Background Understanding the effect of early kangaroo mother care on survival of mild-moderately unstable neonates <2000 g is a high-priority evidence gap for small and sick newborn care. Methods This non-blinded pragmatic randomised clinical trial was conducted at the only teaching hospital in The Gambia. Eligibility criteria included weight <2000g and age 1–24 h with exclusion if stable or severely unstable. Neonates were randomly assigned to receive either standard care, including KMC once stable at >24 h after admission (control) versus KMC initiated <24 h after admission (intervention). Randomisation was stratified by weight with twins in the same arm. The primary outcome was all-cause mortality at 28 postnatal days, assessed by intention to treat analysis. Secondary outcomes included: time to death; hypothermia and stability at 24 h; breastfeeding at discharge; infections; weight gain at 28d and admission duration. The trial was prospectively registered at www.clinicaltrials.gov (NCT03555981). Findings Recruitment occurred from 23rd May 2018 to 19th March 2020. Among 1,107 neonates screened for participation 279 were randomly assigned, 139 (42% male [ n = 59]) to standard care and 138 (43% male [ n = 59]) to the intervention with two participants lost to follow up and no withdrawals. The proportion dying within 28d was 24% (34/139, control) vs. 21% (29/138, intervention) (risk ratio 0·84, 95% CI 0·55 – 1·29, p = 0·423). There were no between-arm differences for secondary outcomes or serious adverse events (28/139 (20%) for control and 30/139 (22%) for intervention, none related). One-third of intervention neonates reverted to standard care for clinical reasons. Interpretation The trial had low power due to halving of baseline neonatal mortality, highlighting the importance of implementing existing small and sick newborn care interventions. Further mortality effect and safety data are needed from varying low and middle-income neonatal unit contexts before changing global guidelines.

Aim: This study describes an Australian cohort of paediatric Buruli ulcer (BU) patients and compares them with adult BU patients. Methods: Analysis of a prospective cohort of all BU cases managed at Barwon Health, Victoria, from 1 January 1998 to 31 May 2018 was performed. Children were defined as ≤15 years of age. Results: A total of 565 patients were included: 52 (9.2%) children, 289 (51.2%) adults aged 16-64 years and 224 (39.6%) adults aged ≥65 years. Among children, half were female and the median age was 8.0 years (interquartile range 4.8-12.3 years). Six (11.5%) cases were diagnosed from 2001 to 2006, 14 (26.9%) from 2007 to 2012 and 32 (61.5%) from 2013 to 2018. Compared to adults, children had a significantly higher proportion of non-ulcerative lesions (32.7%, P < 0.001) and a higher proportion of severe lesions (26.9%, P < 0.01). The median duration of symptoms prior to diagnosis was shorter for children compared with adults aged 16-64 years (42 vs. 56 days, P = 0.04). Children were significantly less likely to experience antibiotic complications (6.1%) compared with adults (20.6%, P < 0.001), but had a significantly higher rate of paradoxical reactions (38.8%) compared with adults aged 16-64 (19.2%) (P < 0.001). Paradoxical reactions in children occurred significantly earlier than in adults (median 17 vs. 56 days, P < 0.01). Cure rates were similarly high for children compared to adults treated with antibiotics alone or with antibiotics and surgery. Conclusions: Paediatric BU cases in Australia are increasing and represent an important but stable proportion of Australian BU cohorts. Compared with adults, there are significant differences in clinical presentation and treatment outcomes.

SYNOPSIS Twelve cases of gastroenteritis caused by Escherichia coli 0142K86H6 are described. Ten of these caseswere clearly involved in an outbreak of cross infection. The other two cases yielded interesting information on infection with E. coli. 0142. Five cases, two being fatal, required repeated intravenous infusion, and one further infant required parenteral replacement therapy on a single occasion only. Cross infection occurred at the primary site-a ward partitioned into cubiclesdespite full barrier nursing techniques. Infection spread also to two other wards, and resulted from transfer of latently infected cases. Illness in several infants was protracted and debilitating because of the relapsing nature of the infection. The pathology of the two fatalities is reported briefly.

the majority of parents in all 4 provinces disagreed with fact that their children gained enough knowledge with virtual education. Reported benefits of virtual education were better time management (362,59.4%), increased interest in virtual education (309,50.7%), and improved virtual communication skills (366,60.1%). Reported negative effects included more sedentary life style (294,48.3%), increased weight gain (340,55.8%), increased screen-time (448,73.6%), missing school friends (279,45.8%) and frustration in children (225,36.9%). Physical symptoms that were more commonly seen during the period of virtual education were headache (225,36.9%) and abdominal pain (101,16.6%). Eleven were exposed to home violence and two children were exposed to sexual abuse during the period of prolonged home stay. Conclusion Virtual education was not cost-effective compared onsite education for the majority of parents. Further, children were deprived of education due to unavailability of internet devices and access. The perceived negative effects were sedentary life style, increased weight gain, increased screen-time, missing school friends and frustration in children. The perceived positive effects were better time management, increased interest in virtual education, improved virtual communication skills.