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July’s #ADC_JC our twitter journal club – 17th July 8-9pm.

7 Jul, 13 | by tessadavis

The first Archives of Disease in Childhood twitter journal club was last month and it was a great success.

We had around 40 people involved in the hour-long twitter chat (#ADC_JC) – it was engaging and exciting to be involved in an online discussion with so many paediatric health professionals.

For July’s #ADC_JC we are hoping to keep the momentum going and get even more people involved.

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A little bit of formula?

9 Jun, 13 | by Giordano Pérez-Gaxiola

milk

Exclusive breastfeeding is regarded by WHO and by most, if not all, paediatric academies, as the ideal for newborns and infants up to 6 months old. It is also recommended that breastfeeding begins as soon as possible after birth. That is why the small pilot study by Flaherman et al is both interesting and controversial.

Researchers randomised exclusively breastfed term newborns that had had 5%-10% weight loss before 36 hours, and were 24-48 hours old at time of recruitment, into two groups: The intervention group was syringe fed 10 ml of an extensively hydrolysed formula after each breastfeeding until mature milk production began; the control group was exclusively breastfed. Both groups were similar. Allocation was concealed. Blinding of parents and researchers was not possible, but the person who assessed outcomes was not aware of the assigned intervention.

The findings are interesting. It seems that infants in the early limited formula group had better outcomes. At 1 week, 2 of 20 infants in the intervention group had received formula in the preceding 24 hours, compared with 9 of 19 in the exclusive breastfeeding control group (risk difference 37%, 95%CI 3.4% to 71.0%). Also, infants in the control group received more formula than the intervention group during that first week. At 3 months, 15 of 19 infants in the intervention group were exclusively breastfed compared to 8 of 19 infants in the control group (risk difference -36.8%, 95%CI -65.6% to -8,1%, calculated from data in the article).

There are a few caveats, though. First, why use an extensively hydrolysed formula in the intervention group? Is it because the authors and/or the patients feel it is ‘less allergenic’ so it would be less likely to harm? Also, one of the authors has been employed by formula companies before. Should we be suspicious? Second, it is surprising that less infants from the control group, who began as exclusively breastfed, were exclusively breastfed at 3 months. Why? Maybe mums who feel they have failed their babies give up more. Researchers and trainers could not be blinded, so maybe there was a difference in how they treated or motivated each group. Lastly, the results, while statistically significant, are imprecise. Confidence intervals are very wide.

So, should be change practice and encourage mothers to give a little bit of formula while mature milk is produced? No. Maybe it won’t hurt, but this paper certainly doesn’t show that it helps. The findings of this study need to be replicated in a larger trial, preferably with independent funding and no conflicts of interest.

 

I can’t intubate .. can I have a mask?

23 Feb, 11 | by Bob Phillips

Not to obscure your deeply shamed face (I know, I’ve had it happen …) but a laryngeal mask, one of those disturbing bits of equipment anesthetists use when the operations’s not long enough to enjoy a nice cup of tea during an operation.

Can an LMA be a reasonable choice in neonatal resuscitation?

Why the obsession with Vitamin D?

7 Feb, 11 | by Bob Phillips

So, in the dark and cold climes of an early Northern Spring, Archi has been assailed by questions of vitamin D. There are, it is claimed, near-miraculous things from Vitamin D sufficiency – less cancer, less heart disease, less rickets. Well, I’ll buy the last one, but the others? And does any child really need supplements, or just those in poverty or the middle classes? (For two reasons; the first for nutritional health, the second for social acceptability.)

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Q: Echogenic bowels and new babies

31 Jan, 10 | by Bob Phillips

Bias plotIt was a vogue around the start of regular antenatal ultrasound scanning to note everything, associate wildly and some up with ‘antenatal markers of disease’, as I recollect. Some of these things turned out to be quite useful (nose bones, for instance, or their absence) and others still confuse me … like the ‘echogenic focus of bowel’ more…

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