The burden of hospitalized sports-related injuries in children: An Australian population-based study, 2005–2013

Background There is concern about recent increase and severity of sports-related injuries in children. Despite the benefits of sports participation, injuries may carry long-term health consequences. We aimed to evaluate the prevalence, characteristics and types of hospitalized sports-related injuries in children. Methods Population-based study of all acute sports-related injuries requiring hospitalization in children 5 to 15 years of age in New South Wales (NSW), Australia, 2005–2013. Health information was obtained from the NSW Admitted Patient Data Collection, a census of all hospital admissions from public and private hospitals. Children with a recorded ICD10-AM injury code (S00-T79) and sport-related activity code (U50-U70) were included. Prevalence and trend in injuries by age group, sporting code, body region affected and type of injury were assessed. Results There was a total of 20,034 hospitalizations for sports-related injuries (2.7% of all hospitalizations in children aged 5–15 years), involving 21,346 recorded injuries in 19,576 children. The overall population hospitalization period prevalence was 227 per 100,000 children aged 5–15 years in 2005–2013, remaining stable over time (RR 0.99; 95% CI 0.98–1.00). Football codes such as rugby league/union and soccer combined represented nearly two thirds of the total (60%). The most common body regions affected were the forearm (31%) head (15%) and hand injuries (13%). Fractures accounted for 65% of injuries followed by dislocations (10%) and traumatic brain injury (10%). Compared to other age groups, children aged 5–8 years had double the proportion of shoulder (15% vs. 7%) while 13–15 year olds had higher proportion of lower-leg (14% vs. 8%) and knee (6% vs.2%) injuries. One in seven injuries sustained while playing rugby league/union, baseball and hockey were traumatic brain injuries. A total of 444 (2.2%) of children had more than one hospitalization for sports-related injuries. Conclusion On average, six children were hospitalized every day for sports-related injuries in the last decade with trends remaining stable. The most common sports involved were football codes, one in three injuries involved the forearm and two thirds were fractures. These findings can be used to inform health policy and sporting governing bodies to target preventive interventions and promote safe sports participation in children

Angiopoietin 1 and 2 serum concentrations in first trimester of pregnancy as biomarkers of adverse pregnancy outcomes

Objective: To assess Ang-1, Ang-2 and the Ang-1/Ang-2 ratio levels in the first trimester of pregnancy, their association with adverse pregnancy outcomes; and their predictive accuracy. Study Design: This cohort study measured serum Ang-1 and Ang-2 levels in 4,785 women with singleton pregnancies attending first trimester screening in New South Wales, Australia. Multivariate logistic regression models were used to assess the association and predictive accuracy of serum biomarkers with subsequent adverse pregnancy outcomes (small for gestational age, preterm birth, preeclampsia, miscarriage >10 weeks and stillbirth). Results: Median (interquartile range) levels for Ang-1, Ang-2 and the Ang-1/Ang-2 ratio for the total population were 19.6 ng/ml (13.6-26.4), 15.5 ng/ml (10.3-22.7) and 1.21 (0.83-1.73), respectively. Maternal age, weight, country of birth and socio-economic status significantly affected Ang-1, Ang-2 and the Ang-1/Ang-2 ratio levels. After adjusting for maternal and clinical risk factors, women with low Ang-2 levels (90th centile) had increased risk of developing most adverse pregnancy outcomes. Compared to the Ang-1/Ang-2 ratio alone, maternal and clinical risk factors had better predictive accuracy for most adverse pregnancy outcomes. The exception was miscarriage [Ang-1/Ang-2 ratio area under ROC curve (AUC) =0.70; maternal risk factors AUC =0.58]. Overall, adding the Ang-1/Ang-2 ratio to maternal risk factors did not improve the ability of the models to predict adverse pregnancy outcomes. Conclusions: Our findings suggest that the Ang-1/Ang-2 ratio in first trimester is associated with most adverse pregnancy outcomes, but do not predict outcomes any better than clinical and maternal risk factor information.Australian National Health and Medical Research Council (NHMRC) Project Grant (#632653)

Adenotonsillectomy and adenoidectomy in children: The impact of timing of surgery and post-operative outcomes

Aim To investigate the impact of adenotonsillectomy (ADT) and adenoidectomy (AD) on child health and evaluated their post-operative complications. Methods We included all children aged <16 years undergoing ADT (tonsillectomy ± adenoidectomy) or AD in New South Wales, Australia, 2008–2017. Health information was obtained from administrative hospitalisation data. Rates of post-operative complications and reoperation were evaluated using generalised estimating equations and Kaplan–Meier methods, respectively. Results Out of 156 500 included children, 112 361 had ADT and 44 139 had AD. Population rates increased during 2008–2017 (ADT: 68–79 per 10 000 children; AD: 25–34 per 10 000), and children were increasingly operated on at a younger age. Overall, 7262 (6.5%) and 1276 (2.9%) children had post-operative complications (mostly haemorrhage), and 4320 (3.8%) and 5394 (12.2%) required reoperation, following ADT and AD, respectively. Complication rates were highest among children aged 0–1 years, lowest for those 2–5 years and increased with age thereafter. Three-year reoperation rates for children aged 0–1 years were 9.0% and 25.9% following ADT and AD, respectively, decreasing thereafter to 0.5% and 2.1% in children aged 12–13 years. Conclusions ADT and AD in Australian children have both increased in frequency and are being done at a younger age. Post-operative complications and reoperation rates highlight surgery is not without risk, especially for children under 2 years old. These findings support a more conservative approach to management of upper respiratory symptoms, with surgery reserved for cases where potential benefits are most likely to outweigh harms

Evaluation of first trimester serum soluble endothelial cell-specific tyrosine kinase receptor in normal and affected pregnancies

Aims: To assess soluble endothelial cell-specific tyrosine kinase receptor (sTie-2) levels in the first trimester of pregnancy and its association with adverse pregnancy outcomes; and examine the predictive accuracy. Study Design: In this nested case-control study, serum sTie-2 levels were measured in 2,616 women with singleton pregnancies attending first trimester screening in New South Wales, Australia. Multivariate logistic regression models were used to assess the association and predictive accuracy of serum sTie-2 with subsequent adverse pregnancy outcomes. Results: Median (interquartile range) sTie-2 for the total population was 19.6 ng/ml (13.6-26.4). Maternal age, weight, and smoking status significantly affected sTie-2 levels. There was no difference in serum sTie-2 between unaffected and women with adverse pregnancy outcomes. After adjusting maternal and clinical risk factors, low sTie-2 (<25th centile) was associated with preeclampsia (Adjusted odds ratio: 1.61; 95%CI: 1.01-2.57), however, the accuracy of sTie-2 in predicting preeclampsia was not different from chance (AUC=0.54; P=0.08) and does not add valuable predictive information to maternal and clinical risk factors. Conclusions: Our findings suggest that low sTie-2 levels are associated with preeclampsia, however, it does not add valuable information to clinical and maternal risk factor information in predicting preeclampsia or any other adverse pregnancy outcomes.NHMR

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries.

Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways

Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries.

Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways

The burden of hospitalized sports-related injuries in children: an Australian population-based study, 2005–2013

Abstract Background There is concern about recent increase and severity of sports-related injuries in children. Despite the benefits of sports participation, injuries may carry long-term health consequences. We aimed to evaluate the prevalence, characteristics and types of hospitalized sports-related injuries in children. Methods Population-based study of all acute sports-related injuries requiring hospitalization in children 5 to 15 years of age in New South Wales (NSW), Australia, 2005–2013. Health information was obtained from the NSW Admitted Patient Data Collection, a census of all hospital admissions from public and private hospitals. Children with a recorded ICD10-AM injury code (S00-T79) and sport-related activity code (U50-U70) were included. Prevalence and trend in injuries by age group, sporting code, body region affected and type of injury were assessed. Results There was a total of 20,034 hospitalizations for sports-related injuries (2.7% of all hospitalizations in children aged 5–15 years), involving 21,346 recorded injuries in 19,576 children. The overall population hospitalization period prevalence was 227 per 100,000 children aged 5–15 years in 2005–2013, remaining stable over time (RR 0.99; 95% CI 0.98–1.00). Football codes such as rugby league/union and soccer combined represented nearly two thirds of the total (60%). The most common body regions affected were the forearm (31%) head (15%) and hand injuries (13%). Fractures accounted for 65% of injuries followed by dislocations (10%) and traumatic brain injury (10%). Compared to other age groups, children aged 5–8 years had double the proportion of shoulder (15% vs. 7%) while 13–15 year olds had higher proportion of lower-leg (14% vs. 8%) and knee (6% vs.2%) injuries. One in seven injuries sustained while playing rugby league/union, baseball and hockey were traumatic brain injuries. A total of 444 (2.2%) of children had more than one hospitalization for sports-related injuries. Conclusion On average, six children were hospitalized every day for sports-related injuries in the last decade with trends remaining stable. The most common sports involved were football codes, one in three injuries involved the forearm and two thirds were fractures. These findings can be used to inform health policy and sporting governing bodies to target preventive interventions and promote safe sports participation in children

Impact and recovery of the COVID-19 pandemic on weight status of children and adolescents

Recent evidence suggests the immediate effects of the COVID-19 lockdowns and restrictions have resulted in increased weight in children and adolescents. However, the longer-term effects have not been assessed. The aim of this study was to examine the impact and longer-term effects of the COVID-19 pandemic on BMI and weight status of children and adolescents. This study used routinely collected clinical data from the Sydney Children\u27s Hospitals Network, comprising two socio-demographically diverse children\u27s hospitals in New South Wales, Australia from 2018 to 2021. Of 245 836 individuals ≤18-years assessed, mean BMI percentile increased from 58.7 (SD 31.6) pre-COVID-19 to 59.8 (SD 31.7) (p \u3c .05) post-restrictions and overweight/obesity increased by 5.5% (obesity alone 6.3%), predominantly in children \u3c12-years and from lower socioeconomic backgrounds. The trend in BMI percentile was steady pre-COVID-19 (β = −0.03 [95% CI −0.07, 0.01]), peaked immediately following COVID-19 restrictions (β = 1.28 [95% CI 0.24, 2.32]) and returned to pre-pandemic levels over ensuing 21 months (β = −0.04 [95% CI – 0.13, 0.04]). Routine anthropometric measurement facilitates ongoing monitoring and evaluation of the weight status of children and adolescents, helping to identify those at-risk. Despite initial BMI and weight increases among children and adolescents, longer-term follow-up highlighted a return to pre-pandemic rates, possibly attributed to state-wide policies aimed at reducing childhood obesity

Prevalence, repairs and complications of hypospadias: An Australian population-based study

© 2015 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health. All rights reserved. Objective To investigate hypospadias' prevalence and trends, rate of surgical repairs and post-repair complications in an Australian population. Methods Hypospadias cases were identified from all live-born infants in New South Wales, Australia, during the period 2001-2010, using routinely collected birth and hospital data. Prevalence, trends, surgical procedures or repairs, hospital admissions and complications following surgery were evaluated. Risk factors for reoperation and complications were assessed using multivariate logistic regression. Results There were 3186 boys with hypospadias in 2001-2010. Overall prevalence was 35.1 per 10 000 live births and remained constant during the study period. Proportions of anterior, middle, proximal and unspecified hypospadias were 41.3%, 26.2%, 5.8% and 26.6%, respectively. Surgical procedures were performed in 1945 boys (61%), with 1718 primary repairs. The overall post-surgery complication rate involving fistulas or strictures was 13%, but higher (33%) for proximal cases. Complications occurred after 1 year post-repair in 52.3% of cases and up to 5 years. Boys with proximal or middle hypospadias were at increased risk of reoperation or complications, but age at primary repair did not affect the outcome. Conclusion One in 285 infants were affected with hypospadias, 60% required surgical repair or correction and one in eight experienced complications. The frequency of late complications would suggest that clinical review should be maintained for &gt;1 year post-repair