive care unit.

Abstract: Aim To examine associations between maternal NICU visitation rates, maternal psychological distress (“distress”), and preterm infant outcome post-NICU discharge in a contemporary cohort of very low birth weight (VLBW) infants.

Functional magnetic resonance imaging can be used to explore tactile and nociceptive processing in the infant brain.

Abstract: Aim Despite the importance of neonatal skin stimulation, little is known about activation of the newborn human infant brain by sensory stimulation of the skin. We carried out functional magnetic resonance imaging (fMRI) to assess the feasibility of measuring brain activation to a range of mechanical stimuli applied to the skin of neonatal infants. Methods We studied 19 term infants with a mean age of 13 days. Brain activation was measured in response to brushing, von Frey hair (vFh) punctate stimulation and, in one case, nontissue damaging pinprick stimulation of the plantar surface of the foot. Initial whole brain analysis was followed by region of interest analysis of specific brain areas. Results Distinct patterns of functional brain activation were evoked by brush and vFh punctate stimulation, which were reduced, but still present, under chloral hydrate sedation. Brain activation increased with increasing stimulus intensity. The feasibility of using pinprick stimulation in fMRI studies was established in one unsedated healthy full-term infant. Conclusion Distinct brain activity patterns can be measured in response to different modalities and intensities of skin sensory stimulation in term infants. This indicates the potential for fMRI studies in exploring tactile and nociceptive processing in the infant brain.

Mental health problems are rising more in Swedish adolescents than in other Nordic countries and the Netherlands

Abstract: Mental health problems increased in adolescents and young adults in Europe between 1950 and 1990, and the cause is largely unknown. Denmark, Finland, the Netherlands, Norway and Sweden form a relatively homogenous group of countries with favourable conditions for children. Our review examined the time trends for mental health problems in these countries between 1990 and 2010. Conclusion: In general, there were only small changes in mental health problems in the countries studied. However, we did note a marked rising trend in mental health problems among adolescents in Sweden, which also has more issues with school achievement and unemployment rates.

Peripheral venous catheter related complications are common among paediatric and neonatal patients.

Abstract: Aim The aims of this study were to describe the characteristics of peripheral venous catheters (PVCs), including dwell time and reasons for removal, and explore predictors for PVC-related complications. Methods We included PVCs in 2032 children - 484 neonatal and 1548 paediatric - from 12 inpatient units. Data were retrieved from the patient record system, and predictors for complications were explored using logistic regression analyses. Results Just over one-third (35.4%) of the PVCs were removed due to complications, in particular infiltration and occlusion (51.9 and 48.4/1000 PVC days, respectively). PVC survival time was shorter in neonatal than paediatric patients (4 versus 5 days), and infiltration was more frequent in neonatal patients (92.8 versus 38.7/1000 PVC days). Infiltration was associated with younger age (odds ratio 0.97) for neonatal patients and with younger age (OR 0.96), insertion in the bend of the arm (OR 1.48) or ankle (OR 2.81) for paediatric patients. Occlusion was, both for neonatal and paediatric patients, associated with longer dwell time (OR 1.32 and 1.22 respectively), insertion in the ankle (OR 5.00 and 3.51) or foot (OR 3.47 and 1.99). Conclusion PVC-related complications, particularly infiltration and occlusion, were more common in hospitalised children but decreased with the child's age.

Very preterm birth and foetal growth restriction are associated with specific cognitive deficits in children attending mainstream school

Abstract: Aim This study investigated the association of prenatal and neonatal factors with cognitive outcomes in schoolchildren born very preterm without impairments at the age of nine. Methods We recruited a prospective regional cohort of 154 very low gestational age (VLGA) children of <32 weeks and 90 term-born comparison children born between November 1998 and November 2002 at Oulu University Hospital, Finland. Cognitive outcome was assessed using an inclusive neuropsychological test repertoire at the age of nine. Results The final study group comprised 77 VLGA children without cerebral palsy or any cognitive impairment and 27 term-born children. VLGA was associated with a 1.5-point [95% confidence interval (CI) 0.6–2.3] reduction in visuospatial–sensorimotor processing and a 1.2-point (95% CI 0.5–1.9) reduction in attention–executive functions scores. Foetal growth restriction (FGR) was the only clinical risk factor that was associated with cognitive outcome. Children with FGR had a significant decrease in language (1.7 points, 95% CI 0.50–3.0) and memory–learning (1.6 points, 95% CI 0.4–2.8) scores. Conclusion Children born very preterm without impairments had poorer performance in specific neurocognitive skills than term-born children. FGR was an independent risk factor for compromised neurocognitive outcome in VLGA children and predicted difficulties in language, memory and learning.

Elevated background TV exposure over time increases behavioural scores of 18-month-old toddlers.

Abstract: Aim To investigate whether trends of TV exposure from age six to 18 months and adult TV programmes were associated with behavioural concerns of 18-month-old Thai toddlers. Methods There were 194 healthy infants recruited at age six months and followed up until 18 months of age in this present cohort. TV exposure variables were assessed by interviewing in depth at both six- and 18-month-old visits. A mother of each participant rated the child's behaviours using the Child Behaviour Checklist. Results Infants who were increasingly exposed to TV from age six to 18 months with adult programmes since six months of age had higher pervasive developmental problems and oppositional defiant behaviours scores. Exposure to adult TV programmes at age six months was also associated with emotionally reactive problems, aggression and externalising behaviours in the final regression models. Conclusion To promote appropriate toddlers' behaviours at age 18 months, elevated background TV exposure over time should be discouraged. Furthermore, paediatricians should emphasise such effects of TV exposure on child behaviours with parents at health supervision visits. As such, parents will be aware of the detrimental effect of increased background TV exposure over time on their children's behaviours.