ABSTRACT Diagnostic and developmental assessment reports communicate outcomes and recommendations for children with neurodevelopmental conditions (NDCs), supporting access to interventions, funding and educational accommodations. However, little is known about caregivers' perceptions of the clarity, usefulness and applicability of these recommendations. Methods This qualitative study explored caregiver experiences of recommendations following comprehensive developmental assessments at a publicly funded tertiary paediatric service in Sydney, Australia. Thirteen semi‐structured interviews involving 14 caregivers of children aged 2–13 years were conducted between January and July 2025. Participants represented diverse cultural, linguistic and educational backgrounds. Interviews explored the clarity, usefulness and relevance of report recommendations. Data were analysed using the Framework Method. Results Five themes were identified: quality of recommendations, practical considerations, access to funding, access to information and broader service‐related issues. Caregivers generally described recommendations as clear, practical, comprehensive and consistent with verbal feedback. Reports supported disability funding applications, educational planning and communication with schools and service providers. Areas for improvement included more personalised, child‐centred recommendations; clearer explanations of diagnostic terminology and funding pathways; greater detail about available services and practical implementation guidance. Caregivers also reported difficulties navigating funding systems, accessing services and prioritising recommendations alongside family demands. Conclusions While recommendations were viewed positively overall, findings identified opportunities to improve relevance, accessibility and implementation. Child‐centred recommendations, structured follow‐up and care coordination may strengthen report impact and better support families to navigate services and interventions.
ABSTRACT The impact of disrupted fluid balance on outcomes in critically unwell children and adults is well described. Recent literature in neonates has demonstrated that both fluid overload and excessive postnatal fluid losses are associated with increased morbidity and mortality. However, neonates present unique challenges in measuring fluid balance as well as defining, preventing and treating fluid overload due to developmental changes in renal physiology, high trans‐epidermal losses, nutritional requirements and limitations in available renal replacement therapies. In the neonatal intensive care unit, significant variations exist in renal physiology and expected fluid shifts between neonates of differing gestational and chronological ages, as well as in the neonate's underlying co‐morbidities. As such, approaches to fluid balance should be individualised to each patient. Recognition of fluid balance as a vital sign, with implications as relevant as a patient's cardiorespiratory status, provides an important opportunity to improve outcomes. In this scoping review we discuss neonatal renal and fluid balance physiology, and present contemporary best practice strategies for measuring fluid balance. We explore the currently available prevention and treatment options for fluid overload in Australia and New Zealand as well as technological advances in neonatally‐adapted haemodialysis (HD) and continuous renal replacement therapies emerging internationally.
