To evaluate the trends in mortality for early- and late-onset neonatal sepsis, as well as the attributable risk factors at global, regional and national levels from 1990 to 2021. Early-onset sepsis occurs within 0–6 days after birth, whereas, late-onset sepsis occurs between 7 and 27 days of life.
Data on deaths from early- and late-onset neonatal sepsis, as well as the proportion attributable to risk factors, was sourced from the Global Burden of Disease Study (GBD) 2021. Temporal trends in mortality rates were assessed using estimated annual percentage changes.
In 2021, global deaths from early- and late-onset neonatal sepsis totalled 136 040 and 70 411, respectively, corresponding to mortality rates of 5549.9 and 965.3 per 100 000 population. Both early- and late-onset neonatal sepsis mortality declined from 1990 to 2021, with a more pronounced reduction in late-onset sepsis. However, total deaths increased in low-SDI regions, driven by early-onset sepsis. The highest mortality rates were observed in Sub-Saharan Africa, particularly in Western and Eastern Sub-Saharan Africa. In 2021, short gestation (gestational age < 38 weeks) and low birth weight (< 2500 g) were responsible for 29.6% and 66.3% of neonatal sepsis deaths globally. Mortality rates showed an inverse correlation with SDI, with higher-SDI regions experiencing faster reductions in mortality.
Neonatal sepsis remains a major global health challenge, particularly in low-SDI regions. Interventions targeting preterm birth, low birth weight and healthcare infrastructure are urgently needed.
Oesophageal atresia and tracheoesophageal fistula (OA/TOF) is a neonatal congenital condition usually repaired within the first days of life. Children with OA/TOF frequently experience long-term aerodigestive tract difficulties, requiring ongoing multidisciplinary care from a variety of different specialties and allied health services. Our aim was to determine the benefit of a coordinated multidisciplinary Aerodigestive follow up clinic for patients with OA/TOF.
We conducted a retrospective cohort study of all patients who underwent OA/TOF repair at Starship Hospital between 2008 and 2022. Follow up data was collected from Paediatric Surgery, Paediatric Otorhinolaryngology (ORL), Gastroenterology, Respiratory, Dietetics and Speech Language Therapy (SLT), and was categorised according to clinics, investigations and operative visits.
Ninety three patients were identified as having OA/TOF repairs during the study timeframe, and 79 were included in the analysis. The median length of hospital stay from birth to discharge was 27 days. During the first year of life, patients had an average of 5.8 clinic visits (range 0–33), 0.8 diagnostic investigations (range 0–4), and 1.9 operative procedures (range 0–17). The mean age at the end of the follow up period was 6.45 years. 19% of included patients had a rural address, indicating greater difficulty in accessing care due to location.
Our results highlight the significant and diverse follow up care that OA/TOF patients require following repair, and the benefit of a multidisciplinary Aerodigestive follow up clinic. A review of data following the establishment of a multidisciplinary clinic at Starship Hospital is planned.
Chronic pain is frequently experienced by adolescents, affecting their psychological health and frequently lasting into adulthood. Increased pain sensitivity has been connected to a number of sleep disorders, including nightmare distress. However, the underlying mechanisms of this relationship remain unclear. In this study, adolescents' perceptions of pain intensity and nightmare distress are examined in connection to the mediating effects of stress, anxiety and depression.
A cross-sectional study was conducted with 600 Lebanese adolescents (mean age = 15.94 years) recruited through random and snowball sampling. Participants completed validated Arabic versions of the Nightmare Distress Questionnaire (NDQ-AV), the Depression, Anxiety and Stress Scales for Youth (DASS-Youth-12) and a self-reported pain intensity scale.
The results showed that depression and anxiety fully mediated the association between nightmare distress and perceived pain intensity. Higher nightmare distress was significantly associated with higher depression (β = 0.04; p < 0.001) and anxiety (β = 0.05; p < 0.001), whereas higher depression (β = 0.19; p < 0.001) and anxiety (β = 0.17; p < 0.001) were significantly associated with higher pain intensity. Finally, nightmare distress was significantly and directly associated with higher pain in both models.
The study emphasises the psychological connections between nightmare distress and pain perception in adolescents. Findings suggest that addressing depression and anxiety in adolescents suffering from nightmare distress may be essential to improving pain management.
Human Metapneumovirus (hMPV) is a common cause of hospitalisation in children; yet there are currently no preventative licensed vaccines or specific treatments available. Our aim was to describe the clinical profile and seasonality of hospitalised children with hMPV, and to highlight those at higher risk of severe disease.
We conducted a retrospective audit at a single quaternary centre, The Royal Children's Hospital Melbourne, Australia. Clinical and epidemiological data were extracted from the electronic medical record for any child (0–18 years) with a positive respiratory Polymerase Chain Reaction (PCR) test for hMPV between May 2016 and December 2023 (study duration 7.5 years).
A total of 1296 children who tested positive for hMPV between May 2016 and December 2023 were included in our study. Children aged < 2 years made up 50% of the cohort (n = 648). Seasonality reflected a consistent end-of-winter rise in case numbers, except during the COVID-19 pandemic when there were no reported cases of hMPV but a spike in case numbers the following year. Of those admitted, 41.2% had a comorbidity such as prematurity, cerebral palsy or malignancy. Children with comorbidities were more likely to have a longer duration of hospital stay with a median of 3 days (IQR 1–7) compared with 1 day (IQR 0–3) and be admitted to the Intensive Care Unit (ICU) (16.1% compared with 6.7%). Three children died within 30 days of returning a positive PCR, all of whom had an underlying malignancy.
Our study describes the impact of hMPV on hospitalisation at a quaternary centre. Younger children, particularly those aged < 2 years, and those with comorbidities were at a higher risk of ICU admission. Prevention strategies are needed to protect children from hMPV infection.
To evaluate the health and developmental concerns for children in out-of-home care in Central Australia and assess whether they received timely and comprehensive paediatric health assessments.
A retrospective audit of paediatric outpatient assessments for all children in out-of-home care in Central Australia, from 1 September 2018 to 1 May 2020. Timeliness of paediatric assessment was compared with the recommended timeframes in the National Clinical Assessment Framework.
A total of 304 children, aged 0–17 years were in out-of-home care during the audit period, with 174 (57%) children seen through paediatric clinics. Ninety-five percent of children were Aboriginal and Torres Strait Islander and all children had health needs identified. Developmental concerns were most common in children over 1-year-old (70%). Sixty-three percent of school-aged children had behavioural concerns and 43% had mental health concerns identified. Foetal alcohol spectrum disorder (FASD) was diagnosed or suspected in 50%–66% of primary school-aged and younger and 43% of high school-aged children. More than 50% of primary school-aged children had diagnosed or suspected attention-deficit/hyperactivity disorder (ADHD). Nearly all children were referred for ongoing paediatric care. Less than half of the children had a comprehensive health assessment within the recommended 3 months of entry into out-of-home care.
Children in out-of-home care in Central Australia experience significant physical, developmental, behavioural and mental health care needs. The findings highlight significant delays in the provision of paediatric health assessments, with most children not seen within recommended timeframes. The findings from this study highlight the importance of timely and consistent access to assessments and should challenge stakeholders to prioritise service, system and policy development.
To investigate whether postnatal haemoglobin oxygen affinity (P50), derived from serial arterial blood gases, is associated with the risk of retinopathy of prematurity (ROP) in preterm infants, as a potential physiologic marker.
Retrospective cohort study.
This study included 232 preterm infants born < 32 weeks gestation. Haemoglobin P50 and lactate values were calculated daily during the first week of life. The primary outcome was the development of any ROP; treatment-requiring (Type 1) ROP was a secondary endpoint. Associations were analysed using logistic regression and ROC analysis.
Infants who developed ROP had significantly higher Day 7 P50 values (mean 26.9 ± 1.8 mmHg) than those without ROP (26.1 ± 1.7 mmHg; p = 0.003). A Day 7 P50 > 26.4 mmHg was independently associated with ROP (OR 2.5; 95% CI 1.3–4.9), though predictive performance was modest (AUC 0.60). Lactate levels showed no association with ROP. P50 was not predictive of Type 1 ROP.
Increased postnatal P50 may be modestly associated with ROP development, reflecting impaired oxygen delivery during early retinal vascularization. While not suitable for screening, P50 may serve as a physiologic marker warranting further mechanistic investigation.
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