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The objective of the present study was to describe the changes in glycaemic control based on data from the nationwide Danish Registry of Childhood Diabetes with valid haemoglobin A1c (HbA1c) readings centrally analysed between 1996 and 2006. The glycaemic control was assessed using generalized linear mixed models. Centre, age, diabetes duration, ethnicity, sex, self-monitoring of blood glucose, insulin regimens and hypoglycaemia was tested as explanatory variables. There were 9291 HbA1c recordings from 2705 children with T1D during the 10-yr period. The unadjusted mean HbA1c value in 1997 was 9.05% (95% CI ± 0.82) and in 2006 was 8.20% (95% CI ± 0.06). Mean HbA1c was significantly reduced over the years with a linear decrease of 0.08% per year (95% CI ±0.011) (p < 0.0001). The decrease was unaffected by adjusting for number of injections, insulin/kg and use of insulin analogous. During the period, an increased frequency of self-monitored blood glucose was observed that was associated with a reduction in HbA1c (p < 0.0001). The percentage of children with severe hypoglycaemia decreased from 12.2 to 7.8% in those with HbA1c between 6 and 8%. Metabolic control in diabetic children has improved on a nationwide basis from the establishment of the national registry in 1996. The reduction in HbA1c was related to an increased number of self-monitoring of blood glucose values and a decrease in the number of hypoglycaemic events in those with the best metabolic control, whereas there were no association with the use of new analogous or insulin regimens. [ABSTRACT FROM AUTHOR]

Abstract Aim To describe the management of children and adolescents with Type 1 diabetes mellitus in Denmark. Methods Quality indicators with standards of childhood diabetes management were chosen based on international and national guidelines. Data originated from the nation-wide Danish Registry for Childhood Diabetes and two questionnaires: one questionnaire was sent to all children with diabetes (response rate 78%, n = 1335) and the other was sent to the 19 centres in Denmark treating these children (response rate 100%). Simultaneously, the children were asked to take a blood sample for central HbA1c -analysis (normal range 4.3–5.8, mean 5.1%). Results Most children were managed at centres which complied with the standards for the process indicators for good diabetes management, but not with the standards for most structure and outcome indicators. Only one third of the children reached the treatment target for HbA1c . Their mean HbA1c -level increased gradually from ages 4–14 without significant difference between genders. The youngest children had the lowest HbA1c (mean 8.2%) and the lowest rate of severe hypoglycaemic events (4.6 events per 100 patient years). The subgroup of children without any hypoglycaemic events had the significantly lowest mean HbA1c -level (8.6%, P = 0.028). Conclusions The Danish Registry for Childhood Diabetes provided useful data for quality improvement, but had to be supplemented with data from questionnaires on the structure and process indicators. Outcome of paediatric diabetes management in Denmark was unsatisfactory. Centres need feedback on ways to improve care to lower the children's risk of developing severe diabetes complications. Diabet. Med. 20, 568–574 (2003). [ABSTRACT FROM AUTHOR]

The primary purpose of treating chronic hepatitis C (HCV) is to prevent the development of liver fibrosis, cirrhosis, and cancer. In the last decade, direct-acting antiviral medicine (DAA) has been approved to treat children with HCV. This treatment has a higher efficacy, shorter duration, and milder side effects than the previously approved treatment. In this review, it is recommended to track down children who might be infected with HCV to enhance early treatment to prevent transmission of the virus and the possible complications., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Relapse of neonatal meningitis is most commonly caused by Escherichia coli . Management to prevent relapse varies and evidence is limited. We present four cases of relapsing neonatal E. coli meningitis in Denmark in 2016-2017 and review the current literature on this subject. During the primary episodes, our patients received cephalosporin for 3 weeks and gentamicin for the first 3 days. The only identified risk factor was delayed CSF sterilization in three of four cases and no repeated lumbar puncture. Relapse occurred after 2-28 days; one case with ventriculitis and one with empyema. Relapses were treated for 6-14 weeks with monotherapy. No children had an underlying disease predisposing to E. coli meningitis. There is generally a trend towards reducing invasive procedures, e.g., lumbar puncture and the length of intravenous antibiotics in pediatric infectious diseases, but our cases highlight a condition where the opposite might be needed.

Aim: The aim of this study was to describe the epidemiological and clinical characteristics in children with either chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection in Denmark., Methods: In this observational study, children and adolescents with either chronic HBV or HCV infection followed at the largest paediatric departments in Denmark between 2001 and 2013 were included. Data collection included as well epidemiological data as clinical data like virus genotype, viral load, serological markers, liver biochemistry, liver elastography and histology if available., Results: The study included 131 children. None of the patients had decreased liver function or end-stage liver disease during follow-up. Ten of the 18 children who underwent liver biopsy had signs of fibrosis. Thirteen (11%) children with HBV and one (7%) child with HCV received treatment. Different indications and different treatment regimens were used., Conclusion: This study confirms that chronic HBV and HCV infections are often mild diseases during childhood. Nevertheless, children are at higher risk of serious liver disease early in life because of the early time of infection and probably also because of the high viral loads., (© 2020 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Chronic hepatitis B (HBV) infection is seen in 400 million persons worldwide. HBV is transmitted vertically or horizontally by infected blood and body fluids. An effective vaccine exists. Most children develop a chronic HBV infection if infected early in life. They are often in an immune-tolerant phase with no indication for antiviral treatment. Antiviral treatment with interferon or a nucleotide analogue is a possibility if the HBV infected child develops into a phase of immune activation. HBV infection can lead to liver cirrhosis and hepatocellular carcinoma.

Chronic hepatitis C (HCV) infection has a prevalence of 2-3% worldwide. The vertical transmission rate is approximately 5%. There is no evidence to recommend abstinence from breastfeeding or elective C-section to prevent transmission. In children, the natural history of HCV infection is typically benign, but liver cirrhosis and hepatocellulary carcinoma are later complications. Children with HCV infection may benefit from early treatment with pegylated interferon and ribavirin with duration depending on genotype. Overall, response to antiviral treatment of HCV infected children is comparable to results in adults.