Patterns and seasonality in pediatric referrals for functional somatic symptoms.

Functional somatic symptoms (FSS), or medically unexplained physical symptoms, are common in children and it has been suggested that the incidence is increasing. To determine the incidence and pattern of referrals for FSS to pediatricians, we performed a retrospective analysis including newly referred pediatric patients to our secondary pediatric practice in Zwolle, The Netherlands, ultimately diagnosed with FSS between 2013 and 2018. FSS was defined as functional abdominal pain, chronic fatigue, chronic musculoskeletal pain and chronic headache without an underlying medical diagnosis. In the 6-year period, 10.4% of elective referrals were related to FSS without a significant upward trend. We found clear seasonal variation with peaks in incidences in March (+31%) and November (+21%) and a nadir around August (-48%). In conclusion, FSS account for 1 in 10 non-acute pediatric referrals, without an increase in incidence in the past 6 years. The seasonal pattern is remarkable and warrants further analysis.

[Intrauterine exposure to SSRIs: no reason for routine hypoglycaemia screening]. / Intra-uteriene blootstelling aan SSRI's: geen reden voor routinematige controle op hypoglykemie.

OBJECTIVE: To investigate whether neonates who have been exposed to selective serotonin reuptake inhibitors (SSRIs) in utero have a higher risk of hypoglycaemia than unexposed neonates. DESIGN: Systematic review of cohort studies. METHODS: We searched in PubMed and Embase for available cohort studies in which neonates exposed to SSRIs in utero were compared to non-exposed neonates, with hypoglycaemia as an outcome parameter. The studies were evaluated with respect to methodological quality by applying the 'Guidelines for assessing quality in prognostic studies' (QUIPS). The results were noted qualitatively. RESULTS: We found 4 studies that were suitable for further analysis. The studies were similar in design but led to very variable results. Important confounders differed greatly between studies and were not corrected for. Therefore, with these studies no answer could be given to the research question. CONCLUSION: The literature does not contain enough evidence to conclude that neonates exposed to SSRIs during pregnancy have a higher risk of developing hypoglycaemia than non-exposed neonates. Only when a neonate shows clinical signs that can be attributed to both hypoglycaemia and withdrawal symptoms a single glucose check is indicated.

Epidemiologic and microbiologic characteristics of recurrent bacterial and fungal meningitis in the Netherlands, 1988-2005.

BACKGROUND: Patients may experience multiple episodes of bacterial meningitis. Information from large studies of recurrent meningitis is limited. We evaluated the incidence of recurrent bacterial meningitis and the distribution of causative organisms in The Netherlands. METHODS: Data for patients with bacterial meningitis were prospectively collected nationwide for the period 1988-2005. Recurrent meningitis was defined as an episode of meningitis that either occurred >or=28 days after a previous episode or occurred <28 days after a previous episode but was caused by a different pathogen or different subtype of the same pathogen. RESULTS: Of 18,915 patients, 202 (predominantly male) patients had recurrent bacterial meningitis (P< .01). Prevailing causative organisms were Streptococcus pneumoniae (40% of cases), Neisseria meningitidis (22%), and non-type b Haemophilus influenzae (9%). Pneumococci serotypes included in the heptavalent vaccine caused only 36% of cases of recurrent pneumococcal meningitis. The proportion of episodes caused by meningococcus serogroups W135, Y, and Z was higher among patients with recurrent meningitis than among those with nonrecurrent meningitis (odds ratio, 12.8), and the proportion caused by nontypeable and type f H. influenzae was also higher among patients with recurrent meningitis (odds ratio, 3.8 and 5.6, respectively). CONCLUSIONS: In The Netherlands, the prevalence of recurrent bacterial and fungal meningitis is low. The distribution of causative microorganisms differs between cases of recurrent meningitis and cases of nonrecurrent meningitis; this could be associated with vaccination.