Journal of paediatrics and child health最新文献

Aim

To evaluate the health and developmental concerns for children in out-of-home care in Central Australia and assess whether they received timely and comprehensive paediatric health assessments.

Methods

A retrospective audit of paediatric outpatient assessments for all children in out-of-home care in Central Australia, from 1 September 2018 to 1 May 2020. Timeliness of paediatric assessment was compared with the recommended timeframes in the National Clinical Assessment Framework.

Results

A total of 304 children, aged 0–17 years were in out-of-home care during the audit period, with 174 (57%) children seen through paediatric clinics. Ninety-five percent of children were Aboriginal and Torres Strait Islander and all children had health needs identified. Developmental concerns were most common in children over 1-year-old (70%). Sixty-three percent of school-aged children had behavioural concerns and 43% had mental health concerns identified. Foetal alcohol spectrum disorder (FASD) was diagnosed or suspected in 50%–66% of primary school-aged and younger and 43% of high school-aged children. More than 50% of primary school-aged children had diagnosed or suspected attention-deficit/hyperactivity disorder (ADHD). Nearly all children were referred for ongoing paediatric care. Less than half of the children had a comprehensive health assessment within the recommended 3 months of entry into out-of-home care.

Conclusions

Children in out-of-home care in Central Australia experience significant physical, developmental, behavioural and mental health care needs. The findings highlight significant delays in the provision of paediatric health assessments, with most children not seen within recommended timeframes. The findings from this study highlight the importance of timely and consistent access to assessments and should challenge stakeholders to prioritise service, system and policy development.

Purpose

To investigate whether postnatal haemoglobin oxygen affinity (P₅₀), derived from serial arterial blood gases, is associated with the risk of retinopathy of prematurity (ROP) in preterm infants, as a potential physiologic marker.

Study Design

Retrospective cohort study.

Methods

This study included 232 preterm infants born < 32 weeks gestation. Haemoglobin P₅₀ and lactate values were calculated daily during the first week of life. The primary outcome was the development of any ROP; treatment-requiring (Type 1) ROP was a secondary endpoint. Associations were analysed using logistic regression and ROC analysis.

Results

Infants who developed ROP had significantly higher Day 7 P₅₀ values (mean 26.9 ± 1.8 mmHg) than those without ROP (26.1 ± 1.7 mmHg; p = 0.003). A Day 7 P₅₀ > 26.4 mmHg was independently associated with ROP (OR 2.5; 95% CI 1.3–4.9), though predictive performance was modest (AUC 0.60). Lactate levels showed no association with ROP. P₅₀ was not predictive of Type 1 ROP.

Conclusion

Increased postnatal P₅₀ may be modestly associated with ROP development, reflecting impaired oxygen delivery during early retinal vascularization. While not suitable for screening, P₅₀ may serve as a physiologic marker warranting further mechanistic investigation.

Aim

In this study, we aimed to provide a comprehensive analysis of real-world implications for the therapeutic efficacy and safety of baloxavir marboxil, oseltamivir phosphate capsules and oseltamivir phosphate granules in the treatment of 160 Chinese children with influenza A.

Methods

This retrospective study included children aged 10–16 with influenza A treated at a hospital in Beijing between January 2023 and August 2024. Participants were categorised into three groups: oseltamivir capsule group (n = 56), oseltamivir granule group (n = 55) and baloxavir group (n = 49). Clinical characteristics, epidemiology, therapeutic effects (e.g., fever clearance time, total illness duration and curative rate), drug costs and adverse reactions were compared among groups.

Results

No significant differences were found in demographics or initial symptoms (p > 0.05). Fever clearance time and total illness duration were significantly shorter in the baloxavir group compared to the oseltamivir capsule group (both p < 0.01) and the oseltamivir granule group (p < 0.01, p < 0.05) mainly in children with high fever. While the total effective rates were similar across groups, baloxavir showed a notably higher curative rate (84%, 41/49) than oseltamivir capsules (45%, 25/56) and granules (49%, 27/55) (p < 0.01). Cost analysis indicated that oseltamivir capsules were the least expensive, with baloxavir being slightly less costly than oseltamivir granules (p < 0.01).

Conclusions

Baloxavir marboxil exhibited superior efficacy in reducing fever and shortening the illness duration. Its single-dose regimen enhances compliance with antiviral therapy, although it remains a relatively more expensive option. In contrast, oseltamivir granules enabled more accurate dosing, while oseltamivir capsules were the most cost-effective treatment.

Aim

To determine the prevalence of abuse-related red flags and the frequency of subsequent evaluations among young children presenting to the emergency department (ED) with trauma-related complaints, and to quantify the association between red flags and further evaluation.

Methods

We conducted a retrospective cohort study of children < 3 years presenting to a tertiary paediatric ED in 2019 with trauma-related chief complaints identified from structured electronic health record (EHR) data. Red flags were categorised as historical, physical, diagnostic, or caretaker/household. Two trained abstractors independently coded red flags from explicit provider documentation; discrepancies were resolved by consensus (inter-rater reliability on a 20% sample; kappa = 0.82). Outcomes were the performance of skeletal surveys, laboratory testing, and social work/child protection consultations. Logistic regression estimated the association between red flags and any subsequent evaluation, adjusting for age.

Results

Among 962 eligible trauma-related visits, 317 children (33%) had ≥ 1 documented red flag. Across the cohort, 8.6% received a skeletal survey, 4.3% had laboratory testing, and 1.5% had a social work consultation. Children with any red flag were more likely to undergo further evaluation (adjusted OR [aOR] 3.7; 95% CI: 2.5–5.4). Historical red flags were associated with skeletal survey (OR 3.7, 95% CI: 1.3–11) and laboratory tests (OR 4.1, 95% CI: 1.3–13.6). Physical red flags were associated with skeletal survey (OR 6.4, 95% CI: 2.1–19.6) and laboratories (OR 5.3, 95% CI: 1.5–19). Diagnostic red flags were associated with skeletal survey (OR 7.0, 95% CI: 2.3–21.6) and neuroimaging (OR 2.4, 95% CI: 1.3–4.5).

Conclusion(s)

One in three children under age 3 with trauma-related ED visits had documented red flags suggestive of possible abuse, yet comprehensive evaluations were infrequent. Findings support the need for nuanced, standardised approaches that prioritise high-yield flags while avoiding extensive evaluations.

Background

While the severity and burden of SARS-CoV-2 infection in children are increasingly described, the literature on the clinical impact of SARS-CoV-2 compared to Respiratory Syncytial Virus (RSV) is still evolving. We compare the morbidity of SARS-CoV-2 with RSV among hospitalised children under 2 years.

Methods

This was a retrospective, cross-sectional, single-centre study. All children under 24 months, admitted to a quaternary children's hospital in Queensland from January 2021 to December 2022 with SARS-CoV-2 or RSV infection, were included. Demographics, oxygen therapy, antibiotic usage and length of stay were compared.

Results

Of 639 children, 175 had SARS-CoV-2 and 465 had RSV. Proportionally more children with SARS-CoV-2 had medical co-morbidity compared to RSV (25.1% vs. 12.1%, p < 0.001), but there was no significant difference in other demographics. Children with RSV had significantly higher rates of oxygen therapy at admission (25.9% vs. 6.5%, p < 0.001), during admission (61% vs. 15.7%, p < 0.001), and a longer duration of stay (3 vs. 2 days, p = 0.002). Antibiotics were prescribed more often in SARS-CoV-2 (40% vs. 30.2%, p = 0.018).

Conclusion

RSV infection in children under 2 years of age was associated with a more severe respiratory illness course than SARS-CoV-2. These findings are relevant to policy regarding RSV and SARS-CoV-2 immunisation in young children.

Objective

Red cell distribution width (RDW) is recognised as a prognostic biomarker for predicting mortality in neonatal sepsis. However, its utility in forecasting 28-day mortality amongst very low birth weight (VLBW) neonates remains uncertain.

Methods

We conducted a retrospective, observational, single-centre study involving neonates with a birth weight of less than 1500 g. The primary endpoint was 28-day mortality. RDW and the Score for Neonatal Acute Physiology–Perinatal Extension II (SNAPPE-II) were measured on Days 1 and 3 following admission to evaluate their predictive value for mortality. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were used to assess the association between RDW and 28-day mortality, and to compare the predictive performance of RDW with SNAPPE-II.

Results

RDW levels were significantly higher in the non-survivor group (n = 35) compared to the survivor group (n = 70) on both Day 1 and 3 post-admission (p < 0.01 for both). Additionally, RDW was positively correlated with SNAPPE-II scores (r = 0.63 and 0.61, p < 0.01). ROC analysis revealed that RDW measured on Day 3 had a strong predictive value for 28-day mortality (AUC = 0.89, p < 0.01), which was significantly greater than the AUC for RDW on Day 1 (AUC = 0.73).

Conclusion

These findings suggest that dynamic RDW changes (on post-admission Day 1–3) are a reliable prognostic biomarker for 28-day mortality in VLBW neonates, with predictive performance comparable to SNAPPE-II. It can serve as a low-cost, easily accessible tool for risk stratification in resource-limited settings.

Trial Registration: China Clinical Trial Registration Center Registration No.: ChiCTR2100043217

Objective

To assess the global, regional, and national burden of pulmonary tuberculosis (TB), including drug-susceptible (DS-TB) and multidrug-resistant TB (MDR-TB), among children and adolescents from 1990 to 2021, and to project trends to 2045.

Methods

Data were extracted from the Global Burden of Disease Study 2021. Age-specific incidence rates (ASIRs) were estimated using DisMod-MR 2.1, and temporal trends were evaluated using estimated annual percentage change (EAPC). Correlation analyses between ASIR and Sociodemographic Index (SDI) were conducted. A Bayesian age-period-cohort model was used to forecast incidence through 2045.

Results

From 1990 to 2021, global tuberculosis cases in this population declined by 37.4%, while MDR-TB increased by 386.9%. Age-specific incidence rates of tuberculosis and DS-TB declined (EAPC = −2.00 and −2.10), whereas the MDR-TB age-specific incidence rate rose (EAPC = 4.50). The highest ASIRs were observed in sub-Saharan Africa and South Asia. MDR-TB incidence was highest in Eswatini, Namibia, and Lesotho. Incidence increased with age and was consistently higher among males in adolescence. Age-specific incidence rates negatively correlated with SDI across tuberculosis types. Projections indicate a further decline in tuberculosis and DS-TB by 2045, but a continued rise in MDR-TB.

Conclusion

Despite progress in reducing DS-TB, the rising burden of MDR-TB among children and adolescents remains a major concern, especially in low-SDI regions. Targeted surveillance, gender-sensitive interventions, and equitable access to diagnostics and treatment are essential to address disparities and reduce the tuberculosis burden in young populations.

Aim

To determine the incidence, causes, and clinical associations of cases of extreme neonatal hyperbilirubinaemia in South Australia.

Methods

This was a population-based case–control study of neonates ≥ 36 weeks gestation with extreme hyperbilirubinaemia (plasma bilirubin level ≥ 450 μmol/L) in South Australia over a 12-year period, between January 2010 and December 2021. Cases of extreme hyperbilirubinaemia were detected via a state-wide pathology system. Further details were obtained using medical records. Population data from the SA Health Pregnancy Outcome Unit was used as the control group.

Results

A total of 68 cases were identified. The overall incidence of extreme hyperbilirubinaemia for the 12-year period was 28.6/100 000 births, higher than a previously published Australian estimate of 9.4/100 000 live births reported over a similar period and determined by clinician reporting. Extreme hyperbilirubinaemia was associated with Asian ethnicity, ventouse delivery and early discharge. A large peak in 2020 was temporally associated with the onset of the SARS-CoV-2 pandemic.

Conclusions

The incidence of extreme hyperbilirubinaemia stayed mostly stable over 12 years in South Australia and was higher than previously described via voluntary clinician reporting. Population-based surveillance monitoring via laboratory systems is likely to be more reliable than voluntary clinician reporting. A spike in incidence in 2020 may have occurred due to pandemic-related changes in maternity and neonatal care practices.

Objectives

The study evaluated neonatal cerebro-spinal fluid (CSF) leucocyte esterase (LE) estimation by reagent strips to diagnose CSF leucocytosis in situations where the CSF leucocyte count is delayed or unavailable.

Methods

This prospective diagnostic study had a cohort-selection design. CSF samples of neonates with clinical sepsis were analysed for LE by reagent strips, cytochemistry, gram stain and culture. CSF LE was measured on an ordinal scale from nil to large. Correlations of CSF LE with CSF leucocyte and neutrophil count were determined. CSF LE was compared versus CSF leucocytosis (defined a priori ≥ 25 leucocytes/μL) and versus CSF neutrophilia (defined a priori ≥ 15 neutrophils/μL) as the reference standard.

Results

A total of 341 neonates were enrolled. CSF LE values correlated with leucocyte count (rho = 0.49, p < 0.001) and neutrophil count (rho = 0.44, p < 0.001). LE had a sensitivity (95% CI) of 63.5% (51.2, 74.1), specificity 90.7% (88.4, 92.6), LR+ (likelihood ratio) 6.79 (4.43, 9.98) and LR− 0.40 (0.28, 0.55) to diagnose CSF leucocytosis. When expressed as an ordinal variable, LE had an area under the receiver operator characteristic curve of 0.77 (95% CI: 0.69, 0.85; p < 0.001) to detect leucocytosis. With respect to all parameters, the diagnostic performance of CSF LE to detect neutrophilia was inferior to the detection of leucocytosis.

Conclusions

CSF leucocyte esterase estimation by reagent strips has a moderately high specificity and a good LR⁺ but, overall, does not have sufficiently robust diagnostic accuracy to substitute CSF leucocyte counts.