Innovative postnatal risk assessment in preventive child health Care: A study protocol

AIM

To introduce the rationale and design of a postnatal risk assessment study, which will be embedded in Preventive Child Health Care. This study will evaluate: (a) the predictive value of an innovative postnatal risk assessment, meant to assess the risk of growth and developmental problems in young children; and (b) its effectiveness in combination with tailored care pathways.

DESIGN

This study concerns a historically controlled study design and is designed as part of the Healthy Pregnancy 4 All-2 program. We hypothesize that child growth and developmental problems will be reduced in the intervention cohort due to the postnatal risk assessment and corresponding care pathways.

METHODS

The study was approved in August 2016. Children and their parents, visiting well-baby clinics during regular visits, will participate in the intervention (N = 2,650). Additional data of a historical control group (N = 2,650) in the same neighbourhoods will be collected. The intervention, consisting of the risk assessment and its corresponding care pathways, will be executed in the period between birth and 2 months of (corrected) age. The predictive value of the risk assessment and its effectiveness in combination with its corresponding care pathways will be assessed by Preventive Child Health Care nurses and physicians in four Preventive Child Health Care organisations in three municipalities with adverse perinatal outcomes. A total risk score above a predefined threshold, which is based on a weighted risk score, determines structured multidisciplinary consultation.

DISCUSSION

The successful implementation of this innovative postnatal risk assessment including corresponding care pathways has potential for further integration of risk assessment and a family-centred approach in the work process of Preventive Child Health Care nurses and physicians.

IMPACT

This study introduces a systematic approach in postnatal health care which may improve growth and developmental outcomes of children and even future generations.

Evidence Based Weighing Policy during the First Week to Prevent Neonatal Hypernatremic Dehydration while Breastfeeding

BACKGROUND

Neonatal hypernatremic dehydration is prevented by daily neonatal weight monitoring. We aim to provide evidence-based support of this universally promoted weighing policy and to establish the most crucial days of weighing.

METHODS

Weight measurements of 2,359 healthy newborns and of 271 newborns with clinical hypernatremic dehydration were used within the first seven days of life to simulate various weighting policies to prevent hypernatremic dehydration; its sensitivity, specificity and positive predictive value (PPV) of these policies were calculated. Various referral criteria were also evaluated.

RESULTS

A policy of daily weighing with a cut-off value of -2.5 Standard Deviation Score (SDS) on the growth chart for weight loss, had a 97.6% sensitivity, 97.6% specificity and a PPV of 2.80%. Weighing at birth and only at days two, four and seven with the same -2.5 SDS cut-off, resulted in 97.3% sensitivity, 98.5% specificity and a PPV of 4.43%.

CONCLUSION

A weighing policy with measurements restricted to birth and day two, four and seven applying the -2.5 SDS cut-off seems an optimal policy to detect hypernatremic dehydration. Therefore we recommend to preferably weigh newborns at least on day two (i.e. ~48h), four and seven, and refer them to clinical pediatric care if their weight loss increases below -2.5 SDS. We also suggest lactation support for the mother, full clinical assessment of the infant and weighing again the following day in all newborns reaching a weight loss below -2.0 SDS.

A permutation test to analyse systematic bias and random measurement errors of medical devices via boosting location and scale models

Measurement errors of medico-technical devices can be separated into systematic bias and random error. We propose a new method to address both simultaneously via generalized additive models for location, scale and shape (GAMLSS) in combination with permutation tests. More precisely, we extend a recently proposed boosting algorithm for GAMLSS to provide a test procedure to analyse potential device effects on the measurements. We carried out a large-scale simulation study to provide empirical evidence that our method is able to identify possible sources of systematic bias as well as random error under different conditions. Finally, we apply our approach to compare measurements of skin pigmentation from two different devices in an epidemiological study.

Call for early prevention: prevalence rates of overweight among Turkish and Moroccan children in The Netherlands

BACKGROUND

Monitoring overweight in risk groups is necessary. Our aim is to assess the trend in overweight and obesity in Turkish and Moroccan children in the Netherlands since 1997 and to monitor the levels of lifestyle-related behaviours in 2009.

METHODS

We selected cross-sectional data of Turkish and Moroccan children aged 2-18 years from two national Growth Studies performed in 1997 and 2009 in the Netherlands. Lifestyle-related behaviours were obtained in the 2009 study by questionnaire.

RESULTS

In 2009, 31.9% of Turkish and 26.6% of Moroccan children had overweight, whereas this was, respectively, 26.7% and 19.6% in 1997. Already at 2 years, 21.1% in Turkish and 22.7% in Moroccan children had overweight in 2009. The prevalence of obesity was above 4% from 3 years onwards. High (i.e. ≥ 25%) prevalence rates of unhealthy lifestyle-related behaviours were found for not having breakfast (26-49%) among Turkish and Moroccan adolescent (i.e. 15-18 years) girls, consuming no fruit (29-45%) and watching TV/PC ≥ 2 h (35-72%) among all Turkish and Moroccan adolescents, no walking/cycling to school/day care among preschool children (2-4 years) (28-56%) and adolescents (34-94%), drinking ≥ 2 glasses of sweet beverages (44-74%) and being <1 h physically active (29-65%) among all children.

CONCLUSION

An upward trend of overweight and obesity occurred in Turkish and Moroccan children. Already at 2 years of age, one out of five Turkish and Moroccan children had overweight, which calls for early prevention with attention to specific lifestyle-related behaviours.

Diagnostic accuracy of referral criteria for head circumference to detect hydrocephalus in the first year of life

BACKGROUND

Increased head circumference is often the first and main sign leading to the diagnosis of hydrocephalus. Our aim is to investigate the diagnostic accuracy of referral criteria for head circumference to detect hydrocephalus in the first year of life.

METHODS

A reference group with longitudinal head circumference data (n = 1938) was obtained from the Social Medical Survey of Children Attending Child Health Clinics study. The case group comprised infants with hydrocephalus treated in a tertiary pediatric hospital who had not already been detected during pregnancy (n = 125). Head circumference data were available for 43 patients. Head circumference data were standardized according to gestational age-specific references.

RESULTS

Sensitivity and specificity of a very large head circumference (>2.5 standard deviations on the growth chart) were, respectively, 72.1% (95% confidence interval [CI]: 56.3-84.7) and 97.1% (95% CI:96.2-97.8). These figures were, respectively, 74.4% (95% CI: 58.8-86.5) and 93.0% (95% CI:91.8-94.1) for a large head circumference (>2.0 standard deviation), and 76.7% (95% CI:61.4-88.2) and 96.5% (95% CI:95.6-97.3) for a very large head circumference and/or a very large (>2.5 standard deviation) progressive growth of head circumference.

CONCLUSIONS

A very large head circumference and/or a very large progressive growth of head circumference shows the best diagnostic accuracy to detect hydrocephalus at an early stage. Gestational age-specific growth charts are recommended. Further improvements may be possible by taking into account parental head circumference.

Curve matching: a data-driven technique to improve individual prediction of childhood growth

Longitudinal growth data are valuable for predicting and interpreting future growth of individual children. This note explores the idea of 'curve matching', a new technique to improve prediction of future growth of an individual child. The key idea is to find existing children in existing databases that are similar to the current child. The growth patterns of the matched children suggest how the current child might evolve in the future. This paper describes the various conceptual and practical issues that need to be addressed before the idea can take off. A demo implementation is available at http://vps.stefvanbuuren.nl:3838/frisodemo/.

Charts for weight loss to detect hypernatremic dehydration and prevent formula supplementing

BACKGROUND

Most breast-fed newborns get the milk they need. However, very rarely milk intake is insufficient mostly as a result of poor breastfeeding techniques. Dramatic weight loss and hypernatremic dehydration may occur. Our aim was to construct charts for weight loss.

METHODS

A case-control study was performed. Charts with standard deviation score (SDS) lines for weight loss in the first month were constructed for 2,359 healthy breast-fed term newborns and 271 cases with breastfeeding-associated hypernatremic dehydration with serum sodium level > 149 mEq/L. Day 0 was defined as the day of birth.

RESULTS

Many cases with (or who will develop) hypernatremic dehydration (84%; +1 SDS line) fell below the -1 SDS line at day 3, the -2 SDS line at day 4, and the -2.5 SDS line at day 5 in the chart of the healthy breast-fed newborns. Weight loss of cases with permanent residual symptoms was far below the -2.5 SDS.

CONCLUSIONS

Already at an early age, weight loss differs between healthy breast-fed newborns and those with hypernatremic dehydration. Charts for weight loss are, therefore, useful tools to detect early, or prevent newborns from developing, breastfeeding-associated hypernatremic dehydration, and also to prevent unnecessary formula supplementing.