INTRODUCTION: Differentiating infants with serious bacterial infections (SBIs) or invasive bacterial infections (IBIs) from those without remains a challenge. We sought to compare the diagnostic performances of single biomarkers (absolute neutrophil count [ANC], C-reactive protein [CRP] and procalcitonin [PCT]) and 4 diagnostic approaches comprising Lab-score, Step-by-Step approach (original and modified) and Pediatric Emergency Care Applied Research Network (PECARN) rule. METHOD: This is a prospective cohort study involving infants 0-90 days of age who presented to an emergency department from July 2020 to August 2021. SBIs were defined as bacterial meningitis, bacteraemia and/or urinary tract infections. IBIs were defined as bacteraemia and/or bacterial meningitis. We evaluated the performances of Lab-score, Step-by-Step (original and modified) and PECARN rule in predicting SBIs and IBIs. RESULTS: We analysed a total of 258 infants, among whom 86 (33.3%) had SBIs and 9 (3.5%) had IBIs. In predicting SBIs, ANC ≥4.09 had the highest sensitivity and negative predictive value (NPV), while PCT ≥1.7 had the highest specificity and positive predictive value (PPV). CRP ≥20 achieved the highest area under receiver operating characteristic curve (AUC) of 0.741 (95% confidence interval [CI] 0.672-0.810). The Step-by-Step (original) approach had the highest sensitivity (97.7%). Lab-score had the highest AUC of 0.695 (95% CI 0.621-0.768), compared to PECARN rule at 0.625 (95% CI 0.556-0.694) and Step-by-Step (original) at 0.573 (95% CI 0.502-0.644). In predicting IBIs, PCT ≥1.7 had the highest sensitivity, specificity, PPV and NPV. The Step-by-Step (original and modified) approach had the highest sensitivity of 100%. Lab-score had the highest AUC of 0.854 (95% CI 0.731-0.977) compared to PECARN rule at 0.589 (95% CI 0.420-0.758) and Step-by-Step at 0.562 (95% CI 0.392-0.732). CONCLUSION CRP strongly predicted SBIs, and PCT strongly predicted IBI. The Step-by-Step approach had the highest sensitivity and NPV, while Lab-score had the highest specificity and AUC in predicting SBIs and IBIs.
Infant ; Humans ; Child ; Calcitonin ; Prospective Studies ; Emergency Service, Hospital ; Bacterial Infections/diagnosis* ; Fever/diagnosis* ; C-Reactive Protein/analysis* ; Meningitis, Bacterial/diagnosis* ; Bacteremia ; Biomarkers ; Emergency Medical Services ; Procalcitonin

INTRODUCTIONToy-related injuries, a common reason for emergency department visits in the paediatric population, constitute a significant health burden in Singapore. Although government regulations imposed on toys and childcare-related items are in place, parents and caregivers still play a pivotal role in ensuring toy safety in children. We hypothesised that deficiencies in knowledge surrounding toy safety issues exist in our adult population.

METHODSWe conducted a cross-sectional questionnaire study at KK Women's and Children's Hospital, Singapore, to examine the current attitudes, knowledge and practices of the local population regarding toy safety. Hypothetical questions on toy selection were included in the questionnaire to assess respondents' ability to identify appropriate toys and discern potentially dangerous toys for a specified age group.

RESULTSThe scores of the 93 respondents showed that they were less able to identify appropriate toys for children in the 1-2 years (66.7%; 95% confidence interval [CI] 61.4%-72.0%) and 2-3 years age groups (69.9%; 95% CI 65.5%-74.3%) than for children in the 0-1 year (82.8%; 95% CI 79.9%-85.7%) and 3-5 years age groups (85.2%; 95% CI 81.2%-89.2%). Our survey also identified key areas for improvement (e.g. educational efforts and government regulation) in current practices in order to attain a higher level of toy safety.

CONCLUSIONOur study highlights the current knowledge deficit in toy safety issues and the need for improvements in regulation, education and surveillance in order to minimise the risk of toy-related injuries in children.

Adult ; Age Factors ; Child ; Child Welfare ; Child, Preschool ; Confidence Intervals ; Consumer Product Safety ; Cross-Sectional Studies ; Female ; Humans ; Incidence ; Needs Assessment ; Play and Playthings ; injuries ; Singapore ; Surveys and Questionnaires ; Wounds and Injuries ; etiology ; physiopathology

We present the revised 2016 Singapore paediatric resuscitation guidelines. The International Liaison Committee on Resuscitation's Pediatric Taskforce Consensus Statements on Science and Treatment Recommendations, as well as the updated resuscitation guidelines from the American Heart Association and European Resuscitation Council released in October 2015, were debated and discussed by the workgroup. The final recommendations for the Singapore Paediatric Resuscitation Guidelines 2016 were derived after carefully reviewing the current available evidence in the literature and balancing it with local clinical practice.

The COVID-19 pandemic has resulted in significant challenges for the resuscitation of paediatric patients, especially for infants and children who are suspected or confirmed to be infected. Thus, the paediatric subcommittee of the Singapore Resuscitation and First Aid Council developed interim modifications to the current Singapore paediatric guidelines using extrapolated data from the available literature, local multidisciplinary expert consensus and institutional best practices. It is hoped that this it will provide a framework during the pandemic for improved outcomes in paediatric cardiac arrest patients in the local context, while taking into consideration the safety of all community first responders, medical frontline providers and healthcare workers.
Infant ; Child ; Humans ; Cardiopulmonary Resuscitation/methods* ; COVID-19/therapy* ; Pandemics ; Singapore ; Heart Arrest