Characteristics of children admitted to neonatal and paediatric intensive care
This study aimed to quantify the characteristics of children under the age of 2 years admitted to neonatal units (NNUs) and paediatric intensive care units (PICUs). The researchers conducted a study compiling routinely collected data from children born between 2013 and 2018, with the main outcome measure defined as admission to PICU before 2 years of age.
The data gathered comprised 384 747 admissions of babies to an NNU, showing that 4.8% of these (n=18 343) were then also admitted to PICU before they reached the age of 2 years. About half of all children in the PICU aged under age 2 years were born within the same time window had also been previously admitted to an NNU.
The main indication for admission to PICU was of cardiac origin in 7138 cases, and for respiratory reasons in 5386 cases. The cardiac admissions were mostly children who were born at term, which was in 5146 cases. However, for preterm babies who were born under 37 weeks of gestational age (n=3550), respiratory issues made up the main reason for admission. The researchers found that one-third of all children admitted to PICU had more than one admission.
The authors concluded that many health professionals see the same children who have admissions to NNU and PICU within the first 2 years of life. The research team noted that some children were admitted for specific care pathways such as elective cardiac surgery. However, the children that need NNU followed by PICU account for a large proportion of the PICU population. This indicates that perceptions of risk for this particular group of children may be affected. Therefore, such risk needs consideration by NNU and PICU teams, and further exploration in future research.
Family-centred care and growth outcomes in NICU infants
A new study published in Neonatology analysed the effect of close collaboration with parents on length of stay in the neonatal intensive care unit (NICU) and growth in preterm infants. Close collaboration is an educational initiative that aims to improve family-centred care practices among healthcare teams.
The authors looked at length of stay, growth, later hospital visits and rehospitalisation. The data were collected from a registry. Preterm infants born under 35 weeks' gestation in Finland from 2006 to 2020 were eligible for inclusion. The full close collaboration group consisted of 2104 infants, where the intervention was given in the NICU of the delivery and the discharge hospitals. There were 515 infants in the partial-close collaboration group, which was classified as having only one of the NICUs using the intervention. In the control group, there were 11 621 babies and neither hospital NICU had implemented the close collaboration intervention.
The full-close collaboration group had an adjusted length of stay of 1.8 days (6%) shorter than the control group. Growth was also found to be better in the group receiving full-close collaboration when compared with the control group. The full-close collaboration babies grew by 11.7 g more per week and by 1.3 mm more per week. The full-close collaboration group also had a lesser chance of unplanned outpatient visits in comparison with the control group, and no significant differences were found among other comparisons.
Itoshima et al therefore concluded that implementation of the initiative to improve a family-centred approach to care practices across NICUs may result in better use of hospital resources through shortening the length of stay and improving growth, while also decreasing hospital visits of preterm infants.
Effects of corticosteroid exposure to term infants during pregnancy
This study aimed to evaluate the impact of mothers' use of antenatal corticosteroids during pregnancy on birth outcomes in term infants. The researchers compared exposed newborns with non-exposed controls in a 1:2 design and used multivariate analysis to assess the effect of antenatal corticosteroids exposure on neonatal outcomes.
A total of 408 newborns were included in the study, 136 of whom had been exposed to antenatal corticosteroids. Results revealed that head circumference in exposed infants was a mean of 33.7 cm whereas the control infants' head circumference was a mean of 34.3 cm. Birth weight was a mean of 3.1 kg in the exposed babies and in the non-exposed control group the mean birth weight was 3.3 kg. Birth height in the exposed group was 47.9 cm and in the exposed group the height was a mean of 49.1 cm. Hypocalcemia was also present in 4.4% of the exposed infants while the condition was present in only 0.7% of the control group.
Interestingly, feeding difficulties were noted in 5.1% of exposed infants and only 1.5% of the non-exposed newborns. The multivariate analysis for head circumference found a significant independent association with antenatal corticosteroids exposure.
The researchers concluded that term newborns exposed to antenatal corticosteroids in pregnancy have a lower birth head circumference and are at an increased risk of neonatal complications.
Burden of chickenpox complications in Poland
According to a previous study, the most common complications from chickenpox are dehydration (15.9%), skin and soft tissue infections (14.6%), pneumonia (12.2%), and cerebellitis (11.0%). However, there is little evidence on the overall burden of chickenpox complications in the Polish general population.
Thus, researchers set out to examine the burden of chickenpox complications and the trends of hospitalisation from 2006–2021 in the Polish population in order to inform future interventions, including the intensification of immunisation efforts.
Data spanning 2006–21 were sourced from the Polish Infectious Diseases Surveillance System, the Nationwide General Hospital Morbidity Study and the Statistics Poland death registry. Standardised and age-specific incidence rates, hospital discharge rates and number of deaths because of chickenpox were calculated.
Between 2006 and 2019, hospitalisation rates from chickenpox increased in children 0–4 years and in rural areas. The risk of chickenpox complications requiring hospitalisation in Poland seems to be higher than in other EU countries. Merging data from routine surveillance and different medical registries can be a helpful tool to monitor the frequency of chickenpox complications, say the researchers.
They conclude that the introduction of a universal immunisation programme could nearly eliminate deaths from chickenpox and considerably limit the number of hospitalisations because of the disease.
It might be useful in the future to merge epidemiological surveillance data with data from different systems collecting data on health situation to evaluate burden scale of complications caused by infectious diseases, they add.
Key drivers of responsive parenting in mothers and fathers – observed and self-reported responsiveness
This review, also from Poland, explored parental responsiveness: the ability of a parent to react to a child's needs adequately, promptly and with tenderness and synchrony.
The purpose of the study was to explore whether individual differences in empathy and attachment in mothers and fathers, and their satisfaction with their relationship, are predictors of parental responsiveness towards infants. Self-report and observational measures of parental responsiveness were compared.
The research showed that responsiveness towards a parent's own child is a complex construct that is affected by a variety of factors. At an individual level, measures of responsiveness (self-report and observational) were not congruent and probably dependent on other variables. However, in couples, there were positive correlations in three aspects of observed parental responsiveness: sensitivity, declared parental responsiveness, and relationship satisfaction.
The hypothesis that higher satisfaction in partners is connected with higher parental responsiveness was confirmed in this study for fathers for both observational measures. The greater the relationship satisfaction in fathers, the higher was their sensitivity and co-operation toward their own child. This result suggests that, for men, marital satisfaction (or satisfaction in the relationship with the child's mother) is an important factor for the relationship with the child.
Empathic concern was a universal predictor of every dimension of parental responsiveness in both mothers and fathers, and also displayed an effect on partners. The higher the empathic concern, the higher the sensitivity, co-operation, and self-report responsiveness in both mothers and fathers.
The findings suggest the importance of including both parents in analyses of the responsiveness of caregivers, say the authors.
Non-pharmacological interventions for asthma prevention and management across the life course
Asthma can manifest at any age, with distinct characteristics. The World Health Organization advocates for a life-course approach to manage chronic conditions, placing a significant emphasis on fostering health and wellbeing throughout all stages of life and recognising the cumulative effects of managing risk factors on long-term outcomes. Therefore, the authors in this study conducted an umbrella review, also known as an overview of systematic review, aiming to assess and synthesise existing evidence on the effectiveness of various proposed non-pharmacological interventions (NPIs) for the prevention and management of asthma. This review sought to provide recommendations for both clinical practice and further research in the management of asthma.
A total of 1719 reviews were identified from the search. Sixteen systematic reviews and meta-analyses included in the analysis examined the impact of NPIs among infants.
Three reviews demonstrated the consistent benefit of exclusive breastfeeding in reducing the long-term risk of developing asthma and relatively strong evidence from a meta-analysis supports exclusive breastfeeding of a duration ≥6 months. There was no significant benefit of vitamin D supplementation for reducing asthma risk during infancy.
About 78 systematic reviews and meta-analyses examined a wide range of NPIs among children, with physical exercise, digital health interventions and vitamin D consumption as the top three sub-types of interventions of interest.
Eleven systematic reviews and meta-analyses assessed the effects of vitamin D, and findings were inconsistent, with a few studies indicating its benefit on asthma-related symptoms, asthma control level, acute exacerbation and hospitalisation.
In conclusion, this study emphasised the significance of delivering NPIs to improve asthma prevention and management and highlights the heterogeneity regarding the impact of NPIs across life courses. High-quality research is urgently needed to further strengthen the evidence base of NPIs and tailored interventions should be considered in guideline development.