BACKGROUND: Schools are key settings for youth suicide prevention, with current interventions typically targeting specific risk groups. However, integrating complementary prevention strategies may better address the heterogeneity of suicide risk in schools. This study evaluated the Multimodal Approach to Preventing Suicide in Schools (MAPSS), which combined universal suicide prevention training (safeTALK), selective screening for suicidal ideation, and an indicated online cognitive behavioural therapy intervention (Reframe-IT). METHODS: MAPSS was implemented across 21 secondary schools in Melbourne, Australia. The universal (safeTALK) and selective (screening) program elements were evaluated using a single-arm pre–post design (n = 1966) with outcomes including suicide literacy, stigma, and intentions to intervene. The indicated intervention (Reframe-IT) was evaluated in a parallel-group superiority randomised controlled trial (n = 93). Students reporting past-month suicidal ideation during screening and who consented to the trial were randomised to Reframe-IT plus treatment as usual (TAU; school-determined supports and external referrals) or TAU alone, with outcomes including suicidal ideation (primary), depression, hopelessness, and problem solving. Help-seeking, acceptability, and iatrogenic effects were assessed across the full program. Participants completed 4 assessments (T1: Baseline; T2: 2 weeks; T3: 12 weeks; T4: 24 weeks) with RCT outcomes assessed T2-T4. RESULTS: safeTALK was associated with modest improvements in intentions to intervene, suicide literacy, and perceived control, but not stigma. Screening identified 733 (37%) students experiencing suicidal ideation. In the RCT, suicidal ideation declined in both groups, with no greater reduction for Reframe-IT (p = .144; d = 0.31). Help-seeking increased during MAPSS, returning to baseline by 24-week follow-up. MAPSS was well tolerated with low distress, though some iatrogenic effects were observed. CONCLUSIONS: MAPSS demonstrated feasibility and safety for delivering multimodal suicide prevention strategies in schools. The universal and selective components were associated with improved knowledge and skills to intervene and enabled identification of students reporting suicidal ideation. However, the indicated intervention conferred no added benefit, likely reflecting an underpowered trial, contextual barriers to delivery, and possible differences in TAU between groups. TRIAL REGISTRATION: Universal and Selective interventions ID: ACTRN12621000770864, originally registered on 21/06/2021, updated on 16/02/2025; Indicated intervention ID: ACTRN12621000279820, originally registered on 12/03/2021, updated on 13/04/2025.
Samuel McKay, Michelle Lamblin, India Bellairs-Walsh et al.
BACKGROUND: Overactive bladder (OAB) affects 5–12% of children and is associated with urgency, frequency, and incontinence, often leading to psychosocial distress. Antimuscarinics are widely used but limited by systemic side effects. Mirabegron, a β3-adrenoceptor agonist, may offer better tolerability. This review evaluated available evidence comparing mirabegron and solifenacin in pediatric OAB. METHODS: Following PRISMA guidelines (PROSPERO: CRD420251129236), we searched PubMed, Scopus, Web of Science, and the Cochrane Library through September 2025 for studies directly comparing mirabegron and solifenacin in children ≤ 18 years with non-neurogenic OAB. Two reviewers independently screened studies, extracted data, and assessed quality. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. RESULTS: Three studies (246 children; 116 mirabegron, 130 solifenacin) met inclusion criteria. Pooled analysis showed no significant difference in treatment response between groups (RR = 1.11, 95% CI: 0.92–1.33; p = 0.28; I² = 58%). Mirabegron was associated with significantly fewer adverse events (RR = 0.44, 95% CI: 0.28–0.70; p = 0.0004; I² = 0%). CONCLUSIONS: Mirabegron and solifenacin demonstrate comparable efficacy in pediatric OAB, with mirabegron suggesting a more favorable short-term safety profile. These preliminary findings require confirmation in larger, long-term trials with standardized outcome measures. CLINICAL TRIAL REGISTRATION: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12894-026-02155-9.
Mostafa Shaheen, Omar Mohamed Ali, Abdullah A Draz et al.
BACKGROUND: Nirsevimab is a monoclonal antibody that prevents serious respiratory syncytial virus (RSV) illness among young children and first became available in Australia in 2024. Prior to the 2024 winter RSV season, the Western Australia (WA) Department of Health began offering nirsevimab to infants entering their first RSV season and children at high risk of severe RSV disease entering their second RSV season. As nirsevimab was a new product and post-marketing safety data were limited, routine reporting through established WA Vaccine Safety Surveillance (WAVSS) mechanisms was augmented to foster rigorous active monitoring of adverse events following immunisation (AEFI). METHODS: Two active surveillance methods were created: 1) weekly automated linkage between the Australian Immunisation Register and statewide healthcare datasets to search for possible AEFI; and 2) an online survey of parents whose newborns received nirsevimab. The data linkage process identified infants with specific ICD-10 codes presenting to an emergency department within 60 days of nirsevimab administration. The newborn survey was sent by SMS to parents consenting while in a maternity ward and queried symptoms in the week following nirsevimab administration. All potential AEFI identified through data linkage, parental survey, and routine WAVSS reports were assessed by experienced vaccine safety clinicians. RESULTS: Between April and September 2024, 23,143 infants received a dose of nirsevimab, including 9727 newborns and 12,195 infants aged under 1 year. Data linkage identified possible AEFI in 7 infants, of which 4 had underlying genetic conditions. The newborn survey SMS was sent to 4218 parents, of which 1106 (26%) responded; 46 (4%) reported that their newborn experienced a possible AEFI, none required medical attention. The most common reactions parents reported were expected and minor AEFI including gastrointestinal issues, injection site reactions, lethargy and irritability. WAVSS received 10 passively reported AEFI; 7 involved co-administration with a vaccine and 3 had concurrent viral infections. Across all three methods, no serious AEFI were attributed to nirsevimab following clinical review. CONCLUSION: WA's enhanced surveillance efforts support the safety of nirsevimab in newborns and infants.
Kaija Strautins, Rachel Foong, Dale Carcione et al.
BACKGROUND: Children aged under five years are at increased risk of infection and complications of influenza. We investigated the uptake of the influenza vaccine for young children, and parent/carer attitudes and beliefs about the influenza vaccines. METHODS: A national quantitative online survey of Australian parents and carers was conducted by an external research company at the height of the COVID-19 pandemic in 2021. A total of 1563 Australian parents and carers with at least one child aged 6-months to <5 years clicked the link to the survey, 1026 completed the survey, producing 1000 eligible responses (64% completion rate). RESULTS: Just over half (56.5%) of children were fully vaccinated against influenza in 2021. A further 13.5% of children were partially protected having received one dose in their first year. Knowing that the influenza vaccine was free for their child (OR 2.211; 95% CI 1.572, 3.109, p < 0.001), recommendation from a general practitioner (OR 1.827, 95% 1.115, 2.993, p = 0.017), and being influenced by a nurse/midwife (OR 1.564, 95% 1.068, 2.290, p = 0.022) positively predicted vaccine uptake. Conversely, not receiving a recommendation from a health professional to vaccinate was associated with lower uptake (OR 0.187; 95% CI 0.105, 0.335, p < 0.001). Many parents and carers worried about the safety of the influenza vaccine for their child (46.3%) and held erroneous beliefs such as you can catch influenza from the vaccine (42.5%), the vaccine overwhelmed their child's immune system (33.9%), and natural immunity against influenza is better than the vaccine (41.2%). CONCLUSIONS: Access to a free vaccine, health care provider recommendations and ongoing efforts to improve parent's understanding and trust of influenza vaccines are essential to increase uptake in young children.
Jane E Frawley, Jane Hutchens, Kerrie Wiley et al.
UNLABELLED: Cough and cold medications (CCMs) are widely used in paediatric practice despite limited evidence of efficacy and concerns regarding safety in young children. This study aimed to evaluate Czech paediatricians' knowledge, attitudes, and recommendation practices related to CCMs and to identify factors associated with inappropriate use in children under 6 years of age. An anonymous questionnaire-based survey was distributed online to hospital paediatricians and general practitioners for children across the Czech Republic. The survey assessed demographic characteristics, patterns of CCMs use, knowledge of efficacy and safety, awareness of international recommendations, and attitudes toward potential restrictions and educational interventions. Associations were analysed using descriptive statistics, logistic regression, and Fisher's exact test where appropriate. Of 266 respondents, 74.1% reported using CCMs in children under 6 years and 40.6% in children under 2 years. Recommendation practices were not associated with age or postgraduate training but varied significantly by region and medical school attended. Reliance on international literature was associated with the lowest use of CCMs, whereas reliance on local sources or older colleagues predicted higher use. Lack of awareness of the unproven efficacy of CCMs, as well as recommendations from the American Academy of Pediatrics and Health Canada, were the strongest predictors of inappropriate recommendations. While knowledge of the Medicines and Healthcare products Regulatory Agency recommendation also showed association with a good recommendation practice, the association was not significant in the multivariable model. CONCLUSION: Despite robust international guidance, CCMs remain commonly used in Czech paediatrics. Knowledge gaps, entrenched habits, and reliance on outdated information sources contribute to inappropriate use. Targeted educational initiatives and harmonised national guidelines are needed to improve practice. WHAT IS KNOWN: ● CCMs remain widely used in paediatrics despite limited efficacy and safety concerns in young children. ● International recommendations, including those from the AAP and Health Canada, advise against CCMs use in children under 6 years. WHAT IS NEW: ● In the Czech Republic, CCMs are used by 74% of paediatricians in children < 6 years and 41% in children < 2 years. ● CCMs recommendation practices vary by region and medical school, but not by age or training level. Higher inappropriate use is associated with reliance on local sources and older colleagues.
BACKGROUND: Child restraint systems (CRS) can effectively prevent injuries to children in road traffic crashes. However, in China, the rates of CRS ownership and use remain relatively low. METHODS: We conducted a community-based intervention trial with an integrated multimodal intervention from August 2024 to March 2025 in five communities in Huangpu District, Shanghai. A total of 501 participants were recruited (201 in the intervention group, 300 in the control group). The intervention included (1) distribution of CRS educational brochures and health education materials, (2) dissemination of online educational articles, and (3) Artificial intelligence-assisted (AI-assisted) voice calls delivering standardized reminders and safety education. The control group received only pamphlets on dietary nutrition. RESULTS: A total of 501 participants completed the study. After the intervention, the rate of CRS ownership showed no significant difference between the intervention and control groups (90.05% versus 91.33%, p = 0.74). However, the rate of consistent CRS use was significantly higher in the intervention group (50.75%) than in the control group (38.33%) (p < 0.01). The intervention group also showed fewer orientation-related installation errors than the control group (0.00% versus 12.55%, p < 0.01). Logistic regression with interaction terms indicated no significant intervention effect on ownership rate (OR = 0.97, 95% CI: 0.41-2.30), but a significant increase in consistent use rate (OR = 2.18, 95% CI: 1.25-3.82). Further analysis showed that ownership rate was associated with child age, parental education level, vehicle price, and travel frequency, while consistent use rate was associated with household registration, travel frequency, and travel distance. CONCLUSION: An integrated community-based intervention combining conventional health education with AI-assisted follow-up improved consistent CRS use and reduced orientation-related installation errors. This approach may be a useful complement to current CRS promotion strategies.
Kawasaki disease is an acute systemic vasculitis that predominantly affects children under 5 years old and represents the leading cause of their acquired heart disease. The most serious complication involves the coronary arteries, leading to the formation of coronary artery aneurysms. The standard first-line therapy for KD consists of high-dose intravenous immunoglobulin combined with aspirin. However, for IVIG-resistant patients and adjunctive treatments such as interleukin-1 (IL-1) receptor antagonists. Despite promising experimental and clinical evidence, no comprehensive evaluation has systematically summarized the efficacy and safety of anakinra in KD patients unresponsive to conventional therapy. Therefore, this systematic review aims to compile and critically assess clinical data published between 2010 and 2024 on anakinra use in pediatric Kawasaki disease patients. Across approximately 60 reported pediatric cases derived from clinical trials, observational studies, and case reports, anakinra administration was consistently associated with rapid fever resolution (typically within 24–48 h) and marked reduction in inflammatory markers, particularly C-reactive protein. Coronary artery outcomes were variable and frequently reported qualitatively. In studies providing Z-score measurements, stabilization or regression of coronary dilatation was described in several cases, including occasional regression of giant aneurysms; however, progression despite therapy was also observed. Interpretation of vascular outcomes is limited by heterogeneity in timing of initiation, concomitant therapies, small sample sizes, and lack of comparator groups. Overall, evidence quality was judged to be low to very low according to GRADE principles due to methodological limitations and imprecision. Current data should therefore be considered exploratory and hypothesis-generating. Well-designed randomized controlled trials with standardized coronary outcome reporting are required to determine the definitive efficacy and long-term cardiovascular impact of anakinra in refractory Kawasaki disease.
Melika Kolahdoozan, Fatemeh Kabiri, Aylin Biyabanaki et al.
BACKGROUND: Neonatal hyperbilirubinemia affects 60-80% of term newborns. The American Academy of Pediatrics (AAP) recommends that infants with elevated bilirubin after discharge who meet specific criteria can receive home phototherapy to preserve family bonding. Despite caregivers increasingly seeking online health information, no research has evaluated large language models (LLMs) as auxiliary guidance tools for home phototherapy. This study aimed to comparatively evaluate seven mainstream LLMs as auxiliary educational tools for guiding caregivers in home phototherapy management, identifying which models provide reliable operational guidance versus those presenting safety risks. METHODS: Seven high-ranking LLMs were selected: ChatGPT-4o, Copilot, Gemini 1.5 Flash, Claude 3.5 Sonnet, DeepSeek-R1, GLM-4, and ERNIE 4.0 Turbo. We developed a 15-item questionnaire covering seven domains based primarily on AAP neonatal hyperbilirubinemia guidelines. Each LLM received three priming prompts followed by 15 caregiver-perspective questions. Two investigators independently queried each model (November 2024-February 2025). Three board-certified neonatologists blindly evaluated 210 responses using modified Likert scales across five dimensions: accuracy, completeness, reproducibility, empathy, and readability. Expert clinician responses served as the "gold standard" and benchmarks. RESULTS: DeepSeek-R1 demonstrated superior performance across all dimensions (total score: 19.31/20), with 87.8% of responses rated as "completely correct" for accuracy (4.89±0.12) and completeness (4.89±0.11). ChatGPT-4o ranked second (16.73/20), with accuracy (4.22±0.72) and completeness (4.18±0.74) scores significantly higher than those of other models. Claude 3.5 Sonnet and GLM-4 achieved moderate performance (>4.0 for clinical dimensions), whereas Copilot, Gemini 1.5 Flash, and ERNIE 4.0 Turbo showed suboptimal accuracy. CONCLUSIONS: DeepSeek-R1 and ChatGPT-4o achieved near-expert accuracy, potentially reliable for basic queries under oversight. Claude 3.5 Sonnet and GLM-4 showed moderate performance with notable gaps. Copilot, Gemini, and ERNIE demonstrated critical errors. However, all models exhibited hallucinated references and a lack of patient-specific reasoning. LLMs should not replace professional medical judgment in treatment decisions. Safe implementation requires restricting high-performing LLMs to narrowly defined procedural questions only, with mandatory physician verification.
INTRODUCTION: To promote home phototherapy adoption, clearer insights are needed on current evidence and the population most likely to benefit. METHODS: Six online databases were searched until 20 January 2025. Studies were included that reported on (cost-)effectiveness, safety, and/or implementation barriers and facilitators of home phototherapy. Two reviewers independently extracted data and assessed bias using the Mixed Methods Appraisal Tool. Data were pooled via random-effects meta-analysis. Barriers and facilitators were analyzed using the Theoretical Domains Framework. GRADE was used to assess evidence quality. RESULTS: Thirty-one studies were included, representing 5059 neonates, 869 healthcare professionals, and 478 parents. Risk of bias was moderate. Hospital (re)admission following home phototherapy was 3.5% (95% CI, 2.2-5.3%). No difference was found in treatment duration (mean difference = +4.9 h, 95% CI -8.0 to +17.9) and daily decline in bilirubin (mean difference = +5.7 μmol/L, 95% CI -2.6 to +13.9). No studies evaluated cost-effectiveness. Key facilitators included eligibility screening and parental education, while key barriers included bilirubin measurement, healthcare professionals' concerns about homecare consequences, and parental insecurity. Quality of evidence was rated low for all outcomes. CONCLUSION: Evidence suggests home phototherapy can be an alternative to in-hospital treatment for hyperbilirubinemia in near-term neonates. Clinical recommendations are limited due to low-certainty evidence. IMPACT: Home phototherapy can be a safe and effective alternative to in-hospital treatment for low-risk neonates with hyperbilirubinemia. Strength of this recommendation is low. Our study is the first to systematically synthesize parent/caregiver and healthcare professional perspectives on home phototherapy using the Theoretical Domains Framework. Key facilitators included eligibility screening and parental education, while key barriers included concerns about home care consequences by healthcare professionals and parental insecurity. Addressing these barriers through improved support and accurate monitoring is recommended.
Jessie Spaan, Lauren E H Westenberg, Erwin Ista et al.
AIM: Nurses play a critical role in the insertion and maintenance of PIVC, and in monitoring and preventing complications and failures associated with this procedure. This study aimed to assess paediatric nurses' knowledge and confidence in the insertion and maintenance of peripheral intravenous catheters for paediatric patients in Saudi Arabia. DESIGN: A cross-sectional study was employed in this study METHODS: This study was conducted among 160 nurses working in paediatric wards, paediatric intensive care units, neonatal intensive care units, paediatric emergency units, and daycare units. The nurses completed an online survey using validated questionnaires to evaluate self-reported knowledge and confidence in PIVC insertion and maintenance. RESULTS: The study findings revealed that the nurses participating had inadequate knowledge of PIVC insertion (mean score: 4.47 ± 1.57) and maintenance (mean score: 5.5 ± 2.11) but high confidence in their ability to perform these procedures (mean score: 41.23 ± 7.37 for insertion and 38.33 ± 6.80 for maintenance). No significant association was observed between nurses' demographic variables, such as age, gender, level of education, working area, training, and experience, and their knowledge or confidence in PIVC insertion and maintenance. PATIENT OR PUBLIC CONTRIBUTION: Based on the study findings, it highlights gaps in paediatric nurses' PIVC insertion and maintenance practice. Addressing these gaps requires targeted education and skill training, which can potentially lead to enhanced success rates for procedures, decrease complications, as well as increase the safety and quality of care given to critically ill paediatric patients.
