Category: Paediatrics

Categories : Paediatrics Pain ManagementTags :

Many Youths Continue to Take Post-surgery Opioids for Months

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A multi-institutional study found that 1 in 6 youths fill an opioid prescription prior to surgery, and 3% of patients were still filling opioid prescriptions three to six months after surgery, indicating persistent opioid use and possible opioid dependence. The study underscores that more guidance is needed to steer clinicians away from prescribing opioids when they are not likely to be needed and recognising patient-specific risk factors for persistent opioid use. The findings were recently published by the journal JAMA Network Open.

Approximately 1.4 million youths undergo surgery in the United States each year, and there is concern that they remain highly susceptible to opioid-related harms. While significant strides have been made in reducing prescriptions for opioids, it is important for clinicians to consider adolescent patients who may be at risk for developing an addiction to opioids due to a range of genetic, neurobiological and social vulnerabilities.  Prior to this study, little was known about risks for persistent opioid use among adolescents and the timing of initial and refill of opioid prescriptions.

“While prior analyses have shown a decline in opioid prescriptions in general, following surgical opioid prescribing recommendations remains a critical issue, especially for adolescents who are more inclined to engage in risk-taking behaviour,” said first study author Tori N. Sutherland, MD, MPH, an attending anaesthesiologist at Children’s Hospital of Philadelphia. “Our study found that these patients are still filling prescriptions that are either not recommended or are in excess of what they may need. They are also filling prescriptions up to two weeks before surgeries not associated with severe pre-operative pain, putting young patients at risk for developing persistent use throughout their lives as they transition into adulthood.”

Using a national insurance database of privately insured patients, the researchers looked at patients between 11 and 20 who underwent 22 surgical procedures that were either common or associated with severe postoperative pain requiring opioids for initial pain management. The patients had not taken opioids prior to their surgeries.

Of more than 100 000 patients, 46 951 (46.9%) patients filled a prescription for opioids, and 7587 (16.2%) of those had a prescription filled up to two weeks prior to surgery for procedures unlikely to be associated with severe preoperative pain. In this group, 6467 (13.8%) patients filled a second prescription for opioids, and 1216 (3.0%) patients filled prescriptions between 91 and 180 days after their surgical procedure.

One of the most important findings was that severe pain following a surgical procedure was not associated with persistent opioid use.  However, patients with pre-existing chronic pain, who often underwent procedures associated with mild or moderate pain that could be managed with non-opioid medications, had increased odds of developing persistent opioid use.

“We believe this study underscores the need for establishing a standard of care for patients who undergo these procedures,” said senior study author Scott Hadland, MD, MPH, Chief of Adolescent and Young Adult Medicine at Mass General for Children and Associate Professor of Pediatrics at Harvard Medical School. “Effective pain management is critical and sometimes require opioids, but clinicians also need to make sure they are doing everything possible not to further contribute to the opioid addiction crisis, particularly with young patients.”

Source: Children’s Hospital of Philadelphia

Categories : PaediatricsTags :

Does More Postnatal Oxygen for Very Premature Babies Improve Survival?

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New evidence shows higher oxygen concentrations may help prevent deaths of preterm babies

Photo by Hush Naidoo on Unsplash

Giving very premature babies high concentrations of oxygen soon after birth may reduce the risk of death by 50%, compared to lower levels of oxygen says new research led by University of Sydney researchers.

Premature babies sometimes need assisted breathing because their lungs haven’t finished developing, so doctors may give them supplemental oxygen via a breathing mask or breathing tube.

The study, published in JAMA Pediatrics, examined clinical trial data and outcomes of over one thousand premature babies who were given different oxygen concentrations. This included low concentrations of oxygen (~30%), intermediate (~50–65%) or high (~90%).

The study found for babies born prematurely, at less than 32 weeks starting resuscitation with high concentrations of oxygen (90% or greater), could increase chances of survival compared to low levels (21–30%).

When a doctor provides oxygen to babies that need help breathing, there is a device that regulates how oxygen is mixed together to reach the desired concentration. The researchers believe higher initial levels of oxygen may jump-start independent breathing, but more research is required to explore the underlying cause for this effect.

The researchers emphasise that additional large studies will be important to confirm this finding, and that even when starting with high oxygen, it needs to be adjusted to lower levels quickly to avoid hyperoxia (oxygen poisoning).

How the oxygen is delivered during the first 10 minutes of the infant’s life is critical. Doctors may give the baby high levels of oxygen at the start but then monitor vital signs and continually adjust the oxygen to avoid over or under exposure.

If confirmed in future studies, the findings challenge current international recommendations that suggest giving preterm babies the same amount of oxygen as babies born at term, 21%–30% oxygen (room air), rather than extra oxygen.

This study also demonstrates that there may not be a one-size-fits-all approach, and babies born prematurely may have different needs than babies born at term.

Worldwide, over 13 million babies are born prematurely each year, and close to 1 million die shortly after birth.

“Ensuring very premature infants get the right treatment from the beginning sets them up to lead healthy lives. There is no better time to intervene than immediately after birth,” said lead author Dr James Sotiropoulos from the University of Sydney’s NHMRC Clinical Trials Centre.

“The goal is to find the right balance – how do we give enough oxygen to prevent death and disability, but not damage vital organs.”

“Whilst promising and potentially practice-changing, these findings will need to be confirmed in future larger studies.”

Historically, oxygen with a 100% concentration was used to resuscitate all newborn infants. But due to studies that found high concentrations of oxygen over time can lead to hyperoxia and subsequent organ damage, in 2010 it prompted changes in international treatment recommendations for the use of blended oxygen (starting with low oxygen) for preterm infants.

Hyperoxia still a danger

However, researchers say the change was mainly based on evidence for full-term infants, who have fully developed lungs and who are often not as sick as premature infants. To date, there is little conclusive evidence to guide best practice for premature infants. The researchers emphasise the findings should not minimise the dangers of hyperoxia.

“The debate around exactly how much oxygen is best for extremely premature babies is still ongoing but, ultimately, everyone has the same shared goal of determining the best treatment for newborns,” said Dr Anna Lene Seidler from the NHMRC Clinical Trials Centre.

“Our findings, together with all the other research that is currently happening, may help the most vulnerable preterm infants have the best chance of survival.”

“We are very lucky to work with a highly collaborative international group on this question, some of whom have been studying it for decades. The group’s diverse expertise and experience is a major strength of this work,” said Dr Sotiropoulos.

Source: University of Sydney

Categories : PaediatricsTags :

Anaemia Reduction Efforts to Improve School Attendance may be Ineffective

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Photo by Mary Taylor on Pexels

In low- and middle-income countries, anaemia reduction efforts are often touted as a way to improve educational outcomes and reduce poverty. A new study, published in Communications Medicine, evaluates the relationship between anaemia and school attendance in India, debunking earlier research that could have misguided policy interventions.

Kumar’s research explores the intersection of global health and poverty reduction. His latest work evaluates the relationship between anaemia and school attendance in India.

The study investigated whether there was a link between anaemia and school attendance in more than 250 000 adolescents ages 15 to 18. Earlier observational studies have shown a link between anaemia and attendance, even after accounting for variables such as gender and household wealth, according to Kumar. But the new study, which applied more rigorous econometric statistical analysis, did not find such a link, he said.

“Most previous research on this topic has used conventional study designs or focused on small geographical areas, which limits its policy relevance,” said study co-author Santosh Kumar, associate professor of development and global health economics at the University of Notre Dame, is co-author of the study. “Earlier estimates may have been distorted by unobserved household factors related to both anaemia and school attendance. So in this study, we focused on the relationship between anaemia and attendance among adolescents who were living in the same household.

“Ultimately,” Kumar said, “we found that the link between anaemia and schooling is more muted than previously suggested by studies that did not consider household-level factors.”

The findings have important implications for policymakers seeking to improve education in low- and middle-income countries like India, Kumar said. India has widespread school attendance issues and struggles with health conditions such as anaemia caused by iron deficiency, particularly in children and adolescents. The country has pushed to improve educational outcomes, in keeping with the United Nations’ Sustainable Development Goals, Kumar said. But to achieve that, he said, more research is needed to pinpoint an evidence-based intervention.

The latest study builds on an earlier one in which Kumar and fellow researchers helped evaluate the results of an iron fortification school lunch program for students ages 7 and 8 in India. That study showed that fortification reduced anaemia but did not affect students’ performance in school. A forthcoming study, set to launch in summer 2024, will look at iron fortification for children ages 3 to 5. The research hypothesis is that an early-age nutritional intervention among preschoolers would make a significant impact on physical and cognitive development.

“Our findings have implications for policymakers who want to improve educational outcomes and reduce poverty,” Kumar said. “Effective policies are based on evidence. We need more rigorous statistical analysis to examine the causal relationship between anaemia and education.

“This work ties into my larger research agenda, which explores the intersection of global health and poverty reduction. I want to use my academic research to support human dignity by helping to identify evidence-based health policies that will make a tangible difference in people’s lives.”

Source: University of Notre Dame

Categories : General Interest PaediatricsTags :

Vodacom and Smile Foundation Celebrate a Legacy of Smiles in Children’s Lives

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Photo by Amina Filkins

Since 2007, Vodacom Foundation has proudly partnered with the Smile Foundation to support Smile Week, an initiative that provides life-changing reconstructive surgery to children with treatable facial anomalies. Smile Week not only addresses the physical challenges faced by these young people but also alleviates the emotional distress associated with feeling different, enabling them to embrace their lives to the fullest.

“As we mark Vodacom’s 30th anniversary this year, it’s a good time to reflect on the dramatic change in the countries in which we operate, in terms of bringing connectivity to people. What we are also particularly proud of is how we have brought purpose to society and how we have made a meaningful difference in people’s lives,” says Shameel Joosub, Vodacom Group CEO.

Orofacial cleft lip/palate (CLP) remains in the top five of South Africa’s most common congenital disorders. Smile Week sees surgeons, their surgical teams, and other medical professionals around the country dedicate their time and expertise to perform reconstructive surgery on children whose families would not otherwise have been able to afford it.

“Families invariably find their way to state hospital facilities, where there are very capable and competent surgeons and medical professionals, but budget constraints have often meant elective surgery has to wait before more critical cases are addressed,” says Marc Lubner, founder and executive chairman of the Smile Foundation.

To date, the partnership between Vodacom and the Smile Foundation has benefited 600 children, with the shared goal of enhancing their overall quality of life and well-being.

“I want to thank all the medical professionals for being partners with us since 2007, and for giving their time and commitment to make this a reality. Vodacom’s support of Smile Week reaffirms our commitment as a company to use our capabilities collaboratively for a brighter, more inclusive future,” says Joosub.

In this video, parents and Smile Week recipients share their experiences and the importance of this initiative in transforming lives.

Click here to access the high-impact video

Categories : Neurology PaediatricsTags :

Poor Sleep, Social Media Use and Adolescents’ Developing Brains

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A new study to be presented at the SLEEP 2024 annual meeting found a distinct relationship between sleep duration, social media usage, and brain activation across brain regions that are key for executive control and reward processing.

Results show a correlation between shorter sleep duration and greater social media usage in teens. The analysis points to involvement of areas within the frontolimbic brain regions, such as the inferior and middle frontal gyri, in these relationships. The inferior frontal gyrus, key in inhibitory control, may play a crucial role in how adolescents regulate their engagement with rewarding stimuli such as social media. The middle frontal gyrus, involved in executive functions and critical in assessing and responding to rewards, is essential in managing decisions related to the balancing of immediate rewards from social media with other priorities like sleep. These results suggest a nuanced interaction between specific brain regions during adolescence and their influence on behaviour and sleep in the context of digital media usage.

“As these young brains undergo significant changes, our findings suggest that poor sleep and high social media engagement could potentially alter neural reward sensitivity,” said Orsolya Kiss, who has a doctorate in cognitive psychology and is a research scientist at SRI International. “This intricate interplay shows that both digital engagement and sleep quality significantly influence brain activity, with clear implications for adolescent brain development.”

This study involved data from 6516 adolescents, aged 10–14 years, from the Adolescent Brain Cognitive Development Study. Participants answered questionnaires about sleep duration and recreational social media use. Brain activities were analysed from functional MRI scans during the monetary incentive delay task, targeting regions associated with reward processing. The study used three different sets of models and switched predictors and outcomes each time. Results were adjusted for age, COVID-19 pandemic timing, and socio-demographic characteristics.

Kiss noted that these results provide new insights into how two significant aspects of modern adolescent life, social media usage and sleep duration, interact and impact brain development.

“Understanding the specific brain regions involved in these interactions helps us identify potential risks and benefits associated with digital engagement and sleep habits,” Kiss said. “This knowledge is especially important as it could guide the development of more precise, evidence-based interventions aimed at promoting healthier habits.”

The American Academy of Sleep Medicine recommends that teenagers 13 to 18 years of age should sleep 8 to 10 hours on a regular basis. The AASM also encourages adolescents to disconnect from all electronic devices at least 30 minutes to an hour before bedtime.

Source: American Academy of Sleep Medicine

Categories : Obstetrics & Gynaecology PaediatricsTags :

Health and Economic Benefits of Breastfeeding Quantified

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Among half a million Scottish infants, those exclusively breastfed were less likely to use healthcare services and incurred lower costs to the healthcare system

Photo by Wendy Wei

Breastmilk can promote equitable child health and save healthcare costs by reducing childhood illnesses and healthcare utilisation in the early years, according to a new study published this week in the open-access journal PLOS ONE by Tomi Ajetunmobi of the Glasgow Centre for Population Health, Scotland, and colleagues.

Breastfeeding has previously been found to promote development and prevent disease among infants. In Scotland – as well as other developed countries – low rates of breastfeeding in more economically deprived areas are thought to contribute to inequalities in early childhood health. However, government policies to promote child health have made little progress and more evidence on the effectiveness of interventions may be needed.

In the new study, researchers used administrative datasets on 502,948 babies born in Scotland between 1997 and 2009. Data were available on whether or not infants were breastfed during the first 6-8 weeks, the occurrence of ten common childhood conditions from birth to 27 months, and the details of hospital admissions, primary care consultations and prescriptions.

Among all infants included in the study, 27% were exclusively breastfed, 9% mixed fed and 64% formula fed during the first 6-8 weeks of life. The rates of exclusively breastfed infants ranged from 45% in the least deprived areas to 13% in the most deprived areas.

The researchers found that, within each quintile of deprivation, exclusively breastfed infants used fewer healthcare services and incurred lower costs compared to infants fed any formula milk. On average, breastfed infants had lower average costs of hospital care per admission (£42) compared to formula-fed infants (£79) in the first six months of life and fewer GP consultations (1.72, 95% CI: 1.66 – 1.79) than formula-fed infants (1.92 95% CI: 1.88 – 1.94). At least £10 million of healthcare costs could have been avoided if all formula-fed infants had instead been exclusively breastfed for the first 6-8 weeks of life, the researchers calculated.

The authors conclude that breastfeeding has a significant health and economic benefit and that increasing breastfeeding rates in the most deprived areas could contribute to the narrowing of inequalities in the early years.

Provided by PLOS

Categories : Paediatrics Substance UseTags :

THC Lingers in Breastmilk with no Clear Peak or Decline

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The psychoactive component THC of cannabis showed up in breastmilk in a study published in the journal Breastfeeding Medicine. Unlike alcohol, when THC was detected in milk there was no consistent time when its concentration peaked and started to decline.

Importantly, the researchers discovered that the amount of THC they detected in milk was low – they estimated that infants received an average of 0.07mg of THC per day. For comparison, a common low-dose edible contains 2mg of THC. The research team stressed that it is unknown whether this amount has any impact on the infant.

“Breastfeeding parents need to be aware that if they use cannabis, their infants are likely consuming cannabinoids via the milk they produce, and we do not know whether this has any effect on the developing infant,” said Courtney Meehan, a WSU biological anthropologist who led the project and is the study’s corresponding author.

Since other research has shown that cannabis is one of the most widely used drugs during breastfeeding, the researchers aimed to uncover how long cannabinoids, like THC, persisted in breastmilk.

For this Washington State University-led study, the researchers analysed milk donated by 20 breastfeeding mothers who used cannabis. The participants, who all had infants younger than six months, provided detailed reports on their cannabis use. They collected milk after abstaining from using cannabis for at least 12 hours and then at regular intervals after use. All of this was done in their own homes, at a time of their choosing and with cannabis they purchased themselves.

The researchers then analyzed the milk for cannabinoids. They found that the milk produced by these women always had detectable amounts of THC, even when the mothers had abstained for 12 hours.

“Human milk has compounds called lipids, and cannabinoids are lipophilic, meaning they dissolve in those lipids. This may mean that cannabinoids like THC tend to accumulate in milk – and potentially in infants who drink it,” said Meehan.

The research also revealed that people had different peak THC concentrations in their milk. For participants who used cannabis only one time during the study, cannabinoids peaked approximately 30 minutes to 2.5 hours after use and then started to decline. For participants who used multiple times during the study, the majority showed a continual increase in concentrations across the day.

“There was such a range. If you’re trying to avoid breastfeeding when the concentration of THC peaks, you’re not going to know when THC is at its peak in the milk,” said lead author Elizabeth Holdsworth, who worked on this study while a WSU post-doctoral researcher and is now on the faculty of The Ohio State University.

A related qualitative study by the research team revealed that many breastfeeding moms are using cannabis for therapeutic purposes: for the management of anxiety, other mental health issues or chronic pain. The mothers often chose cannabis over using other medications because they felt it was safer.

“Our results suggest that mothers who use cannabis are being thoughtful in their decisions,” said co-author Shelley McGuire, a University of Idaho professor who studies maternal-infant nutrition. “These women were mindful about their choices. This is far from a random lifestyle choice.”

While in most cases, the women were using cannabis as alternative treatment for a variety of conditions, McGuire pointed out that there is no evidence yet whether it is safer or more harmful. In fact, scientists know almost nothing about how many commonly used drugs may impact breastfeeding babies, partly because women, especially those who are breastfeeding, have historically been left out of clinical trials on medicines.

“This is an area that needs substantial, rigorous research for moms to know what’s best,” McGuire said.

Some research has been done regarding alcohol with guidelines for new mothers to wait at least two hours after consuming alcohol before breastfeeding. Nothing similar has been developed for cannabis, which has been growing in popularity.

The collaborative research team is currently working to address some of that knowledge gap with further research on cannabis use in breastfeeding moms, holistic composition of the milk they produce and its effects on infant development.

Source: Washington State University

Categories : Hospitals PaediatricsTags :

Refurbished School for Paediatric Patients Bridges Critical Learning Gaps

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April 16 2024 – The Chris Hani Baragwanath Hospital School officially opened in its new location today, marking a key milestone in the partnership between Wits University and the academic hospital. The school caters for all learners in need of longer-term and chronic treatment for various paediatric conditions. Learners between Grades R and 12 are taught.  

“Sick children have multiple needs, and it’s our duty to ensure that they don’t miss out on any schooling. Everyone deserves the right to be educated and to contribute meaningfully to their communities as adults,” said Professor Shabir Madhi, Dean of the Wits Faculty of Health Sciences. 

Professor Madhi noted that the previous school building will be used as a campus for medical students and to grow the university’s teaching and learning footprint at Chris Hani Baragwanath Academic Hospital.  

The school district representative for Johannesburg Central, Ronica Ramdath, said that often sick children forfeit their education, which can be mitigated through the correct teaching approach and through supportive facilities. “When I first came to the school some years back, I was amazed at the teachers’ dedication. I remember seeing a teacher load all their educational resources in a bag and walk to the paediatric ward to teach sick children. Today, these children all benefit from such support,” she said.  

The Wits Faculty of Health Sciences heads of schools were present, together with hospital and teaching representatives.  

Meanwhile, Professor Madhi said that the university’s wifi is available at Chris Hani Baragwanath Hospital, underpinning Wits’ commitment to invest in a world-class academic hospital facility. “We are very proud of our footprint at the hospital and hope to continue to add value through research and clinical work,” he said. 

Source: University of the Witwatersrand – Faculty of Health Sciences

Categories : PaediatricsTags :

Bacteria Behind Meningitis in Babies Explains Resurgence

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A milestone study led by University of Queensland researchers has identified the main types of E. coli bacteria that cause neonatal meningitis, and revealed why some infections recur despite being treated with antibiotics.

The study, published in eLife, discovered that about 50% of neonatal meningitis infections are caused by two types of E. coli.

“E. coli is the most common cause of meningitis in babies born pre-term, but knowing which types allows us to test for those strains and treat them appropriately,” said Professor Mark Schembri, who led the study along with Dr Nhu Nguyen and Associate Professor Adam Irwin.

The study was the largest of its type, examining the genomes of 58 different E. coli bacteria across four continents and using samples collected over 46 years. It found that two types of the bacteria were responsible for the majority of neonatal infections.

Rapid diagnosis and monitoring are key

Associate Professor Irwin, who is also a paediatric infectious disease specialist at the Queensland Children’s Hospital, said speed is of the essence to prevent lasting damage.

“While antibiotics can be effective in treating the infection, this relies on rapid diagnosis. Also, antibiotics don’t always eliminate the bacteria – some of the babies we tracked showed signs of a complete recovery before suffering repeated invasive E. coli infections,” he said.

The researchers discovered the bacteria causing subsequent infections were the same as in the initial infection.

“It’s most likely that bacteria hide out in the intestinal microbiome,” Professor Schembri said. “This tells us we need to keep monitoring these babies after their first infection, as they are at a high risk of subsequent infection.”

Professor Schembri said the E. coli that can lead to meningitis also cause urinary tract infections and colonise the intestinal tract. “There is something about these types of E. coli that equips them to cause both infections,” he said.

“Our next step is to examine the bacteria’s pathway from the intestinal tract or urinary tract into the bloodstream, and then to the brain, so we can consider new ways to stop them.”

Source: University of Queensland

Categories : COVID PaediatricsTags :

Specific Nasal Cells Protect against COVID in Children

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Legend of spirals: This image highlights the appearance of nasal cultures from older adults, revealing distinct spiral-like patterns that were absent in cultures grown from children. Credit: University College London

Important differences in how the nasal cells of young and elderly people respond to the SARS-CoV-2 virus, could explain why children typically experience milder COVID symptoms, finds a new study led by researchers at UCL and the Wellcome Sanger Institute.

The study, published in Nature Microbiology, focused on the early effects of SARS-CoV-2 infection on the cells first targeted by the viruses, the human nasal epithelial cells (NECs).

These cells were donated from healthy participants, including children (0–11 years), adults (30–50 years) and, for the first time, the elderly (over 70 years).

The cells were then cultured to regrow into the different types of nasal cells. Using single-cell RNA sequencing techniques that enable scientists to identify the unique genetic networks and functions of thousands of individual cells, the team identified 24 distinct epithelial cell types. Cultures from each age group were then either mock-infected or infected with SARS-CoV-2.

After three days, the NECs of children responded quickly to SARS-CoV-2 by increasing interferon (the first line of anti-viral defence), restricting viral replication. However, this early anti-viral effect became less pronounced with age.

The researchers also found that NECs from elderly individuals not only produced more infectious virus particles, but also experienced increased cell shedding and damage.

The strong antiviral response in the NECs of children could explain why younger people typically experience milder symptoms. In contrast, the increased damage and higher viral replication found in NECs from elderly individuals could be linked to the greater severity of disease observed in older adults.

Project lead, Dr Claire Smith (Associate Professor at UCL Great Ormond Street Institute of Child Health), said: “Our research reveals how the type of cells we have in our nose changes with age, and how this affects our ability to combat SARS-CoV-2 infection. This could be crucial in developing effective anti-viral treatments tailored to different age groups, especially for the elderly who are at higher risk of severe COVID-19.”

Co-Senior author, Dr Kerstin Meyer (Wellcome Sanger Institute), said: “By carrying out SARS-CoV-2 infections of epithelial cells in vitro and studying the responses with single cell sequencing, we get a much more detailed understanding of the viral infection kinetics and see big differences in the innate immune response between cell types.”

Children infected with SARS-CoV-2 rarely progress to respiratory failure, but the risk of mortality in infected people over the age of 85 remains high, despite vaccination and improving treatment options.

The research underscores the importance of considering age as a critical factor in both research and treatment of infectious diseases.

Co-senior author, Dr Marko Nikolic (UCL Division of Medicine), said: “It is fascinating that when we take away immune cells from nasal samples, and are only left with nasal epithelial cells grown in a dish, we are still able to identify age-specific differences in our body’s response to the SARS-CoV-2 between the young and elderly to explain why children are generally protected from severe COVID-19.”

Dr Smith added: “Understanding the cellular differences at the initiation of infection is just the beginning. We now hope to investigate the long-term implications of these cellular changes and test therapeutic interventions using our unique cell culture model. This ‘gold-standard’ system is only possible with the support of our funders and the willingness of participants to provide their samples.”

The team suggest that future research should consider how ageing impacts the body’s response to other viral infections.

Source: University College London