AIM: We evaluated the impact of 'CoolCuddle', parental cuddling during therapeutic hypothermia intervention for hypoxic-ischaemic encephalopathy, on heart rate variability (HRV). METHODS: In this prospective, single-grou...AIM: We evaluated the impact of 'CoolCuddle', parental cuddling during therapeutic hypothermia intervention for hypoxic-ischaemic encephalopathy, on heart rate variability (HRV). METHODS: In this prospective, single-group, interventional study with repeated measures, we included infants ≥ 36 weeks' gestation undergoing hypothermia and CoolCuddle with HRV data. Time-domain HRV was assessed before, during, and after each cuddle. Primary outcomes were heart rate, mean RR interval (ANN), standard deviation of normal RR intervals, and root mean square of successive differences (RMSSD). RESULTS: In 65 CoolCuddles from 26 infants, CoolCuddle did not significantly alter HRV. However, infants with a 1-min Apgar < 7 had increased heart rates during (+2.33 bpm) and after (+3.27 bpm) cuddling, whereas those with higher Apgar scores showed decreases (-1.43 and -8.21 bpm) compared with pre-cuddle. Infants with Apgar < 7 or abnormal aEEG had reduced ANN during (-11.96 ms, -12.75 ms) and after (-19.89 ms, -19.00 ms), while those with higher Apgar or normal aEEG showed increases (+15.32 ms, +23.33 ms(during-cuddle); +63.94 ms, +55.06 ms (post-cuddle)). Maternal cuddling was associated with higher post-cuddle RMSSD (+1.06 ms) than paternal cuddling (-0.73 ms), (p = 0.04). CONCLUSION: While CoolCuddle had little overall effect on HRV, autonomic responses varied by asphyxia and encephalopathy severity and parent, suggesting differential modulation in vulnerable infants.
AIM: To explore trends and main causes of infant mortality in Norwegian live-born infants (LBIs) from 2009 through 2020 and assess how trends differ by gestational age (GA). METHODS: Population-based cohort study of infa...AIM: To explore trends and main causes of infant mortality in Norwegian live-born infants (LBIs) from 2009 through 2020 and assess how trends differ by gestational age (GA). METHODS: Population-based cohort study of infant deaths using data from the Medical Birth Registry of Norway and the Norwegian Cause of Death Registry. RESULTS: The study population consisted of 676 931 LBIs (48.6% female), of which 1583 (2.3 per 1000 LBIs) died in infancy (43% female). There was a linear decline in the infant mortality from 2.9 to 1.7 per 1000 LBIs (p < 0.001). Age of death remained stable; 70% occurred in the neonatal period and 30% occurred within the first 24 h. The main causes of death were in descending order: prematurity-related (39.6%), malformations/chromosomal abnormalities (27.0%), asphyxia/neonatal encephalopathy (12.4%), other (11.0%), SIDS (6.8%) and infections (3.2%). The highest mortality rate, and the most pronounced decline, was observed among extremely preterm infants (below 28 weeks), declining from 363 to 227 per 1000. CONCLUSION: The infant mortality rate declined by more than 40% from 2009 to 2020. Around 70% of all infant deaths occurred in the neonatal period. Prematurity-related mortality was the most common cause of death but showed the greatest decline.
AIM: To assess the impact of changing the NICU environment from an open bay unit to a single-family room on perceived parental stress. METHODS: An observational longitudinal cohort study was conducted between February 20...AIM: To assess the impact of changing the NICU environment from an open bay unit to a single-family room on perceived parental stress. METHODS: An observational longitudinal cohort study was conducted between February 2021 and January 2024, during which time the NICU environment of the Emma Children's Hospital Amsterdam UMC changed from open bay unit to a single-family room. Parents of infants admitted to the NICU were eligible for inclusion. The Parental Stress Score: NICU questionnaire was used to objectify perceived parental stress on day 8 and 28 of their infants' life. RESULTS: The PSS:NICU was completed by 74 mothers and 57 partners on day 8 and 27 mothers and 9 partners on day 28. The general stress score on day 8 was high for mothers (4.0 [IQR 3.0-5.0]) and partners 3.0 (IQR 3-0-4.0), but similar during the open bay unit and single-family room. On day 28, mothers perceived more stress in the single-family room compared with the open bay unit, which originated from higher scores in the subscale 'Infant Behaviour and Appearance'. CONCLUSION: High stress is experienced throughout the NICU stay. Transition to single-family rooms did not have a major impact on perceived parental stress.
In 2024, the European Academy of Paediatrics (EAP) published a list of 10 low-value practices in paediatric care. Embedded in the Choosing Wisely framework, this list is a step towards promoting targeted and evidence-bas...In 2024, the European Academy of Paediatrics (EAP) published a list of 10 low-value practices in paediatric care. Embedded in the Choosing Wisely framework, this list is a step towards promoting targeted and evidence-based care. However, no single recommendation can change prescription habits and we need to acknowledge that overuse of the available resources has multiple causes. Among them, the physicians' mental framework, cognitive biases, fears of missing a diagnostic and the pressure to act cannot be ignored. Here, the EAP's Choosing Wisely working group explores these causes and outlines three broad paths that may lead to long-lasting reduction in low-value care.
AIM: The prevalence of food allergy has increased in recent decades. We aimed to determine the cumulative incidence of food allergy in early childhood and to identify associated risk factors. METHODS: We conducted a pros...AIM: The prevalence of food allergy has increased in recent decades. We aimed to determine the cumulative incidence of food allergy in early childhood and to identify associated risk factors. METHODS: We conducted a prospective birth cohort study including 1006 newborns recruited over one year at a single hospital in Spain and followed until 4 years of age. Data were collected at birth and through structured telephone interviews during follow-up. Children with suspected food allergy underwent skin prick testing, specific serum IgE measurement and open oral food challenges when indicated. RESULTS: The cumulative incidence of food allergy was 7.2% (72/1006). Independent risk factors for IgE-mediated food allergy included hospitalization for bronchospasm (adjusted odds ratio [aOR] 2.37; 95% CI 1.07-5.26), atopic dermatitis (aOR 7.52; 95% CI 3.77-15.01), maternal asthma (aOR 3.12; 95% CI 1.30-7.53) and paternal allergic rhinitis (aOR 2.79; 95% CI 1.31-5.94). Proton-pump inhibitor use, absence of daycare attendance and early-onset atopic dermatitis were associated with non-IgE-mediated food allergy. CONCLUSION: In this Spanish birth cohort, food allergy affected 7.2% of children by age 4. Atopic dermatitis was the main risk factor for IgE-mediated food allergy, while potentially modifiable early-life exposures were associated with non-IgE-mediated forms.
AIM: This study summarised the global epidemiology, prevention policies, and public health communication strategies related to infant botulism and exposure to honey. METHODS: A narrative review of epidemiological data wa...AIM: This study summarised the global epidemiology, prevention policies, and public health communication strategies related to infant botulism and exposure to honey. METHODS: A narrative review of epidemiological data was carried out from 1976 to 2024, using surveillance reports, national health agency documents, and peer-reviewed literature. RESULTS: Cases were rare, but honey was the only consistently confirmed dietary source of infant botulism. The median age at onset was 3-4 months, and mortality was below 1% if the infants received intensive care support and specific therapy with human botulism immune globulin. A global review from 2007 to 2021 reported that the USA had approximately 130 cases of infant botulism per year, while Europe, Canada, Japan, and Australia reported markedly lower incidences. Italy had 36 cases between 2001-2020, which represented 8% of all confirmed botulism cases in the country during that period. We found that health authorities uniformly advised against consuming honey before 12 months of age, but warning labels remained voluntary in many regions, and caregiver awareness varied. CONCLUSION: Strengthened paediatric counselling, harmonised labelling policies, and culturally tailored communication strategies are needed to reduce infant botulism by preventing infants under 12 months of age from consuming honey.
AIM: To investigate growth deceleration and associations with clinical manifestations and dietary elimination in infants with gastrointestinal cow's milk allergy (CMA). METHODS: In this case series, infants at a speciali...AIM: To investigate growth deceleration and associations with clinical manifestations and dietary elimination in infants with gastrointestinal cow's milk allergy (CMA). METHODS: In this case series, infants at a specialised clinic had their clinical and anthropometric data analysed. Weight (WD) and length deceleration (WD and LD) were determined by z-scores, with reductions > 0.67 classified as failure to thrive (FTT). RESULTS: Sixty infants (1-7 months) were assessed. WD and LD were identified in 53.3% and 51.1%, respectively. FTT was observed in 26.6% (weight) and 14.9% (length). Only 15.0% were exclusively breastfed, and 41.6% received specialised formula. 73.1% of mothers reported multiple food eliminations. Hematochezia (60.0%) was the most frequent clinical manifestation. WD was associated with full-term birth (p = 0.021; effect size [ES] = 0.3) and higher birth weight z-score (p = 0.001; ES = 0.5). LD was associated with a higher birth length z-score (p = 0.039; ES = 0.3) and marginally associated with diarrhoea (p = 0.059; ES = 0.3). CONCLUSION: Growth deceleration was highly frequent among infants with CMA, even prior to confirmation. Clinically meaningful trajectory changes occur in the absence of overt undernutrition. Early nutritional assessment at the time of initial clinical suspicion is essential to prevent progressive nutritional impairment.
AIM: Body dissatisfaction and unhealthy weight control behaviours are common during adolescence. We examined associations between body image, diet, physical activity, and risk behaviours for weight control among high sch...AIM: Body dissatisfaction and unhealthy weight control behaviours are common during adolescence. We examined associations between body image, diet, physical activity, and risk behaviours for weight control among high school students. METHODS: This cross-sectional study included 802 adolescents from five municipalities in southern Brazil, including 795 aged 14-19 years and seven aged 20 years. Data were collected between May and June 2022 using self-administered questionnaires based on the National School Health Survey. Risk behaviours were defined as vomiting, laxative use, or use of weight-loss products in the previous 30 days. Associations were analysed using Poisson regression with robust variance, adjusted for age, sex, maternal education, and socioeconomic status. RESULTS: The sample included 802 adolescents, 50.0% male, with a mean age of 16.7 years (range 14-20). The prevalence of risk behaviours was 4.8%. Body dissatisfaction was associated with a higher likelihood of these behaviours (adjusted prevalence ratio 3.53, 95% confidence interval 1.65-7.53), with stronger effects among females (4.59, 1.33-15.78). No significant associations were found for diet or physical activity. CONCLUSIONS: Body dissatisfaction was associated with harmful weight control behaviours in adolescents and may support early identification and prevention strategies.
AIM: Functional constipation is common during childhood. Parents' concerns about their child's bowel habits are often the reason for seeking healthcare. We aim to report data on normal bowel habits, prevalence of functio...AIM: Functional constipation is common during childhood. Parents' concerns about their child's bowel habits are often the reason for seeking healthcare. We aim to report data on normal bowel habits, prevalence of functional constipation, long-term outcome, and a search for risk factors in children during the first 2.5 years of life. METHODS: This prospective longitudinal birth-cohort study included 122 healthy term infants, and repeated questionnaires were answered by parents. RESULT: Stool frequency declined with age and stabilised after 6 months. Stool consistencies changed, with hard and very hard stools increasing with age. Functional constipation was found in 22.1%, and at the last follow-up, 69.6% were still on medication. Relapse was seen in 26.1% on follow-up. Risk factors at baseline or at 2 months of age that increased the odds of having functional constipation thereafter were not found. Breastfeeding at 2 weeks decreased the probability of FC in the first 2.5 years of life. CONCLUSION: We report data on normal bowel habits from birth to 2.5 years of age. One fifth of the children were diagnosed with functional constipation, and relapse was common; therefore, endurance of treatment, repeated visits, and long-term follow-up are necessary since many children need medication for several years.
AIM: To examine the effectiveness of metaphorical language in framing risk and building trust among parents, children and adolescents in paediatric vaccine communication. METHODS: A narrative synthesis was conducted usin...AIM: To examine the effectiveness of metaphorical language in framing risk and building trust among parents, children and adolescents in paediatric vaccine communication. METHODS: A narrative synthesis was conducted using empirical studies, institutional reports from the Istituto Superiore di Sanità, European Centre for Disease Prevention and Control, and National Institute for Health Research, alongside an original survey involving 2681 Italian adolescents, providing preliminary results. The survey compared three message framings: war metaphors, protective/caring metaphors and neutral factual statements. RESULTS: Protective metaphors emphasising safety, care and collective responsibility achieved the highest Vaccine Confidence Index scores (mean 9.1), significantly outperforming both war metaphors and neutral messages (p < 0.01). While war metaphors may initially mobilise urgency, they risk inducing anxiety, resistance and reduced perceived personal agency, particularly among younger audiences. CONCLUSION: Integrating age-appropriate protective and caring metaphors into paediatric vaccine communication enhances trust and vaccine acceptance. Future campaigns should prioritise language that fosters safety, community and personal responsibility while avoiding metaphors likely to trigger fear or alienation.
AIM: Conventional echocardiographic measurements of cardiac function in neonates have several limitations. Deformation imaging like 2D speckle tracking echocardiography (2DSTE) derived strain can contribute to quantifyin...AIM: Conventional echocardiographic measurements of cardiac function in neonates have several limitations. Deformation imaging like 2D speckle tracking echocardiography (2DSTE) derived strain can contribute to quantifying systolic ventricular and atrial function. Strain is known to detect early changes in cardiac function. While reference values for the paediatric population are available, data for neonates < 30 days of age are scarce. This study aimed to describe myocardial strain in healthy neonates during their first day of life and at 3-4 weeks of age, and to evaluate the feasibility of 2DSTE in this population. METHODS: Full-term neonates (n = 24) were examined twice: on their first day and at 3 weeks of age, according to a designed echocardiographic protocol. RESULTS: Right ventricular free wall strain, left ventricular global longitudinal strain, and right- and left atrial reservoir and conduit strain were all increased (p < 0.001) at the second examination. Conventional measurements of right ventricular function were also higher (p < 0.001) at the second examination. CONCLUSION: Strain analysis is feasible in healthy neonates and contributes to quantifying atrial and ventricular function. The increased myocardial strain at 3-4 weeks of age indicates systolic and diastolic improvement during circulatory adaptation after birth.
Ruuska SM, Tuisku K, Holttinen T
… +1 more, Kaltiala R
Acta Paediatr
· 2026 Jul · PMID 41934366
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AIM: To examine the prevalence of severe psychiatric morbidity among gender-referred adolescents, focusing on gender differences and outcomes related to medical gender reassignment. METHODS: Finnish nationwide cohort of...AIM: To examine the prevalence of severe psychiatric morbidity among gender-referred adolescents, focusing on gender differences and outcomes related to medical gender reassignment. METHODS: Finnish nationwide cohort of all under-23-year-old gender-referred individuals between 1996 and 2019 (n = 2 083) and 16 643 matched controls. Cross-tabulations with X statistics and Cox regression were used to analyse the data. RESULTS: Gender-referred adolescents showed significantly higher psychiatric morbidity than controls both before (45.7% vs. 15.0%) and ≥ 2 years after referral (61.7% vs. 14.6%). Those referred after 2010 had greater psychiatric needs than earlier cohorts, both before (47.9% vs. 15.3%) and ≥ 2 years after (61.3% vs. 14.2%) referral. Among adolescents who underwent medical gender reassignment, psychiatric morbidity increased markedly during follow-up-rising from 9.8% to 60.7% in feminising gender reassignment and from 21.6% to 54.5% in masculinising gender reassignment. After adjusting for prior psychiatric treatment, all gender-referred adolescents had similarly elevated risks of psychiatric morbidity, with hazard ratios approximately three times higher than female controls and five times higher than male controls. CONCLUSION: Severe psychiatric morbidity is common among gender-referred adolescents and appears to be more prevalent in those referred after the recent surge in referrals. Psychiatric needs do not subside after medical gender reassignment.
AIM: This pilot study explored signs of immunological cross-reactivity between SARS-CoV-2 and human coronaviruses (HCoVs) in a Swedish school setting. METHODS: A cross-sectional, hypothesis-generating study was conducted...AIM: This pilot study explored signs of immunological cross-reactivity between SARS-CoV-2 and human coronaviruses (HCoVs) in a Swedish school setting. METHODS: A cross-sectional, hypothesis-generating study was conducted late 2020 before vaccines against COVID-19 were available. Forty-seven 7-8-year-old children, seventy-five 14-year-old adolescents, fifty-four 17-year-old adolescents, and 52 adult school staff were included, and immune responses to SARS-CoV-2 and HCoVs were assessed. RESULTS: The SARS-CoV-2 seroprevalence was high in the older age groups (33%-41%). Seropositive individuals had significantly higher levels of antibodies against betacorona virus compared to seronegative individuals. SARS-CoV-2 seropositivity was rare among the 7-8-year-old children despite the high endemic context. SARS-CoV-2-specific T-cell responses in the absence of SARS-CoV-2-specific antibodies were seen in all age groups. CONCLUSION: The data support a role for cross-reactive immune responses induced by recent HCoV infections, with cross-reactive T-cell responses providing protection against COVID-19 in young children.