Journal of paediatrics and child health最新文献

Background: The aetiology of paediatric acute urinary retention (PAUR) is poorly documented across English medical literature and none from Australasia. This study aimed to document incidence, aetiology and associated time to diagnoses and treatment of PAUR in regional Australia.

Methods: This was a retrospective study of children aged 0-17 years at presentation to two regional hospitals from 01.01.2008-31.12.2018. Data were extracted from patient files following a search for documented cases of acute urinary retention.

Results: There were 56 presentations from 53 children with sex ratio (M:F) of 1.4:1. The median age at presentation was 5.9 (IQR 2.8, 13.3) years, with bimodal peaks at 2-4 years and 12-16 years. Using Poisson regression model, the population incidence increased over the period (p < 0.05). The commonest aetiologies were post-operative (13; 23%), medications excluding anaesthesia (7; 13%), urinary tract infection (UTI) (6; 11%) and phimosis/balanitis (6; 11%), faecal impaction (6; 11%), neoplasia (5; 9%) and uncertain (10; 18%). Time to diagnosis had a median of 3 (IQR 0,14.5) h and a mean of 9.2 (±13.7) h. Time to treatment had a median of 0 (IQR 0,2.5) h and a mean of 3.6 (±11.2) h. Most cases (43/47; 92%) had successful urethral catheterisation, with one requiring suprapubic tap. Nine cases (16%) spontaneously resolved. Analgesia was provided in 49 cases (88%). Majority (40; 71%) were discharged and 15(27%) cases referred.

Conclusion: The most common aetiologies for PAUR were post-operative causes, medication use, UTI, phimosis/balanitis and faecal impaction, all providing opportunities for intervention. The incidence significantly increased over time. Diagnoses and treatment were early in most cases.

Objectives: The study was conducted to investigate the effect of swing on stress and comfort in premature newborns who could not be reunited with their mothers.

Methods: The study was conducted in a randomised controlled experimental design. The intervention group included newborns who received swing intervention (n = 64) and the control group included newborns who did not receive swing intervention (n = 64). Research data were collected using Newborn Information Form, Premature Infant Comfort Scale and ALPS neo newborn pain and stress assessment scale. The research data were collected two times, before and after the intervention was completed.

Result: Experimental and control groups were similar regarding descriptive characteristics. There was no difference between the groups after the swing intervention (p > 0.05). It was determined that there was no significant difference between the groups in terms of comfort levels before and after the swing intervention (p > 0.05). When the intra-group mean scores were compared, it was determined that the comfort level increased in the intervention group before and after the swing intervention, and there was a significant difference between the mean scores (p = 0.028).

Conclusion: It was determined that swing intervention did not affect the stress and comfort level of the newborn.

Aims: Sitosterolemia, is a disorder of increased plant sterol levels leading to a variable presentation and haematological manifestations. Although considered rare, the prevalence is likely underestimated due to the variable phenotype and challenges in diagnosis. The delayed diagnosis may lead to cardiovascular complications. We reviewed the presentation and management of patients with sitosterolemia in our clinic.

Method: We report 4 children aged 18 months to 18 years with variable manifestations from xanthomas to haemolytic anaemia who were subsequently confirmed to have sitosterolemia on genetic testing.

Results: One patient presented with xanthomas, two patients with haematological manifestations and the other with an abnormal lipid profile. All patients had a strong family history of lipid disorders and cardiovascular disease at a young age. All patients had confirmatory genetic testing and were managed with dietary adjustments and ezetimibe resulting in improvement of lipid and haematological profiles.

Conclusion: Sitosterolemia is a likely underdiagnosed lipid disorder due to variable phenotype and specialised genetic and biochemical diagnostic tests. Early diagnosis and treatment fully reverse the clinical manifestations and associated complications.

Aim: The introduction and increasing popularity of indoor trampoline facilities has seen increases in the incidence of trampoline park injuries (TPIs), particularly amongst the paediatric population. A challenge to the development of effective injury prevention interventions is the limited study pool of detailed activity and outcome data to provide better understanding of the characteristics of injurious events.

Methods: A cross-sectional study of individuals under 16 years of age hospitalised after TPI from November 2018 to December 2021 was conducted. Patient demographics and TPI characteristics were collected through prospective case notifications from clinicians across Australia, via the Australian Paediatric Surveillance Unit. Additional data were collected using retrospective medical record review at two major paediatric centres in Australia.

Results: In total, 48 cases of TPIs were reported: median age was 9.5 years with 28 (58.3%) being males. The most common injury mechanism was a fall on the trampoline (n = 34, 72.3%). The most commonly injured body region was upper limb (n = 27, 56.3%), followed by lower limb (n = 11, 22.9%): all limb injuries involved a fracture. Most patients required operative intervention (n = 37, 90.2%).

Conclusions: The results from this study suggest that serious injuries continue to occur at trampoline parks, and thus remain an injury concern that requires attention. This issue needs to be addressed with consistent application of the Australian Standard, along with other injury prevention initiatives.

Aim: To evaluate the associations between breastfeeding and lung function among children without known respiratory diseases and to determine the effects of breastfeeding on spirometry.

Methods: A systematic search of PubMed, Embase and Cochrane was performed from their inception to 11 Oct 2023 (PROSPERO identifier: CRD42023471664). Observational studies (cohort or cross-sectional or case-control design) and randomised controlled trials (RCTs) were searched. A random-effects model meta-analysis was used to estimate the effect size if significant heterogeneity was detected (p < 0.05 or I² > 50%); Otherwise, the fixed-effects model was applied.

Results: In total, 13 observational studies with 18 152 children were included in the qualitative synthesis, and five studies with 5305 children were included in the meta-analysis. Compared to children who were never breastfed, those who were breastfed had better FEV1 (β: 19.34 mL; 95% CI: 6.05, 32.64; p = 0.004) and PEF (β: 87.50 mL/s; 95% CI: 27.43, 147.58; p = 0.004). A similar trend was observed for FVC (β: 17.45 mL; 95% CI: -0.43, 35.33; p = 0.06). Furthermore, compared to children breastfed for less than three to four months, those breastfed for three to four months or more had better FEV1 (β: 19.86 mL; 95% CI: 4.21, 35.51; p = 0.01), FVC (β: 31.90 mL; 95% CI: 7.87, 55.93; p = 0.009) and PEF (β: 75.68 mL/s; 95% CI: 24.40, 126.97; p = 0.004).

Conclusion: This systematic review and meta-analysis revealed associations between breastfeeding and improved lung function in children aged 6-16 years. Further high-quality evidence is needed.

Background: Neuroblastoma stands as the most prevalent extracranial solid tumour in children, yet its epidemiological profile on global, regional, and national scales remains insufficiently explored.

Methods: Long-term trends in the incidence and mortality of paediatric neuroblastoma from 1990 to 2021 were analysed globally, regionally, and nationally using estimated annual percentage changes. Cross-national disparities in the burden of paediatric neuroblastoma were quantified through standard health equity methodologies, with projections of burden shifts extending to 2035.

Results: From 1990 to 2021, the global age-standardised death rate for paediatric neuroblastoma increased from 0.19 (95% UI, 0.16-0.23) to 0.21 (95% UI, 0.14-0.28) per 100 000 population, with an EAPC of 0.2. Regionally, both mortality and incidence rates were highest in low-middle SDI regions and lowest in Oceania. Mortality rates were highest among males aged 12-23 months and females aged 6-11 months, while incidence rates were most pronounced in children aged 2-4 years. Cross-country inequality analyses indicated a reduction in disparities between high and low SDI countries; however, the concentration index revealed an increase in the inequality of burden distribution. The global burden of paediatric neuroblastoma is projected to continue rising through 2035.

Conclusions: Over the past 30 years, global incidence and mortality rates for paediatric neuroblastoma have risen, particularly in low-SDI regions, whereas high-SDI regions have witnessed a downward trend. Although disparities between high- and low-SDI countries have diminished, inequality in burden distribution has grown more pronounced. The global burden of paediatric neuroblastoma is expected to continue its upward trajectory over the next 15 years.

Objective: To evaluate the incidence of thin catheter surfactant administration (TCA) failure and compare short and long-term neonatal outcomes who failed TCA or did not.

Design: Single-center retrospective cohort study. Infants between 25 and 30 weeks of gestational age with respiratory distress syndrome and receiving 200 mg/kg poractant alfa via thin catheter administration were included. TCA failure was defined as the need for early mechanical ventilation (< 72 h). Infants were divided into two groups those who failed TCA or those who did not.

Results: The TCA failure rate was 24.6%. Initial oxygen requirement (0.39% vs. 0.36%) and the number of small for gestational age infants were significantly higher in the TCA failure group (15% vs. 7.9%). Infants who failed TCA had a higher pneumothorax (6.7% vs. 1.1%, p = 0.03), BPD (15% vs.5.5%, p = 0.02), late-onset sepsis (36.7% vs. 18%, p = 0.04), retinopathy of prematurity rates (11.7% vs. 3.3%, p = 0.02) and an increased duration of respiratory support. However, Bayley Scales of Infant Development II scores were comparable between groups at 18 and 26 months of corrected age.

Conclusion: Infants who fail TCA are at increased risk for short-term complications despite favourable long-term neurodevelopmental outcomes. Identifying infants at risk of TCA failure may help early prevention of morbidities and individualise their management.

Background: Children with cystic fibrosis are more likely to become severely unwell with influenza-associated illness compared to children without chronic lung disease. The provision of accessible influenza vaccinations is essential in the prevention of infection.

Objectives: To describe the prevalence of the influenza vaccine uptake in children with cystic fibrosis from 2016 to 2020 at a single tertiary paediatric hospital site and determine if the COVID pandemic of 2020 and the introduction of telehealth encounters affected the vaccine uptake.

Methods: A retrospective study of children with cystic fibrosis aged 6 months to 18 years who reside in South Australia was performed using the Women's and Children's Hospital (WCH) Respiratory Department cystic fibrosis database from 2016 to 2020. The Australian Immunisation Register (AIR) was used to determine vaccination status during this period.

Results: One hundred and eighty two children with cystic fibrosis were identified, one hundred and seventy two of whom vaccination records were available on the Australian Immunisation Register. Proportion of eligible patients who were vaccinated ranged from 66% to 88% in the years 2016-2019. There was no significant decrease in uptake during the COVID-19 pandemic in 2020 (75%). Despite the introduction of Telehealth reviews in 2020 majority (66%) of patients continued to have exclusive face-to-face appointments, of which 73% received the vaccination. Vaccination coverage of those who received combination of Telehealth and face-to-face was 81%.

Conclusion: The high influenza vaccination rate of South Australian children with cystic fibrosis is consistent with rates seen in other tertiary centres globally. This study demonstrated that the pandemic and introduction of Telehealth appointments did not have any impact in the uptake of the influenza vaccination in our South Australian population.

Aim: There is limited data on the PICU outcomes of children with acute severe asthma (ASA) in South Africa. This study aims to describe the profiles and treatment of all children admitted to our PICU with ASA.

Methods: A retrospective audit of all children admitted with ASA to the PICU at Red Cross War Memorial Children's Hospital between 01 January 2009 and 31 December 2019.

Results: There were 14 592 PICU admissions over the 11-year period, of which 180 admissions (1.2%) were for ASA. The median, interquartile range (IQR) age on admission was 67 (37-93) months. Almost all children received nebulisations, steroids and magnesium sulphate before PICU admission. Half of the patients were loaded with intravenous salbutamol (n = 96; 53.3%) and about a third (n = 61; 34%) received a salbutamol infusion before PICU admission. Similar proportions received nebulisations and steroids in PICU, 34 children (19%) received magnesium sulphate again in PICU and a total of 130 children (72.2%) received a salbutamol infusion. Most children received non-invasive respiratory support (n = 167; 90.3%), and 18 children (9.7%) required mechanical ventilation for a median (IQR) of 3 (2-4) days. The median PICU stay was 1 (IQR 1-2) day and median hospital stay was 4 (IQR 3-6) days. No children died.

Conclusion: There has been an increasing number of children admitted to PICU with ASA over the 11-year period. There has been increased use of HFNC and the duration of PICU support is short.