Australasian Children Research Articles

Glycaemic outcomes in Australasian children and adults with type 1 diabetes: failure to meet targets across the age spectrum.

The goal of therapy in type 1 diabetes (T1D) is to achieve optimal glycaemic targets and reduce complications. Robust data representing glycaemic outcomes across the lifespan are lacking in Australasia. To examine contemporary glycaemic outcomes and rate of use of diabetes technologies in Australasian people with T1D. Cross-sectional analysis of de-identified data from 18 diabetes centres maintained in the Australasian Diabetes Data Network registry during 2019. Glycaemia was measured using glycated haemoglobin (HbA1c). The proportion of people with T1D achieving the international HbA1c target of <53 mmol/mol (7%) was calculated. Rates of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) use were determined. A total of 7988 individuals with T1D with 30 575 visits were recorded in the registry. The median (interquartile range) age was 15.3 (10.0) years and diabetes duration was 5.7 (9.4) years with 49% on multiple daily injections (MDI) and 36% on CSII. The mean HbA1c for the whole cohort was 66 mmol/mol (8.2%). HbA1c increased with age, from 60 mmol/mol (7.6%) in children <10 years, increasing during adolescence and peaking at 73 mmol/mol (8.8%) in the 20-25 years age group. The HbA1c target of <53 mmol/mol (7%) was met in 18% of children and 13% of adults. HbA1c was lower on CSII as compared with those on MDI (P < 0.0001). Only a minority of children and adults achieve the recommended glycaemic goals despite access to specialist care in major diabetes centres. There is a need to identify factors that improve glycaemic outcomes.

Factors in childhood associated with lung function decline to adolescence in cystic fibrosis

BackgroundDespite improvements in general health and life expectancy in people with cystic fibrosis (CF), lung function decline continues unabated during adolescence and early adult life. MethodsWe examined factors present at age 5-years that predicted lung function decline from childhood to adolescence in a longitudinal study of Australasian children with CF followed from 1999 to 2017. ResultsLung function trajectories were calculated for 119 children with CF from childhood (median 5.0 [25%-75%=5.0–5.1]) years) to early adolescence (median 12.5 [25%-75%=11.4–13.8] years). Lung function fell progressively, with mean (standard deviation) annual change -0.105 (0.049) for forced vital capacity (FVC) Z-score (p<0.001), -0.135 (0.048) for forced expiratory volume in 1-second (FEV1) Z-score (p<0.001), -1.277 (0.221) for FEV1/FVC% (p<0.001), and -0.136 (0.052) for forced expiratory flow between 25% and 75% of FVC Z-score (p<0.001). Factors present in childhood predicting lung function decline to adolescence, in multivariable analyses, were hospitalisation for respiratory exacerbations in the first 5-years of life (FEV1/FVC p = 0.001, FEF25–75p = 0.01) and bronchoalveolar lavage neutrophil elastase activity (FEV1/FVC% p = 0.001, FEV1p = 0.05, FEF25–75p = 0.02). No examined factor predicted a decline in the FVC Z-score. ConclusionsAction in the first 5-years of life to prevent and/or treat respiratory exacerbations and counteract neutrophilic inflammation in the lower airways may reduce lung function decline in children with CF, and these should be targets of future research.

Identification and diagnosis of Crohn disease and ulcerative colitis in children.

Crohn disease and ulcerative colitis are the two main types of inflammatory bowel disease. High rates of these conditions are seen in Australasian children - furthermore, increasing rates have been evident in recent years. Children can present with typical symptoms of abdominal pain, diarrhoea, haematochezia and/or weight loss. Atypical presentations (such as skin lesions or isolated short stature) can also occur: these may be associated with delays in the consideration and diagnosis of IBD. Initial steps in establishing a diagnosis of IBD include delineation of inflammatory markers exclusion of any other likely aetiology. Definitive diagnosis relies upon key endoscopic, histologic and radiological findings. Overall management of IBD encompasses care within a team-based, child and family-focused, multi-disciplinary setting.

Dietary assessment toolkits: an overview.

A wide variety of methods are available to assess dietary intake, each one with different strengths and weaknesses. Researchers face multiple challenges when diet and nutrition need to be accurately assessed, particularly in the selection of the most appropriate dietary assessment method for their study. The goal of the current collaborative work is to present a collection of available resources for dietary assessment implementation.Design/Setting/ParticipantsAs a follow-up to the 9th International Conference on Diet and Physical Activity Methods held in 2015, developers of dietary assessment toolkits agreed to collaborate in the preparation of the present paper, which provides an overview of each toolkit. The toolkits presented include: the Diet, Anthropometry and Physical Activity Measurement Toolkit (DAPA; UK); the National Cancer Institute's (NCI) Dietary Assessment Primer (USA); the Nutritools website (UK); the Australasian Child and Adolescent Obesity Research Network (ACAORN) method selector (Australia); and the Danone Dietary Assessment Toolkit (DanoneDAT; France). An at-a-glance summary of features and comparison of the toolkits is provided. The present review contains general background on dietary assessment, along with a summary of each of the included toolkits, a feature comparison table and direct links to each toolkit, all of which are freely available online. This overview of dietary assessment toolkits provides comprehensive information to aid users in the selection and implementation of the most appropriate dietary assessment method, or combination of methods, with the goal of collecting the highest-quality dietary data possible.

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

Staphylococcus aureus bacteremia (SAB) in children causes significant morbidity and mortality, but the epidemiology in children is not well characterized. To describe the epidemiology of SAB in children and adolescents younger than 18 years from Australia and New Zealand. 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. 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. 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. 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.

Mitochondrial disorders in australasian children: from enzymes and metabolites to genes

Mitochondrial oxidative phosphorylation (OXPHOS) disorders are the most common group of inherited metabolic diseases but comprise at least 200 different monogenic disorders. Their clinical and genetic diversity makes genetic diagnosis by Sanger sequencing of single genes highly inefficient. Our centre has provided a national focus for diagnosis of paediatric OXPHOS disease for over two decades. Analysis of body fluids for metabolites such as lactate, and more recently FGF-21, can provide diagnostic support but has poor sensitivity and specificity. Mutation analysis of relatively ‘non-invasive’ samples such as blood or urine has traditionally been restricted to testing for mtDNA mutations and typically provides a diagnosis for Most paediatric diagnoses have thus relied on muscle or liver biopsy. Ragged red fibres and enzyme histochemical defects are rare in children but measuring OXPHOS enzymes has allowed us to diagnose >500 cases and guided subsequent analysis of candidate genes. Massively parallel sequencing of mitochondrial DNA, gene panels or exomes is now transitioning from research into clinical practice. I will discuss the utility and limitations of these approaches, which have allowed us to identify mutations in mtDNA and 41 nuclear genes causing OXPHOS defects in over 300 children.

Mitochondrial disorders in australasian children: from enzymes and metabolites to genes

Mitochondrial disorders in australasian children: from enzymes and metabolites to genes

Crohn disease and ulcerative colitis in children: An update for 2014

Crohn disease (CD) and ulcerative colitis (UC), the two main types of inflammatory bowel disease (IBD), have become increasingly common in Australasian children and adolescents in recent years. Furthermore, CD and UC are seen more often in younger children. These conditions are typically more extensive in children and tend to follow more severe disease courses than in adults. Although many children may present with typical symptoms (such as abdominal pain or bloody diarrhoea), others have atypical features (including oral ulceration, short stature or skin manifestations). In addition, many children with IBD will have altered growth or nutrition, which may compromise normal linear growth and pubertal development. Early identification and full assessment of children presenting with possible IBD are essential to avoid consequences of diagnostic delay and to optimise short- and long-term outcomes. Management of IBD encompasses various options and should be undertaken within a team-based, child and family-focused, multidisciplinary setting.

Australasian nutrition research for prevention and management of child obesity: innovation and progress in the last decade

The Food and Nutrition stream of Australasian Child and Adolescent Obesity Research Network (ACAORN) aims to improve the quality of dietary methodologies and the reporting of dietary intake within Australasian child obesity research (http://www.acaorn.org.au/streams/nutrition/). With 2012 marking ACAORN's 10th anniversary, this commentary profiles a selection of child obesity nutrition research published over the last decade by Food and Nutrition Stream members. In addition, stream activities have included the development of an online selection guide to assist researchers in their selection of appropriate dietary intake methodologies (http://www.acaorn.org.au/streams/nutrition/dietary-intake/index.php). The quantity and quality of research to guide effective child obesity prevention and treatment has increased substantially over the last decade. ACAORN provides a successful case study of how research networks can provide a collegial atmosphere to foster and coordinate research efforts in an otherwise competitive environment.

Inflammatory bowel disease in australasian children and adolescents.

Many reports indicate increasing rates of inflammatory bowel disease, with data also showing changing patterns of this chronic disease in children and adolescents. This review focuses upon the available data of the epidemiology of inflammatory bowel disease in children and adolescents in Australia and New Zealand (collectively termed Australasia). Recent data show high incidence of IBD (especially Crohn disease) in this area and indicate rising rates of IBD in children and adolescents.

Bridges to Global Citizenship: Ecologically Sustainable Futures Utilising Children's Literature in Teacher Education

AbstractDeveloping an understanding of the importance of a sustainable future is vital in helping children to become ‘global citizens’. Global citizens are those willing to take responsibility for their own actions, respect and value diversity and see themselves as contributors to a more peaceful and sustainable world. Children's literature — picture and story books in particular — can be used as a powerful tool to help even the youngest citizens become aware of the need to assume responsibility for creating and enjoying a sustainable future through global citizenship. Children's literature can be utilised to help children examine and change personal lifestyles to secure a sustainable future; to identify, investigate, evaluate and undertake appropriate action to maintain, protect and enhance local and global environments; to challenge preconceived ideas, accept change and acknowledge uncertainty and to work cooperatively and in partnerships with others. This article explores and examines ways in which some examples of Australasian children's literature, specificallyStorm Boy(Thiele, 1963),Lester and Clyde(Reece, 1991),The Waterhole(Base, 2001),Window(Baker, 1991) andBelonging(Baker, 2004), have been used in a literacy focused preservice teacher education course to assist preservice teachers entering their internship school placements to develop children's understandings of an ecologically sustainable future. It provides further insight into methods for embedding teaching for a sustainable future into pre-service teacher education.

School-based obesity prevention interventions: Practicalities and considerations

Pediatric obesity continues to be a major public health concern. Once established it is difficult to treat, therefore well-designed and evaluated prevention interventions are vitally important. Schools have an important role in the prevention of childhood obesity, however, their involvement can be limited by a number of constraints and barriers, which need to be considered when designing interventions. Members of the Prevention Stream of the Australasian Child and Adolescent Obesity Research Network have extensive experience in implementing and evaluating school-based obesity prevention initiatives. Based on their collective experience and evidence from implementation research, the aim of this paper was to highlight six areas to consider when designing, implementing and evaluating obesity prevention initiatives in schools. Further, this paper aimed to provide guidance for overcoming some of the challenges and barriers faced in school-based obesity prevention research. The six key areas discussed include: design and analysis; school-community engagement; planning and recruitment; evaluation; implementation; and feedback and sustainability.

Research priorities in 2012 for the effective management of childhood obesity.

In 2010, the Management Stream of the Australasian Child and Adolescent Obesity Research Network (ACAORN) undertook a Delphi survey asking 'What research questions remain to be addressed in the effective management of child and adolescent obesity?' Members of ACAORN, the Child and Adolescent Obesity Clinics of Australasia Network (CAOCOA-Net) and attendees at the Child Obesity symposium at the annual scientific meeting for the Australian and New Zealand Obesity Society (ANZOS) contributed to three rounds of survey development. Although reasonable concordance in ratings was evident for all 10 questions, 'determining the best strategies for long-term weight management' and 'how best to support the primary healthcare system to achieve these strategies' were clearly identified as the highest research priorities. Other priorities included 'how best to identify the right children with whom to intervene' and 'managing factors which impact on service delivery'. Identifying priority research areas from those working in the field offers the opportunity to stimulate research collaboration and provide justification for funding applications.

Characterization of Maximal Respiratory Pressures in Healthy Children

Background: Measurements of maximal voluntary inspiratory (P<smlcap>i</smlcap>_max) and expiratory (P<smlcap>e</smlcap>_max) pressures are used in the management of respiratory muscle disease. There is little data on the appropriate reference range, success rates, or repeatability of P<smlcap>i</smlcap>_max and P<smlcap>e</smlcap>_max in children or on methodological factors affecting test outcomes. Objectives: To determine P<smlcap>i</smlcap>_max and P<smlcap>e</smlcap>_max in healthy children and examine which published reference equations are best suited to a contemporary population. Secondary objectives were to assess within-test repeatability and the influence of lung volumes on P<smlcap>i</smlcap>_max and P<smlcap>e</smlcap>_max. Methods: Healthy children were prospectively recruited from the community on a volunteer basis and underwent spirometry, static lung volumes, and P<smlcap>i</smlcap>_max and P<smlcap>e</smlcap>_max testing. Results: Acceptable and repeatable (to within 20%) P<smlcap>i</smlcap>_max and P<smlcap>e</smlcap>_max were obtained in 156 children, with 105 (67%) children performing both P<smlcap>i</smlcap>_max and P<smlcap>e</smlcap>_max measurements to within 10% repeatability. The reference equations of Wilson et al. [Thorax 1984;39:535–538] best matched our healthy Caucasian children. There was an inverse relationship between P<smlcap>i</smlcap>_max and the percent of total lung capacity (TLC) at which the measurement was obtained (beta coefficient –0.96; 95% CI –1.52 to –0.39; p = 0.001), whereas at lung volumes of >80% TLC P<smlcap>e</smlcap>_max was independent of lung volume (p = 0.26). Conclusion: We demonstrated that the Wilson et al. [Thorax 1984;39:535–538] reference ranges are most suited for contemporary Caucasian Australasian children. However, robust multiethnic reference equations for maximal respiratory pressures are required. This study suggests that 10% within-test repeatability criteria are feasible in clinical practice, and that the use of lung volume measurements will improve the quality of maximal respiratory pressure measurements.

The importance of long-term follow-up in child and adolescent obesity prevention interventions

Pediatric overweight and obesity continues to be a major public health concern. Once established it is difficult to treat; therefore well-designed and evaluated prevention interventions are vitally important. There is considerable evidence to suggest that obesity prevention initiatives can change children's behaviours and weight status over the short- or medium-term; however, there is far less evidence on which to judge the impact over the longer term. In response to the rise in short- and medium-term obesity prevention studies for children and adolescents over recent years, the Prevention Stream of the Australasian Child and Adolescent Obesity Research Network highlight five points as to why the dearth of obesity prevention studies with long-term follow-up should be urgently addressed. Furthermore, recommendations to strengthen the evidence base and outline key implications for research design in this area and the support required for long-term follow-up studies are detailed.

Survey on the utilisation of non-invasive ventilation in UK and Australasian children with cystic fibrosis

Survey on the utilisation of non-invasive ventilation in UK and Australasian children with cystic fibrosis

Secular Changes in Anaerobic Test Performance in Australasian Children and Adolescents

Secular changes in anaerobic fitness test performance in healthy 6- to 17-year-old Australasians were examined by meta-analysis of 232,564 power- and speed-test performances between 1960 and 2002. Overall, power-test performance improved at a rate of +0.05% [95% confidence interval (CI) = +0.01% to +0.09%] per annum, and speed at +0.04% (CI = +0.02% to +0.06%) per annum. Results indicate that anaerobic-fitness-test performances have remained relatively stable in Australasian children and adolescents in recent decades.

Guest Editorial: 5th Australasian Child Abuse and Neglect Conference Edition

Guest Editorial: 5^th Australasian Child Abuse and Neglect Conference Edition