Simon Thornley, Toakase Fakakovikaetau, Mele Tilema Cama, Mele 'Atuekaho Manu, Kalolaine Tahitua, Shunsuke Moritsuka, Richard J Johnson, Viliami Puloka, Losana Vuki, Joseph Takai, Jacqui Williamson, Saptorshi Gupta, Arthur J Morris, Gerhard Sundborn
Background: Scabies is a common health issue in the Pacific and may contribute to rheumatic heart disease (RHD). This study assessed the prevalence of scabies and other skin conditions among Tongan schoolchildren and examined the association between these conditions and RHD.
Methods: Children from four primary schools on Tongatapu were screened for scabies, other skin conditions and RHD. Health workers were trained to recognise scabies and related skin conditions accurately. All children also underwent echocardiographic screening to detect heart valve abnormalities consistent with RHD. Statistical analysis included prevalence ratio calculations, and Fisher's exact tests to evaluate associations between skin and heart findings.
Results: Four hundred children were screened (mean age: 8 years 6 months), with 18 (4.5%) having echocardiographic features of RHD. The prevalence of scabies was 29.8% (119/400), while the prevalence of impetigo was 20% and more severe bacterial skin infection was 15.5%. Children with both scabies and skin infection were 4.65 times more likely than children without any such lesions to have RHD (95% confidence interval: 1.60-13.6). Children with scabies, impetigo and bacterial infection were associated with progressively higher prevalence of RHD (p for trend = 0.008). The population attributable fraction for scabies and infection as a potential cause of RHD was 26.5%.
Conclusions: The results indicate a very high prevalence of scabies, bacterial skin infection, and RHD among Tongan school children. Enhanced treatment and control of scabies are likely to reduce the incidence of both bacterial infection and RHD. Mass drug administration is recommended.
{"title":"The Prevalence of Scabies, Skin Infection and Rheumatic Heart Disease in a Cross-Sectional Study of Tongan Primary School Children.","authors":"Simon Thornley, Toakase Fakakovikaetau, Mele Tilema Cama, Mele 'Atuekaho Manu, Kalolaine Tahitua, Shunsuke Moritsuka, Richard J Johnson, Viliami Puloka, Losana Vuki, Joseph Takai, Jacqui Williamson, Saptorshi Gupta, Arthur J Morris, Gerhard Sundborn","doi":"10.1111/jpc.70248","DOIUrl":"https://doi.org/10.1111/jpc.70248","url":null,"abstract":"<p><strong>Background: </strong>Scabies is a common health issue in the Pacific and may contribute to rheumatic heart disease (RHD). This study assessed the prevalence of scabies and other skin conditions among Tongan schoolchildren and examined the association between these conditions and RHD.</p><p><strong>Methods: </strong>Children from four primary schools on Tongatapu were screened for scabies, other skin conditions and RHD. Health workers were trained to recognise scabies and related skin conditions accurately. All children also underwent echocardiographic screening to detect heart valve abnormalities consistent with RHD. Statistical analysis included prevalence ratio calculations, and Fisher's exact tests to evaluate associations between skin and heart findings.</p><p><strong>Results: </strong>Four hundred children were screened (mean age: 8 years 6 months), with 18 (4.5%) having echocardiographic features of RHD. The prevalence of scabies was 29.8% (119/400), while the prevalence of impetigo was 20% and more severe bacterial skin infection was 15.5%. Children with both scabies and skin infection were 4.65 times more likely than children without any such lesions to have RHD (95% confidence interval: 1.60-13.6). Children with scabies, impetigo and bacterial infection were associated with progressively higher prevalence of RHD (p for trend = 0.008). The population attributable fraction for scabies and infection as a potential cause of RHD was 26.5%.</p><p><strong>Conclusions: </strong>The results indicate a very high prevalence of scabies, bacterial skin infection, and RHD among Tongan school children. Enhanced treatment and control of scabies are likely to reduce the incidence of both bacterial infection and RHD. Mass drug administration is recommended.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Cystic Fibrosis (CF) affects approximately 3800 Australians, including 42% aged under 18 years [<span>1</span>]. CF is associated with significant morbidity, with many people spending at least 60 min per day on treatment. Life expectancy has progressively improved due to the development of new therapies: median survival is now 60.6 years, increased from 47 years in 2008 [<span>1</span>]. Elexacaftor, Tezacaftor and Ivacaftor (ETI) (Trikafta), the first triple-therapy CF transmembrane conductance regulator modulator, became available in Australia on the Pharmaceutical Benefits Scheme in 2022. This study aimed to measure changes in the clinical status of adolescents with CF who have completed 12-months of treatment with ETI in a real-world setting.</p><p>Adolescents with CF aged ≥ 12 years managed at the Royal Children's Hospital (RCH), Melbourne who had completed 12 months of ETI treatment by August 2023 were included. Demographic data and clinical outcomes, including lung function, weight, nutritional status, hospitalisations and microbiology were extracted from the electronic medical record and the Australian Cystic Fibrosis Data Registry (ACFDR). ‘Best’ and ‘mean’ values in the 12-month period pre- and post-ETI initiation were compared. Data analysis was performed in PRISM GraphPad V10.0.3. Rate of change of forced expiratory volume in 1-s (FEV<sub>1</sub>) per annum was calculated using linear regression; for each individual, a regression line was fitted across all FEV<sub>1</sub> measurements within each 12-month period. Paired <i>t</i>-tests and Wilcoxon signed rank tests were used to compare normally and non-normally distributed data, respectively. The study was approved by RCH Human Research Ethics Committee (#101289).</p><p>Sixty-eight adolescents were included in this study (54% male, 51% F508del homozygous, mean age 15.29 ± 1.96 years) (an additional nine patients had commenced ETI prior to 12 years (i.e., via clinical trials), and four had completed < 12 months treatment at the time of analysis). Forty study participants (59%) had prior modulator exposure (Lumacaftor-Ivacaftor 55%; Tezacaftor-Ivacaftor 37.5%; Ivacaftor 7.5%).</p><p>ETI was associated with significant changes in several clinical outcomes (Table 1). Fewer lung function tests were performed following the introduction of ETI (median six and four per patient pre- and post-ETI respectively (<i>p</i> < 0.00001)). Most patients achieved an increase in FEV<sub>1</sub>%-predicted of 1%–10% (Figure 1a), and the rate of change in FEV<sub>1</sub> increased after ETI commencement (<i>p</i> = 0.06). Although there was no significant change in weight or BMI post-ETI initiation, four patients (5.9%) moved from an ‘optimal’ BMI category (50th–85th percentile) to a ‘high’ BMI category (> 85th percentile). There were significant reductions in hospitalisation frequency and duration post-ETI initiation. The total number of hospital admissions decreased from 84 to 34; all patient
{"title":"Impact of Elexacaftor/Tezacaftor/Ivacaftor (ETI) Treatment on Clinical Outcomes in a Single Centre Cohort of Paediatric Patients With Cystic Fibrosis","authors":"Chloe Crainie, K. Frayman, J. Harrison","doi":"10.1111/jpc.70249","DOIUrl":"10.1111/jpc.70249","url":null,"abstract":"<p>Cystic Fibrosis (CF) affects approximately 3800 Australians, including 42% aged under 18 years [<span>1</span>]. CF is associated with significant morbidity, with many people spending at least 60 min per day on treatment. Life expectancy has progressively improved due to the development of new therapies: median survival is now 60.6 years, increased from 47 years in 2008 [<span>1</span>]. Elexacaftor, Tezacaftor and Ivacaftor (ETI) (Trikafta), the first triple-therapy CF transmembrane conductance regulator modulator, became available in Australia on the Pharmaceutical Benefits Scheme in 2022. This study aimed to measure changes in the clinical status of adolescents with CF who have completed 12-months of treatment with ETI in a real-world setting.</p><p>Adolescents with CF aged ≥ 12 years managed at the Royal Children's Hospital (RCH), Melbourne who had completed 12 months of ETI treatment by August 2023 were included. Demographic data and clinical outcomes, including lung function, weight, nutritional status, hospitalisations and microbiology were extracted from the electronic medical record and the Australian Cystic Fibrosis Data Registry (ACFDR). ‘Best’ and ‘mean’ values in the 12-month period pre- and post-ETI initiation were compared. Data analysis was performed in PRISM GraphPad V10.0.3. Rate of change of forced expiratory volume in 1-s (FEV<sub>1</sub>) per annum was calculated using linear regression; for each individual, a regression line was fitted across all FEV<sub>1</sub> measurements within each 12-month period. Paired <i>t</i>-tests and Wilcoxon signed rank tests were used to compare normally and non-normally distributed data, respectively. The study was approved by RCH Human Research Ethics Committee (#101289).</p><p>Sixty-eight adolescents were included in this study (54% male, 51% F508del homozygous, mean age 15.29 ± 1.96 years) (an additional nine patients had commenced ETI prior to 12 years (i.e., via clinical trials), and four had completed < 12 months treatment at the time of analysis). Forty study participants (59%) had prior modulator exposure (Lumacaftor-Ivacaftor 55%; Tezacaftor-Ivacaftor 37.5%; Ivacaftor 7.5%).</p><p>ETI was associated with significant changes in several clinical outcomes (Table 1). Fewer lung function tests were performed following the introduction of ETI (median six and four per patient pre- and post-ETI respectively (<i>p</i> < 0.00001)). Most patients achieved an increase in FEV<sub>1</sub>%-predicted of 1%–10% (Figure 1a), and the rate of change in FEV<sub>1</sub> increased after ETI commencement (<i>p</i> = 0.06). Although there was no significant change in weight or BMI post-ETI initiation, four patients (5.9%) moved from an ‘optimal’ BMI category (50th–85th percentile) to a ‘high’ BMI category (> 85th percentile). There were significant reductions in hospitalisation frequency and duration post-ETI initiation. The total number of hospital admissions decreased from 84 to 34; all patient","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"62 1","pages":"151-154"},"PeriodicalIF":1.4,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.70249","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: Recommencing enteral feeding post-extubation in children is often delayed. This study evaluated a Post-Extubation Early Feeding (PEEF) protocol on early recommencement of enteral nutrition post-extubation in a tertiary paediatric intensive care unit (PICU).
Methods: The PEEF protocol involved direction to re-commence enteral nutrition at 50% of the pre-fasting rate within 1 h of extubation and upgrade to the pre-extubation feeding rate within 2 h. The PEEF protocol was a quality improvement project implemented at a tertiary PICU and was evaluated through a retrospective analysis. The study included children aged 0-18 years who were admitted to PICU, intubated and subsequently underwent planned extubation pre-PEEF (November 2019-October 2020) and post-PEEF (November 2021-October 2022).
Results: A total of 795 patients were included in the study, 372 pre-PEEF and 423 post-PEEF. Demographic variables and severity of illness variables were similar in the two groups. Post implementation of the PEEF protocol, the median (interquartile range) time to re-commence enteral nutrition after extubation was 3.2 h (1.9, 4.7) compared to pre-PEEF, 4.2 h (3.2, 5.5; p = 2.4 × 10-13). Post-PEEF the median time to reach the pre-fasting feeding rate was 5 h (2.6, 10.6), compared to 7.3 h (4.1, 13) pre-PEEF (p = 0.0005).
Conclusions: Implementation of the PEEF protocol reduced the time to resume enteral nutrition and the time to reach pre-extubation feeding rates although improvement was not consistent with the goals of PEEF. Continuing assessment and education are required to drive outcomes further towards target goals.
目的：儿童拔管后肠内喂养的重新开始经常延迟。本研究评估了拔管后早期喂养（PEEF）方案在三级儿科重症监护病房（PICU）拔管后早期重新开始肠内营养。方法：PEEF方案包括在拔管后1 h内以50%的禁食前速率重新开始肠内营养，并在2 h内升级到拔管前喂养速率。PEEF方案是在三级PICU实施的质量改进项目，并通过回顾性分析进行评估。该研究包括0-18岁的儿童，他们在peef前（2019年11月- 2020年10月）和peef后（2021年11月- 2022年10月）入住PICU，插管并随后计划拔管。结果：共有795例患者纳入研究，peef前372例，peef后423例。两组的人口学变量和疾病严重程度变量相似。实施PEEF方案后，拔管后重新开始肠内营养的中位数（四分位数范围）时间为3.2 h(1.9, 4.7)，而PEEF前为4.2 h （3.2, 5.5; p = 2.4 × 10-13）。peef后达到禁食前摄食速率的中位时间为5 h(2.6, 10.6)，而peef前为7.3 h (4.1, 13) （p = 0.0005）。结论：PEEF方案的实施减少了恢复肠内营养的时间和达到拔管前喂养率的时间，尽管这种改善与PEEF的目标不一致。需要继续进行评估和教育，以推动成果进一步实现具体目标。
{"title":"A Post-Extubation Early Feeding Protocol (PEEF) in a Tertiary Paediatric Intensive Care Unit: A Quality Improvement Initiative.","authors":"Sora Jung, Sainath Raman, Ian Hughes, Rahul Joshi","doi":"10.1111/jpc.70251","DOIUrl":"https://doi.org/10.1111/jpc.70251","url":null,"abstract":"<p><strong>Aim: </strong>Recommencing enteral feeding post-extubation in children is often delayed. This study evaluated a Post-Extubation Early Feeding (PEEF) protocol on early recommencement of enteral nutrition post-extubation in a tertiary paediatric intensive care unit (PICU).</p><p><strong>Methods: </strong>The PEEF protocol involved direction to re-commence enteral nutrition at 50% of the pre-fasting rate within 1 h of extubation and upgrade to the pre-extubation feeding rate within 2 h. The PEEF protocol was a quality improvement project implemented at a tertiary PICU and was evaluated through a retrospective analysis. The study included children aged 0-18 years who were admitted to PICU, intubated and subsequently underwent planned extubation pre-PEEF (November 2019-October 2020) and post-PEEF (November 2021-October 2022).</p><p><strong>Results: </strong>A total of 795 patients were included in the study, 372 pre-PEEF and 423 post-PEEF. Demographic variables and severity of illness variables were similar in the two groups. Post implementation of the PEEF protocol, the median (interquartile range) time to re-commence enteral nutrition after extubation was 3.2 h (1.9, 4.7) compared to pre-PEEF, 4.2 h (3.2, 5.5; p = 2.4 × 10<sup>-13</sup>). Post-PEEF the median time to reach the pre-fasting feeding rate was 5 h (2.6, 10.6), compared to 7.3 h (4.1, 13) pre-PEEF (p = 0.0005).</p><p><strong>Conclusions: </strong>Implementation of the PEEF protocol reduced the time to resume enteral nutrition and the time to reach pre-extubation feeding rates although improvement was not consistent with the goals of PEEF. Continuing assessment and education are required to drive outcomes further towards target goals.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145661080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anya Stephenson, Ibrahim S Al-Busaidi, Jonathan Williman, Kirsten Fanning, Phil Hider, Lesley Voss
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.
{"title":"Trends in Community Antibiotic Dispensing for Children and Young People in Aotearoa New Zealand, 2010-2019: Implications for Antimicrobial Stewardship.","authors":"Anya Stephenson, Ibrahim S Al-Busaidi, Jonathan Williman, Kirsten Fanning, Phil Hider, Lesley Voss","doi":"10.1111/jpc.70236","DOIUrl":"https://doi.org/10.1111/jpc.70236","url":null,"abstract":"<p><strong>Aim: </strong>To analyse trends in community systemic antibiotic dispensing to children and young people (0-14 years) in New Zealand between 2010 and 2019.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Loh, C. Mincham, N. Larkins, T. Ford, M. Princehorn, C. Kiraly-Borri, N. Jain
{"title":"Phaeochromocytoma in a Child Presenting With Post-Streptococcal Glomerulonephritis and Hypertensive Encephalopathy—Case Report","authors":"J. Loh, C. Mincham, N. Larkins, T. Ford, M. Princehorn, C. Kiraly-Borri, N. Jain","doi":"10.1111/jpc.70242","DOIUrl":"10.1111/jpc.70242","url":null,"abstract":"","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"62 1","pages":"138-142"},"PeriodicalIF":1.4,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sílvia Duarte Costa, Sofia Silva Faria, Cláudia Ferraz, Ana Azevedo
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.
{"title":"MIST/LISA in Portugal: National Survey of Clinical Practice.","authors":"Sílvia Duarte Costa, Sofia Silva Faria, Cláudia Ferraz, Ana Azevedo","doi":"10.1111/jpc.70247","DOIUrl":"https://doi.org/10.1111/jpc.70247","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>To evaluate MIST/LISA use in Portuguese neonatal intensive care units (NICUs) and identify variations in practice.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>MIST/LISA is widely implemented in Portuguese NICUs, but substantial variability exists. Standardised guidelines are needed to optimise clinical outcomes and reduce practice heterogeneity.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nitrous oxide is a commonly used anaesthetic gas, particularly in paediatric practice; however there are growing concerns about its environmental impact as both a greenhouse gas and ozone-depleting substance. Whilst the nitrous oxide emissions related to healthcare are small compared to other industries, the majority of the nitrous oxide purchased by the healthcare sector is attributed to non-clinical purposes such as leaks from central supply systems. This review aims to contextualise the provision, use, and processing of nitrous oxide in Australian paediatric practice, understand issues associated with its use, and consider whether the clinical utility of nitrous oxide outweighs its environmental impact.
Methods
This review specifically addresses the breadth of paediatric practice including non-anaesthesia use through consideration of pre-existing primary and secondary research and specialist input from paediatric emergency, anaesthesia, and dental experts.
Results
Key findings include the need to measure the nitrous oxide ‘gap’ to determine emissions targets, strategies to facilitate the transition from centralised pipeline systems, and a consideration of alternative approaches throughout and beyond the nitrous lifecycle.
Conclusions
Ultimately, modifications to nitrous oxide supply, efficient clinical use, and viable alternatives to nitrous oxide where appropriate will be necessary to continue providing responsible, sustainable healthcare.
{"title":"Clearing the Air: Nitrous Oxide in Australian Paediatric Practice","authors":"Isabella Natale, Shefali Jani, Eduardo Alcaino, Louisa Swain, Justin Skowno","doi":"10.1111/jpc.70244","DOIUrl":"10.1111/jpc.70244","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Nitrous oxide is a commonly used anaesthetic gas, particularly in paediatric practice; however there are growing concerns about its environmental impact as both a greenhouse gas and ozone-depleting substance. Whilst the nitrous oxide emissions related to healthcare are small compared to other industries, the majority of the nitrous oxide purchased by the healthcare sector is attributed to non-clinical purposes such as leaks from central supply systems. This review aims to contextualise the provision, use, and processing of nitrous oxide in Australian paediatric practice, understand issues associated with its use, and consider whether the clinical utility of nitrous oxide outweighs its environmental impact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This review specifically addresses the breadth of paediatric practice including non-anaesthesia use through consideration of pre-existing primary and secondary research and specialist input from paediatric emergency, anaesthesia, and dental experts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Key findings include the need to measure the nitrous oxide ‘gap’ to determine emissions targets, strategies to facilitate the transition from centralised pipeline systems, and a consideration of alternative approaches throughout and beyond the nitrous lifecycle.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Ultimately, modifications to nitrous oxide supply, efficient clinical use, and viable alternatives to nitrous oxide where appropriate will be necessary to continue providing responsible, sustainable healthcare.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"62 1","pages":"6-15"},"PeriodicalIF":1.4,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lisa Daniels, Barry J Taylor, Jillian J Haszard, Justine Camp, Karen L Magrath, Zoe K Tipa, Victoria Bryant, Sheree J Gibb
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.
{"title":"Early Infant Sleep Environments: An Observational Study of New Zealand Electronic Health Data.","authors":"Lisa Daniels, Barry J Taylor, Jillian J Haszard, Justine Camp, Karen L Magrath, Zoe K Tipa, Victoria Bryant, Sheree J Gibb","doi":"10.1111/jpc.70245","DOIUrl":"https://doi.org/10.1111/jpc.70245","url":null,"abstract":"<p><strong>Aim: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Celia Dewell, Denise L Chan, Vanessa Sarkozy, Eleanor Farley, Jacqueline Russell, David Mowat, Sean E Kennedy, Clara W T Chung
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.
{"title":"Diagnosis and Management of Children With Tuberous Sclerosis Complex.","authors":"Celia Dewell, Denise L Chan, Vanessa Sarkozy, Eleanor Farley, Jacqueline Russell, David Mowat, Sean E Kennedy, Clara W T Chung","doi":"10.1111/jpc.70243","DOIUrl":"https://doi.org/10.1111/jpc.70243","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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