Duration of Breastfeeding and Risk of SIDS: An Individual Participant Data Meta-analysis

John M.D. Thompson, Kawai Tanabe, Rachel Y. Moon, Edwin A. Mitchell, Cliona McGarvey, David Tappin, Peter S. Blair, Fern R. Hauck. Pediatrics Vol. 140 No. 5 November 01, 2017

CONTEXT: Sudden infant death syndrome (SIDS) is a leading cause of postneonatal infant mortality. Our previous meta-analyses showed that any breastfeeding is protective against SIDS with exclusive breastfeeding conferring a stronger effect.The duration of breastfeeding required to confer a protective effect is unknown.

OBJECTIVE: To assess the associations between breastfeeding duration and SIDS.

DATA SOURCES: Individual-level data from 8 case-control studies.

STUDY SELECTION: Case-control SIDS studies with breastfeeding data.

DATA EXTRACTION: Breastfeeding variables, demographic factors, and other potential confounders were identified. Individual-study and pooled analyses were performed.

RESULTS: A total of 2267 SIDS cases and 6837 control infants were included. In multivariable pooled analysis, breastfeeding for <2 months was not protective (adjusted odds ratio [aOR]: 0.91, 95% confidence interval [CI]: 0.68–1.22). Any breastfeeding ≥2 months was protective, with greater protection seen with increased duration (2–4 months: aOR: 0.60, 95% CI: 0.44–0.82; 4–6 months: aOR: 0.40, 95% CI: 0.26–0.63; and >6 months: aOR: 0.36, 95% CI: 0.22–0.61). Although exclusive breastfeeding for <2 months was not protective (aOR: 0.82, 95% CI: 0.59–1.14), longer periods were protective (2–4 months: aOR: 0.61, 95% CI: 0.42–0.87; 4–6 months: aOR: 0.46, 95% CI: 0.29–0.74).

LIMITATIONS: The variables collected in each study varied slightly, limiting our ability to include all studies in the analysis and control for all confounders.

CONCLUSIONS: Breastfeeding duration of at least 2 months was associated with half the risk of SIDS. Breastfeeding does not need to be exclusive to confer this protection.

 

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Medical Cannabinoids in Children and Adolescents: A Systematic Review

Shane Shucheng Wong, Timothy E. Wilens. Pediatrics Vol. 140 No. 5 November 01, 2017

CONTEXT: Legalization of medical marijuana in many states has led to a widening gap between the accessibility and the evidence for cannabinoids as a medical treatment.

OBJECTIVE: To systematically review published reports to identify the evidence base of cannabinoids as a medical treatment in children and adolescents.

DATA SOURCES: Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a search of PubMed, Medline, and the Cumulative Index to Nursing and Allied Health Literature databases was conducted in May 2017.

STUDY SELECTION: Searching identified 2743 citations, and 103 full texts were reviewed.

DATA EXTRACTION: Searching identified 21 articles that met inclusion criteria, including 22 studies with a total sample of 795 participants. Five randomized controlled trials, 5 retrospective chart reviews, 5 case reports, 4 open-label trials, 2 parent surveys, and 1 case series were identified.

RESULTS: Evidence for benefit was strongest for chemotherapy-induced nausea and vomiting, with increasing evidence of benefit for epilepsy. At this time, there is insufficient evidence to support use for spasticity, neuropathic pain, posttraumatic stress disorder, and Tourette syndrome.

LIMITATIONS: The methodological quality of studies varied, with the majority of studies lacking control groups, limited by small sample size, and not designed to test for the statistical significance of outcome measures. Studies were heterogeneous in the cannabinoid composition and dosage and lacked long-term follow-up to identify potential adverse effects.

CONCLUSIONS: Additional research is needed to evaluate the potential role of medical cannabinoids in children and adolescents, especially given increasing accessibility from state legalization and potential psychiatric and neurocognitive adverse effects identified from studies of recreational cannabis use.

 

Neurodevelopment at Age 10 Years of Children Born <28 Weeks With Fetal Growth Restriction

Steven J. Korzeniewski, Elizabeth N. Allred, Robert M. Joseph, Tim Heeren, Karl C.K. Kuban, T. Michael O’Shea, Alan Leviton, for the ELGAN Study Investigators. Pediatrics Vol. 140 No. 5 November 01, 2017

OBJECTIVES: We sought to evaluate the relationships between fetal growth restriction (FGR) (both severe and less severe) and assessments of cognitive, academic, and adaptive behavior brain function at age 10 years.

METHODS: At age 10 years, the Extremely Low Gestational Age Newborns Cohort Study assessed the cognitive function, academic achievement, social-communicative function, psychiatric symptoms, and overall quality of life of 889 children born before 28 weeks’ gestation. A pediatric epileptologist also interviewed parents as part of a seizure evaluation. The 52 children whose birth weight z scores were <−2 were classified as having severe FGR, and the 113 whose birth weight z scores were between −2 and −1 were considered to have less severe FGR.

RESULTS: The more severe the growth restriction in utero, the lower the level of function on multiple cognitive and academic achievement assessments performed at age 10 years. Growth-restricted children were also more likely than their extremely preterm peers to have social awareness impairments, autistic mannerisms, autism spectrum diagnoses, difficulty with semantics and speech coherence, and diminished social and psychosocial functioning. They also more frequently had phobias, obsessions, and compulsions (according to teacher, but not parent, report).

CONCLUSIONS: Among children born extremely preterm, those with severe FGR appear to be at increased risk of multiple cognitive and behavioral dysfunctions at age 10 years, raising the possibility that whatever adversely affected their intrauterine growth also adversely affected multiple domains of cognitive and neurobehavioral development.

Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation

Duarte A, Mebrahtu T, Saramago Goncalves PS, Harden M, Murphy R, Palmer S, et al. Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation. Health Technol Assess 2017;21(64)

Review of 3 RCTs and 6 observational studies found that biological treatments may not be cost effective for the management of psoriaisis in children and young people. Owing to paucity of clinical and economic evidence data there are a number of uncertainties.

National maternity and perinatal audit

The Healthcare Quality Improvement Partnership (HQIP) has published National Maternity and Perinatal Audit: Clinical report 2017.

This report identifies areas of good practice and opportunities for improvement in the care of women and babies in maternity services across Britain. The report recommends further improvements in the quality of maternity data so that more outcomes, such as proportion of births without intervention, can be measured accurately. This data will enable women, clinicians, commissioners and policy makers to evaluate care given locally and nationally and use it to drive further improvements in the quality of maternity services.

Additional links: HQIP press release  | Royal College of Midwives press release

Increasing admissions to paediatric intensive care units in England and Wales: more than just rising a birth rate

Davis P, Stutchfield C, Evans TA, et al. Increasing admissions to paediatric intensive care units in England and Wales: more than just rising a birth rate. Archives of Disease in Childhood Published Online First: 30 October 2017. doi: 10.1136/archdischild-2017-313915

Study noted increasing numbers of admissions to PICUs in England/Wales between 2004 and 2013 is not explained by rising child population and there was no evidence of decrease in admission criteria. Continued increases would present challenging prospect for providers/commissioners

Each baby counts

Each Baby Counts 2015 | The Royal College of Obstetricians and Gynaecologists.

In the UK, each year over 1000 babies die or are left with severe brain injury because something goes wrong during labour.

Each Baby Counts is the RCOG’s national quality improvement programme to reduce the number of babies who die or are left severely disabled as a result of such incidents occurring during term labour.

The report presents key findings and recommendations based on the analysis of complete data relating to term stillbirths, neonatal deaths and babies with brain injuries born during 2015, the first full year of the programme.

Full report: Each baby counts