Princess Margaret Hospital for Children

About: Princess Margaret Hospital for Children is a healthcare organization based out in Perth, Western Australia, Australia. It is known for research contribution in the topics: Population & Randomized controlled trial. The organization has 1501 authors who have published 2068 publications receiving 75773 citations. The organization is also known as: Perth Children's Hospital & PMH.

European Respiratory Society guideline on long-term management of children with bronchopulmonary dysplasia

Abstract: This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and who have been discharged from the hospital, or who were >36 weeks of postmenstrual age. The guideline was based on predefined Population, Intervention, Comparison and Outcomes (PICO) questions relevant for clinical care, a systematic review of the literature and assessment of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. After considering the balance of desirable (benefits) and undesirable (burden, adverse effects) consequences of the intervention, the certainty of the evidence, and values, the task force made conditional recommendations for monitoring and treatment of BPD based on very low to low quality of evidence. We suggest monitoring with lung imaging using ionising radiation in a subgroup only, for example severe BPD or recurrent hospitalisations, and monitoring with lung function in all children. We suggest to give individual advice to parents regarding daycare attendance. With regards to treatment, we suggest the use of bronchodilators in a subgroup only, for example asthma-like symptoms, or reversibility in lung function; no treatment with inhaled or systemic corticosteroids; natural weaning of diuretics by the relative decrease in dose with increasing weight gain if diuretics are started in the neonatal period; and treatment with supplemental oxygen with a saturation target range of 90-95%. A multidisciplinary approach for children with established severe BPD after the neonatal period into adulthood is preferable. These recommendations should be considered until new and urgently needed evidence becomes available.

Epidemiology and Mortality of Staphylococcus aureus Bacteremia in Australian and New Zealand Children.

Abstract: Importance Staphylococcus aureus bacteremia (SAB) in children causes significant morbidity and mortality, but the epidemiology in children is not well characterized. Objective To describe the epidemiology of SAB in children and adolescents younger than 18 years from Australia and New Zealand. Design, Setting, and Participants A prospective cohort study, using data from the Australian New Zealand Cooperative on Outcomes in Staphylococcal Sepsis cohort for 1153 children with SAB from birth to less than 18 years in pediatric and general hospitals across Australia and New Zealand, collected between January 1, 2007, and December 31, 2012. Multivariate analysis was performed to identify risk factors for mortality. Incidence calculations were calculated separately for Australasian children younger than 15 years using postcode population denominator data from Australian and New Zealand census data. Main Outcomes and Measures Demographic data, hospital length of stay, principal diagnosis, place of SAB onset (community or hospital), antibiotic susceptibility and principal antibiotic treatment, and 7- and 30-day mortality. Results Of the 1153 children with SAB, complete outcome data were available for 1073 children (93.1%); of these, males accounted for 684 episodes (63.7%) of SAB. The median age was 57 months (interquartile range, 2 months to 12 years). The annual incidence of SAB for Australian children was 8.3 per 100 000 population and was higher in indigenous children (incident rate ratio, 3.0 [95% CI, 2.4-3.7]), and the incidence for New Zealand children was 14.4 per 100 000 population and was higher in Māori children (incident rate ratio, 5.4 [95% CI, 4.1-7.0]). Community-onset SAB occurred in 761 cases (70.9%), and 142 cases (13.2%) of the infections were methicillin-resistant S aureus (MRSA). Bone or joint infection was most common with 348 cases (32.4%), and endocarditis was uncommon with 30 cases (2.8%). Seven- and 30-day mortality rates were 2.6% (n = 28) and 4.7% (n = 50), respectively. Risk factors for mortality were age younger than 1 year; Māori or Pacific ethnicity; endocarditis, pneumonia, or sepsis; and receiving no treatment or treatment with vancomycin. Mortality was 14.0% (6 of 43) in children with methicillin-susceptible S aureus (MSSA) treated with vancomycin compared with 2.6% (22 of 851) in children treated with alternative agents (OR, 6.1 [95% CI, 1.9-16.7]). MRSA infection was associated with increased length of stay but not mortality. Conclusions and Relevance In this large cohort study of the epidemiology of SAB in children, death was uncommon, but the incidence was higher for infants and varied by treatment, ethnicity, and clinical presentation. This study provides important information on the epidemiology of SAB in children and risk factors for mortality.

Benefits of bifidobacterium breve M-16V Supplementation in preterm neonates -A retrospective cohort study

Abstract: Background Systematic reviews of randomised controlled trials report that probiotics reduce the risk of necrotising enterocolitis (NEC) in preterm neonates.

Why have we failed to reduce the frequency of cerebral palsy

Abstract: OBJECTIVE: To review the data on children with cerebral palsy in relation to quality of obstetric care. DATA SOURCES AND STUDY SELECTION: In our Institute, a regular Medline print-out, certain key journals and Current Contents are perused to create an updated computerised file of publications on the epidemiological, aetiological and other aspects of cerebral palsy. For this study we reviewed data from the Western Australian Cerebral Palsy Register, more than 150 publications from which studies were chosen for sound methodology in countries with modern obstetric practices, and recent population data on cerebral palsy. DATA EXTRACTION AND SYNTHESIS: Three major areas were studied to see: (i) if the prevalence of cerebral palsy has fallen with increasing use of obstetric and neonatal interventions aimed at reducing birth asphyxia; (ii) if there is any evidence that cerebral palsy is caused by birth asphyxia; and (iii) if there is any evidence that intrapartum fetal monitoring or caesarean section reduces the prevalence of cerebral palsy. CONCLUSIONS: We concluded that: cerebral palsy proportions are not falling in spite of significant increases in obstetric and neonatal interventions aimed at reducing asphyxia; cerebral palsy proportions in low birthweight infants are rising in most developed countries, coincident with increases in the neonatal survival of low birthweight babies; few cases of cerebral palsy seem to be caused by birth asphyxia and those that are may not have been preventable by obstetric care; and parents will continue to sue if obstetricians keep promising perfection from obstetric care in the face of 2.0-2.5 cases of cerebral palsy per 1000 children born.

Respiratory impedance and bronchodilator responsiveness in healthy children aged 2–13 years

Abstract: Background The forced oscillation technique (FOT) can be used in children as young as 2 years of age and in those unable to perform routine spirometry. There is limited information on changes in FOT outcomes in healthy children beyond the preschool years and the level of bronchodilator responsiveness (BDR) in healthy children. We aimed to create reference ranges for respiratory impedance outcomes collated from multiple centers. Outcomes included respiratory system resistance (Rrs) and reactance (Xrs), resonant frequency (Fres), frequency dependence of Rrs (Fdep), and the area under the reactance curve (AX). We also aimed to define the physiological effects of bronchodilators in a large population of healthy children using the FOT. Methods Respiratory impedance was measured in 760 healthy children, aged 2-13 years, from Australia and Italy. Stepwise linear regression identified anthropometric predictors of transformed Rrs and Xrs at 6, 8, and 10Hz, Fres, Fdep, and AX. Bronchodilator response (BDR) was assessed in 508 children after 200 mu g of inhaled salbutamol. Results Regression analysis showed that Rrs, Xrs, and AX outcomes were dependent on height and sex. The BDR cut-offs by absolute change in Rrs8, Xrs8, and AX were -2.74hPasL-1, 1.93hPasL-1, and -33hPasL-1, respectively. These corresponded to relative and Z-score changes of -32%; -1.85 for Rrs8, 65%; 1.95 for Xrs8, and -82%; -2.04 for AX. Conclusions We have established generalizable reference ranges for respiratory impedance and defined cut-offs for a positive bronchodilator response using the FOT in healthy children. Pediatr Pulmonol. 2013; 48:707-715. (c) 2012 Wiley Periodicals, Inc.