OBJECTIVES:To determine if a participation-focused therapy (Participate-CP) was more effective than usual care to improve participation in physically active leisure and physical activity for children with cerebral palsy (CP). METHODS:This prospective, multisite waitlist randomized controlled trial included children with CP, aged 8 to 14 years, classified in Gross Motor Function Classification System (GMFCS) levels I-IV. Participate-CP comprised weekly, 60-minute sessions over 12 weeks using motivational interviewing and a toolbox of evidence-based therapy strategies targeting modifiable barriers to participation. Primary outcomes were the Canadian Occupational Performance Measure (COPM) and time spent in moderate-to-vigorous physical activity. Secondary outcomes were the Barriers to Participation in Physical Activities Questionnaire, Participation and Environment Measure for Children and Youth (PEM-CY), Motives for Physical Activities Measure, and Physical Activity Climate Questionnaire and Goal Attainment Scale (GAS). RESULTS:A total of 110 children (mean age 10.4 years [SD, 1.6 years]; 60% boys; and GMFCS I = 58, II = 30, III = 8, and IV = 14) were assigned to Participate-CP (n = 56) or usual care (n = 54). There were no relevant baseline differences between groups. Participate-CP led to greater changes in perceived performance of participation goals (COPM: mean difference [MD], 2.75; 95% CI, 2.08-3.42; P < .001), greater average movement intensity (MD, 4.66; 95% CI, 0.50-8.82; P = .03), fewer barriers to participation (MD, 13.42; 95% CI, 1.69-25.14; P = .03), and greater frequency of community participation (PEM-CY: MD, 0.35; 95% CI, 0.02-0.68; P = .04) and expected goal attainment (GAS T score mean, 53.7; SD, 9.9). There were no differences between groups in the remaining measures. CONCLUSION:Participate-CP was confirmed as effective to improve the performance of physically active leisure goals, average movement intensity, frequency of community participation, and reduced barriers to participation.

Abstract Background Elexacaftor-tezacaftor-ivacaftor (ETI) has been demonstrated to improve lung function in clinical trials; however, evidence describing effects on trajectories and whether long-term improvements are sustained (>1-year) is lacking. We estimated within-person lung clearance index (LCI) trajectories before and after ETI initiation, assessing changes in level and rate of change, alongside acute LCI change, up to three years after ETI initiation. Methods Prospective observational study of children at a tertiary hospital. Children aged 3–17 years with ≥2 LCI testing occasions (i) before and (ii) after starting ETI were used to describe lung function trajectories. Children with ≥1 pre-ETI and ≥1 post-ETI LCI occasion(s) were used to describe acute LCI change after ETI initiation. Age-adjusted LCI trajectories for time periods (i) before and (ii) after ETI initiation were estimated using linear mixed-effects models, and pre- and post-ETI LCIs were compared using paired Wilcoxon tests. Results Mean pre-ETI and post-ETI longitudinal changes in LCI were -0.007 (95% CI: -0.28, 0.27; n=35) and 0.12 (95% CI: -0.17, 0.41; n=20) turnovers per year, respectively. Before ETI initiation, 57% (30/53) of patients had an LCI≥7.1 turnovers (indicating impaired lung function), compared to 26% (14/53) post-ETI, with a median LCI difference of -0.70 (95% CI -0.84, -0.46; p<0.001) turnovers. Within-individual variability in LCI decreased post-ETI. Conclusions Our real-world data within a unique longitudinal study provide a comprehensive picture of ETI benefit by outlining not only acute improvement in LCI but maintained stability in LCI trajectories and improved LCI stability sustained up to three years post-initiation.

PURPOSE:Implement and evaluate near-infrared (NIR) huddles for neonatal peripheral intravenous catheter (PIVC) insertion. METHODS:An implementation project investigated PIVC insertion attempts, site, inserter designation, dwell, and complications during 3 phases (baseline, education, and implementation). Implementation consisted of planning insertion site(s) and attempt frequency with an NIR device huddle. The primary effectiveness outcome was first-time insertion success. Secondary outcomes included: PIVC completion/failure, failure reason, complications. Implementation outcomes were compliance, utility, and acceptability. The association between study phase and primary outcome was assessed using logistic regression. Exploratory analyses investigated intrinsic and extrinsic risks for PIVC insertion failure. RESULTS:Over 5 months, data from 248 (33%) neonates with 771 admissions was collected. Fifty-nine (24%) neonates required multiple PIVCs; resulting in 370 cannulations (n = 94 baseline, n = 55 education, and n = 221 intervention phases). Median birthweight was 2909 grams (IQR 2033-3499), gestation was 37.3 weeks (IQR 33.9-38.9). Length of stay, weight, gestation, and previous PIVC events were similar across phases. Insertion success was lower during education (n = 15, 39.5%) than baseline (n = 29, 56.9%), but differences were not significant. Acceptability of huddle process was higher (mean = 7.5/10, SD 2.2) than NIR device (mean = 5.0/10, SD 3.7). First time insertion failure was higher for forearm compared to hand/wrist (OR 5.94; 95% CI 1.22-28.87). CONCLUSION:The implementation of NIR-huddle failed to improve first-time insertion success, but PIVC dwell time and documentation were improved. Further research is needed to minimize harm and improve neonatal vascular access preservation.

Abstract Introduction Negative Pressure Wound Therapy (NPWT) has been shown to decrease scar formation in acute pediatric burns, but the large size of conventional NPWT devices can limit their acceptability in children. A smaller, ultra-portable NPWT device may reduce this treatment burden while preserving the benefits of NPWT. This study aimed to evaluate the feasibility, safety, and clinical application of ultra-portable NPWT in the management of minor pediatric burns. Methods We conducted a single-center, three-arm, parallel randomized controlled pilot trial at a quaternary pediatric burns unit. Children <16 years with minor burns suitable for the ultra-portable NPWT dressing dimensions were eligible. Participants were randomized to one of three groups: (1) silicone + silver nanocrystalline; (2) silicone + silver nanocrystalline + ultra-portable NPWT; or (3) silicone + silver nanocrystalline (thin) + ultra-portable NPWT. The primary outcome was feasibility, defined by recruitment, treatment fidelity, data completeness, and study completion. Secondary outcomes included the feasibility of the ultra-portable NPWT application, patient/clinician perceptions, complication rates, and the impact on clinical workload. Results Thirty-one participants were randomized (screening rate: 5.6%). All feasibility benchmarks were achieved except recruitment (76.5% vs the prespecified 80%). Dressing feasibility did not differ between groups. Complications were significantly higher in the silicone + regular silver nanocrystalline + ultra-portable NPWT group compared with silicone + silver nanocrystalline alone (p<.001). In contrast, ultra-portable NPWT combined with silver nanocrystalline (thin) did not increase complications (p=.1). Both ultra-portable NPWT groups increased clinician workload compared with standard dressings (p=.01 for silver nanocrystalline, p=.04 for silver nanocrystalline (thin)). Conclusions Ultra-portable NPWT can be feasibly trialed and clinically applied in select pediatric burn patients, though its use is limited by patient eligibility and clinician workload. Future studies should prioritize combinations with silver nanocrystalline (thin) rather than regular silver nanocrystalline, to minimize complications. Applicability of Research to Practice This is the first randomized study to test the feasibility of ultra-portable NPWT in pediatric burns, addressing the need for portable, child-friendly NPWT options. Findings guide clinical application and design of larger trials, with the potential to broaden NPWT accessibility and reduce long-term burn scarring in children. Funding for the study N/A.

Importance Pediatric peripheral intravenous catheter (PIVC) insertion can be difficult and time-consuming, frequently requiring multiple insertion attempts and often resulting in increased anxiety, distress, and treatment avoidance among children and their families. Ultrasound-guided PIVC insertion is a superior alternative to standard technique (palpation and visualization) in high-risk patients. Objective To compare first-time insertion success of PIVCs inserted with ultrasound guidance compared with standard technique (palpation and visualization) across all risk categories in the general pediatric hospital population. Design, Setting, and Participants An open-label, pragmatic, superiority, randomized clinical trial was conducted in an Australian quaternary pediatric hospital. Children (ages 0-18 years) requiring PIVC insertion were included between July 2021 and December 2022. One catheter was studied per patient, and analysis was by intention to treat. Data analysis was performed from April to October 2023. Intervention Eligible children were randomly assigned (1:1 using computer-generated randomization and concealed allocation) to receive ultrasound-guided or standard PIVC insertion. Randomization was stratified by insertion difficulty (low, medium, or high risk) defined using a standardized tool. Main Outcomes and Measures The primary outcome was first-time insertion success. Secondary outcomes included number of insertion attempts, insertion failure, postinsertion complications, dwell time, patient and parent satisfaction, and health care costs. Results A total of 164 children were randomly assigned to ultrasound-guided insertion (n = 84) or standard care (n = 80), with 81 (96.4%) and 78 (97.5%) receiving their allocated intervention, respectively. The median (IQR) age was 24 (10-120) months, and 93 children (56.7%) were male. First-time insertion success was higher with ultrasound-guided PIVC insertion (72 children [85.7%]) compared with standard technique (26 children [32.5%]) (risk difference [RD], 53.6%; 95% CI, 41.7%-65.4%; P < .001). Ultrasound-guided insertion led to significantly greater first-time insertion success across all risk categories, with the following RDs: low risk, 30.8% (95% CI, 8.1%-53.5%); medium risk, 56.2% (95% CI, 37.1%-75.3%); and high risk, 69.6% (95% CI, 52.3%-87.0%). Ultrasound-guided PIVC insertion had higher immediate health care costs (between group difference in total mean cost per person, A$9.33; 95% credible interval, A$8.83-A$10.86 [US $5.83; 95% credible interval, $5.52-$6.78]). Conclusion and Relevance These findings suggest that ultrasound-guided PIVC insertion improves first-time insertion success across all risk categories in pediatrics, supporting the widespread adoption of ultrasound-guided PIVC insertion in children. Trial Registration anzctr.org.au Identifier: ACTRN12621000206820

Background New catheter materials for peripherally inserted central catheters (PICCs) may reduce the risk of device failure due to infectious, thrombotic, and catheter occlusion events. However, data from randomized trials comparing these catheters are lacking. Methods We conducted a randomized, controlled, superiority trial in three Australian tertiary hospitals. Adults and children who were referred for PICC placement were assigned in a 1:1:1 ratio to receive a hydrophobic or chlorhexidine PICC or a standard polyurethane PICC and were followed for 8 weeks. The primary outcome was device failure, which was a composite of infectious (bloodstream or local) or noninfectious (thrombosis, breakage, or occlusion) complications. Results A total of 1098 participants underwent randomization; 365 were assigned to the hydrophobic group, 365 to the chlorhexidine group, and 368 to the standard-polyurethane group. Device failure occurred in 21 of 358 participants (5.9%) in the hydrophobic group, in 36 of 363 (9.9%) in the chlorhexidine group, and in 22 of 359 (6.1%) in the standard-polyurethane group (risk difference, hydrophobic vs. standard polyurethane, -0.2 percentage points [95% confidence interval {CI}, -3.7 to 3.2; P = 0.89]; and chlorhexidine vs. standard polyurethane, 3.8 percentage points [95% CI, -0.1 to 7.8; P = 0.06]). In the hydrophobic group as compared with the standard-polyurethane group, the odds ratio for device failure was 0.96 (95% CI, 0.51 to 1.78), and in the chlorhexidine group as compared with the standard-polyurethane group, the odds ratio was 1.71 (95% CI, 0.98 to 2.99). Complications from any cause during the period of PICC placement occurred in 77 participants (21.5%) in the hydrophobic group, in 140 (38.6%) in the chlorhexidine group, and in 78 (21.7%) in the standard-polyurethane group (odds ratio, hydrophobic vs. standard polyurethane, 0.99 [95% CI, 0.69 to 1.42]; and chlorhexidine vs. standard polyurethane, 2.35 [95% CI, 1.68 to 3.29]). No adverse events were attributable to the interventions. Conclusions Among adults and children who were referred for PICC placement, the risk of device failure due to noninfectious or infectious complications was not lower with hydrophobic or chlorhexidine PICCs than with standard polyurethane PICCs. (Funded by the National Health and Medical Research Council of Australia; PICNIC Australian New Zealand Clinical Trials Registry number, ACTRN12619000022167.).

Aims: This study aimed to (1) evaluate associations between Early and Term structural MRI (sMRI) brain abnormality scores and adverse motor outcomes at 6-years corrected age (CA), (2) determine their diagnostic accuracy in predicting adverse motor outcomes and cerebral palsy (CP) at 6-years CA. Methods: Infants born < 31-weeks gestational age (GA) returning for 6-year follow-up were included. Early and Term sMRI were scored using a validated method, deriving white matter, cortical grey matter, deep grey matter, cerebellar and global brain abnormality scores (GBAS). At 6-years CA, Movement Assessment Battery for Children-2nd Edition (MABC-2) was administered. Linear regression assessed associations between Early and Term GBAS/subscale scores and 6-year MABC-2 total score. For diagnostic accuracy, sMRI scores were categorised as none/mild vs moderate/severe, MABC-2 cut-off < 5th percentile, and CP as present/absent. Results: Infants had Early MRI (n = 123) at mean PMA 32.5-weeks (median GA 28.4-weeks; mean birthweight 1101 g) and n = 114 had Term MRI (Mean PMA 40.8-weeks). Nine had CP and n = 116 had MABC-2 scores. Early (B: -1.92; p <0.001) and Term (B: -1.67; p < 0.01) GBAS were negatively associated with MABC-2 scores. Both Early and Term GBAS had high specificity (Sp) and low sensitivity (Se) in predicting MABC-2 < 5th percentile (Early: Se 36 %, Sp 82 %; Term: Se 28 %, Sp 93 %) and predicted CP with high Se and Sp (Early: Se 78 %, Sp 78 %; Term: Se 75 %, Sp 89 %). Conclusion: High Sp of Early and Term MRI predicting an outcome on MABC-2 may help accurately identify infants unlikely to develop motor impairments at 6-years CA.

OBJECTIVES:Central venous catheters (CVCs) are vital for treating ICU patients. However, up to a quarter of CVCs fail from mechanical or infective complications. Poor securement of CVCs to the skin contributes to catheter failure, particularly CVCs placed in the jugular vein, which are highly vulnerable to pullout forces. This study evaluated the effectiveness of medical liquid adhesive (MLA) for improving jugular CVC dressing adhesion.DESIGN:Multisite parallel group, superiority, randomized controlled trial.SETTING:Four metropolitan Australian ICUs.PATIENTS:Eligible patients were 18 years old or older, within 12 hours of jugular CVC insertion, expected to need the CVC for greater than or equal to 72 hours, and remain in ICU for greater than or equal to 24 hours.INTERVENTIONS:Patients were randomly allocated (stratified by hospital and gender) to standard CVC dressings with the application of MLA to skin under the dressing border (intervention) or standard care CVC dressings (control).MEASUREMENTS AND MAIN RESULTS:The primary endpoint was dressing failure within 7 days due to lifting edges. Secondary outcomes included the total number of dressing changes, skin injury, and CVC failure. In total, 160 participants (82 control; 78 intervention) were enrolled. There were 22 (28%) and 41 (50%) cases of premature dressing failure in the intervention and control groups respectively (odds ratio, 0.39; 95% CI, 0.20-0.76; p = 0.005). The intervention group had fewer dressing changes (incidence rate ratio [IRR], 0.74; 95% CI, 0.55-0.99). Time to dressing failure (log-rank test; p = 0.12) and all-cause CVC failure (IRR, 1.44; 95% CI, 0.36-5.79) did not differ between groups. Three skin injuries occurred: one in the intervention (blister) and two in the control (maceration and skin tear) groups.CONCLUSIONS:MLA is associated with significantly decreased jugular CVC dressing failure and longer dressing dwell, with an acceptable safety profile. MLA should be considered to preserve jugular CVC dressings in ICU.

Importance Pediatric peripheral intravenous catheter (PIVC) insertion can be difficult and time-consuming, frequently requiring multiple insertion attempts and often resulting in increased anxiety, distress, and treatment avoidance among children and their families. Ultrasound-guided PIVC insertion is a superior alternative to standard technique (palpation and visualization) in high-risk patients. Objective To compare first-time insertion success of PIVCs inserted with ultrasound guidance compared with standard technique (palpation and visualization) across all risk categories in the general pediatric hospital population. Design, Setting, and Participants An open-label, pragmatic, superiority, randomized clinical trial was conducted in an Australian quaternary pediatric hospital. Children (ages 0-18 years) requiring PIVC insertion were included between July 2021 and December 2022. One catheter was studied per patient, and analysis was by intention to treat. Data analysis was performed from April to October 2023. Intervention Eligible children were randomly assigned (1:1 using computer-generated randomization and concealed allocation) to receive ultrasound-guided or standard PIVC insertion. Randomization was stratified by insertion difficulty (low, medium, or high risk) defined using a standardized tool. Main Outcomes and Measures The primary outcome was first-time insertion success. Secondary outcomes included number of insertion attempts, insertion failure, postinsertion complications, dwell time, patient and parent satisfaction, and health care costs. Results A total of 164 children were randomly assigned to ultrasound-guided insertion (n = 84) or standard care (n = 80), with 81 (96.4%) and 78 (97.5%) receiving their allocated intervention, respectively. The median (IQR) age was 24 (10-120) months, and 93 children (56.7%) were male. First-time insertion success was higher with ultrasound-guided PIVC insertion (72 children [85.7%]) compared with standard technique (26 children [32.5%]) (risk difference [RD], 53.6%; 95% CI, 41.7%-65.4%; P < .001). Ultrasound-guided insertion led to significantly greater first-time insertion success across all risk categories, with the following RDs: low risk, 30.8% (95% CI, 8.1%-53.5%); medium risk, 56.2% (95% CI, 37.1%-75.3%); and high risk, 69.6% (95% CI, 52.3%-87.0%). Ultrasound-guided PIVC insertion had higher immediate health care costs (between group difference in total mean cost per person, A$9.33; 95% credible interval, A$8.83-A$10.86 [US $5.83; 95% credible interval, $5.52-$6.78]). Conclusion and Relevance These findings suggest that ultrasound-guided PIVC insertion improves first-time insertion success across all risk categories in pediatrics, supporting the widespread adoption of ultrasound-guided PIVC insertion in children. Trial Registration anzctr.org.au Identifier: ACTRN12621000206820

True total-body and extended axial field-of-view (AFOV) PET/CT with 1m or more of body coverage are now commercially available and dramatically increase system sensitivity over conventional AFOV PET/CT. The Siemens Biograph Vision Quadra (Quadra), with an AFOV of 106cm, potentially allows use of significantly lower administered radiopharmaceuticals as well as reduced scan times. The aim of this study was to optimise acquisition protocols for routine clinical imaging with FDG on the Quadra the prioritisation of reduced activity given physical infrastructure constraints in our facility. Low-dose (1 MBq/kg) and ultra-low dose (0.5 MBq/g) cohorts, each of 20 patients were scanned in a single bed position for 10 and 15 min respectively with list-mode data acquisition. These data were then reconstructed simulating progressively shorter acquisition times down to 30 s and 1 min, respectively and then reviewed by 2 experienced PET readers who selected the shortest optimal and minimal acquisition durations based on personal preferences. Quantitative analysis was also performed of image noise to assess how this correlated with qualitative preferences. At the consensus minimum acquisition durations at both dosing levels, the coefficient of variance in the liver as a measure of image noise was 10% or less and there was minimal reduction in this measure between the optimal and longest acquisition durations. These data support the reduction in both administered activity and scan acquisition times for routine clinical FDG PET/CT on the Quadra providing efficient workflows and low radiation doses to staff and patients, while achieving high quality images.

AIM:To determine reproducibility of the Motor Optimality Score-Revised (MOS-R) to assess infants at high risk of adverse neurodevelopmental outcomes, including cerebral palsy (CP), autism, and developmental delays. METHOD:Thirty infants (18 males, 12 females, gestational age mean [range] = 32.5 [23-41] weeks) were randomly selected, according to 2-year outcome (typically developing; CP; or adverse neurodevelopmental outcome [ad-NDO]) from a prospective cohort. Participants had two General Movements videos between 12 weeks and 15 + 6 weeks corrected age. Six assessors, masked to history and outcomes, independently scored the MOS-R from videos. Assessors scored either one (Group 1; n = 3) or two videos for each infant (Group 2; n = 3). Intraclass correlation coefficient (ICC), Gwet's agreement coefficient, and limits of agreement were calculated. RESULTS:Combined interassessor reliability (IRR) over six assessors for total MOS-R was 'fair' (ICC = 0.56, 95% confidence interval [CI] 0.41-0.72), and 'excellent' with consensus agreement (ICC = 0.99, 95% CI 0.98-0.99). Analyses demonstrated a mean interrater difference of 0.316 (95% limits of agreement -11.51, 12.14) over 450 comparisons (15 pairs). IRR was 'moderate' to 'almost perfect' across subcategories, with the highest reliability 'movement patterns' (Gwet's agreement coefficient = 0.73-1.00) and the lowest 'postural patterns' (0.45-0.73). Assessors who scored two videos (Group 2) demonstrated higher reproducibility. IRR for total MOS-R was 'excellent' when infants were typically developing (ICC = 0.90), and 'good' for CP (0.74) and ad-NDO (0.68). INTERPRETATION:The MOS-R is a highly reproducible tool for assessing infants at high risk of ad-NDOs and is feasible for implementation in clinical settings. Reproducibility is best when the tool is used by experienced assessors to gain consensus agreement.

Background and objective: Although prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) has impacted the investigation and management of biochemical recurrence (BCR) of prostate cancer, negative scans are common at low rising prostate-specific antigen (PSA) levels. PET/CT devices with an extended axial field-of-view, such as the Siemens Biograph Vision Quadra (Quadra) scanner, have substantially higher sensitivity than conventional field-of-view scanners. Our aim was to assess whether the enhanced signal-to-noise ratios achieved on the Quadra scanner improve detection of low-volume disease and thereby increase detection of PC at low PSA levels. Methods: We analysed data for the first 300 consecutive patients who underwent clinically indicated PSMA PET/CT for BCR using a Quadra scanner. We assessed scan positivity and the location of detected disease by PSA category. Key findings and limitations: The positivity rate increased with the PSA level from 67% for PSA <0.2 ng/ml to >90% for PSA >1.0 ng/ml (p < 0.05). Disease location also differed by PSA category, with prostate bed recurrence alone identified in 63% of positive cases with PSA <0.2 ng/ml, but <25% of cases with PSA >1.0 ng/ml, and distant metastases present in only 6% of positive cases with PSA <0.2 ng/ml versus >40% of cases with PSA >1.0 ng/ml. In the group with PSA <0.2 ng/ml, pelvic nodal disease without local recurrence was identified in 31% of cases. Conclusions and clinical implications: In comparison to literature data, the Quadra scanner has substantially higher positivity rates at very low PSA levels. At these levels, disease was largely confined to the pelvis and potentially amenable to salvage radiotherapy. However, more than one-third of these patients had disease exclusively outside the prostate bed, with implications for the efficacy and morbidity of current salvage radiotherapy approaches. Patient summary: We investigated a new PET/CT scanner (positron emission tomography/computed tomography) for detection of prostate cancer recurrence. This more sensitive scanner had a higher detection rate, particularly for patients with low PSA (prostate-specific antigen) in their blood. Our results suggest that the new scanner can detect disease recurrence earlier and more accurately than standard PET/CT scanners, which can help in planning further treatment.

Neonatal peripheral intravenous catheters (PIVCs) can be difficult to insert, often requiring multiple attempts, with each attempt causing pain and delaying treatment. The aim of this study was describe the clinical characteristics of neonates requiring multiple PIVCs during hospitalization. A secondary case series of neonates requiring three or more PIVCs during their admission were identified from a cohort admitted to an Australian Neonatal Unit between October 2020 and February 2021. Data were collected at PIVC insertion and removal; with variables including patient characteristics (weight, gestational age, acuity) and device characteristics (treatment indication, location), and outcomes (completion of treatment or failure). Outcomes are reported descriptively. In total, 19 of 248 (7.6%) neonates received three or more PIVCs (n = 101 PIVCs). Median gestation and weight were 26.6 weeks (interquartile-range [IQR] 24.6-28.6 weeks) and 728 grams (IQR 640-1050 g), respectively; all neonates required intensive care admission. The most common anatomical location was the hand (41.5%, n = 42). The maximum number of PIVCs required by a single patient was 12. The median dwell time was 49 h (IQR 35.0-73.5 h), with maximum dwell 263 h. In total, 57% (n=58/101 PIVCs) failed from complications, and 58% (n=59) of failed PIVCs required re-insertion. Despite common clinician perceptions that large babies require more PIVCs, our results found extremely low birth weight babies required frequent cannulation, with many PIVCs failing prior to treatment completion. There is a need for further investigation regarding decision-making, advanced inserter skills and optimization of alternate vascular access device selection for this vulnerable population. Clinical teams caring for neonates, particularly those of low birth weight and/or gestation, are recommended to take extra time considering the device they choose to insert, and the inserting clinicians. The aim of these recommendations is to reduce the number of treatment failures and device complications causing preventable treatment delays and ongoing injuries in neonatal critical care.

AIM:To identify developmental trajectories of impaired hand function in infants aged 3 to 15 months with unilateral cerebral palsy (CP). METHOD:Sixty-three infants (37 male; median gestational age 37 weeks [interquartile range 30-39.1 weeks]) recruited as part of a randomized trial with a confirmed diagnosis of unilateral CP were included. All infants received early upper limb therapy. The Hand Assessment for Infants (HAI) was completed at baseline and until 12 to 15 months corrected age. Group-based trajectory modelling identified groups with similar trajectories of development of impaired hand function. Multinomial logistic regression determined associations between demographic variables and trajectory membership. RESULTS:The three-group trajectory model comprised 'low' 29%, 'moderate' 35%, and 'high' 36% functioning groups. The relative risk ratio of being in the low or moderate relative to high group increased by 16% (95% confidence interval [CI] 1.02-1.32) and 14% (95% CI 1.01-1.29) respectively for each 1 week increase in gestational age. Males were more likely to be in the low relative to high group (relative risk ratio 7.22; 95% CI 1.6-32.5). INTERPRETATION:Three distinct trajectories of development of the impaired hand were identified. Males and infants born closer to term age were at higher risk of being in a low group with little improvement over time, despite receiving early intervention.

ObjectiveTo identify the proportion of hospitalisations (inpatient admissions and emergency department presentations) of Aboriginal and Torres Strait Islander people in Queensland that were medication-related and potentially preventable for nine clinical indicators of cardiovascular disease (CVD).Study designRetrospective cohort study; analysis of linked hospitalisations and emergency department presentations data and administrative records of medical services, pharmaceuticals, and deaths.Setting, participantsAboriginal or Torres Strait Islander adults (18 years or older) admitted to Queensland public and private hospitals, 1 January 2013 - 31 December 2017.Main outcome measuresPotentially preventable medication-related hospitalisations (PPMRHs), defined by a set of clinical indicators describing CVD; deaths within 30 days of PPMRHs; hospital costs.ResultsWe identified 31 472 CVD-related hospitalisations, of which 11 469 were of people with medical histories suggesting harm that was foreseeable and preventable with appropriate treatment. Of the 7886 hospitalisations with congestive heart failure, 4350 (55%) were of people with prior CVD diagnoses; 681 (16%) were associated with use of medicines known to exacerbate congestive heart failure, and 1488 (34%) were associated with underuse of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or angiotensin receptor-neprilysin inhibitors. Of the 1089 hospitalisations with myocardial infarction of people who had previously experienced myocardial infarction or acute coronary syndrome events, 809 (74%) were not receiving recommended treatment at the time of hospitalisation. Of the 5417 hospitalisations with ischaemic events of people with histories including diabetes and earlier ischaemic events, 3343 (62%) were not receiving antiplatelet or lipid-lowering therapy. The median cost associated with PPMRHs for the time period (2013-2017) was $4352 (interquartile range, $8742), and 136 (3%) of CVD-related deaths within 30 days of hospital discharge followed PPMRH events.ConclusionsInterventions supporting targeted and timely medication safety services for Aboriginal and Torres Strait Islander people need to be reviewed and improved to reduce the numbers of avoidable hospitalisations and deaths.

AIM:To examine the diagnostic accuracy of Early structural and diffusion-weighted magnetic resonance imaging (MRI) (acquired at < 36 weeks postmenstrual age) to detect cerebral palsy (CP) or other adverse motor outcomes at or beyond 3 years corrected age in infants born preterm. METHOD:In this systematic review and meta-analysis, we searched the CINAHL, Embase, PubMed, and Web of Science databases for studies without language restrictions and a prospectively registered protocol up to October 2023. We extracted the study details, associations presented, and meta-analyses conducted with pooled sensitivity and specificity. RESULTS:Twenty-seven articles met the overall inclusion criteria. White matter injury, cerebellar haemorrhage, intraventricular haemorrhage, and lower thalamic volume were associated with poorer motor outcomes. Abnormal Early structural MRI detected infants with a later diagnosis of CP (n = 448, eight studies) with a pooled sensitivity of 98% (95% confidence interval [CI] = 86-100), specificity of 75% (95% CI = 51-93), and adverse motor outcomes (n = 215, four studies), with a pooled sensitivity of 39% (95% CI = 20-59) and a specificity of 90% (95% CI = 88-94). INTERPRETATION:Early abnormal structural MRI predicted later CP with high sensitivity and specificity, while specificity was higher than sensitivity in predicting adverse motor outcomes using the Movement Assessment Battery for Children, Second Edition. Further research into diagnostic accuracy and association between Early MRI and long-term motor outcomes is warranted.

Introduction: Despite disease modifying treatments (DMT), assisted ventilation is commonly required in children with Spinal Muscular Atrophy (SMA). Guidelines suggest screening with oximetry and transcutaneous carbon dioxide (TcCO2) 2 ) for sleep disordered breathing (SDB). Aim: To determine the utility of pulse oximetry and TcCO2 2 as a screen for SDB and the need for Non-Invasive Ventilation (NIV) in children with SMA type 1-3. Methods: A prospective cohort study was conducted in Queensland, Australia. Full diagnostic PSG was completed in DMT na & iuml;ve children with SMA. Pulse oximetry and TcCO2 2 were extracted from PSG. Apnoea-hypopnoea indices (AHI) criteria were applied to PSG results to define the need for NIV. Abnormal was defined as: <= 3 months of age [mo] AHI>10 >10 events/hour; >3mo AHI >5 events/hour. Receiver operating characteristic curves were calculated for abnormal PSG and pulse oximetry/TcCO2 2 variables, and diagnostic statistics were calculated. Results: Forty-seven untreated children with SMA were recruited (type 1 n = 13; 2 n = 21; 3 n = 13) ranging from 0.2 to 18.8 years old (median 4.9 years). Oxygen desaturation index >4 % (ODI4) >20events/hour had sensitivity 82.6 % (95 % CI 61.2-95.0) and specificity of 58.3 % (95 % CI 36.6-77.9). TcCO2 2 alone and combinations of oximetry/TcCO2 2 had low diagnostic ability. The same methodology was applied to 36 children who were treated (type 1 n = 7; type 2 n = 17; type n = 12) and oximetry +/- TcCO2 +/- TcCO2 had low diagnostic ability. Conclusion: ODI4 >20events/hour can predict the need for NIV in untreated children with SMA. TcCO2 monitoring does not improve the PPV. If normal however, children may still require a diagnostic PSG. Neither oximetry nor TcCO2 2 monitoring were useful screening tests in the children treated with DMT.