Paediatrics (RCH) - Research Publications

Permanent URI for this collection

Search Results

Now showing 1 - 10 of 5175
  • Item
    Thumbnail Image
    Taking Paediatrics Abroad: Working with low- and middle-income countries in a global pandemic.
    Parker, A ; Tek Chheng, E ; Nasi, T ; Orelly, T ; Aho, G ; Whitaker, S ; Weaver, J ; Phin, S ; Baker, R ; Woolfenden, S ; Currow, K (Wiley, 2021-07)
    Children and young people around the world face challenges to their health and wellbeing. In particular, in low- and middle-income countries they experience a higher burden of disease, exacerbated by global inequity limiting access to quality health care. According to the inverse care law, the availability of quality health care varies inversely to the need of the population, and hardworking health-care professionals in under-resourced countries may face impediments to continued education or subspecialty training. In line with the Sustainable Development Goals, collaborations have been developed between high-income and low- and-middle-income countries to address global disparities in health. These collaborations face challenges of high financial costs, difficulties creating long-term sustainable change, and with the emergence of the COVID-19 pandemic, border closures preventing fly-in volunteers. In this paper, we describe the development of an innovative, paediatric-specific model of care for training and support between high- and low-income countries - Taking Paediatrics Abroad Ltd. Taking Paediatrics Abroad supports the development of mutually beneficial relationships between Australian paediatric health-care professionals and paediatric health-care professionals in developing countries and remote, underserved Australian Aboriginal communities. Since May 2020, there have been over 100 sessions covering a vast array of paediatric specialties. This article explores Taking Paediatrics Abroad's model of care, its implementation and challenges, and opportunities for the future.
  • Item
    Thumbnail Image
    CSNK2B: A broad spectrum of neurodevelopmental disability and epilepsy severity
    Ernst, ME ; Baugh, EH ; Thomas, A ; Bier, L ; Lippa, N ; Stong, N ; Mulhern, MS ; Kushary, S ; Akman, CI ; Heinzen, EL ; Yeh, R ; Bi, W ; Hanchard, NA ; Burrage, LC ; Leduc, MS ; Chong, JSC ; Bend, R ; Lyons, MJ ; Lee, JA ; Suwannarat, P ; Brilstra, E ; Simon, M ; Koopmans, M ; van Binsbergen, E ; Groepper, D ; Fleischer, J ; Nava, C ; Keren, B ; Mignot, C ; Mathieu, S ; Mancini, GMS ; Madan-Khetarpal, S ; Infante, EM ; Bluvstein, J ; Seeley, A ; Bachman, K ; Klee, EW ; Schultz-Rogers, LE ; Hasadsri, L ; Barnett, S ; Ellingson, MS ; Ferber, MJ ; Narayanan, V ; Ramsey, K ; Rauch, A ; Joset, P ; Steindl, K ; Sheehan, T ; Poduri, A ; Vasquez, A ; Ruivenkamp, C ; White, SM ; Pais, L ; Monaghan, KG ; Goldstein, DB ; Sands, TT ; Aggarwal, V (WILEY, 2021-05-26)
    CSNK2B has recently been implicated as a disease gene for neurodevelopmental disability (NDD) and epilepsy. Information about developmental outcomes has been limited by the young age and short follow-up for many of the previously reported cases, and further delineation of the spectrum of associated phenotypes is needed. We present 25 new patients with variants in CSNK2B and refine the associated NDD and epilepsy phenotypes. CSNK2B variants were identified by research or clinical exome sequencing, and investigators from different centers were connected via GeneMatcher. Most individuals had developmental delay and generalized epilepsy with onset in the first 2 years. However, we found a broad spectrum of phenotypic severity, ranging from early normal development with pharmacoresponsive seizures to profound intellectual disability with intractable epilepsy and recurrent refractory status epilepticus. These findings suggest that CSNK2B should be considered in the diagnostic evaluation of patients with a broad range of NDD with treatable or intractable seizures.
  • Item
    Thumbnail Image
    Community use of paracetamol and ibuprofen in children with fever
    Kloeden, B ; Tham, D ; Oakley, E ; Cheek, J (WILEY, 2021-05-26)
    OBJECTIVE: To establish, in children aged from 3 months to less than 13 years with a febrile illness, caregiver medication usage patterns and drivers. Secondary objectives assessed caregiver knowledge and concern about fever. METHODOLOGY: This was a prospective, observational study of a convenience sample of 147 children presenting to a tertiary Paediatric Emergency Department, where the caregivers reported a concern of fever within the preceding 48 h. A paper-based survey was completed by the caregivers, and the results analysed both qualitatively and quantitatively. RESULTS: Caregivers of 92.4% had administered medication for fever in the 48 h prior to presentation. Dual therapy of paracetamol and ibuprofen was used by 45.8%, with paracetamol used more frequently as monotherapy (35.4%). Almost one-third of caregivers woke their child to administer medication. Just over one-third of respondents stated that a temperature of less than 38.0°C is a fever. The majority of caregivers (67.6%) said that fever is bad for their child, with 97.9% being concerned by fever. Almost half the children (46.8%) were given medication purely to treat the degree of the temperature. General practitioners were reported as the strongest influence on medication decision (60%). CONCLUSIONS: This study provides insight into current knowledge and practices of parents regarding fever and its treatment. The results of this study may be used to direct future interventions to educate caregivers on this topic.
  • Item
    Thumbnail Image
    Association of body composition with risk of overall and site-specific cancers: A population-based prospective cohort study
    He, Q ; Xia, B ; Liu, A ; Li, M ; Zhou, Z ; Cheung, EC ; Kuo, ZC ; Wang, B ; Li, F ; Tang, Y ; Zheng, Z ; Sun, R ; Hu, YJ ; Meng, W ; He, Y ; Yuan, J ; Zhang, C (WILEY, 2021-06-04)
    Although excess adiposity has been linked with various cancers, association between body composition and some cancers remains unclear, like lung and prostate cancers. We investigated associations of body composition with risk of overall cancer and major site-specific cancers in a prospective cohort of 454 079 cancer-free participants from UK-Biobank. Body composition was measured with bioimpedance analysis. We evaluated hazard ratio (HR) and 95% confidence interval (CI) with multivariate Cox linear and nonlinear models in men and women separately. We identified 27 794 cancers over 7.6 years of follow-up. Multivariable adjusted models including fat-free mass (FFM) and fat mass (FM) showed that FFM was positively associated with overall cancer risk in men and women (HR 1.03, 95% CI 1.01-1.04 and 1.07, 1.04-1.10, respectively); while the association between FM and overall cancer disappeared after adjusting for FFM. FFM was associated with higher risks of obesity-related cancers combined, stomach (women only), malignant melanoma, postmenopausal breast, corpus uteri, prostate, kidney (men only), and blood cancers and lower risk of lung cancer. FM was associated with higher risks of obesity-related cancers combined, esophageal, colon, lung (men only), postmenopausal breast (at the lower end of FM range), and corpus uteri cancers and lower risks of rectal, malignant melanoma (women only), prostate and blood cancers. FFM and FM seemed to have different effects on cancer risk, and the effects varied substantially by cancer type, in both direction and size. Higher FM/FFM ratio was also associated with some cancers risk, and might be a useful predictor of cancer risk.
  • Item
    Thumbnail Image
    Pediatric and adolescent gynecology through a global lens
    Roos, EJ ; Simms-Cendan, J ; Cheung, C ; Laufer, D ; Grover, SR (WILEY, 2021-05-21)
    Girls and adolescents, aged 0-19 years make up almost 30% of the world's female population yet their specific healthcare needs often slip between the gaps of pediatrics and adult women's health. Pediatric and adolescent gynecology is the clinical field that endeavors to address the reproductive health needs of this age group. The environment and psychosocial well-being, social determinants of health, have direct bearing on reproductive health, affecting menstrual cycles, menstrual hygiene, and risks for unintended pregnancy and sexually transmitted infections. This narrative review will highlight common gynecologic conditions of adolescents, especially where diagnosis and management are distinct from adult women. It will also present preventive health strategies to improve reproductive health through vaccination, improved access to hygiene supplies and contraception.
  • Item
    Thumbnail Image
    Cochrane commentaries
    Williams, K ; Sutton, J ; Brown, J (WILEY, 2021-05-19)
  • Item
    Thumbnail Image
    Suffering and the end of life
    Massie, J (WILEY, 2021-05-17)
    Relief of suffering is an important goal of medicine and aligns with the professional maxim of 'do no harm' and the bioethical principle of non-maleficence. Capturing what individuals experience or third-parties sense in terms of suffering is difficult, made harder in the patient who is too young or not able to tell us. This paper builds on the thoughts and experience of Isaacs and Preisz who open a discussion on suffering at the end of life. The discussion is extended by Tobin who recommends the use of goals of care to try to align clinician and parent expectations of what suffering might mean at the end of life. A further paper by Brancatisano makes a comment that family resource and parental suffering might inappropriately guide parental decision-making at the end of life in cases where suffering is apparent. In my piece, I add my concerns that physicians can write their own narrative about suffering which can compete against the parent's view. Furthermore, suffering can be used as a weapon for physicians to pressure parents towards the medical view.
  • Item
    Thumbnail Image
    Incidence and predictors of vascular events following end-stage kidney disease in childhood
    Le Page, AK ; Kennedy, SE ; Durkan, A ; Chaturvedi, S ; Walker, A ; Sypek, MP (WILEY, 2021-05-10)
    AIM: Cardiovascular death is a leading cause of mortality in paediatric end-stage kidney disease (ESKD). There is however little known about the clinically relevant vascular disease in this population. We aimed to describe the incidence of new onset vascular disease and vascular death in Australian children receiving renal replacement therapy (RRT). We also aimed to identify demographic or childhood risk factors for these endpoints, and whether vascular disease predicts mortality. METHODS: Data on Australian patients who commenced RRT at <18 years of age from 1991 to 2017 were extracted from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). Multivariable competing risks regression was used to identify factors associated with vascular events. RESULTS: A cohort of 1268 patients were followed up for a median of 10.31 years. Vascular disease was reported in 5.4%, and vascular death in 4.1%. The cumulative incidence of any vascular event, that is, disease or death, at 10 and 20 years was 5.5% and 12.8%, respectively. Childhood vascular events were associated with non-Caucasian, non-Indigenous ethnicity, and for the 804 patients followed up after 18 years of age, vascular events were associated with lack of childhood transplantation, longer childhood dialysis duration and Indigenous ethnicity. Vascular disease was only reported for 25.49% of patients who had a vascular death, and although a significant risk factor for mortality, it had limited ability to predict mortality. CONCLUSION: Cumulative incidence of vascular events is significant after commencing RRT during childhood and is associated with ethnicity, longer childhood dialysis duration and lack of childhood transplantation.
  • Item
    Thumbnail Image
    Lives changed: A new era for people with cystic fibrosis
    Louey, S ; Massie, J (WILEY, 2021-04-23)
  • Item
    Thumbnail Image
    Changed ophthalmic workload following introduction of digital retinal photography for retinopathy of prematurity screening
    Tram, JS ; Golding, BM ; Lim, C ; Kuschel, CA ; Elder, JE (WILEY, 2021-04-29)
    BACKGROUND: ROP screening is vital in care of premature infants but is considered burdensome, difficult and time consuming for ophthalmologists. This study assessed the reduction in workload following the introduction of nurse-led WFDRI to a large neonatal nursery. METHODS: We report a retrospective audit of 628 infants screened for ROP in the years 2010, 2013 and 2019 at the Royal Women's Hospital, Victoria. The last complete year of screening for ROP using binocular indirect ophthalmoscopy (BIO) alone (2010) was compared with two subsequent years after the introduction of nurse-led WFDRI. The main outcome measures were the time taken to report and document WFDRI and the time taken to undertake BIO examination of a premature infant and document the results. RESULTS: The ophthalmologist's time taken to conduct BIO, review images and document the results per 100 patient examinations was reduced from 16.7 hours before introduction of WFDRI to 3.7 hours. Similarly, the weekly time spent on this component of ROP screening fell from 2.3 hours per week to 0.8 and 1.0 hours per week after introduction of WFDRI. CONCLUSIONS: The introduction of nurse-led WFDRI has resulted in a dramatic and sustained reduction in ophthalmologist workload involved in ROP screening in a large Australian neonatal nursery. This may result in improved retention of the ophthalmic workforce required to undertake ROP screening.