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AIM Vancomycin is frequently used in paediatric hospitals. Data suggest trough levels of 10-20 mg/L are needed to achieve bacterial killing. This study aimed to evaluate if commonly used dosing regimens are efficient in reaching these levels and if therapeutic drug monitoring (TDM) was appropriately used. METHODS All children receiving intravenous vancomycin at the Children´s Hospital Iceland between 2012 and 2016 were included. Vancomycin trough levels were registered. Student t test, Wilcoxon test and regression models were used for statistical analysis. RESULTS A total of 105 children received 163 vancomycin treatments (55/105 neonates). Average daily dose in neonates was 23.4 mg/kg/day and 38.4 mg/kg/day for older children. No TDM was done in 58 treatments (35.6%). First trough levels were

AIM Abdominal pain is a frequent reason for paediatric emergency department visits, but specific research is lacking. Our aim was to obtain information on the diagnosis of abdominal pain and what healthcare services children with this condition need. METHODS This retrospective study focused on patients visiting the emergency department of the Children's Hospital Iceland in 2010 with abdominal pain and any subsequent visits up to 1 January 2015. RESULTS There were 11 340 visits to the emergency department in 2010 and 1118 children made 1414 (12%) visits due to abdominal pain. The majority (58%) with abdominal pain were girls (p

Publisher's version (útgefin grein), Aim: The aim was to estimate the impact of the 10-valent pneumococcal vaccine (PHiD-CV) on tympanostomy tube placements (TTP) in children under five years of age in Iceland. Methods: This population-based observational cohort study followed 11 consecutive birth-cohorts 2005–2015 from birth until their fifth birthday. Population registries were merged using national identification numbers. The risk of TTP was compared between birth-cohorts adjusted for the number of previous otitis media diagnoses and antimicrobial prescriptions. A Cox regression model was applied and the hazard ratio (HR) of TTP was estimated between each birth-cohort and the last vaccine non-eligible birth-cohort. The vaccine impact of PHiD-CV10 on TTP was estimated as 1-HR ×100%. Results: In total, 51 247 children were followed for 210 724 person-years, of which 14 351 underwent 20 373 procedures. The estimated vaccine impact on TTP was −6% (95% CI −16% to 2.7%). Children in the vaccine-eligible cohorts had fewer previous otitis media diagnoses and had been prescribed fewer antimicrobials prior to the procedure than children in the vaccine non-eligible cohorts. Conclusion: Despite high uptake of PHiD-CV10, tympanostomy procedures increased in Iceland during the study period. Vaccine-eligible children had milder disease prior to the procedure. The reason underlying these findings are speculative., An investigator-initiated study funded by GlaxoSmithKline Biologicals SA. Additionally, a grant was received from the Landspitali University Hospital Research Fund. GlaxoSmithKline Biologicals SA was provided the opportunity to review a draft version of this manuscript, but the authors are solely responsible for final content and interpretation. The authors received no financial support or other form of compensation related to the development of the manuscript.

Tardy development of safe medicines for children : a Nordic network offers new platform to reduce this inequity

Aim: Evaluation of long-term outcome of extremely low-birthweight (ELBW) teenagers born in Iceland in 1991–1995. Method: Participants, 30 of 35 ELBW survivors and 30 full term control teenagers (14–19 years), were assessed for disabilities, health problems and learning difficulties. Results of national standardized tests in mathematics and Icelandic language were compared with results of neurodevelopmental assessment at 5 years of age. Results: A quarter of the ELBW teenagers had disabilities. All were initially diagnosed with neurodevelopmental disorders early in life and neurosensory and/or intellectual disabilities were confirmed later in childhood. Chronic lung disorders, neurological problems and psychiatric disorders were most common health problems. Growth parameters were within normal limits for most of the ELBW teenagers. Learning difficulties affected 57% of the ELBW teenagers, 20% attended special education classes and 37% required special teaching. Results of national standardized tests were significantly lower for ELBW survivors and were significantly related to the results of neurodevelopmental assessment at 5 years of age. Interpretation: A quarter of ELBW teenagers have disabilities albeit most of them mild. Chronic health problems and learning difficulties affect many ELBW survivors. Changes with time emphasize need of long-term follow-up.

Aim: To investigate the aetiology of bacteraemia in children in Iceland, the antibiotic resistance and possible preventive measures. Methods: All positive bacterial blood cultures from children 0–18 years old isolated at Landspo´tali University Hospital Iceland from 1994 to 2005 were included in the study. Epidemiological and microbiological data were registered. The blood cultures were categorized according to likelihood of infection or contamination. Results: During the study period 1253 positive blood cultures were obtained from 974 children; 647 from boys and 606 from girls. Positive blood cultures were most common during the first year of life (594; 47.4%) with 252 of them from neonates. Coagulase negative staphylococci were most common (37%). Of probable or definite infections Streptococcus pneumoniae was the most common (19.3%) followed by Staphylococcus aureus (17.6%) and Neisseria meningitidis (13.5%). The most common pneumococcal serogroups were 23, 6, 7, 19 and 14. Commercially available vaccines contain up to 88% of all pneumococcal strains and 67% of all multi-resistant strains. N. meningitidis group C was not isolated after vaccinations were started in 2002.

Background: The prevalence of adult atopic diseases in Iceland is lower than in other West European countries, despite an affluent lifestyle, but limited data are available on children. The main aim of this study was to investigate the prevalence of atopic diseases and sensitivity to common allergens in 10- to 11-year-old Icelandic schoolchildren as part of phase II of the International Study of Asthma and Allergies in Children (ISAAC). Methods: Nine hundred and forty-six children and their parents answered a questionnaire about atopic diseases. Skin prick tests with six allergens were performed on 773 children and they were examined for signs of atopic dermatitis (AD). Results: The 12-month prevalence of allergic rhinoconjunctivitis and asthma was 11.5% and 8.9% respectively. The reported prevalence of AD was 27%, but only 9.2% had signs when inspected. A positive skin prick test (SPT) was found in 24.4% of the children, that is 18.8% to grass, 12.9% to cat, 3.6% to trees, 3.0% to Dermatophagoides pteronyssinus, 1.4% to D. farinae and 0.5% to Alternaria. Conclusion: The high prevalence of atopic diseases in children at 10–11 years is surprising, as the prevalence in adults is low in Iceland. The findings resemble those in developing countries. Iceland has had an affluent lifestyle for a considerable time, but the absence of dust mites, low pet ownership and relatively low pollen counts in the country raise doubts about the role of exposure levels in the development of sensitization and atopic diseases.

UNLABELLED Familial haemophagocytic lymphohistiocytosis (FHL) is a rare, autosomal recessive disease of infancy and early childhood clinically characterized by fever, hepatosplenomegaly, lymphadenopathy, rash, neurological symptoms and icterus. Common laboratory findings include cytopenia, elevated liver enzymes, hyperbiliriubinaemia, hypofibrinogenaemia and hypertriglyceridaemia. The natural killer cell function is frequently decreased or absent. A diffuse lymphohistiocytic infiltration is seen in the reticuloendothelial system, often with haemophagocytosis. Molecular diagnosis is available in a minority of FHL families. Without adequate treatment and bone-marrow transplantation, the disease is fatal. A 6-wk-old child with FHL is presented. Shortly before the clinical onset of the disease, blood testing and bone-marrow examination had been carried out. All results were considered normal at that time. CONCLUSION Blood tests and bone-marrow examination may be normal shortly before the clinical presentation and therefore do not exclude the diagnosis of FHL. There is a need for extended molecular diagnostic possibilities.