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Showing papers in "Archives of Disease in Childhood in 2013"


Journal ArticleDOI
TL;DR: The evidence linking WSH measures to faecal-oral diseases in children is reviewed, with estimates of the burden of WSH-related disease and a summary of current international targets and progress.
Abstract: In 2007, readers of the British Medical Journal voted that the introduction of clean water and sewerage—the ‘sanitation revolution’ of the Victorian era—was the most important medical milestone since the 1840s,1 over anaesthesia, antibiotics, or vaccines. These improvements led to a dramatic reduction in morbidity and mortality associated with faecal-oral infections, such as typhoid fever and cholera. Today, water, sanitation and hygiene (WSH) measures remain critically important to global public health, especially among children in lower income countries, who are at greatest risk from enteric infections and their associated symptoms, complications and sequelae. In this article, we review the evidence linking WSH measures to faecal-oral diseases in children. Although continued research is needed, existing evidence from the last 150 years supports extending life-saving WSH measures to at-risk populations worldwide.2 One recent estimate3 held that 95% of diarrhoeal deaths in children under 5 years of age could be prevented by 2025, at a cost of US$6.715 billion, through targeted scale-up of proven, cost-effective, life-saving interventions. These include access to safe and accessible excreta disposal, support for basic hygiene practices such as hand washing with soap, and provision of a safe and reliable water supply. We present estimates of the burden of WSH-related disease followed by brief overviews of water, sanitation and hygiene-related transmission routes and control measures.i We conclude with a summary of current international targets and progress. Human excreta can contain over 50 known bacterial, viral, protozoan and helminthic pathogens. The majority of excreta-related infections are obtained through ingestion, less often through inhalation. Excreta-related infections travel through a variety of routes from one host to the next, either as a result of direct transmission through contaminated hands, or indirect transmission via contamination of drinking water, soil, utensils, food and flies (figure 1). The importance of each transmission route …

207 citations


Journal ArticleDOI
TL;DR: The revised BSPGHAN guidelines represent an important shift in diagnostic strategy, aimed at simplifying and shortening the diagnostic process in selected cases, and should be of assistance for paediatricians in specialties other than gastroenterology.
Abstract: The revised BSPGHAN guidelines for the diagnosis and management of coeliac disease represent an important shift in diagnostic strategy, aimed at simplifying and shortening the diagnostic process in selected cases. Guidance is given concerning the indications for testing for coeliac disease, which is still significantly underdiagnosed in the UK. While screening data suggest a likely incidence of 1 in 100 persons, only 10%-20% of this figure is currently being diagnosed.The BSPGHAN guidelines follow the new ESPGHAN guidelines in overall diagnostic strategy, while providing more didactic stratagems, which should be of assistance for paediatricians in specialties other than gastroenterology.

168 citations


Journal ArticleDOI
TL;DR: The most viable strategy to address the treatment gap is through the empowerment of existing human resources who are most intimately concerned with child care, including parents, through innovative technologies, such as mobile health, with the necessary skills for the detection and treatment of child mental disorders.
Abstract: Developmental disabilities, emotional disorders and disruptive behaviour disorders are the leading mental health-related causes of the global burden of disease in children aged below 10 years. This article aims to address the treatment gap for child mental disorders through synthesising three bodies of evidence: the global evidence base on the treatment of these priority disorders; the barriers to implementation of this knowledge; and the innovative approaches taken to address these barriers and improve access to care. Our focus is on low-resource settings, which are mostly found in low- and middle-income countries (LMIC). Despite the evidence base on the burden of child mental disorders and their long-term consequences, and the recent mental health Gap Action Programme guidelines which testify to the effectiveness of a range of pharmacological and psychosocial interventions for these disorders, the vast majority of children in LMIC do not have access to these interventions. We identify three major barriers for the implementation of efficacious treatments: the lack of evidence on delivery of the treatments, the low levels of detection of child mental disorders and the shortage of skilled child mental health professionals. The evidence based on implementation, although weak, supports the use of screening measures for detection of probable disorders, coupled with a second-stage diagnostic assessment and the use of non-specialist workers in community and school settings for the delivery of psychosocial interventions. The most viable strategy to address the treatment gap is through the empowerment of existing human resources who are most intimately concerned with child care, including parents, through innovative technologies, such as mobile health, with the necessary skills for the detection and treatment of child mental disorders.

164 citations


Journal ArticleDOI
TL;DR: In this paper, a systematic review of the literature describing the aetiology of community-acquired neonatal and infant sepsis in developing countries was conducted using meta-analytical methods, and susceptibility was determined to the antibiotic combinations recommended by WHO: (1) benzylpenicillin/ampicillin and gentamicin, (2) chloramphenicol, and (3) third-generation cephalosporins.
Abstract: Objective To review the aetiology and antibiotic resistance patterns of community-acquired sepsis in developing countries in infants where no clear focus of infection is clinically identified. To estimate the likely efficacy of WHO9s recommended treatment for infant sepsis. Design A systematic review of the literature describing the aetiology of community-acquired neonatal and infant sepsis in developing countries. Using meta-analytical methods, susceptibility was determined to the antibiotic combinations recommended by WHO: (1) benzylpenicillin/ampicillin and gentamicin, (2) chloramphenicol and benzylpenicillin, and (3) third-generation cephalosporins. Results 19 studies were identified from 13 countries, with over 4000 blood culture isolates. Among neonates, Staphylococcus aureus , Klebsiella spp. and Escherichia coli accounted for 55% (39–70%) of culture positive sepsis on weighted prevalence. In infants outside the neonatal period, the most prevalent pathogens were S aureus , E coli , Klebsiella spp., Streptococcus pneumoniae and Salmonella spp., which accounted for 59% (26–92%) of culture positive sepsis. For neonates, penicillin/gentamicin had comparable in vitro coverage to third-generation cephalosporins (57% vs 56%). In older infants (1–12 months), in vitro susceptibility to penicillin/gentamicin, chloramphenicol/penicillin and third-generation cephalosporins was 63%, 47% and 64%, respectively. Conclusions The high rate of community-acquired resistant sepsis—especially that caused by Klebsiella spp. and S aureus —is a serious global public health concern. In vitro susceptibility data suggest that third-generation cephalosporins are not more effective in treating sepsis than the currently recommended antibiotics, benzylpenicillin and gentamicin; however, with either regimen a significant proportion of bacteraemia is not covered. Revised recommendations for effective second-line antibiotics in neonatal and infant sepsis in developing countries are urgently needed.

158 citations


Journal ArticleDOI
TL;DR: The continuing increase in very-short-term admission of children with common infections suggests a systematic failure, both in primary care and in hospital, in the assessment ofChildren with acute illness that could be managed in the community.
Abstract: Objective To investigate a reported rise in the emergency hospital admission of children in England for conditions usually managed in the community. Setting and design Population-based study of hospital admission rates for children aged under 15, based on analysis of Hospital Episode Statistics and population estimates for England, 1999–2010. Main outcome Trends in rates of emergency admission to hospital. Results The emergency admission rate for children aged under 15 in England has increased by 28% in the past decade, from 63 per 1000 population in 1999 to 81 per 1000 in 2010. A persistent year-on-year increase is apparent from 2003 onwards. A small decline in the rates of admissions lasting 1 day or more has been offset by a twofold increase in short-term admissions of Conclusions The continuing increase in very-short-term admission of children with common infections suggests a systematic failure, both in primary care (by general practice, out-of-hours care and National Health Service Direct) and in hospital (by emergency departments and paediatricians), in the assessment of children with acute illness that could be managed in the community. Solving the problem is likely to require restructuring of the way acute paediatric care is delivered.

155 citations


Journal ArticleDOI
TL;DR: TV but not electronic games predicted a small increase in conduct problems and screen time did not predict other aspects of psychosocial adjustment, but no associations were found between either type of screen time and emotional symptoms, hyperactivity/inattention, peer relationship problems or prosocial behaviour.
Abstract: Background Screen entertainment for young children has been associated with several aspects of psychosocial adjustment. Most research is from North America and focuses on television. Few longitudinal studies have compared the effects of TV and electronic games, or have investigated gender differences. Purpose To explore how time watching TV and playing electronic games at age 5 years each predicts change in psychosocial adjustment in a representative sample of 7 year-olds from the UK. Methods Typical daily hours viewing television and playing electronic games at age 5 years were reported by mothers of 11 014 children from the UK Millennium Cohort Study. Conduct problems, emotional symptoms, peer relationship problems, hyperactivity/inattention and prosocial behaviour were reported by mothers using the Strengths and Difficulties Questionnaire. Change in adjustment from age 5 years to 7 years was regressed on screen exposures; adjusting for family characteristics and functioning, and child characteristics. Results Watching TV for 3 h or more at 5 years predicted a 0.13 point increase (95% CI 0.03 to 0.24) in conduct problems by 7 years, compared with watching for under an hour, but playing electronic games was not associated with conduct problems. No associations were found between either type of screen time and emotional symptoms, hyperactivity/inattention, peer relationship problems or prosocial behaviour. There was no evidence of gender differences in the effect of screen time. Conclusions TV but not electronic games predicted a small increase in conduct problems. Screen time did not predict other aspects of psychosocial adjustment. Further work is required to establish causal mechanisms.

147 citations


Journal ArticleDOI
TL;DR: Paediatric pharmacodynamic studies are fewer than pharmacokinetic studies, but are required to elucidate the target concentration and consequent dose, and the lack of pharmacodynamics studies is a serious challenge for rational dosing.
Abstract: Paediatric dose cannot be scaled down directly from an adult using weight (eg, mg/kg). This results in a dose too small in infants and children because elimination does not change in direct proportion to weight, and a dose too large in neonates whose drug elimination pathways are immature. The goal of treatment is a desired response (the target effect). An understanding of the concentration-response relationship (pharmacodynamics) can be used to predict the target concentration required to achieve this target effect. Pharmacokinetic knowledge then determines the target dose that will achieve the target concentration. Variability associated with both pharmacokinetics and pharmacodynamics can be reduced by demographic information (covariates), which can be used to help predict the target dose in a specific child. The covariates of size, maturation and organ function are the three principle contributors to pharmacokinetic variability. Children (2 years postnatal age or older) are essentially similar to adults (ie, mature) and differ only in size. Maturation processes are only important in neonates and infants, therefore, this cohort can be viewed as immature children. Paediatric pharmacodynamic studies are fewer than pharmacokinetic studies, but are required to elucidate the target concentration and consequent dose. The lack of pharmacodynamic studies is a serious challenge for rational dosing.

146 citations


Journal ArticleDOI
TL;DR: A meta-analysis to clarify the true magnitude of this risk of testicular malignancy in boys with isolated cryptorchidism, allowing clinicians to better counsel patients and their families is performed.
Abstract: Background Significant variability exists for the relative risk (RR) of testicular malignancy in isolated cryptorchidism. Objective To perform a meta-analysis to clarify the true magnitude of this risk, allowing clinicians to better counsel patients and their families. Setting Secondary research conducted by undergraduate researchers, clinical academics and a clinical statistician. Design, data sources, and methods A search of the English literature was performed for studies relating to testicular cancer and cryptorchidism, published between 1 January 1980 and 31 December 2010, using Embase and Medline databases. 735 papers were identified and analysed by four authors independently in accordance with our inclusion and exclusion criteria. Studies reporting an association between cryptorchidism and subsequent development of testicular malignancy were included. Genetic syndromes or other conditions which predisposed to the development of cryptorchidism were excluded. Pooled estimates and 95% CIs for the RRs were calculated. Results Nine case–control studies and three cohort studies were selected. The case–control studies included 2281 cases and 4811 controls. Cohort studies included 2 177 941 boys, with a total of 345 boys developing testicular cancer (total length of follow-up was 58 270 679 person-years). The pooled RR was 2.90 (95% CI 2.21 to 3.82) with significant heterogeneity (p 2 =89%). Conclusion Boys with isolated cryptorchidism are three times more likely to develop testicular cancer. The limitations of this study must be acknowledged, in particular, possible publication bias and the lack of high-quality evidence focusing on the risk of malignancy in boys with isolated cryptorchidism.

135 citations


Journal ArticleDOI
TL;DR: Pain in young people with CP is highly prevalent and clinicians should routinely assess pain and the efficacy of medical and therapeutic interventions causing pain should be re-examined to establish if their benefit justifies the pain and fear of pain that accompany them.
Abstract: Objective To determine the prevalence and associations of self- and parent-reported pain in young people with cerebral palsy (CP). Design and setting Cross-sectional questionnaire survey conducted at home visits in nine regions in seven European countries. Participants were 13 to 17-year-olds (n=667) drawn from population CP registers in eight regions and from multiple sources in one region. 429 could self-report; parent-reports were obtained for 657. Data were collected on: severity, frequency, site and circumstances of pain in previous week; severity of pain associated with therapy in previous year. Results The estimated population prevalence of any pain in previous week was 74% (95% CI 69% to 79%) for self-reported pain and 77% (95% CI 73% to 81%) for parent-reported pain. 40% experienced leg pains, 34% reported headaches and 45% of those who received physiotherapy experienced pain during therapy. Girls reported more pain than boys (OR=2.1, 95% CI 1.5 to 3.0) and young people reported more pain if they had emotional difficulties (comparing highest and lowest quartiles: OR=3.1, 95% CI 1.7 to 5.6). Parents reported more pain in children with emotional difficulties (OR=4.2, 95% CI 2.7 to 6.6), or with more impaired walking ability. Conclusions Pain in young people with CP is highly prevalent. Because pain causes immediate distress and is associated with lower subjective well-being and reduced participation, clinicians should routinely assess pain. Clinical interventions to reduce pain should be implemented and evaluated. The efficacy of medical and therapeutic interventions causing pain should be re-examined to establish if their benefit justifies the pain and fear of pain that accompany them.

133 citations


Journal ArticleDOI
TL;DR: The only aspects of treatment that have been proved to improve survival are the rapid withdrawal of the suspected offending drugs and an optimal supportive therapy with emphasis in nutritional support, accompanied by management of denuded skin areas.
Abstract: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare life-threatening conditions almost exclusively attributed to drugs. The incidence in children is lower than in adults and has a better outcome. Mycosplama pneumoniae infection may be involved in some cases of paediatric SJS. The main etiologic factors for both SSJ and TEN are sulphonamides and anticonvulsants, followed by penicillins and non-steroidal anti-inflammatory drugs. In rare instances, paracetamol is the only suspected drug. By contrast with adults, allopurinol, oxicams and nevirapine are not identified as causative agents in children, probably due to differences in drug prescriptions. The only aspects of treatment that have been proved to improve survival are the rapid withdrawal of the suspected offending drugs and an optimal supportive therapy with emphasis in nutritional support, accompanied by management of denuded skin areas. The use of specific therapies remains controversial.

118 citations


Journal ArticleDOI
TL;DR: The paediatric LTV population has expanded significantly over 15 years and future planning of paediatric hospital and community services, as well as adult services, must take into account the needs of this growing population.
Abstract: Background Cross-sectional studies have suggested a rapid expansion in paediatric long-term ventilation (LTV) over the last 20 years but information on longitudinal trends is limited. Methods Data were collected prospectively on all patients receiving LTV over a 15-year period (1.1.95–31.12.09) in a single regional referral centre. Results 144 children commenced LTV during the 15-year period. The incidence of LTV increased significantly over time, with an accompanying 10-fold increase in prevalence due to a significant increase in institution of non-invasive ventilation (NIV). There was no significant increase in invasive ventilation. 5-year survival was 94% overall and was significantly higher for patients on NIV (97%) than invasively ventilated patients (84%). 10-year survival was 91% overall. Although some children were able to discontinue respiratory support (21% at 5 years and 42% at 10 years), the number of patients transitioned to adult services increased significantly over time (26% of total cohort). Patients with neuromuscular disease were less likely to discontinue support than other patients. Conclusions The paediatric LTV population has expanded significantly over 15 years. Future planning of paediatric hospital and community services, as well as adult services, must take into account the needs of this growing population.

Journal ArticleDOI
TL;DR: The tablets were the best accepted formulation; the tablets and syrup the most preferred; children and parents preferred the tablet and syrup over the suspension and the suspension over the powder.
Abstract: Objective Liquid medicines are easy to swallow. However, they may have disadvantages, such as a bad taste or refrigerated storage conditions. These disadvantages may be avoided by the use of oral solid medicines, such as powders or tablets. The aim of this study was to investigate the acceptability of and preference among four oral formulations in domiciliary infants and preschool children in The Netherlands. Methods Parents administered four oral placebo dosage forms that were aimed at a neutral taste, at home, to their child (1–4 years of age) twice on one day following a randomised cross-over design: small (4 mm) tablet, powder, suspension and syrup. They were asked to report the child9s acceptability by a score on a 10 cm visual analogue scale (VAS score) and by the result of the intake. At the end of the study, they were asked to report the preference of the child and themselves. Results 183 children were included and 148 children were evaluated. The data revealed a period/cross-over effect. The estimate of the mean VAS score was significantly higher for the tablet than for the suspension (tablet 9.39/9.01; powder 8.84/8.20, suspension 8.26/7.90, syrup 8.35/8.19; data day 1/all days). The estimate of the mean number of intakes fully swallowed was significantly higher for the tablet than for the other formulations (all p values Conclusions All formulations were well accepted. The tablets were the best accepted formulation; the tablets and syrup the most preferred. Trial Registration number ISRCTN63138435.

Journal ArticleDOI
TL;DR: The evidence suggests that services and programmes are best delivered within a framework of progressive universalism—a universal basket of services for all children and families, with additional support commensurate with additional needs, provides the best opportunity for early identification and appropriate intervention for emerging developmental problems and family issues that impact on children's development.
Abstract: Many children arrive at school with problems of development and behaviour which affect their educational achievement and social interaction and can have lifelong consequences. There is a strong association between developmental vulnerability at school entry and a well-documented series of parent and family risk factors, often linked to social disadvantage. Strategies which are likely to make a difference to these children and improve outcomes include family support, high-quality early education and care programmes in the preschool years, and early detection of emerging problems and risk factors. The evidence suggests that these services and programmes are best delivered within a framework of progressive universalism—a universal basket of services for all children and families, with additional support commensurate with additional needs. This provides the best opportunity for early identification and appropriate intervention for emerging developmental problems and family issues that impact on children's development. While there are a number of challenges that need to be addressed and overcome, such an approach is an important investment that will yield measurable educational, social and economic benefits over the long term.

Journal ArticleDOI
TL;DR: The changing brain may lead to abrupt behavioural change with attendant risks, but such a brain is flexible and can respond quickly and imaginatively to the challenges specific to that period of life.
Abstract: Whether or not adolescence should be treated as a special period, there is now no doubt that the brain changes much during adolescence. From an evolutionary perspective, the idea of an under developed brain which is not fit for purpose until adulthood is illogical. Rather, the adolescent brain is likely to support the challenges specific to that period of life. New imaging techniques show striking changes in white and grey matter between 11 and 25 years of age, with increased connectivity between brain regions, and increased dopaminergic activity in the pre-frontal cortices, striatum and limbic system and the pathways linking them. The brain is dynamic, with some areas developing faster and becoming more dominant until other areas catch up. Plausible mechanisms link these changes to cognitive and behavioural features of adolescence. The changing brain may lead to abrupt behavioural change with attendant risks, but such a brain is flexible and can respond quickly and imaginatively. Society allows adolescent exuberance and creativity to be bounded and explored in relative safety. In healthcare settings these changes are especially relevant to young people with long term conditions as they move to young adult life; such young people need to learn to manage their health conditions with the support of their healthcare providers.

Journal ArticleDOI
TL;DR: An optimised dosing regimen, taking into account birth weight, current weight, postnatal age and serum creatinine, was developed based on a one-compartment pharmacokinetic model and should be used routinely to individualise vancomycin continuous infusion therapy in neonates.
Abstract: Objective Because pharmacokinetic data are limited, continuous infusions of vancomycin in neonates are administered using different dosing regimens. The aim of this work was to evaluate the results of vancomycin therapeutic drug monitoring (TDM) under three different dosing regimens and to optimise vancomycin therapy. Methods Vancomycin TDM concentrations were noted and compared prospectively in three hospitals. Population pharmacokinetic analysis was performed to optimise dosing using NONMEM software. Patient-tailored optimised dosing regimens were evaluated in a prospective study. Results Two hundred and seven serum vancomycin concentrations from 116 neonates were analysed. Only 48 neonates (41%) had serum vancomycin concentrations within the therapeutic range of 15–25 mg/l using a current dosing regimen. Concentrations ranged from 5.1 to 61.5 mg/l. Loading doses were required to decrease the risk of sub-therapeutic levels during early treatment. An optimised dosing regimen, taking into account birth weight, current weight, postnatal age and serum creatinine, was developed based on a one-compartment pharmacokinetic model. A prospective validation study in 58 neonates demonstrated a higher percentage of neonates (70.7%, n=41) reaching the therapeutic range and early dosage adaptation (6–12 h post-dose) using an optimised dosing regimen. Conclusions A patient-tailored optimised dosing regimen should be used routinely to individualise vancomycin continuous infusion therapy in neonates.

Journal ArticleDOI
TL;DR: Therapeutic effects of HT seem superior to standard medical care in children with FAP or IBS, although it remains difficult to quantify exact benefits.
Abstract: Objectives Gut directed hypnotherapy (HT) is shown to be effective in adult functional abdominal pain (FAP) and irritable bowel syndrome (IBS) patients. We performed a systematic review to assess efficacy of HT in paediatric FAP/IBS patients. Methods We searched Medline, Embase, PsychINFO, Cumulative Index to Nursing and Allied Health Literature databases and Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT) in children with FAP or IBS, investigating efficacy of HT on the following outcomes: abdominal pain scores, quality of life, costs and school absenteeism. Results Three RCT comparing HT to a control treatment were included with sample sizes ranging from 22 to 52 children. We refrained from statistical pooling because of low number of studies and many differences in design and outcomes. Two studies examined HT performed by a therapist, one examined HT through self-exercises on audio CD. All trials showed statistically significantly greater improvement in abdominal pain scores among children receiving HT. One trial reported beneficial effects sustained after 1 year of follow-up. One trial reported statistically significant improvement in quality of life in the HT group. Two trials reported significant reductions in school absenteeism after HT. Conclusions Therapeutic effects of HT seem superior to standard medical care in children with FAP or IBS. It remains difficult to quantify exact benefits. The need for more high quality research is evident.

Journal ArticleDOI
TL;DR: The paper discusses the evidence base for each of these strategies and considers the rationale for the recent introduction of a temporary vaccination programme for pregnant women in the UK in response to the ongoing outbreak of pertussis.
Abstract: The UK is currently in the midst of a large outbreak of pertussis, with the highest morbidity and mortality occurring in young unimmunised infants. This review considers the potential strategies to optimise control of pertussis in infants, including vaccination of (1) adolescents, (2) close household contacts of newborn infants (cocooning), (3) newborn infants and (4) pregnant women. The paper discusses the evidence base for each of these strategies and considers the rationale for the recent introduction of a temporary vaccination programme for pregnant women in the UK in response to the ongoing outbreak.

Journal ArticleDOI
TL;DR: It is found no evidence to suggest that early treatment with prednisolone reduces the prevalence of proteinuria 12 months after disease onset in children with HSP.
Abstract: Background The long-term prognosis of Henoch-Schonlein Purpura (HSP) is predominantly determined by the extent of renal involvement. There is no consensus as to whether treatment with prednisolone at presentation can prevent or ameliorate the progression of nephropathy in HSP. Methods Children under 18 years of age with new-onset HSP were randomly assigned to receive prednisolone or placebo for 14 days. The primary outcomes were (a) the presence of proteinuria at 12 months (defined as urine protein : creatinine ratio (UP : UC) >20 mg/mmol) and (b) the need for additional treatment (defined as the presence of hypertension requiring treatment or renal biopsy anomalies or the need for treatment of renal disease) during the 12 month study period. Results 352 children were randomised. Of those patients with laboratory UP : UC results available at 12 months, 18/123 (15%) patients on prednisolone and 13/124 (10%) patients on placebo had UP : UC >20 mg/mmol. There was no significant difference in the proportion of patients with UP : UC >20 mg/mmol at 12 months between the treatment groups (OR (prednisolone/placebo)=1.46, 95% CI 0.68 to 3.14, n=247), even after adjusting for baseline proteinuria and medications known to affect proteinuria (adjusted OR=1.29, 95% CI 0.58 to 2.82, n=247). Similarly, there was no significant difference in the time needed for additional treatment between the two groups (hazard ratio (HR) (prednisolone/placebo)=0.53, 95% CI 0.18 to 1.59, n=323). Conclusions This is the largest trial of the role of steroids in children with HSP. We found no evidence to suggest that early treatment with prednisolone reduces the prevalence of proteinuria 12 months after disease onset in children with HSP. Trial registration Number ISRCTN71445600

Journal ArticleDOI
TL;DR: A new, quick and safe technique with a high success rate is described, whereby the discomfort and waste of time usually associated with bag collection methods can be avoided.
Abstract: Aim To describe and test a new technique to obtain midstream urine samples in newborns. Design and methods This was a prospective feasibility and safety study conducted in the neonatal unit of University Infanta Sofia Hospital, Madrid. A new technique based on bladder and lumbar stimulation manoeuvres was tested over a period of 4 months in 80 admitted patients aged less than 30 days. The main variable was the success rate in obtaining a midstream urine sample within 5 min. Secondary variables were time to obtain the sample and complications. Results This technique was successful in 86.3% of infants. Median time to sample collection was 45 s (IQR 30). No complications other than controlled crying were observed. Conclusions A new, quick and safe technique with a high success rate is described, whereby the discomfort and waste of time usually associated with bag collection methods can be avoided.

Journal ArticleDOI
TL;DR: OSAS is highly prevalent in syndromic craniosynostosis and there is some natural improvement, mainly during the first 3 years of life and least in children with Apert or Crouzon/Pfeiffer syndrome.
Abstract: Objective To describe the course of obstructive sleep apnoea syndrome (OSAS) in children with syndromic craniosynostosis. Design Prospective cohort study. Setting Dutch Craniofacial Centre from January 2007 to January 2012. Patients A total of 97 children with syndromic craniosynostosis underwent level III sleep study. Patients generally undergo cranial vault remodelling during their first year of life, but OSAS treatment only on indication. Main outcome measures Obstructive apnoea-hypopnoea index, the central apnoea index and haemoglobin oxygenation-desaturation index derived from consecutive sleep studies. Results The overall prevalence of OSAS in syndromic craniosynostosis was 68% as defined by level III sleep study. Twenty-three patients were treated for OSAS. Longitudinal profiles were computed for 80 untreated patients using 241 sleep studies. A mixed effects model showed higher values for the patients with midface hypoplasia as compared to those without midface hypoplasia (Omnibus likelihood ratio test=7.9). In paired measurements, the obstructive apnoea-hypopnoea index (Z=−3.4) significantly decreased over time, especially in the first years of life (Z=−3.3), but not in patients with midface hypoplasia (Z=−1.5). No patient developed severe OSAS during follow-up if it was not yet diagnosed during the first sleep study. Conclusions OSAS is highly prevalent in syndromic craniosynostosis. There is some natural improvement, mainly during the first 3 years of life and least in children with Apert or Crouzon/Pfeiffer syndrome. In the absence of other co-morbid risk factors, it is highly unlikely that if severe OSAS is not present early in life it will develop during childhood. Ongoing clinical surveillance is of great importance and continuous monitoring for the development of other co-morbid risk factors for OSAS should be warranted.

Journal ArticleDOI
TL;DR: The majority of products had energy content similar to breast milk and would not serve the intended purpose of enhancing the nutrient density and diversity of taste and texture in infants’ diets.
Abstract: Background and aims Health professionals are frequently asked to advise on aspects of complementary feeding. This study aimed to describe the types of commercial infant foods available in the UK and provide an overview of their taste, texture and nutritional content in terms of energy, protein, carbohydrates, fat, sugar, iron, sodium and calcium. Method All infant foods produced by four main UK manufacturers and two more specialist suppliers were identified during October 2010–February 2011. Nutritional information for each product was collected from manufacturers’ websites, products in store and via direct email enquiry. Results Of the 479 products identified in this study 364 (79%) were ready-made spoonable foods; 44% (201) were aimed at infants from 4 months, and 65% of these were sweet foods. The mean (SD) energy content of ready-made spoonable foods was 282 (59) kJ per 100 g, almost identical to breast milk (283(16) kJ per 100 g). Similar spoonable family foods were more nutrient dense than commercial foods. Commercial finger foods were more energy dense, but had very high sugar content. Conclusions The UK infant food market mainly supplies sweet, soft, spoonable foods targeted from age 4 months. The majority of products had energy content similar to breast milk and would not serve the intended purpose of enhancing the nutrient density and diversity of taste and texture in infants’ diets.

Journal ArticleDOI
TL;DR: Male sex and low birth weight were significant predictors of DCD, suggesting that these infants should be followed for detection of this common, but under-recognised disorder.
Abstract: Objective To identify perinatal and neonatal risk factors associated with developmental coordination disorder (DCD) in very low birthweight children (VLBW: Design Retrospective design with prospectively collected cohort. Setting Neonatal Follow-Up Program, Vancouver, Canada. Patients 157 VLBW children assessed at 4–5 years who were free of cerebral palsy or major neurological impairment and had full-scale IQ >70. Main outcome measure Movement Assessment Battery for Children (MABC). Results Using ≤15th percentile on the MABC as the cut-off, 42% of our cohort developed DCD. Perinatal variables significantly associated with DCD were male sex, lower gestational age and lower birth weight, but only male sex and low birth weight independently predicted DCD, accounting for 20% of the variance in MABC scores. Compared with children without motor impairment, children with DCD had greater postnatal steroid exposure, longer duration of ventilation, more days on oxygen and significant retinopathy of prematurity, but only postnatal steroid exposure was significant, accounting for an additional 3% of the variance in MABC scores. Boys performed more poorly than girls on all subtests of the MABC. Conclusions Male sex and low birth weight were significant predictors of DCD, suggesting that these infants should be followed for detection of this common, but under-recognised disorder. Future research aimed at identifying neural underpinnings of DCD and possible antecedents to the disorder is warranted.

Journal ArticleDOI
TL;DR: Although paracetamol appears an effective and safe analgesic in term and near term neonates, its effectiveness and safety for PDA closure are uncertain because the drug is administered in high doses and there remain a limited number of observations so far.
Abstract: There remains a need for alternative medical treatments for patent ductus arteriosus (PDA) closure in extreme preterm neonates because of therapeutic failure and adverse effects associated with non-selective cyclo-oxygenase inhibitors. Reports of an association between paracetamol exposure and PDA closure in a limited number of extreme preterm neonates have been published. However, causality cannot be taken for granted because a link between the current knowledge of the clinical pharmacology of paracetamol and (patho)physiology of ductal closure is not known. In contrast to non-selective cyclo-oxygenase inhibitors, paracetamol has limited effects at peripheral sites, is a poor antithrombotic and anti-inflammatory drug and exerts its effects primarily within the central nervous system. Although paracetamol appears an effective and safe analgesic in term and near term neonates, its effectiveness and safety for PDA closure are uncertain because the drug is administered in high doses and there remain a limited number of observations in this specific subpopulation so far. Prospective comparative trials are reasonable and are urgently needed to establish both the effectiveness and safety data of paracetamol when used for this indication.

Journal ArticleDOI
TL;DR: This systematic review assesses existing early diagnosis research in childhood and young adult cancer and aims to identify whether a consensus exists within the literature in relation to the terminology and methodologies used to investigate TTD in this population.
Abstract: Purpose It is often assumed that prolonged time to diagnosis (TTD) for cancer negatively influences overall survival and survivorship through advanced stage disease at diagnosis. This systematic review assesses existing early diagnosis research in childhood and young adult cancer and aims to identify whether a consensus exists within the literature in relation to the terminology and methodologies used to investigate TTD in this population. Methods Medline, Embase, the Centre for Reviews and Dissemination database and Cochrane library were searched for papers on children and young adults (0–30 years) published from 1948 to the present. Results Of the 1665 potentially eligible citations identified, 32 papers met the inclusion criteria. The majority of work was in European (n=15) or North American (n=8) populations. Most work focused on brain tumours (n=10), retinoblastomas (n=5) and bone and soft tissue sarcomas (n=4). The majority of studies were in hospital-based settings (n=25), with only seven papers adopting a population-based setting. Summary statistics presented were mostly median TTD, the skewed distribution of the data meant comparisons between studies based on medians were difficult and combining studies within a meta-analysis was not appropriate. Conclusions Within the childhood and young adult population, TTD for cancer varies between diagnostic groups and with age at diagnosis in the majority of studies. In order that clear conclusions can be drawn from early diagnosis research in children and young adults, specific criteria identifying circumstances in which delay has occurred should accompany a defined time line to diagnosis or treatment in every study.

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TL;DR: Treatment of certain paediatric cancers in LMIC is very cost effective, and future research should evaluate actual treatment and infrastructure expenditures to help guide policymakers.
Abstract: Approximately 90% of children with cancer reside in low-income and middle-income countries (LMIC) where healthcare resources are scarce and allocation decisions difficult. The cost effectiveness of treating childhood cancers in these settings is unknown. The objective of the present work was to determine cost-effectiveness thresholds for common paediatric cancers using acute lymphoblastic leukaemia (ALL) in Brazil and Burkitt lymphoma (BL) in Malawi as examples. Disability-adjusted life years (DALYs) prevented by treatment were compared to the gross domestic product (GDP) per capita of each country to define cost-effectiveness thresholds using WHO-CHOICE ('CHOosing Interventions that are Cost-Effective') guidelines. The case examples were selected due to the data available and because ALL and BL both have the potential to yield significant health gains at a low cost per patient treated. The key findings were as follows: the 3:1 cost/DALY prevented to GDP/capita ratio for ALL in Brazil was US $771,225; expenditures below this threshold were cost effective. Costs below US $257,075 (1:1 ratio) were considered very cost effective. Analogous thresholds for BL in Malawi were US $42,729 and US $14,243. Actual costs were far less. In Brazil, US $16,700 was spent to treat each patient while in Malawi total drug costs were less than US $50 per child. In summary, treatment of certain paediatric cancers in LMIC is very cost effective. Future research should evaluate actual treatment and infrastructure expenditures to help guide policymakers.

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TL;DR: Limited but consistent evidence suggests higher infant and under-five years mortality for children residing in slums compared with non-slum areas, and the consequences of this form of early childhood on long-term health-related behaviour and non-communicable disease outcomes, such as obesity, heart disease and mental illness.
Abstract: Rapid urbanisation in the 20th century has been accompanied by the development of slums. Nearly one-third of the world's population and more than 60% of urban populations in the least developed countries live in slums, including hundreds of millions of children. Slums are areas of broad social and health disadvantage to children and their families due to extreme poverty, overcrowding, poor water and sanitation, substandard housing, limited access to basic health and education services, and other hardships (eg, high unemployment, violence). Despite the magnitude of this problem, very little is known about the potential impact of slum life on the health of children and adolescents. Statistics that show improved mortality and health outcomes in cities are based on aggregated data and may miss important intraurban disparities. Limited but consistent evidence suggests higher infant and under-five years mortality for children residing in slums compared with non-slum areas. Children suffer from higher rates of diarrhoeal and respiratory illness, malnutrition and have lower vaccination rates. Mothers residing in slums are more poorly educated and less likely to receive antenatal care and skilled birth assistance. Adolescents have earlier sexual debut and higher rates of HIV, and adopt risky behaviours influenced by their social environment. We also know little about the consequences of this form of early childhood on long-term health-related behaviour (eg, diet and exercise) and non-communicable disease outcomes, such as obesity, heart disease and mental illness. Further attention to understanding and addressing child health in slum settings is an important priority for paediatricians and those committed to child health worldwide.

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TL;DR: Protracted bacterial bronchitis (PBB) is a disease caused by the chronic infection of the conducting airways, and is often misdiagnosed as asthma.
Abstract: Chronic cough is common in the paediatric population, yet the true prevalence of this condition remains difficult to define. Protracted bacterial bronchitis (PBB) is a disease caused by the chronic infection of the conducting airways. In many children the condition appears to be secondary to impaired mucociliary clearance that creates a niche for bacteria to become established, probably in the form of biofilms. In others, immunodeficiencies, which may be subtle, appear to be a factor. PBB causes persistent coughing and disturbed sleep, and affects exercise tolerance, causing significant levels of morbidity. PBB has remained largely unrecognised and is often misdiagnosed as asthma.

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TL;DR: Consumption of 1%/skim milk is more common among overweight/obese preschoolers, potentially reflecting the choice of parents to give obese children low-fat milk to drink and emphasising a need for weight-targeted recommendations with a stronger evidence base.
Abstract: Objective To evaluate relationships between type of milk consumed and weight status among preschool children. Design Longitudinal cohort study. Setting The Early Childhood Longitudinal Study, Birth Cohort, a representative sample of US children. Participants 10 700 US children examined at age 2 and 4 years. Main outcome measures Body mass index (BMI) z score and overweight/obese status as a function of milk type intake. Results The majority of children drank whole or 2% milk (87% at 2 years, 79.3% at 4 years). Across racial/ethnic and socio-economic status subgroups, 1%/skim milk drinkers had higher BMI z scores than 2%/whole milk drinkers. In multivariable analyses, increasing fat content in the type of milk consumed was inversely associated with BMI z score (p Conclusions Consumption of 1%/skim milk is more common among overweight/obese preschoolers, potentially reflecting the choice of parents to give overweight/obese children low-fat milk to drink. Nevertheless, 1%/skim milk does not appear to restrain body weight gain between 2 and 4 years of age in this age range, emphasising a need for weight-targeted recommendations with a stronger evidence base.

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TL;DR: The current global level of MDA coverage for the leading childhood NTDs, that is, STH infections, schistosomiasis and trachoma, remains well under 50%.
Abstract: The neglected tropical diseases (NTDs) are a group of 17 lesser known chronic infections which predominantly affect poor and disenfranchised communities. There are a number of NTDs that cause significant global morbidity in children, including the three major soil transmitted helminth (STH) infections (ascariasis, trichuriasis and hookworm infection), schistosomiasis and trachoma. These NTDs, together with lymphatic filariasis and onchocerciasis, are currently being targeted for global control and elimination through mass drug administration (MDA) campaigns. They represent the most common NTDs and share significant geographical overlap. Additionally, many individuals are polyparasitised with more than a single NTD. Integrated NTD control and elimination MDA programmes offer safe and efficacious treatments for all seven NTDs. However, the current global level of MDA coverage for the leading childhood NTDs, that is, STH infections, schistosomiasis and trachoma, remains well under 50%. Limiting factors for global coverage include insufficient global financial support, drug donation capacity of pharmaceutical companies and targeting school age children to the exclusion of other age groups in need of treatment, such as preschool age children. There is also a need for development of novel prevention and treatment modalities, such as next-generation small molecule drugs and vaccines. Efforts are underway to harness the momentum of a 2012 London Declaration on NTDs and a 2013 World Health Assembly (WHA) resolution as a means to control or in some cases eliminate by 2020 these NTDs that affect children worldwide.

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TL;DR: A thorough understanding of the range of potential problems will aid in the evaluation and management of children with DS and respiratory symptoms.
Abstract: Respiratory disease is a common cause of morbidity and mortality in children with Down's syndrome (DS). Causes range from those problems common to many children with DS, such as a narrow airway or impaired immunity, to rare structural lesions, such as tracheal bronchus. Additionally, other organ systems or extrinsic factors may play a role. A thorough understanding of the range of potential problems will aid in the evaluation and management of children with DS and respiratory symptoms.