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Prolonged slow expiration technique improves recovery from acute bronchiolitis in infants: FIBARRIX randomized controlled trial To examine the effect of prolonged slow expiration respiratory physiotherapy treatment on the acute bronchiolitis severity scale and O2 saturation at short-time and at medical discharge in infants and the hospital stay.Randomized controlled trial.Infants' unit of university hospital.Infants with acute bronchiolitis ( N = 80).Infants were randomized into respiratory (...) . Infants in RT group stay less days in hospital than infants in control group and no adverse events were detected.
Analgesic efficacy and safety of morphine in the Procedural Pain in Premature Infants (Poppi) study: randomised placebo-controlled trial. Infant pain has immediate and long-term effects but is undertreated because of a paucity of evidence-based analgesics. Although morphine is often used to sedate ventilated infants, its analgesic efficacy is unclear. We aimed to establish whether oral morphine could provide effective and safe analgesia in non-ventilated premature infants for acute procedural (...) pain.In this single-centre masked trial, 31 infants at the John Radcliffe Hospital, Oxford, UK, were randomly allocated using a web-based facility with a minimisation algorithm to either 100 μg/kg oral morphine sulphate or placebo 1 h before a clinically required heel lance and retinopathy of prematurity screening examination, on the same occasion. Eligible infants were born prematurely at less than 32 weeks' gestation or with a birthweight lower than 1501 g and had a gestational age of 34-42 weeks
2018LancetControlled trial quality: predicted high
Interventions to Prevent Child Maltreatment: US Preventive Services Task Force Recommendation Statement. In 2016, approximately 676 000 children in the United States experienced maltreatment (abuse, neglect, or both), with 75% of these children experiencing neglect, 18% experiencing physical abuse, and 8% experiencing sexual abuse. Approximately 14% of abused children experienced multiple forms of maltreatment, and more than 1700 children died as a result of maltreatment.To update the US (...) Preventive Services Task Force (USPSTF) 2013 recommendation on primary care interventions to prevent child maltreatment.The USPSTF commissioned a review of the evidence on primary care interventions to prevent maltreatment in children and adolescents without signs or symptoms of maltreatment.The USPSTF found limited and inconsistent evidence on the benefits of primary care interventions, including home visitation programs, to prevent child maltreatment and found no evidence related to the harms
. Discussion of terminology and definition of the sudden infant death syndrome. In: Bergman AB, Beckwith JB, Ray CG, eds. Sudden infant death syndrome: proceedings of the Second International Conference on the Causes of Sudden Death in Infants. Seattle, WA: University of Washington Press; 1970:14-22. In 1991, the definition was modified by a panel convened by the National Institute of Child Health and Human Development. The panel defined SIDS as "The sudden death of an infant under 1 year of age, which (...) remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and a review of the clinical history". Willinger M, James LS, Catz C. Defining the sudden infant death syndrome (SIDS): deliberations of an expert panel convened by the National Institutes of Child Health and Human Development. Pediatr Pathol. 1991;11:677-84. http://www.ncbi.nlm.nih.gov/pubmed/1745639?tool=bestpractice.com This remains the widely accepted definition
Exploring the intergenerational effects of undernutrition: association of maternal height with neonatal, infant and under-five mortality in Bangladesh Global or regional evidence showed maternal height as a strong predictor of child survival. However, there is limited information that confirms the intergenerational effect of short maternal height on the risk of offspring mortality in Bangladesh. Therefore, this study aimed to examine the association of maternal height with neonatal, infant (...) for the cluster sampling design. Multivariate 'Modified Poisson Regression' was performed using stepwise backward elimination procedures to examine the association between maternal height and child death.In the adjusted model, every 1 cm increase maternal height was associated with a reduced risk of neonatal mortality (relative risk (RR) = 0.973, 95% CI 0.960 to 0.986), infant mortality (RR = 0.980, 95% CI 0.969 to 0.991) and under-five mortality (RR = 0.982, 95% CI 0.972 to 0.992). Children of the shortest
bladder catheter allowed to drain freely into a closed col- lection bag.Anadditionaladvantageof continuous drainage of the radioactive urine from the bladder is signi?cant re- duction in gonadal radiation dose. However, catheterization, for the child, is an invasive and unpleasant procedure. There- fore, its routine use is controversial. But it is advised in infants and children with HUN, PUV, known VUR, or neu- ropathic bladder. In the absence of an indwelling bladder catheter, all toilet- trained (...) The SNMMI and EANM Procedural Guidelines for Diuresis Renography in Infants and Children PV2 SPECIAL CONTRIBUTION The SNMMI and EANM Procedural Guidelines for Diuresis Renography in Infants and Children Massoud Majd 1 ,ZviBar-Sever 2 ,Ana IsabelSantos 3 ,and DiegoDe Palma 4 1 SNMMI Pediatric Imaging Council, Children’s National Medical Center, Washington, DC; 2 EANM Paediatric Committee, Department of Nuclear Medicine, Schneider Children’s Medical Center, PetachTikva, Israel; 3 EANM Paediatric
Effects of a new device for automated closed loop control of inspired oxygen concentration on fluctuations of arterial and different regional organ tissue oxygen saturations in preterm infants To assess the efficacy of a newly developed system for closed loop control of the fraction of inspired oxygen (FiO2) on variation of arterial (SpO2) and on regional tissue oxygen saturation (StO2) in preterm infants with fluctuations in SpO2.Randomised crossover trial comparing automated (auto) to manual (...) FiO2 adjustment (manual) during two consecutive 24 hours periods using a Sophie infant ventilator (SPO2C).Tertiary university medical centre.Twelve very low birthweight infant (VLBWI) (gestational age (median; IQR): (25; 23-26 weeks); birth weight (mean±SD): (667±134 g); postnatal age (mean±SD): (31.5±14 days)).Time within SpO2 target range.There was an increase in time within the intended SpO2 target range (88%-96%) during auto as compared with manual mode (77.8%±7.1% vs 68.5%±7.7% (mean±SD), p
Impact of Steroid Therapy on Early Growth in Infants with Biliary Atresia: The Multicenter Steroids in Biliary Atresia Randomized Trial To investigate the impact of corticosteroid therapy on the growth of participants in the Steroids in Biliary Atresia Randomized Trial (START) conducted through the Childhood Liver Disease Research Network. The primary analysis in START indicated that steroids did not have a beneficial effect on drainage in a cohort of infants with biliary atresia. We (...) hypothesized that steroids would have a detrimental effect on growth in these infants.A total of 140 infants were enrolled in START, with 70 randomized to each treatment arm: steroid and placebo. Length, weight, and head circumference were obtained at baseline and follow-up visits to 24 months of age.Patients treated with steroids had significantly lower length and head circumference z scores during the first 3 months post-hepatoportoenterostomy (HPE), and significantly lower weight until 12 months. Growth
Preterm Infant Outcomes after Randomization to Initial Resuscitation with FiO2 0.21 or 1.0 To determine rates of death or neurodevelopmental impairment (NDI) at 2 years corrected age (primary outcome) in children <32 weeks' gestation randomized to initial resuscitation with a fraction of inspired oxygen (FiO2) value of 0.21 or 1.0.Blinded assessments were conducted at 2-3 years corrected age with the Bayley Scales of Infant and Toddler Development, Third Edition or the Ages and Stages (...) Questionnaire by intention to treat.Of the 290 children enrolled, 40 could not be contacted and 10 failed to attend appointments. Among the 240 children for whom outcomes at age 2 years were available, 1 child had a lethal congenital anomaly, 1 child had consent for follow-up withdrawn, and 23 children died. The primary outcome, which was available in 238 (82%) of those randomized, occurred in 47 of the 117 (40%) children assigned to initial FiO2 0.21 and in 38 of the 121 (31%) assigned to initial FiO2 1.0
Direct infant UV light exposure is associated with eczema and immune development Suboptimal vitamin D levels during critical periods of immune development have emerged as an explanation for higher rates of allergic diseases associated with industrialization and residing at higher latitudes.We sought to determine the effects of early postnatal vitamin D supplementation on infant eczema and immune development.By using a double-blind randomized controlled trial, newborn infants were randomized (...) to receive vitamin D supplementation (400 IU/d) or a placebo until 6 months of age. Some infants also wore personal UV dosimeters to measure direct UV light (290-380 nm) exposure. Infant vitamin D levels were measured at 3 and 6 months of age. Eczema, wheeze, and immune function outcomes were assessed at 6 months of age.At 3 (P < .01) and 6 (P = .02) months of age, vitamin D levels were greater for the vitamin D-supplemented group than the placebo group, but there was no difference in eczema incidence
The Impact of Pulmonary Hypertension in Preterm Infants with Severe Bronchopulmonary Dysplasia through 1 Year To assess the effect of pulmonary hypertension on neonatal intensive care unit mortality and hospital readmission through 1 year of corrected age in a large multicenter cohort of infants with severe bronchopulmonary dysplasia.This was a multicenter, retrospective cohort study of 1677 infants born <32 weeks of gestation with severe bronchopulmonary dysplasia enrolled in the Children's (...) Hospital Neonatal Consortium with records linked to the Pediatric Health Information System.Pulmonary hypertension occurred in 370 out of 1677 (22%) infants. During the neonatal admission, pulmonary hypertension was associated with mortality (OR 3.15, 95% CI 2.10-4.73, P < .001), ventilator support at 36 weeks of postmenstrual age (60% vs 40%, P < .001), duration of ventilation (72 IQR 30-124 vs 41 IQR 17-74 days, P < .001), and higher respiratory severity score (3.6 IQR 0.4-7.0 vs 0.8 IQR 0.3-3.3, P
Improved Outcomes in Preterm Infants Fed a Nonacidified Liquid Human Milk Fortifier: A Prospective Randomized Clinical Trial To compare growth, feeding tolerance, and clinical and biochemical evaluations in human milk-fed preterm infants randomized to receive either an acidified or a nonacidified liquid human milk fortifier.This prospective, controlled, parallel, multicenter growth and tolerance study included 164 preterm infants (≤32 weeks of gestation, birth weight 700-1500 g) who were (...) randomized to acidified or nonacidified liquid human milk fortifier from study day 1, the first day of fortification, through study day 29 or until hospital discharge.There was no difference in the primary outcome of weight gain from study days 1 to 29 (acidified liquid human milk fortifier, 16.4 ± 0.4 g/kg/day; nonacidified liquid human milk fortifier, 16.9 ± 0.4 g/kg/day). However, in both the intention-to-treat and the protocol evaluable analyses, infants fed nonacidified liquid human milk fortifier
as a feeding tube. It contains small sensors, designed to measure the diaphragm electrical activity (the Edi measurement). This information is used to interpret the neural respiratory drive to control the timing and amount of ventilatory assistance provided. The Edi measurement can also be used for continuous bedside monitoring of a baby or child's breathing effort. NAVA mode is available for babies or children having invasive or non-invasive mechanical ventilation. In babies or children having non (...) \invasive Positive Pressure Ventilation (NIPPV) and Non Invasive Neural Access Ventilatory Assist (NI\u2011\nAVA) (US study). ClinicalTrials.gov identifier: NCT03242057. Status: recruiting (enrolment target: 30). Indication: pre-term babies with bronchopulmonary dysplasia. Devices: NAVA, NIPPV. Primary outcome measure: extubation success. Noninvasive NAVA Versus NIPPV in Low Birthweight Premature Infants (US study). ClinicalTrials.gov identifier: NCT03137225. Status: recruiting (enrolment target: 15
confidence and better delineates abscesses [50,51]. An exception to this may be in infants and younger children with an abundance of nonossified cartilage, in whom infection limited to the intrinsically hyperintense cartilaginous growth plate and epiphyses/apophyses can be occult on unenhanced MRI sequences. Given these considerations, the use of IV contrast may vary with institutional protocol. Variant 5: Child up to age 5. Acute limp. Symptoms localized to lower extremity (not pelvis or hips). Concern (...) infant: imaging and clinical evaluation of trauma. Emerg Radiol 2007;14:219-26. 7. Sawyer JR, Kapoor M. The limping child: a systematic approach to diagnosis. Am Fam Physician 2009;79:215-24. 8. Frick SL. Evaluation of the child who has hip pain. Orthop Clin North Am 2006;37:133-40, v. 9. Katz DA. Slipped capital femoral epiphysis: the importance of early diagnosis. Pediatr Ann 2006;35:102-11. 10. Aronson J, Garvin K, Seibert J, Glasier C, Tursky EA. Efficiency of the bone scan for occult limping
Girlsâ€™ hidden penalty: analysis of gender inequality in child mortality with data from 195 countries Gender inequality has been associated with child mortality; however, sex-specific mortalities have yet to be explored. The aim of this study is to assess the associations between gender inequality and the child mortality sex ratio at country level, worldwide and to infer on possible mechanisms.Data on sex-specific under-five mortality rates (U5MR) and the corresponding sex ratio (U5MSR (...) ) and borderline significantly positively associated with excess under-five female mortality (β = 3.25 (95% CI -0.28 to 6.67, p=0.071). The association between GII and U5MSR was strong and statistically significant only in low-income and middle-income countries and in the Western Pacific area.The more gender unequal a society is, the more girls are penalised in terms of their survival chances, in particular in low-income and middle-income countries. In order to decrease child mortality and excess girl
PACK Child: the development of a practical guide to extend the scope of integrated primary care for children and young adolescents Pioneering strategies like WHO's Integrated Management of Childhood Illness (IMCI) have resulted in substantial progress in addressing infant and child mortality. However, large inequalities exist in access to and the quality of care provided in different regions of the world. In many low-income and middle-income countries, childhood mortality remains a major (...) concern, and the needs of children present a large burden upon primary care services. The capacity of services and quality of care offered require greater support to address these needs and extend integrated curative and preventive care, specifically, for the well child, the child with a long-term health need and the child older than 5 years, not currently included in IMCI. In response to these needs, we have developed an innovative method, based on experience with a similar approach in adults
Effects of Myo-inositol on Type 1 Retinopathy of Prematurity Among Preterm Infants <28 Weeks' Gestational Age: A Randomized Clinical Trial. Previous studies of myo-inositol in preterm infants with respiratory distress found reduced severity of retinopathy of prematurity (ROP) and less frequent ROP, death, and intraventricular hemorrhage. However, no large trials have tested its efficacy or safety.To test the adverse events and efficacy of myo-inositol to reduce type 1 ROP among infants (...) younger than 28 weeks' gestational age.Randomized clinical trial included 638 infants younger than 28 weeks' gestational age enrolled from 18 neonatal intensive care centers throughout the United States from April 17, 2014, to September 4, 2015; final date of follow-up was February 12, 2016. The planned enrollment of 1760 participants would permit detection of an absolute reduction in death or type 1 ROP of 7% with 90% power. The trial was terminated early due to a statistically significantly higher
Creation of the WHO Indicators of Infant and Young Child Development (IYCD): metadata synthesis across 10 countries Renewed global commitment to the improvement of early child development outcomes, as evidenced by the focus of the United Nations Sustainable Development Goal 4, highlights an increased need for reliable and valid measures to evaluate preventive and interventional efforts designed to affect change. Our objective was to create a new tool, applicable across multicultures, to measure (...) items identified at second mapping. A tool comprising 120 items (23 fine motor, 23 gross motor, 20 receptive language, 24 expressive language, 30 socioemotional) was created. The linked data sets on a common scale showed a curvilinear trajectory of child development, highlighting the validity of our approach through excellent coverage by age and consistency of measurement across contributed tools, a novel finding in itself.We have created the first version of a prototype tool for measuring children
Interventions to reduce unnecessary caesarean sections in healthy women and babies. Optimising the use of caesarean section (CS) is of global concern. Underuse leads to maternal and perinatal mortality and morbidity. Conversely, overuse of CS has not shown benefits and can create harm. Worldwide, the frequency of CS continues to increase, and interventions to reduce unnecessary CSs have shown little success. Identifying the underlying factors for the continuing increase in CS use could improve