The Norwegian national recommendations for the evaluation and treatment of bronchiolitis were updated in 2018. Two Choosing Wisely recommendations were launched to reduce unwarranted chest X-ray, repeated blood tests and routine inhalations. The aim of this study was to evaluate adherence to the recommendations, temporal changes and differences between hospitals. In this multicentre retrospective study, we compared routine data from 1186 infants < 12 months of age hospitalised for bronchiolitis at five Norwegian hospitals during the winter seasons 2017–2018, 2018–2019 and 2021–2022. Overall, 29% of the included infants had a chest x-ray taken with non-significant change over seasons. A decreasing proportion had more than one blood test taken over the years (60.4%, 56.6%, 43.5%; p  < 0.001). The use of antibiotics (overall 4.5%), systemic steroids (2.7%) and inhalations with beta-2 agonists or adrenaline (15.4%) was generally low. The use of adrenaline decreased over the three seasons (18.1%, 10.5%, 5.2%; p  < 0.001). There was a large variation in diagnostic and treatment procedures between hospitals. Some diagnostic procedures and treatments for bronchiolitis were reduced in accordance with guidelines, but substantial variation remained between hospitals. There is a potential to further reduce the overuse of chest X-rays and repeated blood testing.

AIM:High-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) are options for respiratory support in infants with bronchiolitis. The aim of this study was to evaluate the use of HFNC and CPAP in infants with bronchiolitis at five hospitals in Norway to study time trends over seasons and differences in use between hospitals. METHODS:In this multicentre retrospective study, we compared data from 1186 infants < 12 months of age hospitalized for bronchiolitis at five Norwegian hospitals during the winter seasons 2017-2018, 2018-2019, and 2021-2022. RESULTS:Over the three seasons, HFNC was provided to 29%-33% and CPAP to 8%-18% of all infants, but with a substantial difference between hospitals for both modalities. The change between seasons was less prominent but also differed between hospitals. The length of stay was longer, and the age and weight were lower in those receiving any non-invasive respiratory support, but this did not differ between infants treated with HFNC or CPAP. CONCLUSION:In Norwegian hospitals there was a substantial variation in the use of HFNC and CPAP for infants with bronchiolitis. This calls for unified and evidence-based guidelines for the use of non-invasive respiratory support for this patient group.

The objective of this study was to evaluate fatigue trajectories of adolescents with paediatric acquired brain injuries (pABI) following metacognitive strategy training (paediatric Goal Management Training; pGMT) or psychoeducation (paediatric Brain Health Workshop; pBHW) for executive dysfunction in the chronic phase after injury. Five-year follow-up data of the CORE randomized controlled trial including participants aged 10-17 years at baseline, randomized to either pGMT or pBHW is presented. Fatigue was measured at five timepoints using the Paediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL MFS). Linear mixed models and Reliable Change Index (RCI) analyses were utilized to assess outcomes. A significant reduction in total fatigue (F(4,62.820) = 2.81, p = .033) and cognitive fatigue (F(4,59.622) = 4.89, p = .002) was observed based on parent-reported data. However, no significant differences emerged between intervention groups or for the group-by-time interaction. Clinically meaningful improvements in fatigue as determined by the RCIs, were noted in 67.6% of participants per parent-report. In conclusion, both pGMT and pBHW may contribute to sustained reductions in fatigue in young people with pABI, particularly cognitive fatigue. The high rate of clinically meaningful change highlights fatigue as a modifiable symptom that should be a key target in long-term rehabilitation strategies.

Background: The burden of severe infections in children remains inadequately characterised. Preterm birth is a risk factor for neonatal sepsis, yet whether this risk persists beyond the neonatal period is unclear. We examined the risk of sepsis-related hospitalisation during childhood and adolescence in term-born and preterm-born children. Methods: Norwegian nationwide birth registry data (1992–2021) were linked with hospital discharge data (2008–2021). Using a standardised definition, sepsis-related hospitalisations were classified as explicit (sepsis diagnosis code) or implicit (infection plus organ dysfunction diagnosis codes). We estimated rate ratios (RRs) using adjusted negative binomial regression and sibling-controlled odds ratios (ORs) using conditional logistic regression by completed weeks of gestation (23–27, 28–31, 32–33, 34–36, 37–38, and 39–41 weeks), stratified by age (3–11 months, 1–5 years, and 6–15 years). Findings: Following 1,672,442 births, 12,932 sepsis episodes were available in the data. Hospitalisation rates for sepsis-related admissions were highest during infancy (23–27 weeks gestation: 75·4 [95% confidence interval (CI) 55·2–95·7], 39–41 weeks: 3·2 [95% CI 3·0–3·4] per 1000 person-years at ages 3–11 months). Compared with term-born, rates of sepsis-related hospitalisations increased by lower gestational age groups in both population and sibling analyses. Comparing extremely preterm versus term-born children, RRs were 23·4 (95% CI 17·7–30·9) at ages 3–11 months, 19·7 (14·7–26·5) at ages 1–5 years, and 4·6 (2·1–10·3) at ages 6–15 years. Sibling ORs were 23·8 (10·5–54·3), 28·9 (11·1–75·6), and 3·8 (1·5–9·8), respectively. Interpretation: Lower gestational age was robustly associated with an increased risk of sepsis-related hospitalisation throughout childhood and adolescence, supporting that low gestational age at birth should be recognised as a persistent risk factor for severe infections beyond the neonatal period.

Background:The role of parechovirus A (PeV-A) in respiratory tract infections (RTI) in children remains unclear. Objectives and methods:We used clinical and virological data from two observational studies to study PeV-A in RTIs in children: a study of children admitted to hospital with RTI, and a study of children examined for RTI while attending day care centres. All had clinical examination and one nasopharyngeal aspirate analysed for PeV-A and 18 other viruses and bacteriae by culture and PCR-tests. Results:In the hospital study 4.6% (15/323) PeV-A positive RTIs were single virus detections. In 95.4% (308/323) other viruses were co-detected, including 28 with PeV-A and respiratory syncytial virus (RSV) and 77 with PeV-A and human rhinovirus (HRV). Multivariable logistic regression analysis showed strong association between single PeV-A and upper RTI (URTI) vs. lower RTI (LRTI) (age-adjusted OR 11.3, 95% CI 3.1-41.3). By retrospective evaluation of medical records, PeV-A was a likely cause of mainly pharyngitis and tonsillitis in 10/15 children with single PeV-A. In multivariable logistic regression modelling the presence of PeV-A had no impact on clinical manifestations and short-term outcomes in children with codetected RSV and HRV. In the day-care study PeV-A was detected in 30 children, among who 8/10 with single PeV-A had pharyngitis and tonsillitis. Conclusion:Single PeV-A detection was associated with pharyngitis and tonsillitis among children in day-care and hospital. Most hospitalized children with PeV-A had LRTI and viral codetections, but the presence of PeV-A did not impact disease severity in those with RSV and HRV.

BACKGROUND:Preterm-born children are vulnerable to respiratory tract infections (RTIs), but we know little about how these were affected by COVID-19 pandemic control measures. METHODS:We studied Norwegian population-wide registry data on 1-5-year olds born 2012-2021. RTI hospitalisations were identified from primary hospitalisation diagnosis codes. We modelled prepandemic hospitalisation rates, January 2017 to March 2020, using quasi-Poisson regression with harmonic seasonal terms. These were compared with monthly hospitalisation rates, March 2020 to December 2022. The calculations were performed separately for gestational age groups: 23-33, 34-36, 37-41 completed weeks. RESULTS:We identified 9734 RTI hospitalisations among 449 105 children aged 1-5 years, with higher rates in the most preterm groups. Across gestational ages, we observed lower hospitalisation rates during control measures in 2020, followed by a surge after measures were lifted in 2021. For children born in weeks 23-33, the rate reduction with 95% CI during the first year of the pandemic compared with the prepandemic years was -21 per 1000 person-years (95% CI -30 to -13), whereas in April-December 2022, there was an increase of 22 (95% CI 12 to 31). For term born (week 37-41), the corresponding changes were -4.9 (95% CI -5.5 to -4.3) and 3.6 (95% CI 2.9 to 4.2). CONCLUSIONS:Compared with term born, preterm-born children of all gestational age groups were more distinctly protected by pandemic control measures. They were also more affected by the resurgence of infections when measures were lifted. These findings call for policies to protect preterm-born children better from RTIs, especially when viral spread is high.

OBJECTIVE:To determine the long-term efficacy of pediatric Goal Management Training (pGMT) versus pediatric Brain Health Workshop (pBHW) in improving executive function (EF) among adolescents with pediatric-acquired brain injury (pABI). METHOD:This study reports a 5-year follow-up of the CORE trial, which included participants aged 10-17 years at baseline, randomized to either pGMT or pBHW. EF was measured at five timepoints using the parent-rated Behavior Rating Inventory of Executive Function (BRIEF), including the Behavior Regulation Index (BRI) and the Metacognition Index (MI). Outcomes were evaluated using linear mixed models (n = 73) and Reliable Change Index (RCI) analyses (n = 34). RESULTS:Significant improvements over time were observed for both BRI (F(4, 65.615) = 9.64, p < 0.001) and MI (F(4, 51.758) = 4.29, p = 0.004). No significant group differences were detected, indicating that both interventions were associated with comparable long-term trajectories. RCI analyses identified clinically meaningful improvements in 12 participants on the BRI (pGMT, n = 3; pBHW, n = 9) and 20 participants on the MI (pGMT, n = 6; pBHW, n = 11). CONCLUSIONS:Adolescents with pABI showed sustained long-term gains in EF over five years following cognitive rehabilitation, with a notable proportion achieving clinical meaningful improvements. However, given study limitations, results should be interpreted with caution.

Influenza viruses (IFV) have major impacts on children’s health. We studied IFV A/B epidemiology and disease severity during a 17 year-long period including the 2009 H1N1 influenza pandemic and post-COVID-19 in 2021–2023. Nasopharyngeal samples from children referred with fever or respiratory symptoms to a Norwegian hospital from 2006 to 2023 were tested with PCR for IFV A/B and 17 other pathogens. We compared IFV hospitalization rates and disease severity before and during the 2009 influenza pandemic, and before and after the COVID-19 pandemic, respectively, using age-adjusted logistic regression analyses. From 2006 to 2023, 502 children with IFV A/B were included (IFV A 74

Background Distinguishing bacterial from non-bacterial community-acquired pneumonia (CAP) in children is challenging and often leads to unnecessary antibiotic prescribing. Host‑response biomarkers may improve diagnostic assessment. We evaluated the performance of C‑reactive protein (CRP), procalcitonin (PCT), tumour necrosis factor‑related apoptosis‑inducing ligand (TRAIL) and interferon gamma‑induced protein‑10 (IP‑10), individually and in combination, in differentiating bacterial from viral and atypical CAP. Methods Banked serum samples from a prospective cohort of Norwegian children with radiologically confirmed CAP (2012–2014) were analysed. Extensive microbiological testing classified cases as bacterial, viral, atypical or indeterminate. Of 265 eligible participants, 138 had measurements for all four biomarkers. Diagnostic performance was assessed using logistic regression and receiver operating characteristic (ROC) curves. Results Children with bacterial CAP generally had higher CRP and PCT and lower TRAIL concentrations than those with viral or atypical CAP. IP‑10 levels were broadly similar across aetiological groups. Among individual biomarkers, PCT (AUC 0.781, 95% CI 0.647–0.916) and TRAIL (AUC 0.776, 95% CI 0.655–0.898) showed slightly better discrimination than CRP or IP‑10, but confidence intervals were wide and largely overlapping. Biomarker combinations yielded numerically higher AUCs than individual markers and the combination of CRP, PCT and TRAIL had the highest AUC (0.848, 95% CI 0.766–0.930), but precision was limited by sample size. Conclusion In children with radiologically confirmed CAP, the combination of CRP, PCT and TRAIL showed the most favourable AUC, though differences between biomarkers and panels were modest. Multi‑biomarker approaches may help support more judicious antibiotic use, but validation in larger, adequately powered cohorts is required.

BACKGROUND AND OBJECTIVE:Early-life insults affect lung function trajectories throughout life. In Nepal there is a high burden of disease from lower respiratory tract infections, and high levels of exposure to household and environmental pollution. To enable assessment of these factors on lung development we aimed to assess the feasibility of establishing a pulmonary function laboratory for tidal breath flow-volume loops (TBFVL) in infants and children in Dhulikhel, Nepal. METHODS:A pulmonary function laboratory was established and TBFVL testing, meeting international quality standards, were performed on healthy children 1-24 months of age, between October 2024 and May 2025, in Dhulikhel, Nepal. Results were interpreted by local staff after initial training and ongoing oversight by international experts. TBFVL indices with coefficient of variation (CoV) were reported and inter-interpreter level of agreement evaluated using Bland-Altman plots. RESULTS:Eighty-six children were included, of which 80 (93%) had successful tests. Fifty-five (69%) 0- <4 months, 12 (15%) 4- < 12 months and 13 (16%) 12-24 months of age. The CoV ranged from 4.7 (4.4, 5.2) for tidal volume to 19.5 (15.8, 24.1) for the ratio of the proportion of time to reach peak tidal expiratory flow to total expiratory time (TPTEF/TE), with CoV being similar across age groups. Agreement between local and expert international assessors was good, with the largest mean inter-interpreter difference observed for TPTEF/TE. CONCLUSION:Establishing a pulmonary function laboratory and achieving high-quality TBFVL measurements with expert-level interpretation is feasible in Nepal and contributes to the knowledge of normal pulmonary function values in Nepali children.

BACKGROUND We investigated the effect of hospital delivery volume and travel time on maternal postpartum health service use in Norway. METHODS We conducted a population-based study including women giving birth from 2008 to 2021. Exposures were (1) annual delivery volume at the observed delivery hospital and travel time by car from the municipality center to the observed delivery hospital, and (2) expected delivery volume and expected travel time based on hospital catchment patterns. The primary outcome was maternal postpartum health service use. We used pseudo–maximum likelihood Poisson regression with adjustment for maternal characteristics, timing of birth, and pre-pregnancy health service use; within-woman analyses used fixed effects. RESULTS The study included 792,330 childbirths by 492,080 women. In the first approach, higher hospital volume (2000 vs. 500 births/year) was associated with 15% more days of GP contacts with a psychiatric diagnosis code (RR 1.15, 95% CI 1.05–1.26). Longer travel time (120-min vs. 30-min) was associated with a 20% longer delivery admission (RR 1.20, 95% CI 1.12–1.28), 5% more days of GP contact (RR 1.05, 95% CI 1.03–1.07), and 10% more days of GP contacts for conversation therapy (RR 1.10, 95% CI 1.01–1.20). In the within-woman analysis, these associations largely disappeared, except for a 13–19% increase in out-of-hours GP contacts at higher volume hospitals. CONCLUSIONS We found little evidence of a causal effect of hospital volume or travel time on overall postpartum health service use. Associations in conventional analyses may reflect residual confounding.

BACKGROUND:Hospital regionalization involves balancing hospital volume and travel time. We investigated how hospital volume and travel time affect perinatal mortality and the risk of delivery in transit using three different study designs. METHODS:This nationwide cohort study used data from the Medical Birth Registry of Norway (1999-2016) and Statistics Norway. We compared estimates across three designs: (1) Observed confounder adjustment: Comparing women giving birth at hospitals of different sizes and travel times (1,066,332 births), (2) Sibling comparison: Comparing women who moved between hospital catchment areas between births (203,464 births), and (3) Neighbor comparison: comparing women living in neighboring municipalities, but in different hospital catchment areas (460,776 births). RESULTS:The study population included 5080 (0.48%) perinatal deaths and 7063 deliveries in transit (0.66%). For hospitals with 2000 compared with 500 births/year, observed confounder adjustment showed 1.81 times higher perinatal mortality (95% confidence interval [CI]: 1.21, 2.73). However, sibling and neighbor comparisons showed a factor of 0.64 (95% CI: 0.43, 0.97) and 0.61% (95% CI: 0.43, 0.88) lower perinatal mortality, respectively. Increased travel time was strongly associated with higher perinatal mortality using observed confounder adjustment, but this was not supported by the other designs. Longer travel time was consistently linked to an increased risk of delivery in transit. CONCLUSIONS:Perinatal mortality was higher in high-volume hospitals when adjusting for observed confounders. However, triangulating inferences from the other designs suggested the opposite, estimating that observed confounder control was insufficient. This supports the idea that access to higher-volume hospitals could improve perinatal outcomes at the population level.

Background:Preterm children are at an increased risk of autism spectrum disorder (ASD), although the determinants of ASD among them remain unclear. In this systematic review and meta-analysis, we summarize the population-based literature on ASD risk factors in preterm-born individuals. Methods:We searched Ovid MEDLINE, Embase, and Web of Science through September 2023 for population-based studies on ASD risk factors in preterm cohorts (<37 weeks' gestation). From 3921 articles, 19 met inclusion criteria. Registered in PROSPERO and following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, data were extracted and analyzed using fixed and random effects meta-analysis models. Primary outcomes included ASD risk factors, pooled when consistently examined in at least 2 studies. Results:The qualitative synthesis included 16 cohort studies, 2 case-control studies, and 1 cross-sectional study, while 3 cohort studies were included in the meta-analysis. Sample sizes ranged from 410 to 515,789. Male sex was the only risk factor eligible for meta-analysis and was associated with increased risk of ASD (relative risk 3.04; 95% CI, 2.02-4.57). Low birth weight suggested a potential positive association with ASD, while neonatal jaundice showed no clear link. Pooled estimates were unavailable for these exposures due to heterogeneity in exposure definitions and effect measures. All other risk factors were examined in two or fewer studies. Conclusions:Significant knowledge gaps remain regarding the risk of ASD in individuals born preterm. The only consistent risk factor identified is male sex, with potential links to low birth weight. To better understand the differences in ASD etiology between preterm and term-born individuals, further research is crucial.

AIMS:The Norwegian national recommendations for the evaluation and treatment of bronchiolitis were updated in 2018. Two Choosing Wisely recommendations were launched to reduce unwarranted chest X-ray, repeated blood tests and routine inhalations. The aim of this study was to evaluate adherence to the recommendations, temporal changes and differences between hospitals. METHODS:In this multicentre retrospective study, we compared routine data from 1186 infants < 12 months of age hospitalised for bronchiolitis at five Norwegian hospitals during the winter seasons 2017-2018, 2018-2019 and 2021-2022. RESULTS:Overall, 29% of the included infants had a chest x-ray taken with non-significant change over seasons. A decreasing proportion had more than one blood test taken over the years (60.4%, 56.6%, 43.5%; p < 0.001). The use of antibiotics (overall 4.5%), systemic steroids (2.7%) and inhalations with beta-2 agonists or adrenaline (15.4%) was generally low. The use of adrenaline decreased over the three seasons (18.1%, 10.5%, 5.2%; p < 0.001). There was a large variation in diagnostic and treatment procedures between hospitals. CONCLUSION:Some diagnostic procedures and treatments for bronchiolitis were reduced in accordance with guidelines, but substantial variation remained between hospitals. There is a potential to further reduce the overuse of chest X-rays and repeated blood testing.

Introduction Asthma is a leading cause of morbidity and healthcare use among children. Risk factors of childhood asthma include atopic predisposition and severe wheezing episodes caused by rhinovirus infection in early life. In children with first-time rhinovirus-induced wheezing, we aim to study the response of a short corticosteroid treatment to prevent recurrent wheezing and asthma.Method and analysis This is a double-blind, randomised, placebo-controlled, phase IV, international multicentre trial involving eight sites in Norway, Sweden and Finland. Two hundred and eighty 3–23 months old steroid-naïve children are randomised 1:1 to receive oral dexamethasone (0.3 mg/kg/day) versus placebo in 3 days for their first wheezing episode and rhinovirus infection. Rhinovirus is diagnosed with multiplex PCR. The two co-primary outcomes are time to next physician-confirmed wheezing episode, and time to asthma, within 24 months from inclusion. Asthma is defined as fulfilment of the 2007 National Asthma Education and Prevention Program—criteria for initiating asthma controller medication in children aged 0–4 years. Primary interaction analyses are age, gender, atopic predisposition, risk genotypes and viral co-detection. The optimal cut-off on the rhinovirus genome load used to define a true rhinovirus infection will be assessed by exploring interactions between rhinovirus genomic loads and study drug on the co-primary outcomes. Secondary outcomes are number of wheezing episodes, duration and severity of each wheezing episode, bronchial hyperreactivity, quality of life and safety (height/weight development) at 24 months from inclusion.Ethics and dissemination Rhinovirus positive children with acute wheezing fulfilling inclusion and exclusion criteria are enrolled after informed consent from both caregivers. This trial has received ethical approval from all sites. Results will be submitted to Competent Authorities and disseminated via peer-reviewed publications and conferences within paediatrics and other relevant fields. If proven effective, findings may be implemented directly into paediatric clinical guidelines.Trial registration number NCT03889743.

OBJECTIVES:Diagnosing paediatric Community-Acquired Pneumonia (CAP) is challenging due to the difficulty in obtaining lung specimens. Studies suggest that the upper-airway density of Streptococcus pneumoniae is related to the risk and severity of CAP. We studied the association between S. pneumoniae and its density in the upper airways with CAP and its severity. Additionally, we examined the relationship between respiratory viral load and severe CAP. METHODS:Seven hundred fifteen children with radiologically confirmed CAP and 673 controls were enrolled over 11 years. Nasopharyngeal aspirates (NPA) were tested for 20 viruses and bacteria using semi-quantitative polymerase chain reaction (PCR). NPAs positive for S. pneumoniae were further analysed by quantitative PCR. Adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) were calculated to assess the association between S. pneumoniae density and CAP and CAP severity. RESULTS:Fewer cases than controls were colonised with S. pneumoniae (culture: 37.6 % vs 51.9 %, p < .001; PCR: 55.3 % vs 69.1 %, p < .001), and the median density was lower (6.20 log10 copies/mL vs 6.62 log10 copies/mL, p < .001). No association was found between S. pneumoniae density and CAP severity. CAP severity was significantly associated with high Respiratory Syncytial Virus (RSV) load (aOR 2.26, 95 % CI 1.43-3.57, p < .001) or high Human Metapneumovirus (HMPV) load (aOR 4.32, 95 % CI 2.19-8.48, p < .001), adjusted by pneumococcal density, other pathogens, age, sex, comorbidities, prior antibiotics and season. CONCLUSIONS:Detection and density of S. pneumoniae in the upper airways do not correlate with CAP presence or severity. High RSV and HMPV loads were linked to severe CAP.

OBJECTIVE:To assess relative age effects (how the youngest children in a school class are at increased risk compared with their older classmates) on healthcare use with psychiatric diagnoses in childhood and adolescence within preterm and term-born boys and girls. DESIGN/SETTING/PATIENTS:Registry-based cohort study including individuals born in Norway from 1991 to 2012 with follow-up data from the National Patient Registry from 2008 to 2017 when they were aged between 4 and 18 years. EXPOSURES:Relative age was defined according to birth month and grouped in four 3-month periods. Gestational age at birth (GA week+days) was categorised into preterm (GA 23+0-36+6) and term (GA 37+0-41+6). MAIN OUTCOME MEASURES:The presence of psychiatric diagnoses (any diagnosis and specific diagnosis groups according to ICD-10) in data from specialist healthcare contacts at different ages during follow-up was compared between relative age groups in preterm and term born using generalised estimating equation logistic regression analyses. RESULTS:Of 1 109 411 individuals, 7% were born preterm. Relative age effects for psychiatric diagnosis and specific diagnosis groups were seen for both preterm and term-born boys and girls, with the strongest estimates for any psychiatric diagnosis in the relatively younger preterm girls born in October-December, compared with the relatively older preterm girls born in January-March (OR 1.43 (95% CI 1.25 to 1.63) at ages 4-10 years). CONCLUSIONS:Relative age effects were widely demonstrated for healthcare use with psychiatric diagnoses within term and preterm born, for both girls and boys. The excess risk for those born late in the year added to already existing adversity in children born preterm, emphasising the need for additional consideration related to school and societal structures.

To explore the characteristic quality of health profiles of children with paediatric acquired brain injury (pABI), and to investigate whether improvement in executive function (EF) following cognitive rehabilitation is associated with improvement in health-related quality of life (HRQOL). A study of secondary endpoints in a blinded, parallel-randomised controlled trial with children (ages 10–17 years) with pABI and executive dysfunction. Data was obtained from 73 children-parent dyads. Explorative analyses were conducted comparing baseline with 8-week post-intervention, and 6-month follow-up data. Outcome measures included the EQ-5D-Y-3L health dimensions and the visual analogue scale (VAS). At baseline and 6-month follow-up, mean (SD) VAS were 76.22 (17.98) and 79.49 (19.82) on the parent-report, and 77.19 (16.63) and 79.09 (17.91) on the self-report, respectively. Comparing children who improved EF to those who did not improve/worsened, no significant improvement was found for the VAS (parent-report) over time (BRIEF-BRI: F = 2.19, p = 0.12, BRIEF-MI: F = 2.23, p = 0.12) for either group. A significant main effect by group was found for BRIEF-MI (F = 4.02, p = 0.049), but no time*group interaction (F = 0.414, p = 0.662). The children and their parents reported only minor problems across EQ-5D-Y-3L dimensions and evaluated overall health as relatively good. Participants with a clinically significant change in the metacognitive aspect of EF had higher HRQOL. Cognitive interventions aiming to ameliorate deficits in EF in pABI may be beneficial to improve HRQOL.

To explore the long-term effectiveness of a paediatric adaptation of Goal Management Training (pGMT), relative to a psychoeducative program (pBHW), in reducing fatigue after pABI 2 years post-intervention. Thirty-eight youths and their parents completed the Paediatric Quality of Life - Multidimensional Fatigue Scale. Primary outcome measures were Total Fatigue Score, General fatigue, Cognitive fatigue, and Sleep/rest fatigue (parent-report). No significant differences in fatigue symptoms by the parental report was observed between the intervention groups at the 2-year follow-up (total score: F = .16, p = .69; general fatigue: F = .36, p = .55; sleep/rest: F = .48, p = .49; and cognitive fatigue: F = .09, p = .76), nor any time*group interactions (total score: F = .25, p = .86; general fatigue: F = .39, p = .76; sleep/rest: F = .20, p = .89; and cognitive fatigue: F = .08, p = .97). In total, 45% of the participants in the pGMT group and 25% in the pBHW group demonstrated a reliable positive clinical change. The significant improvements in fatigue symptoms that were demonstrated 6 months post-intervention could not be confirmed in this 2-year follow-up study. However, a continued positive tendency on most dimensions of fatigue for the participants in the pGMT group could be observed, suggesting that cognitive rehabilitation may help reduce fatigue.