AIM: This study evaluated the effect of combining remote training (RT) with quality improvement (QI) processes on immediate and resuscitative care practices in a hospital in Nepal. METHODS: This prospective, before-after...AIM: This study evaluated the effect of combining remote training (RT) with quality improvement (QI) processes on immediate and resuscitative care practices in a hospital in Nepal. METHODS: This prospective, before-after-design study included 5034 newborns, with 1836 newborns independently observed for immediate and resuscitation care practice. Essential Newborn Care (ENC) training was delivered remotely via zoom to healthcare providers (HCPs) followed by six bi-monthly facilitated QI interventions through Plan-Do-Study-Act (PDSA) meeting. Generalized linear models were used to estimate the multivariable adjusted risk ratios (aRRs) between the periods as well as incidence risk ratio (IRR) change for key HCP performance on a weekly basis during PDSA interventions. RESULTS: The proportion of deliveries for which resuscitation equipment was prepared by HCP increased from 9.6% to 43.7% between the observation periods (aRR = 1.44). Initiation of ventilation within the first minutes of birth improved significantly (0% vs. 18%, aRR = 1.49) with IRR increase by 17% with each additional week (IRR = 1.17; 95% CI; 1.08, 1.26). The proportion of infants who received repeat suctioning decreased non-significantly (88.6% vs. 63.2%, aRR = 1.22). CONCLUSION: Pairing RT with facilitated QI led to improvements in immediate newborn and resuscitation care practice, recommending pairing of remote training and facilitating QI for future resuscitation program.
AIM: To describe the association between different physical activity and sleep parameters in school-aged children born very preterm. METHODS: A cross-sectional analysis was done in a cohort of 6- to 10-year-old children...AIM: To describe the association between different physical activity and sleep parameters in school-aged children born very preterm. METHODS: A cross-sectional analysis was done in a cohort of 6- to 10-year-old children born at < 32 weeks' gestation at the Department of Neonatology, University of Tübingen, Germany. Data were collected between May and November 2022 using actigraphy for sleep and activity, as well as patient records, questionnaires, and anthropometric measurements. RESULTS: Two hundred and thirty five children (46% girls) were analysed at a median age of 8.0 (6.0-9.0) years. Daily sleep duration averaged 8.5 (SD: ±0.7) h. 24.7% achieved daily recommendations of 60 min moderate to vigorous physical activity (MVPA). Total physical activity, measured as counts/min, differed based on gestational age, with children born < 28 weeks' gestation exhibiting higher activity than those born at 28-32 weeks. Regression analysis showed one standard deviation (SD) increase in sleep efficiency associated with a 0.14 SD decrease in total physical activity (Standardized β: -0.14, CI: -0.26 to -0.02) and 37% lower odds of being in the higher MVPA group (OR: 0.63, CI: 0.47 to 0.83). CONCLUSION: Our study revealed important differences in some aspects of sleep and activity behaviour by gestational age that warrant future investigations.
AIM: Prior to the implementation of couplet care in 2025, knowledge of clinical outcomes was central to support feasibility and future evaluation. We aimed to review trends on mode of delivery, duration of respiratory su...AIM: Prior to the implementation of couplet care in 2025, knowledge of clinical outcomes was central to support feasibility and future evaluation. We aimed to review trends on mode of delivery, duration of respiratory support, nutrition at discharge and weight gain. METHODS: This was a descriptive register-based study that used data from a local database, Neobase. The database consisted of prospectively collected data on all infants admitted and discharged from a neonatal intensive care unit in the Capital Region of Denmark. Demographic and clinical data in the period of 2018-2024 were retrieved and analysed. RESULTS: We included 4969 infants with a mean gestational age of 37, 6 weeks and a mean birth weight of 2926 g. Vaginal birth was the most frequent mode of delivery. However, a slight upward trend in Caesarean section was observed. The majority of infants were discharged on their mothers' milk. The median duration of respiratory support remained stable at 1 day, and the median weight gain remained zero throughout the study period. CONCLUSION: Key outcomes considered sensitive to couplet care remained stable over the seven-year period. These findings establish an essential reference for the prospective evaluation of couplet care, as well as its feasibility in practice.
AIM: To examine how early pulmonary phenotype influences treatment response and the interpretation of trial outcomes in bronchopulmonary dysplasia (BPD). METHODS: A narrative review of early respiratory patterns in very...AIM: To examine how early pulmonary phenotype influences treatment response and the interpretation of trial outcomes in bronchopulmonary dysplasia (BPD). METHODS: A narrative review of early respiratory patterns in very preterm infants and their relationship to treatment response, using published trials of postnatal corticosteroids as the primary example. RESULTS: BPD is defined at 36 weeks' postmenstrual age by treatment requirements, reflecting clinical practice rather than the underlying disease biology. The clinical phenotype is evident much earlier. Some infants stabilise with supportive care alone, while others develop persistent pulmonary disease consistent with emerging BPD, with variable responses to treatment. When therapies are applied to broad early populations, spontaneous achievers dilute the apparent treatment effect. As postnatal age increases and populations are enriched for persistent disease, treatment effects become larger and more consistent. Findings from postnatal corticosteroid trials follow this pattern. CONCLUSION: Thus, the effect of disease-modifying therapy in infants at risk of BPD reflects both the intervention and the interaction between population risk and cohort phenotype and is best understood when treatment and trial design align with the early clinical phenotype.
AIM: In Sweden, critically ill children are admitted to one of four dedicated paediatric intensive care units (PICUs) or general intensive care units (ICUs), reflecting a partly centralised system. The Paediatric Index o...AIM: In Sweden, critically ill children are admitted to one of four dedicated paediatric intensive care units (PICUs) or general intensive care units (ICUs), reflecting a partly centralised system. The Paediatric Index of Mortality 3 (PIM3) is a widely used risk stratification tool for predicting mortality in critically ill children. This study aimed to validate PIM3 in a national Swedish cohort, recalibrate the model where indicated and compare outcomes between PICUs and ICUs. METHODS: This retrospective cohort study used prospectively collected data from the Swedish Intensive Care Registry of admissions reported between 1 January 2016 and 30 September 2022. Discrimination and calibration were assessed, and recalibration was performed using logistic regression. RESULTS: 19 183 admissions were included, 10 714 males and 8469 females. Prior to recalibration, PIM3 overestimated mortality in both settings, with standardised mortality rates (SMRs) of 0.72 (95% Confidence Interval (CI) 0.64-0.80) in PICUs and 0.52 (95% CI 0.42-0.63) in ICUs. Following recalibration, SMR was 0.92 (95% CI 0.70-1.20) and 0.96 (95% CI 0.59-1.49) in PICUs and ICUs, respectively. CONCLUSION: PIM3 demonstrated excellent discrimination but systematically overestimated mortality in the Swedish context. Recalibration corrected this bias and attenuated outcome differences between PICU and ICU settings.
AIM: To investigate baseline pneumococcal antibody levels and the influence of allergic sensitization in children under age six with recurrent respiratory infections. METHODS: We conducted a retrospective analysis of 38...AIM: To investigate baseline pneumococcal antibody levels and the influence of allergic sensitization in children under age six with recurrent respiratory infections. METHODS: We conducted a retrospective analysis of 38 fully immunised children (aged 2-5 years) with recurrent respiratory infections. Baseline serum pneumococcal antibody levels were measured against 23 serotypes. An adequate response was defined as protective levels (≥ 1.3 ug/mL) for at least 50% of tested serotypes. Associations between antibody levels and allergic sensitization (defined by skin prick test or specific IgE), asthma, and atopic dermatitis were evaluated. RESULTS: Inadequate baseline pneumococcal antibody levels were found in 71% of the cohort. Allergic sensitization was significantly associated with lower protective antibody levels for non-conjugate serotypes (mean 26% vs. 51%, p = 0.04) but showed no significant correlation with conjugate vaccine serotypes. The prevalence of specific antibody deficiency was low at 5%. No significant associations were found between antibody levels and diagnosed asthma or atopic dermatitis. CONCLUSION: Young children with recurrent respiratory infections frequently exhibit inadequate baseline immunity. Allergic sensitization is specifically linked to impaired responses to non-conjugate polysaccharide antigens, suggesting atopy selectively hinders specific immune pathways.
AIM: Doxapram is used as an additional therapy for apnea of prematurity when standard treatments such as caffeine or continuous positive airway pressure are insufficient, but its impact on long-term neurodevelopment rema...AIM: Doxapram is used as an additional therapy for apnea of prematurity when standard treatments such as caffeine or continuous positive airway pressure are insufficient, but its impact on long-term neurodevelopment remains uncertain. This study evaluated the association between Doxapram exposure and neurodevelopmental outcomes in very low birth weight infants (VLBWI), with a focus on potential dose-dependent effects. METHODS: In this monocentric retrospective cohort study, VLBWI with gestational age ≤ 32 weeks were included. Infants treated with Doxapram (n = 140) were compared to untreated controls (n = 280) matched by year of birth. Exposure was stratified by cumulative dose. The primary outcome was neurodevelopment at 24 months corrected age assessed by the mental development index or global development quotient (MDI/GDQ). Secondary outcomes included mortality, growth parameters and neurological outcomes. Multivariable logistic regression adjusted for confounders. RESULTS: Neurodevelopment did not differ between groups (MDI/GDQ: 94.2 ± 21.2 vs. 97.7 ± 14.8; p = 0.1), nor did mortality (5.0% vs. 6.8%; p = 0.53). No dose-dependent associations were observed. Secondary outcomes were comparable. CONCLUSIONS: Doxapram exposure was not associated with adverse neurodevelopmental outcomes in VLBWI within the investigated dosage range, although definitive conclusions on drug safety cannot be drawn from medium-sized cohorts and confirmation in prospective randomised studies is required.
AIM: Icelandic data on outcomes after preterm birth are limited. The aim was to describe neonatal morbidities, motor development up to 24 months, and examine whether morbidities predicted disability. METHOD: It was a ret...AIM: Icelandic data on outcomes after preterm birth are limited. The aim was to describe neonatal morbidities, motor development up to 24 months, and examine whether morbidities predicted disability. METHOD: It was a retrospective cohort study of 318 children born < 32 weeks of gestation and/or weighing < 1 000 g, who were followed at the University Hospital of Iceland from January 2012 to December 2020. Motor development was assessed using the Alberta Infant Motor Scale to 15 months, and the Bayley Scales of Infant and Toddler Development-III motor scales at 12 and 24 months. Associations between neonatal morbidities and outcomes were examined using correlation and multivariable regression. RESULTS: Neonatal morbidities were more common in children born < 28 weeks of gestation and/or weighed < 1 000 g, who also had higher rates of later disability diagnoses. Motor performance to 24 months was below test norms in this group, but morbidities were not associated with motor scale outcomes. In the cohort of children born before 32 weeks of gestation, cumulative neonatal morbidity burden independently predicted later disability, with adjusted odds increasing by approximately 60% per additional morbidity. CONCLUSION: Children born more prematurely had greater morbidity and disability risk. Cumulative neonatal morbidity predicted later disability, supporting long-term follow-up.
AIM: Varicella is a highly contagious disease affecting approximately 90% of children before the age of 10, constituting a substantial health and societal burden. This study investigates the association between socio-dem...AIM: Varicella is a highly contagious disease affecting approximately 90% of children before the age of 10, constituting a substantial health and societal burden. This study investigates the association between socio-demographic and socio-economic factors and uptake of varicella vaccination in Denmark, 2019-2024. METHODS: This Danish cohort study included 1 356 841 individuals aged 1-18 years. Socio-demographic and socio-economic factors for children and their parents were obtained from Statistics Denmark's registers and linked to varicella vaccination status in the Danish Vaccination Register. We estimated yearly vaccination initiation and cumulative vaccine coverage. Associations were assessed using crude and adjusted multivariable logistic regression models. RESULTS: As of 2024, 16 903 1-18 year olds had received at least one dose of the varicella vaccine, of whom 84% completed the series. Coverage increased markedly from 2019 to 2024 and was highest in the Capital Region and metropolitan municipalities. Vaccination was more likely among children of parents with higher education (aOR: 4.98, 95% CI: 4.05-6.12), higher income (aOR: 3.08, 95% CI: 2.85-3.33) and a background in medicine or nursing (aOR: 1.79, 95% CI: 1.72-1.88). CONCLUSION: Varicella vaccination uptake is higher among children from families with high socio-economic status, and this pattern persists over a 6-year period.
Ullsten A, Bacchini F, Campbell-Yeo M
… +10 more, Eriksson M, Lenells M, Mezzalira E, Mäki-Asiala M, Olsson E, Palomaa AK, Pölkki T, Rajala M, Axelin A, PEARL Research Group
AIM: To analyse the association between specific socioeconomic measures and the risk of incomplete vaccination for diphtheria-tetanus-pertussis (DTP) and measles-containing vaccine (MCV) in Swedish two-year-olds. METHODS...AIM: To analyse the association between specific socioeconomic measures and the risk of incomplete vaccination for diphtheria-tetanus-pertussis (DTP) and measles-containing vaccine (MCV) in Swedish two-year-olds. METHODS: This nationwide, population-based cohort study included 227 457 children born in Sweden during 2014-2015. Data were obtained from the National Vaccination Register (NVR) and linked to socioeconomic data from Statistics Sweden. Multivariable logistic regression was used to estimate the associations between family characteristics-including income, education, employment, and family structure-and incomplete DTP and MCV vaccination at 24 months of age. RESULTS: Incomplete vaccination was found in 13.1% of children for DTP3 (three doses) and 8.7% for MCV1 (one dose). Low family income, single parenthood, parental unemployment, frequent residential mobility, and parental immigration were risk factors for incomplete vaccination. A previously unreported risk factor was having a sibling with a disability or chronic disease, which increased the risk of incomplete DTP3 (aOR 1.15, 95% CI 1.05-1.27) and MCV1 (aOR 1.27, 95% CI 1.14-1.41). CONCLUSION: Despite a tax-funded national immunisation programme, socioeconomic disparities in vaccination coverage exist in Sweden. Children in socially vulnerable families, and those with siblings requiring disability support, need targeted interventions to ensure full immunisation.
AIM: To describe changes in peripheral oxygen saturation (SpO) and regional cerebral oxygenation (rcSO) during less invasive surfactant administration (LISA) in a high-level continuous positive airway pressure (CPAP) res...AIM: To describe changes in peripheral oxygen saturation (SpO) and regional cerebral oxygenation (rcSO) during less invasive surfactant administration (LISA) in a high-level continuous positive airway pressure (CPAP) respiratory support delivery room protocol in very low birth weight infants (VLBW). METHODS: This is a secondary analysis of data from the randomized-controlled Extrauterine Placental Transfusion in Resuscitation of VLBW infants (EXPLAIN) trial. In total, 38 patients were included. The pressure and changes in heart rate, SpO and rcSO were assessed 10 min before until 10 min after the LISA procedure. Basic outcome data for the patient collective were collected. RESULTS: Mean gestational age was 27 + 6 weeks (±15 days), and mean birth weight was 995.8 g (±298.8). All infants were eligible for LISA. During LISA, heart rate, SpO and rcSO decreased significantly (mean change 32.4 (± 27.5) bpm, -14.5 (± 10.7) % and -11.9 (± 9.1) %, respectively; all p < 0.001). Moreover, two infants developed a pneumothorax and three infants required endotracheal intubation within 72 h after birth. CONCLUSIONS: With the approach of a high-level CPAP setting, we observed transient decreases in heart rate and oxygenation levels during LISA. The magnitude of these decreases was within the expected or potentially favourable range compared with prior studies. TRIAL REGISTRATION: ClinicalTrials.gov identifier:NCT03916159.
AIM: To assess postmortem investigations performed in sudden unexpected death in infancy (SUDI) cases in daily practice in France. METHODS: Children deceased from SUDI and registered in the French SUDI registry from 2015...AIM: To assess postmortem investigations performed in sudden unexpected death in infancy (SUDI) cases in daily practice in France. METHODS: Children deceased from SUDI and registered in the French SUDI registry from 2015 to 2024 were included retrospectively. The postmortem investigations performed in SUDI cases were described, their temporal trends since 2015 and their compliance with the French National Health Authority guidelines were assessed. The minimum set of non-invasive postmortem investigations performed in cases required to detect unnatural death, including fundus examinations, imaging and toxicological tests, was studied. RESULTS: We examined 1 934 SUDI cases. Laboratory tests were the most frequently performed procedures (93.0%), and fundus examinations were the least frequent (21.6%). There was a significant increase in fundus examinations (9.3% to 31.6%), laboratory tests (87.6% to 97.3%), bacteriological tests (91.4% to 97.2%), toxicological tests (79.0% to 91.0%), and whole-body imaging (75.2% to 87.3%) from 2015 to 2024. Only 2.1% of cases were investigated strictly according to the French guidelines. We found that 13.2% of cases underwent minimal non-invasive postmortem investigation for detecting unnatural death. CONCLUSION: Although certain investigations are performed more frequently, efforts to improve local protocols and updated guidelines are needed to ensure thorough postmortem investigations, resulting in an improved diagnostic approach.
AIM: Rabies is a universally fatal yet preventable disease when post-exposure prophylaxis (PEP) is administered promptly and appropriately. To describe exposure characteristics, risk categorization and real-world PEP pra...AIM: Rabies is a universally fatal yet preventable disease when post-exposure prophylaxis (PEP) is administered promptly and appropriately. To describe exposure characteristics, risk categorization and real-world PEP practices among children in an endemic urban setting. METHODS: We conducted a retrospective study of children (< 18 years) presenting with rabies-risk contact between January 2013 and October 2023. Data were extracted from the provincial (İzmir) rabies surveillance system and included demographics, exposure type, time to presentation, animal species, risk category, wound care, rabies vaccination, rabies immunoglobulin (RIG) and tetanus prophylaxis. RESULTS: A total of 3732 children were included (median age 9 years, IQR 5-13), with 63.3% being male. Most exposures involved dogs (49.8%) and cats (44.8%) and occurred in İzmir. Same-day presentation occurred in 48.8% of cases, while 0.9% presented after more than 30 days. Risk categorization was documented in only 33.6% of patients, most commonly Category II (61.5%) and Category III (30.5%). RIG was administered to 2.6% of patients and more frequently after wild animal exposures. CONCLUSION: Substantial gaps in risk documentation and variability in pediatric rabies PEP practices were observed, highlighting the need for standardized risk assessment and improved clinical guidance.