Aerobic exercise moderately reduces depressive symptoms in new mothers

Doing aerobic exercise can reduce the level of depressive symptoms experienced by women who have had a baby in the past year | British Journal of General Practice |via National Institute for Health Research (NIHR)


This review of 13 studies showed that involving new mothers in group exercise programmes, or advising them on an exercise of their choice, reduced depressive symptoms compared with usual care. The effect was moderate but significant. Examples of exercise were pram walks, with dietary advice from peers in some studies. The benefits were shown whether or not the mothers had postnatal depression.

The NIHR reports that the evidence does have some limitations regarding its quality but is the best research currently available. This review should give additional confidence to health visitors and GPs to advise women that keeping active after birth can benefit their mental and physical health.

Further detail at NIHR

Full reference: Pritchett R V, Daley A J, Jolly K. Does aerobic exercise reduce postpartum depressive symptoms? A systematic review and meta-analysis. British Journal of General Practice. 2017;67(663)

Multiple birth babies requiring neonatal care

Twin pregnancy and neonatal care in England: a Tamba report | The Twins and Multiple Births Associations   (TAMBA)

This report includes information from neonatal networks for stillbirth rates, neonatal death rates, NICE compliance and neonatal admissions for twins.

Findings revealed that twins were 2.5 times more likely to result in a stillbirth and more than five times more likely to result in a neonatal death, in comparison to singleton pregnancies. The report is being submitted to the national review into neonatal services with a call to highlight where and how care should be delivered to multiple birth babies.

Full document available here

Additional link: Royal College of Midwives press release

High-impact innovations for patient benefit

App that helps pregnant women monitor hypertension among new NHS innovations that will save lives and improve treatment | NHS England


A wireless sensor that better detects breathing rate in hospital patients, an app to help pregnant women monitor hypertension and another that directs patients with minor injuries to treatment units with the shortest queues are among the latest innovations set to be spread across the NHS.

Eleven projects are being backed in the latest round of NHS England’s programme to develop and spread pioneering ideas, equipment and technology that have the potential to save lives as well as money.

Further detail of this latest round of the NHS Innovation Accelerator (NIA) programme  can be found at NHS England



Efficacy and Safety of HLD200, Delayed-Release and Extended-Release Methylphenidate, in Children with Attention-Deficit/Hyperactivity Disorder

JPliszka Steven R., Wilens Timothy E., Bostrom Samantha, Arnold Valerie K., Marraffino Andrea, Cutler Andrew J., López Frank A., DeSousa Norberto J., Sallee Floyd R., Incledon Bev, Newcorn Jeffrey H., and On behalf of the HLD200-108 Study Group. Journal of Child and Adolescent Psychopharmacology. August 2017, 27(6): 474-482.

Objective: Evening-dosed HLD200 is a delayed-release and extended-release methylphenidate (DR/ER-MPH) formulation consisting of uniform, dual-layered microbeads with an inner drug-loaded core. DR/ER-MPH is designed to delay the initial release of drug by 8–10 hours, and thereafter, provide a controlled, extended drug release to target onset of effect upon awakening that lasts into the evening. This phase 3 study evaluated the safety and efficacy of DR/ER-MPH on symptoms and temporal at-home functional impairment in children with attention-deficit/hyperactivity disorder (ADHD).

Methods: This 3-week, randomized, double-blind, multicenter, placebo-controlled, parallel-group, forced-dose titration trial evaluated DR/ER-MPH (40–80 mg/day) in children aged 6–12 years with ADHD. Primary efficacy endpoint was the ADHD rating scale–IV (ADHD-RS-IV), and the key secondary endpoints were the Before-School Functioning Questionnaire (BSFQ), and Parent Rating of Evening and Morning Behavior-Revised, morning (PREMB-R AM) and evening (PREMB-R PM). Safety measures included spontaneously reported treatment-emergent adverse events (TEAEs) and two TEAEs of special interest, appetite suppression and insomnia (with direct questioning on sleep disturbance).

Results: One hundred sixty-one participants were included in the intent-to-treat population (DR/ER-MPH, n = 81; placebo, n = 80). After 3 weeks, DR/ER-MPH achieved significant improvements versus placebo in ADHD symptoms (least-squares [LS] mean ADHD-RS-IV: 24.1 vs. 31.2; p = 0.002), and at-home early morning (LS mean BSFQ: 18.7 vs. 28.4; p < 0.001; LS mean PREMB-R AM: 2.1 vs. 3.6; p < 0.001) and late afternoon/evening (LS mean PREMB-R PM: 9.4 vs. 12.2; p = 0.002) functional impairment. Commonly reported TEAEs (≥10%) were insomnia and decreased appetite.

Conclusions: DR/ER-MPH was generally well tolerated and demonstrated significant improvements versus placebo in ADHD symptoms and at-home functional impairments in the early morning, late afternoon, and evening in children with ADHD.

Early pregnancy care

Clinical nurse specialist in early pregnancy care | The Royal College of Nursing

This document outlines the key skills and knowledge required to develop the role of the clinical nurse specialist in early pregnancy care.  It is intended to provide direction for commissioners and managers when creating roles to support best practice in local service provision for women and their families.

Full document: Clinical Nurse Specialist in Early Pregnancy Care

A step-by-step approach to paediatric neutropenia

Thomas, Angela E. et al.  Paediatrics and Child Health , Volume 27 , Issue 11 , 511 – 516

Neutropenia is a common laboratory finding in children. The aetiology varies from benign transient post-viral suppression to overwhelming systemic disease. For medical providers, identification of the aetiology of neutropenia can be difficult, but clarification of the cause is important for determining management and prognosis. Neutropenia in children may be discovered during evaluation of a fever or illness, or may be found incidentally when a full blood count is undertaken for other reasons. It may be an isolated finding or may be associated with suppression of other cell lines. It is important to distinguish between transient or benign causes and severe congenital neutropenia or neutropenia associated with serious haematological or systemic disease. Appropriate advice and treatment must be given while further assessment and investigation take place. In this review, we will discuss how and where patients may present, initial management and investigation and when and with what urgency to refer to specialty care.

The haematological investigation of suspected Non Accidental Injury

Williams, Michael et al.  Paediatrics and Child Health , Volume 27 , Issue 11 , 495 – 499

Most children suspected of Non Accidental Injury (NAI) will undergo a number of haematological investigations to exclude coagulation defects. Investigations should be dependent on the clinical presentation but often there can be an over or under-requesting of haematological investigations. The correct interpretation of results is reliant on an understanding of both the physiological processes involved in coagulation in children of different ages and of the laboratory testing of the coagulation systems. Age-specific, population-based studies of bruising and bleeding patterns in normal children, NAI children and children with congenital bleeding disorders may be helpful in limiting the number of investigations undertaken for suspected NAI. Investigation of suspected Non Accidental Injury requires a multidisciplinary approach; close liaison between the haematology laboratory and the requesting clinician is integral to this approach. This article describes the use of a staged approach to laboratory investigation.