Journal of paediatrics and child health最新文献

Health-care professionals (HCP) have a responsibility to protect and promote maternal and infant health and breastfeeding is one of the most effective measures to support this. Increasing breastfeeding rates in Australia is crucial to improving population health, but the absence of robust policies, programmes and education for HCP undermines this effort. The pervasive marketing of commercial milk formulas (CMF), including sponsorship of HCP and their organisations, has introduced significant conflicts of interest that distort clinical practice, education, research and guidelines developed in the infant feeding domain. This paper calls on all HCP to seek independence from the CMF industry and to actively support breastfeeding in their practice.

It has now been almost a year since I had the honour of being appointed the acting Editor in Chief (EiC) of the Journal of Paediatrics and Child Health (JPCH). I am the 7th EiC since JPCH was established as the Australian Paediatric Journal in 1965. The last one and a half years was tumultuous, with three EiCs taking the helm within a few short months. The journal's recovery over the last 10 months would not have been possible without the rock-solid foundation built by the previous EiCs and the unrelenting and selfless efforts and support of a (entirely) voluntary editorial board, an army of reviewers the College Journal Committee and the Marketing and Communications team.

The editorial board underwent significant change in 2024. Senior editors were ‘re-classified’ as ‘Section Editors’ to align with their expertise. Some editors who had provided years of generous service to the journal stepped down. Seven section editors and 16 new associate editors were appointed, providing much needed complementary expertise to the editorial board. Currently, the editors cover almost all specialties in paediatrics and hail from 7 countries, including Singapore, Japan, India and China. They bring with them world-leading skills in rapidly developing fields of health care, including global health, evidence synthesis, economics, statistics and ethics.

March 2025 will be the 60th Anniversary of JPCH.

In the first issue in March 1965, Charlotte Anderson, the first editor with Peter Jones, hoped that ‘it (the journal) will help to promote understanding, cooperation and exchange of personnel between countries’ as the voice of Australian paediatricians and South-East Asia. In this issue (Jan 2025), there are manuscripts from 5 Australian states, New Zealand and 10 other countries, covering 12 different specialties, including artificial intelligence and law. Although much has changed in the world and in paediatrics since 1965, I'm proud to say that JPCH continues the aspirations of Dr Anderson and Dr Jones and hope that it's reach and diversity will continue to grow for the next 60 years.

The author declares no conflicts of interest.

Aim: To examine the efficacy of current non-servo-based cooling methods used by NETS NSW in treating hypoxic ischaemic encephalopathy (HIE) with therapeutic hypothermia (TH) in neonatal retrieval.

Methods: A retrospective observational study of infants treated with TH for HIE retrieved by NETS NSW from January 2017 to June 2020 inclusive. Primary outcomes were the proportion of neonates achieving TH within 6 h of life and maintaining temperature in a therapeutic range.

Results: 82 patients were included in analysis. Mean gestational age (GA) was 39 weeks (IQR 38-40) and mean birthweight (BW) 3297 g (SD 607 g). 68 infants (82.9%) were passively cooled while 14 (17.1%) were cooled with gel packs. 20 infants (21.4%) had rectal temperature monitoring before retrieval. 45 infants (55.6%) reached TH within 6 h of birth. Only 56 infants (68.3%) reached TH during retrieval. Of these infants, 45 (80.4%) had subsequent temperatures outside the therapeutic range.

Conclusions: Infants receiving TH through non-servo-controlled methods are commonly exposed to temperature instability and overcooling. Introduction of servo-controlled cooling devices is required to improve care and management of perinatal HIE in retrieval.

Aim: A retrospective study will review episodes of anaphylaxis during bee venom immunotherapy (BVIT) in children, any modifications made to the dosing schedule, and the subsequent outcomes over a nine-year period in Western Australia.

Methods: Patient demographics, dose eliciting anaphylaxis during BVIT, modifications made to BVIT regimen following anaphylaxis (i.e., continuation, modification, or cessation), and the subsequent outcomes were collected for children commenced on BVIT from 1st September 2012 to 31st August 2021.

Results: A total of 624 children were commenced on BVIT from 2012 to 2021. 12/624 (1.9%) did not complete the recommended duration of BVIT, the majority of which were due to poor compliance. 33 children (5.2%) developed anaphylaxis. 2/33 children (6.0%) experienced anaphylaxis on multiple occasions, resulting in 36 separate episodes of anaphylaxis. Most of the anaphylactic episodes occurred on Day 1 of BVIT (56%). 23/35 children (65.7%) developed anaphylaxis during the build-up phase and 12/35 children (34.3%) developed anaphylaxis during the maintenance phase. For those who experienced anaphylaxis in the build phase, 6/23 children (26.0%) continued with immunotherapy on the same day, and 5/6 of these children (83.3%) tolerated the same-day continuation of immunotherapy; 17/23 children (73.9%) ceased immunotherapy and restarted on another day, with 11/17 children (64.7%) tolerating cessation and recommencement of the regimen on another day. For those who developed anaphylaxis during the maintenance phase, 6/12 children (50.0%) tolerated ongoing immunotherapy.

Conclusions: Children who experience anaphylaxis during the build-up phase of BVIT showed a low risk of further anaphylaxis with proceeding immunotherapy on the same day. Children who experience anaphylaxis during the maintenance phase of BVIT appear less likely to tolerate ongoing immunotherapy due to the recurrence of anaphylaxis.

Aim: C-reactive protein (CRP) is commonly used to assess the probability of bacterial infection and the need for empiric antibiotic treatment. We assessed the relationship between CRP levels and bacterial infection in the paediatric emergency room (PER) setting.

Methods: A retrospective cohort study. Relative risks (RRs) were calculated for the relation between CRP levels and various demographic, clinical and diagnosis parameters. Additionally, the sensitivity and specificity of different CRP levels (2, 5, 7 and 10 mg/dL) for bacterial infection diagnosis was calculated.

Results: Overall, 13 092 cases were recorded. Fever, leucocytosis, hospitalisation and bacterial infection diagnosis were associated with elevated CRP levels, while lower CRP levels were associated with young age. Gender, ethnicity, hypoxemia and neutrophilia were not associated with CRP levels. The sensitivity of CRP ≥2 mg/dl for bacterial disease was 65%-70%, declining to <50% in CRP ≥5 mg/dL. The specificity of CRP ≥2 mg/dL for bacterial disease was ~60%, increasing to >80% in CRP ≥5 mg/dL.

Conclusions: CRP levels of ≥5 mg/dl high specificity for bacterial disease, allow for its use as an indicator to start empiric antibiotic treatment, while the low sensitivity of various CRP levels probably excludes the possibility of withholding empiric antibiotic treatment, based only on CRP level.

Aim: To describe the management of neonatal hypoglycaemia within Pacific Island countries and territories by surveying practising clinicians.

Methods: Survey questions were adapted from a similar survey conducted across Australian and New Zealand neonatal nurseries. An anonymous, electronic survey link and QR code were disseminated to clinicians via our partner organisations, Facebook and direct email. Data collected were primarily descriptive.

Results: Fifty-one surveys were received from 13 Pacific Island countries. Two-thirds (69%) of respondents reported having a neonatal hypoglycaemia protocol in their nursery. The four protocols received defined hypoglycaemia as a blood glucose concentration <2.6 mmol/L. However, treatment thresholds reported varied from <1.0 mmol/L to <3.0 mmol/L. Feeding was the most common treatment. One-third of the respondents reported resource barriers to effective management, such as a lack of specialist training and limited resources.

Conclusions: There are variations in the screening, diagnosis and treatment of neonatal hypoglycaemia in the Pacific Island countries, despite consistency in the management of neonatal hypoglycaemia within the clinical protocols. Barriers to the safe and effective management of neonatal hypoglycaemia remain concerning.

Aim: The use of blended tube feeding (BTF) in children is a controversial area with persistent concerns regarding the nutritional adequacy and risk of associated infections and equipment complications. Parents in Australia are electing to use BTF in their children despite local hospital guidelines, calling for further research to support its use.

Methods: A retrospective case-series study was conducted at a tertiary paediatric hospital, to characterise the paediatric population electively using BTF and evaluate their clinical outcomes. Demographic, anthropometric and clinical data were collected from pre-existing medical records.

Results: Data from 178 clinical visits of 26 participants were included in analysis. The median age of participants was 4.1 years (range 7 months -14 years). BTF was most commonly used for symptom control (n = 8, 30.8%). The most common cause of clinical presentation during the use of BTF was respiratory conditions (number of presentations = 60, 47.2%). There was no reported increase in hospital presentations, gastrointestinal infections or equipment complications with the use of BTF. BTF did not promote weight gain in this population of children, particularly those who were already underweight.

Conclusion: This case-series found the use of BTF in a paediatric population with underlying complex medical conditions requiring enteral nutrition was driven by parental preference and the goals of symptomatic control. BTF did not demonstrate benefits of weight gain, though it was not associated with an increase in complications and hospital admission.