Neonatal encephalopathy (NE) is a significant global health concern. It is a leading cause of long-term neurodevelopmental impairment, with hypoxic-ischaemic perinatal brain injury being the most common underlying contributor. Although therapeutic hypothermia has reduced mortality and improved outcomes for some affected infants, many survivors experience neurodevelopmental disability, including cerebral palsy and/or deficits in cognition, behaviour, and executive functioning. Early and accurate prognostication and identification of injury severity remain a challenge due to evolving clinical signs and multiple etiologies. Magnetic resonance imaging (MRI) is the gold standard for characterizing NE-related brain injury. Diffusion-weighted imaging (DWI) enables early detection of injury, and proton magnetic resonance spectroscopy (1H-MRS), specifically the Lac/NAA peak area ratio from basal ganglia and thalamus, provides robust prognostic indicators of two-year neurodevelopmental outcomes. MRI scoring systems incorporating multiple modalities correlate well with later neurodevelopmental outcomes. Advanced imaging modalities, such as diffusion tensor imaging (DTI), arterial spin labelling (ASL), and blood oxygen level-dependent (BOLD) imaging, offer further insights into microstructural integrity, perfusion, and functional connectivity. By standardizing acquisition protocols and post-processing, MRI biomarkers can serve as reliable, early surrogate endpoints in neuroprotection trials, allowing smaller sample sizes and accelerating clinical translation. MRI and 1H-MRS integration enhances prognostication, guides clinical management, and supports informed decision-making in NE care. IMPACT: This article highlights the importance of state-of-the-art MRI and MRS techniques for assessing neonatal encephalopathy (NE), emphasizing optimized protocols, accurate interpretation, and the use of MRI scoring systems to enhance clinical decision-making. It provides a comprehensive guide to advanced MRI/MRS acquisition and interpretation in neonates with NE, addressing current limitations and future directions. By optimizing neonatal MRI/MRS practices, this work aims to improve early diagnosis and prognostication, guide treatment strategies, and ultimately improve the management of neonates with NE.

Abstract Introduction Children with neurodisability (ND) are at increased risk of pervasive sleep disturbances, creating significant implications and challenges for their health, learning and development which, in turn, impacts family well-being. Despite this, prevalence data highlighting the extent and nature of sleep problems in Australian children with ND remains scarce. Methods This cross-sectional study collected parent-reported data from 300 Australian families of children with ND using the Modified Simonds and Parraga Sleep Questionnaire (MSPSQ). Participants were recruited from two sub-groups 1) from three tertiary sleep clinics and (2) from the community recruited through community support organisations. MSPSQ total (TS) and composite scores (CI) were used to quantify overall and domain-specific sleep disturbances. Statistical analyses explored differences by age, ND sub-groups, and referral source. Results Across the sample, 72% of children scored (M = 69.01: SD ±15.77) above clinical cut off (56), indicating a high prevalence of clinically significant sleep disturbance. Diagnostic categories were stratified into 4 broad ND subgroups (genetic syndromes, ASD/ADHD, neurological, Other). All groups scored above the threshold, with the ASD/ADHD group showing greater severity of sleep disturbance. Primary school aged children had the highest sleep disturbance scores. Notably, the community sample reported significantly higher composite scores (CI) than the hospital-referred group, yet nearly half had never accessed specialist sleep services. Conclusion This study highlights the prevalence of significant sleep disturbance in children with ND and aims to bring attention to the need for routine sleep screening and targeted intervention. Addressing this hidden burden could meaningfully improve child and family outcomes.

Acute appendicitis is the most common paediatric emergency presentation requiring timely surgical intervention. The Sydney Children's Hospital Network (SCHN) noted in their National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) data that their appendicectomy postoperative length of stay (LOS) was longer than that of other hospitals. NSQIP-P reports are calculated from case reviews with a 30-day post-operative follow-up. From 2020 to 2022, the post-operative LOS for uncomplicated appendicectomy at SCHN was a median of 24 h (n = 714). A quality improvement project was initiated using Clinical Redesign Methodology. The project team developed an Uncomplicated Appendicectomy Guideline to standardize care. The Guideline also included a criteria-led discharge that could be applied after 6 h of post-operative recovery. Comprehensive information was provided for parents/carers on discharge. In 2024, the median postoperative LOS was reduced from 24 to 16 h (n = 185). This represents a statistically significant reduction in post-operative length of stay of 33% (p < 0.001). There were no statistically significant increase in post-operative readmissions (p = 0.95) or in NSQIP-P morbidity rates, although there was an increase in post-operative Emergency Department presentations noted, from a median of 7-10 annual presentations (p < 0.05, n = 444). There was positive feedback from parents/carers with the earlier discharge (n = 16). Parents/carers who received the discharge information sheet reported that they were better informed about their child's care. Staff in focus groups highlighted a greater autonomy in post-operative care (n = 24). Paediatric patients with uncomplicated appendicitis can be safely discharged from 6 h post-operatively with comprehensive discharge information.

Abstract Background Restless sleep is frequently reported in children and is often linked to sleep fragmentation. Sleep-related movements can serve as indirect markers of sleep disruption. Polysomnography (PSG), while considered the gold standard, is resource-intensive and may interfere with natural sleep. The Sonomat, a contactless, home based system, offers a less intrusive alternative for detecting and quantifying these movements. Aim To compare the detection and quantification of sleep-related movements in children using the Sonomat versus PSG. Methods This retrospective study examined children undergoing simultaneous Sonomat and PSG recordings for suspected sleep-disordered breathing. Movement Index (MI) and Movement Duration (MD) were measured. Overlap and correlation between modalities were evaluated. Results Thirty six patients (15 Female, 21 male) with a median age of 5.9 years (IQR 3, range 2-12.4) underwent concurrent PSG and Sonomat for snoring. The Sonomat recorded more frequent movements (median MI 36.9/hr; IQR 13) and greater cumulative movement duration (median MD 12.3%; IQR 10.9) than PSG (median MI 20.6/hr; IQR 8.57; MD 8.6%; IQR 8.72). Sonomat captured 87.8% of PSG-detected movements, while PSG identified 49.4% of those detected by Sonomat. Differences diminished with longer movements, with no significant difference over 7 seconds. Correlation was strong for MD (Spearman’s r = 0.89, p&amp;lt;.001) and moderate for MI (r = 0.58, p&amp;lt;.001). Conclusion The Sonomat is a promising non-invasive alternative for assessing sleep-related movements in children. Its higher sensitivity to short-duration movements suggests potential utility, though further research is needed to establish normative data and explore clinical significance.

BackgroundCoronary vasospasm, or vasospastic angina (VSA), is a clinical entity that can uncommonly occur in the setting of non-obstructive coronary disease. Refractory VSA can be associated with significant adverse cardiovascular events, and a paucity of evidence-based guidelines makes this a challenging clinical scenario for clinicians to treat effectively.Case summaryA 46-year-old male presenting with a 48 h history of epigastric pain with electrocardiogram changes suggestive of left anterior descending artery stenosis and angiography showing no significant obstructive disease. The patient then developed recurrent early morning chest pain with multi-territory ST elevation despite antispasm therapy with repeat angiography and optical coherence tomography showing no evidence of obstructive disease. The patient was diagnosed with idiopathic refractory coronary vasospasm and ultimately managed with corticosteroids and with a wearable cardiac defibrillator.DiscussionThe case presented highlights the diagnostics challenges and treatment complexity in managing refractory coronary vasospasm in which our patient experienced a good long-term outcome despite high risk features. Steroids are infrequently used in the management of coronary vasospasm but represent a life-saving treatment option in the setting presumed inflammation. Wearable cardiac defibrillator can be used to both investigate and prevent fatal arrhythmia and should be considered in high-risk coronary vasospasm cohorts.

Body stuffing involves hastily ingesting poorly sealed drug packets for concealment. Management varies from no imaging to CT scans and observation for 6-24 h or until packet passage. This study describes the characteristics, management, and outcomes of body stuffers. A retrospective review was conducted on body stuffers reported to the NSW Poisons Information Centre and South-East Area Toxicology Service (2014-2023). Patients who ingested drugs for concealment were included. Body packers, body pushers, and cases without medical records were excluded. Data were collected from databases and medical records. Of 192 patients, 126 met inclusion criteria (85% male, median age 30 years). Median time to presentation was 3.2 h (IQR: 1.7-6.6, n = 84). The median number of packages was one (IQR: 1-3), with balloons being the most common (56%). Concealed substances included opioids (39%) and amphetamines (29%). Thirty-two ingested multiple substances, while 26 denied or had unknown ingestion. Symptoms were present in 61 (48%), commonly sedation (19) or agitation (13). Symptomatic patients mostly concealed sedatives (29) or stimulants (28), while those ingesting tobacco or denying ingestion were usually asymptomatic. Imaging included abdominal X-ray (63) and CT (50). Sensitivity for X-ray and CT was 25% and 52% respectively. No asymptomatic patients developed symptoms during their stay. Twelve re-presented with new symptoms following discharge. This study found that body stuffers concealed various drugs, with opioids and stimulants more likely to cause symptoms. Asymptomatic patients typically had a benign course. Imaging has limited sensitivity; reserving it for those with more high-risk features of exposure seems reasonable.

Precision medicine for paediatric and adult cancers that incorporates drug sensitivity profiling can identify effective therapies for individual patients. However, obtaining adequate biopsy samples for high-throughput (HTP) screening remains challenging, with tumours needing to be expanded in culture or patient-derived xenografts,this is time-consuming and often unsuccessful. Herein, we have developed paediatric patient-derived tumour models using an engineered extracellular matrix (ECM) tissue mimic hydrogel system and HTP 3D bioprinting. Gene expression analysis from a neuroblastoma and sarcoma paediatric patient cohort identified key components of the ECM in these tumour types. Engineered hydrogels with ECM-mimic peptides were used to bioprint and create patient-specific tumouroids using patient-derived cells from xenograft models, and the approach was further confirmed on direct patient tumour samples. Bioprinted tumouroids from the PDX models recapitulated the genetic and phenotypic characteristics of the original tumours and retained tumourigenicity. HTP drug screening of these models identified individualised drug sensitivities. Our approach offers a timely and clinically relevant technology platform for precision medicine in paediatric cancers, potentially transforming preclinical testing across multiple cancer types.