December 2020 COPMM newsletter
Impact of COVID-19 on Young People: Tasmanian update
The Tasmanian Commissioner for Children and Young People has released a new series of briefs, entitled COVID-19 Monitoring Insights. The briefs focus on key areas of the Commissioner’s monitoring work into the impacts of the pandemic on children and young people in Tasmania.
Four Insight briefs are now available and are outlined below.
- New Ways of Working During the COVID-19 Pandemic that examines how public health measures affected conventional service delivery for children, young people and families.
- Children and Young People in Out-of-Home Care During the COVID-19 Pandemic that summarises the outcomes of discussions with organisations providing out-of-home care services to children and young people in Tasmania and with young Tasmanians with a care experience.
- Mental Health and Psychosocial Recovery that provides a snapshot of the impacts of the pandemic on the mental health of Tasmania’s children and young people and the implications for an already overstretched mental health system. The impact on mental health in young people will be covered more extensively in our forthcoming newsletter to be released in early 2021.
- Family Violence During the COVID-19 Pandemic that examines Tasmanian children, young people, and families’ experience of family violence during the pandemic.
Alcohol Pregnancy Warning Labels
Alcohol has been linked to brain damage in unborn babies when consumed during pregnancy- a condition known as Fetal Alcohol Spectrum Disorder. Alcohol can also lead to miscarriage, stillbirth, premature birth, low birth weight and developmental problems. Since there has previously been no legal requirement for alcohol to carry a health warning label on alcohol products, the independent statutory authority of the Foundation for Alcohol Research and Education (FARE) has campaigned to increase awareness and improve alcohol labelling in Australia and New Zealand. FARE seeks to gain the support of the Australian and New Zealand Food Forum Ministers to accept the development of a clear and visible health warning label to appear on all alcohol products sold in Australia and New Zealand. This will replace the ineffective and confusing label applied inconsistently by some alcohol producers to date. To this end, these significant changes aim to put the health and wellbeing of Australian children first.
COPMM wishes to highlight the damage that alcohol can cause from conception (and other stages of family life) and supports the THS public website page regarding pre-conception and pre-pregnancy care in relation to alcohol consumption during pregnancy.
Antimicrobial Stewardship in Australian Health Care-Chapter 14, Antimicrobial stewardship in the care of children
The latest chapters of the Antimicrobial Stewardship in Australian Health Care Book, Antimicrobial stewardship in the care of children is now online and available https://www.safetyandquality.gov.au/publications-and-resources/resource-library/antimicrobial-stewardship-australian-health-care for your interest. Chapter 14 has particularly been noted as the most recent chapter focusing on AMS in the care of children and the specific and important considerations for this population group. Some of the key points outlined in this chapter include the following.
- Antimicrobial resistance affecting children is a growing health problem, resulting in increasing duration and severity of infective illness and limiting the therapeutic options available to treat these infections.
- Antimicrobial resistance patterns for children are different to those of adults. Organisms of particular concern for children are Carbapenemase-producing Enterobacterales (CPE) and ceftriaxone non-susceptible Salmonella species.
- Antimicrobial use promotes bacterial resistance in children.
- Pharmaceutical Benefits Scheme (PBS) data show that in all patients aged less than 65 years, the highest rate of antibiotic dispensing is for children aged 2 to 4 years.
- Antibiotic use in children is often unnecessary. Many childhood infections are caused by viruses, and some uncomplicated bacterial infections do not require treatment with antibiotics. Determining if antibiotic therapy is indicated is an important initial step in the appropriate prescribing of antimicrobials in children.
- Antimicrobials are over-prescribed for children that receive care in Australian hospital, outpatient and general practice settings.
- There is a growing body of evidence that antibiotic exposure in very young children disrupts the developing gut microbiota, which is associated with increased risk of necrotising enterocolitis, fungal infections, childhood asthma, allergy, dermatitis and obesity later in life.
- Paediatric antimicrobial stewardship (AMS)programs have been found to:
- decrease antimicrobial use
- reduce antimicrobial resistance
- decrease prescribing errors
- improve patient outcomes
- decrease medication costs.
- When prescribing antimicrobials for children, it is important to recognise their unique needs with respect to age, size, weight, development, pattern of antimicrobial resistance, antimicrobial risk of harm, suitability of formulations and dose effectiveness.
- Key paediatric AMS strategies include:
- improved focus on appropriateness of antimicrobial prescribing
- reduced duration of treatment
- use of oral therapy where clinically feasible (including intravenous to oral switch)
- dose optimisation.
Recommendations from COPMM’s Latest Annual Report
A list of key Council of Obstetric and Paediatric Mortality and Morbidity (COPMM) recommendations based on the data arising from the review of perinatal, paediatric and maternal death cases reported in 2018 has been highlighted in the Report’s COPMM key recommendations. It is hoped that these will highlight those issues considered by Council to be important and in need of addressing and actioning in the future by relevant statewide organisations. Full Report can be accessed from COPMM’s website.
Highlighted issues based on 2019 data include the following:
- Antimicrobial stewardship programs in health care settings that provide paediatric care should include:
- a multidisciplinary team that specifically comprise members with a range of paediatric expertise
- access to evidence-based prescribing guidance that is appropriate for children (including neonates and infants)
- systems that facilitate and audit adherence to evidence-based treatment
- approaches that target areas of inappropriate antimicrobial use in children-paediatric specific education for staff-education support for parents and carers.
- Smaller services that provide paediatric care, including those located in rural and remote areas, should consider entering into a formalised network arrangement with tertiary paediatric care providers to access additional AMS program support and expertise specific to the care of children.
- General practice has a critical role in reducing childhood antimicrobial use and preventing antimicrobial resistance by:
- achieving high rates of childhood immunisation
- continuous improvement in appropriateness of antimicrobial prescribing
- educating parents and carers in appropriate antimicrobial use
- providing advice on alternative treatment options when antibiotic use is not indicated.
- Paediatric AMS programs measure performance differently to adult AMS programs. The standard measurement of rate of antimicrobial use in adults (defined daily dose [DDD] per 1,000 occupied-bed days) is not suitable for paediatric settings because of weight differences with age. Increased uptake of electronic medicines management systems in Australian paediatric hospitals in the future should facilitate the collection of data required to monitor paediatric antimicrobial usage using the preferred method of days of therapy (DOT).
- Other methods of monitoring AMS programs may include alternative antimicrobial usage measures, appropriateness of use measures and outcome measure such as infection rates.
- An overall significant reduction in smoking rates in women during pregnancy since 2010 including the significant decline in the proportion of teenage mothers who reported smoking whilst pregnant. This trend is encouraging in view of lowering risks associated with extreme prematurity and perinatal mortality and morbidity where smoking and other substance abuse remains as an adverse risk factor in several neonatal deaths following extremely preterm birth.
- Maternal alcohol consumption amongst public patients was significantly lower in 2018 than any year prior to 2017. Again, this trend is encouraging in view of the deleterious effects of alcohol on fetal development and birth outcomes. COPMM continues to support the recommendations from the NHMRC Australian Guidelines (i.e., for women who are pregnant or planning pregnancy, not drinking is the safest option; and for women who are breastfeeding, not drinking is the safest option).
- A lower rate of child deaths reported in Tasmania compared to national figures with a significantly lower number of child deaths reported compared to numbers reported in Tasmania in the last decade. In view of the suspected suicide case reported in 2018 however, COPMM continues to support the Coroner’s recommendations in relation to youth suicide and reiterates the importance of addressing youth suicide and encouraging appropriate measures to be in place within the community to help young individuals considered to be at risk. Furthermore, the finding of an unexplained infant death associated with risk factors in 2018 has led COPMM to continue its recommendation for a consistent message about safe sleeping practices.
- Aggregate survival for infants born preterm in Tasmania from 24-27 weeks gestation for the 5-year epoch 2014-18 (inclusive) is higher (91%) than the national figure of 87% (2018 calendar year).
- The proportion of mothers in Tasmania aged 35 years or more has increased annually since 2005 and mothers under 20 years of age has shown a gradual decrease.
- In Tasmania, a greater proportion of babies were delivered by caesarean section particularly in private hospitals that is a trend consistent with national findings reported in 2018. There is also a higher proportion of preterm deliveries (10.2%) compared to national figures reported in 2018 (7.2%).
- No maternal deaths were reported in Tasmania in 2018.
A decrease in the number of births was reported in all three Tasmanian regions where birth rate has shown a statistically significant decline in Tasmania over the 2014-17 period.
Committees of COPPM
PAEDIATRIC Mortality & Morbidity
This Committee continues to be chaired by Dr Michelle Williams. Since Covid-19 restrictions, meetings of this Committee have been held remotely to progress the review and classification of reported statewide paediatric death cases. The Australian and New Zealand Child Death & Prevention Group (ANZCDRPG) face-to-face meeting has been planned to be rescheduled as a remote 1.5day conference in May 2021 (date tbc).
PERINATAL Mortality & Morbidity
The Committee chaired by Professor Dargaville continues to recommend that Tasmania’s private hospitals use PSANZ guidelines to report on perinatal cases to provide COPMM with more comprehensive information on reported stillbirth cases as required. The updated Tasmanian Perinatal Data Collection Form can be accessed via the COPMM’s website. Clinicians are requested to use the Third Edition Version 3.1 for classification of all perinatal deaths from 2019 onwards.
MATERNAL Mortality & Morbidity
This Committee that is chaired by Associate Professor Amanda Dennis will finalise its review and classification of maternal death cases reported in Tasmania in 2019 prior to drafting its report. Progress of the Australian Maternity Outcomes Surveillance System (AMOSS Project) will continue to be tracked and its relevance to Tasmania’s reporting assessed etc.
The Data Management Committee’s Working Group will meet early in 2021 to begin preparations on its latest COPMM Annual Report based on available audited 2019 data. This report will be tabled in Parliament in October 2021. The Committee continues to monitor national developments in the Congenital Abnormality Registers as well as a national push to improve data timeliness and in-principle support for earlier supply of mortality data to AIHW.
Council’s Operations Report and latest Annual Report were both tabled in Parliament on 15th November 2020. It is expected that the Progress Against Actions report in response to this Report will be progressed in 2021 subject to the continued impact of COVID-19 situation. Upon finalisation, it will be submitted to the Health Minister for consideration in due course.
Membership for the current term (May 2019- May 2022) in accordance with the Terms of Reference includes:
- Dr Michelle Williams (Chair- Paediatrician & RACP rep)
- Professor Peter Dargaville (employed in the delivery of Neonatal Services)
- Dr Anagha Jayakar (UTAS rep)
- Associate Professor Amanda Dennis (UTAS Rep)
- Dr Jill Camier (RACGP rep)
- Ms Kate Cuthbertson, Barrister at Law (Council nomination)
- Ms Sue McBeath (ACMTas rep)
- Dr Tania Hingston (RANZCOG rep)
- Dr Scott McKeown (Department of Health Representative) and
- Commissioner for Children and Young People, Ms Leanne McLean.