Incidence of Antibiotic Exposure for Suspected and Proven Neonatal Early-Onset Sepsis between 2019 and 2021:A Retrospective, Multicentre Study

Management of suspected early-onset sepsis (EOS) is undergoing continuous evolution aiming to limit antibiotic overtreatment, yet current data on the level of overtreatment are only available for a select number of countries. This study aimed to determine antibiotic initiation and continuation rates for suspected EOS, along with the incidence of culture-proven EOS in The Netherlands. In this retrospective study from 2019 to 2021, data were collected from 15 Dutch hospitals, comprising 13 regional hospitals equipped with Level I-II facilities and 2 academic hospitals equipped with Level IV facilities. Data included birth rates, number of neonates started on antibiotics for suspected EOS, number of neonates that continued treatment beyond 48 h and number of neonates with culture-proven EOS. Additionally, blood culture results were documented. Data were analysed both collectively and separately for regional and academic hospitals. A total of 103,492 live-born neonates were included. In 4755 neonates (4.6%, 95% CI 4.5–4.7), antibiotic therapy was started for suspected EOS, and in 2399 neonates (2.3%, 95% CI 2.2–2.4), antibiotic treatment was continued beyond 48 h. Incidence of culture-proven EOS was 1.1 cases per 1000 live births (0.11%, 95% CI 0.09–0.14). Overall, for each culture-proven EOS case, 40.6 neonates were started on antibiotics and in 21.7 neonates therapy was continued. Large variations in treatment rates were observed across all hospitals, with the number of neonates initiated and continued on antibiotics per culture-proven EOS case varying from 4 to 90 and from 4 to 56, respectively. The high number of antibiotic prescriptions compared to the EOS incidence and wide variety in clinical practice among hospitals in The Netherlands underscore both the need and potential for a novel approach to the management of neonates with suspected EOS.</p

A nationwide follow-up study of children of women with type 1 diabetes mellitus

Previous studies have shown that children of women with type 1 diabetes are at risk for cardiometabolic diseases later in life, such as obesity, hypertension and type 2 diabetes. However, most of these studies have been performed in children of mixed cohorts of women with type 1, type 2 and/or gestational diabetes, or in children who were born >20 years ago when glycemic control was not as good as in current times. It has been concluded from a previous nationwide study on pregnancy outcome in women with type 1 diabetes in The Netherlands that the risk of perinatal complications was still increased as compared to the non-diabetic population, despite the fact that prepregnancy care and glycemic control during pregnancy were near-optimal. In this follow-up study we investigated whether the good glycemic control during pregnancy would have beneficial effects regarding the long term adverse effects on the development in the offspring. Therefore, we investigated several aspects of the development at 6-8 years of age in a nationwide cohort of 213 children of women with type 1 diabetes and compared them to those in a control group of 79 children of non-diabetic women. Overall intelligence, fasting glucose regulation, lipid metabolism, cardiac function and prevalence of childhood overweight and other components of the metabolic syndrome were comparable in both groups. Based on these findings, we suggest that near-optimal glycemic control during pregnancy in women with type 1 diabetes may therefore prevent, or at least lower, the incidence of adverse effects on later development in the offspring. However, we did find a slightly higher mean systolic blood pressure and a higher in vitro pro-inflammatory cytokine response in children of women with type 1 diabetes. Future follow-up studies should show whether these subtle cardiovascular and immunological differences may nonetheless be indicative of later cardiometabolic morbidity in these children. We suggest that in the mean time the goal of pregnant diabetic women and their attending physicians should be to achieve the lowest HbA1c level possible, without increasing the incidence of severe maternal hypoglycemia (as this may be harmful to the mother). Children of women with type 1 diabetes who were macrosomic at birth (with a birth weight >90th percentile for gestational age, sex and parity) had developed twice as much overweight compared with children who had a birth weight appropriate for gestational age. Possible targets for prevention of childhood overweight in children of diabetic women are fetal macrosomia, maternal overweight, and an increase in body mass index standard deviation score during the first years of life. Furthermore, severe maternal hypoglycemia during pregnancy had no proven adverse effects on later neurocognitive functioning in the offspring. However, we found that severe neonatal hypoglycemia (which has a high incidence in the direct neonatal period) influenced later neurocognition, and should therefore be avoided. Maternal HbA1c during pregnancy did poorly relate to developmental outcome measures in the offspring, possibly because it is not a reliable indicator of glycemic control during pregnancy

Vermoedens van kindermishandeling in het Wilhelmina kinderziekenhuis : overzicht van casuïstiek en follow-up

0-19, PZ.WN (wetenschappelijk Nederlands

A systematic review of the cost of ketosis in dairy cattle

A systematic review was conducted to assess the cost of ketosis in dairy cattle, and to elucidate how ketosis cost is estimated in each of the studies. Scientific papers addressing the economic impact of ketosis in dairy cows were identified through a search in 4 databases (Medline, ISI Web of Science, CAB Abstracts, and Agricola). The literature search was conducted with no restrictions on the date of study publication, publication type, or language. The methodological quality of the studies was assessed regarding study design, data collection, and analysis and interpretation of the study results. Of 531 identified records, 10 were selected, of which 9 were published from 2015 onward. Of the 10 studies reviewed, 9 report cost of a case of ketosis, and the estimates vary widely, with values ranging from €19 to €812. Two studies report ketosis cost at a farm level (€3.6–€29/ cow per year). Among the studies, we observed great variation not only in the estimation models and inputs used (costs and losses associated with the disease) but also in the definition of ketosis and its prevalence or incidence figures. Moreover, the cost of ketosis was estimated for dairy farms in the United States, Canada, the Netherlands, Denmark, France, Germany, Spain, Sweden, Norway, and India. Consequently, there was great heterogeneity regarding herd characteristics, milk production, milk prices, culled cows’ value, feed prices, and costs of veterinary services. Ketosis cost estimates vary as a consequence of all these aspects. Therefore, although most of the studies were well-designed and used high-quality data, the systematic approach review does not allow combination of the cost estimates of into a single figure. In conclusion, our review highlights an overall considerable economic impact of ketosis in dairy cattle. Economic prevention and mitigation strategies should be taken according to herd- and country-specific conditions. Ketosis cost figures reported in economic studies should always be considered carefully and interpreted with appropriate consideration of the inputs of the estimation, country context, and herd parameters.Sin financiación4.225 JCR (2021) Q1, 6/62 Agriculture, Dairy & Animal Science1.215 SJR (2021) Q1, 12/455 Animal Science and ZoologyNo data IDR 2020UE

Current treatment practice of functional abdominal pain disorders in children: A multicenter survey

Background: Approximately 90% of the children with chronic abdominal pain are diagnosed as having functional abdominal pain disorder (FAPD). The Dutch guideline “functional abdominal pain” provides a stepwise approach to treat FAPD. The aim of this survey was twofold first, to determine adherence to the Dutch guideline, and second to determine current management of FAPDs in clinical practice. Methods: A multicenter survey was designed. The survey was sent to pediatricians and pediatric residents in December 2020. The study ran from October 2020 until March 2021. Participants in ten hospitals in the western region of The Netherlands were invited to complete this survey. Respondents who indicated not to treat children with FAPDs or respondents who completed less than 3 steps of the survey were excluded. Results: In total, 85/174 (48.9%) respondents completed the survey. We included 80 respondents, 68 pediatricians and 12 pediatric residents, for analysis. Overall, self-reported guideline adherence was 85%. Self-reported adherence was higher than actual adherence. Only 50% of all respondents followed the first three steps of the guideline. The reported non-pharmacological and pharmacological treatments were diverse and varied between different age groups. The average follow-up duration was between 2 and 6 months, and the most regularly used outcome measures were attendance at school, quality of life, and adequate pain relief/reassurance. Conclusion: We reportedly observed a large variation in the management of children with FAPDs, due to low guideline adherence among clinicians. Improved guideline adherence may be accomplished by updating the guideline with specific recommendations per subtype, follow-up and outcome measures as well measures to improve guideline implementation

Multicentre study found that adherence to national antibiotic recommendations for neonatal early-onset sepsis was low

Aim: Our aim was to evaluate adherence to the Dutch neonatal early-onset sepsis (EOS) guidelines, adapted from UK guidance. We also looked at the effect on antibiotic recommendations and duration. Method: This was a multicentre, prospective observational cross-sectional study carried out in seven hospitals in the Netherlands between 1 September 2018 and 1 November 2019. We enrolled 1024 neonates born at 32 weeks of gestation or later if they demonstrated at least one EOS risk factor or clinical signs of infection. Results: The Dutch guidelines recommended antibiotic treatment for 438/1024 (42.8%) of the neonates designated at risk, but only 186/438 (42.5%) received antibiotics. The guidelines advised withholding antibiotics for 586/1024 (57.2%) of neonates and in 570/586 (97.3%) cases the clinicians adhered to this recommendation. Blood cultures were obtained for 182/186 (97.8%) infants who started antibiotics and only four were positive, for group B streptococci. Antibiotic treatment was continued for more than 3 days in 56/178 (31.5%) neonates, despite a negative blood culture. Conclusion: Low adherence to the Dutch guidelines meant that the majority of neonates did not receive the antibiotic treatment that was recommended, while some antibiotic use was prolonged despite negative blood cultures. The guidelines need to be revised