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Hassan Al-shehri,1 Dania T Dahmash,2 Niels Rochow,3,4 Basma Alturki,5 Danah Alrajhi,5 Faisal Alayed,5 Faisal Alhazani,5 Hanan Alsuhibany,5 Abdallah Y Naser6 1Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia; 2ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; 3Department of Pediatrics, Rostock University Medical Center, Rostock, 18057, Germany; 4Department of Pediatrics, Paracelsus Medical University, Nuremberg, 90471, Germany; 5College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia; 6Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, 11622, JordanCorrespondence: Abdallah Y Naser, Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan, Tel +962 795285555, Email abdallah.naser@iu.edu.joPurpose: To analyze trends of conditions originating in the perinatal period (COPP) in England and Wales between 1999 and 2020.Patients and methods: An ecological study of COPP was conducted using hospital admission data from April 1999 to March 2020 from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales.Results: The overall hospital admission rates increased by 41.6%, from 1913 per 100,000 persons (95% CI: 1905– 1922) in 1999 to 2709 (95% CI: 2700– 2719) in 2020 (trend test p< 0.001). The most common causes for neonatal admissions were disorders related to the length of gestation and fetal growth, respiratory and cardiovascular disorders specific to the perinatal period, and hemorrhagic and hematological disorders of newborns (28.8%, 27.3%, and 15.2%, respectively). Although the admission rates increased for both males and females (by 33.1% and 35.1%, respectively), hospital admission rates for all causes were higher among males compared to females (p< 0.05).Conclusion: COPP-related hospital admissions rate in England and Wales increased significantly over the past 21 years. Notably, the proportion of COPP-related hospital admissions of males was higher than females. Further studies are warranted to explore the role of gender in hospital admissions and health care for COPP.Keywords: admissions, England, hospital, perinatal, United Kingdom, Wales

Hassan Al-shehri,1 Mohamed O’haj,2 Rayan Elsini,3 Hatem Alharbi,3 Mosleh Jabari,1 Fahad Al-Qashar,4 Niels Rochow5 1Department of Pediatrics, College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia; 2Department of Biochemistry, College of Medicine, University of Bisha, Bisha, Saudi Arabia; 3College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia; 4Department of Pediatrics, Bahrain Defence Force Hospital, Royal Medical Services, Riffa, Bahrain; 5Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada Background: Problem-based learning (PBL) is a method by which students solve clinical scenarios in a small group discussion. The aim of this study was to assess the implementation of PBL in Saudi Universities.Methods: This is a cross-sectional study including 151 participants from 16 universities. A questionnaire was distributed to the faculty members through e-mail messages. The questionnaire consisted of 35 questions with 5-point Likert scale arranged in three subscales.Results: The total mean of PBL implementation score was 2.5 (SD =0.39). The scores of the three PBL implementation subscales showed marked variance, with the average score of the subscale “overall PBL experience in my college” being the most highly affected, with an average score of (3.07, SD =0.72), followed by “implementation of PBL model” (2.36, SD=0.47). The least affected subscale was “preparation for PBL implementation” (2.13, SD =0.67).Conclusion: Relatively moderate level of PBL implementation was observed in Saudi Arabia. However, we suggest that more courses should be introduced in order to improve the skills of faculty members and provide a strong infrastructure to implement PBL model in Saudi medical colleges. Keywords: Saudi Arabia, medical students, problem-based learning, implementation

Objective This study investigated the onset and the choice of treatment in children with very early onset of type 1 diabetes mellitus (T1D). Methods The study included 5,763 patients from the German Diabetes Patient Follow-up registry with onset of T1D in the first 4 years of life from January 2010 – June 2022. The analysis included diabetes-specific parameters, anthropometric data, and mode of treatment at onset, within the first and second year of T1D. Three groups were compared according to age at onset (G1: 223 patients 6–<12 months, G2: 1519 patients 12–<24 months, G3: 4001 patients 24–48 months). Results In 12.3% of all cases in childhood and adolescence, the incidence of diabetes in the first 4 years of life was rare. At the onset, clinical status was worse and diabetic ketoacidosis (DKA) rates were higher in G1 and G2 (52.3% and 46.5%, respectively) compared to G3 (27.3% (p<0.001)). G1 and G2 were significantly more likely to be treated with insulin pump therapy (CSII) 2 years after onset (98.1% and 94.1%, respectively)) compared to G3 (85.8%, p<0.001). Median HbA1c after 2 years did not differ between groups (G1: 7.27% (56.0 mmol/mol), G2: 7.34% (56.7 mmol/mol) and G3: 7.27% (56.0 mmol/mol)) or when comparing CSII vs MDI. The rate of severe hypoglycemia (SH) and DKA during the first 2 years of treatment did not differ among the three groups, ranging from 1.83–2.63/100 patient-years (PY) for DKA and 9.37–24.2/100 PY for SH. Children with T1D under 4 years of age are more likely to be diagnosed with celiac disease but less likely to have thyroiditis than older children with T1DM. Conclusions Young children with T1D had high rates of DKA at onset and were predominantly treated with insulin pump therapy during the first 2 years. The median HbA1c for all three groups was<7.5% (58 mmol/mol) without increased risk of SH or DKA. The use of continuous glucose monitoring (CGM) was not associated with lower HbA1c in children under 48 months. [ABSTRACT FROM AUTHOR]

Neonatal anthropometric data reflect intrauterine development and correlate with postnatal outcome. Therefore, classification of neonates by body dimensions, using gestational age-adjusted population percentiles, is clinically practiced. However, neonatal anthropometric variables are also influenced by maternal constitution and the extent of this influence is currently unknown. We analyzed small for gestational age (SGA) and large for gestational age (LGA) rates according to maternal height and weight. We used data of about 2.3 million singleton pregnancies from the German Perinatal Survey of 1995-2000. A close correlation between maternal and neonatal anthropometric data was found; SGA rates were inversely proportional and LGA rates were directly proportional to maternal height, weight, and body mass index. Neonates of small and light mothers (<155 cm, <50 kg) had, according to the presently used classification scheme, an SGA rate of 25.3% and an LGA rate of 1.7%, respectively. Newborns to tall and heavy women (>179 cm, >89 kg) had a much lower SGA rate (3.1%) and a much higher LGA rate (30.6%). Neonatal body length and head circumference depended on maternal stature in a similar way. Some neonates who are 'appropriate' for their gestational age in that they achieve their genetically determined growth potential are therefore apparently misclassified as SGA or LGA. [ABSTRACT FROM AUTHOR]

Objective: Birth weight percentiles based on weekly measurements are used to assess the nutritional status of preterm infants. However, as preterm infants exhibit a rapid growth rate (up to 20 g/kg/day), their body weight can increase by 15% per week. We calculated birth weight percentiles based on daily measurements, to more precisely classify very preterm infants (gestational age of 154-223 days). Methods: Data of 23,864 (10,720 females and 13,144 males) very preterm singleton infants with a gestational age of 154-223 days (22-31 completed weeks) were retrieved from the German perinatal statistics of 1995-2000. Percentile curves based on the empirical birth weight data were subjected to three statistical smoothing procedures: cubic regression, local regression (LOESS smoothing), and the LMS method. Results: Smoothing of the birth weight percentiles using cubic regression produced the smallest residual variance. Conclusion: Birth weight percentiles based on daily averages allow a more precise assessment of the somatic development of preterm infants. [ABSTRACT FROM AUTHOR]