Setting the Agenda: Research Priorities for Inpatient General Paediatrics in Australia and New Zealand

Variation in inpatient paediatric care is well recognised across Australia and Aotearoa New Zealand (AoNZ). Recent data show differences in clinical decision-making, ranging from the use of high-flow therapy in infants with bronchiolitis 1 to approaches to diagnosing and managing paediatric obesity in hospitals 2. These inconsistencies often reflect gaps in the evidence base rather than differences in patient need, highlighting the importance of establishing clear research priorities to guide more consistent and effective care. The Children's Inpatient Research Collaboration of Australia and New Zealand (CIRCAN) was established to address this need through coordinated, multicentre research. Formed in 2018, the network brings together clinicians and researchers from a range of hospital settings. Its aim is to improve inpatient paediatric care through collaboration, shared research activities, and translation of research into practice 3, 4. It also supports the development of research capability across the workforce. The prioritisation study reported by CIRCAN 5 provides a practical guide for future research. Its focus is on questions that arise in routine clinical care, reflecting decisions clinicians face regularly, often without strong evidence to guide them. A coordinated approach offers an opportunity to generate answers that are directly relevant to practice. Respiratory conditions, particularly asthma and bronchiolitis, feature prominently among the prioritised topics. This reflects their role as leading causes of hospital admission in children and their impact on hospital services during peak seasons. Even for these common conditions, uncertainty in management persists. Differences in treatment approaches and guideline recommendations have been demonstrated across settings 6. Addressing these areas may help reduce variation and improve the efficiency of care. Other high-priority topics include infectious conditions such as sepsis and meningitis, which require early recognition and timely treatment. Differences in clinical practice remain, including variation in recommendations across guidelines in Australia and AoNZ 7. Addressing these gaps will help generate robust, locally relevant evidence. The inclusion of conditions such as paediatric obesity, eating disorders, rehabilitation and coordination of care reflects the changing demands on inpatient paediatric services. General paediatric teams are increasingly caring for children with complex and chronic conditions, often requiring multidisciplinary input and coordination across settings. Research in these areas may be more challenging to deliver but remains essential to improving outcomes. This work also highlights the value of collaborative research networks. Broad participation across institutions allows shared clinical uncertainties to be identified and prioritised. Structured consensus methods provide a transparent approach. One limitation is the lack of direct input from patients and families. Their perspectives are increasingly recognised as important in shaping research priorities, particularly for outcomes beyond immediate clinical care 8. Phased approaches to consumer and family engagement may help address this. Despite the clear need for high-quality, practice-relevant research in inpatient paediatrics, funding remains a major constraint. Success rates for competitive grants in Australia are low. Recent data from the National Health and Medical Research Council (NHMRC) Ideas Grants scheme show a success rate of 8.1% in 2025, meaning most proposals, including many that are highly ranked, are not funded 9. At the same time, limited disbursement from the Medical Research Future Fund (MRFF) has been noted to affect research capacity and workforce sustainability, particularly for early- and mid-career researchers 10. This gap between research priorities and available funding limits progress on key clinical questions. Targeted investment, aligned with agreed priorities, will be important to support networks such as CIRCAN to deliver multicentre studies and produce findings relevant to inpatient paediatric care. Setting priorities is only the beginning. The next step is to translate these questions into studies that can be delivered across multiple centres. Established research networks are well placed to support this by providing the infrastructure for collaboration. Research priorities will evolve over time as evidence emerges and clinical practice changes. Ongoing review will be important to ensure that research efforts remain aligned with clinical needs. These findings provide a clear starting point for research to address key uncertainties in everyday practice, with the potential to improve consistency and outcomes for children receiving hospital care. Habib Bhurawala conceptualised and wrote the manuscript and approved the final manuscript. The author has nothing to report. The author has nothing to report. A/Prof Bhurawala is a member of the Editorial Board of the Journal of Paediatrics and Child Health. The views expressed in this commentary are those of the author and do not necessarily reflect those of the journal or Editorial Board. The data that support the findings of this study are available from the corresponding author upon reasonable request.