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CHILD WELL-BEING IN RICH COUNTRIES
A recent United Nations Children’s Fund (UNICEF) report of child well-being in 21 countries placed the UK last (the US was 20th). Nick Spenser reviews the key elements of this report, highlighting the six dimensions that UNICEF considered—material well-being, health and safety, educational well-being, family and peer relationships, behaviours and risks, and subjective well-being. Each dimension was assessed using different indicators, very few of which relate to “traditional healthcare.” At the end of the article, Dr Spencer highlights both what individual paediatricians as well as the College should do in attempt to promote and enhance child well-being in the UK.
See pages 915
PRELIMINARY STUDIES: ARE THEY WORTH PUBLISHING?
Two preliminary studies are published this month in ADC. Robertson and colleagues describe the “Families for Health” community-based programme for children who are obese. They describe how the programme was developed, and present preliminary data of changes in baseline BMI in 27 children and their parents who participated in the 12-week programme. The results are encouraging. The second study describes an education programme, KICk-OFF, that focuses on children with type 1 diabetes. Various aspects of the programme, including the quality of the curriculum and its acceptability were assessed, and preliminary data, including HbA1c, BMI and episodes of hypoglycaemia, are presented for the 48 children who participated in the 5-day programme. So, are these reports worth publishing? Obviously, we thought so. Both not only describe the programme, but more importantly contain preliminary data about processes of care and health outcomes. We tend to avoid reports that simply describe programme development and acceptability that contain no actual patient outcomes.
THE METABOLIC SYNDROME REVISITED
In a report from Finland, Pirkola et al have used the population-based Northern Finland Birth Cohort of 1986 to examine how different definitions of the metabolic syndrome impact reported prevalence. Using both the International Diabetes Foundation and Adult Treatment Panel III definitions, they found that the prevalence varied between 1.4% and 3.5% in 2862 adolescent males and 0.6% and 3.2% in 2803 adolescent females. I have never been sure what to make of the metabolic syndrome. It seems to be a collection of risk factors that relate to the development of cardiovascular disease, but I am uncertain if using the label improves patient outcomes. A recent editorial in Lancet questions whether the term has any clinical usefulness.1
See pages 945
HARMONISING IMMUNISATION SCHEDULES
In a multi-national randomised clinical trial, conducted in one centre in the UK and nine in Poland, Pace and colleagues describe the results of a Hib-MenC-TT glycoconjugate vaccine as a booster dose in children aged 12–15 months. In 476 toddlers, this vaccine was compared to a MenC-CRM197 vaccine. The authors conclude that the Hib-MenC-TT can be used to boost the waning antibody titres against Hib and MenC following primary immunisation. This study highlights the growing need to better harmonise immunisation schedules around the world, although these schedules are growing increasingly complex. Unfortunately, schedules are often embedded in the timing of the delivery of primary care services and reflect national priorities (eg, in the UK preventing meningococcal disease and in the US preventing varicella), both of which vary substantially from country to country. However, the repeated need for clinical trials to test whether a modified schedule produces immunogenicity seems to be a waste of resources. I recall fondly the days when I could actually remember the immunisation schedule and would gladly answer a question about which shot to give when. Now I would never dare to answer such a question.
See pages 963
THIS MONTH IN FETAL & NEONATAL EDITION
Can ultrasound (US) help when performing a lumbar puncture (LP) in a neonate? In a preliminary report, Arthurs and colleagues performed 116 US measurements in 105 neonates at L3/L4 and have developed a nomogram for predicting mid-canal spinal depth. I look forward to the study that assesses whether US improves the “success” rate of LP in neonates. See page F451
Preterm neonates with suspected sepsis often receive vancomycin. Intermittent infusion is standard of care. These French investigators have experimented with continuous infusion and found that vancomycin concentrations within the therapeutic range can be easily maintained. To determine superiority, a randomised clinical trial will be necessary comparing intermittent with continuous infusion of vancomycin. See page F418
Concerns that early fetal and neonatal factors may impact on disease later in life must be extended to the potential long-term adverse consequences of interventions that are known to be beneficial in the newborn period. There is no doubt that maternal glucocorticoid treatment reduces neonatal mortality for premature infants. In a long-term follow-up study from The Netherlands, Finken et al report on various outcomes, including body composition and insulin resistance, at 19 years of age in 412 premature infants whose mothers received glucocorticoids. See page F442
The treatment of infants with patent ductus arteriosus in highly variable. In a study from Ireland and Australia, El-Khuffash et al explore the utility of cardiac troponin and N-terminal-pro-B type natriuretic peptide to predict outcome in infants with intraventricular haemorrhage and PDA. See page F407