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| 2. |
- Axelsson, Inge, 1947-, et al.
(författare)
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Inhaled corticosteroids in children with persistent asthma : effects of different drugs and delivery devices on growth
- 2019
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Ingår i: Cochrane Database of Systematic Reviews. - : John Wiley & Sons. - 1469-493X. ; :6
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Forskningsöversikt (refereegranskat)abstract
- Background: Inhaled corticosteroids (ICS) are the most effective treatment for children with persistent asthma. Although treatment with ICS is generally considered to be safe in children, the potential adverse effects of these drugs on growth remains a matter of concern for parents and physicians.Objectives: To assess the impact of different inhaled corticosteroid drugs and delivery devices on the linear growth of children with persistent asthma.Search methods: We searched the Cochrane Airways Trials Register, which is derived from systematic searches of bibliographic databases including CENTRAL, MEDLINE, Embase, CINAHL, AMED and PsycINFO. We handsearched respiratory journals and meeting abstracts. We also conducted a search of ClinicalTrials.gov and manufacturers' clinical trial databases, or contacted the manufacturer, to search for potential relevant unpublished studies. The literature search was initially conducted in September 2014, and updated in November 2015, September 2018, and April 2019.Selection criteria: We selected parallel‐group randomized controlled trials of at least three months' duration. To be included, trials had to compare linear growth between different inhaled corticosteroid molecules at equivalent doses, delivered by the same type of device, or between different devices used to deliver the same inhaled corticosteroid molecule at the same dose, in children up to 18 years of age with persistent asthma.Data collection and analysis: At least two review authors independently selected studies and assessed risk of bias in included studies. The data were extracted by one author and checked by another. The primary outcome was linear growth velocity. We conducted meta‐analyses using Review Manager 5.3 software. We used mean differences (MDs) and 95% confidence intervals (CIs ) as the metrics for treatment effects, and the random‐effects model for meta‐analyses. We did not perform planned subgroup analyses due to there being too few included trials.Main results: We included six randomized trials involving 1199 children aged from 4 to 12 years (per‐protocol population: 1008), with mild‐to‐moderate persistent asthma. Two trials were from single hospitals, and the remaining four trials were multicentre studies. The duration of trials varied from six to 20 months.One trial with 23 participants compared fluticasone with beclomethasone, and showed that fluticasone given at an equivalent dose was associated with a significant greater linear growth velocity (MD 0.81 cm/year, 95% CI 0.46 to 1.16, low certainty evidence). Three trials compared fluticasone with budesonide. Fluticasone given at an equivalent dose had a less suppressive effect than budesonide on growth, as measured by change in height over a period from 20 weeks to 12 months (MD 0.97 cm, 95% CI 0.62 to 1.32; 2 trials, 359 participants; moderate certainty evidence). However, we observed no significant difference in linear growth velocity between fluticasone and budesonide at equivalent doses (MD 0.39 cm/year, 95% CI ‐0.94 to 1.73; 2 trials, 236 participants; very low certainty evidence).Two trials compared inhalation devices. One trial with 212 participants revealed a comparable linear growth velocity between beclomethasone administered via hydrofluoroalkane‐metered dose inhaler (HFA‐MDI) and beclomethasone administered via chlorofluorocarbon‐metered dose inhaler (CFC‐MDI) at an equivalent dose (MD ‐0.44 cm/year, 95% CI ‐1.00 to 0.12; low certainty evidence). Another trial with 229 participants showed a small but statistically significant greater increase in height over a period of six months in favour of budesonide via Easyhaler, compared to budesonide given at the same dose via Turbuhaler (MD 0.37 cm, 95% CI 0.12 to 0.62; low certainty evidence).Authors' conclusions: This review suggests that the drug molecule and delivery device may impact the effect size of ICS on growth in children with persistent asthma. Fluticasone at an equivalent dose seems to inhibit growth less than beclomethasone and budesonide. Easyhaler is likely to have less adverse effect on growth than Turbuhaler when used for delivery of budesonide. However, the evidence from this systematic review of head‐to‐head trials is not certain enough to inform the selection of inhaled corticosteroid or inhalation device for the treatment of children with persistent asthma. Further studies are needed, and pragmatic trials and real‐life observational studies seem more attractive and feasible.
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- Edler, Gertrud, et al.
(författare)
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Serious complications in male infant circumcisions in Scandinavia indicate that this always be performed as a hospital-based procedure
- 2016
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 105:7, s. 842-850
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Tidskriftsartikel (refereegranskat)abstract
- AimMore than 7000 male circumcisions are performed in Scandinavia every year. Circumcision is regulated in different ways in Sweden and Denmark and Norway. This study reviewed and described factors associated with complications of circumcision in infant boys in Scandinavia over the last two decades and discussed how these complications could be avoided. MethodsData on significant complications following circumcision on boys under the age of one in Scandinavia over the last 20 years were collected. Information was retrieved from testimonies of circumcisers, witnesses, medical records and verdicts. A systematic review was performed of fatal cases in the literature. ResultsWe found that 32 cases had been reported to the health authorities in the three countries, and we identified a total of 74 complications in these cases. These included four boys with severe bleeding and circulatory shock, which ended in the death of one boy. Other less serious complications may have occurred in other boys, but not been reported. ConclusionComplications following male circumcision in Scandinavia were relatively rare, but serious complications did occur. Based on the analyses of the severe cases, we argue that circumcision should only be performed at hospitals with 24-hour emergency departments.
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| 5. |
- Granbom, Elin, et al.
(författare)
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Respiratory tract infection and risk of hospitalization in children with congenital heart defects during season and off-season : a Swedish national study
- 2016
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Ingår i: Pediatric Cardiology. - New York : Springer. - 0172-0643 .- 1432-1971. ; 37:6, s. 1098-1105
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Tidskriftsartikel (refereegranskat)abstract
- Respiratory tract infections (RTI) are common among young children, and congenital heart defect (CHD) is a risk factor for severe illness and hospitalization. This study aims to assess the relative risk of hospitalization due to RTI in winter and summer seasons for different types of CHD. All children born in Sweden and under the age of two, in 2006-2011, were included. Heart defects were grouped according to type. Hospitalization rates for respiratory syncytial virus (RSV) infection and RTI in general were retrieved from the national inpatient registry. The relative risk of hospitalization was calculated by comparing each subgroup to other types of CHD and otherwise healthy children. The relative risk of hospitalization was increased for all CHD subgroups, and there was a greater increase in risk in summer for the most severe CHD. This included RSV infection, as well as RTI in general. The risk of hospitalization due to RTI is greater for CHD children. Prophylactic treatment with palivizumab, given to prevent severe RSV illness, is only recommended during winter. We argue that information to healthcare staff and parents should include how the risk of severe infectious respiratory tract illnesses, RSV and others, is present all year round for children with CHD.
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| 6. |
- Granbom, Elin, 1986-
(författare)
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Respiratory tract infections in children with congenital heart disease
- 2016
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Respiratory Syncytial Virus (RSV) infection is common among young children. Congenital Heart Disease (CHD) is a risk factor of severe illness and hospitalization. Palivizumab prophylaxis reduces the severity of RSV infection and reduces the risk of hospitalization for children at high risk of severe illness, such as children born premature or with CHD.The aim of this thesis was to evaluate compliance with national guidelines for prophylactic treatment and to study the Relative Risk (RR) of hospitalization due to RSV and unspecified Respiratory Tract Infection (RTI) for children with CHD.In a prospective study, questionnaires were sent to all paediatric cardiology centres in Sweden with questions about prophylactic treatment. Hospitalization rates were retrieved from the national inpatient registry. Heart defects were grouped according to type and the relative risk of hospitalization was calculated for each group and for summer and winter seasons.Half of the patients received prophylactic treatment later than recommended in the guidelines. The risk of hospitalization due to RSV infection was increased (RR=2.06 95% CI 1.6-2.6; p < 0.0001) for children with CHD compared to children without CHD. The RR of hospitalization was also increased for all CHD subgroups, and was further increased during summer for children with the more severe CHD.We conclude that guidelines for prophylactic treatment were not followed and that the risk of hospitalization due to RSV and unspecified RTI was increased for all subgroups of CHD. The risk was increased both during winter and summer and we therefore argue that information to health personnel and parents should include that the risk of severe RTI is present all year round for children with CHD.
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| 7. |
- Grut, Viktor, et al.
(författare)
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National cohort study showed that infants with Down's syndrome faced a high risk of hospitalisation for the respiratory syncytial virus
- 2017
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 106:9, s. 1519-1524
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The respiratory syncytial virus (RSV) is a leading cause of hospitalisation in infants. We investigated this risk in children with Down's syndrome under two years of age, adjusted for other known risk factors. Methods: This national, retrospective 1: 2 matched cohort study comprised all Swedish children born with Down's from 2006 to 2011, who were each randomly matched to two controls without Down's. Data on RSV hospitalisation and risk factors for RSV were obtained from national registers. The risk of RSV hospitalisation was assessed using multivariable Cox regression with pairwise stratification. Results: The study comprised 814 children with Down's and 1628 controls. We found that 82 children with Down's (10.1%) and 22 controls (1.4%) were hospitalised for RSV. The hazard ratio for children with Down's was 4.00 (95% confidence interval 1.58-10.13) for up to one year of age and 6.60 (95% CI: 2.83-15.38) for up to two years of age, adjusted for other risk factors. During the second year of life, RSV hospitalisation continued for children with Down's, while it was minimal for the controls. Conclusion: Children with Down's faced a high risk of RSV hospitalisation, which continued beyond the first year of age.
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| 8. |
- Irevall, T., et al.
(författare)
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B12 deficiency is common in infants and is accompanied by serious neurological symptoms
- 2017
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 106:1, s. 101-104
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Adverse neurological symptoms have been linked to vitamin B12 deficiency in infants. This explorative study described the clinical presentation associated with vitamin B12 deficiency in this age group. Methods: The study comprised infants who were born between 2004 and 2012 and were tested for vitamin B12 levels after they were admitted to a hospital with neurological symptoms at less than one year of age. Vitamin B12 deficiency was defined as low cobalamin in serum and/or increased homocysteine and/or increased methylmalonate. It was diagnosed according to the applicable International Classification of Diseases, 10th revision, and recorded as vitamin B12 deficiency in the medical records. All information was retrieved from medical records and compared to symptomatic infants with normal levels. Results: Of the 121 infants tested, 35 had vitamin B12 deficiency and 86 had normal levels. Vitamin B12 deficiency was diagnosed at an average age of 1.7 months and was more common among boys. Seizures and apparent life-threatening events were the most common symptoms among infants with B12 deficiency compared to infants with normal levels. Conclusion: Vitamin B12 deficiency was more common in infants than we expected and presented with severe symptoms, such as seizures and apparent life-threatening events.
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| 10. |
- Lennelöv, E., et al.
(författare)
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The Prevalence of Asthma and Respiratory Symptoms among Cross-Country Skiers in Early Adolescence
- 2019
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Ingår i: Canadian Respiratory Journal. - : Hindawi Publishing Corporation. - 1916-7245 .- 1198-2241. ; 2019
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine the prevalence of asthma and respiratory symptoms among Swedish cross-country skiers in early adolescence in comparison to a population-based reference group of similar ages.Methods: A postal questionnaire on asthma, asthma medication, allergy, respiratory symptoms, and physical activity was distributed to Swedish competitive cross-country skiers aged 12–15 years (n = 331) and a population-based reference group (n = 1000). The level of asthma control was measured by the Asthma Control Test.Results: The response rate was 27% (n = 87) among skiers and 29% (n = 292) in the reference group. The prevalence of self-reported asthma (physician-diagnosed asthma and use of asthma medication in the last 12 months) and the prevalence of reported wheezing during the last 12 months were 23% and 25%, respectively, among skiers, which were significantly higher than the values reported in the reference group (12% and 14%). Skiers exercised more hours/week than the reference group. Among adolescents with self-reported asthma, neither the usage of asthma medications nor the level of asthma control according to the Asthma Control Test differed between skiers and the reference group.Conclusions: Adolescent competitive cross-country skiers have an increased prevalence of respiratory symptoms and asthma compared to nonskiers.
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