AIM:Respiratory rate is a key vital sign in paediatric assessment, but accurate measurement in emergency settings is difficult because conventional methods (manual counting, capnography) can be unreliable or impractical. Respiratory rate is frequently omitted in busy emergency departments. METHODS:We developed and evaluated a non-contact thermal imaging system that automatically measures respiratory rate and the inspiratory-to-expiratory ratio in paediatric patients. Thermal imaging detects temperature changes around the nostrils produced by inhaling cooler air and exhaling warmer air. Respiratory signals were obtained from 13 paediatric patients (14 datasets, aged 3-13 years) using an uncooled thermal camera. Automated image processing extracted respiratory waveforms and identified respiratory cycles and their inspiratory and expiratory phases using autocorrelation and peak detection. RESULTS:Clear respiratory signals were obtained for all patients, including those wearing masks. Several respiratory rate values were outside published reference percentiles, but all participants were clinically stable with values consistent with physiological variability. The mean inspiratory-to-expiratory ratio was 1.20 ± 0.23. CONCLUSION:These findings demonstrate the feasibility of a fully non-contact thermal system for automatic measurement of respiratory rate and the inspiratory-to-expiratory ratios during mask use. Further validation in larger cohorts with comparison to a gold standard is required before clinical adoption.
AIM:Cervical cancer elimination is a global public health goal, with vaccination against Human Papillomavirus (HPV) and HPV screening being two major prevention pillars. This review focuses on how vaccinations can be used in order to reach the timepoint of cervical cancer elimination faster. METHODS:The concepts in previously published reviews on 'faster cervical cancer elimination' are summarised and explained. RESULTS:Major concepts explained are: HPV vaccines prevent not only cancer precursors, but also the HPV infection itself resulting in public health gains that exceed the individual direct vaccine protection because of herd immunity. The effective population coverages of vaccine-induced immunity required to reach the critical extinction level for infection elimination are moderate, in particular when gender-neutral vaccination is used. Major suggested enabling strategies include catch-up vaccinations of adolescents, one-dose HPV vaccination and use of HPV prevalences to monitor and optimise HPV vaccination programs. Finally, cervical screening with HPV testing is predicted to be easier if there are no new HPV infections. CONCLUSION:The major challenge for faster cervical cancer elimination is to design HPV vaccination strategies that achieve an effective population immunity against the HPV infection as fast as possible.
AIM:To determine growth patterns and catch up potential in children with biliary atresia, in relation to liver disease severity and liver transplantation. METHODS:This retrospective cohort study was conducted at Copenhagen University Hospital between 1 January 2006 and 31 December 2024 and included 63 children. Anthropometry and paraclinical liver tests were assessed every 3 months until age 2, and every 6 months thereafter until age 18. Mixed linear models with 95% CI were used to assess anthropometry over time and its association with blood liver markers. Blood test variables were displayed in association with insulin-like growth factor-1. RESULTS:Children with biliary atresia reached their age-specific height-for-age z score after 7-8.5 years and catch-up growth lasted twice as long in those liver transplanted before versus after 2 years of age. Paraclinical liver parameters were shown to be correlated with weight-for-height and height-for-age in biliary children with and without a liver transplant. Results on IGF-1 revealed no association with paraclinical liver tests. CONCLUSIONS:Children with biliary atresia have the potential to catch up in growth with their age-specific height and weight. Paraclinical liver tests are linked to weight-for-height and height-for-age, suggesting liver disease as a contributing factor in the growth of children with biliary atresia.
AIM:We investigated the relation between infant motor behaviour and cognitive functioning at 4-5 years of age. METHODS:Based on a previous infancy assessment, we invited 369 children with atypical and 334 children with typical infant neurodevelopment at age 4-5. With multivariable regression, we investigated the association between infant motor behaviour, as measured with the Infant Motor Profile (IMP), and cognitive functioning, as measured with the Wechsler Preschool and Primary Scale of Intelligence, whereas controlling for perinatal and demographic variables and correcting for multiple testing. RESULTS:We assessed 518 children (74% of invited children, 53% male, median gestational age 39 weeks [29-42]). Atypical IMP total ratings were significantly related to reduced global, verbal, visual-spatial, reasoning and processing speed abilities at age 4-5 (B = -5.4 to -7.5). Atypical IMP variation was significantly related to reduced reasoning abilities (B = -5.1) and atypical IMP performance was significantly associated with reduced working memory (B = -4.4) and processing speed (B = -5.8). CONCLUSION:Infant motor behaviour is associated with cognitive abilities at age 4-5. This finding suggests that infant motor behaviour could potentially serve as an early indicator for later cognitive functioning.
AIM:To examine associations between gestational age (GA) and clinically recorded sleep outcomes at 6 months, 2 years and school entry. METHODS:This population-based study included 56 856 children. Sleep data from routine health examinations at 6 months, 2 years and school entry were linked to the Medical Birth Registry of Norway. Non-satisfactory sleep, difficulties initiating sleep and night awakenings were recorded during routine consultations. Associations between GA and sleep outcomes were examined using logistic regression analyses. RESULTS:The prevalence of non-satisfactory sleep was 22.4%, 15.1% and 11.6% at 6 months, 2 years and school entry, respectively. Each additional week of GA was associated with higher odds of non-satisfactory sleep at 6 months (adjusted OR 1.06, 95% CI 1.04-1.07). At 2 years and school entry, each additional week of GA was associated with lower odds of non-satisfactory sleep (adjusted OR 0.97, 95% CI 0.96-0.99 and 0.95-0.98, respectively). Few associations were observed between GA and the other sleep outcomes, except for night awakenings at 6 months and difficulties initiating sleep at 2 years. CONCLUSION:Increasing GA was associated with lower odds of non-satisfactory sleep at age 2 years and at school entry, whereas the opposite association was observed at 6 months. Sleep difficulties in children born preterm should remain a focus beyond infancy.
AIM:To determine whether remote recruitment, electronic consent and at-home blood collection enabled enrollment of a geographically and socioeconomically diverse infant cohort in the United States (US). METHODS:We describe the demographics of 256 infants included in this analysis, drawn from 264 enrolled in the Infant Vaccine Biorepository (December 2022-April 2026). Participants were recruited via online advertising and electronic medical record messaging. Geographic distribution was assessed using US Census regions and Rural-Urban Commuting Area (RUCA) codes. Social vulnerability was characterized using the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI) at census tract and county levels, with nationwide rankings. RESULTS:Infants were distributed evenly across the four US geographic regions; 9% resided in rural areas. Based on nationwide census tract-level SVI rankings, 39.8% of participants fell in the medium-high or high vulnerability categories. County-level SVI rankings indicated that 57.0% of participants fell in these same categories. Participants were 78% White and 20% Hispanic; 94.1% of mothers had received at least one COVID-19 vaccine. CONCLUSION:Fully remote recruitment, consent and specimen collection enabled enrollment of infants from diverse geographic and socioeconomic backgrounds across the US. SVI and RUCA provide richer characterization of study populations than traditional demographic measures alone.
AIM:To describe the frequency, burden, and pathogen profile of acute respiratory illnesses (ARIs) in very preterm infants during the first year after neonatal intensive care unit (NICU) discharge. METHODS:Very preterm infants were followed prospectively (August 2015-January 2017) with monthly assessments of symptoms, medication use, and healthcare utilisation. Parent-reported ARIs triggered additional clinical follow-up. Nasal swabs were collected monthly and during ARIs and tested for respiratory pathogens using real-time PCR. RESULTS:Of 125 eligible infants, 99 (79.2%) were enrolled, and 89 completed the 12-month follow-up. All infants experienced at least one ARI during the first year. Male sex was associated with increased risk of wheezy lower respiratory tract illness (LRTI) (RR 1.61), hospitalisation (RR 3.89), and asthma medication use (RR 5.89). NICU discharge during summer was associated with higher ARI rates (RR 1.33) and hospitalisation (RR 2.54). Rhinovirus was most frequently detected (13.5% of monthly swabs; 43.8% of ARI swabs), whereas respiratory syncytial predominated in emergency department presentations and hospital admissions (18.8% and 20.0%, respectively). CONCLUSIONS:Very preterm infants experienced substantial respiratory morbidity during the first year after NICU discharge. These findings highlight the need for improved preventive and post-discharge strategies in this high-risk population.
AIM:This study examined age- and sex-specific prevalence and trends in underweight among Norwegian children and adolescents during the pre-pandemic period from 2010 to 2019 and COVID-19 pandemic period from 2020 to 2022. METHODS:Height and weight data from 78 024 children aged 2 to 13 years in Bergen from 2010 to 2022 were obtained from public health clinic and school health service records. Underweight grades 1 to 3 were defined using the International Obesity Task Force cut-offs. Age- and sex-specific prevalence was analysed longitudinally, and trends were assessed for boys and girls across age groups using regression analyses. RESULTS:Underweight was most prevalent among 2-year-olds and declined with increasing age, more in girls than boys. Among girls, the prevalence decreased from 19.3% at age 2 years to 6.2% at age 13 years, and among boys from 13.3% to 8.6%. The interaction between sex and age was statistically significant. During the pre-pandemic period, prevalence decreased significantly among 2-year-olds. During the pandemic period, increased prevalence of underweight was observed among 8-year-old girls. CONCLUSION:Underweight remains a relevant public health concern, with clear age- and sex-specific patterns. These findings highlight the need for continued monitoring and targeted follow-up in early childhood.
AIM:To investigate parent-reported psychiatric, neurodevelopmental and adaptive functioning outcomes in children with congenital cytomegalovirus (cCMV)-related sensorineural hearing loss. METHODS:Parents of children aged 5-12 years were recruited nationwide in Sweden into three groups: children with congenital cytomegalovirus-related sensorineural hearing loss (n = 10), children with non-syndromic genetic hearing loss (n = 9) and typically developing controls with normal hearing (n = 23). Parents completed a background questionnaire, the Child Behaviour Checklist (CBCL) and the Five-to-Fifteen Revised (FTF-R). Group differences were analysed using non-parametric statistics. RESULTS:Children with congenital cytomegalovirus-related hearing loss had later identification of hearing loss, delayed onset of independent walking and a higher prevalence of neurodevelopmental conditions compared with children with genetic hearing loss. They also had significantly higher parent-reported psychiatric and developmental symptom levels than controls across all main clinical measures. Compared with the genetic hearing loss group, they demonstrated greater developmental difficulties, reduced social participation and poorer school functioning. CONCLUSION:Children with congenital cytomegalovirus-related hearing loss exhibit a substantial burden of psychiatric and neurodevelopmental symptoms extending beyond hearing loss alone. These findings highlight the importance of early identification, structured long-term follow-up and tailored interventions to support this vulnerable population.
AIM:Skin-to-skin contact stabilizes vital signs, particularly body temperature, in preterm infants. The aim was to determine whether there are differences in body temperature depending on whether preterm infants have skin-to-skin contact with their mother or their father. METHODS:In this crossover study, the body temperature of 18 preterm infants (gestational age 29.4 (±2.97) weeks) was measured every minute during two skin-to-skin contact sessions with their mother and two with their father. RESULTS:The infants' skin temperatures during skin-to-skin contact with their mother and father, respectively, were 36.47 (±0.33)°C and 36.44 (±0.38)°C at the start (p = 0.795), after 10 min 36.64 (±0.34)°C and 36.48 (±0.34)°C respectively (p = 0.196), after 60 min 36.93°C (±0.22) and 36.72°C (±0.25) (p = 0.010) and, after 80 min, 36.90°C (±0.29) and 36.70°C (±0.31) (p = 0.045). CONCLUSION:The results show that preterm infants do indeed exhibit different temperature profiles depending on which parent they have skin-to-skin contact with. These differences can be easily compensated for through nursing interventions and do not conflict with kangaroo care provided by fathers. Given the benefits of kangaroo care provided by fathers, it is essential to continue to support this practice unreservedly.
AIM:To assess long-term effects of Kangaroo Mother Care (KMC) on motor development in adults born with birth weights ≤ 1800 g, compared to conventional neonatal care. METHODS:This cohort analysis included 214 young adults with a history of birth weights ≤ 1800 g, mostly preterm, originally enrolled in a randomized controlled trial between 1993 and 1994 evaluating KMC. Motor system development was assessed using transcranial magnetic stimulation (TMS) to measure corticospinal excitability and interhemispheric communication. Fine motor skills were evaluated with the Nine Hole Peg Test (9HPT). A 50 term-born normal birth weight reference group provided TMS values to evaluate KMC effectiveness. RESULTS:Individuals with history of birth weights ≤ 1800 g, regardless of exposition to KMC, demonstrated longer completion times on the 9HPT and reduced grip strength compared to normative values. No significant differences in TMS measures were found between groups. However, in a multivariate logistic regression model, KMC was associated with a 78% effectiveness (95% confidence interval-CI: 4%-95%) on preventing the altered transcallosal conduction time. CONCLUSION:Motor deficits related to low birth weight (LBW) persist into adulthood. KMC may contribute to avoid interhemispheric motor connectivity issues in individuals with birth weights ≤ 1800 g, highlighting its potential for long-term neurodevelopmental benefit.
AIM:To assess how maternal/infant characteristics and early hospital practices influenced exclusive breastfeeding at 2-3 weeks postpartum among mothers intending to breastfeed their late preterm and early term infants. METHODS:This secondary analysis used data from a randomised controlled trial of 72 mothers of late preterm (34 + 0-36 + 6) and early term infants (37 + 0-38 + 6), assigned to either a breastfeeding intervention or control group. Information on hospital practices and infant feeding was collected prior to intervention start. RESULTS:Overall, 62% of infants were exclusively breastfed (57% of late preterm, 75% of early term infants) at 2-3 weeks postpartum. In-hospital formula supplementation was highly prevalent (76%), and particularly larger volumes (30-60 mL per feed) were strongly associated with reduced exclusive breastfeeding (p < 0.001). Being offered support for breastfeeding problems at hospital was also associated with reduced odds of exclusive breastfeeding (OR 0.17, 95% CI 0.04-0.84). Early hospital practices, such as skin-to-skin contact and early breastfeeding initiation, differed between early term and late preterm infants. CONCLUSIONS:The findings highlight the potential impact of modifiable hospital practices, particularly formula supplementation, on exclusive breastfeeding in this group. Strategies to improve these practices warrant further investigation. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT03791749.
AIM:This mini review describes the history of infant respiratory syncytial virus (RSV) immunoprophylaxis and the latest advances in this area. It also reviews the efficacy, safety and impact of the recently introduced prophylactic strategies. METHOD:This narrative review is based on a targeted review of published literature, with emphasis on pivotal clinical trials, regulatory documents and recent real-world evidence. RESULTS:Three immunisation products for preventing RSV in infants have been approved since 2022. These are two long-acting monoclonal antibodies, nirsevimab and clesrovimab, and a maternal RSV vaccine. The efficacy of these interventions has ranged from 49% to 76% against medically attended RSV-associated lower respiratory tract infections and from 55% to 91% against hospitalisation due to RSV-associated lower respiratory tract infection. The efficacy varied between the products and the duration of the follow-up. Similar or higher effectiveness has been reported in post-licensure, real-world evidence studies. Overall, these interventions have been well tolerated, with favourable safety profiles. CONCLUSION:The newly introduced long-acting monoclonal antibodies and the maternal RSV vaccine have proved highly effective and have demonstrated reassuring safety. They have already been implemented in a number of countries and have substantially reduced the RSV burden in infants.
AIM:We investigated current practices of primary ventilation of preterm and term infants directly after birth in hospitals across all levels of neonatal care in Germany, Austria and Switzerland. METHODS:Invitations to an electronic survey were sent to all hospitals with maternity wards in these three countries. Results were compared across countries and gestational age (GA) groups. RESULTS:240 out of 769 (31%) contacted hospitals participated. Most hospitals used T-piece resuscitators for term infants (85%). Use of mechanical ventilators increased with decreasing GA (term: 7%, moderate-to-late preterm (MLP, GA 32-36 weeks): 11%, very preterm (GA < 32 weeks): 23%). In very preterm infants, extended inspiratory times of 1-5 s were the preferred method of initial ventilation (56%), followed by inspiratory times < 1 s (36%). Initial positive end-expiratory pressure (PEEP) increased with decreasing GA; median (interquartile range, IQR) PEEP for term infants 5.0 cmH2O (5.0-6.0 cmH2O), for MLP 6.0 cmH2O (5.0-6.0 cmH2O), and for very preterm infants 6.0 cmH2O (5.0-8.0 cmH2O). Laryngeal masks were used in 14% of centres as the preferred alternative airway for term infants. CONCLUSION:We found considerable differences across and within participating countries and GA groups in the primary respiratory support during delivery room stabilization of newborn infants.
