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The impacts of mine contaminants on ecological connectivity in rivers and streams are poorly documented globally. We used acoustic telemetry to evaluate and refine conceptual models of fish movement in Magela Creek, a stream in the wet-dry tropics of Australia. This creek receives wastewater discharge from a nearby uranium mine, and a secondary objective was to describe behavioural responses of fish to one such discharge event. Of 55 fish (black bream Hephaestus fuliginosus, saratoga Scleropages jardinii, sharp-nose grunter Syncomistes butleri) tagged in dry season refuge pools 18 km upstream of the mine lease area (RPA [Ranger Project Area]), 16 (29%) moved downstream after the first wet season flows, using the RPA as habitat for 3–5 months before moving upstream to their previous locations as flows receded. Of 39 fish (spangled perch Leiopotherapon unicolor, barred grunter Amniataba percoides, black catfish Neosilurus ater) tagged ~ 8–12 km downstream of the RPA in the late wet season, only two were subsequently detected in the RPA. Direct and camera-based observations of 12 species of upstream-migrating fish during mine-water discharge in the late wet season showed no evidence of mine-water avoidance. Our results demonstrate that Magela Creek provides wet season habitat for fish within the RPA and acts as a migration pathway that connects lowland reaches and floodplains to upstream dry season refuges. Use by fish of waterbodies within the RPA highlights the need to manage the site to ensure that future contaminant egress and water quality do not adversely affect fish migration and habitat suitability. [ABSTRACT FROM AUTHOR]

Aim: To link data from a large maternal perinatal trial with the Australian Cerebral Palsy Register (ACPR) to identify children with cerebral palsy (CP).Method: Deidentified data from the Australasian Collaborative Trial of Magnesium Sulphate (ACTOMgSO4 ) and the ACPR were linked. Children born from 1996 to 2000 at Australian hospitals who survived and had 2-year paediatric assessments were included. Children identified with CP in: (1) both the ACTOMgSO4 (2y) and the ACPR (5y), (2) the ACTOMgSO4 only, and (3) the ACPR only were compared.Results: We included 913 children (492 males, 421 females; mean gestational age at birth 27.8wks [standard deviation 2.1wks]; range 23.0-40.0wks). Eighty-four children received a CP diagnosis: 35 by the ACTOMgSO4 and the ACPR, 29 by the ACTOMgSO4 only, and 20 by the ACPR only. The ACTOMgSO4 diagnosed 76.2% (95% confidence interval [CI] 65.9-84.1) and the ACPR identified 65.5% (95% CI 54.7-74.9). Children born in states/territories with long-standing versus more recently established registers were more likely to be included on the ACPR (p<0.05).Interpretation: Linking deidentified perinatal trial data with the ACPR was achieved. Limitations of both strategies for identifying children with CP in this era (late 1990s and early 2000s) probably explain many of the differences observed, and inform future linkage studies and evaluations of CP-preventive interventions.What This Paper Adds: Randomized trial data were linked with the Australian Cerebral Palsy Register. Trial (2y) and register (up to 5y) diagnoses of cerebral palsy (CP) differed. States with long-standing registers were more likely to include children with CP. [ABSTRACT FROM AUTHOR]

Background: Clinical practice guidelines recommend the use of antenatal magnesium sulphate for fetal neuroprotection before preterm birth at <30 weeks' gestation. Aims: This survey assessed the use of antenatal magnesium sulphate for fetal neuroprotection to determine if use has changed since the previous survey in 2012, and to evaluate enablers and barriers to use. Materials and Methods: A questionnaire was sent to clinical leaders at 29 hospitals with a neonatal intensive care unit in Australia and New Zealand asking at what gestational ages magnesium sulphate was given, if use was audited and any enablers and barriers to use. Results: Responses were received for 24 (83%) hospitals. The use of magnesium sulphate for fetal neuroprotection was reported as 89% (IQR 80–90%), an increase from 80% (IQR 53–90%) from the earlier survey. The majority of health professionals were reported as using magnesium sulphate at <30 weeks' gestation. The top enablers for use of magnesium sulphate were availability of pamphlets, posters, case record stickers and PowerPoint presentations. The main reasons as to why eligible women did not receive magnesium sulphate were imminent birth, the hospital being short staffed and the patient declined. The use of antenatal magnesium sulphate has been or is being audited in 11 (46%) of the hospitals. Conclusions: Clinical leaders at institutions in Australia and New Zealand report that uptake in the use of magnesium sulphate for fetal neuroprotection has continued to increase since the earlier, bi‐national survey in 2012. Barriers to the use of magnesium sulphate identified have institutional and consumer implications. [ABSTRACT FROM AUTHOR]

Background: Acute exacerbations of asthma may present as severe life-threatening illness that accounts for as many as 37,500 hospitalisations and 394 deaths each year in Australia. The current cornerstone of therapy in acute asthma includes short acting beta-2 agonists, short acting anti-muscarinic agents and corticosteroids. This systematic review aims to assess the current evidence for the use of intravenous magnesium and its efficacy in acute severe asthma. Materials and Methods: An online literature review of databases including OVID Medline, The Cochrane Database of Systematic Reviews, and PubMed was undertaken, including articles published between 1980 and 2017. Articles were analysed based on evidence regarding respiratory function, hospital admissions, biochemical effects, and adverse effects. Results: Although IV magnesium sulphate did not show statistically significant benefits in all asthma groups, there appeared to be some evidence of its efficacy in a subset of patients with severe asthma that had failed other first-line therapies. The treatment can reduce hospital admission rates with little evidence of adverse effects. Conclusion: The role of IV magnesium sulphate in asthma remains unclear; however, IV magnesium sulphate appears to be efficacious in severe asthma exacerbations when used synergistically with standard therapy. [ABSTRACT FROM AUTHOR]

Background: Since 2010, most tertiary care hospitals in Australia have changed how they care for extremely premature infants. However, in-hospital and longer-term outcome data have suggested unchanged or even worse health outcomes in later epochs, especially respiratory outcomes. This study examined the trend in outcomes since these changes were introduced, particularly the prevalence of chronic neonatal lung disease (CLD)., Methods: This is a retrospective cross-sectional analysis of data from the Neonatal Intensive Care Units' (NICUS) database of all perinatal intensive care units in New South Wales and the Australian Capital Territory, including infants born at ≥ 24 and ≤ 28 weeks of gestational age in tertiary perinatal units between January 1, 2010, and December 31, 2020. Temporal trends and changes in primary outcome were examined by linear and adjusted multivariable logistic regression models., Results: This study included 3258 infants. We saw significant changes in antenatal magnesium sulfate (75% increase), delayed cord clamping (66% increase), delivery room intubations (30% decrease), any time (20% decrease), duration on mechanical ventilation (100-hour decrease), and hours on noninvasive ventilation (200-hour increase). Mortality decreased from 17% to 6%. The incidence of CLD increased significantly even when adjusted for confounders (15% increase). Any time and mean hours spent on mechanical ventilation significantly increased the odds of CLD. This study could not find a significant association of any of the protective antenatal treatments on CLD., Conclusions: The last decade saw a significant improvement in survival and survival to discharge without major morbidity. There was increased use of magnesium sulfate, delayed cord clamping, and less invasive respiratory management of extremely preterm infants. The avoidance of mechanical ventilation may impact the incidence of CLD., (© 2023. The Author(s).)

Signs of Irukandji syndrome (IS) suggest an underlying catecholamine storm with research demonstrating that Carukia barnesi venom causes a significant rise in adrenaline/noradrenaline serum levels. A systematic review was undertaken to ascertain the current evidence in treating IS with magnesium salts. A literature search was conducted using Scopus, Medline and ScienceDirect. Further articles were discarded via title description and/or abstract details. The remaining were read in full, and those identified as not having sufficient information regarding magnesium and patient outcomes were removed. Nine articles were identified. One article was a randomised controlled trial, which concluded that there appears to be no beneficial difference between those patients who received the magnesium sulphate (MgSO4) and those who received the placebo and recommended against the use of MgSO4 in IS. Of the remaining eight, one reported the failure of MgSO4 and the remaining seven were case series reporting varying success in its use. This systematic review found insufficient evidence to support any clear recommendation regarding the use of magnesium, but nor was there clear evidence to recommend against its use in IS. Two case series describe significant reduction in key symptoms and hypertension but are a non-randomised albeit prospective series with the limitations accompanying this. The reporting of recrudescence of symptoms with reduction of dose does suggest a dose-response relationship. The evidence for the use of MgSO4 is at best anecdotal, and further research is required to either confirm its benefit or confirm the randomised controlled trial. [ABSTRACT FROM AUTHOR]

Health professionals at 25 Australian and New Zealand tertiary maternity hospitals were surveyed about local implementation of a clinical practice guideline for antenatal magnesium sulphate for fetal neuroprotection. Seventy-six percent of respondents reported that their hospital is currently following a guideline; 36% confirmed that their hospital is auditing uptake. Estimates of uptake ranged from 53 to 90%. Ongoing education and support are needed to ensure that the guidelines are optimally implemented, and uptake and important health outcomes are monitored. [ABSTRACT FROM AUTHOR]

Background Babies born very preterm (before 30 weeks gestation) are at high risk of dying in their first weeks of life, and those who survive are at risk of developing cerebral palsy in childhood. Recent high-quality evidence has shown that giving women magnesium sulphate immediately prior to very early birth can significantly increase the chances of their babies surviving free of cerebral palsy. In 2010 Australian and New Zealand clinical practice guidelines recommended this therapy. The WISH (Working to Improve Survival and Health for babies born very preterm) Project aims to bi-nationally improve and monitor the use of this therapy to reduce the risk of very preterm babies dying or having cerebral palsy. Methods/Design The WISH Project is a prospective cohort study. The 25 Australian and New Zealand tertiary level maternity hospitals will be provided with a package of active implementation strategies to guide the introduction and local adaptation of guideline recommendations. Surveys will be conducted at individual hospitals to evaluate outcomes related to local implementation progress and the use and value of the WISH implementation strategies. For the hospitals participating in the ‘WISH audit of uptake and health outcomes data collection’, the primary health outcomes (assessed through case note review, and 24 month corrected age questionnaires) will be: the proportion of eligible women receiving antenatal magnesium sulphate; and rates of death prior to primary hospital discharge and cerebral palsy at two years corrected age in infants born to eligible mothers. For hospitals wishing to assess factors influencing translation locally, barriers and facilitators will be measured through interviews with health care professionals, to further guide implementation strategies. Study outcomes for the early phase of the project (Year 1) will be compared with the later intervention phase (Years 2 and 3). Discussion The WISH Project will offer insight into the effectiveness of a multifaceted implementation strategy to improve the uptake of a novel neuroprotective therapy in obstetric clinical practice. The successful implementation of antenatal magnesium sulphate for fetal neuroprotection in Australia and New Zealand could lead to over 90 fewer very preterm babies dying or suffering the long-term consequences of cerebral palsy each year. [ABSTRACT FROM AUTHOR]

Objective:Use of antenatal magnesium sulfate (MgSO4) may reduce cerebral palsy in infants born very preterm. Low systemic blood flow in the first day in very preterm infants has been associated with cerebral injury and adverse motor outcome. The aim was to determine the effect of MgSO4 on systemic blood flow in preterm infants.Study Design:Randomized trial of MgSO4 versus saline placebo given to mothers at risk of delivery before 30 weeks gestation. Echocardiographic monitoring performed at 3 to 5, 10 to 12 and 24 h.Result:A total of 48 infants were exposed to MgSO4 and 39 to placebo. Infants exposed to MgSO4 were significantly more likely to receive volume expansion (42% versus 21%). Inotrope use did not differ significantly (40% versus 26%). There was no significant difference in mean lowest superior vena cava (SVC) flow or right ventricular output (RVO), or incidence of low SVC flow or RVO in the first 24 h. Infants exposed to MgSO4 had a significantly higher heart rate and were more likely to have low SVC flow at 10 to 12 h but not other times.Conclusion:Antenatal MgSO4 produced no consistent cardiovascular effects in the infant in the first 24 h. There is no evidence from this study to suggest the mechanism by which antenatal MgSO4 prevents cerebral palsy is through a cardiovascular effect in the newborn. [ABSTRACT FROM AUTHOR]

Background It is important to establish whether research recommendations regarding magnesium sulphate for neuroprotection can be readily translated into clinical practice and achieve the dual objectives of good coverage of the target group, while minimising unnecessary or prolonged exposure to treatment. Methods This retrospective cohort study included all women admitted to a tertiary obstetric centre at 23-32 weeks gestation in the first 12 months following implementation of the guideline ' Magnesium sulphate for the prevention of cerebral palsy'. We determined the number triaged to receive magnesium sulphate, the proportion of infants who received magnesium sulphate prior to delivery and the total number of doses administered. Results A total of 330 women were admitted at a mean gestational age of 28.2 weeks, and 132/330 (40%) were prescribed magnesium sulphate, of whom 123/132 (93%) delivered. 142/191 (74%) infants born at <32 weeks' gestation received magnesium sulphate prior to delivery, with no significant differences seen by plurality or gestational age. Of the 145 doses administered, only 13 women received more than one dose, and only nine of 145 (7%) doses proved to be unnecessary. The median treatment duration was 3 h 58 min. The infusion was discontinued as result of side effects in 2% of women. Conclusion Research recommendations regarding administration of magnesium sulphate with neuroprotective intent can be successfully translated into clinical practice. Appropriate triaging of women at high risk of imminent preterm birth is feasible, enabling a high level of magnesium sulphate coverage for infants that deliver prior to 32 weeks gestation, with minimal toxicity and a low rate of unnecessary maternal exposure. [ABSTRACT FROM AUTHOR]

The article presents news items on medication safety. The U.S. Food and Drug Administration has warned that menopausal women who use topical oestradiol sprays should avoid touching children and pets with sprayed skin. The U.S. Food and Drug Administration in 2010 approved the use of the drug Exalgo for treatment of severe pain. The Institute for Safe Medication Practices has reported that inaccurate doses of the drug magnesium sulfate bolus can lead to patient harm.

This commentary is on the original article by Shepherd et al. on pages 1170–1175of this issue. [ABSTRACT FROM AUTHOR]

Focuses on the need for effective interventions to prevent cerebral palsy and on two studies in this issue. The research in Australia and New Zealand by Crowther et al assessing whether magnesium sulfate, given to women at risk of preterm birth, would reduce CP among very preterm infants; The strengths of a study by Wu et al, including the assessment of chorioamnionitis.

Background: Eclampsia is a serious consequence of pre-eclampsia. There are limited data from Australia and New Zealand (ANZ) on eclampsia., Aim: To determine the incidence, management and perinatal outcomes of women with eclampsia in ANZ., Materials and Methods: A two-year population-based descriptive study, using the Australasian Maternity Outcomes Surveillance System (AMOSS), carried out in 263 sites in Australia, and all 24 New Zealand maternity units, during a staggered implementation over 2010-2011. Eclampsia was defined as one or more seizures during pregnancy or postpartum (up to 14 days) in any woman with clinical evidence of pre-eclampsia., Results: Of 136 women with eclampsia, 111 (83%) were in Australia and 25 (17%) in New Zealand. The estimated incidence of eclampsia was 2.2 (95% confidence interval (CI) 1.9-2.7) per 10 000 women giving birth. Aboriginal and Torres Strait Islander women were over-represented in Australia (n = 9; 8.1%). Women with antepartum eclampsia (n = 58, 42.6%) were more likely to have a preterm birth (P = 0.04). Sixty-three (47.4%) women had pre-eclampsia diagnosed prior to their first eclamptic seizure of whom 19 (30.2%) received magnesium sulphate prior to the first seizure. Nearly all women (n = 128; 95.5%) received magnesium sulphate post-seizure. No woman received prophylactic aspirin during pregnancy. Five women had a cerebrovascular haemorrhage, and there were five known perinatal deaths., Conclusions: Eclampsia is an uncommon consequence of pre-eclampsia in ANZ. There is scope to reduce the incidence of this condition, associated with often catastrophic morbidity, through the use of low-dose aspirin and magnesium sulphate in women at higher risk., (© 2019 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Background: Opioids have long been the mainstay of drugs used for intra-operative analgesia. Due to their well-known short and long term side effects, the use of non-opioid analgesics has often been encouraged to decrease the dose of opioid required and minimise these side effects. The trends in using non-opioid adjuvants among Australian Anaesthetists have not been examined before. This study has attempted to determine the use of non-opioid analgesics as part of an opioid sparing practice among anaesthetists across Australia and New Zealand. Methods: A survey was distributed to 985 anaesthetists in Australia and New Zealand. The questions focused on frequency of use of different adjuvants and any reasons for not using individual agents. The agents surveyed were paracetamol, dexamethasone, non-steroidal anti-inflammatory agents (NSAIDs), tramadol, ketamine, anticonvulsants, intravenous lidocaine, systemic alpha 2 agonists, magnesium sulphate, and beta blockers. Descriptive statistics were used and data are expressed as a percentage of response for each drug. Results: The response rate was 33.4%. Paracetamol was the most frequently used; with 72% of the respondents describing frequent usage (defined as usage above 70% of the time); followed by parecoxib (42% reported frequent usage) and dexamethasone (35% reported frequent usage). Other adjuvants were used much less commonly, with anaesthetists reporting their frequent usage at less than 10%. The majority of respondents suggested that they would never consider dexmedetomidine, magnesium, esmolol, pregabalin or gabapentin. Perceived disincentives for the use of analgesic adjuvants varied. The main concerns were side effects, lack of evidence for benefit, and anaesthetists' experience. The latter two were the major factors for magnesium, dexmedetomidine and esmolol. Conclusion: The uptake of tramadol, lidocaine and magnesium amongst respondents from anaesthetists in Australia and New Zealand was poor. Gabapentin, pregabalin, dexmedetomidine and esmolol use was relatively rare. Most anaesthetists need substantial evidence before introducing a non-opioid adjuvant into their routine practice. Future trials should focus on assessing the opioid sparing benefits and relative risk of using individual non-opioid adjuvants in the perioperative period for specific procedures and patient populations. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Randomised Trial of Magnesium in the Treatment of Irukandji Syndrome" by N. McCullagh et al.