Journal of paediatrics and child health最新文献

Aim: To analyse trends in community systemic antibiotic dispensing to children and young people (0-14 years) in New Zealand between 2010 and 2019.

Methods: Dispensing data were retrieved from the National Pharmaceuticals Collection and population data from the Te Whatu Ora Populations Web Tool. Dispensing rates were described using the number of defined daily doses/1000 inhabitants per day (DID) and courses dispensed/1000 inhabitants/year.

Results: Total antibiotic dispensing declined over the study period, both in terms of courses dispensed (annual percentage change [APC] -3.4% per year) and DIDs (APC -0.67% per year). Amoxicillin/clavulanic acid showed the greatest decline in dispensing (APC -9.5% per year), while cefalexin had the most significant increase (APC +53.7% per year). The highest dispensing rates were observed among children aged 0-4 years, Pacific patients and those in the lowest socioeconomic quintile. Counties Manukau had the highest regional dispensing rates. Antibiotic stewardship, as per the WHO AWaRe guidelines, improved: Access antibiotics increased from 83% to 91%, while Watch antibiotics decreased from 17% to 9% of total dispensing.

Conclusions: These findings suggest an overall improvement in prescribing practices, likely due to the adoption of antimicrobial stewardship programmes. Further study is under way to understand the reasons for and any risks associated with, high community rates of cefalexin dispensing.

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: New Zealand's post-neonatal mortality rate has remained steady at around 1.4 per 1000 live births since 2015, with Sudden Unexpected Death in Infancy (SUDI) accounting for approximately 60% of these deaths. Safe sleep guidelines are a key element of SUDI prevention but there is limited information on how these guidelines are applied in New Zealand homes. This work aims to examine safe sleep practices among New Zealand infants and explore variations based on demographic, infant and family characteristics.

Methods: This cross-sectional observational study used electronic health data for 45 969 New Zealand infants at approximately 6 weeks of age. Data came from 'Well Child/Tamariki Ora' visits conducted in 2023 by Whānau Āwhina Plunket, a provider of free health assessment and parenting support services for almost 80% of families in New Zealand. 'Safer sleep space' was defined as the exclusive use of recommended spaces (e.g., bassinet, cot, Pēpi-Pod or wahakura) and 'safer sleep position' referred to the supine (back) sleep position.

Results: Most infants were placed in safe sleep spaces (89% day, 93% night) and positions (95% day, 96% night). The prevalence of safe sleep practices varied between regions, ethnic groups and sociodemographic groups. Higher prevalences of safe sleep practices were seen with lower socioeconomic deprivation, adequate housing, non-smoking and employed caregivers, and caregivers with greater knowledge of health and support services.

Conclusions: There was a high prevalence of safe sleep practices with significant variations between sociodemographic, regional and ethnic groups, providing opportunities for targeted interventions to improve infant sleep safety.

Tuberous sclerosis complex (TSC) is a multi-system autosomal dominant condition associated with disease-causing variants in either of the TSC1 or TSC2 genes. It can be associated with variable benign tumours (hamartomas) in different organs, most notably the brain, kidneys, skin and heart with different ages of onset. Affected children may have early-onset epilepsy, refractory epilepsy, varying degrees of developmental disability, ranging from normal cognition and learning difficulties to moderate-severe intellectual disability, neurodevelopmental disorders and mental health disorders. Multidisciplinary TSC-specific clinical care is recommended. A precision medicine (mechanistic target of rapamycin (mTOR) inhibitors) aimed at the early treatment of epilepsy and TSC-specific therapy for tumours can reduce the burden of the disease and improve clinical outcomes. We describe a multidisciplinary model of care for TSC, with an emphasis on the early detection and diagnosis of TSC and active surveillance/management of electrical seizures and clinical seizures. This review article will cover the following: clinical presentation and diagnosis of TSC, its genetic basis, the role of genetic counselling, pre-seizure surveillance of infants and TSC-specific (neurological, neurodevelopmental, renal, dermatological and pulmonary) management guidelines throughout life.