Bubble Wrap PLUS – March ’24

Can’t get enough of Bubble Wrap? The Bubble Wrap Plus is a monthly Paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital). 

This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research.

This month’s list includes many interesting studies, but as always, we have highlighted a few.

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, several studies have evaluated them with conflicting results, often with small cohorts or limited follow-up periods.

This study included 66 non-breastfed children (aged 2-24 months) with suspected IgE—or non-IgE-mediated cow’s milk protein allergy. It switched them to rice hydrolyzed formula and followed them up for twelve months. The outcomes were anthropometry, adherence to the formula, and adverse event occurrence.

The growth pattern for the entire cohort remained within the normal WHO growth reference range. The formula was well tolerated, adherence 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 the latter carrying higher mortality. Appendectomy is the standard treatment, but alternatives like antibiotics exist for simple appendicitis. 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.

A study in JAMA Pediatrics explored a potential gene expression signature in the peripheral blood of a pediatric patient with appendicitis. The study suggests a dysregulated immune response akin to sepsis in patients with perforation, hinting at some genetic involvement.

While promising, the study has limitations. It focuses solely on inflammation and needs to be validated in larger studies. Practical considerations like cost and time also need to be addressed before clinical application is possible.

The Lancet published two excellent studies on important vaccines for global healthcare (malaria and typhoid fever).

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 in preventing the first clinical malaria episode. There was also a reduction in malaria cases per 1000 children years. Vaccine-induced antibodies correlated with efficacy. The vaccine’s efficacy decreased slightly over the first year but remained substantial.

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.

Looking at 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 or 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 important 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 and ongoing improvements in water, sanitation, and hygiene (WASH) practices.

You will find the list of interesting papers broken down into four sections:

If we have missed out on something useful or you think other articles are absolutely worth sharing, please add them in the comments!