The role of endoscopic ultrasound in children with Pancreatobiliary and gastrointestinal disorders: a single center series and review of the literature

BMC Pediatrics published 6th December 2017

Background:
The role of endoscopic ultrasound (EUS) in the management of pancreatobiliary and digestive diseases is well established in adults, but it remains limited in children. The aim of this study was to evaluate the feasibility, safety, and clinical impact of EUS use in children.

Conclusion:
The present findings were consistent with results observed in the current relevant literature and support EUS as a safe and feasible diagnostic and therapeutic tool, which yields a significant clinical impact in children with pancreatobiliary and gastrointestinal disorders.

Link to article here

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BMJ Article: Cognitive trajectories from infancy to early adulthood following birth before 26 weeks of gestation: a prospective, population-based cohort study

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Image: Wikimedia commons

Abstract

Objective To determine the trajectory of cognitive test scores from infancy to adulthood in individuals born extremely preterm compared with term-born individuals.

Design A prospective, population-based cohort study.

Setting 276 maternity units in the UK and Ireland.

Patients 315 surviving infants born less than 26 completed weeks of gestation recruited at birth in 1995 and 160 term-born classroom controls recruited at age 6.

Main outcome measures Bayley Scales of Infant Development-Second Edition (age 2.5); Kaufman Assessment Battery for Children (ages 6/11); Wechsler Abbreviated Scale of Intelligence-Second Edition (age 19).

Results The mean cognitive scores of extremely preterm individuals over the period were on average 25.2 points below their term-born peers (95% CI −27.8 to −22.6) and remained significantly lower at every assessment. Cognitive trajectories in term-born boys and girls did not differ significantly, but the scores of extremely preterm boys were on average 8.8 points below those of extremely preterm girls (95% CI −13.6 to −4.0). Higher maternal education elevated scores in both groups by 3.2 points (95% CI 0.8 to 5.7). Within the extremely preterm group, moderate/severe neonatal brain injury (mean difference: −10.9, 95% CI −15.5 to −6.3) and gestational age less than 25 weeks (mean difference: −4.4, 95% CI −8.4 to −0.4) also had an adverse impact on cognitive function.

Conclusions There is no evidence that impaired cognitive function in extremely preterm individuals materially recovers or deteriorates from infancy through to 19 years. Cognitive test scores in infancy and early childhood reflect early adult outcomes.

Link to article here

Cochrane review:

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Image: Wikimedia commons

Background

Gastro-oesophageal reflux (GOR) is common in infants, and feed thickeners are often used to manage it in infants as they are simple to use and perceived to be harmless. However, conflicting evidence exists to support the use of feed thickeners.

Authors’ conclusions

Gastro-oesophageal reflux is a physiological self resolving phenomenon in infants that does not necessarily require any treatment. However, we found moderate-certainty evidence that feed thickeners should be considered if regurgitation symptoms persist in term bottle-fed infants. The reduction of two episodes of regurgitation per day is likely to be of clinical significance to caregivers. Due to the limited information available, we were unable to assess the use of feed thickeners in infants who are breastfeeding or preterm nor could we conclude which type of feed thickener is superior.

Link to review here

E-Learning for Healthcare: About the Avoiding Term Admissions Into Neonatal units programme

Atain programme

This e-learning programme will help healthcare professionals involved in the care of newborns, both in the hospital and community settings, to improve outcomes for babies, mothers and families through the safer delivery of care.

It is one of the outputs from the Atain programme (an acronym for ‘avoiding term admissions into neonatal units’) to reduce avoidable causes of harm that can lead to infants born at term (i.e. ≥ 37+0 weeks gestation) being admitted to a neonatal unit.

The e-learning programme addresses the key learning needs identified through Atain, with a focus on four key clinical areas:

  • respiratory conditions
  • hypoglycaemia
  • jaundice
  • asphyxia (perinatal hypoxia–ischaemia).

Link to their webpage here

Association Between Early-Life Antibiotic Use and the Risk of Islet or Celiac Disease Autoimmunity

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image: Google images

Question  Is the use of β-lactam or macrolide antibiotics in early life associated with autoimmunity for type 1 diabetes or celiac disease?

Findings  Included in this cohort study were 8495 children and 6558 children enrolled in The Environmental Determinants of Diabetes in the Young (TEDDY) study who were tested for islet and tissue transglutaminase autoantibodies, respectively. Among these children at genetic risk for type 1 diabetes or celiac disease, the use of β-lactam or macrolide antibiotics in early life and before seroconversion was not associated with a risk of autoimmunity for either disease.

Meaning  These results suggest that the use of the most common antibiotics in early life does not increase the risk of autoimmunity in children at increased genetic risk.

Link to article

Tobacco cessation interventions for young people

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Summary

Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the update of a Cochrane Review first published in 2006.

Authors’ conclusions

There is limited evidence that either behavioural support or smoking cessation medication increases the proportion of young people that stop smoking in the long-term. Findings are most promising for group-based behavioural interventions, but evidence remains limited for all intervention types. There continues to be a need for well-designed, adequately powered, randomized controlled trials of interventions for this population of smokers.

Link to review here

Children and young people’s experience of care

childrens care survey

Summary

Read the results of our latest survey, which looks at the experiences of children, young people and their parents and carers attending hospital for treatment as an inpatient or day case.

Key findings for England

Overall children and young people’s experiences of inpatient and day case care were mostly positive. The majority of children and young people said they were well looked after while in hospital, staff were friendly and that they received answers to their questions. Most parents and carers reported positive experiences for how their child’s pain was managed and for receiving enough information about new medication.

The survey results suggest there is scope for improvement in a number of areas, including:

  • Children and young people having enough things to do whilst in hospital
  • Involving children and young people in decision making
  • Being treated on age appropriate wards

Link to article & video here