Journal of paediatrics and child health最新文献

Objectives: To determine the frequency and patterns of dietary modification, sources of dietary advice and associated behaviours in Australian children with inflammatory bowel disease (IBD).

Methods: Mixed-methods cross-sectional study was conducted with IBD patients attending Perth Children's Hospital. Participants completed a validated questionnaire and clinical disease activity (PUCAI/PCDAI) was recorded on the day of consultation. Descriptive statistics, t-tests, chi-square tests, and multivariable logistic regressions were performed using Jamovi.

Results: Sixty-four children participated (34 males; mean age 13.4 ± 2.8 years; 28 Crohn's disease, 36 ulcerative colitis). Over half (33/64, 51.6%) reported dietary modification post diagnosis, most commonly food avoidance. One-third (24/64, 37.5%) regularly skipped meals. On multivariable logistics regression food avoidance (aOR 13.8, 95% CI 2.17-87) and disease activity (aOR 12.4, 95% CI 2.80-55.1) were independently associated with meal skipping. Females were 3.17 (95% CI 1.14-8.80) times more likely to practice food avoidance and 3.56 (95% CI 1.14-8.80) times more likely to report symptom exacerbation with specific foods on univariable analysis. Although gastroenterologists and dietitians were the most trusted sources of dietary advice, over 20% (7/33) of patients were modifying their diet based on non-expert recommendation.

Conclusions: Dietary modification post diagnosis is prevalent among Australian paediatric IBD patients. Meal skipping is independently associated with active disease and self-directed food avoidance; females report higher rates of food avoidance and symptoms exacerbation with foods. These findings highlight the need for proactive, consistent dietary counselling and underscore the importance of further multicentre studies to corroborate these findings.

Aim: To determine the magnitude of high-risk infants cared for at a regional hospital in Victoria, Australia and to identify the resources required to care for them.

Methods: A retrospective study was conducted between January 2017 and December 2019 in a regional hospital in Victoria, Australia. Data of high-risk neonates and their associated risk factors were collected from electronic and physical medical records. Simple descriptive statistics were used to summarise and report the data. Follow-up was proposed based on the high-risk factors as per already known follow-up protocols.

Results: An average of 848 births were registered annually. The special care nursery (SCN) within the regional hospital received an average of 260 admissions per annum. Of the admissions to the SCN, 47% of infants had high-risk factors. Approximately 90% of the high-risk infants were inborn and 10% were outborn. Prematurity, small for gestational age (SGA) and adverse socio-demographic variables were the most common risk factors across all 3 years. Approximately 43% of high-risk infants had two or more risk factors. The prevalence of these high-risk factors between the 3 years remained consistent.

Conclusion: A considerable number of high-risk neonatal admissions were recorded in this regional hospital which serves a large proportion of socio-economically disadvantaged patients. Customised and co-located multidisciplinary team (MDT) follow-up of these high-risk neonates is crucial. Findings can inform local guidelines for MDT neurodevelopmental follow up program to prevent long term adverse outcomes.

Aim: Paediatric intensive care unit (PICU) length of stay (LOS) significantly impacts healthcare resources and costs, yet the influence of admission timing remains uncertain. We compare PICU LOS in patients transferred from wards during office hours versus non-office hours and examine predictors of mortality and LOS among survivors.

Methods: This retrospective cohort study analysed data from children under 18 years admitted to the PICU from wards at King Chulalongkorn Memorial Hospital, Bangkok, Thailand (1 July 2018-30 June 2022). Patients from the emergency room, outpatient department, other hospitals or for post-procedural care were excluded. Variables included demographics, clinical features, laboratory parameters, severity scores (Paediatric Index of Mortality 3 [PIM-3] and Paediatric Logistic Organ Dysfunction 2 [PELOD-2]).

Results: Of 536 patients, 151 (28%) were admitted during office hours and 385 (72%) during non-office hours, with a median age of 1.8 years (IQR 0.7-7.4). Office-hours admissions had higher severity scores and a longer median LOS (5 days, IQR: 2-14 vs. 3.4 days, IQR: 1.6-7.1; p = 0.001). ICU mortality did not differ significantly (7.3% vs. 3.9%; p = 0.10). Multivariate analysis revealed that admission timing was not independently associated with outcomes; however, higher PELOD-2 independently predicted mortality (adjusted hazard ratio 3.51, 95% CI: 1.37-8.99; p = 0.009), and prolonged LOS among survivors (adjusted coefficient 0.45, 95% CI: 0.08-0.83; p = 0.018).

Conclusions: Longer LOS among office-hour admissions is attributable to greater illness severity rather than admission timing, underscoring the need for early identification and management of high-risk patients.

Trial registration: The protocol was registered on 19 May 2023, in the Thai Clinical Trials Registry (TCTR), ID TCTR 20230519001.

Background: Chest x-ray (CXR) and computed tomography (CT) are commonly used for diagnosing bronchopulmonary dysplasia (BPD), though each modality has limitations. CXR has low sensitivity for early parenchymal changes, while CT involves radiation exposure. Lung ultrasound (LUS) has emerged as a promising, radiation-free alternative.

Objective: To assess the diagnostic accuracy of LUS in BPD compared to CT and CXR, and to evaluate correlations between LUS scores and pulmonary function parameters, including spirometry, interrupter resistance technique (RINT), and nocturnal respiratory monitoring (pulse oximetry, polygraphy).

Methods: This was a retrospective, single-center, cross-sectional study conducted over 12 months at San Marco University Hospital (Catania, Italy). Sixty paediatric patients with BPD underwent LUS, CXR and high-resolution CT (HRCT). Pulmonary function tests (spirometry, RINT) and nocturnal monitoring were performed when feasible. Diagnostic performance of LUS was evaluated using receiver operating characteristic (ROC) curves and intraclass correlation coefficient (ICC). Correlations with functional parameters were analysed using Spearman's coefficient.

Results: LUS showed good concordance with CT (ICC = 0.78; 95% CI: 0.72-0.85) and higher diagnostic accuracy than CXR (AUC = 0.87 vs. 0.67). LUS was particularly sensitive in detecting moderate parenchymal abnormalities. LUS scores correlated significantly with airway resistance (r = 0.85), FEV₁ (r = -0.65), and oxygen desaturation index (r = 0.50).

Conclusion: In this study, LUS demonstrated good concordance with CT and outperformed CXR. Its correlation with pulmonary function parameters suggests potential utility in the assessment and monitoring of BPD. Further studies with larger cohorts are needed to validate these findings.

Aim: Non-food object ingestion and resulting oesophageal foreign body (EFB) impactions are a common problem in children, with potentially severe consequences requiring urgent management. This study aimed to assess public knowledge of paediatric EFBs, including prevention, risks and management to inform future primary prevention efforts: METHODS: Members of the public were surveyed between January and May 2024. The pretested, electronic survey was distributed via social media and printed notices. Collected data included demographics, preventative household safety measures, recognition, perceptions of object danger and knowledge of EFB management. Responses were analysed using descriptive statistics.

Results: Overall, 516 respondents completed the survey, including 444 (86%) with children in their home or workplace. Rated on a Likert-type scale from 1 (not dangerous) to 10 (most dangerous), button batteries were perceived as most dangerous EFBs (mean ± standard deviation [SD]: 8.7 ± 2.1), followed by high-powered magnets (8.3 ± 2.4). However, only 33% of participants with children at home reported storing dangerous objects away, most commonly sharp objects (94%), small toys (72%) and coins (69%). Despite being perceived as most dangerous, only 59% of participants stored button batteries and 34% stored high-powered magnets away from children. Upon survey completion, 84% of respondents indicated they would like to learn more about EFBs in children.

Conclusions: Paediatric EFBs represent a significant public health concern, and this study highlights substantial gaps in public knowledge regarding safety and preventative measures. By focusing public health initiatives on addressing these knowledge gaps, there is potential to significantly reduce the prevalence and impact of ingestion incidents in children.