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Background and Aims

Studies on the impact of very preterm birth (VPT) birth on cognition have concluded that cognitive outcomes have not improved since the 1990s. This study aimed to evaluate the trends over time in studies published up to March 2022.

Methods

All primary studies from five systematic reviews investigating the consequences of VPT birth on childhood IQ before 2018 were included and literature searches were extended to March 2022. Information on country of origin, birth years, gestational age and/or birth weight selection criteria and relevant results were extracted. Pooled standardized mean difference (SMD) in intelligence quotient (IQ) between full term and VPT children were estimated and plotted against birth year using cubic spline modeling.

Results

A total of 237 primary studies reporting results from 135 unique VPT cohorts (including 36 from the extended search) were identified. Birth years varied between 1977 and 2016, with 50% with the birth year≥1998. 46% of cohorts were from Europe. The SMD for children born VPT (<32 weeks/<1500g) was 0.74 (79 cohorts; equivalent to a deficit of 11 points, 95%CI 0.67; 0.82) whereas this was 0.95 (28 cohorts; 14 IQ points; 95%CI 0.84;1.07) for extremely preterm (EPT,<28/<1000g). Cubic spline model showed an inverted U-shape relationship between median birth year and the SMDs (figure) with effect sizes reducing since the mid-90s.

Conclusions

Differences in cognition between FT and EPT/VPT may have increased in the 1990s before starting to decline in more recent years, with a different infection point for EPT and VPT births.

Background and Aims

Ten-fold dose errors pose a significant risk to children. The aim of this study was to explore ten-fold errors reported in two hospitals (Sweden and England) and establish any differences in practice which may impact the likelihood of ten-fold errors.

Methods

This was an ecological study. All medication incidents reported in two one-year periods (2017 and 2020) were reviewed. Data including drug name, location, error-type and whether the error reached a patient or not were extracted from the free-text of ten-fold errors reported.

Results

3,596 medication errors were reported. 132 (3.7%) involved a ten-fold error of which 68 reached a patient (53%). The overall rate of ten-fold errors/admission was the same for both hospitals (0.13%), however the rate of ten-fold errors/admission reaching patients differed (0.05% vs 0.1%). In both hospitals, critical care areas reported the most ten-fold errors and opioids were most frequently involved. Prescribing errors were most frequent in the English hospital and administration errors in the Swedish hospital. Processes for prescribing and administration in the hospitals were different.

Conclusions

The differences identified between the hospitals included; near-miss reporting, double-checking practices, neonatal and cardiovascular care and prescribing (paper vs electronic systems).

The similarities between the hospitals were the overall rate of ten-fold error reporting, the drugs involved and administration errors reaching patients.

Comparing hospital medication errors is not recommended due to cultural and organizational aspects, but with a no-blame, careful ecological approach, the information can be used to generate hypothesis for improvement work.

Background and Aims

There is weak evidence that the use of proton pump inhibitors (PPIs) in infancy alleviates non-specific complaints of irritability and spitting often attributed to gastroesophageal reflux. Current international guidelines suggest restrictive use in infants, and we therefore aimed to study temporal trends in the use in this age group.

Methods

This is an observational population-based study of infants (0-11 months) living in Norway, Sweden and Denmark in 2007-2020. We utilised nation-wide registers for pharmaceuticals to study dispensed prescriptions of PPIs. The three countries have approximately 240 000 births annually, and data collected over 14 years provided a total of 3.3 million observed years.

Results

Since 2007, the use of PPI in infancy showed a marked increase in all three countries (Figure). In 2020, PPI use was highest in Denmark (46/1000/year), however this has decreased by 42% since 2017. There was a more than five-fold increase in the number of dispensed prescriptions of PPI in Norway and Sweden. The use increased steadily from 2007 until 2020 reaching 23 and 19 dispensed prescriptions per 1000 children per year.

Conclusions

Despite international recommendations against routine PPI use in infancy, its use in Norway, Sweden and Denmark has increased several-fold over the past two decades. While the reason for the notable increased PPI use in Scandinavian infants cannot be ascertained form our data, this large variation in time and geography likely indicates an unwarranted use.

Background and Aims

There is growing concern that post-tuberculosis sequelae and morbidity are substantial but no studies have included children or controlled for predisposing factors prior to disease.

Methods

We prospectively followed children in a South African birth cohort study. Children were followed for growth, general health, intercurrent wheezing, and tuberculosis using a range of diagnostic tests including culture, Xpert MTB/RIF, chest radiography, symptom screening, and physical examinations. Lung function was assessed in unsedated children at 6 weeks, 1 year, and then annually until 5 years of age. Testing included tidal breathing, exhaled nitric oxide (eNO), and multiple breath washout measures.

Results

Of 1,068 included participants, a total of 25,096 lung function (15,577 tidal breathing, 2,083 eNO, and 7,436 multiple breath washout) and 11,364 anthropometric (5,720 weight and 5,644 length) assessments were performed during follow-up. Tuberculosis was associated with subsequent impaired lung function and lower anthropometric measurements at 5 years of age including tidal volume (-9.32 mL; 95% CI, -14.89, -3.75), length-for-age z-scores (-0.40; 95% CI, -0.68, -0.11), weight-for-age z-scores (-0.30; 95% CI, -0.59, -0.01), and BMI z-scores (-0.54; 95% CI, -0.83, -0.25). Children developing tuberculosis <1 year of age were more likely to wheeze after 1 year (AOR, 2.3; 95% CI, 1.0–5.4) and have recurrent wheezing (AOR, 5.8; 95% CI, 1.1–30.4) during childhood. Lung involvement in chest X-rays modified these relationships.

Conclusions

Tuberculosis in early childhood has long term detrimental general and lung health effects, even after controlling for pre-existing factors.

Background and Aims

This paper explores the diagnostic potential of social atom diagrams in clinical psychiatric diagnostic of patients aged 7 to 17.

The study‘s main focus was on comparing the social atom diagrams between the study group and general population as well as revealing connections between psychiatric disorders and diagrams‘ unique features.

Methods

A retrospective case-control study was conducted. The paper focused on comparing the properties in social atom diagrams of children/adolescents in the age group of 7-17 with psychiatric disorders to that of the general population of the same age. Overall 332 diagrams of social atom were analyzed. Control group included 274 diagrams while clinical group consisted of 58 charts. The patients in clinical group were all treated in Vilnius university Hospital, Child Development center in duration from 12/2019 to 05/2020. Sample’s sociological data was considered as well as features of SoA diagrams­­. Descriptive statistics criteria Spearman’s rank correlation, Mann-Whitney and Chi-square tests were used. With statistical significance level being p<0,05.

Results

Numerous characteristics of both clinical and control groups have been observed in social atom diagrams. Evaluation of comprehensive visual structure features proposes that SoA can be used in practice as a diagnostic tool. An in depth analysis is required for more certain results.

Conclusions

Significant differences in SoA between clinical and control groups were found. These findings reinforce the approach to social atom diagrams as a valuable instrument in clinical psychiatric diagnostic.