McBride CA, Rahiman S, Kennedy M
… +8 more, Schlapbach LJ, Schults JA, Kleidon TM, Baveas T, Paterson R, Byrnes J, Ware RS, Ullman AJ
J Paediatr Child Health
· 2026 Jun · PMID 41978511
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AIM: To evaluate whether, in children treated in paediatric intensive care units (PICU) with peripheral venous access devices (PVADs) receiving intermediate- or high-risk peripheral intravenous medications, the use of a...AIM: To evaluate whether, in children treated in paediatric intensive care units (PICU) with peripheral venous access devices (PVADs) receiving intermediate- or high-risk peripheral intravenous medications, the use of a tissue-infiltration biosensor (ivWatch), compared to standard care, reduces extravasation injuries. METHODS: A superiority, parallel group randomised controlled trial conducted in a single Queensland quaternary hospital PICU from September 2020 to July 2022. Children with PVADs inserted in the distal half of the limb and receiving intermediate- to high-risk infusates for ≥ 24 h were randomly allocated in a 1:1 ratio to biosensor (ivWatch monitor applied within 10-15 mm of the PVAD tip) plus standard clinical observation, or standard observation alone. Primary outcome was extravasation severity on the 4-point Cincinnati Children's Hospital Medical Centre Extravasation Harm Scale. Injuries were compared between treatment groups using ordinal logistic regression. RESULTS: A total of 175 children were enrolled, 88 to biosensor and 87 to standard care. Extravasation severity was similar between groups, with no, mild and moderate injury occurring in 56 (69%), 25 (30%) and 2 (2%) participants in the biosensor group and 61 (70%), 24 (28%) and 2 (2%) in the standard care group (proportional odds ratio = 1.13; 95% CI: 0.59, 2.15, p = 0.71). No statistically significant between-group differences in extravasation severity, volume, treatment sequelae, PVADs used or dwell time were observed. The biosensor was acceptable to nurses. CONCLUSIONS: In this PICU population, biosensor monitoring in addition to standard care did not significantly reduce extravasation injuries. The technology was acceptable to bedside nursing staff. TRIAL REGISTRATION: ACTRN12620000317998.
Liu Y, Chen M, Chen Q
… +4 more, Yu J, Huang Y, Yang B, Cheng Q
J Paediatr Child Health
· 2026 Jun · PMID 41968595
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OBJECTIVE: To explore the link between prenatal blood glucose levels and neonatal heart development. METHODS: From February 2023 to January 2024, a total of 100 pregnant women with gestational diabetes mellitus (GDM) and...OBJECTIVE: To explore the link between prenatal blood glucose levels and neonatal heart development. METHODS: From February 2023 to January 2024, a total of 100 pregnant women with gestational diabetes mellitus (GDM) and their newborns at the Third Hospital of Xingtai City were studied. They were divided into two groups based on blood glucose control: good control (n = 25) and poor control (n = 75). Another 50 healthy pregnant women and their newborns served as controls. We compared blood glucose levels including fasting blood glucose (FBG), 1-h postprandial blood glucose (1hBG), 2-h postprandial blood glucose (2hBG) and glycated haemoglobin (HbA1c), and neonatal cardiac function indicators, including left ventricular ejection fraction (LVEF), aortic root diameter (AO), PA diameter, left ventricular fractional shortening (LVFS), left atrial diameter (LA), right ventricular diameter (RV), interventricular septal thickness (IVS), left ventricular end-diastolic diameter (LV), early diastolic peak velocity (E) and late diastolic peak velocity (A), among the three groups, analysed their correlations, and assessed adverse pregnancy outcomes. RESULTS: Significant differences in HbA1c, FBG, 1hBG and 2hBG were found between groups at admission and before delivery (p < 0.05). The poorly controlled and well-controlled GDM groups had higher blood glucose levels than the controls. Neonates in the poorly controlled group had higher AO, PA, LA, LV, RV and IVS than the other groups (p < 0.05). Positive correlations were observed between blood glucose levels and AO, PA, IVS (p < 0.05). Adverse outcomes, including polyhydramnios, premature rupture of membranes, postpartum haemorrhage, intrauterine distress, hyperbilirubinaemia and neonatal asphyxia, were more frequent in GDM groups (p < 0.05). CONCLUSION: Elevated prenatal blood glucose levels in GDM are associated with adverse pregnancy outcomes and neonatal heart development, with poor control having a more pronounced impact.
J Paediatr Child Health
· 2026 Jun · PMID 41963767
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AIM: The aims of this study were to estimate the incidence of ventilator-associated pneumonia (VAP), explore the patient and clinical factors associated with the diagnosis of VAP, and establish the outcomes of children w...AIM: The aims of this study were to estimate the incidence of ventilator-associated pneumonia (VAP), explore the patient and clinical factors associated with the diagnosis of VAP, and establish the outcomes of children with VAP in our paediatric intensive care unit (PICU). METHODS: This study was conducted in the PICU at the Women's and Children's Hospital, South Australia. Demographic and clinical data were collected from paper-based and electronic medical records for children aged under 18 years who were mechanically ventilated for ≥ 48 h in the PICU between 2019 and 2023. RESULTS: Two hundred and twenty patients were included in the analysis. Twenty-eight patients were clinically diagnosed with VAP, with an incidence of 12.7% and an incidence density of 13.7 per 1000 ventilator days. Patients with clinician-diagnosed VAP were mechanically ventilated for longer than those without VAP (median hours 298.50 compared to 119.50, p = < 0.001). The median hospital length of stay (LOS) was longer by 17 days (95% CI: 2.97-31.03, p = 0.018) and the median ICU LOS was longer by 14 days (95% CI: 9.64-18.36, p = < 0.001) in patients with clinician-diagnosed VAP. The use of vasoactive medications was significantly higher in those with clinician-diagnosed VAP as compared to those without (RR 2.37; 95% CI: 1.09-5.14, p = 0.030). CONCLUSIONS: The incidence of VAP in our PICU was 12.7%. Clinician-diagnosed VAP was associated with longer duration of mechanical ventilation, longer hospital and ICU LOS, and increased use of vasoactive medications.
Pam P, Safari M, Hojati A
… +2 more, Zarrin R, Faghfouri AH
J Paediatr Child Health
· 2026 May · PMID 41961895
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AIM: This systematic review and meta-analysis evaluated the effects of probiotic and synbiotic supplementation on metabolic and hepatic outcomes in children and adolescents with obesity, including those with obesity-rela...AIM: This systematic review and meta-analysis evaluated the effects of probiotic and synbiotic supplementation on metabolic and hepatic outcomes in children and adolescents with obesity, including those with obesity-related metabolic dysfunction-associated steatotic liver disease (MASLD). METHODS: A comprehensive literature search of PubMed, Scopus and Web of Science was conducted up to September 2025. Randomised controlled trials (RCTs) investigating probiotic or synbiotic supplementation in paediatric populations with obesity or MASLD were included. Data were pooled using a random-effects model, and the Cochrane Risk of Bias tool and GRADE framework were used for quality assessment. RESULTS: Thirteen RCTs (n = 848) were included. Pooled analyses demonstrated significant reductions in total cholesterol (WMD: -6.40 mg/dL, 95% CI: -8.78, -4.01), LDL-C (WMD: -2.68 mg/dL, 95% CI: -4.85, -0.50) and alanine aminotransferase (ALT) (WMD: -6.15 U/L, 95% CI: -10.14, -2.16). No significant improvements were observed in BMI z-score, waist circumference, triglycerides, HDL-C or fasting blood sugar. A significant increase in HOMA-IR was found (WMD: 0.68, 95% CI: 0.53, 0.83). Evidence certainty was high for lipid outcomes but low or very low for most other measures. CONCLUSIONS: Despite these mixed results, substantial heterogeneity and limited evidence quality underscore the need for well-designed, strain-specific trials. Probiotic and synbiotic supplementation show promise for specific metabolic outcomes in paediatric populations, though caution is warranted regarding glucose homeostasis, and personalised approaches should be considered in clinical practice.
J Paediatr Child Health
· 2026 Jun · PMID 41947550
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AIM: To describe anogenital examination findings in a large cohort seen for child sexual abuse concerns, with findings classified following current international guidelines. METHODS: Retrospective review of records of th...AIM: To describe anogenital examination findings in a large cohort seen for child sexual abuse concerns, with findings classified following current international guidelines. METHODS: Retrospective review of records of the Starship Children's Hospital child protection team for all children and adolescents (0-17 years) seen over 20 years. RESULTS: A total of 4443 children and adolescents were seen, of whom 3942 (89%) were female. The age distribution was bimodal, with a small peak in childhood and a larger peak in adolescence. Anogenital examination occurred in 2975 (67%), more often in those < 8 years (1197/1394, 86%) compared to those 8 years and older (1778/3049, 58%), p < 0.0001. The proportion examined declined steadily, from 93% in 1999 to 54% in 2018. 2263 examinations (76%) were normal, 425 (14%) had findings unrelated to sexual abuse and 287 (10%) had abnormal findings possibly related to sexual abuse. Of 1426 examined at Tanner Stage 1, 41 (3%) had abnormal findings, compared to 246/1549 (16%) at Tanner Stages 2-5. Of 16 pregnant adolescents examined, 2 (13%) had anogenital findings of previous trauma. In adolescents examined acutely where semen was observed on Gram stain, 8/17 (47%) had anogenital findings of acute trauma. CONCLUSIONS: The cohort seen for sexual abuse concerns has changed over 20 years, becoming increasingly adolescent. This has resulted in a decrease in the proportion examined and an increase in the rate of abnormal findings. Anogenital examinations are often normal in pregnancy or with semen present, reinforcing the international consensus that normal does not mean nothing happened.
Buntsma D, McNab S, Costa-Pinto JC
… +11 more, Gold L, Grant CC, Kepreotes E, Mace AO, McGee RG, Roberts K, Sypek S, Ullman AJ, Vuillermin P, Engelman D, Children's Inpatient Research Collaborative of Australia and New Zealand (CIRCAN)
J Paediatr Child Health
· 2026 May · PMID 41947339
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AIM: To develop consensus on the priorities for multi-centre, inpatient general paediatrics research in Australia and New Zealand. METHODS: The Children's Inpatient Research Collaboration of Australia and New Zealand (CI...AIM: To develop consensus on the priorities for multi-centre, inpatient general paediatrics research in Australia and New Zealand. METHODS: The Children's Inpatient Research Collaboration of Australia and New Zealand (CIRCAN) conducted a three-stage modified Delphi study consisting of three anonymous survey rounds followed by a Hanlon Process of Prioritisation. RESULTS: Participants included paediatricians, paediatric trainees, nursing, allied health staff, and academics. A moderator group (10 members) oversaw the process. In the first survey, 124 participants submitted 306 research questions which were refined to a list of 89 by the moderator group. Eighty-one respondents took part in the second and third survey rounds, leading to identification of 19 priority research questions, which were then anonymously ranked by 18 CIRCAN members through a facilitated Hanlon Process of Prioritisation. The highest ranked topics included asthma (six questions), bronchiolitis (five questions), sepsis/meningitis (four questions), as well as single questions on cellulitis, eating disorders, rehabilitation, and coordination of complex care. CONCLUSION: This prioritisation study established a consensus list of research questions. Research topics regarding respiratory conditions were most highly ranked. These results will inform multicentre inpatient general paediatric research in Australia and New Zealand.
J Paediatr Child Health
· 2026 Jun · PMID 41934220
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AIM: This study aimed to compare the diagnostic accuracy of transcutaneous bilirubin (TcB) measurements obtained from three different skin sites with total serum bilirubin (TSB) levels in preterm neonates before initiati...AIM: This study aimed to compare the diagnostic accuracy of transcutaneous bilirubin (TcB) measurements obtained from three different skin sites with total serum bilirubin (TSB) levels in preterm neonates before initiating phototherapy and to determine which site more accurately reflects TSB. METHODS: This prospective study was conducted in the neonatal unit. Transcutaneous bilirubin levels were measured using a Drager JM-105 bilirubinometer at three different skin sites-forehead, sternum, and interscapular area. Simultaneously, total serum bilirubin (TSB) was estimated using the diazo method. Neonates were excluded if they had poor perfusion, skin lesions at any of the measurement sites, or prior exposure to phototherapy. Phototherapy for preterm neonates was initiated according to the standard NICU protocols. Appropriate statistical analyses were employed. RESULTS: A total of 138 preterm neonates who developed jaundice within the first 14 days of life were enrolled. Transcutaneous bilirubin readings from all three skin sites showed significant correlation with TSB (p < 0.001), with the best correlation at the interscapular site. This site showed the highest area under the ROC curve (AUC 0.938) and highest Pearson correlation coefficient (r = 0.875). The TcB-TSB differences ranged from -2.5 to +3.2 mg/dL at the forehead, -2.5 to +1.9 mg/dL at the interscapular site, and -2.5 to +1.8 mg/dL at the sternum. Compared to the forehead and sternum, the interscapular site demonstrated less negative mean bias, indicating a lower tendency to underestimate TSB. Scatter plots also revealed a stronger linear correlation at this site. The diagnostic performance of TcB was evaluated at all three sites using a TSB threshold of 10 mg/dL. Amongst them, the interscapular site showed the highest sensitivity (97.6%, 95% CI: 93.1-100), specificity (96.8%, 95% CI: 91.9-99.6), and the lowest false-negative rate (11.4%). CONCLUSION: In preterm neonates with jaundice, the interscapular site provides a more reliable estimate of transcutaneous bilirubin compared to the forehead and sternum.
Özkaya K, Öztürk GK, Dindar BG
… +7 more, Halis E, Çoksüer F, Öğütcü A, Gacemer H, Kara GY, Ocak E, Gülen F
J Paediatr Child Health
· 2026 Jun · PMID 41928395
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RATIONALE: Cystic fibrosis (CF) is characterised by chronic inflammation and malnutrition, significantly affecting disease progression and prognosis. The haemoglobin-albumin-lymphocyte-platelet (HALP) score reflects infl...RATIONALE: Cystic fibrosis (CF) is characterised by chronic inflammation and malnutrition, significantly affecting disease progression and prognosis. The haemoglobin-albumin-lymphocyte-platelet (HALP) score reflects inflammatory and nutritional status, and has prognostic associations in various chronic diseases; its role in paediatric CF is unclear. OBJECTIVE: To evaluate the association between HALP measured during clinical stability and (i) baseline disease severity at the index assessment (FEV, MSKS, and BMI z-score), and (ii) subsequent 12-month outcomes (hospitalisation-requiring pulmonary exacerbations, PICU admission, and mortality) in children with CF. METHODS: Retrospective single-centre cohort study of 152 children with CF aged 2-18 years. HALP was calculated at clinical stability. Associations with index severity and 12-month outcomes were analysed; logistic regression for low FEV was restricted to participants with acceptable spirometry. RESULTS: Lower HALP was associated with low FEV (< 70% predicted) at the index assessment (p < 0.001) and with a higher 12-month burden of hospitalisation -requiring pulmonary exacerbations (p < 0.001). PICU admission and mortality were infrequent and analysed exploratorily; HALP was lower in these groups (PICU p < 0.001; mortality p = 0.004). In adjusted logistic regression among participants with spirometry (n = 101), HALP remained associated with low FEV, although the effect size was modest and precision limited (adjusted OR 0.886, 95% CI 0.788-0.996; p = 0.043). CONCLUSIONS: HALP, reflecting nutritional and inflammatory status, may offer prognostic information in paediatric CF. Calculation from routine blood tests could make it a practical tool for identifying higher-risk individuals and informing clinical decision-making. Further large-scale studies are needed to validate its clinical utility in CF management.
Davis B, Kaki A, Yiu EM
… +1 more, Macdonald-Laurs E
J Paediatr Child Health
· 2026 Jun · PMID 41923159
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Acquired demyelinating syndromes may present with movement disorders, including lingual dyskinesia. The differential diagnosis for abnormal tongue movements includes: acquired demyelinating syndromes, structural lesions...Acquired demyelinating syndromes may present with movement disorders, including lingual dyskinesia. The differential diagnosis for abnormal tongue movements includes: acquired demyelinating syndromes, structural lesions involving the basal ganglia, brainstem or cerebral cortex, stroke, tics, adverse drug reactions, systemic autoimmune conditions including Sydenham's chorea, and genetic conditions. In the absence of an alternative explanation, MRI brain should be undertaken in children presenting with new onset abnormal tongue movements.
J Paediatr Child Health
· 2026 Jun · PMID 41923132
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AIM: Guanfacine is a second line option for management of Attention Deficit Hyperactive Disorder (ADHD) and can be prescribed adjunctively with stimulants or as monotherapy. This medical record review evaluated prescribi...AIM: Guanfacine is a second line option for management of Attention Deficit Hyperactive Disorder (ADHD) and can be prescribed adjunctively with stimulants or as monotherapy. This medical record review evaluated prescribing practices, vital sign changes over time, and client outcomes. METHODS: This retrospective medical record review examined 171 records of clients on guanfacine modified release within the Child Development Service (CDS) in Perth, WA, between February 22, 2022, and May 5, 2022. Clients on guanfacine for one week or less were excluded; those who had ceased guanfacine at the time of review were included. RESULTS: Clinicians completed serial vital sign measurements during guanfacine titration for 92 clients (54.12%), partially completed them for 58 clients (34.12%), and did not complete them for 20 clients (11.76%). No significant changes in systolic/diastolic blood pressures or heart rate were observed following guanfacine prescription. Clients on adjunctive therapy reported fewer side effects than those on monotherapy, 26.7% vs. 50.0%, χ2 (1, N = 166) = 9.59, p = 0.02. This relationship was strongest in clients with an Autism diagnosis, 20.0% vs. 51.6%, χ2 (1, N = 61) = 6.61, p = 0.01. A similar but not significant trend was observed in children with ADHD alone, 25.8% vs. 63.6%, χ2 (1, N = 60) = 3.26, p = 0.071. CONCLUSIONS: Clients prescribed guanfacine adjunctively with stimulants reported fewer side effects compared to monotherapy, supporting early adjunctive use in suitable cases. Blood pressure and heart rate remained stable across the cohort. Serial vital sign measurement was performed in 50% of cases.
J Paediatr Child Health
· 2026 Jun · PMID 41915733
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AIM: Invasive Group A Streptococcal (iGAS) disease, associated with severe clinical outcomes and high morbidity and mortality, resurged globally following suppression during the early COVID-19 pandemic. This retrospectiv...AIM: Invasive Group A Streptococcal (iGAS) disease, associated with severe clinical outcomes and high morbidity and mortality, resurged globally following suppression during the early COVID-19 pandemic. This retrospective observational study examines the frequency and clinical characteristics of iGAS cases admitted to an Australian tertiary paediatric hospital over 5 years (1 July 2018-30 June 2023). METHODS: Data was gathered from electronic medical records of patients diagnosed with iGAS at The Children's Hospital at Westmead (CHW) during the study period. Demographic and clinical characteristics were analysed using Student T, Mann-Whitney U and Chi-squared tests. RESULTS: During the study, 61 iGAS patients were admitted to CHW. Admissions peaked in late 2018 and 2019 (22/61), declined sharply throughout 2020 and 2021 (5/61), and rose steeply in 2022 and early 2023 (34/61). The most common iGAS isolates were from blood (40%) and pleural fluid (28%), correlating with the most common iGAS diagnoses: pneumonia (41%), empyema (39%) and sepsis (28%). Many patients presented with cough (48%) and coryza (39%), with 63% of tested individuals having viral coinfections. Pre-pandemic cases showed higher peak neutrophil counts (median: 22.8 × 10/L vs. 17.1 × 10/L, p = 0.04) and ICU admission rates (64% vs. 29%, p = 0.011), while other severity indices remained similar. CONCLUSIONS: This study observed an initial decline in iGAS cases during pandemic restrictions, followed by a resurgence post-pandemic with no concurrent increase in severity. Viral coinfections were frequent, which may complicate clinical assessment, emphasising the need for heightened vigilance. The acute severity of iGAS highlights the importance of early recognition and management.
J Paediatr Child Health
· 2026 Jun · PMID 41888998
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AIM: Although short-term cardiometabolic complications are not usually expected in children with metabolically healthy obesity (MHO), subclinical vascular damage may still occur. This study aimed to evaluate Fibroblast G...AIM: Although short-term cardiometabolic complications are not usually expected in children with metabolically healthy obesity (MHO), subclinical vascular damage may still occur. This study aimed to evaluate Fibroblast Growth Factor 21 (FGF21) levels in children with obesity and their relationship with carotid intima-media thickness (CIMT) and other cardiometabolic risk factors. METHODS: Children with obesity were defined based on their metabolic health status. Children meeting all of the following criteria were categorised as MHO: High-density lipoprotein (HDL) > 1.03 mmol/L, triglycerides (TG) ≤ 1.7 mmol/L, systolic and diastolic blood pressure ≤ 90th percentile for age and height, and fasting glucose < 5.6 mmol/L. Children who did not meet one or more criteria were defined as having metabolically unhealthy obesity (MUO). Anthropometric measurements, serum FGF21 levels, biochemical tests and CIMT assessments were performed. RESULTS: The study was conducted between March and September 2024 with 64 obese and 32 healthy children aged 7-18 years. Children with MUO had the highest mean FGF21 levels. CIMT values were significantly higher in children with MUO compared with children with MHO and healthy controls, whilst no difference was observed between children with MHO and healthy controls. No significant correlation was found between FGF21 and CIMT. CONCLUSIONS: FGF21 levels were elevated in children with MUO compared with children with MHO and healthy controls. However, FGF21 does not appear to be a reliable biomarker. Further studies are required to clarify this relationship.