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Intrapartum antibiotic prophylaxis is effective in preventing early-onset group B streptococcal disease in newborn infants, but it influences gut microbiota development. Gut microbiota composition is, in turn, associated with immune-related diseases in childhood. This study hypothesized that intrapartum antibiotic exposure is associated with immune-related diseases in childhood. We conducted a population-based cohort study of vaginally delivered children. We retrieved data on intrapartum antibiotic exposure from structured electronic medical records and obtained outcome data on childhood autoimmune, allergic, and obstructive airway diseases from comprehensive national registers. We used Cox regression analysis with adjustment for maternal and neonatal covariates and regarded death as a competing risk in the analyses. The study population comprised 45,575 vaginally born children of whom 9733 (21%) had been exposed to intrapartum antibiotics. Intrapartum antibiotic exposure was associated with an autoimmune disease diagnosis (adjusted hazard ratio, 1.28; 95% confidence interval, 1.02–1.62), which corresponds to 22% (95% confidence interval, 6–39) as a theoretical population-attributable fraction. Intrapartum antibiotic exposure was not associated with diagnoses of allergic (adjusted hazard ratio, 1.08; 95% confidence interval, 0.97–1.20) or obstructive airway diseases (adjusted hazard ratio, 1.04; 95% confidence interval, 0.96–1.14). Intrapartum antibiotic exposure may be associated with an increased risk for autoimmune diseases in childhood. This finding supports the efforts to develop more specific group B streptococcal disease prevention strategies in the future. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: There are limited data on the pathogen-related and host-related factors in the pathogenesis of febrile seizures (FS). We designed a controlled study to compare the role of different respiratory viruses and febrile response in FS.Methods: In a prospective cohort study of 1899 pediatric emergency room patients aged 6 months-6 years with a positive respiratory virus multiplex PCR, we identified 225 patients with FSs. We first compared the distribution of respiratory viruses in age-stratified patients with FSs with that in other patients. In an embedded case-control study, we compared the febrile response in patients with FSs with that in the controls matched for age, season and the same respiratory virus.Results: The relative risk for FS was the highest for coronavirus OC43, 229E, and NL63 infections [RR: 3.2, 95 % confidence interval (CI): 1.4-7.2) and influenza A and B [RR: 2.5, 95 % CI: 1.4-4.7] as compared to those with other respiratory viral infections. The patients with FSs had a stronger febrile response of 39.2 °C (difference: 0.8 °C, 95 % CI: 0.5-1.2) later during hospitalization after acute care than the controls matched for the same respiratory virus.Conclusions: Influenza and coronaviruses caused relatively more FS-related emergency room visits than other respiratory viruses. Furthermore, the febrile response was stronger in the patients with FSs than in the controls matched for the same respiratory virus. The results suggest that the pathomechanism of FSs includes modifiable pathogen-related and host-related factors with possible potential in the prevention of FSs. [ABSTRACT FROM AUTHOR]

Aims: Continuous glucose monitoring (CGM) parameters, self-monitored blood glucose (SMBG), HbA1c and oral glucose tolerance test (OGTT) were studied during preclinical type 1 diabetes mellitus.Methods: Ten asymptomatic children with multiple (⩾2) islet autoantibodies (cases) and 10 age and sex-matched autoantibody-negative controls from the Type 1 Diabetes Prediction and Prevention (DIPP) Study were invited to 7-day CGM with Dexcom G4 Platinum Sensor. HbA1c and two daily SMBG values (morning and evening) were analyzed. Five-point OGTTs were performed and carbohydrate intake was assessed by food records. The matched pairs were compared with the paired sample t-test.Results: The cases showed higher mean values and higher variation in glucose levels during CGM compared to the controls. The time spent ⩾7.8mmol/l was 5.8% in the cases compared to 0.4% in the controls (p=0.040). Postprandial CGM values were similar except after the dinner (6.6mmol/l in cases vs. 6.1mmol/l in controls; p=0.023). When analyzing the SMBG values higher mean level, higher evening levels, as well as higher variation were observed in the cases when compared to the controls. HbA1c was significantly higher in the cases [5.7% (39mmol/mol) vs. 5.3% (34mmol/mol); p=0.045]. No differences were observed in glucose or C-peptide levels during OGTT. Daily carbohydrate intake was slightly higher in the cases (254.2g vs. 217.7g; p=0.034).Conclusions: Glucose levels measured by CGM and SMBG are useful indicators of dysglycemia during preclinical type 1 diabetes mellitus. Increased evening glucose values seem to be common in children with preclinical type 1 diabetes mellitus. [ABSTRACT FROM AUTHOR]

Abstract: Background and aims: Most information on the neuropsychological performance of pediatric patients with temporal lobe epilepsy (TLE) is derived from selected surgical series. Non-lesional pediatric TLE patients were studied here at the population level in order to investigate the extent to which neuropsychological deficits predisposing to learning difficulties exist in this more common group. Methods: Language, memory and executive functions were measured in children aged 8–15 years with non-lesional TLE and of normal intelligence (n = 21), and their performance was compared with that of healthy age and gender-matched children (n = 21). The effects of clinical epilepsy variables on performance were examined. Results: Although neuropsychological performance did not differ between the TLE patients and the healthy controls, female gender, early onset, longer duration and abnormal interictal EEG had a negative effect on neuropsychological performance. Conclusions: Children with early-onset epilepsy should be assessed carefully for neuropsychological impairment using sufficiently broad batteries of tests in order to detect even slight deficits. Our sample size was small and these findings should be interpreted as preliminary results and need to be confirmed in larger studies. [Copyright &y& Elsevier]

Abstract: Background: Paediatric forearm shaft fractures show an increasing incidence. The predictive factors of these fractures are not fully understood. Summer weather is suggested to have an effect on the risk of children's fractures. We studied the effect of rainfall, temperature and wind on paediatric forearm shaft fractures in summer. Methods: All 148 children's forearm shaft fractures in the geographic catchment district during the summer months in 1997–2009 were included. There were 1989 days in the study period. Daily meteorological readings captured the maximum daytime temperature, precipitation and wind speed. The direct daily association between fractures (yes/no) and different weather conditions was analysed in this population-based study. Results: The risk of forearm shaft fracture was 50% higher on dry days compared to rainy days (P =0.038). Temperature and wind speed had no statistically significant effect on fractures. Conclusions: The results give support for the presumption by the general public and professionals that summer weather affects children's fractures. A 1.5-fold increase in the risk is especially significant as the forearm shaft fractures are challenging to manage and prone to complications. Paediatric trauma units should prepare themselves for these severe injuries on dry summer days. [Copyright &y& Elsevier]

Background: Because urinary tract infections (UTIs) are caused by bacteria in the stool, dietary factors may affect the risk of contracting a UTI by altering the properties of the fecal bacterial flora. Objective: We studied dietary and other risk factors for UTI in fertile women in a case-control setting. Design: One hundred thirty-nine women from a health center for university students or from the staff of a university hospital (mean age: 30.5 y) with a diagnosis of an acute UTI were compared with 185 age-matched women with no episodes of UTIs during the past 5 y. Data on the women's dietary and other lifestyle habits were collected by questionnaire. A risk profile for UTI expressed in the form of adjusted odds ratios (ORs) with 95% CIs was modeled in logistic regression analysis for 107 case-control pairs with all relevant information. Results: Frequent consumption of fresh juices, especially berry juices, and fermented milk products containing probiotic bacteria was associated with a decreased risk of recurrence of UTI: the OR for UTI was 0.66 (95% CI: 0.48, 0.92) per 2 dL juice. A preference for berry juice over other juices gave an OR of 0.28 (95% CI: 0.14, 0.56). Consumption of fermented milk products ? 3 times/wk gave an OR of 0.21 (95% CI: 0.06, 0.66) relative to consumption < 1 time/wk. Intercourse frequency was associated with an increased risk of UTI (OR for ? 3 times/wk compared with < 1 time/wk: 2.7; 95% CI: 1.16, 6.2). Conclusion: Dietary habits seem to be an important risk factor for UTI recurrence in fertile women, and dietary guidance could be a first step toward prevention. [ABSTRACT FROM AUTHOR]

Abstract: S100B protein concentrations correlate with the severity and outcome of brain damage after brain injuries, and have been shown to be markers of blood–brain barrier damage. In children elevated S100B values are seen as a marker of damage to astrocytes even after mild head injuries. S100B proteins may also give an indication of an ongoing pathological process in the brain with respect to febrile seizures (FS) and the likelihood of their recurrence. To evaluate this, we measured S100B protein concentrations in serum and cerebrospinal fluid from 103 children after their first FS. 33 children with acute infection without FS served as controls for the serum concentrations. In the FS patients the mean S100B concentration in the cerebrospinal fluid samples was 0.21μg/L and that in the serum samples 0.12μg/L. The mean serum concentration in the controls was 0.11μg/L (difference 0.01μg/L, 95% confidence interval −0.02 to 0.04μg/L, P =0.46). There was a correlation between age and serum S100B concentration (r =−0.28, P =0.008) in children under four years, but S100B concentrations did not predict the clinical severity of the FS nor their recurrence. There was no correlation between time of arrival at the hospital after FS and S100B concentration in serum (r =−0.130, P =0.28) or in cerebrospinal fluid samples (r =−0.091, P =0.52). Our findings indicate that FS does not cause significant blood–brain barrier openings, and increase the evidence that these seizures are relatively harmless for the developing brain. [Copyright &y& Elsevier]

In children there is limited understanding about the biological and environmental risk factors of fractures. Therefore, we aimed to study the effect of maternal smoking on preschool children's fractures hypothesizing that the fracture risk might be programmed during intrauterine growth in means of disturbed bone formation. A prospective birth cohort included women living in Northern Finland with an expected date of delivery between July 1st, 1985 and June 30th, 1986 (N = 9362), and their offspring (N = 9432). Smoking was inquired during pregnancy and when the offspring reached seven years of age. Information on in-hospital-treated fractures among the children was collected from the National Hospital Discharge Register (NHDR). The cases who declined to participate or suffered from any bone dysplasia such as osteogenesis imperfecta or any malignancy were excluded, thus 6718 subjects (71.2%) were finally included. Poisson regression analysis with adjustment for gender, asthma, rheumatoid arthritis, socioeconomic status of the family, maternal age and body mass index (BMI) of the children was used to determine the association between maternal smoking during pregnancy and bone fractures. Maternal smoking during pregnancy was associated with a 1.83-fold (95% CI 1.06–3.02, p = 0.022) increased risk of in-hospital-treated fractures at pre-school age. The fracture risk in childhood is perhaps increased as a result of modified bone development of the fetus due to maternal smoking. [ABSTRACT FROM AUTHOR]

Background: It has been claimed that an early respiratory syncytial virus (RSV) infection can induce asthma and recurrent wheezing. Objective: We addressed the question of whether infants contracting an early RSV infection differ from healthy children in their cytokine production at birth. Methods: In a prospective cohort study cord blood samples were collected from 1084 newborns during autumn 2001. Of 47 of these newborns with subsequent virologically confirmed RSV infection before 6 months of age, 24 had enough cells for stimulation in cord blood samples (14 of those were hospitalized). Twenty-eight children had other respiratory virus infections (16 with enough cells), and samples from 48 healthy children of the 1084 total served as control specimens. Stimulated cytokine production of mononuclear cells was measured. The responses in the groups were evaluated by means of factor analysis. Results: The infants hospitalized for RSV infection had higher LPS-stimulated combined IL-6 and IL-8 responses than the infants treated as outpatients (P = .005) or the healthy control subjects (P = .02). The hospitalized patients with RSV showed lower IL-1β, IL-2, IL-4, IL-5, and IL-10 responses than those treated as outpatients (P = .02). High IL-6 and IL-8 responsiveness predicted a severe RSV infection (odds ratio, 2.20; 95% CI, 1.17-4.14; P = .01). The unstimulated cytokine responses at birth did not differ between the patients and healthy control subjects. Conclusion: The results suggest that natural differences in innate immunity predispose children to severe RSV infection rather than the infection modifying immune responses in childhood. [Copyright &y& Elsevier]

Background Febrile seizures are the most common seizures in children, but their pathogenesis remains unknown. Some studies have suggested an association between the light-dependent secretion of melatonin and the occurrence of febrile seizures. The diurnal and seasonal occurrence of febrile seizures could clarify the role daylight plays in febrile seizures. Methods In Finland, summer days are long and bright and winter days are short and dark. We evaluated the diurnal and seasonal occurrence of the first febrile seizures in 461 children and adjusted them according to the epidemiology of the febrile episodes in a population-based study of 1522 children. Results The first febrile seizure most often occurred in the evening, peaking between 6 and 10 PM (31%), and least often at night, in the early morning hours between 2 and 6 AM (8%) ( P < 0.001). This diurnal pattern repeated itself in different seasons according to variance in daylight duration. Febrile seizures occurred irregularly throughout the year, most frequently in winter, concurrently with the febrile episodes, and least frequently in summer; this seasonal variation in the occurrence of febrile seizures disappeared however when adjusted for the number of febrile events. Conclusions We found clear diurnal and seasonal variations in the occurrence of febrile seizures, even though they did not follow the amount of daylight. Our findings do not support the hypothesis that the diurnal and seasonal variation of daylight explains the occurrence of febrile seizures. Moreover, febrile events associated strongly with the occurrence of febrile seizures. [ABSTRACT FROM AUTHOR]

Summary: Background: The incidence of paediatric forearm fractures and their invasive operative treatment is increasing. Evidence supporting increased interest in internal fixation of forearm fractures has been controversial. We studied radiographic outcome and complications of both-bone diaphyseal middle-third forearm fractures according to the type of treatment. The purpose of the study was to determine if there is an advantage in invasive treatment over non-invasive treatment that supports the increasing trend towards invasive surgery. Materials and methods: All children and adolescents (<16 years) with both-bone diaphyseal middle-third forearm fractures in a geographic area with 86,000 children in 2000–2009 were included. There were 168 patients. The types of primary fractures and their malalignment and displacement rates were analysed. The fractures were classified as ‘severe’ or ‘mild’ according to radiographic findings. Radiographic fracture healing and alignment and the rate of complications were compared as regards invasive versus non-invasive surgery. Results: Just over a third of all patients suffered from some complication during follow-up. The overall complication rate was highest in the non-invasive treatment group (58%) and lowest in the intramedullary nailing group (24%) (P <0.001). The difference was significant as regards both mild and severe fractures. Nearly a third of the fractures in the non-invasive treatment group were re-reduced during follow-up. Two third of them were finally fixed invasively. Re-reduction after invasive fixation was rare (1.4%, P =0.001). Re-fracture was equally uncommon (7.1%) in both the invasive and non-invasive groups. Non-union was unusual (1.2%) and it was related to high-energy trauma or chronic disease. Nerve co-morbidity, scar problems, soft-tissue complications and compartmental syndrome were not problems in the study population despite the type of treatment. Conclusions: We found that the complication rate of diaphyseal forearm fractures was twice as common after non-invasive than after invasive treatment. The need of re-reduction after non-invasive treatment was remarkable. Nevertheless, bone healing was equally good despite the treatment. We conclude that intramedullary fixation of both-bone forearm fractures is a good mode of primary treatment of mild and severe middle-third diaphyseal both-bone forearm fractures. [Copyright &y& Elsevier]

Abstract: Background: The incidence of children''s forearm fractures is increasing worldwide. This is different from the declining trend observed in the overall injury rate, and the reason for the increase is not known. Diaphyseal forearm fractures comprise 3–6% of all paediatric fractures, and they offer a challenge to their treatment. The purpose of this study was to evaluate the incidence of diaphyseal both-bone forearm fractures in children during the last decade in Northern Finland. Another objective was to study the background factors, treatment, and re-displacement of these fractures. Materials and methods: All 168 children (<16 years) admitted to our paediatric trauma centre due to diaphyseal both-bone forearm fractures during 2000–2009 were included. The type of injury, background factors, radiographics, treatments and re-dislocations were reviewed. The age-related incidence rates were evaluated. Results: The incidence of diaphyseal both-bone forearm fractures increased 4.4-fold (95% CI 2.0–10.8; P <0.001) between 2000 (8.2/100000) and 2009 (35.9/100000). The increase in the incidence was accelerating (P <0.001) and the overall increase was 338%. The incidence of surgical treatment for diaphyseal fractures increased 4.2-fold (95% CI 1.9–10.4, P =0.001), which is in relation to increasing number of fractures. However, internal fixation increased from 13.3% in 2000–2001 to 52.7% in 2008–2009 (P =0.015), as an alternative to conservative treatment. The re-displacement rate was high (29.9%) amongst the patients with conservative treatment compared to those who were invasively operated (1.4%) (P <0.001). The mean age of the patients increased by 2.4 years in the study period (P =0.019). Trampoline was the most important and still increasing reason for the fractures. At the beginning of the study, there were no trampoline-related fracture, but towards the end of the study 30–41% of the fractures were caused by a trampoline injury (P =0.004). Conclusions: There was an accelerating increase in the incidence of paediatric diaphyseal both-bone forearm fractures during the last decade. Trampoline was the most important and still increasing reason for these fractures. The mean age of the patients was increasing. Increasing proportion of diaphyseal both-bone forearm fractures was treated operatively. Re-displacement was unusual amongst operated cases. [Copyright &y& Elsevier]

Is the growth of term singletons born after frozen embryo transfer (FET) comparable to those born after fresh embryo transfer and natural conception up to 5 years of age? Observational cohort study in an academic medical centre and municipal child health clinics with repeated measurements carried out by medical professionals. Term singletons born after FET (n = 110) and fresh embryo transfer (n = 181) and their matched natural conception controls (n = 543) born in Oulu, Northern Finland, were included. Mean weights, lengths, heights and head circumferences at the ages of 4, 8 and 18 months and 3 and 5 years were compared. At 3 and 5 years, body mass indices were compared. Childhood growth did not differ between term singletons born after FET, fresh embryo transfer and natural conception, correcting for exact age at measurement and adjusting for maternal body mass index and paternal height. Similar growth between children born after FET, fresh embryo transfer and natural conception offers reassurance of the safety and feasibility of the steadily increasing use of embryo cryopreservation in assisted reproduction. [ABSTRACT FROM AUTHOR]

Abstract There are disadvantages in Elastic Stable Intramedullary Nailing (ESIN) of forearm-shaft fractures, such as the need of implant removal. Biodegradable Intramedullary Nailing (BIN) is a new technique developed for these fractures. We hypothesized that there is no difference in rotational ROM between the patients treated by BIN vs. ESIN. A randomized, controlled clinical trial included patients, aged 5–15 years, requiring surgery for forearm-shaft fractures. Biodegradable polylactide-co-glycolide (PLGA) nails (Activa IM-Nail™, Bioretec Ltd., Finland) were used in 19 and titanium nails (TEN®, SynthesDePuy Ltd., USA) in 16 patients. Rotational ROM of forearm after two years was the primary outcome. Elbow and wrist ROM, pain and radiographic bone healing were secondary outcomes. Forearm rotation was mean 162° and 151° in BIN and ESIN groups, respectively (P = 0.201). No difference between the groups was found in any other ROMs. Three cases in the ESIN vs. none in the BIN group reported pain (P = 0.113). There was no clinically significant residual angulation in radiographs. Two adolescents in the BIN group vs. none in the ESIN (P = 0.245) were excluded because of implant failure; another two with complete bone union suffered from re-injury. Therefore, satisfactory implant stability among older children needs to be studied. [ABSTRACT FROM AUTHOR]

Background: Surgical site infections (SSIs) are a pervasive problem in surgery. Sutures coated or impregnated with triclosan might reduce the occurrence of SSIs, but evidence of their efficacy is limited, especially in children.Methods: We designed a randomised, double-blind, controlled trial in patients who underwent elective or daytime emergency surgery at Oulu University Hospital (Oulu, Finland). We included children younger than 18 years staying in the paediatric surgery and orthopaedics ward for any elective or emergency surgery during the daytime and with anticipated use of absorbing sutures. Children were randomly allocated (1:1) to receive either triclosan-containing sutures or ordinary absorbing sutures. The primary outcome was the occurrence of superficial or deep surgical site infections according to the Centers for Disease Control and Prevention criteria within 30 days after surgery. The primary analysis was with modified intention to treat. This trial is registered at ClinicalTrials.gov, number NCT01220700.Findings: Between September, 2010, and December, 2014, 1633 children were recruited. In the modified intention-to-treat group, SSIs occurred in 20 (3%) of 778 patients allocated to receive triclosan-containing sutures and in 42 (5%) of 779 patients allocated to receive control sutures (risk ratio 0·48, 95% CI 0·28-0·80). To prevent one SSI, triclosan-containing sutures had to be used in 36 children (95% CI 21-111). One patient died from suspected mitochondrial disease; no other expected or unexpected adverse events were reported in either of the groups.Interpretation: Use of triclosan-containing sutures effectively reduced the occurrence of all SSIs compared with normal sutures. The results accord with the results of meta-analyses of previous studies in adults. Use of triclosan-containing sutures is a simple way to reduce SSIs in children.Funding: The Alma and K A Snellman Foundation. [ABSTRACT FROM AUTHOR]