Journal of paediatrics and child health最新文献

Objective: This study evaluated the association between intestinal anatomical characteristics-including the resected bowel segment, residual small bowel length (RSBL), and preservation of the ileocecal valve (ICV)-and treatment outcomes in children with short bowel syndrome (SBS).

Methods: A retrospective study was conducted of 35 paediatric SBS patients who underwent small bowel resection at the study site from July 2021 to July 2024. SBS was defined by an RSBL ≤ 25% of the expected length for age or dependence on parenteral nutrition ≥ 60 days. Treatment outcomes were categorised as successful (clinical stabilisation and discharge) or unsuccessful (death or lack of improvement).

Results: Most patients underwent surgery during the neonatal period (91.4%). A majority had RSBL > 38 cm (88.6%), preserved ICV (74.2%), and intact colon (67.7%). The overall treatment success rate was 60% (n = 21), while mortality or failure occurred in 40% (n = 14). The mean RSBL in the success group (86.1 ± 28.1 cm) was significantly longer than in the failure group (52.7 ± 24.9 cm; p < 0.001). All patients with very short (15-38 cm) or ultra-short (< 15 cm) RSBL experienced treatment failure or death (p < 0.05). Preservation of both the colon and ICV was significantly associated with treatment success (p < 0.05). Patients without ICV preservation had longer median hospital stays than those with ICV preservation (126 days vs. 100.5 days; p < 0.05).

Conclusion: Colon and ileocecal valve preservation are key prognostic factors improving outcomes and reducing hospitalisation in paediatric short bowel syndrome.

Background: Congenital upper airway malformations and malacia are important causes of respiratory morbidity in early infancy, yet population-based epidemiological data remain scarce, particularly in Latin America. Most available estimates derive from single-centre cohorts, limiting generalizability and health system planning.

Methods: We conducted a nationwide, retrospective, population-based study using Colombia's administrative healthcare database (RIPS). We identified healthcare encounters coded with ICD-10 diagnoses corresponding to congenital upper airway malformations and malacia among children younger than 1 year between 2016 and 2024. Crude and sex-specific prevalence rates were calculated per 100 000 children. Age-standardised prevalence rates were estimated using the WHO world standard population. Temporal trends were assessed using Poisson regression models with population offsets and visualised using LOESS smoothing.

Results: A total of 29 450 cases were identified, corresponding to a national crude prevalence of 263.0 per 100 000 children and an age-standardised prevalence of 23.1 per 100 000. The most frequent diagnoses were congenital nasal septum perforation, laryngomalacia, tracheomalacia, and unspecified congenital nasal malformations. Overall prevalence was higher among females than males, although marked heterogeneity was observed across specific diagnoses. Temporal trend analysis demonstrated a significant annual increase of approximately 3% in upper airway malformations, with diagnosis-specific patterns showing increasing, stable, or decreasing trends over time.

Conclusions: Congenital upper airway malformations and malacia represent a substantial and evolving burden in Colombian infants. Population-based administrative data provide valuable insights into disease frequency, sex differences and temporal trends, supporting their use for health system planning and epidemiological surveillance.

Aim: A medical emergency team (MET) was introduced to improve early recognition and management of critically ill patients. This study evaluated the impact of MET implementation on emergency airway management in the paediatric intensive care unit (PICU).

Methods: This single-centre pre-post comparative study was conducted from September 2016 to August 2022. Children aged < 16 years who were unexpectedly admitted to the PICU from general wards due to clinical deterioration were included. The primary outcome was emergency tracheal intubation within 1 h of PICU admission. Secondary outcomes were overall intubation rate, PICU stay, and mortality. Fisher's exact and Mann-Whitney U tests were used for univariate analyses, and multivariable logistic regression was performed, adjusting for weight and reason for PICU admission (respiratory failure vs. other causes).

Results: A total of 12 691 and 25 295 admissions occurred before and after MET implementation, respectively. Unexpected PICU admissions decreased (15.4 vs. 12.7 per 1000, p = 0.04). Emergency intubation within 1 h occurred in 31% pre- and 14.3% post-MET (p < 0.01). In multivariable analysis, MET implementation was associated with lower odds of emergency intubation (adjusted OR 0.37, p < 0.001). Within the post-MET cohort, emergency intubation rates did not differ by implementation phase (OR 0.66, p = 0.25) or direct MET activation (OR 1.36, p = 0.60).

Conclusion: MET implementation was associated with a lower incidence of emergency intubation within 1 h of PICU admission. The findings suggest that improved staff awareness and education, rather than direct MET intervention, promoted timely management of patient deterioration.

Background: Meningoencephalitis causes significant morbidity and mortality in children worldwide. Prompt diagnosis remains challenging, yet advances in molecular diagnostic technology have improved diagnostic performance. This study examined whether the introduction of the BioFire FilmArray meningitis/encephalitis (ME) multiplex panel impacted the diagnosis and management of children with suspected meningoencephalitis.

Methods: We conducted a retrospective cohort study (January 2019 to July 2021) at a non-tertiary hospital in Sydney, Australia, during which the BioFire ME panel became available. Patients < 16 years who had cerebrospinal fluid (CSF) sampling for investigation of meningoencephalitis were included. Demographic, clinical and microbiological data were extracted to evaluate time to infection diagnosis, antimicrobial rationalisation and duration, investigations undertaken and admission length.

Results: There were 122 CSF samples collected from children with suspected meningoencephalitis; 70/122 (57.3%) before and 52/122 (42.7%) after BioFire ME panel introduction. Twenty-eight (23.0%) children had BioFire ME testing. Seven bacterial and 27 viral microbiologically confirmed central nervous system (CNS) infections were identified. BioFire ME panel use was associated with faster median confirmation or exclusion of meningoencephalitis (12.6 vs. 48.0 h, p < 0.01, for bacterial and 12.6 vs. 71.5 h, p < 0.01, for viral causes), quicker pathogen identification in viral meningoencephalitis (8.1 vs. 48.7 h, p = 0.019) and earlier antimicrobial rationalisation (24.0 vs. 30.4 h, p < 0.01). Total antimicrobial duration, investigation numbers and hospitalisation duration were not reduced.

Conclusions: The BioFire ME panel has the potential to reduce the duration of empiric broad-spectrum antimicrobials and their associated adverse effects on children, as well as improve healthcare resource efficiencies.

Objectives: To determine the frequency and patterns of dietary modification, sources of dietary advice and associated behaviours in Australian children with inflammatory bowel disease (IBD).

Methods: Mixed-methods cross-sectional study was conducted with IBD patients attending Perth Children's Hospital. Participants completed a validated questionnaire and clinical disease activity (PUCAI/PCDAI) was recorded on the day of consultation. Descriptive statistics, t-tests, chi-square tests, and multivariable logistic regressions were performed using Jamovi.

Results: Sixty-four children participated (34 males; mean age 13.4 ± 2.8 years; 28 Crohn's disease, 36 ulcerative colitis). Over half (33/64, 51.6%) reported dietary modification post diagnosis, most commonly food avoidance. One-third (24/64, 37.5%) regularly skipped meals. On multivariable logistics regression food avoidance (aOR 13.8, 95% CI 2.17-87) and disease activity (aOR 12.4, 95% CI 2.80-55.1) were independently associated with meal skipping. Females were 3.17 (95% CI 1.14-8.80) times more likely to practice food avoidance and 3.56 (95% CI 1.14-8.80) times more likely to report symptom exacerbation with specific foods on univariable analysis. Although gastroenterologists and dietitians were the most trusted sources of dietary advice, over 20% (7/33) of patients were modifying their diet based on non-expert recommendation.

Conclusions: Dietary modification post diagnosis is prevalent among Australian paediatric IBD patients. Meal skipping is independently associated with active disease and self-directed food avoidance; females report higher rates of food avoidance and symptoms exacerbation with foods. These findings highlight the need for proactive, consistent dietary counselling and underscore the importance of further multicentre studies to corroborate these findings.

Aim: To determine the magnitude of high-risk infants cared for at a regional hospital in Victoria, Australia and to identify the resources required to care for them.

Methods: A retrospective study was conducted between January 2017 and December 2019 in a regional hospital in Victoria, Australia. Data of high-risk neonates and their associated risk factors were collected from electronic and physical medical records. Simple descriptive statistics were used to summarise and report the data. Follow-up was proposed based on the high-risk factors as per already known follow-up protocols.

Results: An average of 848 births were registered annually. The special care nursery (SCN) within the regional hospital received an average of 260 admissions per annum. Of the admissions to the SCN, 47% of infants had high-risk factors. Approximately 90% of the high-risk infants were inborn and 10% were outborn. Prematurity, small for gestational age (SGA) and adverse socio-demographic variables were the most common risk factors across all 3 years. Approximately 43% of high-risk infants had two or more risk factors. The prevalence of these high-risk factors between the 3 years remained consistent.

Conclusion: A considerable number of high-risk neonatal admissions were recorded in this regional hospital which serves a large proportion of socio-economically disadvantaged patients. Customised and co-located multidisciplinary team (MDT) follow-up of these high-risk neonates is crucial. Findings can inform local guidelines for MDT neurodevelopmental follow up program to prevent long term adverse outcomes.