AIM: To estimate the prevalence of breastfeeding-overall, exclusive, partial and depending on infants' age-in infants with Down syndrome, and to investigate associated factors. METHODS: A systematic literature search was...AIM: To estimate the prevalence of breastfeeding-overall, exclusive, partial and depending on infants' age-in infants with Down syndrome, and to investigate associated factors. METHODS: A systematic literature search was conducted in Medline, Cochrane Library, Web of Science, Embase, CINAHL and SciELO up to 1 August 2024. Original articles that estimated the prevalence of breastfeeding in infants with Down syndrome, written in French, English or Spanish, were included. Study quality was assessed using the Joanna Briggs Institute (JBI) scale. Meta-analyses were performed for breastfeeding outcomes and meta-regression explored heterogeneity. The review was registered in PROSPERO (CRD42021278019). RESULTS: Twenty-six studies (3463 infants) were included. The estimated prevalence of overall breastfeeding regardless of duration was 71.6% (95% CI [60.3; 80.7]; 25 studies, 3351 infants) with high heterogeneity, I = 94%. The estimated prevalence of exclusive breastfeeding was 38.4% (95% CI [22.4; 57.3]; 10 studies, 1099 infants). No factor assessed in meta-regression was significantly associated with overall breastfeeding. CONCLUSION: The estimated breastfeeding prevalence in infants with Down syndrome is similar to that reported in the general population, despite high heterogeneity. Further studies using standardised methodology to assess breastfeeding barriers and facilitators in the context of Down syndrome would allow us to improve support for breastfeeding.
AIM: To study the incidence, survival, and mortality of dilated cardiomyopathy (DCM) in children in Sweden, 1991-2019. METHODS: Hospital records of 0-18-year-olds diagnosed with DCM over a 29-year period were reviewed. T...AIM: To study the incidence, survival, and mortality of dilated cardiomyopathy (DCM) in children in Sweden, 1991-2019. METHODS: Hospital records of 0-18-year-olds diagnosed with DCM over a 29-year period were reviewed. The annual sex-specific incidence rates of DCM were calculated as new disease cases, divided by the average Swedish same-sex population for each year between 1991 and 2019. RESULTS: Altogether 377 patients were identified, 204 (54%) male and 173 (46%) female. The annual incidence rate of DCM over the study period was 0.62/100 000 person-years. The incidence rate was 5.98/100 000 persons in patients < 1 year old compared with 0.33/100 000 in 1-18-year-olds. Linear regression analysis revealed no change (p = 0.82) in the incidence of DCM over the 29-year period. Among children with a clinical diagnosis and available follow-up (n = 268), the mortality rate was 23%. Children aged > 10 years at diagnosis experienced an increased risk of death compared with children ≤ 3 months of age at diagnosis (hazard ratio 1.92). The heart transplant rate was 26%. CONCLUSIONS: In this national study, we found an incidence rate of paediatric DCM of 0.62/100 000 person-years in Sweden. The mortality risk was highest in children > 10 years old at diagnosis.
AIM: Sleep disruptions are common in hospitalised children. This study described sleep in critically ill and non-critically ill hospitalised children, including young infants and patients with central nervous system inju...AIM: Sleep disruptions are common in hospitalised children. This study described sleep in critically ill and non-critically ill hospitalised children, including young infants and patients with central nervous system injuries. METHODS: This observational cohort study included two groups: critically ill children admitted to a paediatric intensive care unit with expected stay of ≥ 48 h, and non-critically ill children with suspected sleep disordered breathing. Critically ill children were recruited within two clinical studies conducted between 2020 and 2022. Non-critically ill children were recruited from a retrospective database spanning between 2017 and 2021. Sleep was measured using polysomnography and compared with age-specific reference ranges. RESULTS: We included 25 critically ill and 120 non-critically ill children. Median ages were 3.6 (1.0-20.4) and 36.7 (6.1-107.7) months, respectively. In critically ill children, nighttime total sleep time accounted for only 50.9% (49.5-55.5) of 24 h sleep. Rapid eye movement (REM) and deep sleep were reduced in 96.0% and 66.7%, respectively. Electroencephalographic (EEG) abnormalities were common (76.0%). Non-critically ill children had reduced REM sleep in early infancy and shorter, fragmented sleep in older children. CONCLUSION: Critically ill children had disrupted sleep and atypical EEG, while non-critically ill children mainly had reduced fragmented sleep.
AIM: Childhood ischemic stroke is rare but causes substantial long-term morbidity, and its heterogeneous aetiology complicates timely diagnosis and management. METHODS: We conducted a retrospective population-based obser...AIM: Childhood ischemic stroke is rare but causes substantial long-term morbidity, and its heterogeneous aetiology complicates timely diagnosis and management. METHODS: We conducted a retrospective population-based observational study using hospital data and chart review to describe diagnostics, treatment and outcomes of ischemic stroke in patients aged 1 month to 18 years treated at HUS Helsinki University Hospital between 2010 and 2023. Hemorrhagic strokes were excluded. RESULTS: Among 137 patients, the median annual incidence was 2.5 per 100 000 children. The five largest aetiological subgroups were idiopathic (18%), arteriopathy (16%), major surgery (13%), cardiac embolism (13%) and infection (12%). More than half of patients with available data were diagnosed more than 24 h after symptom onset. Hemiplegia was the most frequent symptom (44%), followed by seizures (25%), which were particularly common in infants. At follow-up, about half of the patients had motor and/or neuropsychological deficits. Epilepsy developed in 20 (15%) patients and recurrent stroke occurred in 8 (6%). CONCLUSION: Childhood ischemic strokes in our population had heterogeneous causes and substantial long-term morbidity. Diagnostic delays were frequent, underscoring the need to improve recognition of paediatric stroke. The low recurrence rate highlights the importance of population-specific factors when interpreting risk and outcomes.
AIM: To evaluate whether phototherapy blankets prevent the use of overhead phototherapy in neonates with total serum bilirubin level (TSB) approaching the treatment thresholds. METHODS: A single-centre randomised trial w...AIM: To evaluate whether phototherapy blankets prevent the use of overhead phototherapy in neonates with total serum bilirubin level (TSB) approaching the treatment thresholds. METHODS: A single-centre randomised trial was performed in a tertiary maternity unit. Infants ≥ 35 weeks' gestation and > 24 h of age with suspected hyperbilirubinaemia were eligible if TSB levels were within 35 μmol/L (2.0 mg/dL) of treatment thresholds. Infants admitted to the neonatal unit or with a positive pre-randomisation direct Coombs test were excluded. Infants were randomised to the intervention (phototherapy blanket) arm or control (routine care) arm. Primary outcome was need for overhead phototherapy. RESULTS: Ninety-seven infants were included in the intention-to-treat analysis, 51 in the intervention and 46 in the control arm with no differences in baseline characteristics. Sixteen percent of the intervention group and 15% of the control group required overhead phototherapy (p > 0.99) and no difference in length of stay (p = 0.6) was observed. More infants in the intervention arm were discharged receiving formula feeds exclusively (p = 0.04). CONCLUSION: Use of phototherapy blankets in clinically well term infants with TSB levels below treatment thresholds does not decrease subsequent need for overhead phototherapy, has no effect on length of hospital stay, and may impact breastfeeding. TRIAL REGISTRATION: The trial was retrospectively registered (ISRCTN29045982-https://www.isrctn.com/) on 08/01/2022.
AIMS: To investigate the association between serum ALP levels and the development of AKI in paediatric patients with sepsis. METHODS: Retrospective screening of a computerized database of 4 Israeli regional hospitals for...AIMS: To investigate the association between serum ALP levels and the development of AKI in paediatric patients with sepsis. METHODS: Retrospective screening of a computerized database of 4 Israeli regional hospitals for children (0-18 years) hospitalized between 1.01.2000-1.06.2024 with ICD-9 sepsis-related diagnoses (study group) and age- and sex-matched non-septic febrile patients (controls). Serum ALP levels were sex- and age-adjusted and described as standard deviation scores (SDS). RESULTS: Of 809 952 screened hospitalizations, 701 records comprised the study group. Their median (IQR) age was 17 (10-38) months, 53% were males. Nadir ALP-SDS was lower in the sepsis group compared to controls (-1.65 ± 1.11 vs. -0.97 ± 1.36, p < 0.001) and further lower in those with AKI, which occurred in 23% of the sepsis cohort (-1.95 ± 1.16 vs. -1.56 ± 1.09, p < 0.001). Hospital stay was longer in the AKI compared to non-AKI group [median (IQR): 7 (4, 12) vs. 4 (3, 5) days, p < 0.001]. Lower ALP-SDS was independently associated with AKI [OR (95% CI): 0.7 (0.6-0.8), p < 0.001], after controlling for CRP and leucocyte count. CONCLUSIONS: ALP was lower in sepsis patients compared to controls, and significantly lower in AKI vs. non-AKI group, suggesting it as an additional marker of infection severity.
AIM: This study was designed to determine whether gestational age at birth, the method of delivery, or birth weight were associated with the risk of developing atopic dermatitis (AD), and whether the association of risk...AIM: This study was designed to determine whether gestational age at birth, the method of delivery, or birth weight were associated with the risk of developing atopic dermatitis (AD), and whether the association of risk factors differed between the sexes. METHODS: A large population-based Northern Finland Birth Cohort 1986 Study that has been followed since birth. The dataset consisted of 8993 subjects who were divided into two groups based on presence or absence of AD. RESULTS: The prevalence of AD was 23.7%. The probability of later AD was unaffected by either method of delivery or gestational age at birth. However, low birth weight compared to normal birth weight was a protective factor against AD, albeit only in men (adjusted risk ratio RR 0.54 [95% CI 0.30-0.97]). No such effect was observed in women. CONCLUSIONS: These findings suggest the existence of sex-specific risk factors for AD.
AIM: The COVID-19 pandemic was associated with a marked decline in respiratory infections and asthma exacerbations in children. Following the easing of restrictions, a rebound in respiratory morbidity was observed. Howev...AIM: The COVID-19 pandemic was associated with a marked decline in respiratory infections and asthma exacerbations in children. Following the easing of restrictions, a rebound in respiratory morbidity was observed. However, the long-term impact on paediatric asthma remains unclear. METHODS: We conducted a retrospective study using data from the largest healthcare provider in Israel. Children aged 2-18 years with recurrent wheezing or clinician-diagnosed asthma were included. Healthcare utilisation between January 2019 and July 2023 was analysed. RESULTS: A total of 209 954 children, mean age 6.8 years (56.9% male), were included. During winter 2020-2021, compared with winter 2019-2020, healthcare utilisation declined significantly for chest radiographs (CXR) (RR = 0.69), asthma medication dispensing (RR = 0.67), and emergency department (ED) visits (RR = 0.61). After restrictions were lifted, all outcomes rose sharply, peaking in summer 2021. By winter 2022-2023, rates of CXR (RR = 1.30), asthma medication dispensing (RR = 1.03), ED visits (RR = 1.04), and hospitalisations (RR = 1.30) remained significantly higher than pre-pandemic levels across all age groups. CONCLUSION: Paediatric respiratory-related healthcare utilisation exceeded pre-pandemic levels during the first and second post-pandemic winters. These findings highlight the unpredictable, long-lasting, and indirect consequences of pandemic-era interventions on respiratory health.
AIM: Childhood obesity has been strongly associated with insulin resistance and dysglycaemia. We aimed to evaluate fasting biomarkers and glycated haemoglobin (HbA1c) for identifying children at risk and guiding the need...AIM: Childhood obesity has been strongly associated with insulin resistance and dysglycaemia. We aimed to evaluate fasting biomarkers and glycated haemoglobin (HbA1c) for identifying children at risk and guiding the need for oral glucose tolerance testing (OGTT). METHODS: This single-centre study included 475 consecutive children aged 5-18 years with excess weight who underwent OGTT. Insulin resistance and dysglycaemia were defined based on OGTT-derived indices. Fasting glucose (FG), fasting insulin (FI), homeostatic model assessment of insulin resistance (HOMA-IR), homeostatic model assessment of β-cell function (HOMA-β), and HbA1c were evaluated. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-offs for predicting dysglycaemia. RESULTS: The cohort comprised 281 girls (59.2%) and 194 boys, with a median age of 13.8 years. Insulin resistance was present in 81.5% (387/475) and dysglycaemia in 18.9% (90/475). FG above the 90th percentile, FI and HOMA-IR above the 97.5th percentile, and HbA1c ≥ 39 mmol/mol (5.7%) were significantly associated with dysglycaemia (p < 0.05). ROC analysis for the entire cohort identified FG 5.27 mmol/L, HbA1c 39 mmol/mol, and HOMA-IR 4.88 as significant cut-offs (all p < 0.001). CONCLUSION: Fasting biomarkers and HbA1c identified children with excess weight at risk of dysglycaemia, providing practical thresholds to guide the need for OGTT.
AIM: To explore parents' needs during end-of-life decision-making and to understand their experiences in a neonatal intensive care unit (NICU) following the death of their child. METHODS: This observational, retrospectiv...AIM: To explore parents' needs during end-of-life decision-making and to understand their experiences in a neonatal intensive care unit (NICU) following the death of their child. METHODS: This observational, retrospective study was conducted in the NICU of a tertiary-level hospital. Data were collected using a structured questionnaire administered to parents following the death of their neonate. Three main domains were explored: information and communication, the decision-making process and comfort-focused care. RESULTS: During the study period, 51 neonates died after treatment was redirected towards comfort-focused care. Of the 102 eligible parents, 52 participated. Information and communication were highly rated (mean 6.5/7), particularly the sensitive delivery of information. Parents generally felt supported during decision-making (mean 5.6/7), and most (76.9%) preferred professional guidance. However, only half perceived concordance between their preferences and the final decision. Comfort-focused care was also positively evaluated (mean 6.13/7), although opportunities to choose the place of death were limited. The questionnaire demonstrated acceptable internal consistency (α = 0.72). CONCLUSION: Parents value shared decision-making that respects their values while providing professional guidance. These findings highlight the importance of sensitive communication, adequate time for reflection, ongoing support throughout the decision-making process, and meaningful opportunities to say goodbye.
AIM: Children with food allergies (FA) and their parents frequently fear that accidental skin contact with allergenic foods may cause severe systemic reactions. This study aimed to evaluate the risk of systemic allergic...AIM: Children with food allergies (FA) and their parents frequently fear that accidental skin contact with allergenic foods may cause severe systemic reactions. This study aimed to evaluate the risk of systemic allergic reactions following controlled skin exposure to common food allergens in children with confirmed FA. METHODS: In this multicentre study, children aged 1-18 years with FA underwent patch testing with allergenic food applied to the forearm for 15 min. Two age- and sex-matched control groups were included (with atopic comorbidities without FA and healthy controls). Clinical reactions were monitored. RESULTS: 293 children enrolled, including 192 (65.5%) with FA. Among 263 patch tests in the FA group, 220 (83.7%) were negative, 40 (15.2%) resulted in mild local skin reactions, and 3 (1.1%) induced more extensive skin reactions limited to the tested arm. No systemic reactions or anaphylaxis occurred. Cow's milk was associated with a higher rate of skin reactions: 16/68 (23.5%) mild local and 2/68 (2.9%) more extensive reactions. Younger age was the main predictor of skin reactivity. CONCLUSIONS: In this cohort, skin contact with allergenic foods in children with FA did not induce anaphylaxis and rarely results in mild local symptoms. These findings support that incidental skin exposure poses minimal risk and may help reduce unnecessary environmental restrictions and their associated psychosocial burden.
AIM: To assess the proportion of children with Down syndrome (DS) with creatinine levels above standard paediatric reference ranges in a single-centre Irish outpatient cohort. METHODS: We performed a retrospective cross-...AIM: To assess the proportion of children with Down syndrome (DS) with creatinine levels above standard paediatric reference ranges in a single-centre Irish outpatient cohort. METHODS: We performed a retrospective cross-sectional study of children aged 0-16 years attending the DS Clinic at Children's Health Ireland, Tallaght, between June 2022 and June 2024. Children with known renal disease and acute results were excluded. Creatinine levels were analysed using age- and sex-specific reference ranges. The proportion with creatinine above the upper reference limit was compared with the expected proportion of 2.5% using a one-sided exact binomial test. Estimated glomerular filtration rate (eGFR) was calculated using the bedside Schwartz equation, where height was available. RESULTS: A total of 194 patients were included. Among them, 52 (26.8%) had creatinine levels above the upper reference limit (p < 0.0001). Additionally, 42 (21.6%) had persistently elevated creatinine (p < 0.0001). Height was available for 124 children. Of those, 42 (34%) had an eGFR < 90 mL/min/1.73 m and 1 (0.8%) had an eGFR < 60 mL/min/1.73 m. CONCLUSION: Children with DS in this Irish clinic frequently had creatinine levels above standard reference ranges. Further studies are required to clarify the clinical significance of these findings.