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Aim Methods Results Conclusion Paediatricians using instant messaging phone apps for informal medical discussions poses ethical and legal risks. We filled a gap in the research, by assessing the use of apps and the possible risks.A national, cross‐sectional, questionnaire study was conducted in Israel from 11 August to 20 November 2019. The frequency of informal discussions, clinical details and recommendations were compared to the paediatricians' expertise and work settings. The discussions included work and private phones, consultation with the parents of patients and advice to the paediatricians' friends and families.The 305 paediatricians who responded had a median age of 37 (range 27–74) years: 42% were residents and 58% were specialists. The majority (99%) had carried out informal discussions using a messaging app in the last week and 65% had used them for 1–5 discussions. Specialists were more likely to use apps for more than 10 discussions per week than residents (24% vs. 5%, p < 0.001) and recommend treatment via apps (35% vs. 22%, p < 0.001). A third failed to provide disclaimers about the risks of app‐based discussions.Using instant messaging apps for informal medical discussions was common, but ethical and legal aspects were not always fully considered. [ABSTRACT FROM AUTHOR]

Aim: Sudden unexpected postnatal collapse is a life‐threatening event and may occur in any newborn infant. Safe skin‐to‐skin contact, and awareness of sudden unexpected postnatal collapse are key to its prevention. The aim of this study was to survey the presence of skin‐to‐skin contact and/or sudden unexpected postnatal collapse protocols in the 70 perinatal centres in the Netherlands. Methods: We performed a survey among Dutch paediatricians to examine the safe skin‐to‐skin contact and sudden unexpected postnatal collapse protocols. Results: We received data from 59/70 (85%) perinatal centres. At least one case of sudden unexpected postnatal collapse was reported in 35/59 (59%) of these centres. Nearly half the centres had safe skin‐to‐skin contact and/or sudden unexpected postnatal collapse protocols. Ultimately, 16 protocols were available for analysis. They showed considerable differences in the type of perinatal care provided. Most protocols lacked recently published insights on safe skin‐to‐skin contact. Besides, protocols failed to incorporate awareness of and knowledge on how to prevent sudden unexpected postnatal collapse. Conclusion: This study underlines the importance of drawing up uniform, multidisciplinary guidelines containing recommendations for the prevention of sudden unexpected postnatal collapse in the Netherlands. [ABSTRACT FROM AUTHOR]

The article discusses the ethical responsibility of healthcare professionals, specifically pediatricians, to communicate the risks of air pollution to children and their families. It highlights the detrimental effects of air pollution on children's health, including non-communicable diseases and mortality. The article argues that withholding this information from families is paternalistic and goes against children's rights. It emphasizes the importance of engaging with children and families, advocating for actions that protect children's health, and working towards improving air quality in communities. The article also mentions the broader negative effects of climate change on children and the need for medical organizations to be transparent with patients. [Extracted from the article]

Clemens Freiherr von Pirquet, an innovative paediatrician, basic researcher, and teacher, made significant contributions to the fields of paediatrics, immunology, bacteriology, and allergology. He was born in 1874 in Vienna, Austria, and began his medical studies at the University of Vienna. Pirquet's research on infectious diseases and allergies led to the development of the smallpox vaccine and the identification of hypersensitivity reactions. Despite being nominated for the Nobel Prize multiple times, Pirquet was never awarded the prize. He received other honors and held important positions in academia, but tragically, he and his wife died by suicide in 1929. [Extracted from the article]

Aim: Hypernatraemia typically reflects dehydration, yet in rare instances may be caused by salt poisoning. Identifying these rare cases is a difficult challenge. Making the diagnosis of salt poisoning can have severe consequences, such as the removal of the child from its home or even prison sentences for the implicated carer. It is therefore imperative to get the diagnosis right. Guidelines for the assessment of hypernatraemia emphasise the importance of the fractional excretion of sodium to distinguish between dehydration and salt poisoning, but no generally accepted cut‐off value exists. Opinions about the diagnosis of salt poisoning in some cases consequently may differ. Here, we aim to highlight the challenges and stimulate discussion on how to improve the tools for the assessment of hypernatraemia. Methods: Report of a case of unexplained hypernatraemia in which the treating paediatrician raised the suspicion of salt poisoning. Results: Two consulted experts made opposing judgements about the aetiology of the observed hypernatraemia. Conclusion: Clear diagnostic criteria for the diagnosis of salt poisoning are lacking and more data are needed for their establishment. Without this, victims may experience further harm and carers are at risk of devastating, yet potentially erroneous accusations. [ABSTRACT FROM AUTHOR]

This article discusses the life and achievements of Madeleine Brès, a French pediatrician who paved the way for female doctors in France during the late 19th century. Brès faced societal discrimination and had to overcome numerous obstacles to pursue her dream of becoming a doctor. She specialized in mother and child relationships and hygiene, focusing on the benefits of breastfeeding. Brès also established a free daycare center and authored books on childcare and pediatric nursing. Despite her contributions, she faced poverty and blindness in her later years. Brès received several awards and honors for her work, and her legacy is commemorated through schools, nurseries, and streets named after her. [Extracted from the article]

Aim: We suggest the top ten tips that any clinician working in a pediatric emergency department should always keep in mind. Methods: A literature review was conducted using, as a starting point, the previously published Ten Commandments for Emergency Medicine, Pediatric Emergency Medicine, and Perinatal Medicine. Results and Conclusion: A standard curriculum for pediatric emergency physicians is lacking. These ten commandments should be considered as advice for physicians who practice this profession every day and not as unbreakable rules established from above. [ABSTRACT FROM AUTHOR]

How pioneering paediatrician Andrés Martínez Vargas (1861-1948) improved child health in Spain in the late 19th and early 20th centuries These were attended by healthy wet nurses and were the precursors of Spanish breast milk banks.[1] Vargas believed in nipology, which is the sub-discipline of paediatrics that studies physical and mental development, diseases and nutrition in early childhood. The early history of Spanish paediatrics can be traced back to the 15th-17th century. [Extracted from the article]

Aim: According to the Italian national statistical institute, severe bacterial infections (SBI) in Italy are responsible for 1.7% of mortality under 5 years of age and their recognition is often challenging, especially in the first stages of the disease. We tried to estimate the prevalence of SBI in our target population and to identify signs and symptoms that could guide in the initial evaluation of a child with a possible SBI. Methods: We designed a prospective, multicentre study and enrolled patients aged 0–14 years at the first evaluation to the emergency department with an acute illness lasting a maximum of 5 days. The presence of variables suggestive of SBI was collected for every enrolled patient. One week after the enrolment, every patient was followed up by telephone. Results: SBI is more likely to be detected with the 'gut feeling' in both univariate and multivariate models (univariate OR: 7.16, 95% CI: 4.08–12.56; multivariate OR: 5.34, 95% CI: 2.78–10.25), while abnormal breathing pattern resulted significative only in univariate model (OR 3.83, 95% CI: 1.98–7.40). Nevertheless, their associated sensitivity is low. Conclusion: SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern. [ABSTRACT FROM AUTHOR]

Aim: Child maltreatment is not unusual in our society but little is known about the medical management of cases in the Nordic countries. This study investigated physician knowledge and practice in cases of suspected physical and sexual abuse and neglect. Methods: Using a patient vignette questionnaire, we assessed paediatrician knowledge and clinical decision‐making on paediatric wards at 17 hospitals in Norway. Experts and non‐experts in child maltreatment responded to the survey which described six potential cases of physical and sexual abuse and neglect. Results: A total of 156 paediatricians, 67% of whom were female and with a mean age of 40, responded. There was a high level of unanimity in recognition of abuse, but wide variation and little consensus in clinical decision‐making and adherence to national guidelines, with Fleiss kappa ranging from −0.002 to 0.468. In cases involving physical abuse concerns in infants and toddlers, less than half of all paediatricians reported they would order a full radiologic skeletal survey and head MRI/CT imaging, and less than 30% would plan follow‐up consultations. Conclusion: This study shows little agreement in the paediatric management of child maltreatment cases. These findings suggest the need for a national plan ensuring appropriate paediatric care for maltreated children. [ABSTRACT FROM AUTHOR]

Aim: Dutch national guidelines on follow‐up of paediatric celiac disease (CD) are available. The primary aim was to evaluate guideline adherence by paediatricians during follow‐up. The secondary aim was to determine the clinical relevance and diagnostic yield of routine laboratory tests suggested by these guidelines. Methods: A retrospective, single‐centre, cohort study was performed in paediatric CD patients who visited Tergooi Hospital, the Netherlands, between January 2017 and December 2019, with follow‐up of at least twelve months after diagnosis. We analysed guideline adherence, number of outpatient visits and all laboratory data. Results: We included 91 CD children with a median follow‐up of 4.0 years (range 1–16 years) and 162 follow‐up visits. Strict adherence amongst paediatricians during follow‐up was 8.0% (13/162 cases). A total of 1570 laboratory tests were performed of which 45.4% (713/1570) was in strict compliance with the Dutch national guidelines. Clinically relevant deviations were observed in 5.3% of requested laboratory tests. Conclusion: Strict guideless adherence amongst paediatricians in follow‐up of paediatric CD was low and the clinical relevance of the suggested routine laboratory tests is limited. This underlines the increasing notion that evidence‐based guidelines on follow‐up of CD are warranted. [ABSTRACT FROM AUTHOR]

Aim: To establish the positive predictive value (PPV) of clinical hip examinations performed by referrers in the Danish screening programme for Developmental Dysplasia of the Hip (DDH) utilising three definitions of true positive DDH diagnosis. Methods: We retrospectively identified 290 children (169 female) referred during a 4‐year period to the orthopaedic outpatient clinic at our institution with a positive clinical hip examination. Positive predictive value was calculated for clinical hip examinations across three definitions of a true positive clinical hip examination for all referrers and subgroups consisting of general practitioners, midwives and paediatricians. The PPV for clinical hip examinations was calculated for paediatric orthopaedic surgeons using one of the three definitions. Results: Positive predictive value of clinical hip examinations for all referrers were 5.4%, 3.6% and 1.8% with the definition of a true positive DDH diagnosis defined as clinical instability found by orthopaedic surgeon, ultrasound classification ≥Graf IIc or both definitions combined, respectively. Positive predictive value of clinical hip examinations performed by orthopaedic surgeons was 33.3% with a true positive clinical examination defined as an ultrasound classification ≥Graf IIc. Conclusion: We conclude that the positive predictive value of clinical hip examinations made by referrers in the Danish screening programme for DDH is low. [ABSTRACT FROM AUTHOR]

Aim: To develop a coherent programme that addresses the need for continuing professional development in general paediatrics and educational skills for senior paediatricians at outpatient clinics in Sweden today. Methods: Educational needs in the target group were investigated using a questionnaire. Themes and sub‐themes extracted from responses informed the curriculum formulation of the continuing professional development (CPD) programme, which was completed using a variety of learning, assessment and evaluation methods. Results: Forty‐six paediatricians identified 355 clinical situations. Competencies in general paediatrics and educational skills were incorporated in a CPD programme, implemented in western Sweden between 13 October 2016 and 23 May 2019, with 23 learning modules and 18 participants (male/female 3/15, median age 55 years). The participants' evaluation emphasised the importance of adult learning principles. Their responses to open reflective questions on 23 May 2109 suggested that the programme offered a learning environment in which they could develop their paediatric and educational practices and improve their mentorship, networks and work‐based learning environment. They also described an enhanced feeling of joy at work. Conclusion: The involvement of experienced paediatricians in the programme formulation may be inspirational to clinicians and contribute to the definition, revitalisation and prioritisation of general paediatrics in Sweden in the future. [ABSTRACT FROM AUTHOR]

Aim: To explore corticosteroid prescription practices and knowledge among paediatricians. Methods: The Paediatricians Corticosteroids Survey, a cross‐sectional, web‐based survey distributed to Israeli paediatricians between February and July 2018. Results: Three hundred and forty‐nine paediatricians (105 general paediatricians, 207 subspecialists and 37 paediatric endocrinologists) participated. Two hundred and three (58.2%) had >10 years of paediatric clinical experience and treated >60 patients/wk on average, 175/318 (55%) prescribed corticosteroids to >10% of their patients. On knowledge items, 11/266 (4.1%) responded 'not sure' when tapering of steroids is required, 22/268 (8.2%) to what 'stress dose' meant and 27/268 (10.1%) when a stress dose is required. Multivariate linear analysis showed higher scores were associated with training in paediatric endocrinology (β = 2.271, P = 0.032); medical practice only in a subspecialty (β = 1.909, P = 0.041) or in both general paediatrics and a subspecialty (β = 2.023, P = 0.014), compared to general paediatrics alone and medical studies in Israel (β = 1.059, P = 0.035). Overall, 96.2% thought continued medical education (CME) sessions would be helpful. Conclusion: Our findings suggest that despite clinical experience with corticosteroid usage, respondents demonstrated gaps in knowledge for potentially life‐threatening situations. Corticosteroid‐based CME programs are warranted to improve paediatricians' knowledge and patient management. [ABSTRACT FROM AUTHOR]

Nationwide study found higher paediatric readiness in emergency departments and trauma centres with a paediatrician on-site Abbreviations ED emergency department IQR interquartile range NPRP National Pediatric Readiness Project Injuries are the most common cause of death among children globally.1,2 Although preventive measures have reduced mortality rates in recent decades, injuries are still a major health problem in childhood.1,2 Critically ill and injured children are frequently admitted to mixed adult and paediatric emergency departments (EDs) and trauma centres. In order to become a local expert, emergency physicians staffing the EDs and trauma centres need the special training in paediatric emergency care patients. [Extracted from the article]

Aim: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent liver disease that affects 34% of children with obesity. Besides the liver-related morbidity, NAFLD also increases the risk of cardiometabolic diseases at adult age. Diverse screening recommendations exist on paediatric NAFLD. The aim of this study was to assess screening practices among paediatricians managing children with obesity in the Netherlands.Methods: Between 2016 and 2017, an Internet-based survey was sent to all 167 members of the endocrinology section of the Dutch Paediatricians Society, that includes all paediatricians involved in obesity care. Descriptive statistics (frequencies) were used to analyse responses.Results: In total, 42/167 (25%) of the invited paediatricians responded. Thirty-six of 42 respondents (86%) screen for NAFLD. One-third of those do not follow any guideline. Most respondents use ALT as screening tool, with thresholds varying between 21-80 IU/L. The majority (29/36) indicate they lack guidance on screening and follow-up.Conclusion: In this study sample of Dutch paediatricians, screening for paediatric NAFLD is widely, albeit not universally, performed and in a highly variable way. This underlines the need come to a uniform and comprehensive screening strategy and raise awareness about NAFLD among physicians treating children with obesity. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the pattern, impact on quality of life and management of common functional gastrointestinal disorders (FGIDs) and related signs and symptoms in infants below 1 year of age in Africa.Methods: Multicentre, cross-sectional, observational study in 10 African countries. At the first paediatric consultation of children with gastrointestinal symptoms, the perception of paediatricians on FGIDs (infant colic, constipation and regurgitation) and gas/bloating, impact on infant quality of life and parental anxiety and patient management practices were evaluated by standardised questionnaires.Results: Questionnaires were completed by 759 paediatricians for 10 812 infants. Overall, 49.9% of paediatricians reported ≥30% of first infant consultations each month for FGIDs or related symptoms. Infant colic was most commonly diagnosed (57.6% of infants), followed by gas/bloating (43.2%), regurgitation (39.7%) and constipation (31.4%). Overall, 53% presented >1 symptom. Mean scores for infant quality of life, sleep and parental anxiety were worse when children had multiple symptoms compared to children with a single symptom (P < .025). Prescription of medication was common (62.4%). There were no consistent differences between countries.Conclusion: Functional gastrointestinal disorder occurrence in Africa was high with a gap between expert recommendation that emphasises parental reassurance and nutritional advice and daily practice, particularly prescription of medication. [ABSTRACT FROM AUTHOR]

Aim: The number of primary care paediatricians is decreasing in Europe without a justifiable reason. We aimed to compare the clinical practice of paediatricians and family doctors attending children and adolescents in primary care.Methods: MEDLINE, Embase, CENTRAL, TRIP and Google Scholar were searched from December 2008 to February 2018. No language or study design restrictions were applied. Three reviewers assessed eligibility of the studies. Seven pairs of reviewers performed the data extraction and assessed the methodological quality independently. Discrepancies were resolved by consensus.Results: Fifty-four, out of 1150 studies preselected, were included. We found that paediatricians show more appropriate pharmacology prescription patterns for the illness being treated; they achieve higher vaccination rates and have better knowledge of vaccines and fewer doubts about vaccine safety; their knowledge and implementation of different screening tests are better; they prescribe psychoactive drugs more cautiously and more in line with current practice guidelines; their evaluation and treatment of obesity and lipid disorders follow criteria more consistently with current clinical practice guidelines; and they perform fewer diagnostic test, show a more suitable use of the test and request fewer referrals to specialists.Conclusion: According to published data, in developed countries, paediatricians provide higher quality care to children than family doctors. [ABSTRACT FROM AUTHOR]

Aim: Advance care planning (ACP) is a strategy to align future care and treatment with preferences of patients and families. This study assesses the experiences of ACP among paediatricians caring for children with life-limiting conditions.Methods: Paediatricians from five Dutch university hospitals and the national oncology centre completed a survey during May to September 2017, which investigated experiences with ACP in their most recent case of a deceased child and with ACP in general.Results: A total of 207 paediatricians responded (36%). After exclusion of responses with insufficient data (n = 39), 168 were analysed (29%). These included experiences with an individual case in 86%. ACP themes were discussed with parents in all cases. Topics common to many cases were diagnosis, life expectancy, care goals, the parent's fears and code status. ACP conversations occurred with children in 23% of cases. The joy in living was the most frequent topic. The frequency of ACP conversations was insufficient according to 49% of the respondents. In 60%, it was stated that ACP has to result in a documented code status.Conclusion: Paediatricians reported having ACP conversations mainly with parents focusing on medical issues. There was limited insight into the child's preferences for care and treatment. [ABSTRACT FROM AUTHOR]

Severe primary paediatric immunodeficiency syndromes are rare and potentially fatal unless suspected, diagnosed and treated early. We provide clinical guidance and support for on-call consultant paediatricians working in secondary level hospitals on how to recognise and manage children with these conditions. Our paper addresses four conditions that risk the most severe outcomes if they are not adequately cared for during on-call periods, such as weekends: severe combined immunodeficiency, haemophagocytic lymphohistiocytosis, severe congenital neutropaenia and chronic granulomatous disease. CONCLUSION: On-call paediatricians are provided with advice on handling the most severe primary immunodeficiencies. [ABSTRACT FROM AUTHOR]

Aim: The development of the gut microbiota occurs primarily during infancy, and growing evidence has emphasised its positive role and implications for human health. The aim of this review was to provide essential knowledge about the gut microbiota and to describe and highlight the importance of the factors that influence the gut microbiota in early life and their potential harmful effects later in life.Methods: The European Paediatric Association, the Union of the National European Paediatric Societies and Associations, convened a panel of independent European experts to summarise the research on microbiota for general paediatricians. They used PubMed and the Cochrane Library to identify studies published in English up to June 2018.Results: A number of clinical conditions can disrupt the development of a stable gut microbiota. Changes in the microbiome have been documented in many chronic diseases, mainly immune-mediated gastrointestinal and liver diseases, and distinct patterns have been associated with each specific disease. The gut microbiota can be positively modulated with probiotics, prebiotics, synbiotics, paraprobiotics and postbiotics.Conclusion: Paediatricians can play a key role in preventing harmful events that could permanently influence the composition and/or function of the gut microbiota. Various treatment strategies can be used. [ABSTRACT FROM AUTHOR]

Aim: To investigate differences in palivizumab prescription rates between Dutch paediatricians, and the role of parent counselling in this practice variation.Methods: A retrospective chart review of premature infants <32 weeks of gestation, aged less than six months at the start of the winter season, born between January 2012 and July 2014, in three secondary hospital-based paediatric practices in the Netherlands.Results: We included 208 patients, 133 (64%) of whom received palivizumab. Prescription rates varied considerably between the three hospitals: 8% (6/64), 89% (32/36) and 99% (97/98). A noticeable difference in the way parents were counselled about palivizumab was the use of the number needed to treat (NNT). In the hospital with the lowest prescription rate (8%), an NNT of 20 to prevent one hospitalisation was explicitly discussed with parents. Bronchiolitis-related hospital admissions occurred in 11.3% of patients receiving palivizumab compared to 20.0% in nonimmunised infants (p = 0.086).Conclusion: Considerable practice variation exists among Dutch paediatricians regarding palivizumab prescription rates. The counselling method seems to play an important role. Presenting palivizumab prophylaxis as a preference-sensitive decision, combined with the explicit use and explanation of an NNT, leads many parents to refrain from respiratory syncytial virus immunisation. [ABSTRACT FROM AUTHOR]

Aim: Dyslexia is characterised by a primary difficulty in both reading and cognitive control. Children with reading difficulties also experience a broad range of social and emotional difficulties, such as low self‐esteem, anxiety and depression. The aim of the study was to determine whether there is a linkage between emotional and cognitive‐control difficulties and challenges in reading in children with reading difficulties compared to typical readers. Methods: Children eight years to 12 years of age (N = 98) either with reading difficulties or typical readers participated in the current study. Cognitive control, specifically executive functions, and emotional and reading abilities were compared between the two groups and correlated. Results: Children with reading difficulties showed significantly lower executive functions and emotional abilities compared to typical readers. Decreased reading ability was related to decreased executive functions and emotional abilities. Conclusion: The results provide insight regarding the relationship between cognitive, emotional and reading abilities: executive functions difficulties may cause emotional stress, which in turn decreases the ability to monitor, inhibit and pay attention to the written material, which impair reading to a greater degree. Results support the need for an emotional evaluation in children with reading difficulties that can be performed in a paediatrician's consulting room. [ABSTRACT FROM AUTHOR]

Role of FEF25-75 in children sent by primary care paediatricians for asthma diagnosis Spirometry is the gold-standard tool for detecting airflow limitation in asthma (www.ginasthma.org). Children with abnormal FEF SB 25-75 sb had lower FEV SB 1 sb ( I p i < 0.001), FVC ( I p i = 0.022), and FEV SB 1 sb /FVC values ( I p i < 0.001), higher frequency of bronchial obstruction ( I p i < 0.001), uncontrolled asthma ( I p i < 0.001) and lower cACT values ( I p i = 0.022) than children with normal FEF SB 25-75 sb . [Extracted from the article]

Although survival rates have increased during the past decades, some children still die from disease and many survivors develop chronic diseases and functional impairment as a result.[1] The diagnosis of such illnesses is a life-changing event for their families, as well as for themselves. Adult studies have shown that ACP increased congruence in treatment preferences between patients and medical staff and increased the likelihood that patients' preferences were respected. First, the study had a low response rate (29%) and this might have positively biased the results, as it is most likely that the survey was answered by those physicians who were already interested in ACP. [Extracted from the article]

Aim: This prospective study evaluated the incidence of functional gastrointestinal disorders (FGIDs) during infancy, on their own or combined with other symptoms.Methods: We asked 273 French paediatricians with a specific interest in FGIDs to provide feedback on 2757 infants aged zero to six months from March 2013 to January 2014. Gastrointestinal health status was assessed by two questionnaires at inclusion and at a four-week follow-up visit. FGIDs were assessed according to the Rome III criteria and quality of life (QoL) was monitored.Results: Combined FGIDs were diagnosed in 2145 (78%) infants: 63% with two disorders and 15% with three or more disorders. The most frequently combined FGIDs were gas/bloating and colic (28%), colic and regurgitation (17.0%) and gas/bloating and regurgitation (8%). Compared to infants with a single FGID, combined FGID were associated with lower body weight (4.63 vs 4.79 kg, p = 0.009), shorter breastfeeding duration (33 vs 43 days, p < 0.001), a decreased QoL score (5.9 vs 6.5, p < 0.001), more frequent drug prescriptions (25% vs 13%, p < 0.001) and significantly greater improvements in QoL scores after four weeks (p = 0.003).Conclusion: Combined FGIDs were extremely common in infants up to six months of age and had a negative impact on breastfeeding, weight gain and QoL. [ABSTRACT FROM AUTHOR]

Aim: This study compared the definitions of abnormal growth that are taught across Europe to explain previously reported variations in growth-monitoring practices.Methods: We developed two online surveys in 2016 to obtain the definitions of abnormal growth in European countries and approached the national chairs of the European Confederation of Primary Care Paediatricians in 18 countries and the International Federation of Medical Students' Associations in 33 countries.Results: We obtained definitions from 10 of 18 paediatricians and 18 of 33 students, covering 23 of the 33 European countries surveyed. Abnormal faltering growth was always defined, either by a single parameter (24%) or combined parameters (76%). Four static parameters were used: standardised height (100%), standardised weight (60%), standardised body mass index (12%) and distance to target height (20%). Two dynamic parameters were used: growth deflection (28%) and growth velocity (32%). The thresholds used to define abnormal faltering growth varied slightly in some cases and widely in others. Abnormal accelerated growth appeared in 52% of the definitions, with important variations in parameters and thresholds.Conclusion: There were important between-country discrepancies in the definitions of paediatric abnormal growth that were taught in 23 European countries. Standardisation is vital. [ABSTRACT FROM AUTHOR]

Aim: Very preterm infants are at risk of neonatal hearing loss. However, it is unknown whether infants with a normal neonatal hearing screening result risk sensorineural hearing loss (SNHL) at a later age.Methods: This cohort study was conducted at the Erasmus Medical University Center Rotterdam, the Netherlands, on 77 very preterm infants born between October 2005 and September 2008. All infants underwent auditory brainstem response audiometry during neonatal hearing screening and at two years of corrected age. The frequency of SNHL in infants with a normal neonatal hearing screening was analysed and the risk factors associated with newly diagnosed SNHL in these infants were examined.Results: We found that 3.9% (3/77) of the very preterm infants showed permanent hearing loss during their neonatal hearing screening. In addition, a relatively high prevalence of newly diagnosed SNHL (4.3%) was found in three of the 70 infants followed up at the age of two. The total prevalence rate of permanent hearing loss in the cohort was approximately 8%.Conclusion: A normal outcome of neonatal hearing screening did not guarantee normal hearing at two years of age in this very preterm cohort and paediatricians should be alert to the possibility of late-onset SNHL. [ABSTRACT FROM AUTHOR]

Aim: Perinatal deaths occurring outside the neonatal intensive care unit (NICU) are rarely recorded in outcome studies, despite having a direct impact on perinatal statistics. Our aim was to investigate the timing and modes of perinatal deaths that occurred outside the NICU and changes over time.Method: We reviewed all perinatal deaths from 22 weeks of gestation onwards, without NICU admissions, during two periods in a Canadian tertiary mother and baby hospital and categorised deaths according to nine specific categories.Results: There were 444 perinatal deaths that satisfied the inclusion criteria. The total number of perinatal deaths increased from 2000 to 2002 (n = 197) and 2007 to 2010 (n = 247). The proportion of foetuses alive at the time of their mother's hospital admission, but then stillborn, decreased. There was a significant increase in terminations for congenital anomalies in the second cohort and a decrease in deaths following induction of labour and comfort care for foetal anomalies.Conclusion: Approaches to end-of-life care changed between the two study periods. Paediatricians should be aware of the epidemiology of perinatal mortality in their own practice, as it has a direct impact on the denominator in NICU outcome studies. [ABSTRACT FROM AUTHOR]

Around one in ten adolescents suffer from chronic conditions and disabilities, and the transition from paediatric to adult care can be particularly challenging. Unplanned transfers can complicate education, work and health and result in patients being lost to follow-up, poor treatment adherence and more frequent hospitalisation. The Adolescent Health and Medicine Working Group of the European Academy of Paediatrics has developed a consensus statement for a successful transition.Conclusion: This statement will help paediatricians, adult care specialists, policymakers and other stakeholders to handle chronic care transitions so that they meet the expectations and needs of adolescents and their families. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to survey paediatricians, who taught neonatal resuscitation in Brazil, about when they would apply advanced resuscitation in the delivery room for newborn infants born at 23-26 weeks of gestational age.Methods: This cross-sectional study focused on an electronic questionnaire that was sent to paediatricians who acted as instructors for the Brazilian Neonatal Resuscitation Program from December 2011 to September 2013. The primary outcome was the gestational age at which the respondent would apply advanced resuscitation in the delivery room. Latent class analysis identified the profiles of the instructors, and logistic regression identified the variables associated with belonging to one of the derived classes.Results: The 560 (82%) instructors who agreed to participate fell into three latent classes: pro-resuscitation, intermediate and pro-limitation, with high, intermediate and low probabilities of performing advanced resuscitation in neonates born at 23-26 weeks. In the multivariate model, group membership was associated with the paediatrician's age, years of practice and personal importance of religion and the patient's birthweight, future quality of life and probability of death.Conclusion: The opinions of paediatricians performing advanced resuscitation on extremely preterm infants in the delivery room were diverse and influenced by personal beliefs. [ABSTRACT FROM AUTHOR]

The article offers information on the 26th European Childhood Obesity Group's Annual Congress to be held in Thessaloniki, Greece on October 6 to 8, 2016.

Aim: Although there have been frequent clinical reports about sleep disturbances in children with learning disabilities, no data are available about the prevalence of sleep disturbances in children with developmental dyslexia (DD). This study evaluated sleep disturbances in children with DD referred to a hospital clinic and compared their scores with healthy controls.Methods: We consecutively enrolled 147 children (66% male) aged 10.26 ± 2.63 years who were referred by clinical paediatricians to the Clinic for Child and Adolescent Neuropsychiatry at the Second University of Naples with DD and 766 children without DD (60% male) aged 10.49 ± 2.39 years recruited from schools in the same urban area. Sleep disturbances were assessed with the Sleep Disturbances Scale for Children (SDSC), which was filled out by the children's main carers.Results: Compared with the controls, the children with DD showed significantly higher rates of above threshold scores on the total SDSC score (p < 0.001) and on the subscales for disorders in initiating and maintaining sleep (p < 0.001), sleep breathing disorders (p < 0.001) and disorders of arousal (p < 0.001).Conclusion: Sleep disorders were significantly more frequent in children with DD than in healthy controls. A possible relationship between dyslexia and sleep disorders may have relevant clinical implications. [ABSTRACT FROM AUTHOR]

Unlabelled: Despite extensive use of the term 'standard of care' (SOC), there is no such medical definition. How are neonatal therapies accepted as SOC with huge centre-to-centre variation? What defines SOC? We will consider paths to acceptance of multiple therapies (antenatal corticosteroids, preventing GBS, others). We conclude single-centre trials drive care, but are not consistently predictive for multicentre trials. Innovation/quality improvement initiatives also alter care, despite strong evidence practice changes take time. Furthermore, there are powerful medico-legal implications if a therapy is designated SOC.Conclusion: Defining SOC is a quandary with more legal implications than medical, but what's most critical is keeping current in a rapidly changing field. [ABSTRACT FROM AUTHOR]

Aim: In Finland, specialist paediatrics training is led by university hospitals, but half of it is carried out in regional central hospitals. We audited the training provided by four regional central hospitals in the tertiary care area covered by Tampere University Hospital, in 2003, 2008 and 2015.Methods: The audits comprised hospital visits and discussions with the chief doctor of the paediatric clinic, the trainees and the specialists who trained them. A modified version of the European Union of Medical Specialists 1997 protocol was used, and the key areas that performed poorly in the audits were followed up.Results: In 2008 and 2015, most of the key follow-up issues had improved, but two main areas in need of further development were identified in 2015. These were that educational objectives should be clarified, and their implementation systemically followed up, and that trainees should spend more time working in outpatient settings.Conclusion: Since 2003, a marked improvement had taken place in the paediatric training provided by regional central hospitals, partly because of the increase in paediatric specialist resources. This study underlines the importance of repeat audits and the need for co-opera-tion between the university hospital and regional hospitals, including regular visits. [ABSTRACT FROM AUTHOR]

Aim: Burnout syndrome is common in healthcare workers. We evaluated its prevalence in paediatric residents and investigated its influence on cerebral function correlations, using functional magnetic resonance imaging (MRI), when they carried out an attentional paradigm.Methods: This cross-sectional descriptive study involved 28 residents from the Department of Paediatrics at the University of São Paulo. The functional MRI was carried out while the residents completed the Stroop colour word task paradigm to investigate their attentional task performance. The Maslach Burnout Inventory (MBI) was applied, and stress was assessed using the Lipp Inventory of Stress Symptoms for Adults and by a visual analogue mood scale.Results: The MBI subscales of depersonalisation and emotional exhaustion indicated that 53.1% of the residents had moderate or high burnout syndrome. The whole-brain multivariate analysis showed positive correlations between the blood oxygenation level dependent effect and the MBI depersonalisation and emotional exhaustion indices in the dorsolateral prefrontal cortex, which controls for anxiety.Conclusion: Increased brain activation during an attention task, measured using functional MRI, was associated with higher burnout scores in paediatric residents. This study provides a biological basis for the implementation of measures to reduce burnout syndrome at the start of residency training programmes. [ABSTRACT FROM AUTHOR]

An essay is presented which offers profile of Christian Friederick Louis Leipoldt, a South African paediatrician and prolific writer, and his work about the health of children. It discusses his work as editor-in-chief of the journal "South African Medical Journal" and as lecturer at the University of Cape Town Medical Schools in South Africa. It informs that he advocated unified healthcare system for all children.

The article discusses the findings of a 2016 study that surveyed paediatricians and medical students who chaired national organizations in 23 European countries. The findings offer substantial empirical evidence that the paediatric practices of growth monitoring were suboptimal at the time of the survey. It suggests an urgent need for standardized growth monitoring strategies and practices.

The article presents the author's views on retinal hemorrhages in infants without brain and bodily injury. He refers to the shaken baby syndrome from abusive head trauma can create vitreoretinal traction followed by retinal haemorrhage. The author recommends a detailed history and physical examination by a child abuse pediatrician, including blood tests, head CT and MRI scans, and ophthalmologic exam.

In particular, lung ultrasound has been shown to be sensitive and specific for detecting pneumonia and COVID-19 and is particularly useful for following up both conditions.3 Unfortunately, lung ultrasound is rarely used in some paediatric settings, despite being well-established in paediatric and adult practice. Comment on "High rates of antibiotic prescriptions in children with COVID-19 or multisystem inflammatory syndrome: a multinational experience in 990 cases from Latin America". Tackling antibiotic resistance during the COVID-19 pandemic is a new challenge for paediatricians. [Extracted from the article]

Non-invasive ventilation ( NIV) is commonly used in paediatric intensive care units ( PICUs) for respiratory failure. This review aims to improve paediatricians' understanding of NIV, by specifying technical or practical considerations, giving advice about selecting patients and presenting pertinent published data about NIV in different circumstances. Conclusion NIV is useful in PICUs if children are appropriately selected and carefully monitored. Technological advances and future clinical research will improve its use and success rate in PICU. [ABSTRACT FROM AUTHOR]

Behavioural decision-making theories provide insights into how people make choices under conditions of uncertainty. However, few have been studied in paediatrics. This study introduces these theories, reviews current research and makes recommendations for their application within the context of shared decision-making. Conclusion As parents are expected to share decision-making in paediatrics, it is critical that the fields of behavioural economics, communication and decision sciences merge with paediatric clinical ethics to optimise decision-making. [ABSTRACT FROM AUTHOR]

Aim Most Italian children are cared for by a family paediatrician until they are 14 years old, and their duties include prescribing drugs recommended by specialists so that they are free. This study aimed to draw up a list of the drugs most commonly prescribed by family paediatricians. Methods We surveyed 64 experienced family paediatricians to find out what drugs they prescribed over an 8-week period, including those recommended by a specialist, using cartons of drugs as the unit of measurement. A list of commonly prescribed drugs was then drawn up. Results A total of 381 active substances were prescribed. The most commonly prescribed drugs were amoxicillin (25.8% of the cartons), amoxicillin clavulanate (9.2%) and cetirizine (9.0%). The most commonly prescribed drug classes were antibiotics (43.8%), anti-asthmatics (12.9%) and antihistamines (11.8%). A list of 38 commonly prescribed drugs belonging to 16 therapeutic subgroups and covering 83.1% of cartons was identified. Of these, 33 were prescribed by 50% or more of the paediatricians and five were mainly prescribed following the recommendation of a specialist. Conclusion Our review of the prescribing habits of family paediatricians showed that 38 commonly prescribed drugs were sufficient to treat most common diseases in children under 15 years of age. [ABSTRACT FROM AUTHOR]

Even if the parents agree with their son drinking, the physician should tell the patient they cannot condone the activity for legal and health reasons. The ongoing relationships with the child and his family play a pivotal role, and physicians should only discuss such issues in a spirit of mutual knowledge and trust with the patients and the family. [Extracted from the article]

The article reports on the late Swedish paediatrician Rolf Kostmann. It offers information about his contribution as physician to the country and to other Swedish medical researchers, his passion as paediatrician as well as his occupational achievement. Also emphasized is Kostmann's report on infantile hereditary agranulocytis depicting severe chronic neutropenia as genetic disease.

The article focuses on a study related to deployment of anaesthetic services for magnetic resonance imaging (MRI) observations among paediatric patients. Topics discussed include observation of knowledge gap among paediatric physicians related to anaesthesia and apnoea requirements; examination of referral frequency by physicians regarding MRI services; and analysis of different approaches for usage of anaesthesia such as midazolam or general anaesthesia.

A biography of Professor Jan Winberg is presented. He was born in 1923 in Stockholm, and trained at the Karolinska Hospital in the city to become a paediatrician. He did research work on urinary tract infection (UTI) focusing on things like its diagnosis, the importance of faecal bacterial flora in it, and the promotion of breastfeeding by him. He also started a clinic that provided services for children with UTI.