Susan Donath

Susan Donath
University of Melbourne | MSD · Department of Paediatrics

About

234
Publications
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Publications

Publications (234)
Article
Background: Globally, the majority of newborns requiring resuscitation at birth are full term or late-preterm infants. These infants typically have their umbilical cord clamped early (ECC) before moving to a resuscitation platform, losing the potential support of the placental circulation. Physiologically based cord clamping (PBCC) is clamping the...
Article
Full-text available
Randomised trials in emergency settings must quickly confirm eligibility and allocate participants to an intervention group without delaying treatment. We report rapid randomisation during two neonatal resuscitation trials using the non-commercial REDCap platform accessed via smartphone. This simple, reliable method has wide applicability for trial...
Article
Background: There is no standardized definition for infant eczema, and various tools have been used across studies, precluding direct comparison. Objective: The aim of the study was to assess and to compare the accuracy of diagnostic tools for infant eczema using the extensive data collected in Melbourne Infant Study: BCG for Allergy and Infecti...
Article
Introduction Bacille Calmette-Guérin (BCG) and hepatitis B (HBV) vaccines are frequently given concomitantly at birth. Neonatal BCG vaccination induces off-target immunological effects. Whether HBV vaccine has immunomodulatory effects is unknown. As off-target effects might vary when vaccines are given simultaneously, this randomised controlled tri...
Article
Rationale: Scar formation following bacille Calmette-Guérin (BCG) vaccination has been associated with lower all-cause mortality; the relation between scar and mycobacterial-specific protection against tuberculosis is debated. Objectives: To evaluate the association between BCG skin reaction and mycobacteria-specific immune responses. Methods:...
Article
Aim This study aimed to determine the feasibility and parental acceptability of screening for congenital cytomegalovirus (cCMV) through saliva polymerase chain reaction in infants who did not pass their newborn hearing screening. Additionally, the utility (i.e. time to diagnosis and treatment) of this enhanced clinical pathway was evaluated. Metho...
Article
Background The Pediatric Emergency Care Applied Research Network (PECARN) head trauma clinical decision rules informed the development of algorithms that risk stratify the management of children based on their risk of clinically important traumatic brain injury (ciTBI). We aimed to determine the rate of ciTBI for each PECARN algorithm risk group in...
Article
Background Bacille Calmette-Guérin (BCG) vaccine could play a role in counteracting the rising prevalence of atopic diseases, through its beneficial off-target effects. We aimed to determine whether neonatal BCG vaccination reduces the incidence of eczema in infants. Methods Randomised controlled trial with 1272 infants allocated to receive BCG-De...
Article
Background Bacille Calmette-Guérin (BCG) vaccination has beneficial off-target effects that may include protecting against non-mycobacterial infectious diseases. We aimed to determine whether neonatal BCG vaccination reduces lower respiratory tract infections (LRTI) in infants in the MIS BAIR trial. Methods In this investigator-blinded trial, neon...
Preprint
Full-text available
Background: Reference intervals (RIs), which are used as an assessment tool in laboratory medicine, change with age for most biomarkers in children. Addressing this, RIs that vary continuously with age have been developed using a range of curve-fitting approaches. The choice of statistical method may be important as different methods may produce su...
Article
Background Bacillus Calmette–Guérin (BCG) vaccine provides partial protection against Buruli ulcer caused by Mycobacterium ulcerans in epidemiological studies. This study aimed to quantify M. ulcerans-specific immune responses induced by BCG immunisation. Methods Intracellular cytokine analysis of in-vitro experiments done 10 weeks after BCG immun...
Article
Introduction There is an emerging realisation that paediatric reference intervals (RIs) estimated using discrete age-groups may be misleading, especially close to age cut-off values. This limitation has been addressed by estimating RIs that vary continuously with age. This systematic review examines the range of statistical methods used over the pa...
Article
Establishing paediatric reference intervals (RIs) is a challenging task due to difficulties in subject recruitment, collection of adequate blood volume, and the inherent physiological changes of many biomarkers with age. Despite these challenges, several national and international initiatives have demonstrated: (a) the feasibility of prospectively...
Article
Introduction: To facilitate best possible patient care, reference intervals (RIs) adopted by a laboratory must be appropriate for the population demographics and, where applicable, the analytical principle and/or the analytical instrument used. While guidelines from the Clinical and Laboratory Standard Institute (CLSI) recommend a validation proce...
Article
Background: Management of children with minor blunt head trauma often includes a period of observation to determine the need for cranial computed tomography (CT). Our objective was to estimate the effect of planned observation on CT use for each Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) risk group amon...
Article
Aim: To characterise the causes, clinical characteristics and short-term outcomes of neonates who presented to paediatric emergency departments with a head injury. Methods: Secondary analysis of a prospective data set of paediatric head injuries at 10 emergency departments in Australia and New Zealand. Patients without neuroimaging were followed...
Article
Introduction: BCG vaccination reduces all-cause infant mortality in high-mortality settings by more than can be attributed to protection against tuberculosis. This is proposed to result from non-specific protection against non-vaccine targeted ('off-target') infections. There is also evidence that BCG protects against allergic diseases. Methods a...
Article
Aim: Abusive head trauma (AHT) is associated with high morbidity and mortality. We aimed to describe characteristics of cases where clinicians suspected AHT and confirmed AHT cases and describe how they differed. Methods: This was a planned secondary analysis of a prospective multicentre cohort study of head injured children aged <18 years acros...
Article
Background: Probiotic supplementation to mothers and/or their term-born infants has been suggested to prevent allergic disease, in particular eczema; however, no studies have investigated probiotics for prevention of allergic diseases in very preterm infants. We evaluated the effect of a postnatal probiotic combination on development of allergic d...
Article
Full-text available
Background: Age-specific reference intervals (RIs) have been developed for biochemistry analytes in children. However, the ability to interpret results from multiple laboratories for 1 individual is limited. This study reports a head-to-head comparison of reference values and age-specific RIs for 30 biochemistry analytes for children across 5 anal...
Article
Full-text available
Background/aim Closure of the processus vaginalis (PV) is considered as the last step of testicular descent. Therefore, patent processus vaginalis (PV), and inguinal hernias are linked to cryptorchidism. As the National Australian incidence of orchidopexy has decreased over the previous 20 years, we aimed to explore the incidence of inguinal hernio...
Article
Full-text available
Introduction: Immunisation during pregnancy to protect infants against tetanus, pertussis and influenza is recommended in many countries. However, maternal antibodies can interfere with infant vaccine responses. We investigated the effect of antenatal diphtheria-tetanus-acellular pertussis (dTpa) and trivalent inactivated influenza (TIV) immunisati...
Article
Introduction: Bacillus Calmette-Guérin vaccine (BCG), one of the most widely used vaccines, does not only provide protection against tuberculosis and other mycobacterial infections, but also has non-specific (heterologous) immunomodulatory effects. In participants in a randomised trial, we investigated the effect of neonatal BCG immunisation on ant...
Conference Paper
Aims Using intravenous (IV) antibiotics to treat urinary tract infection (UTI)/pyelonephritis places a significant burden on patients, their families and health care resources. Despite a recent Cochrane review, guidelines do not clearly state the criteria for IV antibiotics in children with UTI/pyelonephritis. We aim to derive and validate a clinic...
Article
Full-text available
Background: Current immune-based TB tests, including the tuberculin skin test (TST) and interferon-gamma release assays (IGRA), have significant limitations, including the inability to distinguish between latent TB infection (LTBI) and active TB. Few biomarkers with the potential to discriminate between these two infection states have been identifi...
Article
Background: Phenytoin is the current standard of care for second-line treatment of paediatric convulsive status epilepticus after failure of first-line benzodiazepines, but is only effective in 60% of cases and is associated with considerable adverse effects. A newer anticonvulsant, levetiracetam, can be given more quickly, is potentially more effi...
Article
Background: In adults, continuous infusions of vancomycin (CIV) are associated with earlier attainment of target drug concentrations, require fewer blood samples for monitoring, and may reduce drug toxicity. We aimed to determine, in young infants, if CIV or intermittent infusions of vancomycin (IIV) better achieves target vancomycin concentration...
Article
: media-1vid110.1542/5972298232001PEDS-VA_2018-1420Video Abstract BACKGROUND: The evidence is unclear about the optimal route of treatment for children with cellulitis, specifically how to assess the risk of moderate-to-severe cellulitis requiring intravenous (IV) antibiotics. We aimed to derive and validate a cellulitis risk assessment scoring sys...
Article
Objective Although there is a large body of research on head injury (HI) inflicted by caregivers in young children, little is known about intentional HI in older children and inflicted HI by perpetrators other than carers. Therefore, we set out to describe epidemiology, demographics and severity of intentional HIs in childhood. Methods A planned s...
Article
Full-text available
Study objective: To determine the cost-effectiveness of 3 clinical decision rules in comparison to Australian and New Zealand usual care: the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE), the Pediatric Emergency Care Applied Research Network (PECARN), and the Canadian Assessment of Tomography for Child...
Article
Objective: To identify risk factors associated with mortality in critically ill children requiring continuous renal replacement therapy. Design: Retrospective observational study based on a prospective registry. Setting: Tertiary and quaternary referral 30-bed PICU. Patients: Critically ill children undergoing continuous renal replacement th...
Article
Full-text available
Background Clinical decision rules (CDRs) aid in the management of children with traumatic brain injury (TBI). Recently, the Scandinavian Neurotrauma Committee (SNC) has published practical, evidence-based guidelines for children with Glasgow Coma Scale (GCS) scores of 9–15. This study aims to validate these guidelines and to compare them with othe...
Article
Objective The National Emergency X-Radiography Utilisation Study II (NEXUS II) clinical decision rule (CDR) can be used to optimise the use of CT in children with head trauma. We set out to externally validate this CDR in a large cohort. Methods We performed a prospective observational study of patients aged <18 years presenting with head trauma o...
Article
Objectives: The role of venoarterial extracorporeal membrane oxygenation in the treatment of severe pediatric septic shock continues to be intensely debated. Our objective was to determine whether the use of venoarterial extracorporeal membrane oxygenation in severe septic shock was associated with altered patient mortality, morbidity, and/or leng...
Article
Aim Penetrating head injuries (pHIs) are associated with high morbidity and mortality. Data on pHIs in children outside North America are limited. We describe the mechanism of injuries, neuroimaging findings, neurosurgery and mortality for pHIs in Australia and New Zealand. Methods This was a planned secondary analysis of a prospective observation...
Article
Study objective: Three clinical decision rules for head injuries in children (Pediatric Emergency Care Applied Research Network [PECARN], Canadian Assessment of Tomography for Childhood Head Injury [CATCH], and Children's Head Injury Algorithm for the Prediction of Important Clinical Events [CHALICE]) have been shown to have high performance accur...
Article
Objective: To prospectively compare the proportion of traumatic brain injuries (TBIs) that would be classified as 'mild' using different published definitions by applying published definitions of mild TBI to a large prospectively collected dataset and to examine the variability in the proportions included by various definitions. High rates of mild...
Article
Full-text available
Objective To determine the impact of one probiotics combination on the neurodevelopment of very preterm children at 2–5 years corrected gestational age (CA). Design Follow-up study of survivors of a double-blinded, placebo-controlled, randomised trial of probiotic effects on late-onset sepsis in very preterm infants that found reduced necrotising...
Article
Background/aim: International criteria currently suggest orchidopexy at 6-12months for congenital undescended testis (UDT). Some children require repeat orchidopexy for recurrent UDT. This study aimed to assess practice in Australia over a 20-year period. Methods: We examined 20years of Australian orchidopexy data (1995-2014) from the Department...
Article
Aim: The aims of this study were to estimate the proportion of emergency department presentations attributable to children with cerebral palsy (CP), investigate the frequency of emergency department presentations in a CP cohort, and compare emergency department presentations among children with CP with those of other children. Method: This was a...
Article
Background: Oral immunotherapy has attracted much interest as a potential treatment for food allergy, yet little is known about its long-term effects. We aimed to assess long-term outcomes in participants who completed a randomised, double-blind, placebo-controlled trial of combined probiotic and peanut oral immunotherapy (PPOIT), which was previo...
Article
Aim: We aimed to examine the impact of weather on hospital admissions with bronchiolitis in Australia and New Zealand. Methods: We collected data for inpatient admissions of infants aged 2-12 months to seven hospitals in four cities in Australia and New Zealand from 2009 until 2011. Correlation of hospital admissions with minimum daily temperatu...
Article
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Background: Group A Streptococcus (GAS) skin infections are particularly prevalent in developing nations. The GAS M protein, by which strains are differentiated into >220 different emm types, is immunogenic and elicits protective antibodies. A major obstacle for vaccine development has been the traditional understanding that immunity following inf...
Article
Full-text available
Background Convulsive status epilepticus (CSE) is the most common life-threatening childhood neurological emergency. Despite this, there is a lack of high quality evidence supporting medication use after first line benzodiazepines, with current treatment protocols based solely on non-experimental evidence and expert opinion. The current standard of...
Article
Aim: Clean catch urine (CCU) collection is commonly used in pre-continent children. CCU can be time-consuming and specimens may be contaminated. Our aim was to determine the time taken for CCU attempts and to describe the success of this method in diagnosing or excluding urinary tract infection. Methods: Prospective observational study of CCU in...
Article
Objectives: To describe the rate of intensive care unit (ICU) admission, type of ventilation support provided and risk factors for ICU admission in infants with bronchiolitis. Design: Retrospective review of hospital records and Australia and New Zealand Paediatric Intensive Care (ANZPIC) registry data for infants 2-12 months old admitted with b...
Conference Paper
Aims Clinical decision rules (CDRs) can assist in determining the need for computed tomography (CT) in children with head injuries (HIs). We assessed the accuracy of 3 high quality CDRs (PECARN, CATCH and CHALICE) in a large prospective cohort of head injured children. However in addition to CDR accuracy, the baseline physician accuracy is one of a...
Conference Paper
Aims While the majority of head injuries (HIs) in children are non-intentional, there is limited information on intentional HIs outside abusive head trauma. The objective of this study was to describe epidemiology, demographics and severity of intentional HIs in childhood in a multicentre study in Australia and New Zealand. Methods Planned seconda...
Conference Paper
Aims Clinical decision rules (CDRs) can be applied in Emergency Departments (EDs) to optimise the use of computed tomography (CT) in children with head trauma. The National Emergency X- Radiography Utilisation Study II (NEXUS II) CDR, as amended for children, has not been externally validated in a large paediatric cohort. The objective of this stud...
Conference Paper
Aims Urinary tract infection is common and important to diagnose or exclude in febrile young children. Limitations exist with current urine collection methods and clinician collection preferences vary. UK NICE Guidelines recommend clean catch urine (CCU) which is convenient but can be unreliable and time-consuming. An ideal urine collection method...
Conference Paper
Aims Mild traumatic brain injury (TBI) in children is a major public health issue, yet there is wide variation in the way ‘mild’ TBI is defined in the literature and in guidelines. To date no study has prospectively detailed the proportion of children presenting with mild TBI to Emergency Departments (EDs) according to these various definitions. Th...
Article
Background: Clinical decision rules can help to determine the need for CT imaging in children with head injuries. We aimed to validate three clinical decision rules (PECARN, CATCH, and CHALICE) in a large sample of children. Methods: In this prospective observational study, we included children and adolescents (aged <18 years) with head injuries...
Article
Aim: Neonatal clinicians may be asked to review X-ray images when unable to directly access the original image. Transmitting an X-ray image to a smartphone is a technique increasingly being used by clinicians in a number of settings. Minimal data exist on its use in the neonatal setting. Our aim was to compare the ability of neonatal clinicians to...
Article
Objective: Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cause of hospitalisation. We aimed to assess whether intravenous hydration (IVH) was more cost-effective than nasogastric hydration (NGH) as a planned secondary economic analysis of a randomised trial involving 759 infants (aged 2-12 months) ad...
Article
Background: More than 120 million doses of BCG vaccine are administered worldwide each year. Most infants are given BCG at birth in accordance with WHO recommendations. However, the effect of the maturing neonatal immune system on the immune response and protection conferred by BCG remains uncertain. Previous studies investigating the influence of...
Article
Full-text available
Objective Historical cohort studies have reported adverse neurodevelopment following cardiac surgery during early infancy. Advances in surgical techniques and perioperative care have coincided with updating of neurodevelopmental assessment tools. We aimed to determine perioperative risk factors for impaired neurodevelopment at 2 years following sur...
Article
In Victoria, neonates with severe unconjugated hyperbilirubinaemia at risk of requiring exchange transfusion are retrieved by the Paediatric Infant Perinatal Emergency Retrieval Service and transferred to a Neonatal Intensive Care Unit where an exchange transfusion can be performed if necessary. Transfer may result in prolonged periods without phot...
Article
Full-text available
Current immunodiagnostic tests for tuberculosis (TB), including the tuberculin skin test (TST) and interferon-gamma (IFN-γ) release assays (IGRA), have significant limitations, which include their inability to distinguish between latent TB infection (LTBI) and active TB, a distinction critical for clinical management. To identify mycobacteria-speci...
Article
Background: To describe prospectively the extent, onset, and persistence of maternal physical health symptoms (cesarean delivery pain, perineal pain, back pain, constipation, hemorrhoids, urinary incontinence, bowel incontinence, and fatigue) in the first 8 weeks postpartum. Methods: A prospective cohort of 229 primiparous women was recruited ante...
Article
Full-text available
Head injuries in children are responsible for a large number of emergency department visits. Failure to identify a clinically significant intracranial injury in a timely fashion may result in long term neurodisability and death. Whilst cranial computed tomography (CT) provides rapid and definitive identification of intracranial injuries, it is reso...
Article
Background and objective: Late-onset sepsis frequently complicates prematurity, contributing to morbidity and mortality. Probiotics may reduce mortality and necrotizing enterocolitis (NEC) in preterm infants, with unclear effect on late-onset sepsis. This study aimed to determine the effect of administering a specific combination of probiotics to...
Article
Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cause of hospital admission. Hydration is a mainstay of treatment, but insufficient evidence exists to guide clinical practice. We aimed to assess whether intravenous hydration or nasogastric hydration is better for treatment of infants. In this multicentr...
Article
Full-text available
Background: The use of high-flow nasal cannulae is an increasingly popular alternative to nasal continuous positive airway pressure (CPAP) for noninvasive respiratory support of very preterm infants (gestational age, <32 weeks) after extubation. However, data on the efficacy or safety of such cannulae in this population are lacking. Methods: In...
Article
Full-text available
Background: Very preterm infants can be treated with nasal continuous positive airway pressure (CPAP) from birth, but some fail. A rapid test, such as the stable microbubble test (SMT) on gastric aspirate, may identify those who can be managed successfully using CPAP. Objective: To determine if SMT can identify soon after birth, very preterm inf...