Breast-feeding and infections during infancy

Background: Human milk is the most suitable food for newborn and young infants and its exclusive supply for at least the first six months of life ought to be universally provided. A wide array of benefits of breastfeeding have been well documented, including financial, psychosocial, developmental and prevention of illnesses, including infections. Although it has long been shown that breastfed infants are less prone to a variety of infections, skeptics have asserted that breastfeeding and formula-feeding mothers differ in ways which might alter infantile risk for infection and that the breastfeeding protective effect may be attributable to confounding factors and may be expressed less in societies with high health standards. Purpose:Σο prospectively investigate the effect of breastfeeding on both the frequency, expressed as number of infectious episodes, and the severity, expressed as need for doctor visits and hospitalization for common infections throughout the first year of life, in a well-defined, well-vaccinated infant population with adequate health standards. Based on existing experience in the field, the study was designed first to verify the hypothesis that breastfeeding protects against common infantile infections, second to explore the impact of exclusive breastfeeding and its duration, and third to investigate this impact during both the first and the second 6 months of infancy (months 1-6 and months 6-12). Study design: The study was conducted as a prospective observational study in a fixed cohort in the island of Crete. From a total of 6,878 births in 2004, a representative cohort of 1,049 (15.2%) mother-infant pairs was formed. Sampling was based on consecutive births in random days from October to December, 2004 and from April to July, 2005. This 2-period sampling facilitated assessment of the effect of breastfeeding on infections as related to season of birth. In 926 infants, successfully followed up for 12 months, feeding mode and all infectious episodes, including acute otitis media (AOM), acute respiratory infection (ARI), gastroenteritis, urinary tract infection, conjunctivitis and thrush, were recorded at 1, 3, 6, 9 and 12 months of life. Severity of infections was estimated by the number of doctor visits and admissions to hospital. Potential confounders evaluated were ethnic origin, average parental age (years), average years of parental education, birth weight, sex, season of birth (autumn/spring), gestation duration, delivery mode and number of siblings. ..........................

Conjugate vaccines dramatically reshaped the epidemiology of bacterial meningitis in a well-defined child population

Aim We explored the impact of vaccination on bacterial meningitis in a well-defined population of children on the island of Crete, Greece, over a 27-y period. Methods This was a retrospective observational study of all mandatory notifications of bacterial meningitis in patients aged 1 mo-14 y from 1991 to 2017. Results There were 245 patients with proven (n = 227) or suspected (n = 18) bacterial meningitis, and eight deaths were recorded, giving a case fatality rate of 3.3%. The mean annual incidence rate (IR) per 100 000 children was 4.9 for Neisseria meningitidis, 2.2 for Streptococcus pneumoniae and 0.4 for Haemophilus influenzae type b (Hib). Cases of meningitis C dropped significantly after the conjugate meningitis C vaccine was licensed for routine vaccination in Greece in 2000 (IR of 1.5 vs 0.3, P < 0.028) while the Streptococcus pneumoniae cases showed a threefold decrease after the PCV13 vaccine was licensed in Greece in 2009 (IR 2.7 vs 1.0, P 0.03). Vaccination had already eliminated Hib in Greece in the 1990s. Conclusion Bacterial meningitis cases decreased in children following the introduction of the meningitis C and PCV13 vaccines in Greece. Hib had already disappeared and significant reductions in meningitis C and Streptococcus pneumoniae were observed

Characteristic of imaging in Kawasaki- like MIS-C and MIS-C patients.

Characteristic of imaging in Kawasaki- like MIS-C and MIS-C patients.</p

Clinical signs and symptoms in Kawasaki- like MIS-C and MIS-C patients.

Clinical signs and symptoms in Kawasaki- like MIS-C and MIS-C patients.</p

The baseline characteristics and clinical outcome in MIS-C and Kawasaki- like MIS-C.

The baseline characteristics and clinical outcome in MIS-C and Kawasaki- like MIS-C.</p

Laboratory features in Kawasaki- like MIS-C and MIS-C patients.

Laboratory features in Kawasaki- like MIS-C and MIS-C patients.</p

Complication in Kawasaki- like MIS-c and MIS-c patients.

Complication in Kawasaki- like MIS-c and MIS-c patients.</p

Treatment in Kawasaki- like MIS-C and MIS-C patients.

Treatment in Kawasaki- like MIS-C and MIS-C patients.</p

High Rates of Prescribing Antimicrobials for Prophylaxis in Children and Neonates: Results From the Antibiotic Resistance and Prescribing in European Children Point Prevalence Survey

Background. This study was conducted to assess the variation in prescription practices for systemic antimicrobial agents used for prophylaxis among pediatric patients hospitalized in 41 countries worldwide. Methods. Using the standardized Antibiotic Resistance and Prescribing in European Children Point Prevalence Survey protocol, a cross-sectional point-prevalence survey was conducted at 226 pediatric hospitals in 41 countries from October 1 to November 30, 2012. Results. Overall, 17 693 pediatric patients were surveyed and 36.7% of them received antibiotics (n = 6499). Of 6818 inpatient children, 2242 (32.9%) received at least 1 antimicrobial for prophylactic use. Of 11 899 prescriptions for antimicrobials, 3400 (28.6%) were provided for prophylactic use. Prophylaxis for medical diseases was the indication in 73.4% of cases (2495 of 3400), whereas 26.6% of prescriptions were for surgical diseases (905 of 3400). In approximately half the cases (48.7% [1656 of 3400]), a combination of 2 or more antimicrobials was prescribed. The use of broad-spectrum antibiotics (BSAs), which included tetracyclines, macrolides, lincosamides, and sulfonamides/trimethoprim, was high (51.8% [1761 of 3400]). Broad-spectrum antibiotic use for medical prophylaxis was more common in Asia (risk ratio [RR], 1.322; 95% confidence interval [CI], 1.202-1.653) and more restricted in Australia (RR, 0.619; 95% CI, 0.521-0.736). Prescription of BSA for surgical prophylaxis also varied according to United Nations region. Finally, a high percentage of surgical patients (79.7% [721 of 905]) received their prophylaxis for longer than 1 day. Conclusions. A high proportion of hospitalized children received prophylactic BSAs. This represents a clear target for quality improvement. Collectively speaking, it is critical to reduce total prophylactic prescribing, BSA use, and prolonged prescription