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.

Background: Scabies is a common health issue in the Pacific and may contribute to rheumatic heart disease (RHD). This study assessed the prevalence of scabies and other skin conditions among Tongan schoolchildren and examined the association between these conditions and RHD.

Methods: Children from four primary schools on Tongatapu were screened for scabies, other skin conditions and RHD. Health workers were trained to recognise scabies and related skin conditions accurately. All children also underwent echocardiographic screening to detect heart valve abnormalities consistent with RHD. Statistical analysis included prevalence ratio calculations, and Fisher's exact tests to evaluate associations between skin and heart findings.

Results: Four hundred children were screened (mean age: 8 years 6 months), with 18 (4.5%) having echocardiographic features of RHD. The prevalence of scabies was 29.8% (119/400), while the prevalence of impetigo was 20% and more severe bacterial skin infection was 15.5%. Children with both scabies and skin infection were 4.65 times more likely than children without any such lesions to have RHD (95% confidence interval: 1.60-13.6). Children with scabies, impetigo and bacterial infection were associated with progressively higher prevalence of RHD (p for trend = 0.008). The population attributable fraction for scabies and infection as a potential cause of RHD was 26.5%.

Conclusions: The results indicate a very high prevalence of scabies, bacterial skin infection, and RHD among Tongan school children. Enhanced treatment and control of scabies are likely to reduce the incidence of both bacterial infection and RHD. Mass drug administration is recommended.

Background: Minimally/less invasive surfactant therapy/administration (MIST/LISA) is increasingly used for surfactant delivery in preterm infants with respiratory distress syndrome, aiming to reduce complications associated with invasive methods. Despite its growing adoption, variations in clinical practice remain.

Objective: To evaluate MIST/LISA use in Portuguese neonatal intensive care units (NICUs) and identify variations in practice.

Methods: A national, anonymous questionnaire was distributed to neonatologists. The survey explored surfactant administration techniques, experience with MIST/LISA, device preferences, premedication strategies and protocols. Responses were analysed descriptively.

Results: Fifty-two responses were collected. Most respondents reported using MIST/LISA (87%), preferring it over INSURE or standard intubation. Practices varied widely in pre-intervention drug use and catheter choice. Surfcath was the most used device (71%). Only one-third consistently used pre-sedation.

Conclusion: MIST/LISA is widely implemented in Portuguese NICUs, but substantial variability exists. Standardised guidelines are needed to optimise clinical outcomes and reduce practice heterogeneity.

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: 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.