Journal of paediatrics and child health最新文献

Aim: Neonatal cardiac surgery (NCS) is associated with a risk of neurodevelopmental impairment. We reviewed outcomes of a national pre-school screen, the Before School Check (B4SC), of children who had NCS compared to the national cohort to determine whether NCS children had higher rates of abnormality and whether the B4SC could be useful to identify at-risk NCS children.

Methods: B4SC results of children who had NCS between 2006 and 2014 were compared to controls. Sub-analyses were performed by cardiac subtype and timing of diagnosis. Outcome measures were the Parental Evaluation of Developmental Status (PEDS), vision and hearing screening, and the Strengths and Difficulties Questionnaire parent version (SDQ-P). Multivariable analysis adjusted for ethnicity, socio-economic positioning, and sex.

Results: Of 508 NCS children, 390 (76.8%) had B4SC outcomes completed. The 371 without a syndrome or chromosomal anomaly, were compared with controls (n = 543 971). NCS children were more likely to have abnormal PEDS (27.9% versus 19.8%, p < 0.001), vision (10.5% versus 5.6%, p < 0.001) and hearing (18.0% versus 9.0%, p < 0.001). There was no difference on SDQ-P. Adjusted for confounding variables, children with single ventricle (SV) had higher rates of abnormal PEDS (RR 1.9, CI 1.4-2.5), whilst SV and 2V with prenatal diagnosis had increased risk of an abnormal vision screen (RR 3.1, CI 1.8-5.5, and 2.2, CI 1.4-3.4). Abnormal hearing screen was increased in all NCS groups.

Conclusion: NCS children have higher rates of abnormal PEDS, hearing and vision screening on the B4SC. The B4SC may help to identify at-risk NCS children who may benefit from intervention.

Aim: To assess the prevalence, clinical features and treatment of otitis media (OM) among Aboriginal children in the Kimberley region of Western Australia, and to determine if a correlation exists between OM and protracted bacterial bronchitis (PBB).

Methods: Data was extracted from clinic records of Aboriginal children from four remote Kimberley communities participating in a whole-population lung health screening program during 2018-2019. Records were retrospectively reviewed 3 months before and after the screening date. OM prevalence and related complications were determined. Management was assessed against regional guidelines. The relationship between OM and the presence of PBB was assessed using chi-square testing.

Results: One-hundred ninety-one children (median age 3.5 years, 48.7% female) were included. Otorrhoea and/or otalgia was documented in 14.1% of children, and 53.9% had abnormal otoscopy findings. Earwax obscured visualisation of the tympanic membrane in 31.4% of examinations. Audiometry was performed in 27.2% of children, with hearing loss detected in 46.1% of those tested. OM, including acute OM with or without perforation, OM with effusion, or chronic suppurative OM, was diagnosed in 43.5% of children. Adherence to guideline-recommended antibiotic route and duration was seen in 15.8% of children with acute OM. No association was found between OM and PBB.

Conclusion: Despite the absence of a relationship between OM and PBB, there is a high burden of OM among Aboriginal children in the Kimberley. Training clinicians in earwax removal and improving eardrum visualisation may enhance detection and timely treatment of OM, improving ear health disparities among Aboriginal populations.

Background: South African children face a double burden of malnutrition from undernutrition and rising obesity. Simple, accurate methods to estimate fat-free mass, a key health indicator, are needed, as bioelectrical impedance analysis is limited by cost, availability and lack of local validation.

Objectives: To develop and validate prediction equations for fat-free mass using simple anthropometric measurements in children aged 6-9 years.

Methods: In this cross-sectional study, anthropometric and bioelectrical impedance data were obtained from 117 children. Bioelectrical impedance-derived fat-free mass was used as reference in multivariable regression models. Four equations were externally validated in 75 Black prepubertal children, using dual-energy X-ray absorptiometry-derived fat-free mass as standard. Relationships, mean differences, and agreement were assessed using Pearson's correlation, independent t-tests and Bland-Altman plots, respectively.

Results: Fourteen prediction equations, containing five to nine variables, were developed (R ² range: 0.88-0.92) in the sample of children (51% Black; 55% boys; 7.9 ± 0.8 years). Four equations were strongly correlated with dual-energy X-ray absorptiometry-derived fat-free mass (r > 0.95; p < 0.001) in the validation sample (8.5 ± 1.3 years), and three yielded estimates with acceptable agreement (mean difference: 0.16-0.94 kg; limit of agreement: ±5 kg).

Conclusion: Fat-free mass of prepubertal children can be predicted using simple anthropometric measurements, allowing assessment of body composition in low-resource settings.

Aim: To evaluate neonatal nutrition practices in Australia and New Zealand (NZ) in 2024 and compare these with previous surveys, international recommendations and British Dietetic Association workforce standards. The survey aimed to investigate progress towards standardisation, variations in practice and priorities for neonatal dietetic service development.

Methods: A two-part online survey was distributed to members of the Australasian Neonatal Dietitians Network (ANDiN) and dietitians working in Australasian neonatal units. Part 1 gathered site-level data; Part 2 focused on individual dietitians' roles. Responses were analysed descriptively and compared with the 2018 ANDiN survey. Dietitian full-time equivalent (FTE) allocations were benchmarked against (BDA) service recommendations.

Results: About 39 neonatal units (26% NZ, 74% Australia) and 66 dietitians responded. Growth monitoring was near-universal, with 86% using Fenton 2013 charts and 91% using z-scores. However, 32% transitioned to WHO charts at 40 weeks, earlier than recommended. Parenteral nutrition hang time practices varied significantly. Donor breastmilk was available in 77% of units and probiotics were used in 89%. Only 23% of units met the recommended dietitian FTE and 16% reported ≤ 0.1 FTE. While 61% of dietitians attended ward rounds weekly or more, one-third never attended. Research participation remains low at 21%.

Conclusions: Progress is evident in standardised growth assessment and nutrition practices. However, wide variation remains in feed strategies, parenteral nutrition protocols and workforce capacity. Greater alignment with consensus guidelines and workforce benchmarks is needed. Enhancing neonatal dietitian integration, research engagement and resourcing is critical to supporting equitable, high-quality neonatal nutrition care.

Aim: The aim of this scoping review was to identify, explore and map the available literature on long-term health-related outcomes in children born with congenital diaphragmatic hernia (CDH) in Australia, following discharge from a neonatal intensive care unit (NICU).

Study design: This scoping review used Johanna Briggs Institute (JBI) review methods to identify qualitative and quantitative peer-reviewed journal publications, published between January 2005 and June 2025.

Data sources: Ovid MEDLINE, Scopus, Ovid Embase and Google Scholar.

Data synthesis: Database searches produced 57 potential studies; 5 met the inclusion criteria. All studies included Australian-based participants and discussed outcomes after discharge from NICU. Children surviving at 1 year of age were identified in two of the included studies. Neurodevelopment and psychosocial long-term health-related outcomes and sequelae were identified in three of the five studies. Quality of life was discussed in two of the studies, and multisystem involvement, such as respiratory and gastrointestinal, was the focus of one study.

Conclusion: The findings of this scoping review demonstrate that there is a dearth of peer-reviewed literature available on long-term health-related outcomes for children born with CDH in Australia. As survival rates of neonates born with CDH continue to increase, more research is needed to better understand the long-term health outcomes, and therefore the long-term health needs, of this population group.

Introduction: Acute leukaemia (AL) is the most common childhood cancer globally. Children with AL who live outside of a major city experience poorer survival rates. Current literature exploring this survival discrepancy focuses on variables related to the patient and family. There is a gap in our understanding of the role of the non-metropolitan healthcare centre. Our study aims to identify how children with AL were initially managed in regional northern Queensland (NQ) hospitals, Australia. Our goal is to provide the necessary foundation for improvements in service delivery and reduce survival discrepancy associated with rurality.

Method: A multi-centre retrospective cohort study of all patients aged ≤ 16 years with AL who presented to all major NQ hospitals between June 2016 and July 2023 was conducted. Clinical and laboratory characteristics on initial presentation alongside initial management were collected from medical records and compared to internationally recognised gold standard recommendations.

Results: This study identified 40 patients. Children with febrile neutropenia received antibiotics at a median time of 3.5 h from initial presentation. There was no difference in fluid delivery (p = 0.29) or chest imaging (p = 0.20) in children with leucocytosis and/or peripheral blasts compared to children without these high-risk laboratory features. There was a difference in allopurinol administration (p = 0.04) dependent on leucocytosis and/or peripheral blast status. Eight (20.0%) children and their families did not receive social work support.

Conclusion: Initial management of children presenting with AL to regional NQ hospitals differed from gold standard management. This study expands on existing dialogue through identifying which key areas of initial management require focused improvement regionally. Implementation of site-specific guidelines on initial management reflecting these findings may improve patient health outcomes regionally.

Aim: To evaluate the diagnostic yield and clinical triage performance of a structured, multistep algorithm in children referred for suspected inborn errors of immunity (IEI) due to recurrent infections.

Methods: This single-centre study included 705 children (0-18 years) referred for recurrent infections. All were screened using JMF and/or MENA criteria. Of these, 132 met at least one criterion and underwent stepwise immunologic evaluation, including advanced testing when indicated.

Results: Of 705 children referred with recurrent infections, 132 (18.7%) met screening criteria and underwent structured immunologic evaluation. Inborn errors of immunity were diagnosed in 50 patients (7.1%), with a 71% diagnostic confirmation rate. Pathogenic variants were detected in 74%, immunoglobulin abnormalities in 78% and all showed lymphocyte subset disturbances. The most common classifications were antibody deficiencies (32%) and syndromic combined immunodeficiencies (28%). Half received intravenous immunoglobulin, and no mortality occurred during follow-up.

Conclusion: The structured diagnostic algorithm based on JMF and MENA criteria improved IEI diagnosis and enabled effective prioritisation of children presenting with non-infectious immune phenotypes. This model reduced unnecessary testing, supported efficient allocation of limited resources and facilitated timely diagnosis. The approach offers a practical, cost-effective solution particularly applicable in regions with high consanguinity rates and limited access to advanced immunologic diagnostics.