Restrictions for COVID-19 prevented other respiratory infections and reduced emergency visits in children

publishedVersionNon peer reviewe

Antibiotic stewardship programmes had a low impact on prescribing for acute respiratory tract infections in children

Aim: This mini review summarises the available data on antibiotic stewardship programmes (ASP) for acute respiratory tract infections (ARTI) in paediatric outpatients, particularly the implementation and impact of programmes. Methods: PubMed was searched from 1 January 2012 to 31 December 2021 for papers with abstracts that used the terms respiratory tract infection, antibiotic, child and guideline. We then saw how many of these included the individual terms impact, implementation or stewardship. After exclusions, we included 10 papers that were published in English on children treated as outpatients for ARTIs. All of these included data on implementing and assessing the impact of ASPs. Results: The primary care data were mainly from the United States. The ASP programmes did not influence antibiotic prescription rates, but broad-spectrum antibiotics decreased by 43–48%. The emergency department data were mainly from France and the antibiotic prescription rate decreased by 31–35% and the rate for broad-spectrum antibiotics by 63–71%. A nationwide register-based study from France confirmed these results. Conclusion: ASPs had a low impact on overall antibiotic prescription rates and a modest impact on prescribing broad-spectrum antibiotics. The implementation of ASP protocols needs further development, and more research is necessary on barriers to complying with ASPs.publishedVersionPeer reviewe

Lasten kurkunpäätulehdus

Kurkunpäätulehdus (laryngiitti) on virustauti, jonka tavallisimpia aiheuttajia ovat parainfluenssavirukset. Lasten kurkunpäätulehduksen diagnoosi on kliininen, ja tyypillisiä oireita ovat kuiva, usein haukkuva yskä sekä sisäänhengityksen vinkuna ja vaikeutuminen. Kurkunpäätulehduksen tyypillinen esiintymisikä on 0,5-3 vuotta. Alle vuoden ikäisillä tulee muistaa kurkunpään rakenteelliset ja toiminnalliset poikkeavuudet, jotka aiheuttavat kurkunpäätulehdusta muistuttavia oireita infektion yhteydessä. Suurin osa lasten kurkunpäätulehduksista voidaan hoitaa kotona. Suun kautta annettava glukokortikoidi ja inhaloituna annettava raseeminen adrenaliini ovat tehokkaita lääkkeitä päivystyksessä

Milloin otan lapselta keuhkokuvan?

Keuhkokuvaus on yleisin lapsille tehty röntgentutkimus. Sen yleisimmät aiheet ovat vaikean keuhkokuumeen diagnostiikka, keuhkokuumeen komplikaatioiden tutkiminen, astman perusselvittelyt muiden sairauksien toteamiseksi tai poissulkemiseksi sekä vierasesineaspiraatiot silloin, kun kliininen epäily ei suoraan johda bronkoskopiaan. Avohoidossa lasten keuhkokuume diagnosoidaan kliinisten oireiden ja löydösten perusteella, mutta sairaalahoitoa vaativissa tapauksissa keuhkokuumeen diagnoosi varmistetaan keuhkokuvalla. Keuhkojen kuvantaminen on ainoa luotettava tapa selvittää keuhkokuumeen komplikaatiot ja niiden vakavuus. Keuhkokuvan kontrolloiminen keuhkokuumeen jälkeen on aiheellista vain erityistapauksissa

Alle kolmen kuukauden ikäinen lapsi päivystyksessä

Alle kolmen kuukauden ikäisen lapsen tutkiminen ja hoito päivystyksessä vaatii erilaista toimintatapaa isompiin lapsiin verrattuna. Lieväkin yskä ja oksentelu saattavat olla tässä ikäryhmässä merkkejä vakavasta sairaudesta. Lisäksi pienten imeväisten oireet ovat usein epämääräisiä ja joskus vaikeasti havaittavia ja tulkittavia. Lääkärin tekemä yleisarvio on diagnostiikan perusta, ja laboratoriokokeista tai kuvantamisesta on avohoidon päivystyksessä harvoin hyötyä. Suurin osa vakavista sairauksista on infektioita, mutta niiden lisäksi päivystyksessä tulee muistaa myös sydämen vajaatoiminnan, akuutin vatsan sekä metabolisten ja neurologisten tautien mahdollisuus. English summary: An infant less than three months of age at emergency call service Examination and treatment of an infant less than three months of age requires different action at the emergency department as compared with bigger children. Even slight cough and vomiting may be indications of a severe disease in this age group. In addition, symptoms in small infants are often diffuse and sometimes difficult to observe and analyze. A general assessment by the physician constitutes the basis for diagnostics. Of the severe diseases, most are infections

Evaluation of asthma risk index application in treating early childhood asthma

Abstract Finnish current care guidelines recommend that the treatment of asthma in young children should be based on the number of wheezing episodes and on the assessment of asthma risk profile consisting of two major and three minor criteria, constructed on the basis of the international asthma predictive index. The aim of the present study was to assess whether the current guidelines and risk profile determination are applied in the treatment of asthma in children aged less than three years. In all, 179 children aged 1-35 months were admitted for wheezing during four winter-months from 1 st Nov, 2006 to 28 th Feb. 2007. The data on treatment decisions, and major and minor asthma risk factors were retrospectively collected from patient records. Recorded data sufficient for the retrospective determination of the asthma risk profile were found for 112/179(63 %) children. Data on minor criteria were missing in almost all cases. Most of the children with data not available were first-time wheezers. Twenty-one children (19%) were on maintenance medication at admission. The decision whether or not to start maintenance medication was in line with the current care guidelines in 76/91(84 %) children. In conclusion, the treatment of asthma in young children mostly took place according to the national current care guidelines, though the application of the asthma risk profile was insufficient. The minor criteria of the asthma risk profile are not sufficiently sensible for clinical practice, and therefore need to be up-to-dated