AIM:Evidence-based guidelines do not recommend imaging in cryptorchidism, but anecdotally most referrals include an ultrasound report. We aimed to assess the frequency, utility and burden of imaging in children referred with presumptive disorders of testicular descent, and to assess trends over a 7-year period before and after local and international guidelines have been introduced. METHODS:This was a prospective cohort study of children referred to the Queensland Children's Hospital for anomalies of testicular descent between 2015-2017 and 2023-2024. Data were collected regarding demographics, referral details, imaging performed and surgical diagnosis. RESULTS:A total of 268 children were recruited. Ultrasound frequency has not significantly changed over time (72.8%, 2015-2017; 63.6% 2023-2024; P = 0.11). Currently, 17.6% of families are charged, and 31.9% need to take time off work, for the ultrasound. This is a significant increase from the 2015-2017 cohort. Parents report concern and anxiety, and find it traumatic for their child. Following review, the majority (65.7%) had physiologically normal testes, while 4.9% and 22.4% were diagnosed with bilateral or unilateral cryptorchidism, respectively, and 7.0% had other diagnoses. Ultrasound was concordant with the surgical diagnosis in 25.0% (2015-2017) and 30.7% (2023-2024). Ultrasound did not contribute to diagnosis nor management in any patient. CONCLUSIONS:Despite international and local guidelines, cryptorchid children continue to undergo ultrasound prior to referral. Such ultrasounds do not provide utility, or value for cost. We recommend avoiding their routine use for suspicion of testicular maldescent and working together to improve strategies for translating evidence-based guidelines into clinical practice.

Introduction: Lipoblastoma is a rare soft tissue tumour that occurs predominantly in infants and children. They are slow growing and occur intra-abdominally only similar to 10% of the time. Due to their benign nature and slow progression, intra-abdominal lipoblastomas have been described to produce few symptoms.Case Presentation: A three-year-old male was referred with a large asymptomatic abdominal mass, incidentally noted by their GP. His abdomen was obviously distended but soft. Laboratory investigations were within reference ranges for his age. CT imaging found a large abdominal mass thought to arise from the retroperitoneum. The mass was excised via exploratory laparotomy, weighing 1.736kg. Histopathological assessment supported the diagnosis of lipoblastoma.Conclusion: Surgical removal allows for a definitive diagnosis of lipoblastoma to be made. It is important to differentiate lipoblastomas from simple lipomas or myxoid liposarcomas due to the varying clinical management and surveillance requirements. Considering this child and earlier cases described in the limited literature, we propose that knowledge of, and clinical assessment for lipoblastoma is important to allow for timely investigation and appropriate management.

Bloody nipple discharge in infancy and childhood is a rare clinical finding. Most pediatric cases of bloody nipple discharge have been attributed to mammary duct ectasia. We present the case of a three-month-old exclusively formula-fed male infant with bilateral bloody nipple discharge as a result of mammary duct ectasia. With bilateral spontaneous resolution occurring after a total period of five months, this report highlights the self-limiting nature of bloody nipple discharge resulting from mammary duct ectasia in infancy.

Background: Although caesarean delivery at periviable gestations may minimize birth trauma, it may not necessarily improve perinatal outcomes. The aim of this study was to assess the impact of mode of birth on outcomes for breech versus cephalic presentation at 22 + 0-25 + 6 weeks.Methods: Retrospective cohort study of single, nonanomalous infants at 22 + 0-25 + 6 weeks gestation born at a tertiary center in Australia. Neonatal outcomes were analyzed comparing both breech and cephalic presentation and mode of delivery.Results: Six hundred and eighty eight women fulfilled the inclusion criteria with 39.7% (273/688) breech and 60.3% (415/688) cephalic infants. Survival was 31.5% (86/273) and 38.1% (158/415) in the breech and cephalic cohorts respectively. Vaginal breech infants had reduced odds of survival compared to the vaginal cephalic group (aOR 0.37, 95% CI 0.17-0.75, p < .01) with no difference in survival if delivery occurred by caesarean section. Vaginal breech birth had higher odds of very low Apgar scores, stillbirth, and neonatal death. At 22 + 0-22 + 6 weeks, outcomes were universally fatal. At 24 + 0-24 + 6 and 25 + 0-25 + 6 weeks, vaginal breech birth had lower odds of survival (aOR 0.33, 95% CI 0.13-0.84, p < .05 and aOR 0.10, 95% CI 0.03-0.34, p < .001 respectively) compared to caesarean breech births.Conclusions: Caesarean section improves perinatal outcomes for periviable breech infants > 24 + 0 weeks.

Background: The low risk of adenocarcinoma developing in colorectal polyps <10 mm is used as justification to resect and discard these without histopathology.1