Mental Health of School-Aged Children Treated with Propranolol or Atenolol for Infantile Hemangioma and Their Parents

Background: Infants with infantile hemangioma (IH) have been effectively treated with propranolol or atenolol. Concerns were raised about the mental health of these The trial registration: Netherlands Trial Register Trial NL7703.children at school age, due to central nervous system effects of propranolol and visible nature of IH. Objective: This study aimed to compare the mental health at school age of children treated with propranolol to children treated with atenolol for IHs and their parents. Methods: This two-centered cross sectional study included children aged =6 years and treated with either propranolol or atenolol for IH during infancy. Children’s outcomes were performance-based affect recognition (Dutch version of the Developmental Neuropsychological Assessment-II [NEPSY-II-NL]), parent-reported emotional and behavioral functioning (Child Behavioral Checklist [CBCL]), and health-related quality of life (KIDSCREEN27). Parents’ outcome was parenting stress (Parenting Stress Questionnaire [OBVL]). Results: Data of 105 children (36 propranolol, 69 atenolol; 6.0–11.8 years) were analyzed. Mental health outcomes did not differ between both ß-blocker groups. Although overall functioning was in line with norms, children presented specific problems concerning affect recognition, parent-reported attention, and social quality of life. Parents showed increased physical symptoms, depressive symptoms, and parent-child relationship problems. Conclusion: No difference in mental health at school age was found between children treated with propranolol or atenolol for IH. Although few overall mental health problems were found, specific problems require follow-up. Follow-up of children should be directed toward affect recognition, attention, and social functioning in daily life. Problems reported by parents could be ameliorated by mental health support during and after their infant’s ß-blocker treatment.</p

Prognostic Factors for Long-term Aesthetic Outcome of Infantile Haemangioma Treated with Beta-blockers

Parents of infants treated with beta-blockers for infantile haemangioma are often concerned about the long-term aesthetic outcome. This cross-sectional study assessed the influence on the long-term aesthetic outcome of characteristics of the infantile haemangioma, the beta-blocker treatment, and the infant. The study included 103 children aged 6-12 years, treated with beta-blockers (propranolol or atenolol) for infantile haemangioma during infancy (age at treatment initiation ≤1 year) for ≥6 months. Dermatologists and parents scored the Patient Observer Scar Assessment Scale, and the child scored a visual analogue scale. Dermatologists identified whether telangiectasia, fibrofatty tissue, and atrophic scar tissue were present. The long-term aesthetic outcome of infantile haemangioma was judged more negatively by dermatologists and parents in case of a superficial component, ulceration, older age at treatment initiation, higher cumulative dose, and/or shorter follow-up time. According to children, infantile haemangioma located on the head had better aesthetic outcome than infantile haemangioma located elsewhere. Close monitoring, particularly of infantile haemangioma with a superficial component, is essential for early initiation of treatment, and to prevent or treat ulceration. These outcome data can support parental counselling and guide treatment strategy.</p

Guselkumab for hidradenitis suppurativa:a phase II, open-label, mode-of-action study

BACKGROUND: The effectiveness of available biologics for the treatment of hidradenitis suppurativa (HS) is limited. Additional therapeutic options are needed. OBJECTIVES: To investigate the efficacy and mode of action of guselkumab [an anti-interleukin (IL)-23p19 monoclonal antibody] 200 mg subcutaneously every 4 weeks for 16 weeks in patients with HS. METHODS: An open-label, multicentre, phase IIa trial in patients with moderate-to-severe HS was carried out (NCT04061395). The pharmacodynamic response in skin and blood was measured after 16 weeks of treatment. Clinical efficacy was assessed using the Hidradenitis Suppurativa Clinical Response (HiSCR), the International Hidradenitis Suppurativa Severity Score System (IHS4), and the abscess and inflammatory nodule (AN) count. The protocol was reviewed and approved by the local institutional review board (METC 2018/694), and the study was conducted in accordance with good clinical practice guidelines and applicable regulatory requirements. RESULTS: Thirteen of 20 patients (65%) achieved HiSCR with a statistically significant decrease in median IHS4 score (from 8.5 to 5.0; P = 0.002) and median AN count (from 6.5 to 4.0; P = 0.002). The overall patient-reported outcomes did not show a similar trend. One serious adverse event, likely to be unrelated to guselkumab treatment, was observed. In lesional skin, transcriptomic analysis revealed the upregulation of various genes associated with inflammation, including immunoglobulins, S100, matrix metalloproteinases, keratin, B-cell and complement genes, which decreased in clinical responders after treatment. Immunohistochemistry revealed a marked decrease in inflammatory markers in clinical responders at week 16. CONCLUSIONS: Sixty-five per cent of patients with moderate-to-severe HS achieved HiSCR after 16 weeks of treatment with guselkumab. We could not demonstrate a consistent correlation between gene and protein expression and clinical responses. The main limitations of this study were the small sample size and absence of a placebo arm. The large placebo-controlled phase IIb NOVA trial for guselkumab in patients with HS reported a lower HiSCR response of 45.0-50.8% in the treatment group and 38.7% in the placebo group. Guselkumab seems only to be of benefit in a subgroup of patients with HS, indicating that the IL-23/T helper 17 axis is not central to the pathophysiology of HS.</p

Parenting NICU graduates

This thesis reflects the results of our randomized, clinical trial on the effectiveness of a generic parenting intervention named Primary Care Triple P. We investigated whether Primary Care Triple P reduced emotional and behavioral problems in preterm-born and asphyxiated term-born preschoolers. The rationale for this study was that approximately 20% of preterm-born and asphyxiated term-born preschoolers have emotional and behavioral problems, which is twice as much as healthy, term born preschoolers.1,2 Furthermore, preterm birth and perinatal asphyxia are the two most common causes for admission to a neonatal intensive care unit (NICU), and therefore affect a large population of children and parents.3 It has been found that parenting NICU graduates may differ from parenting healthy, term-born children, which could indicate that specific parenting programs may be necessary.4 However, when problem behavior develops in NICU graduates, parents are usually referred to generic parenting intervention programs, since there are currently no standardized and evidence based interventions that are specifically designed to reduce emotional and behavioral problems in these children. Although generic parenting programs are available and many have been reported to be effective in the general population, it is currently not known whether these programs are also effective in preterm-born and asphyxiated term-born preschoolers. We investigated the effectiveness of a generic parenting program – Primary Care Triple P – on parent-reported emotional and behavioral problems, teacher-reported emotional and behavioral problems, parenting stress, the quality of observed parent-child interaction, observations of trained parenting skills, parenting styles, and parent perceived child vulnerability. During the screening phase of our randomized clinical trial, we found that parents of NICU graduates reported less stress than we had expected based on our clinical impressions. To investigate this finding, we conducted a meta-analysis on parental stress in parents of preterm-born children. Furthermore, after the results of our randomized controlled trial were analyzed, we explored predictors of short-term changes in emotional and behavioral problems in preterm-born children, to identify modifiable predictors that could provide a foundation for future interventions

Effectiviteit van Triple P in Nederland: stand van zaken en controverse

Objective: The Triple P – Positive Parenting Program is available in over 50% of the Dutch municipalities. In this article we summarize the effects of Triple P as found in international meta-analyses and Dutch research. We also discuss the controversy surrounding Triple P. Method: We systematically discuss international meta-analyses and Dutch studies with a control group. Results: According to international research, the effect of Triple P on child behavioural problems and parenting skills is greater than that of care-as-usual. In the Netherlands, Triple P levels 3 and 4 are not more effective than care-as-usual; other levels of Triple P have not been studied. Discussion: Conflict of interest among the developers of Triple P appears to influence the results of international research on Triple P in which they are often involved. Dutch research is performed independently of Triple P developers except for one study) and finds that Triple P is not more effective than care-as-usual

Alarm-assisted urotherapy for daytime urinary incontinence in children: A meta-analysis.

OBJECTIVES: Wearable alarm systems are frequently used tools added to urotherapy for children with both daytime and nighttime urinary incontinence. For functional daytime incontinence (DUI) specifically, the effect of alarm interventions has not been systematically reviewed. This study systematically evaluates, summarizes, reviews, and analyzes existing evidence about the effect of wearable alarm systems in urotherapy for children with functional DUI. STUDY DESIGN: We completed a comprehensive literature search in August 2022 using MEDLINE/PUBMED, EMBASE, PsycINFO, Cochrane Library, Web of Science, Google Scholar, conference abstracts, and citation tracking. Clinical controlled trials at controlled-trials.com and clinicaltrials.gov were consulted, as was the National health Service Center For Reviews And Dissemination. Eligible studies including the use of noninvasive wearable alarm systems as (part of) treatment for functional DUI in children were included. The main outcome was continence after treatment. Three independent reviewers extracted data. Risk of bias was assessed using Cochrane and National Heart, Lung and Blood Institute quality assessment tools. RESULTS: A total of 10 studies out of 1,382 records were included. Meta-analysis revealed a nonsignificant risk ratio of 1.4 (95% CI: 0.8-2.6) for the use of alarm systems. Urotherapy with alarm systems resulted in a 48% (95% CI: 33-62%) continence rate after treatment. CONCLUSIONS: Alarm systems might be helpful as part of urotherapy for functional DUI in select cases. Adherence is problematic, and the optimal duration of the use of alarm systems is to be determined. Overall, the risk of bias was high in all studies