Journal of paediatrics and child health最新文献

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.

Aims: To benchmark early rehabilitative intervention by occupational therapists, physiotherapists and speech and language therapists (Neonatal Neurodevelopmental Therapists, NNTs) in Neonatal Intensive Care Units (NICU) and Special Care Baby Units (SCBU) in Aotearoa New Zealand (NZ). Benchmarking included content and amount of service provision of neurodevelopmental therapy, and respondent views on workforce priorities.

Methods: An online cross-sectional survey was conducted with clinical directors of NICU/SCBU and NNTs recruited via professional networks. The survey included multiple-choice and open-ended questions. Descriptive statistics were used to analyse quantitative responses and thematic analysis for qualitative data.

Results: Completed surveys (n = 64) were received from 17 clinical directors (85% of all clinical directors in New Zealand) and 47 NNTs. Early rehabilitation intervention delivered by NNTs is substantially below international recommended levels in all units. Only 5/17 (29%) of units employed dedicated NNTs. Within their limited time, NNT's activity included assessment (100%), intervention (82%), parent education and support (92.3%) and staff education and support (82%). Few NNTs (36.2%) had specialist training with this population. Themes in workforce priorities were the desire for continuity of care of infants by NNTs, a preference for dedicated NNT and greater access to training.

Conclusions: The limited availability of NNT in NICU/SCBU is likely to compromise the amount of early rehabilitation intervention and reach to neonates and their families, particularly more vulnerable populations such as Māori and Pacific. Substantial scale up of service provision and establishment of a national network of NNT are proposed to advance training, continuity and equity of care.

Objective: This randomised controlled trial aimed to evaluate the effect of a multi-strain probiotic on the incidence of common infections among children in early childhood education (ECE) settings.

Methods: Prospective, randomised, double-blind, placebo-controlled trial was conducted using a multi-strain (mixture of 5 strains) probiotic at a daily dose of 10 billion active fluorescent units. Participating children were randomly assigned to either the intervention or control group. The supplementation period lasted 24 weeks, during which weekly questionnaires were administered to track the incidence of infections.

Results: A total of 118 children were enrolled in the trial. An intention-to-treat analysis revealed a 62% reduction in the incidence of gastrointestinal tract infections (GITIs) (incidence rate ratio: 1.62, p = 0.055) between the placebo and probiotic groups in the last 16 weeks of the study. Notably, it took up to 8 weeks for probiotics to exhibit a significant protective effect. However, probiotic supplementation had no impact on respiratory tract infections (RTIs). Additionally, probiotic use led to an estimated cost saving of AU$4748 in relation to reducing GITIs for 16 weeks after the protective effect was achieved.

Conclusion: Multi-strain probiotic has the potential to reduce the risk of GITIs among children in ECE settings, though no beneficial effect was observed on RTIs despite recording over 450 infections. Larger, multi-arm trials are recommended to further investigate this area.

Trial registration: ClinicalTrials.gov identifier: ACTRN12622000153718.

Aim: To evaluate clinical features, management, and outcomes of paediatric bone and joint infection (BJI) in a regional Australian hospital and assess weight-based oral antibiotic prescribing.

Methods: We conducted a retrospective study of 171 children aged 0-18 years admitted with septic arthritis and/or osteomyelitis between 2011 and 2021. Cases were identified using ICD-10-AM codes, and data on clinical presentation, microbiology and treatment were extracted from medical records. Oral antibiotic doses were assessed against international evidence-based guidelines.

Results: A total of 171 children were included (median age 27 months); 59.6% were aged ≤ 5 years, and 13.5% identified as Aboriginal or Torres Strait Islander. Staphylococcus aureus was the most frequently identified pathogen overall (53/108, 49.1%), and Kingella kingae in children < 5 years of age (20/57, 35.1%). Severe disease occurred in 29.8%. Oral antibiotic doses were below international guideline recommendations in 43.3% of cases, mostly with amoxicillin-clavulanate and cephalexin. Relapse (4.1%) and long-term sequelae (6.1%) were infrequent.

Conclusions: Paediatric BJI mostly occurred in young and in Aboriginal and Torres Strait Islander children. Oral antibiotic weight-based dosing was often lower than international guideline recommendations for BJI. These findings highlight the need for standardised antibiotic dosing in BJI and further studies to optimise dosing in children.

Objective: Sepsis is a major cause of mortality among children, with the highest burden evident in neonates and young infants, particularly, in resource-constrained healthcare settings. Despite this burden, there are insufficient published data to delineate the epidemiology of neonatal sepsis from many of these settings. We aimed to address this research gap by evaluating the epidemiology of sepsis in neonates and young infants in Sri Lanka, a populous country in Southeast Asia, and to evaluate the efficacy of currently-recommended empiric antibiotic regimens to treat these infections in the context of evolving antimicrobial resistance.

Design: We evaluated the pathogens (including susceptibility profiles) responsible for infections in neonates and young infants over a 7-year period alongside clinical outcomes (2015-2021).

Setting: A 1100 bed urban tertiary hospital in Colombo, Sri Lanka.

Patients: Neonates and young infants (aged 0 to ≤ 180 days).

Main outcome measures: Blood culture-positive pathogen profiles, antibiotic susceptibility against empiric antibiotic regimens and mortality.

Results: We identified 231 neonates and young infants with clinically significant blood cultures incorporating 251 pathogens over the study period, of whom 22 died. Where gestational data were available, most babies with culture-positive sepsis were premature (71%, 65/91), born at a median gestational age of 32 weeks (interquartile range [IQR] 27-38 weeks). Gram-negative bacteria predominated as a cause of culture-positive infections (66%, 166/251), including in 86% of neonates and young infants who died (19/22). There were high rates of non-susceptibility to first- and second-line antibiotics currently recommended to treat neonatal sepsis.

Conclusions: There is a high burden of antibiotic-resistant gram-negative infections in neonates and young infants in Sri Lanka, highlighting an urgent need to prioritise the development of new antimicrobial regimens to treat neonatal infections.