Eesti eelkooliealiste laste hõlmatus immuniseerimiskava vaktsiinidega 2010. aasta sünnikohordi põhjal Eesti Haigekassa raviarvete alusel

Taust, eesmärk. Eestis puudub seni ülevaade, kui paljude lastega viiakse läbi kõik immuniseerimiskavas ette nähtud plaanilised vaktsineerimised. Uurimuse eesmärk oli anda ülevaade, kui suurel osal eelkooliealistest lastest on Eesti Haigekassa raviarvete alusel kõik immuniseerimiskavas ette nähtud vaktsineerimised tehtud. Metoodika. Analüüsiti Eesti Haigekassale perearstide ja eriarstide esitatud raviarveid (n = 1 091 275) kõigi 2010. aastal sündinud laste kohta (n = 16 464), kes Eestis perioodil 2010–2018 tervishoiuteenuseid tarbisid. Hinnati immuniseerimiskavas toodud vaktsineerimistega hõlmatust 3- ja 8aastaste laste seas. Tulemused, järeldused. 3aastaseks saanud lastest läbis raviarvete alusel kõik sellele vanusele immuniseerimiskavas ette nähtud vaktsineerimised 68,9%, osaliselt vaktsineeriti 24,4% ning vaktsineerimata oli 6,7%. 8aastastest olid kõik vaktsiinid manustatud 49,5%-le lastest, osaliselt 43,9%-le ja vaktsineerimata oli 6,5%. Seega on vaktsineerimisega hõlmatus kogu immuniseerimiskava järgi Eestis väiksem, kui üksikute vaktsiinikomponentidega hõlmatuse põhjal võiks arvata. Kõige sagedamini puudusid raviarved DTPa-IPV (DTPa – difteeria, teetanuse ja atsellulaarse läkaköha vaktsiin, IPV – inaktiveeritud poliomüeliidi vaktsiin) teise revaktsineerimise kohta (vaktsineerimine 6–7 aasta vanuses)

Hospitalised neonates in Estonia commonly receive potentially harmful excipients

Abstract Background Information on the neonatal exposure to excipients is limited. Our aim was to describe the extent of excipient intake by Estonian neonates; to classify the excipients according to potential neonatal toxicity and thereby to measure the extent of exposure of neonates to potentially harmful excipients. Methods A prospective cohort study that recorded all medicines prescribed to patients aged below 28 days admitted to Tartu University Hospital from 01.02-01.08 2008 and to Tallinn Children’s Hospital from 01.02- 01.08 2009 was conducted. Excipients were identified from Summaries of Product Characteristics and classified according to toxicity following a literature review. Results 1961 prescriptions comprising 107 medicines were written for 348/490 neonates admitted. A total of 123 excipients were found in 1620 (83%) prescriptions and 93 (87%) medicines. 47 (38%) of these excipients were classified as potentially or known to be harmful to neonates. Most neonates (97%) received at least one medicine (median number 2) with potentially or known to be harmful excipient. Parabens were the most commonly used known to be harmful excipients and sodium metabisulphite the most commonly used potentially harmful excipient, received by 343 (99%) and 297 (85%) of treated neonates, respectively. Conclusions Hospitalised neonates in Estonia are commonly receiving a wide range of excipients with their medication. Quantitative information about excipients should be made available to pharmacists and neonatologists helping them to take into account excipient issues when selecting medicines and to monitor for adverse effects if administration of medicines containing excipients is unavoidable.</p

Effect of allopurinol in addition to hypothermia treatment in neonates for hypoxic-ischemic brain injury on neurocognitive outcome (ALBINO): Study protocol of a blinded randomized placebo-controlled parallel group multicenter trial for superiority (phase III)

Background: Perinatal asphyxia and resulting hypoxic-ischemic encephalopathy is a major cause of death and long-term disability in term born neonates. Up to 20,000 infants each year are affected by HIE in Europe and even more in regions with lower level of perinatal care. The only established therapy to improve outcome in these infants is therapeutic hypothermia. Allopurinol is a xanthine oxidase inhibitor that reduces the production of oxygen radicals as superoxide, which contributes to secondary energy failure and apoptosis in neurons and glial cells after reperfusion of hypoxic brain tissue and may further improve outcome if administered in addition to therapeutic hypothermia. Methods: This study on the effects of ALlopurinol in addition to hypothermia treatment for hypoxic-ischemic Brain Injury on Neurocognitive Outcome (ALBINO), is a European double-blinded randomized placebo-controlled parallel group multicenter trial (Phase III) to evaluate the effect of postnatal allopurinol administered in addition to standard of care (including therapeutic hypothermia if indicated) on the incidence of death and severe neurodevelopmental impairment at 24 months of age in newborns with perinatal hypoxic-ischemic insult and signs of potentially evolving encephalopathy. Allopurinol or placebo will be given in addition to therapeutic hypothermia (where indicated) to infants with a gestational age ≥ 36 weeks and a birth weight ≥ 2500 g, with severe perinatal asphyxia and potentially evolving encephalopathy. The primary endpoint of this study will be death or severe neurodevelopmental impairment versus survival without severe neurodevelopmental impairment at the age of two years. Effects on brain injury by magnetic resonance imaging and cerebral ultrasound, electric brain activity, concentrations of peroxidation products and S100B, will also be studied along with effects on heart function and pharmacokinetics of allopurinol after iv-infusion. Discussion: This trial will provide data to assess the efficacy and safety of early postnatal allopurinol in term infants with evolving hypoxic-ischemic encephalopathy. If proven efficacious and safe, allopurinol could become part of a neuroprotective pharmacological treatment strategy in addition to therapeutic hypothermia in children with perinatal asphyxia. Trial registration: NCT03162653, www.ClinicalTrials.gov, May 22, 2017