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Preterm infants suffer from a higher incidence of acute diseases such as necrotising enterocolitis and sepsis. This risk can be mitigated through probiotic prophylaxis during admission. This reduction in risk is likely the result of acute modulation of the gut microbiome induced by probiotic species, which has been observed to occur up until discharge. We aimed to determine if this modulation, and the associated probiotic species, persisted beyond discharge. We conducted both a cross-sectional analysis (n = 18), at ~ 18 months of age, and a longitudinal analysis (n = 6), from admission to 18 months of the gut microbiome of preterm infants using both shotgun metagenomics and 16S rRNA profiling respectively. The 16S amplicon sequencing revealed that the microbial composition of the probiotic-supplemented infants changed dramatically over time, stabilising at discharge. However, species from the probiotic Infloran®, as well as positive modulatory effects previously associated with supplementation, do not appear to persist beyond discharge and once prophylaxis has stopped. Conclusions: Although differences exist between supplemented and non-supplemented groups, the implications of these differences remain unclear. Additionally, despite a lack of long-term colonisation, the presence of probiotics during early neonatal life may still have modulatory effects on the microbiome assembly and immune system training. What is Known:• Evidence suggests modulation of the microbiome occurs during probiotic prophylaxis, which may support key taxa that exert positive immunological benefits.• Some evidence suggests that this modulation can persist post-prophylaxis. What is New:• We present support for long-term modulation in association with probiotic prophylaxis in a cohort of infants from North Queensland Australia.• We also observed limited persistence of the probiotic species post-discharge.

Aim To determine whether being small for gestational age (SGA) is associated with increased mortality and short-term morbidity for extremely low birth weight (ELBW) babies at Townsville University Hospital (TUH). Methods All babies with a birth weight of Results Of 461 ELBW babies, 62 (13.4%) were SGA. The SGA babies were significantly smaller at 714 (580–850) versus 810 (700–885) g (p Conclusions Being SGA is not an independent predictor of mortality nor adverse short-term morbidity for ELBW babies.

Aim and objective: To explore and establish the language, clinical opinions and workplace culture around neonatal skin injury nomenclature. Specifically, what nomenclature is used to describe, define, identity and communicate neonatal skin injuries including (a) terms, (b) locations, (c) associated risks and (d) mechanical forces. Background: Skin injuries are affirmed or denied based on visual assessment with findings reported by language rather than measurements. However, if language or nomenclature is ambiguous, assessments could be misinterpreted effecting healthcare delivery. Design Qualitative enquiry including applied discourse analysis and between-method triangulation, within a larger exploratory mixed-methods study. Methods: Data were collected over two years from four sources: literature, documents, interviews/focus groups and free text injury assessments. Data analysis included content analysis, selective coding and thematic analysis. The collective data were further explored using discourse analysis and triangulation to achieve collective conclusions about opinions, emotions, feelings, perceptions and workplace cultures. The COREQ checklist provided structure for the reporting of study methods, analysis and findings. Results: A total of 427 data points were collected from literature, documentation and two clinical data sources. Data convergence revealed that neonatal skin injuries are described by numerous terms with preferences for "injury," "trauma" or "redness". Injuries occur in over 20 anatomical locations and risks for injuries included hospitalisation, specific treatments and prematurity. Essential medical devices, clinical condition, lack of clinician experience and overactive neonates were uniquely associated risks. There was incongruency between sources. The literature and documents empathise pressure as the primary force related to skin injury, while varied forces were identified within interviews, focus groups and free text injury assessments. Conclusions: The variety of unique terms, locations and risks for injury indicate the need for updated neonatal skin injury frameworks. If frameworks and policies continue to be created without the empirical knowledge of neonatal clinicians, misrepresentation of neonatal skin injury locations and risk will continue to dominate the literature. Relevance to Clinical Practice The recognition and management of neonatal skin injuries are related to language used to describe assessments in the absence of diagnostic confirmation, which has implications for both the neonate and the healthcare team.

To evaluate consistency in the assessment of neonatal skin injuries.Injury images collected during a multicentre period prevalence study (n = 297) were screened for optimal quality before 60 images, stratified for size and colour, were randomly selected for assessment by three neonatal and two adult specialists. The principal investigator's assessments were the baseline for comparison and consistency. Injury characteristics and assessments were reported as descriptive statistics. Comparison of injury assessments for colour and stage were calculated using Chi-square, with p-value of0.05 considered significant.Neonatal specialists assessed injury elements more confidently than adult specialists reporting 59-60 (98-100%) injuries visible compared to 51-53 (85-93%) respectively. Neonatal specialists attributed mechanical force to 93% of the skin injuries compared to 70% by adult specialists. Consistency of colour assessment was achieved more often with neonatal specialists (n = 50, 85%), compared to adult specialists (n = 41, 73%). Neonatal specialists' consistency for injury staging (n = 107, 60%) was higher compared to adult specialists who were uncertain (n = 8,16%) and less consistent (n = 47, 44%). When comparing specialists as a group, consistency with baseline assessment was significantly different between neonatal and adult specialists for colour (p 0.010) and injury stage (p 0.009).Field of expertise (neonatal versus adult) differences were noted likely related to experience and understanding of empirical differences between neonatal and adult skin structure and maturity. These results highlight the need for specialist neonatal skin injury and wound training for clinicians involved in assessment, treatment and best practices for neonates.

Background Preterm birth is associated with the development of acute and chronic disease, potentially, through the disruption of normal gut microbiome development. Probiotics may correct for microbial imbalances and mitigate disease risk. Here, we used amplicon sequencing to characterise the gut microbiome of probiotic-treated premature infants. We aimed to identify and understand variation in bacterial gut flora from admission to discharge and in association with clinical variables. Methods Infants born Results 71 admission and 63 discharge samples were collected. Univariate analyses showed significant changes in the gut flora from admission to discharge. Mixed-effects modelling showed significantly lower alpha diversity in infants diagnosed with either sepsis or retinopathy of prematurity (ROP) and those fed formula. In addition, chorioamnionitis, preeclampsia, sepsis, necrotising enterocolitis and ROP were also all associated with the differential abundance of several taxa. Conclusions The lower microbial diversity seen in infants with diagnosed disorders or formula-fed, as well as differing abundances of several taxa across multiple variables, highlights the role of the microbiome in the development of health and disease. This study supports the need for promoting healthy microbiome development in preterm neonates. Impact Low diversity and differing taxonomic abundances in preterm gut microbiota demonstrated in formula-fed infants and those identified with postnatal conditions, as well as differences in taxonomy associated with preeclampsia and chorioamnionitis, reinforcing the association of the microbiome composition changes due to maternal and infant disease. The largest study exploring an association between the preterm infant microbiome and ROP. A novel association between the preterm infant gut microbiome and preeclampsia in a unique cohort of very-premature probiotic-supplemented infants.

Background:The gut microbiome plays a critical role in the healthy development, immunity and metabolism of infants. Preterm birth disrupts microbiome development and can contribute to acute and chronic disease. To promote microbial and infant development, and to mitigate the risk of disease, premature infants may be treated with probiotics. Here we used 16S rRNA high throughout sequencing to characterize the bacterial microbiome of probiotic-supplemented premature infants. The study aimed to identify and understand variation in bacterial gut flora, including changes from admission to discharge, and the effect of several clinical variables using a combination of univariate and mixed effects analyses.Results: Infants born n = 71) and at discharge (n = 63). Our research builds on previous research and supports significant changes over time in the preterm infant microbiome, and in response to several variables. Univariate analysis showed admission and discharge samples had significantly different microbial populations, with Staphylococcus enriched at admission and Enterobacter, Lactobacillus, Colstridium sensu stricto 1 and Veillonella at discharge. From the mixed effects modeling we observed significantly lower alpha diversity in infants diagnosed with either sepsis or retinopathy of prematurity (ROP), and those that only received formula milk. Chorioamnionitis, preeclampsia, sepsis, necrotizing enterocolitis and ROP were also all associated with differential abundance of several taxa.Conclusions:Our study builds on previous research and supports significant changes in the preterm microbiome over time and in association with several factors. The fact that several associations were observed, and some in ways that counter previous work, highlights the complexity of microbiome ecology.

The premature infant gut microbiome plays an important part in infant health and development, and recognition of the implications of microbial dysbiosis in premature infants has prompted significant research into these issues. The approaches to designing investigations into microbial populations are many and varied, each with its own benefits and limitations. The technique used can influence results, contributing to heterogeneity across studies. This review aimed to describe the most common techniques used in researching the preterm infant microbiome, detailing their various limitations. The objective was to provide those entering the field with a broad understanding of available methodologies, so that the likely effects of their use can be factored into literature interpretation and future study design. We found that although many techniques are used for characterising the premature infant microbiome, 16S rRNA short amplicon sequencing is the most common. 16S rRNA short amplicon sequencing has several benefits, including high accuracy, discoverability and high throughput capacity. However, this technique has limitations. Each stage of the protocol offers opportunities for the injection of bias. Bias can contribute to variability between studies using 16S rRNA high throughout sequencing. Thus, we recommend that the interpretation of previous results and future study design be given careful consideration.

The objective of this study was to explore neonatal skin injury period prevalence, classification, and risk factors. Skin injury period prevalence over 9 months and χ2, Mann-Whitney U, and independent-samples t tests compared injured and noninjured neonates, with P values less than .05 considered statistically significant. Injury prediction models were developed using Classification and Regression Tree (CART) analysis for the entire cohort and separately for those classified as high or low acuity. The study took place in 3 Australian and New Zealand units. Neonates enrolled (N = 501) had a mean birth gestational age of 33.48 ± 4.61 weeks and weight of 2138.81 ± 998.92 g. Of the 501 enrolled neonates, 206 sustained skin injuries (41.1%), resulting in 391 injuries to the feet (16.4%; n = 64), cheek (12.5%; n = 49), and nose (11.3%; n = 44). Medical devices were directly associated with 61.4% (n = 240) of injuries; of these medical devices, 50.0% (n = 120) were unable to be repositioned and remained in a fixed position for treatment duration. The strongest predictor of skin injury was birth gestation of 30 weeks or less, followed by length of stay of more than 12 days, and birth weight of less than 1255 g. Prediction for injury based on illness acuity identified neonates less than 30 weeks' gestation and length of stay more than 39 days were at a greater risk (high acuity), as well as neonates less than 33 weeks' gestation and length of stay of more than 9 days (low acuity). More than 40% of hospitalized neonates acquired skin injury, of which the majority skin injuries were associated with medical devices required to sustain life. Increased neonatal clinician education and improved skin injury frameworks, informed by neonatal epidemiological data, are vital for the development of effective prevention strategies.

Commentary on: Al Khalaf SY, O'Reilly EJ, McCarthy FP, et al . Pregnancy outcomes in women with chronic kidney disease and chronic hypertension: a National cohort study. Am J Obstet Gynecol 2021:S0002-9378(21)00225-8. doi: 10.1016/j.ajog.2021.03.045. 1. Pregnant women with chronic kidney disease are at risk of pre-eclampsia, preterm birth and caesarean delivery. 2. They need close surveillance with multidisciplinary expertise to reduce the risk of pregnancy complications which in turn may increase risk of postpartum adverse outcomes if untreated. Chronic kidney disease (CKD) affects up to 3% of pregnant women in developed countries and is associated with adverse pregnancy outcomes. However, due to the heterogeneity of CKD and evolving and advances in therapy, it is uncertain if poor outcomes are associated with any specific maternal characteristics. Understanding these differences will allow improved identification, intervention and prognostication for women with CKD. Al Khalaf et al 1 used population data linkage methods to address these knowledge gaps. …

Aim This study proposed to (1) develop a metric graduated colour tool and (2) demonstrate the effectiveness of the tool for use in the assessment of neonatal skin injuries. Materials/methods Findings from wound literature informed the metric graduated colour tool's development. Tool development included consideration of colours, size (comparative to neonatal skin injuries), cost, materials, feasibility and suitability for the neonatal clinical setting. Assessment of the tool's applicability with clinical images was then tested using digital cameras with specific evaluation of image sharpness and colour. Further evaluation was conducted within a case series of neonatal skin injuries. Results The metric graduated colour tool comprised of 15 colours, measures 60 mm, displays metric dimensions, and offers a discernible reference for clinical images and injury/wound bed comparison. Images collected appeared enhanced with clear wound edges compared to previous methods. Four neonates who acquired skin injuries were included in the case series for which the tool provided reliable metric and colour comparison of epidermal stripping, extravasation, birth injury, and pressure injury. When used to compare injury assessments for series subjects measurements of both increased and decreased severity were obtained. Conclusion A metric and colour tool can be used in conjunction with digital photographs to enhance objective assessment of neonatal skin injuries/wounds. The metric and colour tool provides the foundation for vital skin injury assessment and documentation essentials including injury bed colour, size and consideration of depth of damage.

[Extract] The terms intrauterine growth restriction (IUGR) and small for gestational age (SGA) are frequently encountered in the neonatal population. It is the second cause of perinatal mortality after prematurity (Mandruzzato et al., 2008), estimated to be a contributing factor in 52% of stillbirths. Foetal growth restriction is a multifactoral condition that may be foetal, maternal, genetic or environmental in origin, (See Table 1 & Fig. 2).

Aim: to review admissions to the hospital due to Paediatric Melioidosis over a 10 year period. Methods: This was a retrospective chart review of all paediatric patients admitted to Townsville Hospital between 1996 and 2006 that were proven to have positive cultures for B. pseudomallei. Details were obtained from the Microbiology Department of Townsville Hospital. Results: Between 1996 and 2006, there were 150 cases of culture-confirmed melioidosis in North Queensland. Of these, eight (5.3%) were in children aged under 16 years. There were three deaths in this group. Three patients developed neurological melioidosis and there were no cases of parotid involvement. In our series, neurological melioidosis appeared to be statistically more significant in children compared with adults. Conclusion: Melioidosis is an uncommon paediatric infection in Australia. In our series, neurological melioidosis appeared to be common in children compared with adults with devastating sequelae. The reasons for this remain unclear.

Aim: To review outcomes of gastroschises originating in North Queensland and repaired in the neonatal centre in Townsville from 1988–2007, and compare these outcomes with published data from other centres. Methods: A retrospective chart review of outcomes after primary operative repair (POR) with wound closure in fascial layers in the theatre, primary non-operative repair (PNOR) with apposition of the umbilical cord and adhesive dressing in the ward, secondary repair (SR) after a silo, and complex repair (CR) of cases with obstruction, perforation or atresiae. Epidemiological data of babies originating in North Queensland but managed in Brisbane were secured from Mater Mothers' Hospital and the Royal Hospital for Children. Results: Fifty cases were treated in Townsville: 16 by PNOR, 22 by POR, 6 by SR and 6 by CR. Outcomes of uncomplicated cases treated by PNOR, POR and SR were similar. Outcomes of complicated cases after CR were significantly worse. No significant differences were found between PNOR in Townsvillle and published outcomes after SR from four overseas units. No differences were detected in outcomes of inborn and outborn babies, those delivered by vaginal or caesarean birth or between indigenous and non-indigenous babies. Three (6%) died. Gastroschisis is increasing in North Queensland, particularly in younger mothers. The incidence is 2–3 times higher in indigenous mothers. Conclusion: No significant differences were found between PNOR and other techniques for uncomplicated cases. PNOR avoids the use of theatre and staff, reducing delay and cost, and the need to transport a sick baby.

Objectives: To identify risk factors significantly associated with retinopathy of prematurity (ROP) and evaluate the usefulness of digital funduscopy for ROP screening in a regional neonatal unit in Townsville, Australia. Method: This is a retrospective study. Basic data was retrieved from the department's prospectively maintained database and stored in the digital camera (Retcam) data storage device. ROP candidates were defined as babies who were born with a birth weight at or less than 1250 g and/or, born at or before 28 weeks. Results: One hundred babies satisfied the criteria for inclusion into the study. There were 44 male neonates. Birth weights ranged from 470-1342g (mean 986±177). Female babies were significantly smaller than males (p0.05). Twenty three babies had ROP. Retinal images from 6 babies were sent for remote expert opinion and 2 babies were transferred for treatment. Conclusions: ROP is significantly associated with prematurity. More clinical trials on bigger cohorts are necessary to evaluate digital funduscopy on ROP screening.