Discipline of Paediatrics and Child Health

Child, Australia

Discipline of Paediatrics and Child Health

Child, Australia
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Wen L.M.,University of Sydney | Baur L.A.,Discipline of Paediatrics and Child Health | Rissel C.,University of Sydney | Flood V.M.,University of Wollongong
Archives of Pediatrics and Adolescent Medicine | Year: 2011

Objective: To assess the effectiveness of a home-based early intervention on infant feeding practices and "tummy time" for infants in the first year of life. Design: Randomized controlled trial with follow-up measures scheduled at 6 and 12 months. Setting: Socially and economically disadvantaged areas of Sydney, Australia. Participants: We recruited 667 first-time mothers and their infants in 2007 and 2008. Interventions: The intervention consisted of 5 or 6 home visits from a specially trained research nurse delivering a staged home-based intervention in the antenatal period and at 1, 3, 5, 9, and 12 months. Main Outcome Measure: Changes in infant feeding practices and "tummy time." Results: The intervention group had a significantly higher median duration of breastfeeding at 12 months than the control group (17 weeks [95% confidence interval, 13.9-20.4 weeks] vs 13 weeks [95% confidence interval, 10.1-15.0 weeks]; P=.03). Compared with the control group, the hazard ratio for stopping breastfeeding in the intervention group was 0.82 (95% confidence interval, 0.68-0.99). The intervention also resulted in a significantly later introduction of solid foods (P<.001 for trend), reducing the proportion of mothers who introduced solids before 6 months by 12% (95% confidence interval, 4%-20%) from 74% to 62%. The intervention also decreased the age at which infants started tummy time (P=.03 for trend) and increased the daily practice of tummy time by 7% from 76% to 83% (P=.05). Conclusion: The home-based early intervention delivered by trained community nurses significantly improved some infant feeding practices and resulted in earlier daily practice of tummy time. Trial Registration: anzctr.org.au Identifier: ACTRNO12607000168459. ©2011 American Medical Association. All rights reserved.

Baur L.A.,Discipline of Paediatrics and Child Health | Baur L.A.,Childrens Hospital at Westmead | Fitzgerald D.A.,Discipline of Paediatrics and Child Health | Fitzgerald D.A.,Childrens Hospital
Journal of Paediatrics and Child Health | Year: 2010

The prevalence of severe obesity and associated co-morbidities is increasing in adolescence. Although support for long-term whole-of-family lifestyle change is the mainstay of paediatric obesity treatment, there is increasing recognition of the place of other therapies, including bariatric surgery, in the management of severely obese adolescents. While there are rising numbers of reports of bariatric surgery in adolescents, there are as yet no Australian or New Zealand recommendations available to guide decisions as to which adolescents should receive such surgery and how they should best be managed. This paper presents a summary of the recommendations that are contained within the full position paper developed on behalf of the Royal Australasian College of Physicians Paediatric Policy and Advocacy Committee Working Party on Bariatric Surgery for Adolescents, working in conjunction with the Australia and New Zealand Association of Paediatric Surgeons and the Obesity Surgery Society of Australia and New Zealand. © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Kozlowska K.,Childrens Hospital at Westmead | Kozlowska K.,Brain Dynamics Center | Kozlowska K.,Discipline of Paediatrics and Child Health
Current Opinion in Psychiatry | Year: 2013

PURPOSE OF REVIEW: Functional somatic symptoms (FSS) are common in children and adolescents, but explanatory models that synthesize research findings are lacking. This article reviews the studies published from January 2012 to March 2013 that investigate the neurophysiological mechanisms that may underlie FSS. RECENT FINDINGS: Studies from diverse medical disciplines suggest that FSS are associated with functional differences in hypothalamic-pituitary-adrenal function, imbalances in vagal-sympathetic tone, upregulation of immune-inflammatory function, and primed cognitive-emotional responses that serve to amplify reactivity to threatening stimuli, thereby contributing to the subjective experience of somatic symptoms. SUMMARY: FSS appear to reflect dysregulations of the stress system. When seemingly disparate research findings are interpreted together within an overarching 'stress-system' framework, a coherent explanatory model begins to emerge. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Lutz T.L.,University of Sydney | Lutz T.L.,Royal Prince Alfred Hospital | Elliott E.J.,Discipline of Paediatrics and Child Health | Jeffery H.E.,University of Sydney | Jeffery H.E.,Royal Prince Alfred Hospital
Pediatric Research | Year: 2016

Background:The incidence of sudden unexpected early neonatal death (SUEND) or acute life-threatening events (ALTEs) is reported as 0.05/1,000 to 0.38/1,000 live births. There is currently no national system in Australia for reporting and investigating such cases.Methods:A 3-y prospective, national surveillance study, run in collaboration with the Australian Pediatric Surveillance Unit (APSU). Data were provided by pediatricians reporting to APSU; and independently ascertained by the Coroner in two states (NSW and QLD) and the Newborn Early Transport Network in NSW. A detailed deidentified questionnaire was created.Results:In NSW and QLD, the incidence was 0.1 and 0.08/1,000 live births, respectively. Forty-eight definitive cases were identified. Common causes included accidental asphyxia, cardiac disease, persistent pulmonary hypertension of the newborn, and sudden infant death syndrome. Twenty-six babies collapsed on day 1 and 19 were found on the carer's chest.Conclusion:The incidence in NSW and QLD is higher than previously published. The first postnatal day is a vulnerable period for newborns, who require close observation particularly during skin-to-skin contact. Development and implementation of guidelines for safe sleeping in hospital are needed. Collaboration between obstetricians, midwives, and pediatricians is essential to ensure safety of the newborn. Copyright © 2016 International Pediatric Research Foundation, Inc.

Bartelink I.H.,University Utrecht | Bartelink I.H.,Leiden University | Boelens J.J.,University Utrecht | Bredius R.G.M.,Leiden University | And 11 more authors.
Clinical Pharmacokinetics | Year: 2012

Background and Objectives: The wide variability in pharmacokinetics of busulfan in children is one factor influencing outcomes such as toxicity and event-free survival.Ameta-analysis was conducted to describe the pharmacokinetics of busulfan in patients from 0.1 to 26 years of age, elucidate patient characteristics that explain the variability in exposure between patients and optimize dosing accordingly. Patients and Methods: Data were collected from 245 consecutive patients (from 3 to 100 kg) who underwent haematopoietic stem cell transplantation (HSCT) in four participating centres. The inter-patient, interoccasion and residual variability in the pharmacokinetics of busulfan were estimated with a population analysis using the nonlinear mixed-effects modelling software NONMEM VI. Covariates were selected on the basis of their known or theoretical relationships with busulfan pharmacokinetics and were plotted independently against the individual pharmacokinetic parameters and the weighted residuals of the model without covariates to visualize relations. Potential covariates were formally tested in the model. Results: In a two-compartment model, body weight was the most predictive covariate for clearance, volume of distribution and inter-compartmental clearance and explained 65%, 75% and 40% of the observed variability, respectively. The relationship between body weight and clearance was characterized best using an allometric equation with a scaling exponent that changed with body weight from 1.2 in neonates to 0.55 in young adults. This implies that an increase in body weight in neonates results in a larger increase in busulfan clearance than an increase in body weight in older children or adults. Clearance on the first day was 12% higher than that of subsequent days (p < 0.001). Inter-occasion variability on clearance was 15%between the 4 days. Based on the final pharmacokinetic-model, an individualized dosing nomogram was developed. Conclusions: The model-based individual dosing nomogram is expected to result in predictive busulfan exposures in patients ranging between 3 and 65 kg and thereby to a safer and more effective conditioning regimen for HSCT in children. © 2012 Springer International Publishing AG. All rights reserved.

Barnes M.,Childrens Hospital at Westmead | Britton P.N.,Childrens Hospital at Westmead | Britton P.N.,Discipline of Paediatrics and Child Health | Singh-Grewal D.,Childrens Hospital at Westmead | Singh-Grewal D.,Discipline of Paediatrics and Child Health
Journal of Paediatrics and Child Health | Year: 2013

Within a 3-month period, two infants presented non-specifically to hospital and rapidly progressed developing flaccid paralysis. Both children were diagnosed with infant botulism. We briefly review these two cases and discuss the diagnostic and management issues involved with this rare childhood disease. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Jones C.A.,Discipline of Paediatrics and Child Health | Jones C.A.,University of Sydney | Jones C.A.,Childrens Hospital at Westmead | Raynes-Greenow C.,Discipline of Paediatrics and Child Health | And 3 more authors.
Clinical Infectious Diseases | Year: 2014

Background. Neonatal herpes simplex virus (HSV) infection is uncommon, but mortality after disseminated disease and morbidity after encephalitis are high. For the last decade, increased dose and duration of acyclovir has been advised to prevent disease progression and recurrence. We sought to determine prospectively the epidemiologic, clinical, and secular trends of this condition in Australia. Methods. This was prospective national active surveillance for neonatal HSV disease through the Australian Paediatric Surveillance Unit from 1997 to 2011. Case notification triggered a questionnaire requesting de-identified data from the pediatric clinician. Results. We identified 131 confirmed cases of neonatal HSV disease in 15 years from 261 notifications (95% response). The reported incidence (3.27 cases per 100 000 live births overall; 95% confidence interval [CI], 2.73-3.86) was stable. Overall mortality was 18.8% (95% CI, 12.1-25.5); the mortality rate was significantly lower in the latter part of the study period, 2005-2011, compared with 1997-2004 (P = .04). There were significantly more young mothers (<20 years of age) compared with Australian birth record data (18.5% vs 4.8%; P < .001). HSV-1 infection was more common than HSV-2 (62.7% vs 37.3%; P < .001), and the rate of HSV-1 infections increased significantly over the surveillance period (P < .05). From 2002, most infants received high-dose acyclovir. The time from symptom onset to initiation of therapy in survivors did not change over time. Conclusions. Mortality from neonatal HSV infection has fallen but remains high. HSV-1 is the major serotype causing neonatal disease in Australia. Young mothers represent an important target group for prevention. © The Author 2014.

Walker K.,Childrens Hospital at Westmead | Walker K.,Discipline of Paediatrics and Child Health | Walker K.,University of Sydney | Halliday R.,Childrens Hospital at Westmead | And 5 more authors.
Journal of Paediatrics and Child Health | Year: 2013

Aim To compare the developmental outcome of infants with oesophageal atresia with or without trachea-oesophageal fistula (OA/TOF) who underwent surgery in early infancy with healthy control infants in New South Wales, Australia. Methods Infants diagnosed with OA/TOF requiring surgical intervention were enrolled prospectively between 1 August 2006 and the 31 December 2008. Healthy control infants were enrolled in the same time period. The children underwent a developmental assessment at 1 year of age (corrected) using the Bayley Scales of Infant and Toddler Development (Version III). Results Of 34 infants with OA/TOF that were enrolled, 31 had developmental assessments. The majority (75%) were term infants (≥37 weeks gestation) with a mean birth weight of 2717 g. Fourteen infants (44%) had an associated birth defect and one infant with multiple associated anomalies subsequently died. Developmental assessments were also performed on 62 control infants matched for gestational age. Infants with OA/TOF had a mean score significantly lower on the expressive language subscale (P < 0.05) compared with the control infants. Conclusions This study found a lower than expected developmental score for infants following surgery for OA/TOF in the expressive language subscale compared with the healthy control infants. These findings support concerns over the potential impact of OA/TOF and its effects on development. Further studies, including continuing developmental review to determine whether these differences persist and their functional importance, should be performed. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Lam L.T.,University of Sydney | Lam L.T.,Discipline of Paediatrics and Child Health | Lam L.T.,The Hong Kong Institute of Education
Child and Adolescent Psychiatry and Mental Health | Year: 2014

Background: This study aims to investigate the association between mental health literacy and the mental health status, particularly depression, among adolescents. Methods: This was a population-based health survey utilising a two-stage sampling technique. Mental health literacy was measured by the Australian National Mental Health Literacy and Stigma Youth Survey with the depression vignette only. Depression was assessed by the Depression sub-scale of the Depression, Anxiety, Stress Scale. Data were analysed using multiple logistic regression modelling techniques with adjustment for cluster sampling effect. Results: A total of 1678 students responded to the survey providing usable information. Only 275 (16.4%) respondents were classified as having an adequate mental health literacy level with correct identification of depression and also intended to seek help, with 392 (23.4%) of the total sample correctly identified the vignette as depression. Two hundred and forty eight (14.8%) were classified to have moderate to severe depression. Multiple logistic regression analysis results suggested that young people who had experienced moderate to severe level of depression in the week prior to the survey were more likely to have an inadequate level of MHL (OR = 1.52, 95% C.I. = 1.01-2.31) after adjusting for a potential confounding factors and cluster sampling effects. Conclusions: Results suggested that mental health literacy level was associated with mental health status, particularly depression of young people. The results have important implications, both clinically and on a population level, on the prevention of mental health problems and for the improvement of the mental health status of adolescents. © 2014 Lam; licensee BioMed Central Ltd.

Chang A.B.,Charles Darwin University | Chang A.B.,Royal Childrens Hospital | Van Asperen P.P.,Discipline of Paediatrics and Child Health | Glasgow N.,Australian National University | And 10 more authors.
Chest | Year: 2015

BACKGROUND: Chronic cough is associated with poor quality of life and may signify a serious underlying disease. Differentiating nonspecific cough (when watchful waiting can be safely undertaken) from specific cough (treatment and further investigations are beneficial) would be clinically useful. In 326 children, we aimed to (1) determine how well cough pointers (used in guidelines) differentiate specific from nonspecific cough and (2) describe the clinical profile of children whose cough resolved without medications (spontaneous resolution). METHODS: A dataset from a multicenter study involving children newly referred for chronic cough (median duration, 3-4 months) was used to determine the sensitivity, specificity, predictive values, and likelihood ratios (LRs) of cough pointers (symptoms, signs, and simple investigations [chest radiography, spirometry]) recommended in guidelines. RESULTS: The pretest probability of specific cough was 88%. The absence of false-positive results meant that most pointers had strongly positive LRs. The most sensitive pointer (wet cough) had a positive LR of 26.2 (95% CI, 3.8-181.5). Although the absence of other individual pointers did not change the pretest probability much (negative LR close to 1), the absence of all pointers had a strongly negative LR of 0 (95% CI, 0-0.03). Children in the resolved spontaneously group were significantly more likely to be older, to be non-Indigenous, and to have a dry cough and a normal chest radiograph. CONCLUSIONS: Children with chronic dry cough without any cough pointers can be safely managed using the watchful waiting approach. The high pretest probability and high positive LRs of cough pointers support the use of individual cough pointers to identify high risk of specific cough in pediatric chronic cough guidelines. TRIAL REGISTRY: Australian New Zealand Clinical Trials Registry; No.: 12607000526471; URL: www.anzctr.org.au. © 2015 American College of Chest Physicians.

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