07mrt 24Journal club maart 2024

Door prof. dr. J. Toelen en dr. A. Raaijmakers wordt maandelijks een lijst samengesteld van interessante artikels uit de pediatrische literatuur.

Omdat het lastig is om alle literatuur door te nemen wordt deze lijst beschikbaar gesteld om zo een makkelijk overzicht te krijgen van alle nieuwigheden.

Voor de lijst volg onderstaande link:

Journal Club maart 2024

Enkele "teasers" vind je hieronder:

In a prospective cohort study in the J Pediatr Gastroenterol Nutr researchers examined the growth patterns of children who were given rice hydrolyzed formula. Although formulas made from hydrolyzed rice proteins have been developed and marketed over the last two decades, they have been evaluated in several studies with conflicting results, often with small cohorts or limited follow-up periods. The researchers of this study included 66 non-breastfed children (aged 2-24 months) with suspected IgE- or non-IgE-mediated cow's milk protein allergy, switched them to rice hydrolyzed formula, and followed them up for 12 months. The outcomes were anthropometry, adherence to the formula, and occurrence of adverse events. For the entire cohort, the growth pattern remained within the normal range of WHO growth references. The formula was well tolerated, adherence was optimal, and no adverse events were reported. However, this study does not address lingering concerns such as arsenic content, effects on bone mineralization, or the acquisition of immune tolerance,... One could state that ‘more research is needed’.

Acute appendicitis is a common surgical emergency in children, categorized into simple appendicitis (SA) or perforated appendicitis (PA), with PA carrying higher mortality. Appendectomy is standard treatment, but alternatives like antibiotics exist for SA. Management of PA includes conservative approaches or drainage before surgery. Diagnosis relies on clinical evaluation, scoring systems, and imaging, though none are perfect. Blood-based biomarkers, including those identified through machine learning, are being explored. In a study in  JAMA Pediatrics a potential gene expression signature in peripheral blood of pediatric patient with appendicitis was explored. The study suggests a dysregulated immune response akin to sepsis in PA patients, hinting at genetic involvement in appendicitis. While promising, the study has its limitations: it focuses solely on inflammation and needs to be validated in larger studies, also practical considerations like cost and time need to be addressed as well before clinical application is possible.

Two excellent studies on important vaccines for global healthcare (malaria and typhoid fever) have been published in the Lancet. The malaria vaccine was tested in over 4800 children across four African countries. Children aged 5-36 months were randomly assigned to receive either the vaccine or a control. The vaccine was well-tolerated, with mild adverse effects such as injection site pain and fever. Importantly, there were no treatment-related deaths. Vaccine efficacy remained high, with a 12-month efficacy of 75% at seasonal sites and 68% at standard sites for preventing the first clinical malaria episode. A reduction in malaria cases per 1000 children-years was observed. Vaccine-induced antibodies correlated with efficacy. The vaccine's efficacy slightly decreased over the first 12 months but remained substantial. The findings indicate that this vaccine could significantly contribute to malaria control efforts in sub-Saharan Africa. Its low cost, high efficacy, and WHO prequalification promise widespread availability, potentially alleviating the malaria burden in the region. Regarding the typhoid fever vaccine, the final analysis of a randomized controlled trial in Malawi evaluated efficacy over more than 4 years of follow-up. Healthy children aged 9 months to 12 years were randomly assigned to receive the typhoid vaccine or a meningococcal vaccine. After a median follow-up of 4.3 years, the typhoid vaccine showed durable efficacy, with a 78.3% reduction in blood culture-confirmed typhoid fever compared to the control group. Despite the high number needed to vaccinate (163), this result is relevant given the rise in multidrug-resistant strains and healthcare challenges in many endemic regions. The findings support WHO recommendations for mass vaccination campaigns targeting children in typhoid-endemic regions, combined with ongoing improvements in water, sanitation, and hygiene (WASH) practices.

Enjoy the list!

Jaan and Anke

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