Acute respiratory infections (ARI) cause 3 million deaths in children worldwide each year. Most of these deaths occur from pneumonia in developing countries, and hypoxaemia is the most common fatal complication. Simple and adaptable indications for oxygen therapy are important in the management of ARI. The current WHO definition of hypoxaemia as any arterial oxygen saturation (SpO2) <90% does not take into account the variation in normal oxygen saturation with altitude. This study aimed to define normal oxygen saturation and to estimate the threshold of hypoxaemia for children permanently living at different altitudes.
We carried out a systematic review of the literature addressing normal values of oxygen saturation in children aged 1 week to 12 years. Hypoxaemia was defined as any SpO2 at or below the 2.5th centile for a population of healthy children at a given altitude. Meta-regression analysis was performed to estimate the change in mean SpO2 and the hypoxaemia threshold with increasing altitude.
14 studies were reviewed and analysed to produce prediction equations for estimating the expected mean SpO2 in normal children, and the threshold SpO2 indicating hypoxaemia at various altitudes. An SpO2 of 90% is the 2.5th centile for a population of healthy children living at an altitude of ~2500 m above sea level. This decreases to 85% at an altitude of ~3200 m.
For health facilities at very high altitudes, giving oxygen to all children with an SpO2 <90% may be too liberal if oxygen supplies are limited. In such settings, Spo2 <85% may be more appropriate to identify children most in need of oxygen supplementation.
Atopic eczema in infants has increased in western societies. Environmental factors and the introduction of food may affect the risk of eczema.
To investigate the prevalence of eczema among infants in western Sweden, describe patterns of food introduction and assess risk factors for eczema at 1 year of age.
Data were obtained from a prospective, longitudinal cohort study of infants born in western Sweden in 2003; 8176 families were randomly selected and, 6 months after the infant’s birth, were invited to participate and received questionnaires. A second questionnaire was sent out when the infants were 12 months old. Both questionnaires were completed and medical birth register data were obtained for 4921 infants (60.2% of the selected population).
At 1 year of age, 20.9% of the infants had previous or current eczema. Median age at onset was 4 months. In multivariable analysis, familial occurrence of eczema, especially in siblings (OR 1.87; 95% confidence interval (CI) 1.50 to 2.33) or the mother (OR 1.54; 95% CI 1.30 to 1.84), remained an independent risk factor. Introducing fish before 9 months of age (OR 0.76; 95% CI 0.62 to 0.94) and having a bird in the home (OR 0.35; 95% CI 0.17 to 0.75) were beneficial.
One in five infants suffer from eczema during the first year of life. Familial eczema increased the risk, while early fish introduction and bird keeping decreased it. Breast feeding and time of milk and egg introduction did not affect the risk.
Inhaled corticosteroids (ICS) are effective treatment for childhood asthma. Cross-sectional studies indicate that some asthmatic children are treated with excessively high doses of ICS and are at risk of serious adverse effects.
To describe longitudinal trends in asthma prescribing for children, with particular reference to very-high-dose (unlicensed) ICS prescribing.
Retrospective, cross-sectional, observational study of general practitioner prescribing for asthma drugs in children aged under 12 years with a recorded asthma diagnosis between 1992 and 2004 using the General Practice Research Database (GPRD).
Data were available for an average of 357 956 children per year. The percentage of children prescribed ICS increased from 2.7 in 1992 to 7.0 in 1997 and 1998 and then fell to 3.3 in 2004. In children under 5 years with asthma, very-high-dose ICS prescriptions (>400 µg/day) fell from 10.6% of all ICS prescriptions in 1992 to 4.5% by 2004. In contrast, very-high-dose ICS prescriptions (>800 µg/day) for asthmatic children aged 5–11 years rose from 1.1% in 1992 to 4.6% in 2004. Oral corticosteroid prescribing in under 5-year-olds who had been prescribed ICS fell from 37.1% in 1992 to 21.7% 1999 and remained constant thereafter; the respective percentages for those aged 5–11 years olds were 20.1 and 12.4.
Trends for corticosteroid prescribing in childhood asthma changed dramatically between 1992 and 2004. There are several plausible reasons for this.
UK child health promotion guidelines expect health visitors to assess family needs before new babies are aged 4 months and offer targeted care on that basis thereafter. Data from an intensive family support programme were used to assess how accurately family needs can be predicted at this stage.
A population based cohort of 1202 families with new babies receiving an intensive health visiting programme. Analysis of routinely recorded data.
Starting Well project, Glasgow, UK.
Health visitor rating of family needs.
Families receiving high visiting rates or referred to social work services.
Of 302 families rated high need, only 143 (47%) were identified by age 4 months. Visiting rates in the first year for those initially rated high need were nearly double those for the remainder, but around two thirds of those with high contact rates/referred to social work were not initially rated high need. Six family characteristics (no income, baby born preterm, multiple pregnancy, South Asian, prior social work/criminal justice involvement, either parent in care as a child) were identified as the commonest/strongest predictors of contact rates; 1003 (83%) families had one such characteristics and/or lived in a highly deprived area, including 228 (93%) of those with high contact rates and 157 (96%) of those referred to social work.
Most families at risk will not be identified on an individual basis in the early weeks. Most families in deprived areas need continued input if the most vulnerable families are to be reliably identified.
Preterm infants have a substantially increased risk of developing respiratory illnesses. The goal of this study was to consider the impact of modifiable postnatal exposures on respiratory morbidity among a cohort of very low birth weight (VLBW) infants.
(1) Assess the rates of respiratory morbidity and exposure to indoor respiratory triggers in a population of VLBW infants at 1 year; (2) determine the association between exposures and respiratory morbidity.
We enrolled 124 VLBW infants into a prospective cohort study. Parents were called at 1 year to assess respiratory outcomes and environmental exposures. We used bivariate and multivariate analyses to assess the relationship between environmental exposures and acute care for respiratory illnesses.
At 1 year, 9% of infants had physician-diagnosed asthma, 47% required >=1 acute visit and 11% required hospitalisation for respiratory illness. The majority of infants (82%) were exposed to at least one indoor respiratory trigger. Infants living with a smoker (61% vs 40%) and infants exposed to pests (62% vs 39%) were more likely than unexposed infants to require acute care for respiratory problems. In a multivariate regression controlling for demographics, birth weight, bronchopulmonary dysplasia, and family history of asthma or allergies, both living with a smoker (OR 2.62; CI 1.09 to 6.29) and exposure to pests (OR 4.41; CI 1.22 to 15.94) were independently associated with the need for acute care for respiratory illnesses.
In this sample, respiratory morbidity and exposure to triggers were common. VLBW infants may benefit from interventions that decrease exposure to respiratory triggers.
To investigate the clinical manifestations of autoimmune thyroiditis (AIT) leading to referral in children and adolescents, in addition to disease course and long-term outcome.
Chart review.
Major tertiary hospital.
114 children/adolescents (92 female, 22 male; mean (SD) age 11.8 (35) years) with AIT referred for evaluation/treatment.
Clinical characteristics at presentation, reasons for referral, treatment and long-term (mean 6 years) outcome; by thyroid and pubertal status.
The male/female (1:4.2) ratio was lower than in adult AIT (1:10) and varied by age. Patients with noticeable goitre at presentation (39.5%) accounted for half the total number in whom goitre was eventually diagnosed. Other reasons for referral were clinical symptoms of hypothyroidism (28.9%) and findings on work-up for an unrelated problem (19.2%) or for high-risk groups (10.5%). There was no difference in management or outcome between patients who underwent ultrasound (n = 79) or not. Treatment was initiated shortly after diagnosis in all 42 hypothyroid patients and 44/48 compensated hypothyroid patients, and within 16 months in 19/24 euthyroid patients. There was no change in thyroid status in the nine untreated patients. Height standard deviation score (SDS) was normal at referral and last visit and correlated with parental height SDS. Puberty was normal. There was no significant difference in body mass index SDS at referral by pubertal or thyroid status. There was no difference from the general population in the prevalence of obesity.
Although goitre is the main symptom leading to diagnosis of AIT, it is still often overlooked, underscoring the need for thorough thyroid evaluation on routine physical examination. Acquired hypothyroidism is not often associated with obesity, and ultrasound usually has no added diagnostic value. Adequate treatment in this age group leads to normal growth, puberty and final height.
To examine stuttering by children speaking an alternative language exclusively (LE) or with English (BIL) and to study onset of stuttering, school performance and recovery rate relative to monolingual speakers who stutter (MONO).
Clinical referral sample with supplementary data obtained from speech recordings and interviews.
South-East England, 1999–2007.
Children aged 8–12 plus who stuttered (monolingual and bilingual) and fluent bilingual controls (FB).
Participants’ stuttering history, SATS scores, measures of recovery or persistence of stuttering.
69 (21.8%) of 317 children were bilingual. Of 38 children who used a language other than English at home, 36 (94.7%) stuttered in both languages. Fewer LE (15/38, 39.5%) than BIL (23/38, 60.5%) children stuttered at first referral to clinic, but more children in the fluent control sample were LE (28/38, 73.7%) than BIL (10/38, 26.3%). The association between stuttering and bilingual group (LE/BIL) was significant by 2 test; BIL speakers have more chance of stuttering than LE speakers. Age at stuttering onset and male/female ratio for LE, BIL and MONO speakers were similar (4 years 9 months, 4 years 10 months and 4 years 3 months, and 4.1:1, 4.75:1 and 4.43:1, respectively). Educational achievement was not affected by bilingualism relative to the MONO and FB groups. The recovery rate for the LE and MONO controls together (55%) was significantly higher by 2 test than for the BIL group (25%).
BIL children had an increased risk of stuttering and a lower chance of recovery from stuttering than LE and MONO speakers.
To investigate the relationship between primary immunisation status and MMR uptake.
Nationally representative Millennium Cohort Study.
Children born in the UK, 2000–2002.
14 578 children with immunisation data.
MMR status at 3 years, defined as immunised with MMR, immunised with at least one single antigen vaccine or unimmunised.
88.6% of children had been immunised with MMR, 5.2% had received at least one of the single antigen vaccines and 6.1% were unimmunised against measles, mumps and rubella at age 3 years. Children who were unimmunised with the primary vaccines at ages 9 months (1.2%, n = 168) and 3 years (0.4%, n = 67) were 13 (95% CI 10.8 to 14.7) and 17 (95% CI 14.6 to 19.7) times more likely to be unimmunised against measles, mumps and rubella compared with children who were fully immunised. They were also more likely to be immunised with at least one of the single antigen vaccines with risk ratios of 2.8 (95% 1.2 to 6.1) and 4.3 (95% CI 1.8 to 10.1). Similar but smaller associations were observed if children were partially immunised with the primary vaccines at 9 months (3.4%, n = 502) and 3 years (3.6%, n = 522) with risk ratios of 4.0 (95% 3.2 to 4.9) and 5.2 (95% 4.2 to 6.1) for no MMR immunisation, and 2.0 (95% C 1.1 to 3.6) and 1.6 (95% CI 1.1 to 2.5) for single antigen vaccine use.
Children who remain unimmunised with primary vaccines are also more likely not to receive MMR. More work is needed to determine how best to target this group.
Thirty-one patients (14 females, 17 males) were alive, 27 of whom were <15 years. Twenty-six patients had Hurler syndrome, four had Hurler-Scheie and one had Scheie syndrome. The birth incidence was 1 in 26 206 births with a carrier frequency of 1 in 81. Of note, 19/26 (73%) Hurler patients were Irish Travellers. Amongst Irish Travellers the incidence was 1 in 371 with a carrier frequency of 1 in 10. This is the highest recorded incidence worldwide. Given the morbidity and mortality associated with delayed treatment we recommend targeted newborn screening for this population.
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