Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2020

For 27 years, national prospective data on selected rare childhood diseases have been collected monthly by the Australian Paediatric Surveillance Unit (APSU) from paediatricians and other clinical specialists who report cases in children aged up to 16 years. We report here the annual results of APSU surveillance in 2020 for ten rare communicable diseases and complications of communicable diseases, namely: acute flaccid paralysis (AFP); congenital cytomegalovirus (CMV) infection; neonatal herpes simplex virus (HSV) infection; perinatal exposure to human immunodeficiency virus (HIV); paediatric HIV infection; severe complications of seasonal influenza; juvenile onset recurrent respiratory papillomatosis (JoRRP); congenital rubella syndrome; congenital varicella syndrome; and neonatal varicella infection. We describe the results for each disease in the context of the total period of study, including demographics, clinical characteristics, treatment and short-term outcomes. Despite challenges presented by the coronavirus disease 2019 (COVID-19) pandemic in 2020, more than 1,400 paediatricians reported regularly to the APSU and an overall monthly reporting rate of > 90% was achieved. The minimum AFP target of 1 case per 100,000 children aged less than 15 years was achieved and there were few cases of vaccine-preventable diseases (JoRRP, rubella, varicella). However, high cases of congenital CMV, neonatal HSV and perinatal exposure to HIV persist. There were no severe complications of seasonal influenza reported for the first time in 13 years. This is consistent with other surveillance data reporting a decline of influenza and other communicable diseases in 2020, and likely reflects the wider effects of public health measures to reduce transmission of SARS-CoV-2 in the Australian community.

Life-threatening bronchopulmonary dysplasia: a British Paediatric Surveillance Unit Study

ObjectivesTo assess the minimum incidence of life-threatening bronchopulmonary dysplasia (BPD), defined as need for positive pressure respiratory support or pulmonary vasodilators at 38 weeks corrected gestational age (CGA), in infants born <32 weeks gestation in the UK and Ireland; and to describe patient characteristics, management and outcomes to 1 year.MethodsProspective national surveillance study performed via the British Paediatric Surveillance Unit from June 2017 to July 2018. Data were collected in a series of three questionnaires from notification to 1 year of age.Results153 notifications met the case definition, giving a minimum incidence of 13.9 (95% CI: 11.8 to 16.3) per 1000 live births <32 weeks’ gestation. Median gestation was 26.1 (IQR 24.6–28) weeks, and birth weight 730 g (IQR 620–910 g). More affected infants were male (95 of 153, 62%; p<0.05). Detailed management and outcome data were provided for 94 infants. Fifteen died at median age 159 days (IQR 105–182) or 49.6 weeks CGA (IQR 43–53). Median age last receiving invasive ventilation was 50 days (IQR 22–98) and total duration of pressure support for surviving infants 103 (IQR 87–134) days. Fifty-seven (60.6%) received postnatal steroids and 22 (23.4%) pulmonary vasodilators. Death (16%) and/or major neurodevelopmental impairment (37.3%) or long-term ventilation (23.4%) were significantly associated with need for invasive ventilation near term and pulmonary hypertension.ConclusionsThis definition of life-threatening BPD identified an extremely high-risk subgroup, associated with serious morbidity and mortality. Wide variability in management was demonstrated, and future prospective study, particularly in key areas of postnatal steroid use and pulmonary hypertension management, is required.

SP5 Tenfold medication errors in children – Welsh paediatric surveillance unit study 2017–9

AimsTo establish the incidence and characteristics of tenfold or greater and a tenth or less medication errors in children <16 years in Wales to help inform patient safety on a population level.MethodPopulation-based incidence study in Wales, UK, from June 2017 - May 2019 (24 months). Cases were reported from paediatricians and hospital pharmacists using the monthly Welsh Paediatric Surveillance Unit (WPSU).Results46 confirmed incidents in 44 children from 63 notifications were identified. Cases came from 8 hospitals in Wales with 29 (63%) from the sole tertiary hospital. Median age was 1.7 (range 1 week to 15) years and weight 10 kg (0.6 to 59).39 (85%) were overdosing (up to 1000x fold error) and 7 underdosing. 40 different medications were involved, 16 (37%) intravenous. Of 29 cases involving enteral medication, 26 (90%) were liquid formulations. Three cases were discharge medication prescribed or dispensed incorrectly and administrated at home. Stage of errors were primarily in prescribing 37 (80%), administration 7 (16%) and dispensing 2 (4%).18 (42%) cases reached the patient, 10 from prescribing. Seven cases were spotted after multiple doses were given. Six errors resulted in harm, three which required intensive care treatment. No deaths or permanent disabilities were reported. Half (23/46) of all errors reported and two-thirds (12/18) of cases that reached the child occurred in <10 kg children.Several human factor themes were identified: Prescribing confusion between gram milligram and microgram (none reached patient, n=7), confusing between mg and mg/kg (n=6 including 3 underdosing errors), leading zero errors (e.g. 0.1 vs 0.001 mg, n=6) and prescribing reconciliation errors where admitting doctor attempted to prescribe chronic medication in mg by reversing calculating liquid dosage expressed in mL (n=4).During this study period 164,000 hospital admissions occurred in children <16 years in Wales. Our data estimates a tenfold error incidence of 1:3600 paediatric admissions, with drug reaching the child in 1:9000 admissions.ConclusionIn this unique first ever population surveillance study, tenfold errors in children occurred at every stage of medication process and in the full range of care settings. Errors found were very different from those obtained from tertiary hospital single centre study and UK National Reporting and Learning System (NRLS). Strategies for error reduction will be more productive if designed across a whole national healthcare system.

Australian Paediatric Surveillance Unit (APSU) Annual Surveillance Report 2019

The Australian Paediatric Surveillance Unit (APSU) has been prospectively collecting national data on rare childhood conditions since 1993, with monthly reporting of cases by paediatricians. In this report we describe annual results from studies for ten communicable diseases and complications of communicable diseases that were conducted using APSU surveillance in 2019 and place these in an historic context. Results are reported on acute flaccid paralysis, congenital cytomegalovirus infection, neonatal herpes simplex virus infection, perinatal exposure to HIV, paediatric HIV infection, severe complications of seasonal influenza, juvenile onset recurrent respiratory papillomatosis (JoRRP), congenital rubella syndrome, congenital varicella syndrome and neonatal varicella infection. APSU provides rich clinical data to complement data collected from other surveillance systems and to improve understanding and response to rare childhood infections.