Journal of paediatrics and child health最新文献

Background: Extant literature indicates autistic students have lower school attendance compared to the general population. However, there remains considerable heterogeneity between studies, a lack of large population-based studies beyond the UK and US, and insufficient consideration of age and sex differences in attendance rates. The aim of this study was to examine school attendance among autistic compared with non-autistic students including stratification by age and sex.

Methods: This was a national retrospective cohort study using population-level data on students aged 5 to 16 years in 2018. Autism was identified using diagnostic information contained within multiple health datasets. Regular attendance was defined as attending 90% or more of school half days. The association between autism and attendance was estimated using complete-case 2-level random intercept modified Poisson regression.

Results: Among 654 438 students, 8427 (1.3%) were autistic. In adjusted analyses, autism was associated with significantly decreased likelihood of regular attendance (incident rate ratio [IRR] 0.88; 95% CI, 0.86-0.90). Age and sex stratification revealed significant age differences with likelihood of regular school attendance lower for younger autistic students (5-11 years) (IRR 0.85; 95% CI, 0.83-0.87) while sex differences were marginal. The most frequent type of non-attendance among autistic students was justified (including medical) absence (8.2% of recorded attendance hours for autistic students vs. 5.0% for non-autistic students).

Conclusion: This study provides further, whole-population evidence of the significant disparities experienced by Autistic students. To improve attendance of autistic students, comprehensive and targeted supports are required to help the student, family and school.

Aim: To assess the effectiveness of intravenous caffeine citrate in paediatric asthma exacerbation unresponsive to beta2-agonists and steroids.

Methods: A 10-year retrospective cohort study was conducted on asthmatic children unresponsive to beta2-agonists and steroids, who were treated with either intravenous caffeine citrate or magnesium sulphate. The study outcomes were changes in the Paediatric Respiratory Assessment Measure (PRAM) score, duration of oxygen therapy and paediatric intensive care unit (PICU) length-of-stay.

Results: Overall, 296 children were treated in the PICU between January 1, 2011, and December 31, 2020. Fifteen and 26 children unresponsive to beta2-agonists and steroids (median ages 2.3 [0.7-11] and 3.0 [1.2-8.5] years), respectively, received caffeine citrate and magnesium sulphate. The two groups showed similar demographic characteristics and baseline parameters. At 24 and 48 h, the median (IQR) PRAM scores for the caffeine and magnesium groups were 4 (2-6) and 5 (4-6), respectively (p = 0.27), and 7 (6-8) and 8 (5-9), respectively (p = 0.57). The median (IQR) durations of PICU stay for the caffeine and magnesium groups were 36 (19-46) and 32 (23-45) h, respectively (p = 0.77). The median (IQR) durations of oxygen therapy for the caffeine and magnesium groups were 25 (10-30) and 20 (15-30) h, respectively (p = 0.29). No serious adverse events occurred in the caffeine group. One occurred in the magnesium group.

Conclusions: Caffeine citrate and magnesium sulphate demonstrated comparable effectiveness in treating steroid- and beta2-agonist-resistant asthma. A multicentre prospective study is needed to validate these results.

Aim: To improve delayed cord clamping (DCC) rates for preterm infants (≤ 34 + 0 weeks' gestation) and establish DCC as standard practice using quality improvement (QI) methods.

Methods: A multi-departmental initiative was undertaken. An audit of DCC for preterm infants born at or before 34 + 0 weeks was performed. Using this data and feedback from multidisciplinary staff meetings, barriers to DCC implementation were identified and targeted QI interventions were introduced. Ongoing data surveillance monitored the effects of these interventions.

Results: DCC rates were evaluated for 862 preterm infants from January 2014 to August 2022. This QI project commenced in February 2018, with a detailed audit of 225 preterm infants across three time periods: epoch 1 (immediately prior to QI initiative), epoch 2 (QI implementation phase), and epoch 3 (immediate post-implementation surveillance). Inconsistent documentation of cord clamp time and admission hypothermia were identified as potential barriers to implementation of DCC. Over the course of the initiative, the documentation rate increased from 16% to 92.6%. Hypothermia at admission decreased from 76% in epoch 1 to 43.2% in epoch 3. The baseline rate of DCC was low in epoch 1 (12%), but improved to 70% in epoch 3, with this change sustained in ongoing DCC rate evaluation to August 2022.

Conclusions: There has been a significant and sustained improvement in DCC for preterm infants at our centre. A structured approach to QI and collaboration between multiple departments were each integral in effecting this improvement in clinical care.

Background: Bubble Continuous Positive Airway Pressure (bCPAP) has become a crucial intervention in neonatal care, particularly in resource-limited settings where access to advanced respiratory support is scarce. While bCPAP offers a cost-effective solution for neonatal respiratory distress, conducting clinical trials in these settings presents significant ethical challenges. Issues of justice, beneficence, and autonomy arise due to disparities in healthcare infrastructure, complexities surrounding informed consent, and the potential exploitation of vulnerable populations.

Methods: In this study, I examine the ethical principles essential to the design and implementation of bCPAP trials, focusing on justice, beneficence, and autonomy within the constraints of resource-limited settings. A normative analysis was conducted, drawing on key ethical frameworks to establish guiding principles for conducting ethically sound bCPAP trials.

Results: Applying frameworks such as Rawls' theory of distributive justice and Sen's capability approach, I argue for prioritizing neonatal populations in low-resource settings while addressing the potential for exploitation. Autonomy underscores the need for informed consent processes that are culturally appropriate and accessible, empowering caregivers in decision-making. Beneficence and non-maleficence are evaluated through both utilitarian and deontological perspectives, balancing the potential benefits of innovation against the risks to participants. Structural inequities that complicate neonatal care and research are also critically examined.

Conclusion: I advocate for the integration of ethical safeguards, including community-centered consent processes, rigorous trial protocols, and international collaboration to mitigate systemic inequities. By incorporating these ethical considerations, bCPAP research can better serve the interests of neonates and their families while ensuring their safety and dignity are upheld.

Aim: COVID-19 has brought unprecedented challenges to the healthcare system. The rapid spread of the virus, laboratory burn-out, exhausted staff, diagnostic uncertainty and lack of guidelines cumulatively disrupted hospital antimicrobial stewardship (AMS) programs. This scoping review evaluated how the COVID-19 pandemic has impacted the implementation of AMS, particularly within the context of clinical audits.

Methods: An initial trend analysis was performed using a database search from 2000 to 2022. This review was developed following PRISMA-Scr guidelines. Databases such as Medline, Embase, Cochrane Library and CINAHL were searched using Medical Subject Headings and free text for 'Children', 'antimicrobial stewardship' and 'COVID-19'. Primary studies that reported data on antimicrobial use among hospitalised children during COVID-19 from December 2019 to December 2022 were considered.

Results: Paediatric AMS-related research output changed annually by -4.94% in 2022 compared to 14.44% in 2019. Of 677 articles, 15 were included, with 3 added through snowballing technique. All the studies were observational and from countries of all income levels. A quantitative measure of antibiotic use was the commonly assessed sub-category of AMS, while three studies performed the audit for a reason for antibiotic use, microbiological cultures, and surgical prophylaxis. Most studies reported antimicrobial use as prevalence, while two reported the days of therapy, and two used the AWaRe classification and the antibiotic spectrum index (ASI).

Conclusions: Paediatric AMS activities were disrupted during the COVID-19 pandemic. A basic quantitative measure of antibiotic use was the only measure of assessment, with other AMS components unreported. A robust paediatric-focused AMS resilient to future pandemics and evidence-informed stewardship approach is needed.

Background: Hospital care for neonates can be challenging for parents, and a negative parental experience can affect the well-being of the infant after discharge. A family-centred approach is the gold standard of care in neonatology.

Aim: This study aimed to identify common themes in voluntary unstructured feedback received from parents and caregivers of infants admitted to the neonatal intensive care unit, special care nursery or postnatal ward or followed up by neonatal outpatient services at a tertiary Australian Women and Children's Hospital. These findings are intended to inform the development of effective family-centred neonatal care approaches.

Methods: This single-centre observational study used routinely collected unstructured parental voluntary feedback received between 2010 and 2021. All feedback is entered prospectively in the online consumer feedback module of a reporting database (RiskMan). Deductive thematic analysis (whereby themes, codes and categories were chosen prior to the analysis) was used to analyse the extracted quotations.

Results: During the study period, 3533 unstructured feedback items were received. Most of the feedback received was compliments (2725/3533, 77.1%). The main feedback category was 'staff competency and efficiency', which accounted for 80.8% (2201/2755) of the compliments and 45.0% (364/808) of the complaints. Most complaints were from outpatient services and postnatal wards and centred around 'infrastructure and systems' (280/808, 34.7%) and 'information, explanation and communication' (152/808, 18.8%).

Conclusions: Parental satisfaction was positively affected by 'staff competency and efficiency'. This study supports collecting and analysing unstructured feedback to reflect parental experiences and drive quality improvement.

Aim: To identify factors and diagnoses associated with unplanned readmission of paediatric patients to a Western Sydney metropolitan hospital.

Method: A retrospective cross-sectional study on paediatric patients admitted to a non-tertiary hospital in Western Sydney from January 2017 to December 2022. Multivariate modelling was used to determine demographic factors and diagnoses associated with unplanned readmission.

Results: 1334 (6.3%) of 21 262 admissions had an unplanned readmission within 28 days of the initial admission. Being First Nations had an OR of 1.31 (95% CI 1.11-1.54), while each additional day of admission had an OR of 1.05 (95% CI 1.03-1.07). Increasing age had an OR of 0.95 (95% CI 0.93-0.96) per year, and those admitted during the COVID pandemic had an OR of 0.61 (95% CI 0.54-0.69). A diagnosis of diabetes was found to have an OR of 2.36 (95% CI 1.45-3.84) and bronchiolitis an OR of 1.9 (95% CI 1.53-2.36), whereas a diagnosis of injury had an OR of 0.76 (95% CI 0.58-0.99) and otitis media an OR of 0.23 (95% CI 0.11-0.49).

Conclusions: Being First Nations and having a longer length of stay increased the likelihood of unplanned readmission in paediatric patients, while older age and admission during the COVID pandemic decreased the likelihood. A diagnosis of diabetes or bronchiolitis, among others, increased the likelihood of unplanned readmission. Conversely, a diagnosis of injury or otitis media decreased the likelihood of unplanned readmission. This lays the groundwork for further research and targeted interventions to reduce unplanned readmissions and associated costs.

Background: Previous studies have focused predominantly on socioeconomic disparities in adolescent obesity, but the sources of inequality may be more extensive.

Objectives: We aim to quantify and decompose the inequality of opportunity (IOp) in adolescent obesity caused by circumstances and examine the indirect effects of these circumstances on obesity through key effort factors.

Methods: Based on the IOp framework and previous evidence, we categorised age, gender, socioeconomic status, and family-school environments of adolescents (N = 9117) as circumstances and obesity-related behaviours as efforts. The IOp was quantified and decomposed to determine the contribution of each circumstance. We also analysed the association between sleep debt and the circumstances to calculate the magnitude of indirect effects.

Results: Of the obesity-related behaviours, only sleep debt showed a significant association with obesity (OR = 1.21, p < 0.05). Age and gender contributed 45.97% to the IOp, whereas socioeconomic status contributed 10.43% and family-school environments contributed 43.59%. Older and female adolescents whose fathers held high-status occupations tended to suffer from obesity due to sleep debt, while the opposite was true for adolescents whose mothers exercised, only children, boarders, high school students, and those from wealthier families.

Conclusions: Family-school environments contribute much greater to the IOp in adolescent obesity than socioeconomic status, and sleep debt plays an essential mediating role. The government bears the responsibility to undertake corresponding prioritised actions.

Aims: Primary aim was to review severe acute respiratory infections (SARI) hospitalisations caused by respiratory syncytial virus (RSV) in children aged < 2 years in paediatric hospitals in Australia. Secondary aims included RSV subtyping, assessing RSV seasonality and contributing to the World Health Organisation's RSV surveillance programme.

Methods: We prospectively reviewed the medical records of children (< 2 years of age) with a confirmed SARI who were admitted to one of four major Australian paediatric hospitals and had a respiratory sample analysed by Polymerase Chain Reaction (PCR). A detailed dataset was completed for RSV positive cases.

Results: Between 1 January 2021 and 31 December 2022, 2290 RSV (laboratory-confirmed) admissions were identified (53.4% of all SARI admissions). Approximately 50% of all RSV cases were aged 0-6 months. RSV-A predominated in 2021 with peak infections observed in summer while in 2022 RSV-B predominated with peak infections in the more traditional winter months. The median total length of stay (LOS) for RSV positive admissions was 46 h (IQR: 22-82 h). 9% of these children required an ICU admission with a prolonged median LOS 68 h (IQR: 40-112 h). Respiratory support utilisation was consistent over the 2 years. 1.8% required mechanical ventilation; 4.6% continuous positive airway pressure; 23.3% high flow oxygen; and 50.8% low flow oxygen.

Conclusions: RSV in children continues to cause a significant disease burden at Australian tertiary paediatric centres. Ongoing hospital surveillance is required to document the impact of RSV preventative therapies that have become available in 2024.

Aim: Angiostrongylus cantonensis, the leading cause of eosinophilic meningoencephalitis, is well established in eastern Australia. Prolonged wet weather in Queensland during 2021-2022 coincided with anecdotal reports of increased neuroangiostrongyliasis cases, prompting an evaluation of paediatric cases from 2013 to 2022.

Methods: This retrospective observational study reviewed children (0-16 years) with cerebrospinal fluid (CSF) eosinophilia (≥ 10% of the total CSF leukocyte count) and/or A. cantonensis testing (serology or polymerase chain reaction) between 01/01/2013 and 31/12/2022, using statewide laboratory data and patient records.

Results: Eighty children were identified: 59 (74%) had CSF eosinophilia without A. cantonensis testing, 9 (11%) had CSF eosinophilia with A. cantonensis testing, and 12 (15%) had A. cantonensis testing without CSF eosinophilia. Neuroangiostrongyliasis was either proven or probable in seven children: five (71%) during 2021-2022, coinciding with prolonged wet weather. A significant positive correlation was observed between rainfall and case numbers (r = 0.88, p < 0.01). Median age of diagnosed children was 4 years (IQR 1.8-8.5, range 1.5-13 years) and five (71%) were male. Snail or slug exposure was reported in four (57%) children. All children presented with vomiting, and six also had a headache and focal neurology (86%). Abnormal neuroimaging was noted in six (86%) cases. Five children received corticosteroid therapy alone (71%), while two (29%) were managed conservatively. There were no deaths, but one child had persistent focal neurological abnormalities at discharge.

Conclusion: Awareness of A. cantonensis and exposure risks is crucial, especially during prolonged wet weather conditions. While most children in this study had good outcomes, this is not always the case.