Research on child and adolescent health in low- and middle-income countries in 2023-2024.

Between July 2023 and June 2024, there were 540 publications from randomised controlled trials (RCTs) in child and adolescent health in low- and middle-income countries (LMICs), identified using a standardised process that has been in use for 21 years. This year, trials addressed a wide range of diseases and conditions impacting the health, development and well-being of children, newborns, adolescents and mothers. The RCTs reflected old, new and neglected problems, the rapidly changing epidemiology and the evolving social and economic circumstances in many countries.

Fluid and electrolyte pathophysiology in common febrile illness in children and the implications for clinical management.

Achieving fluid homeostasis and the management of fluid and electrolyte complications are constants in the treatment of seriously ill children worldwide. Consensus on the most appropriate fluid strategy for unwell children has been difficult to achieve and has evolved over the last two decades, most notably in high-income countries where adverse events relating to poor fluid management were identified more readily, and official robust inquiries were possible. However, this has not been the situation in many low-income settings where fluids that are prohibited from use in high-income countries may be all that are available, local guidelines and processes to recognise adverse events are not developed, and there has been limited training on safe fluid management for front-line healthcare workers.

Birth defects in a rural province in Papua New Guinea.

Background: Globally, birth defects are the fourth most common cause of neonatal mortality. They cause substantial morbidity, and often long-term disability. Despite this, the impact of birth defects on public health has received little attention in low- and middle-income countries.

Hypoxaemia and risk of death among children: rethinking oxygen saturation, risk-stratification, and the role of pulse oximetry in primary care.

Pulse oximeters are essential for assessing blood oxygen levels in emergency departments, operating theatres, and hospital wards. However, although the role of pulse oximeters in detecting hypoxaemia and guiding oxygen therapy is widely recognised, their role in primary care settings is less clear. In this Viewpoint, we argue that pulse oximeters have a crucial role in risk-stratification in both hospital and primary care or outpatient settings.

Services for critical and emergency care of children in Victoria.

The population of children requiring intensive care in Victoria has increased and changed markedly since the 1990s, the result of many epidemiological, demographic, and social changes, and this is more evident during and after the Covid pandemic. The model of ultra-centralised paediatric intensive care services in the 1990s is not sufficient for the current era, and services are under daily pressure. Solutions will take time and need to be wide-ranging, including increased critical care capacity in selected regional centres, decentralisation of some services for low-risk conditions, improvements and reforms in medical and nursing education, pre-service and post-graduate, including for other acute care disciplines and for general practitioners and a more structured state-wide paediatric system.

Typhoid fever in children in Goroka, Papua New Guinea.

Background: Typhoid is endemic in many low-income countries, including in Papua New Guinea. This study aimed to describe the burden and clinical features of typhoid in children in a provincial hospital, to describe environmental conditions that lead to typhoid, and to document the antibiotic sensitivity of Salmonella spp. in the Eastern Highlands Province.

Effectiveness of bubble continuous positive airway pressure for treatment of children aged 1-59 months with severe pneumonia and hypoxaemia in Ethiopia: a pragmatic cluster-randomised controlled trial.

Background: The safety and efficacy of bubble continuous positive airway pressure (bCPAP) for treatment of childhood severe pneumonia outside tertiary care hospitals is uncertain. We did a cluster-randomised effectiveness trial of locally made bCPAP compared with WHO-recommended low-flow oxygen therapy in children with severe pneumonia and hypoxaemia in general hospitals in Ethiopia.

Methods: This open, cluster-randomised trial was done in 12 general (secondary) hospitals in Ethiopia.

The identification of WHO emergency signs in children by nurses at triage in an emergency department.

Background: The World Health Organization recommends the use of a three-tier triage system to recognise a sick child in low- and middle-income countries. The three tiers are based on standardised emergency and priority signs. No studies have evaluated the prevalence or reliable detection of these emergency signs.

Making respiratory care safe for neonatal and paediatric intensive care unit staff: mitigation strategies and use of filters.

Background: Many medical devices in pediatric and newborn intensive care units can potentially expose healthcare workers (HCWs) and others to transmission of respiratory and other viruses and bacteria. Such fomites include ventilators, nebulizers, and monitoring equipment.

Approach: We report the general, novel approach we have taken to identify and mitigate these risks and to protect HCWs, visitors and patients from exposure while maintaining the optimal performance of such respiratory equipment.

Implementation of bubble continuous positive airway pressure for children with severe pneumonia and hypoxemia in intensive care unit of Dhaka Hospital, Bangladesh-Effect on pneumonia mortality.

Background: After the completion of a randomized trial at Dhaka Hospital in 2013, bubble continuous positive airway pressure (BCPAP) oxygen therapy was incorporated as the part of the standard treatment for children with severe pneumonia with hypoxemia in an intensive care unit at Dhaka Hospital in August 2013 instead of World Health Organization (WHO) standard low flow oxygen therapy.

Objective: To understand the long-term effectiveness of the introduction of bCPAP oxygen therapy by comparing pneumonia mortality in the post-trial period (August 2013 to December 2017) with the pre-trial (February 2009 to July 2011) and trial periods (August 2011 to July 2013).

Methods: It was a retrospective analysis of prospectively collected hospital data of all admissions.

Adolescent health care and perceptions in a provincial hospital in Papua New Guinea.

Objectives: Adolescents make up an estimated 22 % of the 11.8 million population of Papua New Guinea (PNG), yet, as in many low and middle income countries, there are limited specific services for adolescents, who in traditional health service design fall between paediatric and adult patients. With more survivors of chronic illnesses, including tuberculosis and HIV, congenital and acquired heart disease, epilepsy and cerebral palsy, diabetes, cancer and other chronic conditions, there are gaps in the care of such young people, and in their eventual transition to adult services.

Precision of weight measurement in critically ill infants: a technical report.

To investigate the precision of weight measurements in critically ill infants in a paediatric intensive care unit (PICU). Prospective cohort study. Royal Children's Hospital PICU.

A Clinical Score for Quantifying Edema in Mechanically Ventilated Children With Congenital Heart Disease in Intensive Care.

Unlabelled: Standardized clinical measurements of edema do not exist.

Objectives: To describe a 19-point clinical edema score (CES), investigate its interobserver agreement, and compare changes between such CES and body weight.

Design Setting And Participants: Prospective observational study in a tertiary PICU of mechanically ventilated children with congenital heart disease.

Severe encephalitis: aetiology, management and outcomes over 10 years in a paediatric intensive care unit.

Objective: To describe the characteristics, differential diagnoses, management and outcomes of severe encephalitis in children.

Design: A 10-year retrospective cohort study in children admitted to a tertiary paediatric intensive care unit (PICU) with suspected encephalitis. One to 6 months' follow-up data were compared between different categories.

Randomised controlled trials in child and adolescent health in 2023.

In the year July 2022 to June 2023 there were 501 publications from randomised controlled trials (RCTs) in child and adolescent health in developing countries identified through a standardised search strategy that has been going for 20 years. This year, trials addressed the widest range of diseases and conditions that affect the health, development and well-being of children, newborns, adolescents and mothers. RCTs reflected old, neglected and new problems, the changing epidemiology of child health, social and economic circumstances in many countries, local and global priorities of low-income and middle-income countries, environmental causes of poor child health, and inequities.

Effectiveness, safety and economic viability of daycare versus usual hospital care management of severe pneumonia with or without malnutrition in children using the existing health system of Bangladesh: a cluster randomised controlled trial.

Background: We aimed to define clinical and cost-effectiveness of a Day Care Approach (DCA) alternative to Usual Care (UC, comparison group) within the Bangladesh health system to manage severe childhood pneumonia.

Methods: This was a cluster randomised controlled trial in urban Dhaka and rural Bangladesh between November 1, 2015 and March 23, 2019. Children aged 2-59 months with severe pneumonia with or without malnutrition received DCA or UC.

Children with palliative care needs in Papua New Guinea, and perspectives from their parents and health care workers: a qualitative study.

Introduction: The World Health Organisation defines paediatric palliative care (PPC) as caring for the child's body, mind, and spirit, and giving support to the family. In life-limiting conditions it is important that palliative support can be provided even when curative attempts are being utilised. In Papua New Guinea, as in other low- and middle-income countries there is a lack of services and training on PPC.

Quality of inpatient paediatric and newborn care in district hospitals: WHO indicators, measurement, and improvement.

Poor-quality paediatric and neonatal care in district hospitals in low-income and middle-income countries (LMICs) was first highlighted more than 20 years ago. WHO recently developed more than 1000 paediatric and neonatal quality indicators for hospitals. Prioritising these indicators should account for the challenges in producing reliable process and outcome data in these settings, and their measurement should not unduly narrow the focus of global and national actors to reports of measured indicators.

Agreement Between Measured Weight and Fluid Balance in Mechanically Ventilated Children in Intensive Care.

Objectives: To investigate the agreement between change in body weight (BW) and fluid balance (FB), and the precision and safety of BW measurement in mechanically ventilated infants in intensive care.

Design: Prospective observational study.

Setting: Tertiary PICU.

Child health nurses in Solomon Islands, piloting the 'Bachelor of nursing: Child health'.

Aim: In 2016, the Solomon Islands National University developed and implemented the country's first nursing specialisation in child health, the Bachelor of Nursing: Child Health. This qualitative study aimed to explore the experiences of the first cohort of students (n = 14) during this course in order to evaluate the programme.

Background: The Bachelor of Nursing: Child Health was implemented in 2016 to develop nurses' knowledge and skills in child health and improve child health outcomes and so on.

Low birthweight newborns in Vanuatu: A longitudinal follow-up study.

Aim: Medical care and technology have increased the survival of low birthweight babies (LBW), but especially in low- and middle-income settings the longer term thriving of such babies is not assured because of their fragility, limited services and difficult access after discharge from hospital. In Vanuatu, a Pacific nation of dispersed islands, improving LBW outcomes and survival remains a significant challenge. In this study, we prospectively document the survival, developmental and nutritional outcomes of a cohort of LBW over the first year of life.