Screening, assessment and management of type 2 diabetes mellitus in children and adolescents: Australasian Paediatric Endocrine Group guidelines.

INTRODUCTION: The incidence of type 2 diabetes mellitus has increased in children and adolescents due largely to the obesity epidemic, particularly in high risk ethnic groups. ß-Cell function declines faster and diabetes complications develop earlier in paediatric type 2 diabetes compared with adult-onset type 2 diabetes. There are no consensus guidelines in Australasia for assessment and management of type 2 diabetes in paediatric populations and health professionals have had to refer to adult guidelines. Recent international paediatric guidelines did not address adaptations to care for patients from Indigenous backgrounds. MAIN RECOMMENDATIONS: This guideline provides advice on paediatric type 2 diabetes in relation to screening, diagnosis, diabetes education, monitoring including targets, multicomponent healthy lifestyle, pharmacotherapy, assessment and management of complications and comorbidities, and transition. There is also a dedicated section on considerations of care for children and adolescents from Indigenous background in Australia and New Zealand. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES: Published international guidelines currently exist, but the challenges and specifics to care for children and adolescents with type 2 diabetes which should apply to Australasia have not been addressed to date. These include: recommendations regarding care of children and adolescents from Indigenous backgrounds in Australia and New Zealand including screening and management; tighter diabetes targets (glycated haemoglobin, ≤ 48 mmol/mol [≤ 6.5%]) for all children and adolescents; considering the use of newer medications approved for adults with type 2 diabetes under the guidance of a paediatric endocrinologist; and the need to transition adolescents with type 2 diabetes to a diabetes multidisciplinary care team including an adult endocrinologist for their ongoing care.

Twelve-year review of neonatal deaths in the delivery room in a perinatal tertiary centre.

AIM: To describe decisions made for babies who died in the delivery room as a result of clinical practice of non-resuscitation or unsuccessful resuscitation. METHODS: A retrospective study was conducted of neonatal deaths (NNDs) ≥ 400 g and/or ≥20 weeks' gestation born at Mater Mothers' Hospitals 1998-2009 who were not admitted to a neonatal nursery. Deaths were divided into not resuscitated and unsuccessful resuscitation and subdivided by cause of death as extremely preterm, congenital abnormality or 'other'. RESULTS: Of all 539 NNDs, 217 (40.3%) were not admitted to a neonatal nursery, comprising 174 (80.2%) not resuscitated and 41 (18.9%) unsuccessful resuscitation, while in a further two newborn infants resuscitation was not required. Only 13 of 123 (10.6%) extremely preterm infants who died in the delivery room had resuscitation attempted. Of 77 infants who died from congenital abnormalities in the delivery room 18 (23.3%) had resuscitation attempted. Fifteen babies with other diagnoses died in the delivery room; five with severe intrapartum asphyxia without resuscitation and a further 10 (8 preterm) with Apgar scores of 0-1 at 1 min and ≤3 at 5 min who did not respond to extensive resuscitation. CONCLUSIONS: A large proportion of NNDs occurred outside the neonatal nurseries involving end-of-life decision-making. Review of the circumstances of these NNDs in the subcategories of extreme prematurity, congenital abnormalities and 'other' raises different management dilemmas with the potential for clinical practice improvement in compassionate care and transparency in decision-making.