Eristys päivähoidosta infektion vuoksi

Pienet lapset sairastavat paljon tarttuvia tauteja, ja päiväkodissa kontaktit ovat tiiviitä. Lapsen poissaolo päivähoidosta määräytyy ennen kaikkea hänen vointinsa mukaan: sairas lapsi hoidetaan kotona, ja hoitoon voi palata oireiden helpottaessa. Joskus lapsi pitää eristää päivähoidosta kotiin sen vuoksi, että estetään taudin tarttumista muihin lapsiin ja henkilökuntaan. Tartuntatautilaki edellyttää eristystä tiettyjen infektioiden kohdalla, mutta nämä ovat harvinaisia tilanteita. COVID-19-pandemian aikana tautitapaukset pyritään toteamaan tehokkaasti ja katkaisemaan tartuntaketjut eristystoimilla. Päiväkodit eivät näytä olevan merkittävässä osassa koronaviruspandemian leviämisessä. Useimpien muiden hengitystieinfektioiden kohdalla eristykseen ei ole tarvetta. Ripuliin sairastunut lapsi on hyvä pitää kotona vielä kaksi vuorokautta oireiden loppumisesta

Helium-oxygen in bronchiolitis-A systematic review and meta-analysis

Introduction Bronchiolitis is common reason for infant hospitalization. The aim of our systematic review and meta-analysis was to evaluate helium-oxygen (heliox) in bronchiolitis. Methods We screened 463 studies, assessed 22 of them, and included six randomized controlled trials. Primary outcomes were the need for continuous positive airway pressure (CPAP) or intubation, hospitalization duration, and change in the modified Woods Clinical Asthma Scale (M-WCAS). We calculated mean differences with 95% confidence intervals (CIs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. Results Six studies (five double- and one single-blinded) with 560 infants were included. The risk of bias was high in one, moderate in four, and low in one. The RR for the need for CPAP (three studies) was 0.87 (CI: 0.56-1.35), and for intubation (four studies) was 1.39 (CI: 0.53-3.63), heliox compared to air-oxygen. The hospital stay (four studies) was 0.25 days longer (CI: -0.22 to 0.71) in the heliox group. The mean decrease in M-WCAS from the baseline (three studies) was 1.90 points (CI: 1.46-2.34) greater in the heliox group. Conclusion We found low-quality evidence that heliox does not reduce the need for CPAP, intubation, or length of hospitalization for bronchiolitis. Based on the M-WCAS scores, heliox seems to relieve respiratory distress symptoms rapidly after its initiation. The included studies had high heterogeneity in their methods and included relatively mild cases of bronchiolitis. A larger randomized controlled trial with more severe cases of bronchiolitis with enough power to analyze the need for intubation is needed in the future.Peer reviewe

Lasten vaikeat A-streptokokki-infektiot

Vaikeat A-ryhmän streptokokki-infektiot lisääntyvät kaikkialla maailmassa.Vesirokko on lapsilla tärkein yksittäinen altistava tekijä. Myös pienet ihorikkoumat, leikkaus, tylppä vamma tai A-streptokokin aiheuttama tauti perheenjäsenellä lisäävät riskiä.Infektiofokus voi olla missä kohdassa elimistöä tahansa. Pehmytosan vaikea kipu voi olla diagnostinen vihje invasiivisesta streptokokki-infektiosta.Nopea hoidon aloitus beetalaktaamin ja klindamysiinin yhdistelmällä ja tarvittaessa kirurginen fokuksen avaus nopeuttavat paranemista ja vähentävät kuolleisuutta

Antibiotic Treatment Duration for Community-Acquired Pneumonia in Outpatient Children in High-Income Countries : A Systematic Review and Meta-Analysis

BACKGROUND: The optimal treatment duration of community-acquired pneumonia (CAP) in children has been controversial in high-income countries. We conducted a meta-analysis to compare short antibiotic treatment (3-5 days) with longer treatment (7-10 days) among children aged ≥6 months. METHODS: On 31 January 2022, we searched PubMed, Scopus, and Web of Science databases for studies published in English from 2003 to 2022. We included randomized controlled trials focusing on antibiotic treatment duration in children with CAP treated as outpatients. We calculated risk differences (RDs) with 95% confidence intervals and used the fixed-effect model (low heterogeneity). Our main outcome was treatment failure, defined as need for retreatment or hospitalization within 1 month. Our secondary outcome was presence of antibiotic-related harms. RESULTS: A total of 541 studies were screened, and 4 studies with 1541 children were included in the review. Three studies had low risk of bias, and one had some concerns. All 4 studies assessed treatment failures, and the RD was 0.1% (95% confidence interval, -3.0% to 2.0%) with high quality of evidence. Two studies (1194 children) assessed adverse events related to antibiotic treatment, and the RD was 0.0% (-5.0% to 5.0%) with moderate quality of evidence. The diagnostic criteria varied between the included studies. CONCLUSIONS: A short antibiotic treatment duration of 3-5 days was equally effective and safe compared with the longer (current) recommendation of 7-10 days in children aged ≥6 months with CAP. We suggest that short antibiotic courses can be implemented in treatment of pediatric CAP.publishedVersionPeer reviewe

Noro- and rotavirus detections in children during COVID-19 pandemic—A nationwide register study in Finland

publishedVersionNon peer reviewe

The impact of the lockdown and the re-opening of schools and day cares on the epidemiology of SARS-CoV-2 and other respiratory infections in children : A nationwide register study in Finland

Background: Nationwide restrictions started in Finland in March to prevent the spread of COVID-19, leading to school and day care closures. The aim of this study is to describe the effect of closures and re-openings on the respiratory pathogen epidemiology. Methods: Laboratory-confirmed cases of SARS-CoV-2; respiratory syncytial virus (RSV); influenza (A & B); parainfluenza-, adeno-, and rhinoviruses; Mycoplasma pneumoniae; and Streptococcus pneumoniae in children were collected from the National Infectious Disease Register over the period of 2017–2020. Weekly incidences (weeks 1 to 35) with 95% confidence intervals (CIs) were calculated per 100 000 children in 2020 and compared by incidence rate ratios (IRRs) to corresponding periods in 2017−2019. Findings: The lockdown had immediate impact on the incidences of respiratory pathogens except SARS-CoV-2. Week after the lockdown began IRR was 0•3 (CI 0•3–0•4) and next week the IRR was 0•1 (0•1–0•2). The incidence of SARS-CoV-2 started to decline eight weeks after the lockdown began. The highest recorded weekly incidence of SARS-CoV-2 was 7•2/100 000 children. The effect of the lockdown lasted until late summer. Rhinovirus and SARS-CoV-2 began to increase before the schools or day cares opened in August. The re-opening of schools seemed to have no impact on the incidence of any pathogen. Interpretation: Our results suggest that general social distancing, including school and day care closures, played a crucial role in reducing infections, and the effect lasted for several weeks. The re-opening of schools and day care centres seems to have had no immediate impact on the incidences of any respiratory pathogens. Funding: This study had no funding source.publishedVersionPeer reviewe

Experiences of using an interactive audience response system in lectures

BACKGROUND: Lectures are good for presenting information and providing explanations, but because they lack active participation they have been neglected. METHODS: Students' experiences were evaluated after exposing them to the use of voting during lectures in their paediatrics course. Questions were delivered to the students taking paediatrics course. Thirty-six students out of the total of 40 (90%) attended the opening lecture, at which the first survey concerning previous experiences of lectures was performed. Thirty-nine students (98%) answered the second series of questions at the end of the paediatrics course. RESULTS: Most of the students felt that voting improved their activity during lectures, enhanced their learning, and that it was easier to make questions during lectures than earlier. CONCLUSIONS: The students gained new, exciting insights much more often during the paediatrics course than before. We as teachers found that voting during lectures could easily overcome some of the obstacles of good lecturing

Hospital bed occupancy for rotavirus and all cause acute gastroenteritis in two Finnish hospitals before and after the implementation of the national rotavirus vaccination program with RotaTeq®

Background Vaccination-impact studies of the live-attenuated pentavalent oral vaccine Rotateq® have demonstrated that the burden of rotavirus gastroenteritis has been reduced significantly after the introduction of RotaTeq® vaccination, but less is known about the benefit of this vaccination on hospital overcrowding. Methods As part of an observational surveillance conducted during the RV seasons 2000/2001 to 2011/2012, we analysed hospital discharge data collected retrospectively from two Finnish hospitals (Oulu and Tampere), concerning ICD 10 codes A00-09 (acute gastroenteritis, AGE) and A08.0 (rotaviral acute gastroenteritis RV AGE). We estimated the reduction in the number of beds occupied and analysed the bed occupancy rate, for RV AGE and all cause AGE, among 0–16 year-old children, before and after the implementation of the RV immunisation program. Results The rate of bed days occupied for RV AGE was reduced by 86% (95% CI 66%-94%) in Tampere and 79% (95% CI 47%-92%) in Oulu after RV vaccination implementation. For all cause AGE, reduction was 50% (95% CI 29% to 65%) in Tampere and 70% (95% CI 58% to 79%) in Oulu. Results were similar among 0–2 year-old children. This effect was also observed on overcrowding in both hospitals, with a bed occupancy rate for all cause AGE >25% in only 1% of the time in Tampere and 9% in Oulu after the implementation of the immunisation program, compared to 13% and 48% in the pre-vaccination period respectively. After extrapolation to the whole country, the annual number of prevented hospitalizations for all cause AGE in the post-vaccination period in Finland was estimated at 1,646 and 2,303 admissions for 0–2 and 0–16 year-old children respectively. Conclusions This study demonstrated that universal RV vaccination is associated with a clear decrease in the number of bed days and occupancy rates for RV AGE and all cause AGE. Positive consequences include increase in quality of care and a better healthcare management during winter epidemics.BioMed Central open acces