Health visitor plays crucial role in child's eye cancer diagnosis, says charity
The children's cancer charity, the Childhood Eye Cancer Trust (CHECT), is highlighting the crucial role health visitors can play in the early diagnosis retinoblastoma, a rare form of eye cancer.
Mum Megan spotted an unusual glow in her son Arlo's eye in August 2023. She said, ‘I had noticed something and the next day my sister had him for the day. She called me and said that his eye was completely white while playing in his cousin's room, directly in the sunlight. I was pregnant at the time and had my health visitor coming that week so I thought I would ask her advice and she said to take him straight to the hospital. Arlo had just turned 5.’
After routine eye tests at their local hospital, Arlo was referred urgently to the Royal London Hospital, where he was diagnosed with retinoblastoma. A week later, his right eye was removed, followed by chemotherapy. Arlo, who turns 6 in May, has recovered well.
Retinoblastoma is a rare eye cancer that affects babies and young children, mainly under the age of six. Around 40–50 cases are diagnosed a year in the UK – or one child a week. It represents 3% of all childhood cancers and 10% of cancers in babies under the age of one in the UK.
CHECT are urging parents and health professionals to be aware of the most common possible symptoms of eye cancer – a white glow in the eye in flash photo or in certain light, and a squint. The main symptoms reported by parents of children diagnosed with retinoblastoma are:
Richard Ashton, Chief Executive of CHECT said: ‘The symptoms of retinoblastoma are usually confined to the eye, with children often seeming well in themselves, which can make it hard to recognise they have a serious condition. Although 98% of children with retinoblastoma in the UK survive, in just under half of all cases, a child will have an eye removed as part of their treatment. We are incredibly grateful for the role that Arlo's health visitor played in ensuring his symptoms were investigated as soon as possible, so that he was referred on for diagnosis and treatment without delay.’
World Retinoblastoma Awareness Week is being held from 12–18 May. More information can be found at: https://chect.org.uk/retinoblastoma-week-2024.
Health visitors can help make sure every affected child is diagnosed as quickly as possible by becoming familiar with the signs and symptoms of retinoblastoma at: www.chect.org.uk/hv.
Opioids in pregnancy not linked to ‘substantially increased’ risk of psychiatric disorders in children
Opioid use during pregnancy is not associated with a substantial increase in the risk of neuropsychiatric disorders such as ADHD in children, finds a large study from South Korea published by the BMJ.
A slightly increased risk of neuropsychiatric disorders was found, but the researchers say this should not be considered clinically meaningful as it was limited to mothers exposed to more than one opioid prescription, high doses, and over longer time periods during pregnancy.
Data from the Centers for Disease Control and Prevention show around 7% of women in the US were prescribed opioids during pregnancy in 2019.
Previous studies have shown mixed findings on the association between opioid use in pregnancy and various health outcomes in children due to small sample sizes and short follow-up periods. An international team of researchers set out to investigate the potential association between opioid exposure during pregnancy and risk of neuropsychiatric disorders in children.
Their findings are based on data from the National Health Insurance Service (NHIS) of South Korea for 3 128 571 infants born between 2010 and 2017 and 2 299 664 mothers (average age 32). Mothers were grouped according to dose, duration, and frequency of opioid prescriptions during pregnancy and infants were followed up for an average of 6 years.
Factors including mother's age at delivery, household income and pre-existing health conditions, and infant sex, birth weight and breastfeeding history were taken into account.
A sibling comparison analysis was also carried out to account for genetics, lifestyle, and environmental influences. Overall, 216 012 (7%) of the 3 128 571 infants were exposed to opioids during pregnancy (prenatal exposure). A small increased risk of neuropsychiatric disorders was found among children exposed to prescription opioids during pregnancy compared with those not exposed, but the researchers interpret this as clinically insignificant.
However, exposure to prescription opioids during the first trimester of pregnancy, at higher doses, and for 60 days or more were associated with a slightly increased risk of mood disorders, ADHD and intellectual disability. The researchers conclude: ‘These results support cautious opioid prescribing for relief of pain during pregnancy, highlighting the importance of further research for more definitive guidelines.’
In a linked editorial, researchers agree that while short-term use of lower dose prescription opioids after the first trimester appears relatively safe, caution is warranted when prescribing opioids for longer durations or at higher dosages.
Scottish Government announces funding for perinatal mental health
The Royal College of Midwives (RCM) says it welcomes the announcement by the Scottish Government that it will provide additional funding to improve perinatal mental health services in the north of Scotland.
Minister for Mental Health of Scotland, Maree Todd MSP, announced that in the first phase, £85 000 will be allocated towards providing support for severely ill women. The announcement follows a call by the RCM for increased spending and allocation of resources to give equal priority to mental health and physical health.
The Perinatal and Infant Mental Health Fund, which is now open for applications, enables organisations to provide a range of one-to-one and group-based support and care for parents, carers and new babies. The Scottish government says over 10 000 parents, expectant parents and infants have been supported by existing funded organisations since 2019. The new round of funding will start from October 2024.
Mental Wellbeing Minister Maree Todd said: ‘It is very important that all mothers and their families have access to good mental healthcare throughout pregnancy and the postnatal period. The third sector provides vital access to perinatal mental health support, and we are dedicated to supporting them to do so. This latest round of funding of up to £1.5 million, building on previous awards of over £2.8 million over four years, is designed to increase the provision of parenting and infant support, peer support and counselling or psychological support. The Fund will enable organisations to provide the services that women and their families need.’
RCM Director for Scotland Jaki Lambert said: ‘[The] funding announcement by the Scottish Government is a good start towards addressing the challenges women face in accessing intensive perinatal mental healthcare. That said there is still much more to do. The money itself is not a magic wand and the Government must make sure that any improvements are not just a flash in the pan and that there is a long-term focus on improving equity of access to perinatal mental health services across Scotland once this first phase is complete.’
Prioritising perinatal mental health alongside physical health is something the RCM has been pushing hard for across the UK.
Last year, the RCM launched its Roadmap for Perinatal Mental Health, which highlighted the steps policymakers and healthcare leaders need to take to ensure women receive the right care at the right time.
For more information about the Fund, visit: https://inspiringscotland.org.uk/fund/perinatal-infant-mental-health-fund-2024.
HPV vaccine ‘continues to be highly effective’ despite falling uptake
New data released by the Office for National Statistics has shown that the human papillomavirus (HPV) vaccination programme is up to 95% effective in preventing cervical cancer.
The HPV virus causes 99% of cervical cancers and can also cause other types of cancer. The vaccine is administered to school children aged 12–13.
The vaccine has proven to be highly effective, with studies showing that the prevalence of the virus dropped dramatically to less than 1% in vaccinated women, and that cervical cancer was almost eliminated. Studies show that protection lasts for around 10 years. Despite the effectiveness of the vaccine, uptake has failed to meet pre-pandemic levels, with coverage falling across England. In November, NHS England pledged to eliminate cervical cancer by 2040.
Commenting on the release of the data, William Roberts, Chief Executive of the Royal Society for Public Health, said: ‘The HPV vaccination programme is a success story of public health prevention. It is a simple, safe and effective intervention that is having dramatic results. When we think big on public heath, the results are transformative.
‘This vaccine has the potential to save, and improve the lives of thousands of children by giving them a life free of cancer.
‘As well as saving the health service money, the vaccine will prevent the children of today, as they grow up, from having to deal with the immense physical and emotional hardship that cancer has on people and their loved ones. Like all vaccines, its success wholly depends on continued uptake. That's why it's disappointing to see vaccination rates falling among children. Like many in the public health community, we are concerned about the long-term implications this could have.
‘We know that young people overwhelmingly trust vaccines and we need to find ways to make it as simple as possible to get jabbed. This is a trend that we can and need to reverse to protect the health of future generations.’
Esketamine injection just after childbirth ‘reduces depression in new mothers’
A single low-dose injection of esketamine given immediately after childbirth reduces major depressive episodes in individuals with depressive symptoms during pregnancy (prenatal depression), finds a clinical trial published by the BMJ.
The results suggest that low dose esketamine should be considered in new mothers with prenatal depressive symptoms. Esketamine is made from ketamine and is used as an anaesthetic and to treat depression; yet the effect for mothers with perinatal depression is unclear, the authors say.
The researchers, based in China and the USA, wanted to find out if a single low dose injection of esketamine given just after childbirth might reduce subsequent depression in mothers with pre-existing prenatal depression. Their findings are based on 361 mothers (average age 32 years) enrolled from five Chinese hospitals from June 2020 to August 2022 with no medical history of depression and no diagnosis of depression in pregnancy, but who had scores on a scale consistent with mild prenatal depression and were preparing for childbirth.
None of the participants had severe pregnancy complications or any condition that meant they could not be given esketamine.
Information on factors including age, weight (BMI), education level, family income and existing health conditions was recorded at the start of the trial and participants were randomly assigned to either esketamine or placebo intravenously infused over 40 minutes after childbirth. Participants were interviewed 18–30 hours after giving birth and again at 7 and 42 days. Major depressive episode was diagnosed with the Mini-International Neuropsychiatric Interview at 42 days. Depression was also assessed using the Edinburgh depression score at 7 and 42 days, and the Hamilton Depression Rating Scale score at 42 days. No participant took antidepressants or received psychotherapy during the follow-up period. At 42 days after giving birth, 12 of 180 (6.7%) of mothers given esketamine experienced a major depressive episode compared with 46 of 181 (25.4%) of those given placebo (a relative risk reduction of about three-quarters).
As expected, mothers given esketamine had lower Edinburgh depression scores at 7 and 42 days, and a lower Hamilton depression score at 42 days. Based on these figures, the researchers estimate that, for every five mothers given esketamine, one major depressive episode would be prevented.
More neuropsychiatric adverse events such as dizziness and diplopia (double vision) occurred with esketamine (45% v 22%). However, symptoms lasted less than a day and none needed drug treatment.
The researchers acknowledge that excluding mothers with pre-pregnancy mood disorders may have affected the validity of their results, and the short follow-up period may have led to under-reporting of neuropsychiatric symptoms and other adverse events.
Most participants had only mild prenatal depressive symptoms, so it's unclear whether esketamine is equally effective in those with more severe depressive symptoms.
Nevertheless, they conclude that for mothers with prenatal depressive symptoms, a single low dose of esketamine given shortly after childbirth decreases major depressive episodes at 42 days postpartum by about three quarters.