Acta Paediatrica最新文献

{"title":"Common Radiological Features on Chest X-Rays of Infants With Bronchiolitis: Do They Support Management?","authors":"C Towriss, A Evans, T A Betts, A E Darby, M Edwards","doi":"10.1111/apa.17603","DOIUrl":"https://doi.org/10.1111/apa.17603","url":null,"abstract":"","PeriodicalId":55562,"journal":{"name":"Acta Paediatrica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Neonatal Hyperglycaemia in Sweden-A Survey Study.","authors":"Ludvig Henriksson Frithiof, Magnus Domellöf, Itay Nilsson Zamir","doi":"10.1111/apa.17583","DOIUrl":"https://doi.org/10.1111/apa.17583","url":null,"abstract":"<p><strong>Aim: </strong>Neonatal hyperglycaemia is associated with a multitude of adverse outcomes, including mortality and impaired neurological development. The aim of this study was to characterise the current management of neonatal hyperglycaemia in Swedish neonatal units.</p><p><strong>Methods: </strong>A digital survey was sent to 27 Swedish neonatal units providing care to preterm infants born before 32 completed gestational weeks.</p><p><strong>Results: </strong>Sixty-eight responses were collected from 21 different units. Thirty-two percent (22/68) of clinicians reported having a local treatment guideline for neonatal hyperglycaemia. Hyperglycaemia was defined as a glucose concentration above a value in the range of 8.0-10.0 mmol/L by 62.5% of clinicians, while 16.7% and 21.8% used a definition between 10.1 and 12.0 mmol/L and > 12 mmol/L, respectively. Intravenous glucose reduction was initiated at higher glucose concentrations by clinicians working at university hospital units (p = 0.006). Glucose concentration threshold for initiation of insulin treatment varied between 8 and 30 mmol/L. Three clinicians (3/35 (8.5%)) reported having experienced problems with frequent hypoglycaemia during ongoing insulin treatment.</p><p><strong>Conclusions: </strong>This study demonstrates extensive differences in clinical practice regarding neonatal hyperglycaemia both within and between neonatal units in Sweden. Randomised controlled trials are needed to provide evidence for clinical guidelines and to improve and standardise the care of these infants.</p>","PeriodicalId":55562,"journal":{"name":"Acta Paediatrica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EBNEO Commentary: Parent-Guided Developmental Intervention for Infants With Very Low Birth Weight","authors":"Srishti Jayakumar,&nbsp;Heather Burris,&nbsp;Andrea Duncan,&nbsp;Sara B. DeMauro","doi":"10.1111/apa.17608","DOIUrl":"10.1111/apa.17608","url":null,"abstract":"&lt;p&gt;R. C. Silveira, N. C. Valentini, T. M. O'Shea, et al., “Parent-Guided Developmental Intervention for Infants with Very Low Birth Weight: A Randomized Clinical Trial,” &lt;i&gt;JAMA Network Open&lt;/i&gt;. 7, no. 7 (2024): e2421896, Published 2024 Jul 1, doi:10.1001/jamanetworkopen.2024.21896, PMID: 39018071.&lt;/p&gt;&lt;p&gt;Very preterm birth is associated with injury in the developing brain and subsequent impairments in cognitive, motor, behavioural and emotional skills [&lt;span&gt;1, 2&lt;/span&gt;]. Early childhood provides a critical window for neurorestorative interventions, including developmental interventions, in the hospital and after discharge [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Developmental interventions vary widely in their component elements, intensity, target domains, parental involvement and cost. A majority of studies evaluating these interventions have been based in high-income countries [&lt;span&gt;4&lt;/span&gt;]. Given the heterogeneity of medical systems and access to follow-up care across the globe, results from prior studies may not be generalizable to low-to-middle-income (LMIC) countries. The randomised trial by Silveira et al., based in Brazil, addressed this critical gap and demonstrated that a parent-guided developmental intervention administered to high-risk preterm infants in an LMIC improved cognitive, language and motor development through 18 months corrected age.&lt;/p&gt;&lt;p&gt;Silveira et al. observed a stronger effect of enhanced developmental support on motor outcomes compared to cognitive outcomes. While it is plausible that early motor developmental skills are more amenable to improvement with the study intervention, this finding is in contrast to many prior studies that show greater improvements in cognitive domains with early developmental intervention programmes [&lt;span&gt;5&lt;/span&gt;]. Notably, the effect on motor skills strengthened between 4 and 18 months, suggesting a sustained or even increasing intervention effect over time.&lt;/p&gt;&lt;p&gt;Strengths of this study include parental training beginning in the first week after birth and the assessment of numerous factors influencing neurodevelopment, including parents' childhood experiences and socioeconomic status. Testing in the participants' homes allowed for assessment of child neurodevelopment in a comfortable, familiar setting. The use of multiple scales measuring non-overlapping aspects of development allowed for a holistic evaluation of the child and their environment. The randomised design, use of blinded outcome assessments and robust sample size are additional strengths of the study.&lt;/p&gt;&lt;p&gt;This study could have been further strengthened by the inclusion of validated measures of infant state control, parent–infant bonding, parental mental health and self-efficacy. The Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), used to assess the primary outcome, is known to overestimate development [&lt;span&gt;6-9&lt;/span&gt;]. Notably, the intensity of follow-up care provided to the control group is markedly high","PeriodicalId":55562,"journal":{"name":"Acta Paediatrica","volume":"114 5","pages":"1082-1083"},"PeriodicalIF":2.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apa.17608","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning About Their Condition: The Gradual Path of Young People With Childhood-Onset Motor Disabilities.","authors":"Charlotte Martin, Christina Akre, Christopher J Newman","doi":"10.1111/apa.17609","DOIUrl":"https://doi.org/10.1111/apa.17609","url":null,"abstract":"<p><strong>Aim: </strong>Young people with childhood-onset motor disabilities face unique challenges in understanding and managing their condition. This study explored how they learnt about their condition.</p><p><strong>Method: </strong>A descriptive qualitative study was conducted in 2023-2024 at a Swiss paediatric neurorehabilitation unit. Ten participants aged 15-24 years were recruited through purposive sampling, representing diverse conditions and socio-educational backgrounds. Inductive thematic analysis was conducted on interview transcripts.</p><p><strong>Results: </strong>Four themes emerged. First, learning paths revealed that participants gradually acquired knowledge about their condition. Early explanations often involved parents and visual aids, with moments of awareness and evolving information needs shaping their learning over time. Second, building blocks of understanding showed that knowledge was constructed through interactions with physicians, therapists, parents, peers and the Internet. Third, interacting with healthcare professionals highlighted the importance of trust and continuity in relationships with healthcare professionals to support learning. Last, improving the learning process suggested strategies such as dedicated consultations for recapping information during adolescence and increasing disability awareness in schools.</p><p><strong>Conclusion: </strong>Young people with motor disabilities require information and support tailored to their individual learning needs. Adapting these resources could enhance their understanding of their condition, supporting the development of their autonomy and self-advocacy within healthcare.</p>","PeriodicalId":55562,"journal":{"name":"Acta Paediatrica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Misses and Near Misses in Paediatric Appendicitis: An Eight-Year, Single-Centre Retrospective Review.","authors":"Eric Scheier, Walid Abu Zvis, Sarah Borsekofsky","doi":"10.1111/apa.17599","DOIUrl":"https://doi.org/10.1111/apa.17599","url":null,"abstract":"<p><strong>Aim: </strong>Diagnostic error can result in the appendectomy of a normal appendix, commonly known as negative appendectomy (NA). Missed appendicitis (MA) is related to a poor outcome. The aim of this study was to determine whether there are factors in presentation associated with NA or MA.</p><p><strong>Methods: </strong>This is a single-centre, retrospective chart review of histology-confirmed appendicitis over an eight-year period. We defined MA as appendicitis diagnosed within the week of a paediatric emergency department discharge for a similar presentation. Negative appendectomy was defined as a histologic examination of the appendix that lacked signs of inflammation.</p><p><strong>Results: </strong>A total of 845 children had appendicitis on pathologic examination. NA included 69 children, and MA 29 children. Inflammatory markers were lower for children with NA than for children with appendicitis, and children with NA were less likely to undergo CT. Almost half of the children with MA were discharged without laboratory evaluation, and almost three quarters were discharged without imaging evaluation. Half of the children with MA returned with complicated appendicitis.</p><p><strong>Conclusion: </strong>Increased rates of laboratory and/or imaging evaluations in patients with abdominal pain or non-classic gastroenteritis, along with observation or early follow-up, may decrease MA. More frequent use of ultrasound and MRI may keep the NA rate to a minimum.</p>","PeriodicalId":55562,"journal":{"name":"Acta Paediatrica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors for Development of Asphyxiated Neonates Treated With Therapeutic Hypothermia.","authors":"Fabienne Kühne, Nina Wald de Chamorro, Laura Glasmeyer, Maria Grigoryev, Yee Lee Shing, Claudia Buss, Christoph Bührer, Angela M Kaindl","doi":"10.1111/apa.17598","DOIUrl":"https://doi.org/10.1111/apa.17598","url":null,"abstract":"<p><strong>Aim: </strong>To describe the long-term neurodevelopmental outcomes of asphyxiated neonates treated with hypothermia in association with neonatal magnetic resonance imaging (MRI) findings.</p><p><strong>Methods: </strong>We evaluated, retrospectively, clinical and radiological single-centre data at 0, 2, and 5 years of age of 53 asphyxiated neonates born between 2005 and 2015. Neonatal cranial MRI was re-evaluated using the Weeke score ranging from 0 (normal finding) to 55 (cerebral devastation) by a single neuroradiologist blinded to patient outcomes. Neurodevelopmental outcomes were evaluated using the Bayley Scales of Infant Development (BSID) at 2 years, and tests assessing intellectual performance at 5 years of age.</p><p><strong>Results: </strong>Of the 191 asphyxiated neonates treated with hypothermia, 53 returned for their 5-year follow-up. There were 10 children with MRI scores ≥ 10, all of whom had epilepsy, 9 had severe cognitive impairment, and 9 had cerebral palsy. In contrast, MRI scores < 10 were poorly predictive of later development. BSID at 2 years of age showed good correlation with IQ scores at 5 years of age (R_s = 0.58, p < 0.001).</p><p><strong>Conclusion: </strong>The Weeke score can be used to identify severely impaired children in the neonatal period. In contrast, the neurocognitive test results at 2 years of age were indicative of mild or moderate impairment at 5 years of age.</p>","PeriodicalId":55562,"journal":{"name":"Acta Paediatrica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorporating an Elevated Perfusion Index in the Right Hand Enhanced Screening Sensitivity for Critical Aortic Arch Obstruction in Newborn Infants.","authors":"Katarina Lannering, Ingegerd Östman-Smith, Mats Mellander","doi":"10.1111/apa.17601","DOIUrl":"https://doi.org/10.1111/apa.17601","url":null,"abstract":"<p><strong>Aim: </strong>Newborn infants with critical aortic arch obstruction are often undiagnosed at discharge, despite screening. This study investigated if adding the perfusion index improved early detection.</p><p><strong>Methods: </strong>We retrospectively studied 38 newborn infants with critical aortic arch obstruction, who were routinely screened in 2014-2019 by 13 Swedish hospitals using pulse oximetry and the perfusion index. They were identified through surgery records and national mortality databases. The controls were 512 healthy newborn infants from one hospital. Optimal perfusion index cut-offs were determined using frequency distribution analysis.</p><p><strong>Results: </strong>The groups had similar median gestational ages and birth weight. No infants with critical aortic arch obstruction were diagnosed just because of a positive perfusion index result. However, the right-hand perfusion index was significantly higher in the cases than in controls (p < 0.001). A perfusion index of > 3%, or positive pulse oximetry or positive physical examination, yielded 76% sensitivity and 85% specificity, with an area under the receiver operating characteristic curve of 0.81 (range 0.73-0.89, p < 0.0001). Pulse oximetry and just neonatal physical examinations had a lower sensitivity (45%, p = 0.009).</p><p><strong>Conclusion: </strong>A high perfusion index in the right hand enhanced critical aortic arch obstruction screening and repeated measurements should be explored to minimise false positives.</p>","PeriodicalId":55562,"journal":{"name":"Acta Paediatrica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating C-Reactive Protein and Procalcitonin Discordance Among Febrile Infants at Risk of Serious Bacterial Infections.","authors":"Shu-Ling Chong, Stella Jinran Zhan, Zi Xean Khoo, Rupini Piragasam, Lena Wong, Seyed Ehsan Saffari, Jan Hau Lee, Sashikumar Ganapathy, Gene Yong-Kwang Ong","doi":"10.1111/apa.17602","DOIUrl":"https://doi.org/10.1111/apa.17602","url":null,"abstract":"<p><strong>Aim: </strong>We aimed to investigate the prevalence and factors associated with C-reactive protein (CRP) and procalcitonin (PCT) discordance in febrile infants with serious bacterial infections (SBIs).</p><p><strong>Methods: </strong>We performed a retrospective review of febrile infants ≤ 90 days old presenting to the emergency department between December 2018 and June 2023. We compared conservative and pragmatic thresholds for PCT (< 0.5 ng/mL and < 1.7 ng/mL) and CRP (< 10 mg/L and < 20 mg/L). Discordance was defined as normal CRP with abnormal PCT and vice versa. Performance was presented using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).</p><p><strong>Results: </strong>Among 3459 infants, 426 infants (12.3%) had SBIs, among whom 355 (83.3%) had both CRP and PCT performed. Overall, a conservative CRP threshold had the highest sensitivity (74.1%, 95% CI 69.2%-78.6%) and NPV (95.6%, 95% CI 94.6%-96.4%). Among those with SBIs, 148/355 (41.7%) had a normal PCT (< 1.7 ng/mL) and an abnormal CRP (≥ 20 mg/L), while 16/355 (4.5%) had a normal CRP (< 20 mg/L) and an abnormal PCT (≥ 1.7 ng/mL). An increased discordance, specifically abnormal CRP with normal PCT, was found in males, infants 29-90 days old, and those with urinary tract infections.</p><p><strong>Conclusion: </strong>SBI clinical decision rules should consider CRP-PCT discordance in specific patient populations.</p>","PeriodicalId":55562,"journal":{"name":"Acta Paediatrica","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors and Readers Need to Be Wary of Predatory Medical Titles and Focus on High-Quality Peer-Review Journals","authors":"Annika Janson,&nbsp;Göran Wennergren,&nbsp;Hugo Lagercrantz","doi":"10.1111/apa.17605","DOIUrl":"10.1111/apa.17605","url":null,"abstract":"&lt;p&gt;In January 2025, Laine et al. [&lt;span&gt;1&lt;/span&gt;] published a very important editorial in a number of prestigious medical journals. It encouraged reputable journals to warn their readers and authors about the growing number of predatory entities that are misrepresenting themselves as scholarly journals. The authors, who are all editors and members of the International Committee of Medical Journal Editors, said that the organisation was constantly receiving queries about such journals. They estimated that there were as many as 15 000 in 2021. Many appear to be operating purely for financial gain, by offering extremely fast publication rates, rather than disseminating high-quality scientific research.&lt;/p&gt;&lt;p&gt;As a well-respected, peer-reviewed journal, with an established international reputation, we share the concerns raised by Laine et al. [&lt;span&gt;1&lt;/span&gt;]. We thought it would be useful to explain to our readers and authors how &lt;i&gt;Acta Paediatrica&lt;/i&gt; handles the manuscripts that we receive.&lt;/p&gt;&lt;p&gt;Our slogan is &lt;i&gt;nurturing the child&lt;/i&gt;, and our aim is to publish high-quality research that can improve the health of children. Last year, we handled just over 1500 manuscripts and accepted about a third of them for publication. All these papers were carefully reviewed and many of them were resubmitted several times before we made our final decision. The integrity of the journal is paramount, and we depend on the superb work of our reviewers, who are experts in their fields and donate their precious time to scrutinising the work of other researchers. We are also indebted to our editorial staff, our senior, associate and adjunct editors and our statistical editor and language editor.&lt;/p&gt;&lt;p&gt;In this issue, we acknowledge the reviewers who played a key role in the journal in 2024. Our reviewers are driven by their sense of responsibility and duty as members of the international scientific community, as well as their interest in the messages in the papers they review. We are deeply grateful to them for their skills and dedication to paediatrics. Altruistic and anonymous reviewers are for science what blood donors are for surgery: It would not be possible to work without them. It is worrying that finding suitable reviewers has become a challenge for most journals. Peer reviews should be recognised as an integral part of research and requested, and recognised, by all high-quality research structures.&lt;/p&gt;&lt;p&gt;Acta Paediatrica was founded in Sweden in 1921 and is owned by &lt;i&gt;Stiftelsen Acta Paediatrica&lt;/i&gt;, a foundation that is run by a board of recognised senior members of the research community. Our publisher, John Wiley &amp; Sons Ltd., is one of the largest publishing houses in the world and provides the structures and technical skills needed for scientific publishing. Although &lt;i&gt;Acta Paediatrica&lt;/i&gt; can claim an impressive heritage and track record, we know that that is not enough. That is why we constantly review our processes, to make sure that they are f","PeriodicalId":55562,"journal":{"name":"Acta Paediatrica","volume":"114 5","pages":"786-787"},"PeriodicalIF":2.4,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/apa.17605","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Care for Young Febrile Infants Varied Widely Among Spanish Paediatric Emergency Departments","authors":"Ainara Lejarzegi,&nbsp;Roberto Velasco,&nbsp;David Andina,&nbsp;Borja Gómez,&nbsp;Santiago Mintegi,&nbsp;the Spanish Pediatric Emergency Research Network Febrile Infant Study Group","doi":"10.1111/apa.17597","DOIUrl":"10.1111/apa.17597","url":null,"abstract":"","PeriodicalId":55562,"journal":{"name":"Acta Paediatrica","volume":"114 5","pages":"1066-1068"},"PeriodicalIF":2.4,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}