Group B Streptococcal Audit

The GBS audit examined current practice in preventing early-onset neonatal group B streptococcal disease (EOGBS).

The project was led by the RCOG and the London School of Hygiene and Tropical Medicine (LSHTM), supported by the Royal College of Midwives and funded by the UK National Screening Committee.

Aims of the audit

  • Investigate the implementation of the RCOG guideline (2012) on preventing EOGBS in NHS maternity units
  • Examine variation in preventive care for EOGBS
  • Identify areas for improving adherence to the RCOG guideline and preventive care

Reports from the GBS audit

Second report, January 2016

Second report from the GBS audit, January 2016 [PDF]

This second and final report contains the results of a survey of midwife-led units, a review of local protocols for preventing EOGBS and a review of written patient information on GBS infection.

Childhood obesity

The Commission on Ending Childhood Obesity (ECHO) has presented its final report to the WHO Director-General, culminating a two-year process to address the levels of childhood obesity and overweight globally.

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The report Ending Childhood Obesity proposes a range of recommendations for governments aimed at reversing the rising trend of children aged under 5 years becoming overweight and obese.

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The 6 main recommendations for governments are:

  • Promote intake of healthy foods

  • Promote physical activity

  • Preconception and pregnancy care

  • Early childhood diet and physical activity

  • Health, nutrition and physical activity for school-age children

  • Weight management

Evidence base for the prevention and management of child obesity

Robertson, W. et al. Paediatrics and Child Health. Available online: 26th January 2016


Image source: Jixuan Zhou

Obesity in childhood is a public health priority. The prevalence of overweight and obesity in children has increased since the mid 1990s, although prevalence is now stabilising. The National Child Measurement Programme shows that a third of 10–11 year olds in England are currently overweight or obese. Obesity increases the risk of poor physical health and mental health in childhood, and children who are obese are more likely to be obese in adulthood.

Four tiers of services are recommended in the care pathway: universal prevention services; lifestyle weight management services often run in the community; specialist support from a clinical team; and surgery (in exceptional circumstances to over 12s). The current evidence on prevention indicates that interventions targeting schools and the home are promising, and reducing free sugar intake and sugar sweetened drinks is fast becoming a policy imperative. The evidence of the effectiveness of tier 2 weight management services is mixed, indicating that childhood obesity is hard to treat. Future research is turning to a whole systems approach to tackle childhood obesity.

In this article we aim to outline how childhood obesity is measured, the scale of the problem globally and in the UK, the determinants and the consequences of childhood obesity. We will then give an overview of prevention and treatment interventions.

Read the abstract here

A Randomized Controlled Trial to Determine the Effect of Depth of Anesthesia on Emergence Agitation in Children.

Anaesthetics News

Fredrick, H. et al. Anesthesia & Analgesia: Published online: January 14, 2016

Background: The cause of emergence agitation (EA) in children is unknown. Rapid emergence from inhaled anesthesia has been implicated because EA is more common with sevoflurane than with halothane. A dose-dependent effect of sevoflurane, which increases seizure-like electroencephalogram activity, has also been proposed.

Methods: To determine whether depth of anesthesia as measured by bispectral index (BIS) affects EA, 40 ASA physical status I to II children aged 2 to 8 years undergoing ophthalmic surgery were enrolled in a blinded randomized controlled trial of low-normal (40-45, deep) versus high-normal (55-60, light) anesthesia. To distinguish transient irritability from severe EA, the primary outcome was first-stage postanesthesia care unit (PACU I) peak Pediatric Assessment of Emergence Delirium (PAED) score, with secondary outcomes of PAED and Face, Legs, Activity, Cry, and Consolability scores at emergence, postoperative fentanyl dose, emergence time, and discharge time. Subjects…

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Crib Bumpers Continue to Cause Infant Deaths: A Need for a New Preventive Approach

Scheers, N. J. et al. The Journal of Pediatrics: Volume 169, February 2016, Pages 93–97.e1

Objectives: To assess whether clutter (comforters, blankets, pillows, toys) caused bumper deaths and provide an analysis of bumper-related incidents/injuries and their causal mechanisms.

Study design: Bumper-related deaths (January 1, 1985, to October 31, 2012) and incidents/injuries (January 1, 1990, to October 31, 2012) were identified from the US Consumer Product Safety Commission (CPSC) databases and classified by mechanism. Statistical analyses include mean age, 95% CIs, χ2 test for trend, and ANOVA with a paired-comparisons information-criterion post hoc test for age differences among injury mechanisms.

Results: There were 3 times more bumper deaths reported in the last 7 years than the 3 previous time periods (χ2(3) = 13.5, P ≤ .01). This could be attributable to increased reporting by the states, diagnostic shift, or both, or possibly a true increase in deaths. Bumpers caused 48 suffocations, 67% by a bumper alone, not clutter, and 33% by wedgings between a bumper and another object. The number of CPSC-reported deaths was compared with those from the National Center for the Review and Prevention of Child Deaths, 2008-2011; the latter reported substantially more deaths than CPSC, increasing the total to 77 deaths. Injury mechanisms showed significant differences by age (F4,120 = 3.2, P < .001) and were caused by design, construction, and quality control problems. Eleven injuries were apparent life-threatening events.

Conclusion: The effectiveness of public health recommendations, industry voluntary standard requirements, and the benefits of crib bumper use were not supported by the data. Study limitations include an undercount of CPSC-reported deaths, lack of denominator information, and voluntary incident reports.

Read the abstract via the Journal of Pediatrics

Survival, Hospitalization, and Acute-Care Costs of Very and Moderate Preterm Infants in the First 6 Years of Life: A Population-Based Study

Stephens, A. et al. The Journal of Pediatrics Volume 169, February 2016, Pages 61–68.e3

Image source: Bobjgalindo

Objectives: To investigate survival, hospitalization, and acute-care costs of very (28-31 weeks’ gestation) and moderate preterm (32-33 weeks’ gestation) infants in the first 6 years of life and compare outcomes with the more widely studied extremely preterm infants (24-27 weeks’ gestation) and to full term (low risk) infants (39-40 weeks’ gestation).

Study design: Birth data from all women residing in New South Wales, Australia, with gestational ages between 24-33 and 39-40 weeks in 2001-2011 were linked probabilistically to hospitalization and mortality data. Study outcomes were evaluated with the use of descriptive and multivariable analyses at birth (N = 559 532), discharge (N = 540 240), and at 1 (N = 487 447) and 6 years of age (N = 230 498).

Results: Mortality was greatest among extremely preterm infants (eg, 31.2% within 6 years) and decreased with increasing gestational age. Likewise, hospitalization within the first year of life increased with decreasing gestational age (aOR 5.5 [95% CI 4.7-6.4], 3.7 [3.4-4.0], and 2.6 [2.5-2.8] for birth at 24-27, 28-31, and 32-33 weeks’ gestation, relative to 39-40 weeks’ gestation). Hospitalization remained significantly increased with preterm birth at each year of age up to 6 years (aORs 1.3-1.6 at 6 years). Cumulative costs were significantly greater with preterm birth within the first year of life, and also between 1 and 6 years of age.

Conclusions: The risks of adverse health outcomes were significantly greater in very and moderately preterm infants relative to full term infants but lower than extremely preterm infants. Crucially, preterm birth was associated with prolonged increased odds of hospitalization (up to age 6 years), contributing to greater resource use.

Read the abstract via the Journal of Pediatrics