Journal of paediatrics and child health最新文献

Aims: Neonatal septicemia is a life-threatening condition with high mortality, and its early diagnosis remains a major challenge. Rapid and reliable biomarkers are essential for timely management. Presepsin, a soluble CD14 subtype, has emerged as a promising early sepsis marker, though evidence in neonates is scarce. This study evaluated its diagnostic and prognostic performance in suspected neonatal sepsis, covering bacterial and fungal infections.

Methods: An analytical cross-sectional study was conducted in the NICU of a tertiary hospital from May 2023 to November 2024. Eighty-eight neonates with clinically suspected sepsis were enrolled. Blood samples were collected for culture, C-reactive protein (CRP) measured by semiquantitative latex agglutination and Presepsin measured by ELISA. Diagnostic performance was assessed via receiver operating characteristic analysis, and associations with clinical features, birth weight, and outcomes were evaluated.

Results: Blood cultures were positive in 57 (64.8%) neonates, including 39 bacterial and 18 fungal cases. Presepsin levels were significantly higher in culture-proven sepsis (1208.5 ± 319.4 pg/mL) than probable sepsis (828.9 ± 235.5 pg/mL, p < 0.001). ROC analysis identified a cutoff of 906.6 pg/mL, yielding 90% sensitivity, 88% specificity, and 84% diagnostic accuracy. Presepsin levels rose faster than CRP, enabling earlier detection. Higher levels were noted in fungal sepsis (1441.4 ± 357.5 pg/mL) and in neonates with poor outcomes, correlating with longer hospital stays.

Conclusions: Presepsin is a rapid, reliable biomarker for early diagnosis and prognosis of neonatal sepsis, including fungal infections. Its use alongside clinical assessment can support timely therapeutic decisions, reduce hospital stay, and improve survival in high-risk neonates.

Aims: To describe the current clinical practices relating to nasal high-flow therapy (NHF) therapy for infants with bronchiolitis across Australia and New Zealand, with a focus on describing the approach to non-hypoxic infants.

Methods: Voluntary online questionnaire distributed to Emergency Department and inpatient unit staff affiliated with the Paediatric Research in Emergency Departments International Collaborative (PREDICT) and Children's Inpatient Research Collaboration of Australia and New Zealand (CIRCAN) networks. The survey explored clinicians' general approach to NHF and included six clinical scenarios to assess self-reported practice patterns.

Results: A total of 704 clinicians (386 physicians and 318 nurses) from 42 healthcare services across Australia and New Zealand responded. For non-hypoxic infants with moderate illness, 55% of nursing staff would commence NHF, compared with 24% of doctors (p < 0.001). For hypoxic infants with moderate illness, 70% of nurses compared with 34% of doctors reported initiating NHF (p < 0.001). Nurses were more likely than doctors to consider moderate work of breathing, and worsening tachypnoea (not meeting emergency response criteria), as indications to initiate NHF for non-hypoxic infants, whereas doctors more frequently cited critical work of breathing and apnoea. Key therapeutic objectives of NHF identified were 'reduced work of breathing' (96%) and 'reduced tachypnoea' (80%).

Conclusions: Substantial variability exists in the clinical application of NHF therapy for infants with bronchiolitis, particularly in cases of moderate illness without hypoxia. Clearer clinical guidelines and better evidence for NHF in non-hypoxic infants may reduce this variability.

Aim: To describe the age- and problem-related characteristics of children referred for discussion at a multidisciplinary child abuse and neglect meeting as part of the Safer Kids Project 'SKiP' at Royal Prince Alfred Hospital. Second, to compare the initial period of program establishment in 2021 with the 2022 period once the program was embedded, in terms of actions and outcomes prompted by SKiP.

Methods: A retrospective descriptive and comparative audit was performed for two 12-week periods of data from the SKiP meetings from May to September 2021 (inaugural roll-out of the SKiP model) and May to September 2022 (the same period 1 year later after the model was embedded). N = 1382 cases were included.

Results: Pre-verbal children (aged 0-2 years) and teenagers (aged 11-16 years) showed an overrepresentation in cases requiring further action post multidisciplinary meeting. Comparison of initial versus embedded periods suggested improvements in the assessment and management of children while they were in the Emergency Department and several reductions in additional child protection measures required post multidisciplinary meeting, with an implication these actions were increasingly being performed in real time.

Conclusion: A multi-modal, multidisciplinary child protection model of care can be effective at improving child protection assessment in the Emergency Department and staff effectiveness at recognising and actioning cases concerning child maltreatment.

Aim: Clinical supervision plays an important role in the success of Competency Based Medical Education. This study aims to explore the Victorian Training Programme Community Child Health (VTPCCH) supervisory practices from the perspectives of trainees and supervisors.

Methods: Nine peadiatric trainees enrolled in the VTPCCH who were based at the Royal Children's Hospital Melbourne and 15 supervising consultants were recruited in this study. Questionnaires were designed according to the roles of trainee and supervisor, exploring their experiences related to clinical supervision in the VTPCCH. Mixed quantitative and qualitative analyses were conducted.

Results: Sixteen responded (seven trainees and nine supervisors). Quantitative analysis revealed that respondents were highly satisfied with the overall training programme and quality of clinical supervision (median = 5.0 [trainee], 4.0 [supervisor], p > 0.05). Learning opportunity, especially the overall learning experience was valued, (median = 5.0 vs. 4.0 [supervisor], p = 0.03). Trainees were less satisfied with the opportunity to discuss patients and accessibility to supervision (median = 3.0, 4 [supervisor], p > 0.05) while supervisors perceived lower level of satisfaction pertaining to workload monitoring and extent of support they could provide in meeting the training requirements (median = 3.0, 4.0 [trainee], p > 0.05). Higher level of burnout was rated by trainee (median = 4.0, 3.0 [supervisor], p > 0.05). Access to supervision, heavy workload, inconsistent practices, lack of clarity and valuable educational opportunities are factors impacting participants' perceived satisfaction with the clinical supervision.

Conclusions: Our findings indicate learning opportunity as the valued factor while suggesting gaps around access to supervisors, heavy workload, inconsistent and lack of clarity in practices as areas for improvement. Recommendations are being implemented with the 2025 cohort of paediatric trainees.

Aim: The Australian and New Zealand model for neonatal point of care ultrasound (POCUS) training was developed in 2009 and is the first of such certification available internationally. Despite this, there has only been a modest increase in the number of certified POCUS clinicians in the last 10 years. Little is known about the accessibility to training. To address this knowledge gap, we conducted a binational survey of the neonatal clinicians.

Methods: An online questionnaire was distributed through the Australian and New Zealand Neonatal Network (ANZNN) mailing list in May 2024. The network consists of all 32 NICUs in Australia and New Zealand, and the distribution list includes neonatologists and trainees registered with the network.

Results: A total of 132/283 (47%) responses were received. Sixty-seven percent were from neonatologists, and the remainder were trainees. 33% had completed POCUS training, 23% were enrolled, 17% did not complete training and 27% were not enrolled. Forty-three percent worked in a NICU where POCUS service was available 24/7, and the rest were available ad hoc (43%), or during business hours only (12%); 2% worked in a NICU with no POCUS service. The main barriers include a lack of protected teaching time (73%), POCUS supervisors (52%) and a formal curriculum (40%). Seventy-two percent felt POCUS training should be included in the neonatal specialist training curriculum.

Conclusion: Neonatal clinicians recognise the importance of POCUS training and its benefits for patient care. However, there are significant barriers limiting access to training. The results of this survey may help inform curriculum design and educational strategies that can lead to wider implementation of training and integration of POCUS into clinical care.

Background/aim: Dermatological consultations from paediatric emergency departments are common but often underreported. Understanding the profile and outcomes of these consultations is crucial for improving diagnostic accuracy and patient management. The aim was to retrospectively analyse paediatric patients referred from the paediatric emergency department to the dermatology clinic in a tertiary care hospital over a 5-year period, focusing on demographic characteristics, preliminary and final diagnoses, diagnostic concordance and treatment modalities.

Methods: This retrospective observational study included paediatric patients (aged 0-18 years) consulted at the dermatology clinic from the paediatric emergency department of a tertiary care centre. Data collected included demographics, triage codes, consultation response times, diagnoses, examination findings and treatments.

Results: A total of 486 patients were included, with a mean age of 95.3 ± 66.6 months. The gender distribution was 48.1% (n = 234) female and 51.9% (n = 252) male. The most frequent final diagnoses were scabies 14% (n = 68), insect bites 7.8% (n = 38) and urticaria-angioedema 7% (n = 34). Diagnostic concordance between paediatricians and dermatologists was 64.23% (n = 88 of 137 with preliminary diagnoses). Topical antibiotics 40.3% (n = 196), systemic antihistamines 27.2% (n = 132) and topical steroids 24.7% (n = 120) were the most commonly prescribed treatments. Hospitalisation was required for 1.9% (n = 9) of patients, and 4.3% (n = 21) underwent biopsy.

Conclusion: The majority of dermatology consultations from the paediatric emergency department were for non-emergent conditions. Strengthening dermatology education in paediatric training programmes and establishing specialised paediatric dermatology outpatient clinics may improve diagnostic accuracy and patient care.

Pharmacogenomics (PGx) is the study of how interindividual genetic variability affects drug response. Clinically, PGx testing may be used to enhance individualised pharmacotherapy, minimising adverse drug reactions and improving treatment outcomes. This review explores the clinical application of PGx testing in paediatrics, particularly in emphasising oncology, psychiatry and other supportive therapeutic areas due to its primacy of use in these fields. In paediatric oncology, TPMT and NUDT15-guided pharmacotherapy may significantly reduce drug toxicity without increasing symptomatic relapse rates. The clinical utility of PGx testing extends to inflammatory bowel disease, antimicrobial stewardship, analgesic use and psychotropic prescribing, where case studies provided in this review will demonstrate how tailored approaches may improve clinical outcomes. Despite these advancements, PGx implementation faces systemic barriers, limited clinician training, complex reporting formats, and low public awareness inhibiting the uptake of PGx use into everyday clinical care. We provide future directions to these systemic barriers, including standardised reporting, professional education initiatives and multidisciplinary collaborations, which are all helping to address these current challenges. Furthermore, access and reimbursement constraints also hinder individual adoption. However, health economic analyses and the decreasing costs of genetic testing offer hope for expanded accessibility. Enhanced data governance and public education are also required to overcome privacy concerns and foster acceptance. Continued investment in paediatric-specific PGx research and age-specific guidelines is vital in bridging knowledge gaps and addressing developmental differences in drug metabolism.