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Aim: To summarise and critique existing knowledge and evidence relating to the utility, and post‐insertion complications surrounding tunnelled non‐cuffed central venous catheters (tncCVCs) in infants. Methods: A scoping review of original research studies reporting the use of, and post‐insertion complications associated with, tncCVCs in infants was completed. MeSH terms were used to formulate a systematic search, and data were extracted using a customised data extraction form. Data were analysed descriptively across key themes based on the research questions. Study quality was evaluated using the Mixed Methods Appraisal Tool. Results: The systematic search generated 3994 studies, of which 9 studies met final inclusion criteria. Studies included 644 tncCVCs in infants based in the USA, Europe and Australia. Most studies were retrospective cohort studies. The most common vein of insertion, where individually specified, was the internal jugular (n = 177). Tunnel length, where reported, was 2.5–5 cm. Infection rates were most commonly reported (eight studies), with results ranging from 0 to 12.8%, and device dislodgements of up to 20% reported. Participant follow‐up and definition of complications varied greatly between studies. Study quality across all papers was sound. Conclusions: This review has identified only a small number of studies, with small participant numbers, reporting the performance of tncCVCs in infants. Definitions of complications measured varied significantly between studies, and vastly different patient follow‐up protocols were reported. Further larger‐scale studies on the performance of tncCVC, employing internationally recognised reporting standards is warranted to ensure clinicians can make informed choices for medication and infusion delivery. [ABSTRACT FROM AUTHOR]

Tissue samples may be collected from children in the course of their clinical care, or when they participate in research. Those samples may be stored in research biobanks. However, as the removal of tissue from children in Australia is regulated by State and Territory legislation, clinicians and researchers require an understanding of the regulatory framework. Removal of tissue from children for purposes not authorised under legislation can result in offences being committed. In addition, ethical issues arise from the collection and storage of children's tissue for research purposes. Tissue used for genomic research also brings additional risks to participants. This paper describes the current law, discusses its inadequacies and raises some of the key ethical issues that Australian researchers need to know. This paper focuses on the removal and use of paediatric tissue for research purposes only. [ABSTRACT FROM AUTHOR]

New South Wales has recently added the capability of extracorporeal membrane oxygenation to the neonatal and paediatric retrieval process and this paper describes the early experiences and protocol development for the first eight cases transported. [ABSTRACT FROM AUTHOR]

Genomic testing for a genetic diagnosis is becoming standard of care for many children, especially those with a syndromal intellectual disability. While previously this type of specialised testing was performed mainly by clinical genetics teams, it is increasingly being 'mainstreamed' into standard paediatric care. With the introduction of a new Medicare rebate for genomic testing in May 2020, this type of testing is now available for paediatricians to order, in consultation with clinical genetics. Children must be aged less than 10 years with facial dysmorphism and multiple congenital abnormalities or have global developmental delay or moderate to severe intellectual disability. This rebate should increase the likelihood of a genetic diagnosis, with accompanying benefits for patient management, reproductive planning and diagnostic certainty. Similar to the introduction of chromosomal microarray into mainstream paediatrics, this genomic testing will increase the number of genetic diagnoses, however, will also yield more variants of uncertain significance, incidental findings, and negative results. This paper aims to guide paediatricians through the process of genomic testing, and represents the combined expertise of educators, clinical geneticists, paediatricians and genomic pathologists around Australia. Its purpose is to help paediatricians navigate choosing the right genomic test, consenting patients and understanding the possible outcomes of testing. [ABSTRACT FROM AUTHOR]

Legal and clinical complexities surrounding consent to medical treatment for trans and gender diverse (TGD) youth in Australia continue to develop. New Australian Standards of Care and Treatment Guidelines have also introduced substantial clinical developments. Significant changes to legal principles from court decisions require doctors and health authorities, youth and parents, and legal advisors, to make and administer treatment decisions in compliance with the new legal requirements. Recent developments in the law relating to consent for medical treatment of TGD youth are clarified, with focus on the 2017 case Re: Kelvin and its implications for clinical practice. This article presents a new medico‐legal analysis of clinical practice for treating TGD youth, mapping Australian clinical guidelines and legal principles against three stages of clinical treatment. Clinical scenarios are used to demonstrate situations where the legal framework no longer presents a barrier to clinical practice, as well as those where ambiguity remains. The aim of this paper is to ensure that clinicians working with TGD youth understand what the law currently requires in term of consent, with reference to the stages of treatment, and where the law fails to provide clear guidance for patients, parents and health professionals. Residual uncertainty in the applicable legal principles requires legislative or judicial resolution and policy clarity. [ABSTRACT FROM AUTHOR]

Liver transplantation has become the standard of care for children with end‐stage liver disease. In Australia and New Zealand, there are four paediatric liver transplant units, in Sydney, Melbourne, Brisbane and Auckland. Over the past 30 years, there have been significant changes to indications for transplant, as well as medical and surgical advances. In this paper, using retrospective data from the Australia and New Zealand Liver Transplant Registry, we review 977 children (less than 16 years of age) who underwent liver transplant from 1985 to 2018. The most common indication was biliary atresia (54%), although there has been an increase in other indications, including inborn errors of metabolism, fulminant hepatic failure and malignant liver tumours. Over the past 3 decades, areas of change and innovation include: the use of 'split grafts' to enable an adult and a child to receive the same donor liver, live donation, improvements in immunosuppressive regimens and infectious prophylaxis protocols and innovative surgical techniques allowing transplantation in smaller infants. The outcomes for children who undergo liver transplant in ANZ are excellent, with current 10‐year patient survival rates of 95%, comparable to other larger centres around the world. [ABSTRACT FROM AUTHOR]

Multicentre research provides advantages over single-centre research by maximising available patient numbers while pooling varied expertise and resources available across different participating investigators and sites. The increased complexity of multicentre regulatory approvals, communication and study management, can be mitigated by the formation of a research network where multicentre efforts move from ad hoc, single projects to formalised ongoing collaboration. Network research helps prioritise research efforts and importantly fosters the development of a collaborative track record in terms of research expertise, research capacity and grant success. It also has the potential to rapidly change patient care across many hospitals as research results will be more generalizable and definitive. This paper sets out the key elements of network research, its benefits and possible challenges drawing on the example of PREDICT (Paediatric Research in Emergency Departments International Collaborative) an established paediatric emergency research network in Australia and New Zealand. [ABSTRACT FROM AUTHOR]

Aim: This paper describes the incidence and outcomes of childhood renal malignancies in Australia using national population-based data from the Australian Childhood Cancer Registry.Methods: De-identified data for children (0-14 years) diagnosed with renal malignancies from 1983 to 2015 inclusive were extracted. Cause-specific (CSS) and event-free survival up to 20 years from diagnosis were estimated using the cohort method. Adjusted excess mortality hazard ratios were calculated using a multivariable flexible parametric survival model. Details relating to second primary malignancies (SPMs) were also examined.Results: There were 1046 children diagnosed with renal malignancies in Australia between 1983 and 2015 (91% nephroblastoma), generating an annual age-standardised incidence rate of 8 per million children, which remained constant over the study period. CSS was 89% (95% confidence interval = 87-91%) and 88% (86-90%) at 5 and 20 years, respectively, and 5-year event-free survival was 82% (80-84%). Five-year CSS did not change over the study period and was highest for nephroblastoma (91%). Of the 94% of patients achieving remission, 15% relapsed and subsequent 5-year CSS was 49% (40%-58%). Eleven children were diagnosed with SPM (standardised incidence ratio = 2.9, 95% confidence interval = 1.6-5.3, P < 0.001), and five of them (45%) died within 5 years of the second diagnosis.Conclusions: Children treated for renal malignancies in Australia have excellent long-term survival, which is unchanged since 1983. SPMs are uncommon following treatment for childhood renal cancer but carry a poor prognosis. Relapse carries a similarly poor prognosis to SPM but is more common. These data are comparable to registry outcomes in similarly developed nations. [ABSTRACT FROM AUTHOR]

Aim: In New Zealand, there is a paucity of information on children with chronic conditions and disabilities (CCD). One reason is that many are managed in hospital outpatients where diagnostic coding of health-care events does not occur. This study explores the feasibility of coding paediatric outpatient data to provide health planners with information on children with CCD.Methods: Thirty-seven clinicians from six District Health Boards (DHBs) trialled coding over 12 weeks. In five DHBs, the International Classification of Diseases and Related Health Problems, 10th Edition, Australian Modification (ICD-10-AM) and Systematised Nomenclature of Medicine Clinical Terms (SNOMED-CT) were trialled for 6 weeks each. In one DHB, ICD-10-AM was trialled for 12 weeks. A random sample (30%) of ICD-10-AM coded events were also coded by clinical coders. A mix of paper and electronic methods were used.Results: In total 2,604 outpatient events were coded in ICD-10-AM and 693 in SNOMED-CT. Dual coding occurred for 770 (29.6%) ICD-10-AM events. Overall, 34% of ICD-10-AM and 40% of SNOMED-CT events were for developmental and behavioural disorders. Chronic medical conditions were also common. Clinicians were concerned about the workload impacts, particularly for paper-based methods. Coder's were concerned about clinician's adherence to coding guidelines and the poor quality of documentation in some notes.Conclusion: Coded outpatient data could provide planners with a rich source of information on children with CCD. However, coding is also resource intensive. Thus its costs need to be weighed against the costs of managing a much larger health budget using very limited information. [ABSTRACT FROM AUTHOR]

Measles continues to be a public health concern world-wide. Vulnerable individuals including those in which vaccinations is contraindicated, may be reliant on normal human immunoglobulin (NHIG) prophylaxis in an aim to prevent disease. This paper will summarise and discuss a tertiary paediatric hospital's clinical experience and the practicalities of administering intramuscular (IM) NHIG to paediatric patients as per the current measles prophylaxis guidelines in Australia. Following potential exposure within the emergency department, 17 paediatric patients (0-15 years) were recommended IM NHIG for prophylaxis. The dose of NHIG ranged from 0.6 to 15 mL and required multiple (2-8) injections. Two patients required sedation for staff to safely administer the injections. Staff involved with these cases reported administering multiple injections to paediatric patients to be a traumatising experience. They also expressed views that the injection of large volumes via the IM route was an impractical method of administration. Based on this experience, we recommend intravenous immunoglobulin be considered when large volumes of NHIG are recommended intramuscularly. [ABSTRACT FROM AUTHOR]

Aim: The continuing existence of 'teaching by humiliation' of medical students and junior doctors in Australia has recently been highlighted in a number of research publications and media reports. This study investigates medical students' experiences of being intimidated or humiliated during their clinical rotations in Australian hospitals in paediatrics and adult medicine.Methods: From factors identified in earlier research, a two-page survey was developed for administration at two Australian medical schools. Administered in Semester 2 of 2014, students were invited to add their own free-text comments at the conclusion of 17 closed questions. Using thematic analysis of the qualitative data, the researchers identified the common themes in the students' free-text comments, which are reported in this paper.Results: We found five main themes in the qualitative data: a spectrum of interpretations of and responses to 'teaching by humiliation', an accepted means of enculturating the young, teachers' techniques for asking questions, the victims and perpetrators of mistreatment and the variance of prevalence in different contexts.Conclusion: Research shows the persistence of 'teaching by humiliation', even in paediatrics, particularly when doctors are questioning students in ways that shame them for their lack of knowledge. Given the many personal and professional costs of these practices, this cycle of mistreatment needs to be brought to an end. There is a need for students' reports of intimidation and humiliation to be acknowledged; the offending practices need to be interrupted, and more effective and respectful approaches to teaching need to be adopted. [ABSTRACT FROM AUTHOR]

Food allergy is an increasing phenomenon in Australia, with most recent reports of food allergy occurring in 1 in 12 children. A number of studies have demonstrated that children and adolescents with food allergies experience a decreased quality of life across a number of domains. More recent evidence suggests that this population also experiences an increased occurrence of bullying compared to similar school-aged children. Some individuals have reported being bullied because of their allergies, whilst others have reported specific allergy-related-bullying, such as being touched with foods that they are allergic to or having their food being intentionally contaminated with an allergen. Where there may be a risk of severe anaphylaxis, this is of great concern. This article reviews the current literature on bullying in populations of children and adolescents with food allergies. Several papers worldwide have investigated this, providing evidence of its occurrence in North America, Canada, Italy and Japan. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the attitudes and practices of Australian general practitioners (GPs) regarding infant gastro-oesophageal reflux disease (GORD) diagnosis and management.Methods: A national cross-sectional survey, involving a random sample of currently practising Australian GPs (n = 2319) was undertaken between July and September 2011. GPs attitudes and management of infant GORD were surveyed via an online and paper-based 41-item questionnaire.Results: In total, 400 responses were analysed (17.24% response rate). The majority of GPs employed empirical trials of acid-suppression medication and/or lifestyle modifications to diagnose infant GORD. GPs frequently recommended dietary modification despite the belief that they were only moderately effective at best. In addition, GPs frequently prescribed acid-suppression medication, despite concerns regarding their safety in the infant population. Other GP concerns included the lack of clinical guidelines and education for GPs about infant GORD, as well as the level of evidence available for the safety and efficacy of diagnostic tests and treatments.Conclusion: Despite the important role Australian GPs play in the diagnosis and management of infant GORD, high-level evidence-based guidelines for GPs are lacking. Consequently, GPs engage in diagnostic and management practices despite their concerns regarding the safety and effectiveness. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper was to investigate the relationship between circulating 25-hydroxyvitamin D (25(OH)D) and cardio-metabolic risk factors in a large cohort of obese youth attending tertiary paediatric obesity services.Methods: We conducted a retrospective cross-sectional study. Data were retrospectively collected from all new consultations of children and adolescents attending obesity outpatient clinics between 2008 and 2011 at the two major paediatric hospitals in Melbourne, Australia. Information collected included demographics, anthropometry, blood pressure, pubertal staging, body composition and fasting serum levels of 25(OH)D, glucose, insulin, cholesterol, triglyceride, high-density lipoprotein, liver function, calcium and phosphate.Results: 25(OH)D data were available in 229 patients (age 3-18 years; 116 men; mean (standard deviation) body mass index ( BMI) Z-score 2.5 (0.5) ). One hundred four (45%) participants were 25(OH)D deficient (<50 nmol/L). Lower serum 25(OH)D levels were associated with higher BMI Z-score (P-trend = 0.001), total fat mass (P-trend = 0.009), systolic (P-trend = 0.03) and diastolic blood pressures(P-trend = 0.009). In multivariable-adjusted regression analysis, 25(OH)D was significantly lower in those with elevated blood pressure after adjustment for BMI(P-trend = 0.004) or total fat mass (P-trend = 0.01).Conclusion: Overweight and obese youth attending specialist obesity services have a high prevalence of vitamin D deficiency. In this population, lower levels of vitamin D were seen in those with greater adiposity, and independent of this, in those who had higher blood pressure. [ABSTRACT FROM AUTHOR]

Aim To accurately establish the extent to which breastfeeding exclusivity and duration and the introduction of foods other than breast milk are congruous with Australian infant feeding guidelines among a cohort of primiparous women and their infants in Australia. Method The Feeding Queensland Babies Study is primarily a questionnaire-based prospective birth cohort study of infant feeding attitudes and behaviours but also collected significant data on feeding patterns in infancy. These data were extracted from the demographic questionnaire and from questionnaires administered at 4 and 6 months of infant age. Participants were healthy primiparous Australian women aged between 18 and 40 years, recruited by convenience sampling in Queensland, Australia. Data were collected by self-administered questionnaire both online and on paper between October 2010 and September 2011. Results Breastfeeding initiation in this cohort is high; however, by 4 months of age, 15.4% of mothers had completely ceased any breastfeeding, 28.7% of infants had been given formula and 18.5% had been introduced to baby cereal. By 6 months of age, 98.4% of infants had been introduced to non-milk foods, most commonly at a rate of one new food every 4 to 5 days. Conclusion Contemporary prospective data on infant feeding have value in describing trends that may influence the health outcomes of a generation of Australian children. Even in this group of relatively well-educated Australian women, premature cessation of breastfeeding and the early introduction of foods other than breast milk to infants demonstrate behaviours not congruous with evidence-based guidelines. [ABSTRACT FROM AUTHOR]

Children develop in the domains of cognition, speech and language, motor, personal skills, social skills and activities of daily living in a predictable and organised manner. Between 3000 and 9000 Australian children born in any one year may be diagnosed with global developmental delay. Paediatricians are often faced with the dilemma of 'who' and 'how' to investigate, as the yield is often considered to be low. 'Best practice' guidelines on the investigation of global developmental delay have been published, but the evidence available for the specific recommendations varies significantly and is based mostly on levels III and IV evidence (non-experimental descriptive studies and expert opinions). This paper discusses the current views and suggests a possible algorithm for clinical practice in Australia. [ABSTRACT FROM AUTHOR]

Aim The aims of this paper are to describe the growth of urban Australian Aboriginal infants from birth to 24 months of age and to identify the proportion of these infants experiencing rapid weight gain ( RWG) and overweight/obesity. Methods The Gudaga Study is a longitudinal birth cohort of 159 Australian Aboriginal children born on the urban fringe of Sydney. Birthweight and length were extracted from hospital data. Children with a birthweight >1500 grams were included in the analysis ( n = 157). Weight, length and head circumference were measured at 2-3 weeks and then six-monthly until 24 months of age. Age- and gender-specific Z-scores were determined from the Centers for Disease Control (CDC) 2000 growth charts for weight, length, head circumference and body mass index ( BMI). The proportion of children experiencing RWG (an increase in weight-for-age Z-scores ≥0.67 between birth and 12 months) was calculated. The association between RWG and ≥85th CDC percentile for BMI at 24 months was tested using Pearson's χ2. Results The mean weight of Gudaga infants was less than the CDC mean length-for-age at birth and 2-3 weeks of age but greater than CDC mean length-for-age and weight-for-age at 18 and 24 months of age. Overall, 42 infants (34.4%) experienced RWG, and 45 infants (36.9%) were overweight/obese at 24 months of age. A greater proportion of those who experienced RWG (61.9%) were overweight/obese at 24 months than those who did not experience RWG (23.8%). Conclusion Our study suggests a concerning proportion of urban Indigenous infants experience RWG and overweight/obesity in early childhood. [ABSTRACT FROM AUTHOR]

Aims The study aims to examine whether patterns of health behaviours (based on sleep duration, physical activity, screen time and diet) were associated with obesity in Australian children. Methods This paper included 1833 children aged 6-7 years (51.6% male) recruited in 2006 as part of the Longitudinal Study of Australian Children. Latent class analysis was performed to identify the presence of distinct behavioural profiles on the basis of sleep duration, physical activity, screen time and eating habits. Logistic regression was performed to examine the association between the behavioural profiles and obesity assessed at baseline and 2-year follow-up. Results Three behavioural profiles, healthy (27.7%), sedentary (24.8%) and short sleepers/unhealthy eaters (47.5%), were identified. Compared with the healthy profile, the sedentary profile (odds ratio = 1.59, 95% confidence interval (1.06-2.38)) and short sleepers/unhealthy eaters (odds ratio = 1.47 (1.03-2.13)) had elevated odds of obesity at 2-year follow-up. Conclusions The present study identified distinct profiles of health behaviours in this sample of Australian children. These findings add to existing findings that many health behaviours co-occur and that obesity interventions should target patterns of behaviours in children. [ABSTRACT FROM AUTHOR]

This paper summarises a 1-day scientific consensus forum that reviewed the evidence underpinning the Australian SIDS and Kids Safe Sleeping Health Promotion Programme. The focus was on each of the potentially modifiable risk factors for sudden unexpected deaths in infancy, including sudden infant death syndrome (SIDS) and fatal sleeping accidents. In particular infant sleeping position, covering of the face, exposure to cigarette smoke, room sharing, unsafe sleeping environments, bed sharing, immunisation, breastfeeding, pacifier use and Indigenous issues were discussed in depth. The participants recommended that future 'Reducing the Risk' campaign messages should focus on back to sleep, face uncovered, avoidance of cigarette smoke before and after birth, safe sleeping environment, room sharing and sleeping baby in own cot. [ABSTRACT FROM AUTHOR]

Sick and injured children, like combatants wounded by shot and shell in war, are disproportionately represented in the tallies of both man-made and national disasters. Paediatricians have a particularly proud heritage of military service, a nexus dating in Australia from the early 19th century. This paper traces this link between service to children in peacetime and the care of servicemen, women and children in times of war and disaster. The extraordinary record of Australian 'paediatric' doctors who also served in the Gallipoli Campaign (1915) is documented as an illustration of this duality. Paediatricians who serve in the Defence Reserves and in civilian non-government organisations which respond to disasters and civil wars have special credentials in their advocacy for the protection of children enmeshed in conflict or disaster. Such applies particularly to the banning of the recruitment and use of child soldiers; support for children caught up in refugee and illegal immigrant confrontations; and continued advocacy for greater international compliance with the Ottawa Convention to ban the use of anti-personnel landmines. Volunteering for such service must occur in cold 'down time', ensuring that paediatricians are trained in disaster and conflict response, when such challenges inevitably confront the paediatricians of the future. [ABSTRACT FROM AUTHOR]

Organ donation in Australia has undergone a series of important changes in the past 3 years. An ethically complex and emotionally profound subject, important questions are being raised about the approach to organ donation by the government, by health-care professionals and also by the public. This paper highlights some of the changes within the Australian organ donation community and explores several controversies that accompany the widespread implementation of measures aimed at significantly improving organ donation throughout the country. [ABSTRACT FROM AUTHOR]

Previous studies have proposed a link between the presence of specific single nucleotide polymorphisms (SNPs) and cerebral palsy and the majority of these associations remain to be confirmed or rejected by prospective studies with sufficient statistical power. Prior studies have also given little attention to the interaction of genomic characteristics and clinical risk factors. This paper describes the design of a prospective case-control study to test these genetic associations in conjunction with more stringent data collection in respect to clinical features associated with pregnancy, particularly maternal infection. Here we consider the ethical requirements, our hypothesis that genetic susceptibility modifies the risk of cerebral palsy in the presence of perinatal environmental triggers, a priori primary and secondary aims, power calculations, participant recruitment strategies, data linkage, sampling methods of genetic material and subsequent SNP analysis, collection of clinical data and the proposed final statistical analysis. [ABSTRACT FROM AUTHOR]

This paper provides a general overview of the literature investigating the nexus between education and health; discussing the relationship between these domains at individual, family and community levels. We then briefly examine the programme and research implications of such a framework for interventions aimed at improving education and health, with specific reference to young Indigenous Australians. We find that while education and health are inextricably linked, throughout the life course and at different levels of influence, there is less empirical work exploring this relationship in an Indigenous context. Given the gravity of literacy and numeracy failure rates in school-based education and its potential impact on Indigenous health, we assert an urgent case for rigorous research into interventions that address the barriers to effectiveness in implementing quality educational experiences and opportunities for Indigenous children. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding for the first 6 months of life is recommended as the optimal way to feed infants. This paper reviews the measurement of exclusive breastfeeding in Australian studies over the past 10 years. Only half the studies identified that claimed to measure exclusive breastfeeding used a definition consistent with the World Health Organisation. Three studies used 24-h or 7-day recall indicators that have been shown to produce overestimations of the prevalence of exclusive breastfeeding. Measurement of exclusive breastfeeding with a valid and consistent definition is vital for monitoring rates and trends, for comparison between different studies and countries and to reach conclusions on various health benefits. Any future measurement of exclusive breastfeeding in Australia should use the World Health Organisation definition and the 24 h recall study design should not be used for this purpose. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper was to explore the opinions and practices of tertiary health-care professionals in Australia and New Zealand regarding air and oxygen blending (OB) for the resuscitation of preterm infants. Methods: Structured questionnaires were sent to the directors of 25 tertiary perinatal units, with instructions to distribute the questionnaires to 15 pertinent clinical staff. Results: Response rate was 72% ( n = 271); medical-staff response was 25%. Sixteen (64%) perinatal units had OB resuscitation equipment. Among respondents, 114 (42%) had access to OB and 73 (27%) had OB for all resuscitations. Pulse oximetry was available to 160 (59%) of respondents. The majority (173, 64%) would initiate resuscitation with Fractional inspired oxygen (FiO2) ranging from 0.3 to 0.9 (mean 0.5), with 15% and 21% preferring air and 100% oxygen, respectively. There were large variations in managing FiO2 changes thereafter. Half of the respondents were either unsure (39%) or not convinced (15%) that 100% oxygen during resuscitation would cause harm. Conversely, 42% suggested that OB might improve outcome with bronchopulmonary dysplasia and retinopathy of prematurity being the most important considerations. Most (92%) would advocate for OB in the delivery suite. Set-up cost (50%) and lack of guided experience (38%) ranked highest as barriers to change. Conclusions: Two-thirds of the tertiary centres have at least some OB equipment in the delivery suite, but the ways and opinions in which OB is utilised differ widely. Most practitioners would advocate for a change. There is an urgent need for further research to achieve a consistent and meaningful clinical management for OB resuscitation of preterm infants. [ABSTRACT FROM AUTHOR]

Aim: Paediatric overweight has a high incidence and has serious consequences for health, including non-alcoholic fatty liver disease (NAFLD). However, very little is known about NAFLD among young people, particularly from a population perspective. This paper reports the prevalence of elevated concentrations of four liver enzymes and their associations with adiposity in a representative population sample of Australian adolescents. Methods: Overnight fasting blood samples were collected from a representative population sample of 500 Grade 10 students (15-years-old) attending schools in Sydney, Australia, between February and May, 2004. Weight, height and waist girth were measured. The prevalence of adverse concentrations of the enzymes alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were described for all boys and girls and by body mass index (BMI) categories. The nature of the associations between the enzyme concentrations and indices of adiposity were characterised, and regression equations for estimating enzyme concentrations from BMI were prepared. Results: The prevalence of adverse concentrations of ALT (most likely as a result of NAFLD) and GGT were approximately 10%, while the prevalence of adverse concentrations of AST and ALP were approximately 7% and 5% respectively. The prevalence of adverse concentrations of ALT, GGT and AST increased across BMI categories, while the prevalence of adverse concentrations of ALP declined across BMI categories. Conclusions: The high prevalence of NAFLD in a population sample of healthy Australian adolescents represents a significant burden of disease. [ABSTRACT FROM AUTHOR]

Aim: To explore the socio-demographic factors and other maternal characteristics that influence breastfeeding initiation rates. In particular, this paper aims to (i) estimate the rate of breastfeeding by maternal socio-demographic factors and other maternal characteristics at first well-baby visit; and (ii) investigate the relationship between breastfeeding rates and these maternal factors. Methods: Cross-sectional data were obtained for 9618 babies in south-western Sydney in New South Wales from the Ingleburn Baby Information Systems database from January 2000 to June 2004 and included information on breastfeeding status, socio-demographic factors and other maternal characteristics. Results: At first visit, 59.8% of mothers were breastfeeding. The factors that increased the risk for NOT breastfeeding on multivariate analysis were being Australian-born (OR = 1.67, 95% CI 1.45–1.89, P < 0.001), unmarried (OR = 1.79, 95% CI 1.52–2.11, P < 0.001), living in disadvantaged accommodation (OR = 1.90, 95% CI 1.60–2.26, P < 0.001), having lower levels of education (OR = 1.88, 95% CI 1.38–2.54, P < 0.001) and current smoking (OR = 1.72, 95% CI 1.51–1.96, P < 0.001). Conclusion: The results from this large population-based study suggest that breastfeeding rates are significantly influenced by socio-demographic factors and maternal characteristics. Consequently, subgroups of the population ‘at risk’ for not breastfeeding can be identified and targeted for further strategies to promote breastfeeding. [ABSTRACT FROM AUTHOR]

Aim: Sleep problems in the second 6 months of life are common and associated with maternal depression. This paper extends previous research to (i) establish the prevalence of sleep problems in younger infants from a broader socio-economic spectrum, (ii) examine the relationship between infant sleep problems and maternal physical, as well as mental, health, and (iii) explore mothers’ sleep quality as a potential mediator of this relationship. Methods: Design: Cross-sectional, community survey in Melbourne, Australia. Sample: Mothers of 3- to 6-month-old infants (mean 4.6 months) recruited from well-child clinics in six sociodemographically diverse metropolitan local government areas. Outcome measures: Maternal mental and physical health; standardised questionnaire on infant sleep patterns; maternal report of an infant sleep problem (yes/no). Results: The survey was completed by 692 mothers; 237 (34%) reported an infant sleep problem, of whom 73 (31%) rated the problem as severe. Sleep patterns characterising a problem included the infant waking seven nights per week, nursing the infant to sleep at the beginning of the night, the infant sleeping in the parent’s room, and parental disagreement regarding managing infant sleep. There was no relationship between sleep problems and socio-economic levels. Mothers reporting infant sleep problems had poorer mental and physical health compared with those not reporting sleep problems. Conclusion: Sleep problems are common in early infancy across metropolitan socio-economic levels and are associated with poorer maternal health and well-being. Preventive strategies for infant sleep problems need to begin early in primary care to improve mothers’ health. [ABSTRACT FROM AUTHOR]

Newly arrived refugees and asylum seekers are faced with many difficulties in accessing effective health care when settling in Australia. Cultural, language and financial constraints, lack of awareness of available services, and lack of health provider understanding of the complex health concerns of refugees can all contribute to limiting access to health care. Understanding the complexities of a new health care system under these circumstances and finding a regular health provider may be difficult. In some cases there may be a fundamental distrust of government services. The different levels of health entitlements by visa category and (for some) detention on arrival in Australia may further complicate the provision and use of health services for providers and patients. Children are particularly at risk of suboptimal health care due to the impact of these factors combined with the effect of resettlement stresses on parents’ ability to care for their children. Unaccompanied and separated children, and those in detention experience additional challenges in accessing care. This article aims to increase awareness among health professionals caring for refugee children of the challenges faced by this group in accessing and receiving effective health care in Australia. Particular consideration is given to the issues of equity, rights of asylum seekers, communication and cultural sensitivities in health care provision, and addressing barriers to health care. The aim of the paper is to alert practitioners to the complex issues surrounding the delivery of health care to refugee children and provide realistic recommendations to guide practice. [ABSTRACT FROM AUTHOR]

Classifications of perinatal deaths have been undertaken for surveillance of causes of death, but also for auditing individual deaths to identify suboptimal care at any level, so that preventive strategies may be implemented. This paper describes the history and development of the paired obstetric and neonatal Perinatal Society of Australia and New Zealand (PSANZ) classifications in the context of other classifications. The PSANZ Perinatal Death Classification is based on obstetric antecedent factors that initiated the sequence of events leading to the death, and was developed largely from the Aberdeen and Whitfield classifications. The PSANZ Neonatal Death Classification is based on fetal and neonatal factors associated with the death. The classifications, accessible on the PSANZ website ( ), have definitions and guidelines for use, a high level of agreement between classifiers, and are now being used in nearly all Australian states and New Zealand. [ABSTRACT FROM AUTHOR]

Objective: To understand factors associated with successfully conducting longitudinal studies across early childhood by (i) describing the designs of Australian and New Zealand birth cohort studies; (ii) describing the breadth of variables studied; and (iii) identifying factors influencing study quality, productivity and contributions.Methods: A systematic review was undertaken of 13 birth cohort studies. Data were collected from published papers and questionnaires administered to study investigators.Results: These single cohort studies recruited children prior to their first birthday. Using an ecological model as an organizing framework, the studies were found to have contributed to knowledge about health and development in multiple domains and well beyond early childhood. Areas for increased focus included policy-relevant environmental factors such as child-care and rural/urban differences, and the influence of fathers, family factors, peers, social competence, and genetic factors. Investigators' responses indicated desires for an increased depth of data collection and stronger sampling designs. Data quality was enhanced by maintaining skilled staff and reduced by inadequate data for tracking study participants. Productivity ranged from 1 to 760 publications per study (median = 14.0). The most productive studies were those that had started before 1990, had representative samples, ongoing funding, and larger research teams. Policy impacts have included changed infant sleeping practices, reduced environmental lead emissions and regulated swimming pool safety standards.Conclusions: A suite of coordinated and nested studies could meet sampling needs and facilitate depth of inquiry. Stable, long-term funding is required to staff and maintain well-designed longitudinal studies that can address priority research areas and contribute to the development of health and social policy. [ABSTRACT FROM AUTHOR]

In Australia the issue of fetal alcohol syndrome (FAS) has not been the subject of policy development or of extensive research. There is a lack of knowledge, both in the general community and by health professionals, of the nature of the risks associated with heavy alcohol consumption during pregnancy and the factors that increase this risk. This paper reviews the literature surrounding FAS with the aim of providing the reader an understanding of the diagnostic features and epidemiology of FAS and of the developmental sequelae associated with this syndrome. [ABSTRACT FROM AUTHOR]

This paper provides specific guidelines on the management of tuberculosis infection and disease, covering general principles, recommended drug regimens and discuss the evidence to support these. It also covers use of corticosteroids, intermittent therapy, directly observed therapy and an approach to the management of a patient with drug-resistant tuberculosis. [ABSTRACT FROM AUTHOR]

Pancreatic enzyme replacement therapy (PERT) is a major factor associated with achieving optimum growth and nutritional status in cystic fibrosis (CF) patients with pancreatic insufficiency and consequent malabsorption. Currently in Australian CF clinics policies for the usage of PERT vary considerably. This paper highlights the current issues related to fat absorption and use of PERT in CF. It also provides evidence to support the recommendation of a PERT dose based on a standard ratio of lipase units per gram of dietary fat consumed for individual patients. A consistent approach to PERT doses will facilitate identification of patients whose PERT intake increases their risk of fibrosing colonopathy and for whom gastroenterological review is warranted. Recent reports indicate that PERT intake can be reduced with a secondary improvement in growth and nutrition status as a consequence of increased dietetic input. These Australian guidelines for the judicious use of PERT in CF should lead not only to a refinement in nutritional management of patients with CF but should also facilitate an improvement in compliance with therapy due to sophistication in patient education materials. The Australian guidelines for the use of PERT in CF if correctly applied, will also provide patients and their families with a better understanding of the relationship between PERT and nutritional status. [ABSTRACT FROM AUTHOR]

Human milk (HM) is considered to be the optimal feed of choice for neonates, however, for preterm infants, HM fortifiers are often added to increase growth. If HM is unavailable, preterm formula is the next best option for preterm infants. Choosing which fortifier, if any, to use or which formula can be confusing. In this paper, the composition of milk feeds available in Australia and New Zealand is reviewed with the aim of assisting paediatricians to decide which feed is most appropriate for their patients. [ABSTRACT FROM AUTHOR]