Yanhong Jessika Hu

Aims: Tunneled noncuffed central venous catheters (tncCVCs) have been used in pediatric populations for years. This study examines whether their use is efficacious and explores the reasons for complications and failure. Methods: This 6‐year case series examines the success rate of tncCVCs inserted in patients less than 2 years old receiving intravenous antibiotics in a single institution and the reasons for device complications and failure. Results: Three hundred and thirty‐one devices were inserted into 311 patients. Median patient age was 0.7 years (IQR 0.15–1.27) and median weight 7.8 kg (4.8–10.6). Median CVC dwell time was 13 (IQR 9.2–18.2) days. The success rate in completing prescribed treatment with the device was 94.9%, with 17 failures. Thirteen failures were due to accidental dislodgement (3.9% of all comers, 77% of failures). A large majority (79%) of patients received outpatient antibiotic therapy. Patients with any history of previous CVC insertion were more likely to have failed devices. All neonatal patient devices successfully completed treatment. A total of 55 different proceduralists inserted the devices. Conclusions: Success rates for tncCVCs when used in infants to complete a median of 13 days of antibiotic therapy on a single device appear acceptable.

Objectives: Antibiotic exposure during pregnancy is common, accounting for over 80% of all medications prescribed. Antibiotics in pregnancy are linked to increased childhood disease risk, through direct toxicity or potentially microbiome dysbiosis. This systematic review investigated the relationship between in-utero exposure to antibiotics and childhood hearing loss. Methods: We searched Ovid Medline, Embase, and PubMed for studies examining antibiotic exposure during pregnancy and its associations with hearing loss in offspring. Studies with children whose mothers had data on antibiotic exposure during pregnancy were selected. The meta-analysis calculated (1) pooled prevalence of childhood hearing loss and (2) pooled odds ratios (ORs) for associations between in-utero exposure to antibiotics and childhood hearing loss. Results: Of 1244 studies identified, 18 met the inclusion criteria. Among 161,053 children exposed in-utero to antibiotics, 4368 developed hearing loss. The pooled prevalence of childhood hearing loss was 0.9% (95% CI 0.0–2.8%, I² = 99.6%). In-utero exposure to antibiotics was associated with an increased risk of childhood hearing loss (pooled OR 1.2, 95% CI 1.1 to 1.3, I² = 15.4%). Aminoglycoside exposure during pregnancy was associated with a higher risk of hearing loss (pooled OR 1.2, 95% CI 1.1 to 1.3, I² = 38.4%), while exposure to other antibiotic classes showed no association. Conclusions: The prevalence of childhood hearing loss among those exposed to antibiotics during pregnancy is high. Although the overall risk appears modest, aminoglycosides are linked to a significantly higher risk, suggesting maternal aminoglycoside exposure may indicate a risk for child hearing loss. Further research is needed to clarify causal pathways and long-term effects of in-utero exposure to antibiotics.

Background: The misuse of antibiotics in both humans and food-producing animals poses significant risks to human health and contributes to the rise of antibiotic resistance. Raising public awareness is crucial to managing antibiotic resistance, particularly among university students, as they represent a future force in tackling this global issue. Methods: A cross-sectional study was conducted from July 2022 to May 2024 in seven cities in Southern and Central China to assess university students’ knowledge, attitude, and practice regarding antibiotic use in humans and food-producing animals. Binary logistic regression was used to identify associated factors. Results: A total of 6357 students from 72 universities participated. Less than half of the students answered the knowledge items appropriately. Only 21.47% to 29.98% had a proper understanding of basic antibiotic concepts and their use in humans and food-producing animals. Respectively, 21.49% and 28.50% students paid attention to antibiotic content in food from food-producing animals and refused to buy food containing antibiotics. Factors associated with higher knowledge, attitude, and practice total scores included being male, being of older age, having a postgraduate education, majoring in the medical science discipline, studying at a double-first-class university, having a higher family monthly income, having parents in the medical area, and using antibiotics in the past year (p < 0.001). Conclusions: Given students’ insufficient knowledge—particularly in identifying antibiotics and understanding their functions—and inappropriate practices related to purchasing food from food-producing animals, targeted education programs are suggested. These programs should address the fundamental concepts of antibiotic use in both humans and food-producing animals while providing practical guidance on individual behaviors to help mitigate antibiotic resistance.

BackgroundMedication use in pregnancy is common; however, it is unknown if clinical practice guideline (CPG) prescribing recommendations referred to in Australia at the state, national and international level are consistent.AimsThis systematic review aimed to: (1) identify sources of CPGs that inform prescribing during pregnancy in Australia; (2) assess CPG quality; and (3) evaluate variation within CPG recommendations for medication use in three common conditions in pregnancy: prophylactic antibiotics following premature rupture of membranes (PROM) at term, antidepressants in pregnancy and metformin in gestational diabetes mellitus (GDM).Materials and MethodsA literature search was conducted across PubMed, Scopus and EMBASE databases. Grey literature was identified through publicly available Australian policy statements. Prescribing recommendations for prophylactic antibiotics following PROM at term, antidepressants in pregnancy and metformin in GDM, were compared at the state, national and international levels. CPG quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.ResultsWe identified 39 CPG sources that inform prescribing during pregnancy in Australia. CPG quality varied between resources. There was minor variation in recommendations for antibiotic prophylaxis in PROM at term. Recommendations regarding metformin use in GDM were also variable, with CPGs either recommending its use as a first-line agent when lifestyle modifications are not effective or when insulin therapy is not practicable. Recommendations for antidepressant use were consistent across CPGs analysed.ConclusionMultiple CPGs exist to inform prescribing during pregnancy in Australia, with variation present within CPG quality and recommendations. These findings offer insight into potential sources of variation in maternal and neonatal health outcomes.

Introduction: Early-life antibiotic exposure is common and impacts the development of the child’s microbiome and immune system. Information on the impacts of early-life antibiotics exposure on childhood asthma is lacking. Methods: This study examined associations between early-life (0–24 months) antibiotics exposure with childhood (6–15 years) asthma trajectories through the Australian Longitudinal Study of Australian Children (LSAC) and their linked data from the Pharmaceutical Benefits Scheme. Asthma phenotypes were derived by group-based trajectory modeling. Results: Of 5107 LSAC participants, 4318 were included in the final analyses (84.6% retention). Four asthma phenotypes were identified: Always-low-risk (79.0%), early-resolving asthma (7.1%), early-persistent asthma (7.9%), and late-onset asthma (6.0%). Any early-life antibiotic exposure increased risk 2.3-fold (95% CI: 1.47–3.67; p < 0.001) for early-persistent asthma among all children. In subgroup analyses, early-persistent asthma risk increased by 2.7-fold with any second-generation cephalosporin exposure, and by 2-fold with any β-lactam other than cephalosporin or macrolide exposure. Conclusion: We concluded that early-life antibiotic exposure is associated with an increased risk of early-persistent childhood asthma. This reinforces scrutiny of early-life antibiotic use, particularly for common viral infections where no antibiotics are required.

Linking very large, consented birth cohorts to birthing hospitals clinical data could elucidate the lifecourse outcomes of health care and exposures during the pregnancy, birth and newborn periods. Unfortunately, cohort personally identifiable information (PII) often does not include unique identifier numbers, presenting matching challenges. To develop optimized cohort matching to birthing hospital clinical records, this pilot drew on a one-year (December 2020–December 2021) cohort for a single Australian birthing hospital participating in the whole-of-state Generation Victoria (GenV) study. For 1819 consented mother-baby pairs and 58 additional babies (whose mothers were not themselves participating), we tested the accuracy and effort of various approaches to matching. We selected demographic variables drawn from names, DOB, sex, telephone, address (and birth order for multiple births). After variable standardization and validation, accuracy rose from 10% to 99% using a deterministic-rule-based approach in 10 steps. Using cohort-specific modifications of the Australian Statistical Linkage Key (SLK-581), it took only 3 steps to reach 97% (SLK-5881) and 98% (SLK-5881.1) accuracy. We conclude that our SLK-5881 process could safely and efficiently achieve high accuracy at the population level for future birth cohort-birth hospital matching in the absence of unique identifier numbers.

Focus and outcomes for participants: “Children are our future” - the wellbeing of our future adults will influence the future of the world. However, this generation of children and mid-life adults face increasing rates of complex health and development problems, and many of them are preventable. Traditional research approaches are not keeping pace with need. Discovery and testing of solutions is blocked by the lack of fast, cheap, large-scale, low burden and effective ways to conduct research for the population and its many subgroups. Innovation in epidemiological methods is required to deliver large scale studies of unprecedented scale and scope. These will support research that enables better prevention, prediction and treatment – all of which are needed to solve today’s pressing child and adult health problems. This 90-minute symposium will draw on the forthcoming Generation Victoria (GenV) to illustrate innovative epidemiological methods established in its foundation phase to enable large-scale studies. GenV is designed to address physical, mental and social issues experienced during childhood and mid-adulthood, as well as the antecedents of a wide range of diseases of ageing. Parents of all newborns (estimated. 170,000) in the state of Victoria (population 6.5 million), Australia, will be approached from 2021 for two full years. Following consent, GenV proposes to bank biosamples collected during routine care, link to administrative and clinical data, and directly collect parent and child data using interactive electronic interfaces with the potential for face-to-face assessment during the school years. Encompassing clinical trials, registries, health services and geospatial as well as discovery research, GenV’s initial focus will be on pregnancy and newborns, reaching into regional and rural communities and traditionally hard-to-reach groups in sizeable numbers. Permission will be sought to link trials, registries, and health services research with existing pre- and post-birth administrative and electronic health record datasets, and also to bank biospecimens collected during routine care. We will discuss why innovation is essential to the next wave of large-scale studies such as GenV, and share practical examples of method innovations being developed within GenV. We will forecast the opportunities and challenges of large-scale studies for improving wellbeing and reducing the disease burden with children and adults. Focus: Outcomes: Rationale for the symposium, including for its inclusion in the Congress: The future wellbeing and productivity of our societies depend on wellbeing and good health of our children and adults. However, today’s children and mid-life adults are facing both old and new challenges. Traditional research approaches have largely failed to deliver progress towards solving these challenges. For example, most existing cohorts only allow for observational follow up, and children are greatly under-represented in gold-standard clinical trials, which leads to less evidence to children’s treatment and prevention. Multi-purpose, low burden, high up-take innovative large studies are required to address these gaps. GenV seeks to generate translatable evidence (prediction, prevention, treatments, and services) to improve future wellbeing and reduce the future disease burden of children and adults. It will allow researchers, clinicians and policy makers to better understand the issues affecting Victorian children and their families with greater speed and precision, and therefore outcomes be translated more quickly into practice. Also it will help facilitate an environment where researchers, clinicians, policy makers, and other organisations can come together to enact change for future generations’ wellbeing. With this symposium, we intend to share our reflections on how the scale of cohort studies is changing, and showcase new trends in research design. The GenV team will then show how we practically achieve innovation in large-study methodology and design, with the aim of encouraging others to think ambitiously at large-scale. We will share our intentions and rationale for these innovations as well as the challenges. The symposium is designed to spark a discussion with the audience, seeking their reflections and suggestions on shaping our innovations. Finally, we aim to encourage researchers (especially early career researchers) to exchange their vision and views on innovations and methods for cohort studies. Presentation program (90 minutes): Names of presenters: Prof Melissa Wake, Dr Susan Clifford, Dr Yanhong Jessika Hu, A/Prof Jo Said, Dr Joan Leong, Dr Suzanne Mavoa.