Archives of Disease in Childhood - Fetal and Neonatal Edition
ISSN / EISSN : 1359-2998 / 1468-2052
Published by: BMJ (10.1136)
Total articles ≅ 6,326
Latest articles in this journal
Published: 25 October 2021
Archives of Disease in Childhood - Fetal and Neonatal Edition; https://doi.org/10.1136/archdischild-2021-322888
To compare health-related quality of life (HRQL) in childhood for extremely preterm (EP) births before 26 weeks of gestation in England in two eras: 1995 and 2006. Prospective cohort studies. School or home-based assessments at 11 years of age. Available data for 88 EP children born before 26 weeks of gestation in 2006 (EPICure2) were compared with those of 140 born in England during 1995 (EPICure). To account for social secular trends, the comparison between eras was also made for term-born controls as reference. HRQL was measured using the parent-completed Health Utilities Index (HUI) questionnaire with utility scores calculated using the HUI3 classification system. Eight attributes were assessed: vision, hearing, speech, ambulation, dexterity, emotion, cognition and pain. At 11 years, mean utility scores were significantly lower in EPICure2 (2006) than in EPICure (1995; Δ −0.12, 95% CI −0.20 to –0.04). The difference increased (Δ −0.27, 95% CI −0.41 to –0.12) after adjusting for significant perinatal and demographic differences between cohorts. Rates of suboptimal function were increased in EPICure2 for all eight attributes, but statistically significant differences were only found in speech (p=0.004) and dexterity (p=0.020). After excluding children with severe neurodevelopmental impairment, the adjusted difference between cohorts remained significant but attenuated (−0.14 (−0.26 to –0.01)). Mean utility scores for controls were similar between cohorts (Δ −0.01 (−0.04 to 0.02)). Using parent report, there was a clinically significant decline in HRQL ratings for EP children over time. Areas contributing the most to the decline were speech and dexterity. ISRCTN86323684.
Published: 20 October 2021
Archives of Disease in Childhood - Fetal and Neonatal Edition, Volume 106; https://doi.org/10.1136/archdischild-2020-320901corr1
Published: 20 October 2021
Archives of Disease in Childhood - Fetal and Neonatal Edition, Volume 106, pp 571-571; https://doi.org/10.1136/archdischild-2021-323337
Francesco Cavallin and colleagues performed a randomised controlled study in 15 Italian tertiary hospitals. They studied infants with estimated birthweight <1500 g or gestation <30+6 weeks. In one group manually adjusted thermal control was provided during initial stabilisation, with the heater set on full. In the other group servo control was used. There were 450 infants in the study. There was no difference in the rate of normothermia (temperature 36.5–37.5 C) at the time of neonatal unit admission. All infants were placed in plastic bags. Normothermia rates were relatively low in both groups (39.6% and 42.2%), with hypothermia being more frequent. Very few infants were hyperthermic. Servo control of temperature during initial stabilisation offered no advantage. Low normothermia rates show that initial thermal care is a complex dynamic process challenge that is not solved simply by choice of equipment. See page F572
Published: 19 October 2021
Archives of Disease in Childhood - Fetal and Neonatal Edition; https://doi.org/10.1136/archdischild-2021-322813
Published: 19 October 2021
Archives of Disease in Childhood - Fetal and Neonatal Edition; https://doi.org/10.1136/archdischild-2021-322611
Background Guidelines advise for more than 20 years to use occlusive plastic wraps for temperature management during delivery room care but data on efficacy of different types of wrap are still scarce. Methods A random sample of seven different types of plastic wrap was tested using prewarmed aluminium blocks. Results The most effective wrap increased the time to cool by 2°C by one-third for the core and by 100% for the surface whereas the least effective wrap led to even faster heat loss compared with no wrap at all. The least effective wrap concerning all capacities tested was made from polyurethane that contains potentially toxic and narcotic monomers. Heat and water retention did not correlate to wrap thickness. Discussion Large differences in heat and water retention capacity warrant a careful choice of the type of wrap as some might be counterproductive. Wraps containing polyurethane should not be used.
Archives of Disease in Childhood - Fetal and Neonatal Edition; https://doi.org/10.1136/archdischild-2021-321967
Objective To look at the association of socioeconomic status (SES) with the suitability of the maternity where children are born and its association with mortality. Design Retrospective analysis of a prospective cohort constituted using hospital discharge databases. Setting France Population Live births in 2012–2014 in maternity hospitals in mainland France followed until discharge from the hospital. Main outcome measure Unsuitability of the maternity to newborns’ needs based on birth weight and gestational age, early transfers (within 24 hours of birth) and in-hospital mortality. Results 2 149 454 births were included, among which 155 646 (7.2%) were preterm. Preterm newborns with low SES were less frequently born in level III maternities than those with high SES. They had higher odds of being born in an unsuitable maternity (OR=1.174, 95% CI 1.114 to 1.238 in the lowest SES quintile compared with the highest), and no increase in the odds of an early transfer (OR=0.966, 95% CI 0.849 to 1.099 in the lowest SES quintile compared with the highest). Overall, newborns from the lowest SES quintile had a 40% increase in their odds of dying compared with the highest (OR=1.399, 95% CI 1.235 to 1.584). Conclusions Newborns with the lowest SES were less likely to be born in level III maternity hospitals compared with those with the highest SES, despite having higher prematurity rates. This was associated with a significantly higher mortality in newborns with the lowest SES. Strategies must be developed to increase health equity among mothers and newborns.
Archives of Disease in Childhood - Fetal and Neonatal Edition; https://doi.org/10.1136/archdischild-2021-322565
Archives of Disease in Childhood - Fetal and Neonatal Edition; https://doi.org/10.1136/archdischild-2021-322762
Archives of Disease in Childhood - Fetal and Neonatal Edition; https://doi.org/10.1136/archdischild-2021-323100
Published: 7 October 2021
Archives of Disease in Childhood - Fetal and Neonatal Edition; https://doi.org/10.1136/archdischild-2021-321633
Objective Neonatal-onset mitochondrial disease has not been fully characterised owing to its heterogeneity. We analysed neonatal-onset mitochondrial disease in Japan to clarify its clinical features, molecular diagnosis and prognosis. Design Retrospective observational study from January 2004 to March 2020. Setting Population based. Patients Patients (281) with neonatal-onset mitochondrial disease diagnosed by biochemical and genetic approaches. Interventions None. Main outcome measures Disease types, initial symptoms, biochemical findings, molecular diagnosis and prognosis. Results Of the 281 patients, multisystem mitochondrial disease was found in 194, Leigh syndrome in 26, cardiomyopathy in 38 and hepatopathy in 23 patients. Of the 321 initial symptoms, 236 occurred within 2 days of birth. Using biochemical approaches, 182 patients were diagnosed by mitochondrial respiratory chain enzyme activity rate and 89 by oxygen consumption rate. The remaining 10 patients were diagnosed using a genetic approach. Genetic analysis revealed 69 patients had nuclear DNA variants in 36 genes, 11 of 15 patients had mitochondrial DNA variants in five genes and four patients had single large deletion. The Cox proportional hazards regression analysis showed the effects of Leigh syndrome (HR=0.15, 95% CI 0.04 to 0.63, p=0.010) and molecular diagnosis (HR=1.87, 95% CI 1.18 to 2.96, p=0.008) on survival. Conclusions Neonatal-onset mitochondrial disease has a heterogenous aetiology. The number of diagnoses can be increased, and clarity regarding prognosis can be achieved by comprehensive biochemical and molecular analyses using appropriate tissue samples.