J Paediatr Child Health
· 2026 May · PMID 42083133
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AIM: Community-acquired pneumonia (CAP) remains a major cause of morbidity in children. Although severity assessment tools are available, they are not specifically designed to predict the development of a broad spectrum...AIM: Community-acquired pneumonia (CAP) remains a major cause of morbidity in children. Although severity assessment tools are available, they are not specifically designed to predict the development of a broad spectrum of pulmonary and systemic complications. This study aimed to identify admission factors associated with complicated pneumonia (CP) in hospitalized children with CAP and to develop a practical risk scoring model for early risk stratification. METHODS: Patients hospitalized with CAP were classified into two categories: uncomplicated CAP and complicated pneumonia. Independent predictors for the development of complicated pneumonia were identified. RESULTS: Multivariate logistic regression identified the following as independent risk factors for complicated pneumonia: older age (OR: 1.011; p < 0.001), hypotension (OR: 28.083; p < 0.001), altered mental status (OR: 5.033; p = 0.024), low haemoglobin values (OR: 0.835; p = 0.015), leukopenia (OR: 3.197; p = 0.040), increased neutrophil-to-lymphocyte ratio levels (OR: 1.045; p = 0.049), hyponatremia (OR: 2.840; p < 0.001), hypoalbuminemia (OR: 6.489; p < 0.001) and increased C-reactive protein levels (OR: 1.034; p = 0.039). The scoring system demonstrated a sensitivity of 82% and a specificity of 79%. CONCLUSIONS: We identified admission characteristics associated with the development of pulmonary and systemic complications in hospitalized children with CAP and developed a complication-focused risk scoring model based on routinely available parameters. The model showed good performance within this retrospective cohort and may support early risk stratification. Prospective multicentre validation is required to confirm its generalizability and clinical utility.
Peart SR, Haj-Yahya R, Nugent M
… +5 more, Ganbold O, Harbinson L, Jly C, Manley BJ, Whitehead CL
J Paediatr Child Health
· 2026 Jun · PMID 42068116
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BACKGROUND: Preterm birth rates may have been affected during the COVID-19 pandemic but the impact of this on perinatal morbidity is unknown. AIM: To review the impact of the COVID-19 pandemic on rates of preterm birth a...BACKGROUND: Preterm birth rates may have been affected during the COVID-19 pandemic but the impact of this on perinatal morbidity is unknown. AIM: To review the impact of the COVID-19 pandemic on rates of preterm birth and perinatal mortality. METHODS: Medline, Embase, and online pre-prints were searched from Jan 2020 to Oct 2022. Case-control, cohort studies and reports comparing rates of preterm birth, stillbirth and neonatal death before and during the COVID-19 pandemic period were included. The pooled odds ratio (OR) for preterm birth, stillbirth and neonatal death was calculated using a random effects model. The primary outcome was the rate of preterm birth, stillbirth and neonatal death in the pre-pandemic and pandemic periods. RESULTS: 100 studies were included. Compared with pre-pandemic periods, there was a decrease in preterm births during the pandemic period: OR 0.95 (95% CI 0.94-0.97) I = 0.93, with the greatest reduction for births < 28 weeks' gestation in high-income countries: OR 0.92 (95% CI 0.88-0.96), I = 0.46. There was a reduction in neonatal deaths in high-income countries: OR 0.78 (95% CI 0.64-0.95), I = 0.4. In low- and middle-income countries the stillbirth rate increased during the pandemic compared with the pre-pandemic period: OR 1.18 (95% CI 1.02-1.36), I = 0.86. CONCLUSION: The COVID-19 pandemic was associated with a reduction in preterm births and neonatal deaths. Further research is needed to investigate the mechanisms underlying these findings. Stillbirth rates increased in low- and middle-income countries where access to healthcare may have been restricted and strategies to address this in future pandemics are warranted.
Driver B, Babl FE, Cheng D
… +7 more, Gelbart B, Long E, McNab S, Osowicki J, Salib P, Williams A, Haeusler GM
J Paediatr Child Health
· 2026 May · PMID 42068108
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Early recognition and treatment of paediatric sepsis has been shown to improve survival. Automated sepsis alerts embedded in electronic medical records (EMRs) offer real-time identification of high-risk patients and may...Early recognition and treatment of paediatric sepsis has been shown to improve survival. Automated sepsis alerts embedded in electronic medical records (EMRs) offer real-time identification of high-risk patients and may improve timeliness of sepsis care, with possible limitations including overdiagnosis, overtreatment and alert fatigue. It is currently unclear whether automated alerts improve clinical outcomes in paediatric sepsis. We conducted a systematic review and narrative synthesis of studies evaluating clinical outcomes (mortality, PICU admission rate, length of stay), process measures (time to fluids/antibiotics, bundle adherence), and balancing measures (hospitalisation rate, antibiotic use) after implementation of EMR-based automated sepsis alerts in patients under 18 years of age. Twelve studies met inclusion criteria. Automated alerts were associated with improvements in process measures, notably reduced time to antibiotics (4/6 studies) and fluids (2/5 studies). Mortality was reduced in one study of PICU patients (29.9% vs. 17.4%, p = 0.011), and a trend towards reduced PICU admissions was observed. No significant impact on hospital or PICU length of stay was noted. Alerts did not increase hospital admission rates or antibiotic usage. Automated sepsis alerts may improve time to fluids and antibiotics in paediatric sepsis. While inconsistently reported, alerts were not found to increase hospital admission rates or antibiotic use. The impact on clinical outcomes, particularly mortality, remains uncertain. High quality randomised studies are needed to define their role in improving paediatric sepsis outcomes.
Parry G, Abelian A, Williams CCE
… +3 more, Roberts LE, Athersmith M, Oni L
J Paediatr Child Health
· 2026 Jun · PMID 42046265
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INTRODUCTION: Placebo-controlled trials can provide strong evidence on safety and efficacy, but their ethical acceptability in paediatric research is contested because children have limited decisional capacity and placeb...INTRODUCTION: Placebo-controlled trials can provide strong evidence on safety and efficacy, but their ethical acceptability in paediatric research is contested because children have limited decisional capacity and placebo use may entail withholding effective therapy. OBJECTIVE: To identify the ethical and methodological conditions under which placebo controls are acceptable in paediatric clinical trials, using a systematic review of the literature and regulatory guidance. METHODS: We searched Medline, Scopus and Embase for sources addressing the ethics, acceptability or regulation of placebo use in paediatric trials. We extracted study characteristics and ethical arguments, mapped them to beneficence, non-maleficence, autonomy and justice, and then synthesised findings using Emanuel, Wendler and Grady's seven requirements for ethical clinical research. We also obtained expert guidance from UK, USA and European regulators. RESULTS: We included 51 sources spanning neonatal research, disease-specific paediatric contexts, parental perspectives and general ethics/regulatory discussions. Placebo was generally considered acceptable when methodologically necessary and scientifically sound, when no proven effective therapy was withheld (or any withholding carried minimal incremental risk), and when safeguards such as rescue therapy, early escape, and close monitoring were in place. Common emphases included limits on non-beneficial risk in children, assent and parental permission, and fair participant selection. CONCLUSION: Placebo use in paediatric trials is acceptable only under constrained conditions centred on scientific necessity, minimising harm from withholding therapy, robust safeguards and appropriate permission/assent processes. Further work should translate these conditions into disease-specific, operational guidance.
AIM: This study explored whether a single music therapy session could reduce 22q11.2 deletion syndrome (DS) children and adolescents' clinic-related anxiety when visiting the hospital outpatient clinic for health appoint...AIM: This study explored whether a single music therapy session could reduce 22q11.2 deletion syndrome (DS) children and adolescents' clinic-related anxiety when visiting the hospital outpatient clinic for health appointments. METHODS: The research employed a within-subjects, single-session, intervention design. The effect of the 30-min music therapy session on children and adolescents' (henceforth children) anxiety was assessed at baseline and the end of the session. A triangulated approach examined children's anxiety through parent and child self-report questionnaires, electrocardiograph (heart rate) and observational behavioural measures. RESULTS: Children's self-reported anxiety was low and did not significantly change pre-post session, while parent/caregiver perceptions of their child's anxiety significantly decreased. Significant reduction in the frequency of anxious eye-gaze behavior and face and bodily expressions, and an increase in non-anxious behaviours and expressions were observed pre-post the session. Heart rate did not significantly decrease pre-post the music therapy session. Up to a week after the session, parents/caregivers reported a pronounced change in their child's overall anxiety after the session and a substantial improvement in their usual overall clinic experience that day. CONCLUSION: The findings from parent/caregiver reports and behavioural observations suggest that the music therapy session regulated the children's clinic-related anxiety, with parents/caregivers perceiving benefits extending post-session. However, these findings did not neatly align with children's self-reported anxiety and heart rate data, possibly reflecting characteristics of the population and measurement challenges. Active engagement in musical experiences with a skilled facilitator, such as a music therapist, might offer a safe and potentially inexpensive non-pharmacological approach to reducing hospital clinic-related anxiety in 22q11.2 (DS) children and adolescents, and enhance the clinic experience.
Thanalingam Y, Hamm L, Russell J
… +2 more, Muir C, Langridge F
J Paediatr Child Health
· 2026 May · PMID 42023705
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INTRODUCTION: The global rise in neurodevelopmental conditions (NDD), alongside increased life expectancy for affected individuals, underscores the critical importance of effective transition from paediatric to adult hea...INTRODUCTION: The global rise in neurodevelopmental conditions (NDD), alongside increased life expectancy for affected individuals, underscores the critical importance of effective transition from paediatric to adult healthcare. The transition between paediatrics and adults is an important stage to consider for emotional, psychosocial and psychological development. This scoping review aimed to summarise published literature on current tools and strategies designed to support the transition of young adults with NDD. METHODS: A comprehensive literature search was conducted using MEDLINE, Embase, and PsychInfo via the OVID platform. Studies were included if they described interventions that facilitated the transition of young adults with NDD from child- to adult-centred health services. Screening and data extraction were performed independently by two reviewers per published study. Findings were synthesized using descriptive statistics and thematic analysis. RESULTS: Out of 1876 records, 61 studies met inclusion criteria, the majority originating from the USA (66%). Five key intervention types emerged: education (62%), facilitation of paperwork (59%), transition clinics (57%), transition coordinators (33%), and clinical guidelines (7%). Only 38% of studies incorporated young people in the design of interventions, and only 8% addressed cultural considerations. Implementation was reported in 59% of studies, with 57% providing outcome evaluations; however, heterogeneity in measures limited assessment of efficacy. CONCLUSION: This scoping review highlights while tools and strategies exist, future efforts should focus on culturally informed, youth-centred approaches underpinned by consistent outcome measures. A holistic, relationship-based model-engaging families, young people, and health professionals-is essential for successful and sustainable transitions in care.
Kleidon TM, de Souza S, Kuerten Rocha P
… +6 more, Comber E, Cunninghame J, Hyun A, da Silva Moura JW, Ullman AJ, Takashima M
J Paediatr Child Health
· 2026 May · PMID 42023682
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CONTEXT: Central venous access devices (CVADs) are essential in paediatric care but pose significant risks. Synthesising existing evidence is needed to guide safe, effective, and equitable practice amid evolving interven...CONTEXT: Central venous access devices (CVADs) are essential in paediatric care but pose significant risks. Synthesising existing evidence is needed to guide safe, effective, and equitable practice amid evolving interventions and complex management needs. OBJECTIVE: To develop an evidence and gap map (EGM) to identify, categorise, and visualise paediatric evidence on interventions aimed at improving CVAD outcomes. DATA SOURCES: Following Campbell Collaboration guidance, systematic searches were conducted in PubMed, CINAHL, Scopus, and CENTRAL (date limits: 2014 to 30 June 2024). STUDY SELECTION: Eligible studies included patients (0-18 years) evaluating an intervention to improve CVAD outcomes, including randomised and non-randomised trials, implementation studies, and systematic reviews. DATA EXTRACTION: Two reviewers independently screened and extracted data on CVAD type, intervention, setting, outcomes, and study design. Data were descriptively analysed and visualised in Tableau. RESULTS: Of 952 studies in the broader EGM, 151 were paediatric-specific. Most were conducted in high-income countries (72%) and high-acuity settings, including critical care (41.9%) and oncology (38.5%). CVAD type was unspecified in 80.1% of studies. Systematic reviews (22.5%) and randomised controlled trials (28.5%) were available, though 40.4% of studies were before-and-after studies without controls. Common interventions addressed infection prevention, insertion technologies, and flushing. Clinical outcomes, particularly bloodstream infection (27.8%), dominated reporting, while patient-reported, economic, and device removal outcomes were rarely reported (< 2%). LIMITATIONS: Only studies from the last 10 years and English-language databases were included. No formal quality appraisal was conducted. CONCLUSIONS: Significant evidence gaps exist. Future research should prioritise rigorous, paediatric-specific studies across diverse settings and outcome domains. TRIAL REGISTRATION: Open Science Framework (OSF) q6gcr: https://osf.io/q6gcr/overview.
BACKGROUND: Abusive head trauma is the most common cause of death in children suffering non-accidental injury (NAI). Intracranial haemorrhage can (rarely) be caused by inherited bleeding disorders. Evaluation of children...BACKGROUND: Abusive head trauma is the most common cause of death in children suffering non-accidental injury (NAI). Intracranial haemorrhage can (rarely) be caused by inherited bleeding disorders. Evaluation of children with suspected NAI and intracranial bleeding involves diagnosis or exclusion of a bleeding disorder; however, there is a paucity of evidence to guide haematological evaluation in these patients. OBJECTIVES: To determine the prevalence of inherited bleeding disorders in children with intracranial haemorrhage suspected of NAI and determine which tests have the highest diagnostic yield. METHODS: We conducted a retrospective cohort study of children referred to the Child Protection Unit at Sydney Children's Hospital, Australia, between 2011 and 2020 with intracranial haemorrhage. Descriptive analyses of the data were completed. RESULTS: A total of 120 children were included in the cohort. Eighty-seven (73%) had a baseline coagulation screen (FBC, PT and APTT) performed with initial pathology testing within 72 h of presentation. Three children (2.5%) were identified to have an underlying inherited bleeding disorder, all of whom (100%) had a prolonged APTT on initial testing. CONCLUSION: An extensive array of haematological investigations was performed, but with a lack of consistency. Three patients were identified to have an inherited bleeding disorder, including haemophilia A, haemophilia B and von Willebrand disease, two of whom were confirmed NAI regardless. All three had abnormal APTT on the initial coagulation screen. We propose initial haematological screening with FBC, PT/APTT/fibrinogen only, unless bleeding risk factors are identified. If an abnormality is detected, subsequent factor levels and further haematological investigations are recommended.
AIMS: This is the study protocol of an ongoing prospective randomised controlled trial (RCT) designed to assess the safety and efficacy of early enteral nutrition after elective enterostomy closure in children, written i...AIMS: This is the study protocol of an ongoing prospective randomised controlled trial (RCT) designed to assess the safety and efficacy of early enteral nutrition after elective enterostomy closure in children, written in accordance with the SPIRIT guidelines. MATERIALS AND METHODS: This is a multicentre, RCT that will be conducted in two Australian tertiary paediatric hospitals with a planned sample size of 68. Children that meet the inclusion criteria aged between 3 months and 16 years (inclusive) undergoing an elective enterostomy closure will be invited to participate. To assign treatment group, stratified permutated block randomisation will be used, with block sizes of four and six, and strata including: age group (3 months-< 6 years, 6-≤ 16 years); stoma type (ileostomy, colostomy); and hospital (Sydney Children's Hospital, Randwick, The Children's Hospital at Westmead). The control group will commence feeds on return of bowel function or when nasogastric tube aspirates are non-bilious. The intervention group will be offered feeds within 24 h of admission to the recovery room. The primary outcome is the length of stay, measured in hours. Secondary outcomes include time to oral feeds, time to first spontaneous passage of stool, highest post-operative pain score, complications, analgesia use and parent satisfaction. Data analyses will use an intention-to-treat principle. Length of stay, time to feeds and passing of stool will be analysed using restricted mean survival time. Other secondary outcomes will be analysed using regression models.
J Paediatr Child Health
· 2026 Jun · PMID 41992475
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AIM: The aim of this study was to evaluate the knowledge of child and adolescent psychiatrists (CAP) and other physicians working with paediatric patients (paediatrics and paediatric surgery) on delirium. METHODS: To mea...AIM: The aim of this study was to evaluate the knowledge of child and adolescent psychiatrists (CAP) and other physicians working with paediatric patients (paediatrics and paediatric surgery) on delirium. METHODS: To measure the level of knowledge about delirium, participants were asked to complete an online questionnaire consisting of 17 statements developed by paediatric delirium experts at Johns Hopkins Hospital, which were asked to be evaluated as true/false. RESULTS: Of the 249 physicians who participated in the study, 57% (n = 141) were in the CAP group and 43% (n = 108) were in the other doctor group. The median total number of correct answers to the questions was significantly higher in the CAP group (15 [14, 15]) than in the other doctor group (14 [12-15]). The most significant knowledge gap relates to delirium treatment, with 68% of paediatric and paediatric surgery physicians believing that benzodiazepines are frequently recommended for delirium treatment. CONCLUSIONS: It was found that physicians working with children may have misinformation about the risk factors, diagnosis and management of delirium and that there may be differences between specialties. Recalling missing information about delirium and correcting misconceptions will be of great importance in the prevention and treatment of delirium.
Catheter-associated urinary tract infections (CAUTI) are a common healthcare-associated infection in children and a major contributor to increased morbidity, prolonged hospital stays and higher healthcare costs. This nar...Catheter-associated urinary tract infections (CAUTI) are a common healthcare-associated infection in children and a major contributor to increased morbidity, prolonged hospital stays and higher healthcare costs. This narrative review uses an evidence-informed approach highlighting recent paediatric literature (2000-2025) to provide an overview of epidemiology, pathophysiology, management and prevention of CAUTI in children. Two populations are considered: children requiring short-term catheterisation (typically peri-procedural or during hospitalisation) and those requiring long-term (continuous/intermittent) catheterisation for conditions such as neurogenic bladder and/or children who have had surgery for urogenital abnormalities. Diagnosis of CAUTI can be challenging due to the high prevalence of asymptomatic bacteriuria (particularly in long-term catheterisation), non-specific symptoms and the lack of specificity of bedside tests. Prevention strategies, including judicious catheter use, adherence to aseptic technique, staff training, and implementation of CAUTI bundles, have been shown to substantially reduce the incidence of hospital CAUTI. For children with long-term catheterisation, evidence on optimal approaches to reduce risk of CAUTI remains limited, highlighting the need for further research and tailored guidelines.