European Academy Of Paediatrics Research Articles

Sollen Säuglingsnahrungen sowohl Docosahexaensäure als auch Arachidonsäure enthalten?

The new guidelines of the European Commission on infant and follow-on formulae stipulate that from February 2020 onwards all such products sold in the European Union must contain a high amount of 20–50 mg/100 kcal of the omega 3-fatty acid docosahexaenoic acid (DHA, ≈0.5–1% of fatty acids), while there is no requirement to include arachidonic acid (ARA, omega 6-fatty acids). This novel compositional concept for infant formulae has raised controversy and concerns because there is no accountable evidence for its suitability and safety. In accordance with the European Academy of Paediatrics, the Committee on Nutrition of the German Society for Pediatrics and Adolescent Medicine recommends the use of infant and follow-on formulae that contain at least the same amount of ARA along with DHA, as long as no convincing data on the suitability and safety of alternative concepts are available based on adequately designed and powered clinical trials.

Rotavirus vaccination for all children or subgroups only? Comment of the European Academy of Paediatrics (EAP) and the European Society for Paediatric Infectious Diseases (ESPID) recommendation group for rotavirus vaccination.

Rotavirus gastroenteritis affects all children. Studies indicate that by the age of 5years, almost all children have developed rotavirus antibodies. It has been estimated that in Europe, approximately 6550 children each year die as a result of rotavirus infection. Most of this mortality does not affect children from identifiable risk groups, but previously healthy infants. There is no accountable evidence on increased severity of rotavirus infection in specific risk groups, including children previously born preterm or immunocompromised children. Universal immunization in areas that have successfully achieved large coverage has greatly improved the health of children, reducing infection rates, hospitalization, and costs. Vaccination of infants with presumed high risk may be beneficial for the vaccinated individuals, and such a strategy may also be cost-effective in certain settings. Identifying all high-risk infants within the first few weeks of life is rather difficult especially in countries without primary care pediatricians and goes along with additional costs.Conclusion: Rotavirus vaccines should be recommended as a universal approach for all children and not be restricted to subgroups with assumed increased risk. Targeted vaccination could be considered as an option in countries with limited financial resources.

Off-label use of medicines in neonates, infants, children, and adolescents: a joint policy statement by the European Academy of Paediatrics and the European society for Developmental Perinatal and Pediatric Pharmacology.

Health-care professionals who prescribe medicines have the professional duty to choose medicines that are in the best interest of their individual patient, irrespective if that patient is an adult or a child. However, the availability of medicines with an appropriate label for pediatric use is lagging behind those for adults, and even available pediatric drugs are sometimes not suitable to administer to children. Consequently, health-care professionals often have no other option than to prescribe off-label medicines to children. An important reason for use of off-label medicines is to improve access to (innovative) treatments or to address medical needs and preferences of patients, especially when no other options are available. However, off-label use of medicines is in general not supported by the same level of evidence as medicines licensed for pediatric use. This may result in increased uncertainty on efficacy as well as the risk for toxicity and other side effects. In addition, liability may also be of concern, counterbalanced by professional guidelines.Conclusion: The purpose of this joint EAP/ESDPPP policy statement is to offer guidance for HCPs on when and how to prescribe off-label medicines to children and to provide recommendations for future European policy.

Overtesting and overtreatment-statement from the European Academy of Paediatrics (EAP).

Child health has improved considerably, partly due to increased availability of appropriate disease surveillance and treatment. Inappropriate testing and treatment may impose a risk. There is a large and unexplained variation in the use of tests and treatments for children between and within countries. This suggests that non-scientific factors determine their use. In an era of increasing availability of health services, pediatricians have an important role in balancing risks and benefits of available tests and treatments. Examples from the medical literature of overtesting and overtreatment challenge us to reconsider current practices. Antibiotic overuse, overtreatment of bronchiolitis, and non-indicated radiological procedures are found in common practice across Europe. Choosing Wisely is an initiative to improve the quality of care by reducing unnecessary testing and treatment.Conclusion: Clinicians have the challenge to find the optimal balance between too much and too little medicine-just appropriate.

Medical care for migrant children in Europe: a practical recommendation for first and follow-up appointments

Between 2015 and 2017, an estimated 200,000 to 400,000 children were seeking asylum each year in EU/EEA countries. As access to high-quality health care is important, we collected and compared current recommendations across Europe for a consensus recommendation on medical care for migrant (asylum-seeking and refugee) children. Existing recommendations were collected from published literature and identified through national representatives from paediatric societies of 31 EU/EEA countries through the European Academy of Paediatrics (EAP). Recommendations were systematically extracted and collected in a database. Those mentioned in at least one recommendation were evaluated for inclusion, and evidence on recommendations was specifically identified in literature searches focused on recent evidence from Europe. For eight EU/EEA countries, a national recommendation was identified. Growth and development, vision and hearing impairment, skin and dental problems, immunisations, anaemia, micronutrient deficiency, helminths, hepatitis B and C, human immunodeficiency virus, malaria, schistosomiasis, syphilis, tuberculosis, mental health disorder and sexual health were most frequently mentioned and therefore selected for inclusion in the recommendation.Conclusion: The current document includes general recommendations on ethical standards, use of interpreters and specific recommendations for prevention or early detection of communicable and non-communicable diseases. It may serve as a tool to ensure the fundamental right that migrant children in Europe receive a comprehensive, patient-centred health care.

European Antibiotic Awareness Day 2017: training the next generation of health care professionals in antibiotic stewardship

Antimicrobial stewardship (AMS) aims to optimise treatment, minimise the risk of adverse effects and reduce health care costs. In addition, it is recognised as a key component to stop the current spread of antimicrobial resistance in Europe. Educational programmes are particularly important for the successful implementation of AMS. Training should start during medical school, continue during clinical training and be reinforced throughout postgraduate training. National core curricula for paediatric training should include passive and active training of competencies needed for AMS and future paediatricians should be skilled in taking leadership roles in AMS initiatives. Other core members of the paediatric AMS team should also receive training focused on the unique medical needs of the paediatric patient.Conclusion: Ideally, all communities, hospitals and health regions in Europe should have AMS that serve all patient types, including children. We all have the responsibility to ensure that existing antibiotics remain effective.What is Known:• Antimicrobial stewardship (AMS) is a key component to stop the current spread of antimicrobial resistance• Educational programmes are particularly important for the successful implementation of AMSWhat is New:• All medical doctors in Europe who will be undertaking significant practice in child health should master the competencies needed to prescribe antibiotics to children rationally as described in the European Academy of Paediatrics (EAP) Curriculum for Common Trunk Training in Paediatrics• Interdisciplinary approaches of education need to be developed, as all hospitals and health regions in Europe ideally should have AMS programmes that serve all patient types, including children

Reviewing and addressing the link between mass media and the increase inobesity among European children: The European Academy of Paediatrics (EAP) and The European Childhood Obesity Group (ECOG) consensus statement.

Health policies in Europe must take account of the range of social media influences that promote the development of childhood obesity.

EAP viewpoint on unpublished data from paediatric clinical trials.

The European Academy of Paediatrics (EAP) therefore actively supports initiatives that increase the public dissemination of paediatric clinical trial data. The EAP will raise awareness about the guidelines for Good Publication Practice among European paediatricians and subspecialty societies.

Vitamin D in European children-statement from the European Academy of Paediatrics (EAP).

Vitamin D is synthesized in human skin upon sun exposure and is also a nutrient. It regulates calcium and phosphate metabolism and is essential for the maintenance of bone health. Vitamin D supplementation during infancy, in order to prevent rickets, is universally accepted. Many human cell types carry vitamin D receptor, this being a drive for conducting studies on the possible association between vitamin D status and other diseases. Studies have affirmed that a considerable number of healthy European children may be vitamin D deficient, especially in high-risk groups (darker pigmented skin, living in areas with reduced sun exposure and other disorders). However, the definition of deficiency is unclear due to inter assay differences and due to a lack of consensus as to what is an "adequate" 25(OH)D level. Therefore, there is no justification for routine screening for vitamin D deficiency in healthy children. An evaluation of vitamin D status is justified in children belonging to high-risk groups. All infants up to 1year of age should receive an oral supplementation of 400IU/day of vitamin D. Beyond this age, seasonal variation of sunlight should be taken into account when considering a national policy of supplementation or fortification.

Health, integrity, and doping in sports for children and young adults. A resolution of the European Academy of Paediatrics

The European Academy of Paediatrics (EAP) is dedicated to promoting healthy lifestyles for children from birth into young adulthood. Physical exercise and leisure are essential to the development of healthy bodies, strong minds, and social skills. All children, without regard to their physical or mental capacities, should be provided with the time, the leadership, the facilities, and the equipment needed to exercise through sports while enjoying playing, even competing, in an environment appropriate to their capacities and aspirations. During exercise and sports, children should be assured of a safe and an appropriate environment that protects and promotes their human rights. Top sports that engage the best competitive athletes in an age group, in a region, in a country, or in the world should provide role models and even dreams for all children. These top sports, however, are also most usually surrounded by large political, economic, and/or business interests where only the best can compete while at times exacting a too high physical and/or psychological cost for those who have survived the cut, made the grade. Alongside this more and more children are being raised in environments with fewer open spaces as well as inside a media and digital culture making significantly less room for the enjoyment of physical exercise and leisure. Children's diets have also been changed dramatically by a significant intake of calorierich foods, which often have little nutritional value and which even a child's high metabolism rates not able to burn off efficiently. Conclusion With this Resolution, the EAP is calling for a renewed look at the role of sports and leisure in the lives of children and, by implication, at the way we structure, finance, and promote sports in Europe. The EAP is also asking that this Resolution be adopted by all organizers of sports involving children and young adults in Europe (and beyond), be that on the playground, in schools, in clubs, or in professional sporting organizations. The EAP would like that every child, throughout his or her childhood years and into young adulthood, can fully participate in sports in a safe environment where winning is playing and playing is winning.

We strongly support childhood immunisation-statement from the European Academy of Paediatrics (EAP).

The eradication of smallpox and the elimination of several other infectious diseases from much of the world has provided convincing evidence that vaccines are among the most effective interventions for promoting health. The current scepticism about immunisation among members of the new US administration carries a risk of decreasing immunisation rates also in Europe. While only a small minority of the population are strongly anti-vaccine, their public activities have significantly influenced an uncertainty among the general population about both the safety of and the necessity for vaccination. Therefore, the EAP calls for greater publically available, scientifically supported information on vaccination, particularly targeted at health care providers, for the further development of electronically based immunisation information systems (IIS). We further call on all European countries to work together both in legislative and public health arenas in order to increase vaccination coverage among the paediatric population. In the interest of children and their parents, the EAP expresses its strong support for childhood immunisation and recommended vaccination schedules. We are prepared to work with governments and media and share the extensive evidence demonstrating the effectiveness and safety of vaccines.

European Academy of Paediatrics Statement: Vision zero for child deaths in traffic accidents.

Road traffic accidents are the leading cause of death and disability in children throughout Europe. They remain the leading cause of death among children 5--19 years old in Europe. Children may be injured as pedestrians, bicyclists, motorcyclists or passengers in cars. The European Academy of Pediatrics (EAP) strives to prevent morbidity and death in children. We urge policy-makers to actively work for a "vision zero", where no child is killed in traffic. EAP suggests simple measures such as, secure transport for children between home and school, speed limits, road bumps, wearing bike helmets and seat belts, using child-restraints for small children and enforcement of legislation on road safety.

Human papillomavirus vaccination crisis in Japan.

The European Academy of Paediatrics (EAP) is gravely concerned about the human papillomavirus (HPV) vaccination crisis in Japan and particularly about the negative position taken by governmental authorities. Given that the HPV vaccine is both safe and effective, there is no recognizable reason to date to withhold this lifesaving and cost effective public health measure from a population. Therefore, the EAP strongly encourages the Japanese health authorities to actively support HPV vaccination for the future health of their children and adolescents.

731 Organisation of Paediatric Emergency Care in Europe

Paediatric Emergency Medicine (PEM) is a relatively new and rapidly evolving subspecialty, and in other parts of the world it is now established as a Board-certified paediatric subspecialty. In Europe, PEM has been growing in many countries, even if very heterogeneously. In the UK, PEM has received official recognition in 2003. In France, Italy, Spain, Switzerland, and Sweden, PEM is not yet recognised, but it is practised by an increasing number of paediatricians in 3rd-level Paediatric Emergency Departments. A WG on PEM convened in Paris on 18-19th September 2009 with the aim of writing an European Training Syllabus on PEM to be approved by both the European Academy of Paediatrics (EAP) and the Multiple Joint Committee (MJC) on EM. During the meeting, the various organisations of PEM were reviewed in the above-listed countries. Although the organisation of PEM was very heterogeneous between the various countries, some common features emerged: 1) the wide range of pathologies from life-threatening to self-limiting; 2) the increasing attendance, particularly at nights and the week-ends, reflecting a lower coverage of primary care; 3) the impact of winter epidemics (eg, bronchiolitis, gastro-enteritis, influenza A H1N1 (2009) on the attendance; 4) the critical importance of a good triage system and timely clinical-making decision; 5) the necessary good communication between PEM physicians and other hospital specialists including paediatric surgeons. Thus, the approval of the European Training Syllabus on EM by both the EAP and MJC on EM should help develop PEM throughout the EU on more homogeneous grounds.

267 Euorpean Guidance on End-Of-Life Decisions in Paediatric Medicine

This presentation addresses the development of European guidance on end-of-life decision-making within the Ethics Working Group of the European Academy of Paediatrics (EAP). It looks at the background to this discussion, starting in 1997, as well as recent proposals for assisting paediatric care providers with approaches for decision-making. The topics addressed include consulting with parents and families, ceasing therapeutic intervention, pain management, seeking second opinions or ethical appraisals, and palliative care. The paper approaches decision-making from an ethical point of view, taking into account different cultural values as well as medical considerations surrounding European paediatric care, including an appreciation of the current discussion on euthanasia. The presentation provides a practical approach to end-of-life decision-making in paediatric medicine.