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To describe antimicrobial use in hospitalised Australian children and to analyse the appropriateness of this antimicrobial use.Multicentre single-day hospital-wide point prevalence survey, conducted in conjunction with the Antimicrobial Resistance and Prescribing in European Children study.Eight children's hospitals across five Australian states, surveyed during late spring and early summer 2012.Children and adolescents who were inpatients at 8 am on the day of the survey.Quantity and quality of antimicrobial prescribing.Of 1373 patients, 631 (46%) were prescribed at least one antimicrobial agent, 198 (31%) of whom were 1 year old. The highest antimicrobial prescribing rates were in haematology and oncology wards (76% [95/125]) and paediatric intensive care units (55% [44/80]). Of 1174 antimicrobial prescriptions, 550 (47%) were for community-acquired infections, 175 (15%) were for hospital-acquired infections and 437 (37%) were for prophylaxis. Empirical treatment accounted for 72% of antimicrobial prescriptions for community-acquired infections and 58% for hospital-acquired infections (395 and 102 prescriptions, respectively). A total of 915 prescriptions (78%) were for antibacterials; antifungals and antivirals were predominantly used for prophylaxis. The most commonly prescribed antibacterials were narrow-spectrum penicillins (18% [164 prescriptions]), β-lactam-β-lactamase inhibitor combinations (15% [136]) and aminoglycosides (14% [128]). Overall, 957 prescriptions (82%) were deemed appropriate, but this varied between hospitals (range, 66% [74/112]) to 95% [165/174]) and specialties (range, 65% [122/187] to 94% [204/217]). Among surgical patients, 65 of 187 antimicrobial prescriptions (35%) were deemed inappropriate, and a common reason for this was excessive prophylaxis duration.A point prevalence survey is a useful cross-sectional method for quantifying antimicrobial use in paediatric populations. The value is significantly augmented by adding assessment of prescribing quality.

OBJECTIVE: Australia's response to refugees and people seeking asylum is a matter of national debate. We sought to determine the knowledge and attitudes of paediatricians about refugee and asylum seeker issues (both onshore and offshore). Design, setting and participants: In November 2013, we emailed a questionnaire web link to all Australian general and community paediatricians registered with the Royal Australasian College of Physicians. Main outcome measures: Proportion of respondents by demographic characteristics using χ(2) and Fisher exact test (α = 0.05). RESULTS: There were 139 respondents (response rate, 40.5%). Respondents' characteristics were broadly representative of all Australian general paediatricians. Over 80% correctly used the term "asylum seeker" rather than "boat person" or "illegal immigrant" for children applying for protection. Over 80% agreed with the Australian Medical Association assertion that mandatory detention of children constitutes child abuse, and disagreed with offshore processing. Less than half knew which subgroups were eligible for Medicare or had had pre-departure HIV and tuberculosis screening tests; or that the average stay in refugee camps before settlement in Australia was more than 10 years. Only about 60% knew that the Minister for Immigration and Citizenship was the legal guardian of detained unaccompanied minors. One in eight knew about the Medicare eligibility hotline. Respondents' sex, where their medical degree was obtained, frequency of seeing refugees and asylum seekers and years of experience had little association with responses. CONCLUSIONS: Australian paediatricians considered mandatory detention a form of child abuse and strongly disagreed with offshore processing. There is a clear need for education about practical issues such as current health screening practices and Medicare eligibility. Language: en

○ Zoster immunoglobulin (ZIG) should be offered to pregnant, varicella-seronegative women with significant exposure to varicella-zoster virus (VZV) (chickenpox) infection. ○ Oral aciclovir prophylaxis should be considered for susceptible pregnant women exposed to VZV who did not receive ZIG or have risk factors for severe disease. ○ Intravenous aciclovir should be given to pregnant women who develop complicated varicella at any stage of pregnancy. ○ Counselling on the risk of congenital varicella syndrome is recommended for pregnant women who develop chickenpox. ○ ZIG should be given to a baby whose mother develops chickenpox up to 7 days before delivery or up to 28 days after delivery. ○ Intravenous aciclovir should be given to babies presenting unwell with chickenpox, whether or not they received ZIG. ○ Breastfeeding of babies infected with or exposed to VZV is encouraged. ○ A mother with chickenpox or zoster does not need to be isolated from her own baby. ○ If siblings at home have chickenpox, a newborn baby should be given ZIG if its mother is seronegative. ○ The newborn baby does not need to be isolated from its siblings with chickenpox, whether or not the baby was given ZIG. ○ After significant nursery exposure to VZV, ZIG should be given to seronegative babies and to all babies born before 28 weeks' gestation.

Objective: To examine the pattern and incidence of sepsis occurring in neonatal units in Australia.

What we know: Respiratory viral infections caused by rhinoviruses, coronaviruses, influenza, parainfluenza and respiratory syncytial viruses (RSVs) are important triggers of asthma attacks. Mycoplasma and Chlamydia infections can also provoke asthma attacks, although less commonly. RSV infections probably do not cause asthma, but are potent triggers of wheezing, with the result that RSV infection often reveals underlying asthma in children. RSV infection does not cause atopy. Bacterial respiratory infections in infancy appear to protect against later atopy. What we need to know: Does RSV infection in infancy alter a child's T(H)1/T(H)2 responses to later infections with other respiratory pathogens? What are the mechanisms (immunological or mechanical) by which respiratory pathogens cause wheezing? What is the role of respiratory infections in exacerbations of asthma? Can epidemiology shed light on this? Do viruses such as RSV cause asthma or uncover underlying asthma? Do children respond differently to RSV than to other viruses? Does atopy affect those responses? Do bacterial respiratory infections truly protect against future atopy?