AIM: To examine the population pattern of bronchopulmonary dysplasia (BPD), death and composite outcome (BPD/death) in preterm infants in Australia. METHODS: A retrospective population study using linked statewide health...AIM: To examine the population pattern of bronchopulmonary dysplasia (BPD), death and composite outcome (BPD/death) in preterm infants in Australia. METHODS: A retrospective population study using linked statewide health administrative data between 2005 and 2015 to estimate the incidence of BPD, death and composite outcome stratified by gestation: extremely preterm (EPT), very preterm (VPT) and moderate-to-late preterm (MPT). Associated risk factors were analysed using generalized estimating equation logistic regression models. RESULTS: Of 1 047 885 live births, 73 314 (7%) were preterm, of whom 1906 died and 1898 developed BPD (25.9/1000). BPD incidence was highest in EPT (324.6/1000), followed by VPT (89.7/1000) and MPT (1.5/1000) infants. Annual BPD incidence increased from 23.5 (in 2005) to 28.0/1000 (in 2015) (p < 0.001), while composite outcome marginally decreased from 55.3 to 46.3/1000 (p = 0.629), driven by reduced mortality (32.5 to 18.8/1000) (p < 0.001). Among 10 407 < 32 weeks infants, risk factors for BPD, death and composite outcomes were born EPT (aOR ranging 8.5-13.35), assisted vaginal/breech delivery (aOR 1.25-1.41), small-for-gestational-age (aOR 3.27-3.88), male sex (aOR 1.21-1.42) and had low 5-min APGAR score (aOR 1.64-12.47). CONCLUSION: The rising BPD incidence, predominantly among EPT survivors, was offset by reduced overall preterm mortality. Findings call for healthcare planning to cater for increased BPD survivors.
AIM: This study examined associations between parental attitudes towards children's screen time, children's screen use, and their language skills. METHODS: Subjects were 315 children aged 36 to 42 months and their parent...AIM: This study examined associations between parental attitudes towards children's screen time, children's screen use, and their language skills. METHODS: Subjects were 315 children aged 36 to 42 months and their parents from Croatia, Estonia, Finland and Poland. The Screen Time Inventory was used to collect information on parental attitudes towards screen time in relation to the development of speaking, communication skills, and acquiring knowledge, and information on the amount of children's screen time (alone, co-viewing, total). Information on children's language skills (vocabulary, grammatical skills) was collected using the MacArthur-Bates Communicative Development Inventory III. Analysis of covariance was used. RESULTS: Parental attitudes towards screen time were mostly consistent across countries, although Finnish parents considered screen time more beneficial than parents in other countries. Across countries, the more beneficial parents considered screen time, the more screen time their children spent co-viewing and in total, after controlling for children's age, gender, and parental educational level. Furthermore, the more screen time children had alone and in total, the lower their language skills. CONCLUSION: Parental attitudes were associated with children's screen habits, which in turn were linked to language skills. Identifying parental attitudes and informing parents of potential risks of screen time is important.
AIM: Decentralised implementation of therapeutic hypothermia (TH) for neonatal hypoxic-ischaemic encephalopathy (HIE) in Germany historically caused heterogeneous clinical practices. The aim of this study was to assess t...AIM: Decentralised implementation of therapeutic hypothermia (TH) for neonatal hypoxic-ischaemic encephalopathy (HIE) in Germany historically caused heterogeneous clinical practices. The aim of this study was to assess the impact of the German Hypothermia Registry on clinical standardisation and confidence in neonatal HIE care since its initiation in 2022. METHODS: We conducted a nationwide, two-phase, web-based survey in 2022 (n = 66) and 2025 (n = 222). A longitudinal subgroup analysis included physicians participating in both surveys (n = 30). Outcomes included guideline adherence, subjective diagnostic and therapeutic confidence, and perceived needs for further standardisation. RESULTS: From 2022 to 2025, clinician confidence improved across most domains. Complete confidence in diagnosing HIE increased from 42.4% to 80.0% in the longitudinal subgroup, while confidence in performing TH rose from 53.0% to 86.7%. Clarity regarding inclusion criteria reached 100% among longitudinal participants. In contrast, complete confidence in neurological assessment (36.7%) and amplitude-integrated electroencephalography (aEEG) interpretation (60.0%) remained comparatively lower in 2025. CONCLUSION: The German Hypothermia Registry markedly improved standardisation and clinician confidence in neonatal HIE care. However, neurological assessment and aEEG interpretation remain key areas requiring targeted educational support.
AIM: To review the long-term epidemiological and immunological impact of pneumococcal conjugate vaccines (PCVs) in the context of serotype replacement and the development of higher-valency formulations. METHODS: Brief li...AIM: To review the long-term epidemiological and immunological impact of pneumococcal conjugate vaccines (PCVs) in the context of serotype replacement and the development of higher-valency formulations. METHODS: Brief literature overview of current evidence on pneumococcal biology, natural and vaccine-induced immunity, population-level effects of PCVs and the epidemiological dynamics of serotype distribution. RESULTS: PCVs have profoundly reshaped the landscape of paediatric infectious diseases, leading to a dramatic decline in Streptococcus pneumoniae infections in children and, through herd protection, in adults. The decline in vaccine-type infections has been partially offset by the gradual emergence of non-vaccine serotypes. However, despite this serotype replacement, PCVs remain among the most powerful paediatric vaccines ever developed. The diversity of pneumococcal biology, the interplay between natural and vaccine-induced immunity and the dynamic process of serotype replacement create a constantly moving target. The introduction of higher-valency vaccines, now including up to 15 or 20 serotypes, seeks to address this adaptation but faces intrinsic immunological limits. CONCLUSION: Three decades after the first clinical trials, our understanding of their long-term epidemiological and immunological impact is still evolving. Future vaccine strategies must optimize the balance between expanded serotype coverage and durable immune protection at both the individual and population levels.
AIMS: To establish transepidermal water loss values on the first postnatal day in healthy term neonates and associations with perinatal factors utilising a closed-chamber system. METHODS: A cross-sectional single-centre...AIMS: To establish transepidermal water loss values on the first postnatal day in healthy term neonates and associations with perinatal factors utilising a closed-chamber system. METHODS: A cross-sectional single-centre study was conducted over a 7-month period. Healthy infants ≥ 37-week gestation and 2-24 h old were recruited. Transepidermal water loss was measured at a single time-point, non-invasively under typical ambient conditions using a standardised approach. Anthropometric and perinatal variables were collated. Outcomes assessed included device validity and reliability, transepidermal water loss values, and interactions with maternal and infant variables. RESULTS: A total of 120 term infants were recruited. The intra-class correlation coefficient of three consecutive readings was 0.735, indicating good reliability. There was no interaction between transepidermal water loss and ambient conditions. Mean values were 13.9 ± 3.28 g/m/h. The 5th and 95th percentiles were 9.7 and 20.3 g/m/h, respectively. Each additional postnatal hour conferred a reduction in transepidermal water loss of 0.11 g/m/h. Caesarean section increased transepidermal losses by 1.4 g/m/h. No other associations were significant. CONCLUSION: Early postnatal transepidermal water loss in the term infant is low but variable. Physiological variability is not attributable to typical ambient conditions or common perinatal factors, indicating a uniformly competent skin barrier at term.
AIM: This study aimed to evaluate point-of-care ultrasound (POCUS) findings in children with functional constipation who achieved complete clinical improvement following standard treatment in accordance with internationa...AIM: This study aimed to evaluate point-of-care ultrasound (POCUS) findings in children with functional constipation who achieved complete clinical improvement following standard treatment in accordance with international guidelines. MATERIAL AND METHODS: The study included 58 children (31 boys) aged 0.9-16.1 (mean age 5.22 ± 3.24), diagnosed with functional constipation, who attended two visits: First due to constipation-related symptoms and second to evaluate the treatment response. Each patient underwent a complete abdominal ultrasound examination before or during the first visit and a POCUS assessment at follow-up. RESULTS: The median time to follow-up was 3.7 months (IQR: 2.5-7.4), with a range of 0.9-29.2 months. The mean rectal diameter decreased from 38.93 ± 10.7 mm at baseline to 24.46 ± 11.54 mm after treatment. Initially, hard stool predominated in the rectal ampulla (96.6%) and sigmoid colon (93.1%). At follow-up, hard stool decreased to 63.7% in the rectum and 45.5% in the sigmoid colon. Although symptom resolution and physical examination would suggest continuing the current treatment, it was intensified in 51.7% of patients based on POCUS findings. CONCLUSION: In the studied children with functional constipation, POCUS findings provided additional, clinically meaningful information for evaluating treatment response.
AIM: Post-vaccination fever is a common adaptive immune response. Antipyretics are frequently used in paediatric practice to manage symptoms; however, concerns have emerged regarding potential interference with vaccine-i...AIM: Post-vaccination fever is a common adaptive immune response. Antipyretics are frequently used in paediatric practice to manage symptoms; however, concerns have emerged regarding potential interference with vaccine-induced immunogenicity, particularly when administered prophylactically. METHODS: A narrative review of paediatric studies assessing prophylactic and therapeutic use of paracetamol and ibuprofen after routine vaccinations was conducted. Evidence was derived from randomized trials, systematic reviews, and real-world health-economic analyses, focusing on fever, reactogenicity, antibody titers, and clinical safety. RESULTS: Prophylactic paracetamol consistently reduced fever but was associated with attenuated antibody titers during the primary vaccine series, notably with pneumococcal conjugate vaccines. Ibuprofen showed no measurable immunogenic suppression but is not recommended as a routine preventive strategy. Therapeutic antipyretic use, administered only after symptom onset, demonstrated no negative effect on immune responses. Ibuprofen was more effective than paracetamol for fever reduction in symptomatic children but is unsuitable in infants < 6 months. Prophylactic paracetamol is selectively justified only in high-reactogenicity contexts (e.g., 4CMenB) or in children at risk of febrile seizures. CONCLUSIONS: Routine pre-dosing of antipyretics should be avoided. A symptom-based approach optimizes immune priming, ensures clinical safety, and supports adherence to vaccination schedules.
AIM: To evaluate whether Retinopathy of Prematurity (ROP) research cohorts should be defined exclusively by gestational age (GA) thresholds rather than the current standard of combining GA with birth weight (BW). METHODS...AIM: To evaluate whether Retinopathy of Prematurity (ROP) research cohorts should be defined exclusively by gestational age (GA) thresholds rather than the current standard of combining GA with birth weight (BW). METHODS: Literature search of publications between 1971 and 2024, and data extraction using predefined search terms and inclusion criteria. RESULTS: ROP prevalence changes notably at around 28 weeks GA, decreasing appreciably at older gestational ages. Including BW alongside GA (as is done in some ROP screening guidelines) affects the variability of ROP prevalence data and may obscure the true population-level association between GA and ROP severity. CONCLUSION: Clinical study populations for ROP research should be defined by GA thresholds only, without additional BW inclusion criteria.
Critically Appraised Summary Table (CAST) for the "Expectant Management vs Medication for Patent Ductus Arteriosus in Preterm Infants: The PDA Randomized Clinical Trial."Critically Appraised Summary Table (CAST) for the "Expectant Management vs Medication for Patent Ductus Arteriosus in Preterm Infants: The PDA Randomized Clinical Trial."
AIM: To synthesise evidence on the effectiveness, harms and benefits of different approaches to prevent early-onset Group B Streptococcus (EOGBS) and identify gaps in short and longer-term outcomes. METHODS: A two-phase...AIM: To synthesise evidence on the effectiveness, harms and benefits of different approaches to prevent early-onset Group B Streptococcus (EOGBS) and identify gaps in short and longer-term outcomes. METHODS: A two-phase rapid review. Phase 1 included an overview of systematic reviews (SRs). Phase 2 identified primary studies from SRs supplemented by additional searches. Outcomes included screening effectiveness, maternal and neonatal health outcomes and reported harms or benefits. RESULTS: Phase 1 identified three moderate-high quality reviews; 78 primary studies met phase 2 eligibility criteria. Any prevention strategy reduced EOGBS incidence, all-cause early-onset sepsis (EOS) and EOGBS-related mortality compared to no strategy. Universal screening was more effective in reducing EOGBS and all-cause EOS compared with risk-based approaches, with no evidence of any difference between the approaches for non-GBS EOS incidence or EOGBS-related mortality. Evidence was low to very-low certainty. Other neonatal outcomes (meningitis, pneumonia, late-onset GBS or maternal outcomes) were limited. Long-term child outcomes were under-reported. Few studies reported women's views. Protocol violations and missed opportunities were reported. CONCLUSION: Any prevention strategy reduces the incidence of EOGBS, all-cause EOS and EOGBS-related mortality compared to no strategy. Differences between universal and risk-based approaches remain unclear. Improved reporting, longer-term evaluation and implementation-focused research are needed.
AIM: The study aimed to analyse the effects and associated outcomes of noradrenaline in treating hypotension in preterm neonates. METHODS: We searched PubMed, Web of Science, and Scopus to August 2025 for randomised and...AIM: The study aimed to analyse the effects and associated outcomes of noradrenaline in treating hypotension in preterm neonates. METHODS: We searched PubMed, Web of Science, and Scopus to August 2025 for randomised and observational studies on noradrenaline use in preterm neonates. The studies were summarised without statistical pooling. RESULTS: Of 202 screened abstracts, eight studies (one randomised controlled trial [RCT], seven observational) were included. In total, 340 preterm infants were treated with noradrenaline. Sample sizes ranged from 21 to 70. The risk of bias was low in the RCT and moderate to critical in the observational studies. Mortality was similar in the RCT and lower in one observational study comparing noradrenaline to dopamine, although evidence certainty was very low. Evidence for bronchopulmonary dysplasia, intraventricular haemorrhage, and necrotising enterocolitis was limited and showed no consistent differences between treatments. Noradrenaline consistently increased mean blood pressure within hours, but the effect on heart rate was modest. CONCLUSION: Noradrenaline increases blood pressure and improves perfusion markers in preterm infants with hypotensive shock. However, evidence comparing it with dopamine is limited and of very low certainty. Noradrenaline may be effective, but robust comparative studies are needed to confirm its safety and efficacy, especially in extremely preterm infants.
AIM: To investigate the impact of different tourniquet pressures and application durations on venous diameter and compliance in children, in order to optimise conditions for peripheral intravenous catheter insertion. MET...AIM: To investigate the impact of different tourniquet pressures and application durations on venous diameter and compliance in children, in order to optimise conditions for peripheral intravenous catheter insertion. METHODS: This non-randomised clinical study included 21 healthy children aged 6-10 years. Vein diameter was measured using ultrasound. The force required to fully compress the vein was measured with a pressure-sensing device. Tourniquet pressures of 20-100 mmHg were applied for 60 s, with measurements every 10 s. Data were analyzed using non-parametric methods to assess changes over time and correlations between variables. RESULTS: Vein diameter changed significantly over time at all applied pressures. All tourniquet pressures showed a significant reduction in venous compliance. Substantial interindividual variation was observed in the pressure and timing that yielded optimal changes in vein diameter and compliance. Vein diameters ranged from 1 to 5 mm, with no consistent correlation with age or body weight. CONCLUSION: Paediatric tourniquet application markedly increases venous diameter and reduces venous compliance. The substantial interindividual variation in these responses motivates individualised rather than universal approaches. Future research should aim to develop practical techniques to assess and optimise venous conditions, thereby improving the success rate of paediatric intravenous catheter insertion.