Is there a "European Paediatrics"?

The journey from birth to adulthood is paved with threats to health and wellbeing, rendering this age group with its invaluable future potential particularly vulnerable. Therefore, children and adolescents deserve medical attention of the highest professional level based on solid, well founded training guidelines, the availability of a well-coordinated platform for the continuous acquisition of knowledge, exchange of ideas, and collaboration on research and clinical projects, and comprehensive continuing education. For the European region these crucial specifications are met to varying degrees by three major paediatric organisations: the European Academy of Paediatrics (EAP) with the European Board of Paediatrics (EBP) as the paediatric section of the European Union of Medical Specialists (UEMS PS), the European Paediatric Association (EPA/UNEPSA) and the European Confederation of Primary Care Paediatricians (ECPCP). A major goal of this paper is to call for the closest possible collaboration between these organizations in advocating for the health and rights of European children and adolescents and in effectively fostering the paediatric profession with a strong, unified voice.

Prospective Randomized Observational Pilot Trial Evaluating the Effect of Information of Early Childhood Intervention on Stress Levels of Parents of Extremely Low Gestational Age Infants at the NICU.

It is not known to what extent early information on early childhood intervention (ECI) by ECI professionals reduces or increases stress levels of parents having an extremely preterm infant at the neonatal intensive care unit (NICU). Using an observational pilot study, we gave information on ECI in a randomized matter to parents of an extremely low gestational age newborn (ELGAN) at the chronological age of 3-4 weeks (cases) or not (controls). After informed consent, parents judged the infants at the age of 5-7 weeks with the Parental Stressor Scales: Neonatal Intensive Care Unit [PSS: NICU test has three subscales = "Sights and Sounds" (five items), "Parental Role Alteration" (14 items), and "Look and Behave" (seven items)]. Total scales score and subscales scores were comparable between 13 cases and 13 controls over a study period of 1.5 years. Total scores were 9.32 ± 0.72 in the cases compared to 10.02 ± 0.76 in the controls, (95% CI -6.93 to 4.93). Overall, the cases scored lower in most of the items. Early information on ECI at the NICU was provided to parents with an ELGAN did not result in higher stress levels measured with the PSS: NICU. Whether early information on ECI is a strategy, which might be able to reduce parental stress levels, has to be proven in larger studies.

Prospective Randomized Observational Pilot Trial Evaluating the Effect of Different Durations of Interdisciplinary Early Intervention and Family Support in Parents of Very Low Birth Weight Infants (Early Bird Study).

Background: Early childhood intervention (ECI) is a holistic approach for infants with or at risk for psychomotor and/or cognitive and/or behavioral impairment. It aims to optimally support them and positively influence their neurodevelopmental outcome. The right dosage of intervention and when the intervention should start are still to be determined. Hypothesis: Parents are more satisfied when the duration of ECI is longer (120 min once a week) than the usual 90-min session. Methods: We developed a parental questionnaire (both mother and father) that evaluated the level of satisfaction of parents with the intervention. We compared 120 with 90 min of ECI per week during the school year 2017/18. Included were parents of very low birth weight infants (<1,500 g) following informed consent. ECI was initiated at the NICU at an infant age of ≥ 2 weeks. Parents were randomized (https://www.randomizer.at/) to a 120- or 90-min duration and had to answer the questionnaire to the approximate time-point of 1, 3, and 6 months. Answers were classified as strongly agree, agree, neither agree nor disagree, disagree, and strongly disagree except for the last question, which directly rated the ECI professional. Results: Eleven fathers (55%) and 19 mothers (95%) of the 10 parents of each group participated in the study. Demographic data did not differ between groups, and the median time-points of questionnaire answers were 77, 137, and 220 days, respectively. Overall, 120-min ECI sessions were not superior to 90-min sessions for both parents regarding parental satisfaction during the study time. We found no differences between fathers and mothers and minimal changes over time. All parents were satisfied with the ECI professionals, irrespective of ECI duration. Conclusion: An ECI duration of 120 min once per week was not superior to a 9- min duration regarding parental satisfaction with ECI professionals and their work.

Cortical depth-specific microvascular dilation underlies laminar differences in blood oxygenation level-dependent functional MRI signal.

Changes in neuronal activity are accompanied by the release of vasoactive mediators that cause microscopic dilation and constriction of the cerebral microvasculature and are manifested in macroscopic blood oxygenation level-dependent (BOLD) functional MRI (fMRI) signals. We used two-photon microscopy to measure the diameters of single arterioles and capillaries at different depths within the rat primary somatosensory cortex. These measurements were compared with cortical depth-resolved fMRI signal changes. Our microscopic results demonstrate a spatial gradient of dilation onset and peak times consistent with "upstream" propagation of vasodilation toward the cortical surface along the diving arterioles and "downstream" propagation into local capillary beds. The observed BOLD response exhibited the fastest onset in deep layers, and the "initial dip" was most pronounced in layer I. The present results indicate that both the onset of the BOLD response and the initial dip depend on cortical depth and can be explained, at least in part, by the spatial gradient of delays in microvascular dilation, the fastest response being in the deep layers and the most delayed response in the capillary bed of layer I.

Informed consent/assent in children. Statement of the Ethics Working Group of the Confederation of European Specialists in Paediatrics (CESP).

Informed consent means approval of the legal representative of the child and/or of the competent child for medical interventions following appropriate information. National legal regulations differ in regard to the question when a child has the full right to give his or her autonomous consent. Informed assent means a child's agreement to medical procedures in circumstances where he or she is not legally authorised or lacks sufficient understanding for giving consent competently. Doctors should carefully listen to the opinion and wishes of children who are not able to give full consent and should strive to obtain their assent. Doctors have the responsibility to determine the ability and competence of the child for giving his or her consent or assent. All children, even those not judged as competent, have a right to receive information given in a way that they can understand and give their assent or dissent. This consent/assent process must promote and protect the dignity, privacy and confidentiality of the child and his or her family. Consent or assent is required for all aspects of medical care, for preventive, diagnostic or therapeutic measures and research. Children may effectively refuse treatment or procedures which are not necessary to save their lives or prevent serious harm. Where treatment is necessary to save a life or prevent serious harm, the doctor has the duty to act in the best interest of the child. However, parents may also refuse to consent and in this case national laws and legal mechanisms for resolving disputes may be used.

Short-term event recording as a measure to rule out false alarms and to shorten the duration of home monitoring in infants.

Apnea and cardiorespiratory home monitors are commonly used for electronic surveillance of infants. Frequent alarms can be very stressful for parents and lead to unnecessarily prolonged home monitoring. The aims of this study were to determine the frequency and type of significant events by using short-term home event recordings of respiratory, electrocardiogram and oxygenation patterns, to consider the pros and cons of oxygenation recording, to correlate the findings with observations made by parents and to find out whether parents could be reassured by the use of these monitors. We investigated recordings from 26 healthy symptomless infants (14 male, 12 female) whose parents experienced anxiety and stress owing to frequent alarms on their apnea (n = 2) or cardiorespiratory home monitors (n = 24). 770 events were analyzed and compared with the parents' interpretation. Median duration of monitoring was 10 days. Only 39/770 alarms (5.1%) were classified as true alarms. Of these, 30 alarms (76.9%) were misinterpreted as false alarms by parents. In contrast, of 218 alarms regarded as true by parents only 15 (6.9%) were in fact true, alarms. The comparison of monitor data and the parents' reports showed no correlation in interpretation of alarms, for both true (r = 0.06) and false alarms (r = -0.09). Of 283 oxygenation alarms, only two were due to real desaturation. Following short-term monitoring, 21/26 parents (80.7%) declared they were reassured. Monitoring could immediately be discontinued in 17/26 infants (65.4%). Short-term event recording can clarify the significance of frequent alarms, reassure parents and shorten the duration of home monitoring.

Infrared thermography in newborns: the first hour after birth.

OBJECTIVE: It was the aim of this study to investigate the surface temperature in newborns within the first hour after delivery. Furthermore, the influence of different environmental conditions with regard to surface temperature was documented. METHODS: Body surface temperature was recorded under several environmental conditions by use of infrared thermography. 42 newborns, all delivered at term and with weight appropriate for date, were investigated under controlled conditions. RESULTS: The surface temperature immediately after birth shows a uniform picture of the whole body; however, it is significantly lower than the core temperature. Soon after birth, peripheral sites become cooler whereas a constant temperature is maintained at the trunk. Bathing in warm water again leads to a more even temperature profile. Radiant heaters and skin-to-skin contact with the mother are both effective methods to prevent heat loss in neonates. CONCLUSIONS: Infrared thermography is a simple and reliable tool for the measurement of skin temperature profiles in neonates. Without the need of direct skin contact, it may be helpful for optimizing environmental conditions at delivery suites and neonatal intensive-care units.

Classification of sudden infant death (SID) cases in a multidisciplinary setting. Ten years experience in Styria (Austria).

OBJECTIVE: Sudden infant death syndrome (SIDS) remains a challenge for health professionals despite decreasing rates in recent years. The figures for different areas and time periods are hardly comparable, because of differences in postmortem investigations and classification criteria. In 1992, the European Society for the Study and Prevention of Infant Deaths (ESPID) proposed a classification for any sudden and unexpected death in infancy. This proposal has been used in our study since 1993 to better classify sudden infant death (SID) cases. METHOD: 56 consecutive SID cases observed between 1993 and 2002 in Styria, the south-eastern province of Austria, were analysed by a multidisciplinary team of health professionals. The study group consisted of pediatricians, forensic pathologists, pathologists, psychologists, nurses, members of the parents' association and health authorities. SID cases were analysed with regard to potential risk factors during pregnancy and early life, the circumstances of death (death scene) and post-mortem findings. From the latter, every SID was classified as either 1) classic SIDS, 2) borderline SIDS, 3) non-autopsied SID or 4) explained death. RESULTS: Of the 56 SID cases, 22 were assigned to category 1, 19 to category 2, four to category 3, and in 11 cases death could be explained by major post-mortem findings. For 17/22 cases in category 1 and 11/19 cases in category 2, the death scene investigation showed the typical risk profile of manner of bedding and/or environmental conditions. In three cases, child abuse or infanticide was considered possible but could not be proven despite careful autopsy. In recent years, SIDS incidence in Styria has decreased to approximately 0.18/1,000 live-born infants, and the few deaths still occurring mainly present with the typical risk profile. CONCLUSION: An extensive analysis of SID events is a prerequisite for reliable and comparable SIDS statistics. Our data show that in several SID cases careful post-mortem examinations led to an explanation of death. In other cases, minor alterations may have contributed to the lethal event. These findings should therefore be considered in the classification of SIDs. The ESPID classification of 1992 appears to be very useful for this purpose and its use may therefore be recommended.

Pacifier use and sudden infant death syndrome: should health professionals recommend pacifier use based on present knowledge?

The aim of this paper is to review and compare results from different studies describing the possible preventive effect of pacifiers on the sudden infant death syndrome. A Medline and Pubmed search was performed in order to find relevant references. Four groups of researchers were found, and referring to the most recent publications of each working group, these papers were reviewed with regard to sample size, setting of the studies, odds ratios and confidence intervals. All four research groups found an association between pacifier use and a reduced risk of sudden infant death syndrome, but they all concluded that the association does not necessarily imply that the use of a pacifier is protective against the sudden infant death syndrome. Therefore, they provide no definite recommendation for pacifier use on the grounds of protection against the sudden infant death syndrome.

[Sudden infant death in Austria--status quo and recommendations of the SIDS Consensus Working Group for Improved Registration]. / Der plötzliche Säuglingstod in Osterreich--Status quo und Empfehlungen der SIDS-Konsensusarbeitsgruppe zur verbesserten Erfassung.

Sudden infant death (SID) is the most common cause of death among infants aged 2 to 12 months in Austria. The complete autopsy required in order to diagnose SID, including the additional investigations, and the comprehensive autopsies needed for epidemiological studies are not common practice because of the different statutory regulations in the provinces and the absence of a uniform federal law in this regard. According to statistics, in the last four years only 83% (1997) to 70% (1999) of the reported SID cases in Austria were autopsied. Our survey in the forensic medicine and pathological institutes of Austria also revealed markedly different practices in regard of the manner in which autopsies are performed and parents are interviewed and followed up. For this reason, the SIDS Consensus Work Group of Austrian centers for the prevention of sudden infant death recommends the following: a) a comprehensive autopsy by a trained specialist to be established as a prerequisite for diagnosing "SIDS"; b) performing autopsies on a centralized basis in those forensic or pathological institutes that have agreed to adhere to protocol-based autopsy standards; c) the introduction of quality control in terms of a regional clinical-pathological conference; and d) standardizing the elements of the interview with parents of SID victims. Implementing these measures and entering the collected information into a data base in which the master data are encoded by the individual institutions, will help to evaluate the role of major epidemiological risk factors that information campaigns are focused upon, namely sleeping in prone position, the role of nicotine, etc. In addition, it will be necessary to formulate federal laws that standardize the divergent provincial regulations.