Question How do infant feeding practices influence gut microbiota and risk of overweight?
Findings Among 1087 infants from the Canadian Healthy Infant Longitudinal Development (CHILD) cohort, earlier cessation of breastfeeding and supplementation with formula (more so than complementary foods) were associated with a dose-dependent increase in risk of overweight by age 12 months; this association was partially explained by specific gut microbiota features at 3 to 4 months. Subtle but significant microbiota differences were observed after brief exposure to formula limited to the birth hospital stay, but these differences were not associated with overweight.
Meaning Breastfeeding may contribute to protection against overweight by modifying the gut microbiota, particularly during early infancy.
Community-acquired pneumonia in children is associated with significant morbidity and mortality; however, data are limited in predicting which children will have negative outcomes, including clinical deterioration, severe disease, or development of complications. The Pediatric Infectious Diseases Society/Infectious Diseases Society of America (PIDS/IDSA) pediatric pneumonia guideline includes criteria that were modified from adult criteria and define pneumonia severity to assist with resource allocation and site-of-care decision-making. However, the PIDS/IDSA criteria have not been formally developed or validated in children. Definitions for mild, moderate, and severe pneumonia also vary across the literature, further complicating the development of standardized severity criteria. This systematic review summarizes (1) the current state of the evidence for defining and predicting pneumonia severity in children as well as (2) emerging evidence focused on risk stratification of children with pneumonia.
The use of long-term ventilation (LTV) in children is growing in the UK and worldwide. This reflects the improvement in technology to provide LTV, the growing number of indications in which it can be successfully delivered and the acceptability of LTV to families and children. In this article, we discuss the various considerations to be made when deciding to initiate or continue LTV, describe the process that should be followed, as decided by a consensus of experienced physicians, and outline the options available for resolution of conflict around LTV decision making. We recognise the uncertainty and hope provided by novel and evolving therapies for potential disease modification. This raises the question of whether LTV should be offered to allow time for a therapy to be trialled, or whether the therapy is so unlikely to be effective, LTV would simply prolong suffering. We put this consensus view forward as an ethical framework for decision making in children requiring LTV.
These Standards for Children and Young People in Emergency Care Settings (4th edition) were published in June 2018. They were developed by the Intercollegiate Committee and are aimed at all health professionals working in emergency care.
The landscape of urgent and emergency care provision for children has changed significantly in recent years and continues to evolve at pace, albeit with much complexity and variation across the UK.
These standards aim to ensure that urgent and emergency care is fully integrated to ensure children are seen by the right people, at the right place and in the right setting.
In total, there are 70 standards, covering the following areas:
An integrated urgent and emergency care system
Environment in emergency care settings
Workforce and training
Management of the sick or injured child
Safeguarding in emergency care settings
Children with complex medical needs
Major incidents involving children and young people
Death of a child
Information system and data analysis
Research for paediatric emergency care
Practice examples are included within the standards to support services delivering these standards. Metrics have been included and an accompanying audit toolkit is in development, to help monitor local progress and generate ideas for how standards can be best met.
These standards were developed by the Intercollegiate Committee for Standards for Children and Young People in Emergency Care Settings, including representatives from: Association of Paediatric Emergency Medicine, British Association of Paediatric Surgeons, Joint Royal Colleges Ambulance Liaison Committee, Royal College of Anaesthetists, Royal College of Emergency Medicine, Royal College of General Practitioners, Royal College of Nursing, Royal College of Paediatrics and Child Health, Royal College of Psychiatrists.
Since its publication in the American Journal of Psychiatry a few weeks ago, Schuch et al.’s authoritative international study has been setting the world alight, or at least it’s got my pulse racing. With over 450 media outlets reporting on it and Twitter buzzing about it, the finding that increasing physical activity levels reduce the odds of developing depression in men and women of all ages and geographical locations, has been getting people excited. Let’s hope it gets them exercising as well.
If my enthusiasm for exercise hasn’t come across by now, let me be clear, I love it! I’m not saying I’m any good at it, but I love running, cycling, swimming, football, Gaelic football, whatever. I’m happiest in the hills fell running with my wife or with friends. I promise I will try to put this bias aside and give a fair assessment of the study.
CONTEXT: Nonpharmacologic treatments for attention-deficit/hyperactivity disorder (ADHD) encompass a range of care approaches from structured behavioral interventions to complementary medicines.
OBJECTIVES: To assess the comparative effectiveness of nonpharmacologic treatments for ADHD among individuals 17 years of age and younger.
DATA SOURCES: PubMed, Embase, PsycINFO, and Cochrane Database of Systematic Reviews for relevant English-language studies published from January 1, 2009 through November 7, 2016.
STUDY SELECTION: We included studies that compared any ADHD nonpharmacologic treatment strategy with placebo, pharmacologic, or another nonpharmacologic treatment.
DATA EXTRACTION: Study design, patient characteristics, intervention approaches, follow-up times, and outcomes were abstracted. For comparisons with at least 3 similar studies, random-effects meta-analysis was used to generate pooled estimates.
RESULTS: We identified 54 studies of nonpharmacologic treatments, including neurofeedback, cognitive training, cognitive behavioral therapy, child or parent training, dietary omega fatty acid supplementation, and herbal and/or dietary approaches. No new guidance was identified regarding the comparative effectiveness of nonpharmacologic treatments. Pooled results for omega fatty acids found no significant effects for parent rating of ADHD total symptoms (n = 411; standardized mean difference −0.32; 95% confidence interval −0.80 to 0.15; I2 = 52.4%; P = .10) or teacher-rated total ADHD symptoms (n = 287; standardized mean difference −0.08; 95% confidence interval −0.47 to 0.32; I2 = 0.0%; P = .56).
LIMITATIONS: Studies often did not reflect the primary care setting and had short follow-up periods, small sample sizes, variations in outcomes, and inconsistent reporting of comparative statistical analyses.
CONCLUSIONS: Despite wide use, there are significant gaps in knowledge regarding the effectiveness of ADHD nonpharmacologic treatments.
Cheap and simple plastic wrapping used in the first 10 minutes after birth helps pre-term and low birth weight infants avoid hypothermia. Infants treated in this way are likely to be warmer when admitted to neonatal intensive care than those treated according to standard care. Pre-term infants are most likely to benefit.
Routine infant care usually involves ensuring the delivery room is warm, drying the infant immediately after birth, wrapping the infant in pre-warmed dry blankets and pre-warming surfaces. Despite this, about a quarter of babies born eight weeks early have temperatures that are too low and additional measures to warm pre-term and low birth weight infants are needed.
Although babies were warmer after the intervention, this review of 19 published studies did not show that these interventions improved survival, or reduced the chances of short or long-term conditions associated with cold, perhaps because of the size of the trials.