new RHS patients were identified. Referral reasons were compared with first RHS assessment diagnoses. Most referrals (254/310; 81.7%) were from HEHS, reflecting humanitarian entrants. However, 15.2% (47/310) had previous detention experience. Detention affected the acuity of referrals, with significantly more triaged urgent (34/47; 72.3% vs. non-urgent 13/47; 27.7, P < 0.001).Significantly, more active issues of concern were identified following completed initial RHS assessment compared with referral reasons (all referrers: mean 2.3 AE SD 1.2 issues versus RHS assessment: mean 5.1 AE SD 2.1 issues, P < 0.001). Striking effects of detention were noted. Those with detention histories had higher number of issues identified by the RHS (detained mean 6.2 AE SD 2.6 issues vs. non-detained 4.9 AE SD 1.9, P < 0.001). Psychological and educational concerns were higher in those patients with detention experience (Table 1).Our findings reinforce the sustained adverse effects of detention on children, adolescents and their parents. The effects were demonstrated across multiple domains, particularly educational and psychological health. Developmental concerns were not analysed, as referrals were not reviewed by age. Many issues are not able to be identified through traditional infection-based screening guidelines, but instead rely on expert knowledge and standardised multidisciplinary assessment to identify, manage and subsequently advocate for change. These data highlight the ongoing need to improve AS families' access to appropriate paediatric refugee health services. Education and collaboration between refugee health providers underpins improvements.

An 8-day-old neonate was presented with severe respiratory distress and diagnosed as primary pulmonary hypertension of the newborn on functional echocardiogram. Evaluation showed bounding pulse, enlarged umbilical cord, and bruit over the periumbilical region. Transthoracic echocardiography and CT angiogram showed a large fistulous communication between the umbilical vein and artery suggestive of congenital umbilical arteriovenous malformation leading to high-output cardiac failure and pulmonary artery hypertension. The patient was stabilised with medications and ventilation. Transcatheter closure of communication was done using coils, vascular plug, and KONAR-MFTM device. The patient improved from heart failure soon after the procedure and thriving normally at 6 months of follow-up.

Cow’s milk protein allergy (CMPA) is the most common food allergy in infants. A previously healthy neonate fed with infant formula presented diarrhoea, vomiting and respiratory distress with cyanosis. Investigations showed thrombocytosis and leucocytosis with lymphocyte predominance. To our surprise blood gas analysis showed metabolic acidosis and a high methaemoglobin level of 33% (normal range <3%). Clinical status, metabolic acidosis and methaemoglobin level returned to normal following fluid resuscitation and methylene blue administration. The neonate was later managed with breast feeding and elemental formula. CMPA was diagnosed based on history and clinical improvement after elemental formula. Although not common in CMPA, methaemoglobinaemia should be recognised as a differential diagnosis in a hypoxic infant with metabolic acidosis and diarrhoea as early recognition and treatment with methylene blue can save a child’s life.

Purpose : Despite improvements in preterm neonatal care, the incidence of bronchopulmonary dysplasia (BPD) has not decreased. Systemic glucocorticoids minimize BPD, but they may interfere with brain development. The impact of intratracheal budesonide along with surfactant on the incidence of BPD in extremely preterm infants is unknown. Methods: This two arm parallel pilot trial over a period of 18 months recruited extreme preterm (<28 weeks) and extreme low birth weight (ELBW) neonates who were diagnosed with severe RDS (respiratory distress syndrome). Neonates were randomly allocated to one of two groups (54 intervention and 55 control). Intratracheal surfactant and budesonide were administered to the intervention group, while surfactant alone was administered to the control group. Results: The study population had a mean gestational age of 26.1 ± 0.2 weeks and birth weight of 770.5 ± 31.5 grams. Death ( RR 0.65 [0.30-1.38]; p = 0.267) and combined BPD or death (RR 0.88 [0.73-1.06]; p = 0.211) exhibited a non-significant decreasing trend; however, a significant reduction in the combined outcome of severe BPD or death (RR 0.57(0.33-0.97);p=0.040) was observed in the intervention group. Conclusion: Intratracheal budesonide with surfactant administration is feasible . This may minimize severe BPD or death in extremely preterm infants with severe RDS without any harm.

No abstract