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Explaining Sudden Unexpected Infant Deaths, 2011-2017

Pediatrics - Vie, 30/04/2021 - 10:01
BACKGROUND:

Sudden unexpected infant death (SUID) represents a broad group of explained and unexplained infant deaths (<1 year old). Explaining why SUID occurs is critical to understanding etiology and prevention. Death certificate data cannot differentiate explained from unexplained SUID cases nor describe the surrounding circumstances. We report SUID rates by explained and unexplained categories and describe demographics and history of recent injury or illness using the Centers for Disease Control and Prevention SUID Case Registry.

METHODS:

The registry is a population-based surveillance system built on Child Death Review programs. Data are derived from multiple sources, including death certificates, scene investigations, and autopsy reports. Cases included SUIDs reported by states or jurisdictions participating in the registry during 2011–2017. Cases were classified into explained and unexplained categories by using the registry’s classification system. Frequencies, percentages, and mortality rates per 100 000 live births were calculated.

RESULTS:

Of the 4929 SUID cases, 82% were categorized as unexplained. Among all cases, 73% had complete case information. Most SUIDs (72%) occurred in an unsafe sleep environment. The SUID mortality rate was 97.3 per 100 000 live births. Among explained and possible suffocation deaths, ~75% resulted from airway obstruction attributed to soft bedding.

CONCLUSIONS:

Unsafe sleep factors were common in explained and unexplained SUID cases, but deaths could only be classified as explained suffocation for ~20% of cases. Further analysis of unexplained deaths, including continued improvements to death scene investigation and documentation, may generate hypotheses for physiologic and genetic research, advance our understanding of gaps in SUID investigation, and enhance our understanding of infants at highest risk.

Risk Factors for Maltreatment in Siblings of Abused Children

Pediatrics - Vie, 30/04/2021 - 10:01
OBJECTIVES:

To examine the association between child maltreatment (abuse and neglect) in one sibling and that in another as well as associated risk factors.

METHODS:

The participants were 520 sibling pairs enrolled in a population-based birth cohort study in Brisbane, Australia (N = 1040). Exposure to suspected child maltreatment was measured by linkage with state child protection agency data. Self-reports of childhood sexual abuse were also collected at the 21-year follow-up.

RESULTS:

There were notifications in both children for 8.5% of the sibling pairs (n = 44). A notification in the first sibling was associated with a 60-fold increase in the likelihood of a notification in the second sibling (95% confidence interval: 29.3–125.1), resulting in nearly three-quarters being the subject of a report. In terms of the subtypes, neglect revealed the strongest association, followed by sexual abuse. At the 21-year follow-up, 58% of second siblings reported sexual abuse when the first sibling disclosed similar experiences. On adjusted analyses, maternal age of <20 years was the strongest and most consistent predictor of abuse, with indigenous status, maternal depression, parental relationship, and familial poverty playing a lesser role.

CONCLUSIONS:

Our results highlight the close association between child abuse in one sibling and maltreatment in a second sibling as well as possible risk factors. Greater awareness of these factors may inform interventions, particularly primary and secondary prevention.

Clinical Impact of a Diagnostic Gastrointestinal Panel in Children

Pediatrics - Vie, 30/04/2021 - 10:01
OBJECTIVES:

Many hospitals have transitioned from conventional stool diagnostics to rapid multiplex polymerase chain reaction gastrointestinal panels (GIP). The clinical impact of this testing has not been evaluated in children. In this study, we compare use, results, and patient outcomes between conventional diagnostics and GIP testing.

METHODS:

This is a multicenter cross-sectional study of children who underwent stool testing from 2013 to 2017. We used bivariate analyses to compare test use, results, and patient outcomes, including length of stay (LOS), ancillary testing, and hospital charges, between the GIP era (24 months after GIP introduction) and conventional diagnostic era (historic control, 24 months before).

RESULTS:

There were 12 222 tests performed in 8720 encounters. In the GIP era, there was a 21% increase in the proportion of children who underwent stool testing, with a statistically higher percentage of positive results (40% vs 11%), decreased time to result (4 vs 31 hours), and decreased time to treatment (11 vs 35 hours). Although there was a decrease in LOS by 2 days among those who received treatment of a bacterial and/or parasitic pathogen (5.1 vs 3.1; P < .001), this represented only 3% of tested children. In the overall population, there was no statistical difference in LOS, ancillary testing, or charges.

CONCLUSIONS:

The GIP led to increased pathogen detection and faster results. This translated into improved outcomes for only a small subset of patients, suggesting that unrestricted GIP use leads to low-value care. Similar to other novel rapid diagnostic panels, there is a critical need for diagnostic stewardship to optimize GIP testing.

Virological Characteristics of Hospitalized Children With SARS-CoV-2 Infection

Pediatrics - Vie, 30/04/2021 - 10:01
BACKGROUND AND OBJECTIVES:

In children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, virological characteristics and correlation with disease severity have not been extensively studied. The primary objective in this study is to determine the correlation between SARS-CoV-2 viral load (VL) in infected children with age, disease severity, and underlying comorbidities.

METHODS:

Children <21 years, screened for SARS-CoV-2 at the time of hospitalization, who tested positive by polymerase chain reaction were included in this study. VL at different sites was determined and compared between groups.

RESULTS:

Of the 102 children included in this study, 44% of the cohort had asymptomatic infection, and children with >1 comorbidity were the most at risk for severe disease. VL in children with symptomatic infection was significantly higher than in children with asymptomatic infection (3.0 x 105 vs 7.2 x 103 copies per mL; P = .001). VL in the respiratory tract was significantly higher in children <1 year, compared with older children (3.3 x 107 vs 1.3 x 104 copies per mL respectively; P < .0001), despite most infants presenting with milder illness. Besides the respiratory tract, SARS-CoV-2 RNA was also detectable in samples from the gastrointestinal tract (saliva and rectum) and blood. In 13 children for whom data on duration of polymerase chain reaction positivity was available, 12 of 13 tested positive 2 weeks after initial diagnosis, and 6 of 13 continued to test positive 4 weeks after initial diagnosis.

CONCLUSIONS:

In hospitalized children with SARS-CoV-2, those with >1 comorbid condition experienced severe disease. SARS-CoV-2 VL in the respiratory tract is significantly higher in children with symptomatic disease and children <1 year of age.

Socioeconomic and Racial and/or Ethnic Disparities in Multisystem Inflammatory Syndrome

Pediatrics - Vie, 30/04/2021 - 10:01
OBJECTIVES:

To characterize the socioeconomic and racial and/or ethnic disparities impacting the diagnosis and outcomes of multisystem inflammatory syndrome in children (MIS-C).

METHODS:

This multicenter retrospective case-control study was conducted at 3 academic centers from January 1 to September 1, 2020. Children with MIS-C were compared with 5 control groups: children with coronavirus disease 2019, children evaluated for MIS-C who did not meet case patient criteria, children hospitalized with febrile illness, children with Kawasaki disease, and children in Massachusetts based on US census data. Neighborhood socioeconomic status (SES) and social vulnerability index (SVI) were measured via a census-based scoring system. Multivariable logistic regression was used to examine associations between SES, SVI, race and ethnicity, and MIS-C diagnosis and clinical severity as outcomes.

RESULTS:

Among 43 patients with MIS-C, 19 (44%) were Hispanic, 11 (26%) were Black, and 12 (28%) were white; 22 (51%) were in the lowest quartile SES, and 23 (53%) were in the highest quartile SVI. SES and SVI were similar between patients with MIS-C and coronavirus disease 2019. In multivariable analysis, lowest SES quartile (odds ratio 2.2 [95% confidence interval 1.1–4.4]), highest SVI quartile (odds ratio 2.8 [95% confidence interval 1.5–5.1]), and racial and/or ethnic minority background were associated with MIS-C diagnosis. Neither SES, SVI, race, nor ethnicity were associated with disease severity.

CONCLUSIONS:

Lower SES or higher SVI, Hispanic ethnicity, and Black race independently increased risk for MIS-C. Additional studies are required to target interventions to improve health equity for children.

Comparative Efficacy of Bronchiolitis Interventions in Acute Care: A Network Meta-analysis

Pediatrics - Vie, 30/04/2021 - 10:01
CONTEXT:

Uncertainty exists as to which treatments are most effective for bronchiolitis, with considerable practice variation within and across health care sites.

OBJECTIVE:

A network meta-analysis to compare the effectiveness of common treatments for bronchiolitis in children aged ≤2 years.

DATA SOURCES:

Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform were searched from inception to September 1, 2019.

STUDY SELECTION:

A total 150 randomized controlled trials comparing a placebo or active comparator with any bronchodilator, glucocorticoid steroid, hypertonic saline solution, antibiotic, helium-oxygen therapy, or high-flow oxygen therapy were included.

DATA EXTRACTION:

Data were extracted by 1 reviewer and independently verified. Primary outcomes were admission rate on day 1 and by day 7 and hospital length of stay. Strength of evidence was assessed by using Confidence in Network Meta-Analysis .

RESULTS:

Nebulized epinephrine (odds ratio: 0.64, 95% confidence interval [CI]: 0.44 to 0.93, low confidence) and nebulized hypertonic saline plus salbutamol (odds ratio: 0.44, 95% CI: 0.23 to 0.84, low confidence) reduced the admission rate on day 1. No treatment significantly reduced the admission rate on day 7. Nebulized hypertonic saline (mean difference: –0.64 days, 95% CI: –1.01 to –0.26, low confidence) and nebulized hypertonic saline plus epinephrine (mean difference: –0.91 days, 95% CI: –1.14 to –0.40, low confidence) reduced hospital length of stay.

LIMITATIONS:

Because we did not report adverse events in this analysis, we cannot make inferences about the safety of these treatments.

CONCLUSIONS:

Although hypertonic saline alone, or combined with epinephrine, may reduce an infant’s stay in the hospital, poor strength of evidence necessitates additional rigorous trials.

Predictive Value of Clinician "Gestalt" in Pediatric Community-Acquired Pneumonia

Pediatrics - Vie, 30/04/2021 - 10:01
OBJECTIVES:

Validated prognostic tools for pediatric community-acquired pneumonia (CAP) do not exist. Thus, clinicians rely on "gestalt" in management decisions for children with CAP. We sought to determine the ability of clinician gestalt to predict severe outcomes.

METHODS:

We performed a prospective cohort study of children 3 months to 18 years old presenting to a pediatric emergency department (ED) with lower respiratory infection and receiving a chest radiograph for suspected CAP from 2013 to 2017. Clinicians reported the probability that the patient would develop severe complications of CAP (defined as respiratory failure, empyema or effusion, lung abscess or necrosis, metastatic infection, sepsis or septic shock, or death). The primary outcome was development of severe complications.

RESULTS:

Of 634 children, 37 (5.8%) developed severe complications. Of children developing severe complications after the ED visit, 62.1% were predicted as having <10% risk by the ED clinician. Sensitivity was >90% at the <1% predicted risk threshold, whereas specificity was >90% at the 10% risk threshold. Gestalt performance was poor in the low-intermediate predicted risk category (1%–10%). Clinicians had only fair ability to discriminate children developing complications from those who did not (area under the receiver operator characteristic curve 0.747), with worse performance from less experienced clinicians (area under the receiver operator characteristic curve 0.693).

CONCLUSIONS:

Clinicians have only fair ability to discriminate children with CAP who develop severe complications from those who do not. Clinician gestalt performs best at very low or higher predicted risk thresholds, yet many children fall in the low-moderate predicted risk range in which clinician gestalt is limited. Evidence-based prognostic tools likely can improve on clinician gestalt, particularly when risk is low-moderate.

Health Outcomes in Young Children Following Pertussis Vaccination During Pregnancy

Pediatrics - Vie, 30/04/2021 - 10:01
BACKGROUND AND OBJECTIVES:

Maternal immunization with tetanus, diphtheria, and acellular pertussis vaccine (Tdap) is routinely recommended in many countries as a strategy to protect young infants against severe pertussis infection; few studies have assessed whether prenatal exposure to the vaccine is associated with any longer-term adverse health effects in children. We evaluated the long-term safety of exposure to Tdap vaccination during pregnancy.

METHODS:

Population-based retrospective cohort study conducted in Ontario, Canada using multiple linked province-wide health administrative databases. All live births between April 2012 and March 2017 were included, and children were followed for up to 6 years to ascertain study outcomes. Children exposed to prenatal Tdap were propensity score matched to unexposed children at a 1:5 ratio. Tdap vaccination during pregnancy was ascertained by using vaccine-specific fee codes. Immune-related (infectious diseases, asthma) and nonimmune-related (neoplasm, sensory disorders) outcomes and a nonspecific morbidity outcome (urgent or inpatient health service use) were evaluated from birth to end of follow-up.

RESULTS:

Of 625 643 live births, 12 045 (1.9%) were exposed to Tdap in utero. There were no significant increased risks of adverse childhood outcomes and prenatal Tdap exposure; however, we observed inverse associations (adjusted incidence rate ratio [95% confidence interval]) with upper respiratory infections (0.94 [0.90–0.99]), gastrointestinal infections (0.85 [0.79–0.91]), and urgent and inpatient health service use (0.93 [0.91–0.96]).

CONCLUSIONS:

Exposure to Tdap vaccination in pregnancy was not associated with any increased risk of adverse health outcomes in early childhood, supporting the long-term safety of Tdap administration in pregnancy.

Racial and Ethnic Diversity in Studies Funded Under the Best Pharmaceuticals for Children Act

Pediatrics - Vie, 30/04/2021 - 10:01
BACKGROUND AND OBJECTIVES:

The Best Pharmaceuticals for Children Act (BPCA) incentivizes the study of on-patent medicines in children and mandates that the National Institutes of Health sponsor research on off-patent drugs important to pediatric therapeutics. Failing to enroll cohorts that reflect the pediatric population at large restricts the generalizability of such studies. In this investigation, we evaluate racial and ethnic minority representation among participants enrolled in BPCA-sponsored studies.

METHODS:

Data were obtained for all participants enrolled in 33 federally funded studies of drugs and devices conducted from 2008 through June 2020. Observed racial and ethnic distributions were compared with expected distributions by sampling Census data at the same geographic frequency as in the studies. Racial and ethnic enrollment was examined by demography, geography, study type, study burden, and expected bias. Standard descriptive statistics, 2, generalized linear models, and linear regression were applied.

RESULTS:

A total of 10 918 participants (51% male, 6.6 ± 8.2 years) were enrolled across 46 US states and 4 countries. Studies ranged from treatment outcome reviews to randomized, placebo-controlled trials. Minority enrollment was comparable to, or higher than, expected (+0.1% to +2.6%) for all groups except Asian Americans (–3.7%, P < .001). American Indian and Alaskan Native and multiracial enrollment significantly increased over the evaluation period (P < .01). There were no significant differences in racial distribution as a function of age or sex, although differences were observed on the basis of geography, study type, and study burden.

CONCLUSIONS AND RELEVANCE:

This study revealed no evidence of racial and ethnic bias in enrollment for pediatric studies conducted with funding from BPCA, fulfilling the legislation’s expectation to ensure adequate representation of all children.

Día Mundial contra la Meningitis 2021: 24 de abril

Durante los primeros meses de confinamiento a causa de la pandemia, los pediatras observaron un descenso temporal de las tasas de vacunación infantil que, a día de hoy, ya se ha recuperado en casi todas las vacunas incluidas en el calendario oficial financiado. Sin embargo, las vacunas no financiadas y las destinadas a proteger a los adolescentes y jóvenes frente a la enfermedad meningocócica todavía no han recuperado los niveles de cobertura prepandémicos.

Con motivo del Día Mundial contra la Meningitis, que se celebra mañana, día 24 de abril, los pediatras recuerdan la importancia de cumplir con el calendario de vacunación para prevenir esta grave enfermedad infecciosa.

El doctor Francisco Álvarez, coordinador del Comité Asesor de Vacunas (CAV) de la Asociación Española de Pediatría (AEP), apunta que “en comunidades autónomas como Cantabria, Canarias y Murcia todavía...

¿Es eficaz la alarma de enuresis?

Esparza Olcina MJ, Fraile Astorga G. ¿Es eficaz la alarma de enuresis? Evid Pediatr. 2021;17:19.

Corticoides antenatales, ¿son tan buenos como parece?

Ortega Páez E, Ruiz-Canela Cáceres J. Corticoides antenatales, ¿son tan buenos como parece? Evid Pediatr. 2021;17:20.

La AEP y la AEPap publican una guía inédita que recopila toda la evidencia acumulada en el último año sobre la COVID-19 en población infantil

AEPAP - Lun, 26/04/2021 - 14:49
Fuente:  AEP-AEPap Fecha de publicación:  26 de Abril de 2021

Los niños y adolescentes se contagian con menos frecuencia, a menudo presentan una menor carga viral y sufren síntomas más leves de la COVID-19. Esta es la impresión general que, durante los últimos meses, han trasladado los pediatras desde sus consultas. Un año después, además, estas afirmaciones pueden sustentarse en la información científica disponible sobre la enfermedad y cómo afecta a la edad pediátrica. Así se recoge en la guía Covid-19 en Pediatría: valoración crítica de la evidencia, a la que se puede acceder en los sitios web de AEP y AEPap, en la que se abordan todos los aspectos relacionados con la enfermedad en la edad pediátrica: la epidemiología, la clínica, las pruebas diagnósticas, el tratamiento, la prevención y también las vacunas.

Manejar la evidencia científica sobre COVID-19 y niños es una tarea compleja, por la gran cantidad de información disponible y la dificultad de poder conocer todos los aspectos de la pandemia y su repercusión en la infancia. Para responder a muchas de las preguntas que se plantean en la práctica clínica diaria, el grupo de pediatría basada en la evidencia de la Asociación Española de Pediatría (AEP) y la Asociación Española de Pediatría de Atención Primaria (AEPap), ha elaborado la citada guía de práctica clínica, documentada científicamente, que desarrolla contenidos relacionados la infección por SARS-CoV-2 en la infancia. Se trata de un documento inédito, de gran trascendencia en el ámbito asistencial en un momento de crisis sanitaria.

Puedes consultar nota de prensa completa en el archivo adjunto y acceder a la guía completa pinchando aquí.

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La AEPap se suma a la celebración del Día del Niño y la Niña el 26 de abril para homenajear el comportamiento de los menores durante la pandemia

AEPAP - Lun, 26/04/2021 - 14:41
Fuente:  Aepap Fecha de publicación:  26 de Abril de 2021 Archivos adjuntos:  Nota de prensa Compartir en...

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