Predicting chance of liver transplantation for pediatric wait‐list candidates

Information about wait‐list time has been reported as one of the single most frequently asked questions by individuals awaiting a transplant but data regarding wait‐list time have not been processed in a useful way for pediatric candidates. To predict chance of receiving a DDLT, we identified 6471 pediatric (<18 years), non status‐1A, liver‐only transplant candidates between 2006 and 2017 from the SRTR. Cox regression with shared frailty for DSA level effect was used to model the association of blood type, weight, allocation PELD and MELD, and DSA with chance of DDLT. Jackknife technique was used for validation. Median (interquartile range) wait‐list time was 100 (34‐309) days. Non‐O Blood type, higher PELD/MELD score at listing, and DSA were associated with increased chance of DDLT, while age 1‐5 years and 10‐18 years was associated with lower chance of DDLT (P < 0.001 for all variables). Our model accurately predicted chance of transplant (C‐statistic = 0.68) and was able to predict DDLT at specific follow‐up times (eg, 3 months). This model can serve as the basis for an online tool that would provide useful information for pediatric wait‐list candidates.     

Reducing newborn mortality in the Asia–Pacific region: Quality hospital services and community‐based care

Improving newborn health and survival is an essential part of progression toward Millennium Development Goal 4 in the World Health Organization Western Pacific and South East Asian regions. Both community and facility‐based services are required. Strategies to improve the quality of care provided for newborns in health clinics and district‐ and referral‐level hospitals have been relatively neglected in most countries in the region and in the published literature. Indirect historical evidence suggests that improving facility‐based care will be an increasing priority for improving newborn survival in Asia and the Pacific as newborn mortality rates decrease and health systems contexts change. There are deficiencies in many aspects of newborn care, including immediate care and care for seriously ill newborns, which contribute substantially to regional newborn morbidity and mortality. We propose a practical quality improvement approach, based on models and standards of newborn care for primary‐, district‐ and referral‐level heath facilities and incorporated within existing maternal, newborn and child health programmes. There are examples where such approaches are being used effectively. There is a need to produce more nurses, community health workers and doctors with skills in care of the well and the sick newborn, and there are World Health Organization models of training to support this, including guidelines on emergency obstetric and newborn care and the Pocket Book of Hospital Care for Children. There are also simple data collection and analysis programmes that can assist in auditing outcomes, problem identification and health services planning. Finally, with increased survival rates there are gaps in follow‐up care for newborns at high risk of long‐term health and developmental impairments, and addressing this will be necessary to ensure optimal developmental and health outcomes for these children.     

Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya

Early diagnosis and start of treatment are fundamental goals in cancer care. This study determines the time lag and the factors that influence the time to diagnosis and start of treatment. Study participants were parents of childhood cancer patients diagnosed between August 2013 and July 2014 in a hospital in Kenya. Patient, physician, diagnosis, treatment, health care system, and total delay were explored using a questionnaire. Demographic and medical data were collected from the patients' medical records. Parents of 99 childhood cancer patients were interviewed (response rate: 80%). Median total delay was 102 (9–1021) days. Median patient delay (4 days) was significantly shorter than health care system delay (median 87 days; P < .001). Diagnosis delay (median 94 days) was significantly longer than treatment delay (median 6 days; P < .001). days. Lack of health insurance at diagnosis and use of alternative medicine before attending conventional health services were associated with a significantly longer patient delay (P = .041 and P = .017, respectively). The type of cancer had a significant effect on treatment delay (P = .020). The type of health facility attended affected only patient delay (P = .03). Gender, age at diagnosis, stage of disease, parents' education level or income, and distance from hospital did not have a significant effect on the length of any type of delay. Training on childhood cancer should be included in the curricula for medical training institutes. In-service workshops should be held for the health workers already working. Families must be obligated to get health insurance. Families should be encourage to attend conventional health facilities and informed on symptoms of cancer through mass media.     

Survival of high‐risk pediatric neuroblastoma patients in a developing country

Little information is available about survival of high‐risk pediatric neuroblastoma patients in developing countries. We aimed to assess survival among high‐risk pediatric neuroblastoma patients in La Plata, Argentina. Individuals eligible for our cohort were aged <20 yr when diagnosed with high‐risk neuroblastoma and received cancer‐directed therapy including stem cell transplantation at Hospital de Niños Sor Maria Ludovica between February 1999 and February 2015. We estimated overall survival probabilities using an extended Kaplan–Meier approach. Our study population comprised 39 high‐risk neuroblastoma patients, of whom 39% were aged >4 yr at diagnosis, 54% were male, and 62% had adrenal neuroblastoma. We observed 18 deaths, and the median survival time of our study population was 1.7 yr. The five‐yr overall survival probability was 24% (95% CL: 10%, 41%). In contrast, five‐yr survival of high‐risk neuroblastoma patients ranges between 23% and 76% in developed countries. Survival among high‐risk neuroblastoma patients is generally poor regardless of geographic location, but our results illustrate dramatically worse survival for patients in a developing country. We speculate that the observed survival differences could be attenuated or eliminated with improvements in treatment and supportive care, but addressing these issues will require creative solutions because of resource limitations.     

Screen time is more strongly associated than physical activity with overweight and obesity in 9‐ to 16‐year‐old Australians

Background: Both reduced moderate‐to‐vigorous physical activity (MVPA) and increased screen time have been implicated in the aetiology of childhood overweight/obesity. This study aimed to determine which behaviour had the stronger association with overweight/obesity. Method: 2200 randomly selected 9‐ to 16‐year‐old Australians provided four 24‐h use‐of‐time recalls. Participants were classified into weight status categories and as high or low physical active, and high or low screen time according to Australian guidelines (≥60 min MVPA; ≤120 min recreational screen time daily). Multivariate logistic regression was used to calculate the odds ratios (OR) for overweight/obesity for each screen time and MVPA category. Results: Increased likelihood of overweight or obese was often associated with high screen time (ORs, 2.13–2.55 for boys and 1.47–1.72 for girls), but only sometimes and less strongly associated with low MVPA (ORs, 0.49–2.55 for boys and 1.06–1.47 for girls). Analyses conducted for combined screen time and MVPA categories showed screen time to be a stronger indicator of weight status than physical activity, especially in boys. Conclusion: Overweight and obesity were more strongly associated with screen time than physical activity. Screen time may be an important target for interventions aimed at reducing childhood overweight and obesity.     

Child protection in the time of COVID‐19

As the number of cases of coronavirus disease 2019 (COVID‐19) caused by the virus SARS‐CoV‐2 rises exponentially in Australia with consequences for the health system and society at large, we need to remember that during this pandemic that necessary social distancing measures, effective school closures and rising unemployment levels may lead to an increased risk for child abuse and neglect.