Journal of paediatrics and child health最新文献

Aim: Stunting, defined as low height-for-age, impairs growth, cognitive development and contributes to long-term poverty through poor school performance and health outcomes. In Tanzania, 28% of children under 5 are stunted, with Iringa Region showing the highest prevalence (57%). It is unclear why such high incidences occur despite the region being a leading food producer.

Methods: To explore underlying factors, a community-based cross-sectional survey was conducted in four districts of Iringa in September-October 2024, involving children under 2 years. Data were collected using household questionnaires covering feeding practices, water, sanitation and hygiene (WaSH), vaccination, illness and socio-demographic factors.

Results: The median age was 14 months and 205 (51%) were male. Overall, out of 397, 59% were stunted, though most had normal underweight (89%) and wasting status (97.5%). Additionally, 94% met minimum dietary diversity, confirming diet alone does not explain the high stunting rate. Bivariate analysis identified nine significant variables: gender, underweight status, toilet sharing, child hand wash before and after feeding, continued breastfeeding, measles vaccination, vitamin A supplementation and feeding diversity, of which five (5) remained significant in multivariate analysis. Multivariate analysis showed male children had 2.2 times higher odds of stunting; risk also increased among underweight children but was lower in those under 1 year. Continued breastfeeding after 6 months reduced odds of stunting by 61%. Children in households sharing toilets had almost half the odds.

Conclusion: Findings highlight the need to promote breastfeeding beyond 6 months, strengthen nutrition and WaSH programs and target interventions for male and underweight children.

Introduction: STORCH refers to a group of congenital infections (syphilis, toxoplasmosis, rubella, cytomegalovirus and herpes) that can impact the central nervous system. As clinical signs may not appear until several months or years after birth, the early detection of risk in STORCH-exposed infants has been challenging, and the use of sensitive tools in this population is understudied.

Objective: To compare STORCH-exposed infants with non-exposed controls using the Hammersmith Infant Neurological Examination (HINE) at 3 months of age.

Methods: This is an observational cohort study. A total of 60 infants were included and equally allocated into two groups: an exposed group, whose mothers had a clinically confirmed diagnosis of a classic STORCH infection during pregnancy, and a non-exposed control group, whose mothers did not present STORCH infections during gestation. At 3 months of age (13.83 ± 1.09 weeks post-term), infants were assessed using the HINE. Group comparisons were performed for the global score, subscores across the five scorable domains (cranial nerve function, posture, spontaneous movements, tone and reflexes and reactions), number of asymmetries and risk of cerebral palsy.

Results: The exposed group showed lower global scores and lower subscores in most HINE domains compared to controls, along with a higher frequency of asymmetries and an increased proportion of infants classified as at high risk for cerebral palsy.

Conclusion: Infants prenatally exposed to STORCH infections showed an increased risk of impairment based on the HINE when compared to controls. Potential neurological limitations were detectable in the exposed group at 3 months of age.

Objective: The Victorian Virtual Emergency Department (VVED) is a statewide virtual emergency service in Victoria, Australia providing real-time online audio-visual consultations for patients with non-life-threatening conditions. This study aims to explore the utilisation and impact of the paediatric arm of the VVED (VVED-Kids).

Study design: This was a retrospective analysis of routinely collected data from the VVED. Data was extracted from the VVED data warehouse on patients aged 0-17 years presenting to VVED-Kids during the initial two-year period of the dedicated paediatric department (March 2023-February 2025). Outcome variables included sociodemographic data, referral source, recommended disposition and diagnosis (ICD code). Descriptive statistics were used to report patient demographics and service-related characteristics of presentations.

Results: During the two-year period, there were 130 821 presentations to VVED-Kids. The median patient age was 3 years, 53.1% of presentations were in males, and 73% of presentations were from children living in metropolitan areas. The most common referral source was self-referral (64.1%), followed by Nurse-on-Call (20.0%) and paramedic consultations (6.5%). Over half of VVED-Kids presentations comprised viral infections, including fevers, gastroenteritis or respiratory illnesses. The majority of presentations were managed without requiring transfer to a physical ED (85.6%).

Conclusions: Based on discharge disposition, VVED-Kids appears to divert patients from attending physical EDs, preserving in-person care for higher acuity patients who need it most. Partnerships with key healthcare providers such as Nurse-on-Call and Ambulance Victoria can support more families in avoiding the physical ED and receiving care in their own homes.

Objective: In paediatric intensive care units (PICUs), beta-lactam antibiotic administration is often suboptimal, placing critically ill children at risk. We aimed to investigate the mortality, PICU length of stay, and pharmacokinetic/pharmacodynamic (PK/PD) benefits of prolonged beta-lactam infusions in PICU compared to intermittent infusions.

Methods: A systematic review was conducted to identify studies investigating prolonged infusions compared to intermittent infusions. Studies were sourced from a previously published review and a systematic search of MEDLINE, Cochrane, Embase and Web of Science databases. Case reports, case series, systematic reviews and non-English language reports were excluded (PROSPERO CRD 42022375397). A meta-analysis with odds ratios (OR) and 95% confidence intervals (CIs) was conducted. When insufficient data were available, a descriptive analysis was undertaken. Risk of bias was assessed using the Robins-I tool.

Results: In total, 566 studies were screened, of which 10 studies were included in the systematic review. All studies were observational, with sample sizes from 21 to 174 PICU patients (median 76; IQR 33-156). There was no reduction in mortality (N = 6 studies; OR 0.60; 95% CI 0.24, 1.51; I² = 40%) in the prolonged infusion group compared to the intermittent group. There was insufficient data to perform further meta-analyses. The risk of bias was high and the overall quality of evidence was low.

Conclusions: Available studies on prolonged infusions of beta lactams in PICU patients are limited and of low quality. Further research is needed to assess for clinical benefits associated with prolonged beta-lactam infusions for treatment of severe infection.

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: This study aimed to identify diverse ways nonspeaking and speaking children are involved in clinical encounters.

Methods: The study analysed video recordings of paediatric palliative care encounters in Australia. Conversation analytic coding methods were used to identify embodied (e.g., gesture) and vocal (e.g., grunting) modes of interaction used by all children and lexical verbalisations (i.e., words) used by speaking children. Analysis focused on interactions between children and adults (both family members and clinicians).

Results: A total of 38 child patients (seven speaking, 31 nonspeaking), 56 family members and 50 clinicians participated across 60 video-recorded encounters with the child patient present. Analysis identified 1737 spates (i.e., periods) of interaction with child patients. Nonspeaking children were involved in a median of 38.0 spates of involvement per hour and speaking children in a median of 58.7 spates per hour. Observed practices of nonspeaking and speaking children included adult clinicians and family members doing something with a child without speaking, identifying the child as a recipient of some action, assessing the child, telling the child something, and physically tending to the child with verbal commentary. Clinicians and adult family members more often initiated spates of involvement (62.9%) than children themselves and were more responsive to spates initiated by nonspeaking children (89.6%) than speaking children (79.3%).

Conclusions: This study demonstrates how children-including nonspeaking children-are regularly involved in clinical encounters. The study findings indicate a need to avoid exclusively focusing on verbal communication, to appreciate the diverse ways that children can be involved in clinical encounters about them.

Paediatricians strive to deliver best practice care for their patients. However, when they encounter a child with one of the over 8000 rare diseases, a majority (> 70%) of which have a genetic cause, it is challenging to find clinical guidelines and point-of-care resources to support their practice. This article provides a framework for a collaborative management approach for rare diseases. It draws on the team's experience in delivering multidisciplinary clinics for ultra-rare conditions, running a rare disease registry and undiagnosed disease programme, and in founding a rare disease patient advocacy group for SCN2A-related conditions. This article signposts useful resources to facilitate paediatricians in delivering 'wraparound' rare disease care that is comprehensive, holistic and child and family-centred. These include Australia's first National Recommendations for Rare Disease Health Care and the RARE (Rare Awareness Rare Education) portal led by the national peak body for people living with a rare disease, Rare Voices Australia. Six key approaches are suggested that paediatricians can incorporate into their clinical practice to deliver high quality care for each child and young person with a rare disease. This includes strategies to support a timely diagnosis, including accessing undiagnosed disease programmes and linking children, young people and their caregivers with peers, patient advocacy groups and rare disease registries to reduce isolation and uncertainty. As less than 5% of rare diseases are currently amenable to a targeted therapy, it also suggests resources and approaches to facilitate access to and shared decision-making about research and novel advanced therapeutics.

Aim: Portable swimming pools present a child drowning risk; however, evidence on parental and caregiver knowledge, risk perceptions, and safety practices about these products remains limited.

Methods: We conducted a cross-sectional survey of a representative sample of Australian parents and caregivers of children aged 0-5 years who owned a portable pool. Safety practices examined included pool fencing, active supervision, and emptying and storing the pool immediately after use. Descriptive statistics, non-parametric significance tests, and t-tests (comparing portable pools with in-ground pools) were used to assess knowledge, risk perceptions, and safety practices.

Results: Among 214 respondents, the majority correctly identified supervision (76%; χ² = 56.54; p < 0.001) and emptying and storing practices (89%; χ² = 131.89; p < 0.001) as key prevention strategies. In contrast, only 26% demonstrated knowledge of legal fencing requirements (χ² = 50.54; p < 0.001). Risk perceptions were significantly lower for portable pools compared with in-ground pools. Only 19% reported their portable pool was fenced.

Conclusion: While self-reported supervision and storage practices were high, compliance with fencing requirements, the most effective drowning prevention strategy, was markedly low. Stronger action is needed to promote fencing compliance and confront misconceptions about the safety of shallow portable pools.