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Acta Paediatrica

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Acta Paediatrica last won the day on September 27 2017

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    Stockholm, Sweden

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  1. Acta Paediatrica October 2017 We have highlighted some of October issue's articles and most of them you can access freely in the journal below. Helping Babies Breathe training can improve neonatal resuscitation Helping Babies Breathe (HBB) is a neonatal resuscitation programme that is designed to train health professionals in low-resource settings. A study by Amy Rule et al showed that 10 months after HBB training in a rural referral hospital in Kenya, the suspected hypoxic–ischaemic encephalopathy (SHIE) rate had decreased by 53% to 7.1/1000. However, the rates increased after the initial decline and investigations revealed that half of the midwives who received HBB training had been transferred. When the data were presented to healthcare administration personnel, this improved staff retention and the SHIE rate then decreased again. Christabel Enweronu-Laryea and Nicola Robertson comment on the study. Readers may also be interested in the editorial by Susan Niermeyer, who comments on Johan Wrammert et al’s paper on an HBB project in Nepal, which was published in a previous issue. Nipple temperature may help guide newborns to breastfeed Newborn babies instinctively have the ability to crawl to the breast when placed skin-to-skin on the mother's abdomen. A new Italian study by Vincenzo Zanardo et al indicates that a higher temperature around the mother’s nipple with respect to the surrounding breast skin may facilitate this process. The study conducted on 41 full-term infants and their mothers showed that a temperature gradient may support mother-infant thermal identification and communication in the breast crawl process. One breath of oxygen may shorten the return to spontaneous circulation Asphyxiated newborn infants should be resuscitated with air, but it has been unclear whether supplementary oxygen is needed when effective ventilation cannot be provided immediately during resuscitation. In this study, Rikard Linner et al found that one single breath of oxygen shortened the time to return of spontaneous circulation in asphyxiated newborn piglets. Small but critical amounts of oxygen was essential for sustained circulatory recovery in this experimental model of asphyxia. The clinical applicability of these findings should be further investigated, according to the accompanying editorial by Anne Lee Solevåg and Georg Schmölzer. Recorded maternal voices reduced pain in preterm infants undergoing heel lance procedures This study evaluated whether recorded maternal voices limited pain in preterm infants undergoing heel lance procedures. Gaetano Chirico et al enrolled 40 preterm infants at a gestational age of 26–36 weeks and randomised them to listen to, or not listen to, a recording of their mother’s voice during the procedure. Infants in the intervention group had significantly lower pain scores and fewer decreases in oxygen saturation, with no significant side effects. Readers may also be interested in the brief article by Ellyn Hamm et al, who report that a parent–infant music therapy intervention improved neurodevelopment after neonatal intensive care. Using a standardised protocol reduced hospitalisation for childhood immune thrombocytopenia Childhood immune thrombocytopenia (ITP) is an immune-mediated disorder, with a platelet count of less than 100 9 109/L an no underlying cause. Although current guidelines suggest that most patients are just observed, children still receive platelet-enhancing therapy because of concerns about complications related to bleeding. Roxane Labrosse et al report that introducing a standardised protocol with a step-down approach reduced hospitalisation and the length of prednisolone treatment in children with newly diagnosed ITP, without any increase in disease complications. Ljung comments on the findings. Severe postwar malnutrition did not have a negative impact on subsequent earnings and pensions Hermanussen et al explored whether German men born and raised shortly after World War Two, during severe and long-standing nationwide malnutrition, had lower earnings and subsequent pension payments. They found that being born in postwar Germany in 1945–1948 was only associated with a tiny impairment in work-related earnings, which was not visible in the at-riskof-poverty rates. The findings question previous statements associating early childhood malnutrition and lower lifetime earnings.
  2. Acta Paediatrica September 2017 IMPACT Factor: 2.043 We have highlighted some of September issue's article that you can access freely in the journal below. Preterm birth needs to be considered a chronic condition In this review, Raju et al report that an overwhelming majority of adults born preterm were healthy and well. However, a small, but significant, fraction of them still faced a higher risk of developing neuropsychological and behavioural problems, hypersensitive disorders and metabolic syndrome earlier than their term-born counterparts. The authors maintain that preterm birth needs to be considered a chronic condition, with a slight increase in the risk for long-term morbidities. Therefore, obtaining a birth history from all patients, irrespective of their age, should be routine, as this would help early diagnoses and timely interventions. Nilsson and Ignell discuss the paper. Important EEG features for the assessment of brain maturation in premature infants This review by Pavlidis et al describes the maturational features of the baseline electroencephalogram (EEG) in the neurologically healthy preterm infant. Features such as continuity, sleep state, synchrony and transient waveforms are described also in extremely preterm infants. Illustrated examples are presented. The review demonstrates the importance of multichannel conventional EEG monitoring for preterm infants as many of the features described are not apparent if limited channel EEG monitors are used. Changes in perinatal hospital deaths outside the neonatal intensive care unit Dupont-Thibodeau et al reviewed perinatal deaths outside the neonatal intensive care unit from 22 weeks of gestation in a Canadian tertiary mother and baby hospital during two study periods of three years between 2000 and 2010. They found that approaches to end-of-life care changed between the study periods. The total number of perinatal deaths increased, while the proportion of fetuses who were alive at the time of their mother’s hospital admission, but were subsequently stillborn, decreased. There was also an increase in terminations for congenital anomalies in the second cohort and a decrease in deaths following induced labour and comfort care for fetal anomalies. Norman comments on the findings. Risk factors for executive function difficulties in preschool and early school-age preterm children Preterm children face a higher risk of developing executive function difficulties than their full-term peers, according to an Australian study by O’Meagher et al. Deficits in executive function influence problem-solving abilities and can have a substantial impact on social and academic function and quality of life. This study identified social risks and, in particular, pointed out that the main carer’s education level was a key predictor for cognitive and executive function difficulties in preterm children when they started school. Skranes comments on the findings. Management of bronchiolitis varied between, and within, hospitals The clinical management of bronchiolitis in infants varied considerable between three Finnish hospitals, according to a study by Elenius et al, as did the use of strict or loose definitions of bronchiolitis. The authors concluded that a stronger commitment to evidence-based bronchiolitis guidelines is needed. Shmueli et al used different treatment protocols for bronchiolitis in three paediatric wards in Israel and found that no treatment regime proved superior. However, inhalations of hypertonic saline or adrenaline were associated with a longer hospital stay. See also Abstracts from XXV Biennial Meeting of the International Perinatal Collegium, Edinburgh, Scotland, 2–6 July 2017 Selected articles from the previous Biennial Meeting of the International Perinatal Collegium are available as a virtual issue
  3. Highlights in Acta Paediatrica's March 2017 issue Evidence-based neonatology commentaries In this month's issue, we are delighted to announce a new feature, the Evidence-Based Neonatology Commentary. This represents a unique collaboration between Acta Paediatrica and the International Society for Evidence-Based Neonatology (EBNEO). Readers will find objective appraisals of trials related to the care of neonates. The commentaries will be published in Acta Paediatrica and displayed in more detail on the EBNEO website. The goal of this initiative was to reduce the time it takes to implement evidence-based research. See the editorial by Wright et al for more details. Moderate drinking during pregnancy also affects offspring Heavy maternal alcohol consumption is well known to cause foetal alcohol spectrum disorders, but there is some controversy about whether low-to-moderate drinking during pregnancy can affect offspring. Sundelin-Wahlsten et al examined the effects of mothers’ self-reported alcohol consumption and reported negative effects on their children's growth, development and behaviour after moderate drinking. In the accompanying editorial, Landgren discusses the implications of recognising alcohol as a teratogen. Swiss end-of-life decisions in the French, German or Italian way Hendriks et al conducted a nationwide telephone survey of the general population in the French-, German- and Italian-speaking regions of Switzerland, to explore attitudes and values with regard to extreme prematurity. The majority of the 1210 respondents, almost 78%, showed a strong preference for shared decision-making, although this was lower in the Italian region (66%) than in the German (78%) and French (80%) regions. In the accompanying editorial, Bührer asks whether end-of-life decisions about extremely preterm infants are influenced by language, gender and education. Large differences between the Nordic countries in the use of less invasive surfactant administration Less invasive surfactant administration (LISA) – which is surfactant instillation administered through a thin catheter in the trachea during spontaneous breathing – is increasingly used for premature infants. Heiring et al surveyed Nordic neonatal units in autumn 2015 and of the 73 units who responded, 32% said that they used LISA. However, it was more common in Iceland (100%) and Norway (82%) than in Denmark (11%) and Sweden (9%), with Finland falling in between (60%). Premedication was used by 78%, which is more often than previously reported. Readers may also be interested to read the survey by Mukerji et al, who evaluated practice variations in noninvasive respiratory support use across Canadian neonatal intensive care units. Forty years of childhood encephalitis in Sweden In this paper, Wickström et al describe childhood encephalitis in Stockholm, Sweden, from 1970 to 2009, covering the diagnostics, aetiology and outcomes. The incidence was similar over the 40-year period and, although mortality markedly decreased and aetiologies shifted during that time, no clear long-term improvements in outcome were seen. The need for intensive care was relatively unchanged (18%–20%) for each of the study intervals, possibly indicating that the severity of cases remained unaltered.
  4. The rights of the newborn at the edge of viability and other NICU related highlights in Acta Paediatrica's November issue The recent fall in postperinatal mortality in New Zealand and the Safe Sleep programme Free Article The decline in postneonatal mortality in New Zealand plateaued in 2000. Recognition of the fact that more than 50% of sudden unexpected deaths in infancy were associated with unsafe sleeping, especially bed sharing, led to various safe sleep initiatives. The most important of these was the introduction of the Wahakura, a portable infant safe sleeping device that can be placed in the adult bed to improve the safety of bed sharing. Māori midwives issued the Wahakura, and the similar Pēpi-Pod device, to families together with advice on safe sleep. The successful programme, described in detail in Edvin A Mitchell et al’s paper, resulted in a 29% decrease in postperinatal mortality in New Zealand from 2009 to 2015. Göran Wennergren comments on the paper in: No bed sharing or safer bed sharing? Free article Why does nobody like preemies? Ola Saugstad writes about the rights of the newborn at the edge of viability Free Article Countries and institutions that define a lower gestational age limit for offering treatment to extremely preterm infants, such as 23 or 24 weeks, may be violating the United Nations Convention on the Rights of the Child says Ola Saugstad in this editorial. He states that each child has the right to an individual assessment. Over two-thirds of the adolescents who received active perinatal care after extremely preterm birth only had mild disabilities or none at all Active perinatal care increases the survival of extremely preterm infants, but may increase the rate of disabilities. Antti Holsti et al examined the outcomes of 132 adolescents aged 10–15 years who were born at gestational ages of 23–25 weeks and received active perinatal care, and compared them with term-born controls. Over two-thirds of the adolescents born extremely preterm only had mild disabilities or none at all. Is a delivery room hospice approach for periviable infants a feasible alternative? Garbi et al present the case of a periviable infant born at 23 weeks of gestation, whose mother suffered distress while watching her child struggle to breathe. At first, the mother opted to defer resuscitation, based on the belief that it was in the best interests of her child. However, she later changed her mind and requested resuscitation, as she could not bear to watch her infant struggle. The case led the authors to question the limitations of the current ethical rationale for the care of periviable infants. They propose an alternative model that uses a delivery room hospice care approach involving the administration of opioids. Brian S Carter discusses the paper in an editorial. Free article Emergency transport by a specialist paediatric transport team Centralisation of paediatric intensive care increases the need to transport critically ill children. Tova Hanneard-Hamrin et al looked at 221 children who were transported to a paediatric intensive care unit by a specialist paediatric transport team. The transported patients were sicker, younger, stayed longer in intensive care and needed more specific therapies than other patients admitted to the same unit. Despite the higher severity of illness in the transport cohort, the standardised mortality ratio was similar in both groups and survival rates were not affected by the mode of transport or the distance. Michael T Bigham and Brent McSharry comment on the paper.
  5. This article is now free online! Fast food versus slow food in very and extremely low-birthweight infants: speed of feeds is a little more than a gut feeling by Sascha Meyer et al.
  6. Thank you Ruth! That's a very good point! The Editorials by Dirk Wackernagel, Frans J Walther and David Askenazi are already open. I'll check if we can open some of the other articles too. For the regular articles and reviews the abstracts are open access. The paper by Sasha Meyer et al about fast vs slow food is an "a different view paper" an this article type doesn't have an abstract. Kind regards, Anna, Acta Paediatrica Editorial Office
  7. Infant feeding and other NICU related content in Acta Paediatrica's October issue! Fast food versus slow food in very and extremely low-birthweight infants: speed of feeds is a little more than a gut feeling. Sascha Meyer et al present their local feeding strategies and explain how a more careful feeding regime, based on a slow increment, resulted in a remarkably low incidence of NEC in their neonatal intensive care unit. Dirk Wackernagel comments on the paper and discusses the current evidence on how to feed preterm infants. Children born preterm and full term have similar rates of feeding problems at three years of age, by Tjitske Nieuwenhuis et al, with accompanying commentaries by Frans J Walther and Roberta G Pineda Review of the clinical significance of respiratory virus infections in newborn infants, by Raakel Luoto et al Positioning newborns on their back or right side for umbilical venous catheter insertion, by Emily A Kieran et al Treating perinatal asphyxia with theophylline at birth helps to reduce the severity of renal dysfunction in term neonates, A randomized controlled trial by Alok Raina et al, with David Askenazi commenting on the finding. See also a summary of the Highlights in the October 2016 issue!
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