Tag: paediatrics

Categories : NeurologyTags :

Protecting Newborns’ Brains During Rewarming Stage of Cooling Therapy

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Oxygen-deprived newborns who undergo hypothermia therapy have a higher risk of seizures and brain damage during the rewarming period, according to a new study. The finding, published online in JAMA Neurology, could lead to better ways to protect these vulnerable patients during an often overlooked yet critical period of hypothermia therapy.

“A wealth of evidence has shown that cooling babies who don’t receive enough oxygen during birth can improve their neurodevelopmental outcomes, but few studies have looked at events that occur as they are rewarmed to a normal body temperature,” said study leader Lina Chalak, MD, MSCS, Professor at UT Southwestern. “We’re showing that there’s a significantly elevated risk of seizures during the rewarming period, which typically go unnoticed and can cause long-term harm.”

Millions of newborns around the world are affected by neonatal hypoxic-ischaemic encephalopathy (HIE), brain damage initially caused by hypoxia during birth. Although the World Health Organization estimates that birth asphyxia is responsible for nearly a quarter of all neonatal deaths, those babies that survive oxygen deprivation are often left with neurological injuries, Dr Chalak explained.

To help improve outcomes, babies diagnosed with HIE are treated with hypothermia, using a cooling blanket that brings the body temperature down to as low as 33.5°C, said Dr. Chalak.

Studies initially showed that during cooling, babies with HIE commonly have symptomless seizures, which are neurological events that can further damage the brain, prompting the addition of electroencephalographic (EEG) monitoring to the hypothermia protocol. However, Dr Chalak explained, babies typically haven’t been monitored during the rewarming period, in which the temperature of the blanket is increased by 0.5°C every hour.

To better understand seizure risk during rewarming, Dr. Chalak and colleagues studied 120 babies who were enrolled in another study that compared two different cooling protocols, one longer and colder than the other. The babies in the study were also monitored with EEG to check for seizures both during the cooling and the rewarming phases of hypothermia.

When the researchers compared data from the last 12 hours of cooling and the first 12 hours of rewarming, they found that rewarming roughly tripled the odds of seizures. Additionally, babies who had seizures during rewarming, there was twice the risk of mortality or neurological disability by age 2, compared with those who didn’t have seizures during this period. This finding held true even after adjusting for differences in medical centers and the newborns’ HIE severity.

While it is not known how to prevent seizures from occurring in babies with HIE, treating seizures when they do occur can help prevent further brain damage, Dr Chalak said. Thus, monitoring during both cooling and rewarming can help protect the babies’ brains from further insults while they heal.

“This study is telling us that there’s an untapped opportunity to improve care for these babies during rewarming by making monitoring a standard part of the protocol,” said Dr Chalak.

Source: EurekAlert!

Categories : VaccinesTags :

Typhoid Vaccine Safe for Children in Sub-Saharan Africa

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Source: Pixabay CC0

A typhoid vaccine has proven to be safe and effective for children, which raises hope of fighting the disease in Sub-Saharan Africa, according to a new study conducted in Malawi.

There are more than 1.2 million typhoid cases and 18 703 deaths per year in the region, the researchers wrote. The World Health Organization (WHO) recommended the typhoid conjugate vaccine in 2018 for use in countries where the disease is endemic.

Clinical trials in Malawi showed that a single dose of typhoid conjugate vaccine (the only one licensed for children as young as six months) prevented typhoid in roughly 84% of 14 069 children aged 9 months to 12 years.

“It is a great result for Malawi and for Africa,” says study co-author Melita Gordon, professor of clinical infection, microbiology and immunology at the University of Liverpool and the Malawi-Liverpool-Wellcome Trust Clinical Research Programme.

“We were the only site chosen for the trial on the continent. The other sites were in Nepal and Bangladesh and the results were completely consistent across the three sites.”

Typhoid is endemic in Malawi, which records 400 to 500 cases per 100 000 every year, according to Queen Dube, chief of health services at Malawi’s Ministry of Health.

While typhoid is treatable, it can impair physical and cognitive development in children, affect school attendance and performance, limit productivity and reduce earning potential.

“The existing vaccine could not be used in very young children. In addition, the first line antibiotics have been found to be ineffective against multi-drug resistant strains,” Prof Gordon said. “With this vaccine, we can now expect a reduced typhoid burden.”

After 18 to 24 months of surveillance, the vaccine was found to be safe, with no serious adverse effects on children. It also worked equally well on pre-school aged children.

Prof Gordon explains that the study encountered challenges such as a few children moving out of the research sites within the study period, and COVID-19 forced them to suspend the study for two months.

“However, we eventually managed a good retention rate due to regular text messaging to parents and the hard work of health surveillance assistants in mobilisation activities,” she added.

The efficacy data of the typhoid conjugate vaccine is the first in Africa, according to Gordon, who hopes that other African countries will follow Malawi’s example in planning to roll out the vaccine.

Source: SciDev.Net

Categories : PaediatricsTags :

Gymnast Simone Biles Urges Paediatricians to Report Abuse

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Photo by National Cancer Institute on Unsplash

Renowned American gymnast Simone Biles has a combined total of more than 30 Olympic and world championship medals, not to mention several world records. But there’s more to her than that, she said during a plenary session at the American Academy of Pediatrics (AAP) virtual meeting.

“I’m a person at the end of the day and people respect that and understand that,” she said, noting that the positive support she received during the Japan summer games when she cited mental health concerns, and withdrew from several events, “made me feel whole as a person and an athlete.”

In her AAP keynote talk with AAP president Lee Savio Beers, MD, 24 year-old Biles explained that “Growing up, we’re told ‘Push through, Push through,’ but I knew at that point [during the 2020 Tokyo games, held in 2021], I really couldn’t…my safety and my health were on the line.”

She also acknowledged that “I honestly expected a lot more backlash than what I got [for withdrawing]. What I got was an overwhelming outpouring of support and love and understanding. That’s something I never expected…so that was quite a twist for me.”

Injury, overtraining, and pressure in competitive athletes can take a toll on athletes’ mental health, research has shown. Biles is among a number of high-profile athletes who have been outspoken about supporting the mental health of athletes. She has adopted a platform “to help advocate for mental health and support initiatives that provide education and assistance for children and young adults associated with adoption and foster care,” according to AAP News. Biles and her siblings were in and out of foster care before being adopted by their grandparents.

Biles also talked about Larry Nassar, DO, the former team doctor of the US women’s national gymnastics team who was jailed for sexual abuse and child pornography, and tampering with evidence.

In testimony before Congress in September, Biles said, “I blame Larry Nassar, and I also blame an entire system that enabled and perpetrated his abuse.” The gymnast singled out the FBI which she said “turned a blind eye” as Nassar molested young female patients, according to the Washington Post.

Biles offered this advice on how paediatricians can help abuse cases: “If you see something, speak up no matter what the consequences are because not only could you be helping that individual, but you could be helping multiple individuals too.”

Biles hopes more youth athletic programs will educate young children on spotting and reporting abuses. “From a very young age, a lot of us are thrown into these sports and we don’t know what’s right or wrong, unless somebody sits down and tells us, or we have adults looking after us, so I think handbooks can be a really good thing.”

Biles told the AAP audience that, before she became a gymnast, she wanted to be a paediatric nurse like her mother. “After making five World and two Olympic teams, the nursing career didn’t work out for me,” she said, “but…I’ve always wanted to help kids and I love kids…and I come from a family of [nurses].”

Source: MedPage Today

Categories : VaccinesTags :

World-first Malaria Vaccine Receives WHO Recommendation

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Mosquito
Photo by Егор Камелев on Unsplash

The World Health Organization (WHO) is recommending widespread use of a new malaria vaccine among children in sub-Saharan Africa and in other regions with moderate to high P. falciparum malaria transmission. The vaccine, known as the RTS,S/AS01 (RTS,S or Mosquirix), has been trialled in three countries in a pilot programme involving 800 000 children.

Though the vaccine only offers moderate protection against malaria, with 36% protection against malaria cases among children. One study estimated that even with realistic vaccine coverage, at a constraint of 30 million doses, 5.3 million cases and 24 000 deaths could be prevented among children under five, .

“This is a historic moment. The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”

This comes amid stagnation in progress in recent years against the deadly disease. In sub-Saharan Africa, malaria remains a primary cause of childhood illness and death. More than 260 000 African children under the age of five die from malaria annually.

“For centuries, malaria has stalked sub-Saharan Africa, causing immense personal suffering,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We have long hoped for an effective malaria vaccine and now for the first time ever, we have such a vaccine recommended for widespread use. Today’s recommendation offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease and we expect many more African children to be protected from malaria and grow into healthy adults.”

The WHO recommends that in the context of comprehensive malaria control the RTS,S malaria vaccine be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by the WHO. This vaccine should be provided in a schedule of 4 doses in children from 5 months of age for the reduction of malaria disease and burden.

The outcome of the pilots informed the recommendation based on data and insights generated from two years of vaccination in child health clinics in Ghana, Kenya and Malawi. Findings include:

  • Vaccine introduction is feasible, improves health and saves lives, with good and equitable coverage of RTS,S seen through routine immunization systems. This occurred even in the context of the COVID pandemic.
  • RTS,S enhances equity in access to malaria prevention.
  • Data from the pilot programme showed that more than two-thirds of children in the 3 countries who are not sleeping under a bednet are benefitting from the RTS,S vaccine.
  • Layering of tools results in over 90% of children benefitting from at least one preventive intervention (insecticide treated bednets or the malaria vaccine).
  • Strong safety profile: To date, more than 2.3 million doses of the vaccine have been administered in 3 African countries – the vaccine has a favorable safety profile.
  • No negative impact on uptake of bednets, other childhood vaccinations, or health seeking behavior for febrile illness. In areas where the vaccine has been introduced, there has been no decrease in the use of insecticide-treated nets, uptake of other childhood vaccinations or health seeking behavior for febrile illness.
  • High impact in real-life childhood vaccination settings: Significant reduction (30%) in deadly severe malaria, even when introduced in areas where insecticide-treated nets are widely used and there is good access to diagnosis and treatment.
  • Highly cost-effective: Modelling estimates that the vaccine is cost effective in areas of moderate to high malaria transmission.

Next steps for the WHO-recommended malaria vaccine will include funding decisions from the global health community for broader rollout, and country decision-making on whether to adopt the vaccine as part of national malaria control strategies.

The pilot programme was financed through collaboration between Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Unitaid.

Source: WHO

Categories : Allergies PaediatricsTags :

A Third of Children with Food Allergies are Bullied

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Using a multi-question assessment, researchers found that 1 in 3 children with food allergies reported food allergy-related bullying, indicating the problem is more widespread than commonly believed.

For the study, reported in the Journal of Pediatric Psychology, children were asked a simple ‘yes’ or ‘no’ question about food allergy-related bullying, to which 17% of kids indicated they’d been bullied, teased or harassed about their food allergy. But when asked to reply to a multi-item list of victimisation behaviours, that number jumped to 31%. Furthermore, Children’s National Hospital researchers found that only 12% of parents reported being aware of it. 

The reported bullying ranged from verbal teasing or criticism to more overt acts such as an allergen being waved in their face or intentionally put in their food. Researchers say identifying accurate assessment methods for this problem are critical so children can get the help they need.

“Food allergy-related bullying can have a negative impact on a child’s quality of life. By using a more comprehensive assessment, we found that children with food allergies were bullied more than originally reported and parents may be in the dark about it,” says Linda Herbert, Ph.D., director of the Psychosocial Clinical and Research Program in the Division of Allergy and Immunology at Children’s National and one of the study’s researcher.

“The results of this study demonstrate a need for greater food allergy education and awareness of food allergy-related bullying among communities and schools where food allergy-related bullying is most likely to occur,” Dr Herbert added.

The study examined food allergy-related bullying and evaluated parent-child disagreement and bullying assessment methods. It included 121 children and 121 primary caregivers who completed questionnaires. The children ranged in age from 9 to 15 years of age and had an allergy diagnosis of one or more of the top eight IgE-mediated food allergies: peanut, tree nut, cow’s milk, egg, wheat, soy, shellfish and fish.

Of the 41 youth who reported food allergy-related bullying:

  • 51% reported experiencing overt physical acts such as an allergen being waved in their face, thrown at them or intentionally put in their food.
  • 66% reported bullying experiences including non-physical overt victimisation acts including verbal teasing, remarks or criticisms about their allergy and verbal threats or intimidation.
  • Eight reported relational bullying, such as rumour spreading, people speaking behind their back and being intentionally ignored or excluded due to their food allergy.

The researchers also note that food allergy bullying perpetrators included, but were not limited to, classmates and other students, and bullying most commonly occurred at school.

The authors found that only 12% of parents reported that their child had been bullied because of their food allergy and of those, 93% said their child had reported the bullying to them. Some parents even reported being made fun of or teased themselves because of concerns about their child’s food allergy.

“It’s important to find ways for children to open up about food allergy-related bullying,” Dr Herbert said. “Asking additional specific questions about peer experiences during clinic appointments will hopefully get children and caregivers the help and support they need.

Source: Children’s National Hospital

Categories : PaediatricsTags :

Mothers’ Touch Synchronises Brainwaves and Heart With Babies

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A new study found that when mothers had close physical contact and played with their babies, their brain activity and heart rhythms synchronised.

Touch is fundamental to interpersonal communication, and was not until recently it was not known how affectionate touch and physical contact affect the brain activity and heart rhythms of mothers and babies. Developmental psychologists Trinh Nguyen and Stefanie Höhl from the University of Vienna have investigated this question in a study published in NeuroImage. 

Affectionate touch and bodily contact create social connections and can reduce stress. This effect has been observed in romantic couples, linked to a mutual alignment of brain activity and heart rhythms.  Since touch is a fundamental mode of communication between caregiver and infant, Trinh Nguyen, Stefanie Höhl and US colleagues sought to find out whether proximity and touch also contribute to the attunement of brain and heart rhythms between mother and baby.

In the new study, four to six-month-old babies played and watched videos together with their mothers. Functional near-infrared spectroscopy (fNIRS) was used to measure brain activity while electrocardiography (ECG) was used to simultaneously assess the heart rhythms of mother and baby. With fNIRS, changes in oxygen saturation are recorded in the outermost layer of the brain – here in particular in the frontal brain. Activation in this region is associated with mutual emotional attunement, attentiveness and self-regulation. These processes are particularly relevant for social interactions and develop during the first years.

The results showed that mother-baby pairs mutually adjusted their brain activity, especially when they touched each other. Mutual neural adjustment occurred when the mother held the baby close to her body and both watched a video together, and when they played together face-to-face and the mother lovingly touched the baby. The new study shows that touch plays a fundamental role in the early adaptation of brain activity between mothers and infants. An adaptation of heart rhythms was also shown when mother and baby played together, but it was independent of touch. In the case of the heartbeat, a mutual adaptation was particularly evident when babies signalled discomfort, which was presumably transmitted to the mothers.

The researchers next want to investigate how this mutual attunement in brain activity and heart rhythms affects long term development, particularly the later relationship between mother and child, as well as children’s language development.

Source: University of Vienna

Categories : PaediatricsTags :

Managing Children Who Swallowed Button Batteries

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Small, flat ‘button’ batteries are commonly used in many electronic devices, and increasing numbers of children are ingesting button batteries, US data shows. A practice article in the CMAJ’s (Canadian Medical Association Journal) “Five things to Know About…” series highlights some key points for managing button battery ingestion.

  • Injuries from battery ingestion are increasing according to US data. Between 1999 and 2019, the United States National Poison Data System reported a 66.7% increase in yearly ingestion of button batteries and a 10-fold increase in complications.
  • Battery size and type influence complications. Lithium batteries and those 20 mm or larger are more dangerous and can become lodged in the oesophagus, especially in children under six years of age.
  • Urgency of management depends on the location of the battery. Batteries in the oesophagus should be removed immediately by a health care provider to prevent tissue erosion. Urgent removal in a health care setting is advised in children under five years who swallow batteries 20 mm or larger. Otherwise, children should be monitored as outpatients to see if they pass the battery.
  • Honey or sucralfate should be administered after battery ingestion. Honey given to children older than one year by their caregiver (10mL every 10 minutes, up to six doses) before arrival to the hospital and sucralfate administered in hospitals can reduce tissue damage due to swallowed button batteries.
  • Monitor children for long-term complications. Serious complications can occur despite removal of the battery. Caregivers should monitor for symptoms, including gastrointestinal bleeding and vomiting, weeks to months after removal.

Source: Medical Xpress

Categories : PaediatricsTags :

Better Outcomes in Children Receiving Living Donor Liver Transplants

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A new study from Children’s Hospital Los Angeles pooled examining outcomes for 8000 paediatric patients across four continents revealed that children receiving living donor liver tissue for transplants have a far lower risk of serious complications.

With medical advances and the liver’s fantastic regeneration capacity, healthy individuals can donate a portion of their liver. While many countries now exclusively perform living donor liver transplants, in the United States, only 8% of liver transplants are from living donors, such as those done by Children’s Hospital Los Angeles.

“We have published large-scale studies showing the benefits of living donor liver transplantation in adults,” said Juliet Emamaullee MD, PhD, Research Director, Division of Abdominal Organ Transplantation, Children’s Hospital Los Angeles. “And we’ve observed the benefits in kids too. But we really wanted to evaluate it systematically, to provide evidence from around the world to back up what we’ve seen.”
The screened over 2500 studies, distilling relevant studies, compiling data from 8000 paediatric patients who had received either living or deceased donor livers. Results showed that a year after the procedure, children who had received living donor liver transplants had nearly twice the survival rate while the risk of organ rejection was nearly halved.

Living donor tissue for liver transplants has a number of benefits, which may explain some of the difference in outcomes. Patients may need to wait a shorter time as they do not need to wait for an appropriately sized deceased organ donor, a particular challenge for infants and toddlers, who make up over 50% of paediatric liver transplants. But the biggest advantage may be that patients can be healthier at the time of their procedure.

“When a liver becomes available, the basic rule is that it goes to the sickest child,” said Dr Kohli. “And that makes sense. We don’t want any child dying on the waiting list.” Unfortunately though, this means that children can be on the waiting list for years before getting a transplant. They can be very ill as a result at the time of transplant, possibly affecting how well a child does once they receive a new liver.

“These results are important and relevant for families,” said Dr Emamaullee. “Not all children are at a center that offers living donor liver transplant. Now we have the data to suggest that kids really should be offered this option. Families should have the chance to donate to their children rather than having to wait until an organ donor comes along.”

“As a paediatrician, I want children getting the best chance possible,” said Dr Kohli. “Studies like these inform our care. They show us how to do the best possible job for our kids.”

Source: Children’s Hospital Los Angeles

Categories : PaediatricsTags :

Early Developmental Intervention Dramatically Cuts Autism Risk

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A first-of-its-kind study has shown that parent-led therapy supporting the social development of babies with early autism signs greatly reduced the odds of a later autism. 

The research, led by CliniKids at the Telethon Kids Institute and published in JAMA Pediatrics, found that a diagnosis of autism at age three was only a third as likely in children who received the pre-emptive therapy (iBASIS-VIPP)compared to those who received usual treatment.

The findings were the first evidence showing that a pre-emptive intervention during infancy could result in such a significant improvement in children’s social development that they then fell below the threshold for an autism diagnosis.

Study leader Professor Andrew Whitehouse, Telethon Kids Institute, said: “The use of iBASIS-VIPP resulted in three times fewer diagnoses of autism at age three. No trial of a pre-emptive infant intervention, applied prior to diagnosis, has to date shown such an effect to impact diagnostic outcomes – until now.”

Professor Whitehouse said many therapies for autism tried to replace developmental differences with more ‘typical’ behaviours. Instead, iBASIS-VIPP attempts to work with each child’s unique differences, creating a social environment around the child helping them learn in a way optimised for them.

“The therapy uses video-feedback to help parents understand and appreciate the unique abilities of their baby, and to use these strengths as a foundation for future development,” said Professor Whitehouse. “By doing so, this therapy was able to support their later social engagement and other autistic-related behaviors such as sensory behaviors and repetitiveness, to the point that they were less likely meet the ‘deficit-focused’ diagnostic criteria for autism.”

“We also found increased parental sensitivity to their baby’s unique communication and an increase in parent-reported language development. Other general aspects of development were not affected.” The children falling below the diagnostic threshold still had developmental difficulties, but by working with each child’s unique differences, rather than trying to counter them, the therapy has effectively supported their development through the early childhood years.”

The four-year randomised clinical trial enrolled babies aged 9-14 months, all of whom having shown early behavioural signs of autism. Over five months, half received the video intervention, while a control group received current best practice treatment.

Eighty-nine children completed an assessment at the start of the study, at the end of the therapy period, and when they were two and three years of age. With the high prevalence of autism worldwide, the implications of the findings were enormous, said Professor Whitehouse. Around 2% of all children in Australia have an autism diagnosis.
“Autism is not typically diagnosed until three years of age, however, interventions commencing during the first two years of life, when the first signs of development difference are observed and the brain is rapidly developing, may lead to even greater impact on developmental outcomes in later childhood,” Professor Whitehouse said.

Professor Whitehouse said that a follow-up of study participants in later childhood, when autism behaviours may be more apparent, would be critical to determining the longer-term significance of the video intervention.

Source: Telethon Kids Institute

Categories : Cancer General InterestTags :

Childhood Cancer Survivor Set to Break Barriers in Space

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Hayley Arcenaux, seated furthest left, is the Medical Officer for the Inspiration4 flight. She is a survivor of childhood cancer and works as a physician assistant at St Jude’s Children’s Hospital, for which the flight is raising funds and awareness.

The first chartered spaceflight into orbit, scheduled for launch on September 15, will have a crewmember who is both a childhood cancer survivor and physician assistant as part of the crew. 

The three-day long mission aboard a SpaceX Dragon spacecraft was chartered by entrepreneur Jared Isaacman. Dubbed Inspiration4, the flight is in fact also raising money and awareness for St Jude Children’s Hospital, which was given two of the four seats on the spacecraft. The funds raised for the hospital are believed to have exceeded the cost of the flight.

Isaacman offered the first seat to 29 year-old Hayley Arceneux, who works as a physician assistant at St Jude’s and will be the medical officer for the flight. She was also a patient at the very same hospital. At age 10, she was diagnosed with osteosarcoma, the most common primary paediatric bone malignancy. In addition to a dozen rounds of chemotherapy, she had a limb-sparing operation which replaced her knee and inserted a titanium reinforcing rod in her femur. This will make her the first person with a prosthetic in space. Such a medical history would have immediately disqualified her for astronaut selection with any of the government-run space agencies like NASA.

In an interview with The Cut, she described her work as a physician assistant at St Jude’s: “I work inpatient… with leukaemia and lymphoma patients specifically. The majority of them received their cancer diagnoses pretty recently, so a big part of  my role is helping to educate and support families through the beginning of treatment. I help them understand, What is cancer? What does the treatment process look like? What should I expect?

“We also manage the kids while they are in treatment. If they get an infection or if they get a fever, we take that really seriously. So I’ll manage their IV antibiotics or other treatment-related complications that can occur.. I check on patients, assess labs, order tests, update families on the results, order meds for outpatients. It is a lot of coordinating and educating. It’s hard, but it’s the greatest job in the world.”

St Jude’s held an auction for the other crew seat that Isaacman offered. The winning bidder declined the seat and gifted it to data engineer Christopher Sembroski. The final seat was won in an entrepreneurial competition by Dr Sian Proctor, a geologist and pilot who narrowly missed out on being chosen as a NASA astronaut. 

Speaking about the auction, Richard C. Shadyac Jr, president and chief executive of American Lebanese Syrian Associated Charities, which raised fund for St Jude’s, said: “The impact of the Inspiration4 mission has been immeasurable, serving as an incredible platform to educate and engage millions in the movement to find cures and deliver care for childhood cancer and other catastrophic diseases through accelerated research and treatment. The auction is a critical component of the overall campaign as it enables us to reach new audiences and supporters as we work to fulfill our mission.”

So far, $100 million has been raised for St Jude’s.

While in space, the crew will conduct experiments such as examining fluid shifts in zero gravity using ultrasound, as well as other medical experiments including measuring blood glucose levels — in order to help expand space travel to those with diabetes.

A documentary has been made of the crew’s training, and is available to stream on Netflix.